Report finds many Maui wildfire survivors still face health, housing challenges

Nearly three years after the Maui wildfires, many survivors are returning to work, gaining health insurance and finding more stable housing, but thousands continue to struggle with food insecurity, mental health challenges and lingering physical health concerns, according to a report released Monday.

The report, "The Road to Recovery: Strengthening Health, Stability, and Resiliency Three Years After the Maui Wildfires," is based on the Maui Wildfire Exposure Study, or MauiWES, one of Hawaii's largest long-term disaster recovery efforts. More than 2,500 adults and children have participated since the Aug. 8, 2023, wildfires, with University of Hawaii Economic Research Organization (UHERO) researchers completing more than 4,000 health screening appointments.

Researchers said the findings show that while recovery is progressing, many survivors continue to face challenges that extend far beyond rebuilding homes.

"Maui's experience offers both a warning sign as well as a roadmap," said Ruben Juarez, UHERO-Hawaii Medical Service Association (HMSA) Distinguished Professor of Health Economics and a lead researcher on the study. "The flames may last for days, but recovery is measured in years."

Among adults who returned for follow-up visits, employment increased from 62% to 80.9%, health insurance coverage rose from 85.1% to 90.5%, and the share of participants living in temporary housing declined from 40.6% to 34.4%. At the same time, nearly 45% remained food insecure, about one-third were still living in temporary housing, and high levels of social support fell from 62.3% to 53.7%.

Juarez said those findings point to four pillars of long-term recovery: food and income security, stable housing, access to healthcare and follow-up services, and strong family and community connections.

"Housing, food, income and social support are health interventions," he said. "They are not separate from healthcare. They determine whether people can heal, manage illnesses or rebuild their lives."

The report also found that physical health concerns remain common among survivors.

Alika Maunakea, MauiWES co-director and professor at the University of Hawaii's John A. Burns School of Medicine, said visible rebuilding across Maui does not necessarily reflect survivors' health.

"The health and emotional consequences of a disaster are often less visible, and they don't necessarily follow the same timeline as physical reconstruction," Maunakea said.

Among returning participants, 27.1% had blood pressure readings in the Stage 1 hypertension range, another 31% met Stage 2 hypertension criteria and nearly 20% had lung function screening results below the expected range. Researchers emphasized those are screening results rather than clinical diagnoses but said they may serve as early warning signs for cardiovascular and chronic respiratory disease.

Maunakea cautioned the study reflects the health of its participants rather than every person affected by the fires, noting thousands more residents experienced the disaster.

"Our goal is not simply to study recovery," he said. "It's to connect every concern to appropriate care and sustained follow-up."

The report found mental health challenges remain widespread, with nearly half of adult participants reporting symptoms of depression, about one in four screening positive for moderate-to-severe anxiety and nearly one-third experiencing PTSD symptoms. High social support also declined over the past year.

For Christopher Knightsbridge, a MauiWES mental health therapist based in Lahaina, those numbers mirror what he has witnessed while working with survivors every week over the past two years.

"What I see on the ground matches the data," Knightsbridge said.

He described a community showing resilience while continuing to carry profound grief and exhaustion.

"Resilience doesn't mean people have stopped hurting," he said. "It just means they're still doing their best to move on while carrying that pain with them."

Researchers found adults with low levels of social support were far more likely to experience depression, anxiety and suicidal thoughts than those with strong support networks, underscoring the importance of family, friends, schools, churches and community organizations in long-term recovery.

The findings were especially concerning in regard to children: about 40% of children in the study continued to show elevated symptoms of depression or PTSD, severe depressive symptoms increased from 11.8% to 15.1%, and low self-esteem doubled from 12.9% to 26%. Roughly one in four screened positive for a possible anxiety disorder.

"Children and most adults do not recover alone," Knightsbridge said. "Healing after trauma happens through families, schools, culture, trusted adults and community."

Researchers said the next phase of MauiWES will focus on connecting survivors with long-term medical and mental health care, expanding outreach and continuing health monitoring as Maui rebuilds in the upcoming years.

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