The Defense Health Agency announced Monday that it will begin evaluating — and potentially providing medical treatment to — civilians affected by the Red Hill water crisis from now until March 10 on a “space available” basis.

The military officially opened its Red Hill Clinic at Branch Health Clinic Makalapa on Joint Base Pearl Harbor-Hickam in January to evaluate people reporting ongoing symptoms after exposure to fuel-contaminated water after jet fuel from the Navy’s Red Hill fuel storage facility tainted the service’s Oahu water system in November 2021.

In addition to servicing JBPHH, Red Hill housing, Aliamanu Military Reservation and other military housing areas, the Navy’s water system also served former military housing areas that have since become the Kapilina Beach Homes, the Moanalua Shopping Center, as well as several schools.

When the Red Hill clinic first opened, it was available only to service members and civilians on the military’s TRICARE insurance system. Department of Defense officials have said they were trying to navigate a labyrinth of legal roadblocks and bureaucratic red tape to open the system to island residents.

But the exclusion of people from local communities affected by the fuel leaks elicited outrage and has continued to be a topic of heated discussion at town hall meetings. Now, more than a year after the crisis began, Undersecretary of Defense for Personnel and Readiness Gilbert Cisneros Jr. has conferred Secretarial Designee status to civilians who report symptoms they believe are tied to the Red Hill leaks.

In its statement, DHA said that “any civilian who resided in housing served by the Joint Base Pearl Harbor- Hickam Water Distribution System, or who worked full- or part-time on the base or any DOD facility served by the base between November 20, 2021 and March 18, 2022, and who are experiencing persistent symptoms the individual attributes to jet fuel contamination are invited to call to schedule their medical assessment.”

U.S. Rep. Ed Case praised the move, telling the Honolulu Star-Advertiser in a statement that “since the immediate Red Hill crisis in November 2021, I have been highlighting and pursuing not just the expeditious and safe defueling and closure of Red Hill but the fullest possible identification and treatment of health consequences for the thousands exposed to tainted water.”

Case, who made a surprise visit to the Red Hill clinic in January, said it “is fully staffed and resourced to conduct a professional health assessment for permanent residents of military housing or workers on the Navy water system.”

Members of Hawaii’s congressional delegation have pushed the Pentagon on treatment. In 2022’s iteration of Congress’ annual defense funding bill, Case advocated for a directive to the Department of Defense to track the long-term health implications of fuel leaks from Red Hill in conjunction with the Centers for Disease Control and the state Department of Health.

“The DOD has a responsibility for the health and well being of all those impacted by the Red Hill fuel leaks,” said U.S. Sen. Mazie Hirono in a statement. “As Chair of the Armed Services Subcommittee on Readiness, I’m glad to see the Undersecretary for Personnel and Readiness authorize the expansion of DOD care at the Red Hill Clinic to civilians impacted by the fuel leaks, in addition to military personnel and their families. I’ll continue working to ensure DOD meets its obligation to everyone affected and that Red Hill is safely and quickly defueled and closed.”

Wayne Tanaka, director of the Sierra Club of Hawaii, said that “so many affected civilians, like those at Kapilina Beach Homes, were not told about the danger with their water until days or even weeks after those living in military communities were informed — prolonging their exposure to contaminated water, and potentially exacerbating their health impacts. … Why did it take over a year and a half for the Department of Defense to even acknowledge that the many, many civilians poisoned in November and December of 2021 may need medical attention?”

Xavier Bonilla was one of those residents. He told the Star-Advertiser that in December 2021 he had to rush his teenage son to an emergency room when his throat became swollen, his eyes red and his gums bleeding, after showering and brushing his teeth at their residence in Kapilina. Bonilla said the doctor determined it was the result of a toxic reaction.

Though the military says the Red Hill clinic will run indefinitely, civilians have a window of less than a year to seek evaluation and treatment.

DHA also said in its news release that the new designation “does not establish an entitlement to civilian health care at DOD expense or to health care at any other military medical treatment facility” for issues outside the scope of symptoms related to fuel exposure. But Peter Graves, a DHA spokesperson, stressed that civilian patients will have their care covered, explaining “if the Red Hill Clinic writes a referral to Tripler (Army Medical Center) — for example — for care, there will be no cost to the patient.”

But throughout the crisis, health care professionals have warned that fuel exposure has not been studied extensively and that diagnosing it could prove tricky. When the military announced in November that it would stand up the Red Hill clinic, Dr. Jennifer Espi­ritu of Defense Health Agency Region Indo-Pacific told reporters that “the health effects that we’re looking for typically take decades — cancers, as well as neurological conditions. We’re branching into new territory. … This is an unprecedented exposure.”

Espiritu also said the struggle to find definitive answers has prompted some families to seek out “alternative” sources of medical advice, resulting in a spread of “disinformation” by self- proclaimed medical experts giving families questionable advice. The Sierra Club and other groups criticized Espi­ritu, accusing her of making excuses and downplaying the symptoms people were reporting.

More than a year after the fuel entered the system, many military families who were affected have transferred out of the state. Many of the local families have also left Oahu. Bonilla moved to California after deciding he couldn’t trust state or military officials that the water was safe and couldn’t find another place on the island to live that he could afford.

“At this point, so many civilian and military families have had to move off-island to find treatment or escape a water system they can no longer trust — will they be given an opportunity to be ‘assessed’?” Tanaka said. “And with all the reported difficulties of actually accessing the Red Hill clinic, we can only hope that this announcement is not just another case of too little, too late.”

DHA said appointments will be available 8 a.m. to 4 p.m. Monday through Friday and that “days vary depending on base access.” Those calling will be asked whether they have access to the military bases where medical facilities are located, and those without access to military bases “will receive additional information on accessing the Red Hill Clinic during the appointment booking process.” After completion of the initial health assessment, people will receive a letter determining whether they are eligible for care.

To start the process, call the TRICARE Nurse Advice Line at 800-874-2273, select option 1 and request an appointment at the Red Hill Clinic. The line is available 24/7.