A version of this article was co-published with The San Francisco Chronicle.

The Arctic landscape is devoid of color during the frozen days of February. There's the white of the tundra, the white of sea ice and often the sky, and the darkness of cold, long nights.

So when a wall of coffee-colored smoke rolled toward the small village of Nuiqsut in 2012, there was no mistaking—something was wrong.

Martha Itta, of the native village government, was at her desk when a colleague burst through the door and shouted "Check Facebook!" A worker on an oil well site 18 miles away, owned by the Spanish company Repsol, had posted a video.

"Rig's having a blowout here. They're evacuating the rig," the worker said as drilling mud and smoke spewed into the air and onto the tundra. "Ain't f---ing looking so good."

Itta scrambled to dial any authority she could think of—the North Slope Bureau, the EPA—to find out if Nuiqsut should be evacuated. "We weren't getting any answers," she said. Air monitoring in Nuiqsut is done by ConocoPhillips because it owns major drill sites just beyond town, but the monitor was down for routine maintenance at the time of the explosion.

Martha Itta saw her own young son struggle with respiratory illness and believes pollution blowing in from the North Slope's oil fields is raising the risks. Credit: Sabrina Shankman/InsideClimate News

"Our community was pretty much in panic mode. We didn't have any data—no air monitoring to show us what was out there in the air or if we should evacuate," Itta said. Villagers recall that dozens of people in the town got sick that day.

For many in this largely Inupiaq community, the Repsol disaster underscored their worst fears of a link between the oil drilling boom surrounding the town and respiratory illness.

It's not just blowouts that concern Itta now. She fears every-day pollutants in the wind, coming from vast drilling operations, turning the sky a hazy green some days and leaving black soot on the snow on others. When that happens, noses run and asthma flares up.

Nuiqsut is the only town planted in the midst of Alaska's most prolific oil region on the state's North Slope, which today is poised for another drilling boom. Just eight miles from the grid of single family homes, government offices, a grocery store and schools, more than 50,000 barrels of oil—or roughly a tenth of the state's oil production—is pumped each day from oil fields owned by ConocoPhillips. Repsol, Armstrong and Oil Search also have oil fields just outside town. Parents get a view of the newest well, three miles from town, when they drop their kids at school.

That number will balloon in the coming years as three new projects come online, including one that will go after an estimated 500 million to 3 billion barrels of recoverable oil. As the Trump administration clears the way for even more Arctic drilling, major companies have made more discoveries—oil the state hopes can revitalize its struggling economy.

Amid this development, Nuiqsut—where more than three-quarters of residents still live off the fish they catch, the whales they harvest and the caribou they hunt—has found itself on the frontlines of a modern crisis. Fossil fuel burning has already brought climate change to the town's doorstep, causing Arctic temperatures to rise twice as fast as the global average, changing the sea ice and impacting species that people rely on for hunting.

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Emissions of black carbon, a short-lived climate pollutant from fossil fuel production, accelerate the crisis, not just by exacerbating warming worldwide, but also by darkening the surface of Arctic sea ice, causing it to melt faster.

Black carbon brings health consequences of its own. It's a main ingredient in fine particulate matter, among the leading environmental causes of poor health and premature death. And it's just one of the pollutants from oil, gas and coal production that can impact health. The unique way these emissions interact in the Arctic—and their precise impact on human health—is only now beginning to be understood by scientists. In Nuiqsut, it's the issue.

Oil wells are visible from the streets of Nuiqsut, the only town in the heart of the North Slope's busy oil fields. The newest well is just three miles away. Credit: Sabrina Shankman/InsideClimate News

Tension between oil development and fears about public health exists in other pockets of the United States, from the Permian Basin in Texas to Pennsylvania's Marcellus Shale. Up here—250 miles above the Arctic Circle, with no year-round road access—it's different. Ties that bind people to the land mean survival. Help is hundreds of miles away, and some here say decades of pleas for assistance have fallen on deaf ears—at times even from within the village.

"The development has proceeded too rapidly, without enough care for the health of the people from an air quality and subsistence perspective," said Pamela Miller, the executive director of Alaska Community Action on Toxics. "And now they're virtually surrounded."

The oil fields around Nuiqsut are poised for another drilling boom. Credit: Sabrina Shankman/InsideClimate News

Rosemary Ahtuangaruak, who worked as a health aid in Nuiqsut from 1986 to 2000, saw the number of people treated for respiratory illness during that time rise from one to 75—an increase that far outpaced population growth—at the same time that wells crept closer to town.

The increase was stunning for a village of around 400 people, said Ahtuangaruak, who is now a health advocate for the community. But as she tried to raise awareness about it, she struggled to get any help. "Our voices are not being heard," she wrote in the Anchorage Daily News in 2003.

