Nearly two years after the devastating Maui wildfires, survivors continue to struggle with the mental, physical and social impacts, according to researchers from the University of Hawaii at Manoa.
The UH Economic Research Organization’s latest report, released Wednesday, found that mentally, half the survivors it has been tracking are showing depressive symptoms, with a quarter reporting moderate to severe anxiety.
Physically, many adults are struggling with high blood pressure, and some are exhibiting reduced lung function. While many have managed to get back on their feet, 41% are still living in temporary housing and 25% are still looking for work.
“Nearly two years after the deadliest disaster in Hawaii’s history, the message from the data is clear,” said author Ruben Juarez, UHERO health economics professor, during a virtual news conference. “Maui is healing, but the journey is far from over.”
The Aug. 8, 2023, wind-driven wildfires that swept through Lahaina and Upcountry Maui took 102 lives, destroyed more than 2,000 structures, and displaced thousands.
Summer has once again arrived, bringing peak fire season with it, along with anxiety over potential wildfires.
The struggle is still very real, according to author Alika Maunakea, a professor at John A. Burns School of Medicine.
“So many in our community are still living in crisis,” Maunakea said. “Nearly 3 out of 4 adults have high blood pressure, which is a silent but serious risk factor for long-term illness. More than 1 in 4 show signs of reduced lung function that’s likely tied to the fire-related exposure and air pollutants during that time, but we’re also looking at potential long-term exposures and persistent exposures from the environment.”
Additionally, he said, 1 in 3 residents are still struggling to get access to health care, especially in West Maui and in rural areas.
UH launched the Maui Wildfire Exposure Study (MauiWES) in January 2024 in an effort to understand the healing process over time as well as identify where more help and support are needed along the way.
Keiki under stress
For the past 18 months, UH research teams have been reaching out to Maui wildfire survivors in hotel parking lots, church halls and pop-up tents to recruit participants.
The study now follows a cohort of about 2,000, including 1,800 adults and 200 children, that it plans to follow over the long term.
The latest report is the first to offer a snapshot of about 200 children in the cohort, and the findings have raised some red flags, particularly for their mental well-being.
Researchers are concerned to find that 51% of children ages 10 to 17 screened positive for depression, with 22% in the severe range.
Additionally, about 30% reported anxiety symptoms and nearly 45% show signs of post-traumatic stress disorder, with 4.3% at severe levels. One in four children reported low self-esteem and many are experiencing challenges at school and home.
Physically, nearly 40% had elevated blood pressure, which is unusual for children, with the highest rates among Filipino youth. When given lung tests, Maunakea said, nearly 1 in 5, or 20%, have reduced breathing capacity.
“Our children may look OK on the outside,” he said, “but inside, many of our keiki are still fighting invisible battles.”
Some additional stressors include the recent end of Federal Emergency Management Agency housing subsidies for survivors, along with ongoing news of immigration raids.
Christopher Knightsbridge, a child psychologist on Oahu who flies to Lahaina once a week, said the anxiety is compounded by the current political turmoil.
“As a clinician seeing patients in Lahaina, I can personally attest about 30% to 40% of sessions address political anxiety under the current administration,” he said. “A lot of the Hispanic population, of course, the children, are incredible worried about it.”
Among children, symptoms of depression are often underreported, he said, so rates are likely higher. At the same time, Maui has a shortage of mental health professionals available for children.
Researchers said the study points to the need for long-term investment in trauma-informed care at schools, more mental health counselors, and more pulmonologists on Maui.
They hope it’s a wake-up call on the need for early intervention to help prevent these risks among keiki from becoming lifelong health burdens.
Despite ongoing challenges, as noted in the report, there have been some glimpses of recovery among some of the participants a year after the initial survey.
Researchers were able to follow up on about 400 adults in May, a year after their initial survey, and found that reports of worsened health dropped from 48% to 36%.
Rates of severe depression and severe anxiety among this group also fell, suggesting that some emotional healing is underway.
Although access to health care still needs improvement, insurance coverage for this group increased from 86% to 91%, largely due to outreach efforts and support, including those by Kaiser Permanente. Community support also remained strong, with 3 in 5 participants reporting dependable support from family and neighbors.
“I think we’re at a tipping point right now,” Juarez said. “It is a time to invest in health. That’s why MauiWES is calling urgently for sustained investments in school-based, trauma-informed care for keiki, long-term monitoring for lung, heart as well as exposure to contaminants, permanent housing and job stability programs — and culturally-rooted, multilingual access to mental health programs.”
Future reports will focus on the impacts of other stressors, as well as if there were potential exposures to chemical hazards from the fires and in their aftermath.
Those future reports, however, are also tenuous, depending on future funding.
UHERO’s initial support came from the Hawaii Community Foundation’s Maui Strong Fund and other partners.
Funding from the National Institutes of Health is available to cover 500 participants into the next year, while state funding expires in mid-August. UHERO has applied for more grants, and is reaching out to philanthropic partners in hopes that the study on wildfire survivors can continue.
