A US federal court has granted Hawaiian lawmakers permission to slash benefits for residents whose families formerly lived on a string of Pacific islands that the US military used as a nuclear test site in the decades after World War II.

The US Court of Appeals for the Ninth Circuit removed an injunction Tuesday that prevented the state from reducing the health benefits paid out to residents of Micronesia, Palau, and the Marshall Islands, where a number of people claim they are still suffering from health problems caused by the military tests.

In the years between 1946 and 1958, at least 67 nuclear weapons tests were conducted on the small group of atolls located north of Australia and just east of the Philippines. Over 7,200 Hiroshima-sized bombs were dropped on the Marshall Islands alone. The “Bravo Test” of 1954 dropped a bomb 1,000 times more powerful than the atom bomb used to decimate the Japanese city.

Not long after, families in Micronesia and other Pacific islands began birthing stillborn babies and children with birth defects. Others suffered the early onset of cancer, sterility, and illnesses they likely could have avoided had radiation not permeated the mostly isolated region.

Decades later, US lawmakers signed the 1986 Compact of Free Association (COFA) with the Federated States of Micronesia and the Republic of the Marshall Islands. In exchange for influence over the thousands of small atolls, the US began permitting residents from both of the aforementioned countries and Palau to freely enter and exit the US as they pleased.

While not American citizens, residents admitted to the US under the COFA parameters were required to pay US taxes and allowed to work and receive medical care in the US, among other legal rights. Their Medicaid benefits were cut in 1996 under the federal Welfare Reform Act. The state of Hawaii then pledged its support in 2010, giving the islanders up to 10 days of hospital care each year, 12 annual outpatient visits, six mental health visits, and no more than four medication prescriptions each month, according to Courthouse News.

Critics of the state’s new health program, dubbed Basic Health Hawaii (BHH), have asserted that islanders visiting their longtime doctors for dialysis, cancer, and the like were suddenly told they had lost that essential healthcare.

Tony Korab, one of the residents representing the islanders in a class-action suit against Hawaii, told the Ninth Circuit court that because the islanders are taxpayers, the BHH program violates the equal-protection clause of the US Constitution and the Americans with Disabilities Act. The court disagreed, with the majority of the divided justices ruling that Hawaii had simply acted where Congress did not.

“The basic flaw in the proposition is that Korab is excluded from the more comprehensive Medicaid benefits, which included federal funds, as a consequence of congressional action,” Judge M. Margaret McKeown wrote in the majority opinion on Tuesday.

“Congress has plenary power to regulate immigration and the conditions on which aliens remain in the United states, and Congress has authorized states to do exactly what Hawaii has done here – determine the eligibility for, and the terms of, state benefits for aliens in the narrow third category, with regard to whom Congress expressly gave states limited discretion. Hawaii has no constitutional obligation to fill the gap left by Congress’s withdrawal of federal funding for COFA residents,” she wrote.

The issue has divided the Hawaiian population, with migrants claiming their health has not only been complicated by a generation of radiation victims, but also by dietary and cultural disruptions that have come with adapting to a new environment.

Those complaints, in many cases, have fallen on deaf ears. For example, it is not rare, according to Jon Letman of Al-Jazeera, for anti-immigrant graffiti to be scrawled across islander-owned homes or businesses. COFA children are frequently singled out and bullied in school, sources said, despite their having no choice in where they live.

“Money has become more valuable than our culture,” COFA resident Sound-Kikku told Letman. “One of our elders said, ‘We used to be masters of the currents of the Pacific but today we are slaves to the currency of the United States.’”

Civil rights advocates have publicly asked frustrated Hawaiians to empathize with the various COFA populations. William Hoshijo, executive director of the Hawaii Civil Rights Commission, appeared in a Japanese American Citizens League-produced documentary about the simmering conflict.

“Hawaii residents from COFA nations have been scapegoated and described negatively as a burden and drain on resources,” he said, as quoted by Al Jazeera, “but for those who care about fairness and justice in Hawaii, it’s our responsibility to speak out to support our brothers and sisters in their struggle against discrimination.”