Largest medical ghost town

The largest medical ghost town is the Kalaupapa National Historical Park, on the Island of Molokai in Hawaii, USA. Kalaupapa was built to house native Hawaiians infected with Hansen's disease (leprosy), who were forcibly exiled to this remote peninsula under a law that was in place from 1865 to 1969. At its peak in the late 19th century, there were more than 800 people living in this isolated community. In 1969, following the introduction of effective treatments for Hansen's disease, the law was repealed and the residents of the town were free to leave. Around half stayed, but few remain today. As of October 2024, only four of the community's original residents remain, the oldest of which is over 100.

Hansen's disease was introduced to Hawaii by European sailors in the early 19th century, and had become alarmingly widespread by the 1850s. There are no detailed figures from that time, but data from 1990 – decades after the introduction of the mandatory quarantine – reports that around 0.7% of the island's population had the disease rising to 2.5% among native Hawaiians. This is much higher than the incidence of the disease in other countries at the time.

King Kamehameha V signed and approved the "Act to Prevent the Spread of Leprosy" on 3 January 1865, which introduced a policy of mandatory quarantine for anyone with Hansen's disease. Later that same year the Kalaupapa peninsula, an isolated outcrop of land on the north coast of Kaui, was selected as the site for a segregated settlement. Anyone in Hawaii discovered to have Hansen's disease – regardless of age – was to be removed to a purpose-built town at Kalaupapa and forced to live out the rest of their life on this remote peninsula, which was cut off from the rest of the island by a tall mountain ridge and only accessible by boat.

The first Hansen's disease exiles arrived at Kalaupapa on 6 January 1866. At this time, the community had no medical facilities and, excepting periodic shipments of necessary supplies, its inhabitants were left to fend for themselves. Each was told that this was to be their home for life – once they arrived at Kalaupapa they were legally prohibited from leaving.

Unsurprisingly, there was considerable resistance to the 1865 law, especially as the enforcement of these policies fell to the agents of the Board of Health, who were almost all European settlers, while the Hansen's disease sufferers they targeted were almost all native Hawaiians. Several Board of Health agents were killed during attempts to arrest people with Hansen's disease, and one group's attempts to resist forced deportation in 1893 escalated into an armed rebellion that only ended when the army was called in.

In its early years, Kalaupapa had the atmosphere of a prison camp, with scant resources and poor accommodation. New inmates were dropped off without warning, and usually without any thought given to how they would be housed and fed. The death rate was very high, both to complications from Hansen's disease and other causes.

Over time, however, the community became more stable and set down firm roots at Kalaupapa. The original Board of Health overseers were joined by people from among the exiles, and they instituted reforms in how the settlement was governed. Various missionary groups also began investing in the community, building churches and providing education for the children who had often separated from their families and sent there alone. While it was populated by unwilling inmates who were still subject to draconian rules, by the early 20th century Kalaupapa was a functioning settlement with a post office, schools, an infirmary and several churches.

The first reasonably effective treatments for Hansen's disease were developed in the 1920s, based on research conducted in Hawaii by the chemist Alice Ball. These didn't entirely halt the progression of the disease but slowed it considerably. More effective treatments appeared in the 1940s, though some cases proved to be resistant to these early medicines.

These advances meant that few new patients were admitted to Kalaupapa after the 1940s. According to a statement made to the press in the early 1960s, the last person sent to Kalaupapa arrived in 1956, though the laws that gave health authorities the power to send people there weren't repealed until 1969.

The 1950 US census lists 339 people living at Kalaupapa, of whom 264 are described simply as "inmates". The remaining 75 people were employed in the upkeep of the settlement and the care of its sicker residents, and while they were listed separately to the "inmates" most probably also had Hansen's disease. The population had dropped to around 220 by 1960, and only 50 people in the settlement still had treatment-resistant Hansen's disease infections.

Most of the town's population left after the law was repealed, but a few stayed on, either because they were significantly disabled by their condition and required extensive care, or because they were unwilling to leave the only place they knew as home (it should be remembered that many were brought to Kalaupapa when they were as young as eight).

As of October 2024, there were still four former Hansen's disease patients living at Kalaupapa, the oldest of which is over 100. A few other areas of the town are occupied on a seasonal basis by healthcare workers and park rangers.