ConocoPhillips Alaska says it's aware of concerns in Nuiqsut and has worked with the community to investigate them. The company also insists that decades of its own air quality monitoring have not indicated a problem. "Our measurements show that the air quality of the North Slope, at all locations, is consistently better than national ambient air quality standards," said spokeswoman Natalie Lowman.

Studies done by various state and regional agencies, based largely on ConocoPhillips' data, attribute respiratory health issues to spikes in viruses, smoking, poor indoor ventilation and cars left idling for hours in freezing temperatures. Those things surely contribute to the problem, but Itta and other residents believe they are red herrings.

Most immediately, Itta wants a third party—someone without direct ties to industry—to monitor the air in Nuiqsut. Even though ConocoPhillips shares its monitoring results with the village, there's deep-seated mistrust of authorities here, of government and of the oil companies working nearby.

"The tribe has been working really hard to get the data—the real data—and to get the real air monitoring stations that we need," she said. "We've been working really hard to make things right."

'Afraid of Retribution' for Monitoring Their Air

Itta's son Gerald Kanayurak was just 2 years old when the trouble started. A few months after the Repsol blowout, he began showing signs of respiratory distress. His mother would rush him to the health aids at a local clinic. They would monitor him as his oxygen levels dropped and then scramble to get him on a flight for more advanced medical care. "He ended up having seizures and was on a ventilator," Itta said.

Several times, Gerald was flown from the gravel airstrip in Nuiqsut to Utqiagvik (formerly Barrow) for treatment. Once there, she recalls something strange would happen. "He would clear up. He'd get really good," Itta said. "They would send us back home, and then it would start all over again."

Itta says her doctor eventually told her, "'It's something in the air he's breathing.' He said I should consider moving out of my area because it's in the air."

But as a single mom with seven kids (four of her own, two adopted and a grandson), Itta didn't see moving as an option. Instead, from her position as tribal administrator, she decided to find out more about what's in the air.

That meant bringing in an outsider to train Itta and others on how to monitor air themselves.

In mid-2012, Miller from Alaska Community Action on Toxics came to Nuiqsut. She was showing seven people how to use monitoring equipment when a board member of the local corporation burst into the room.

Kuukpik Corporation owns land around the village and contracts with oil companies that want to drill there.

Itta remembers the Kuukpik board member demanding of Miller, "Who are you guys? Who invited you here? No environmentalists."

The board member left and Miller continued the training, but she noticed the mood had changed. "I think the people there felt embarrassed and intimidated."

Nuiqsut, with about 400 residents, sits some 250 miles north of the Arctic Circle. Fossil fuel burning has already brought climate change to its doorstep. Arctic temperatures have risen twice as fast as the global average, changing the sea ice and affecting species residents rely on for hunting. Credit: Sabrina Shankman/InsideClimate News

Miller was not surprised that no one ended up using the monitors she left behind.

Kuukpik Corporation wields a particular kind of power here. Some of its 250 shareholders are elders who resettled Nuiqsut in 1973, after years of forced relocation by the federal government. Now, with an array of subsidiaries operating drilling and oil services for oil companies, it's one of the largest employers around.

"That's really why I think they haven't been able to sustain a community-based monitoring program," Miller said. "There could be retribution against anyone who's trying to collect in-depth information."

That fear is reflected in a report by the state Department of Health and Social Services. In May 2012, an Anchorage-based attorney with the Trustees for Alaska heard that a number of Nuiqsut residents were having trouble breathing after seeing smoke from the Alpine Field. "She stated that Nuiqsut residents and health aides were 'afraid of retribution' if they reported this, so she was reporting this information," the report said.

Pollution Footprint Each Step of the Way

Though oil companies have made strides in decreasing emissions since the early, anything-goes days of North Slope development, air pollution remains a byproduct of drilling.

Back when she was a health aid, Ahtuangaruak recalls the sense of foreboding when she'd drive to the Nuiqsut clinic and see two dozen stacks flaring gas. "Those were the nights I knew I wouldn't be able to sleep," she said. "One person would have trouble breathing, and another would be in before I had finished treating the first. Next thing you know it's 7 a.m. and I haven't gone home for the night."

"Our voices are not being heard," Rosemary Ahtuangaruak wrote in 2003. Her fears for the health of people living in this region haven't subsided. Credit: Sabrina Shankman/InsideClimate News

Each step in the extraction process on the North Slope can yield pollution, from diesel generators that keep operations running, to flares burning off excess gas, to trucks barreling down the ice roads.

Stacks that flare off gas like 24/7 pilot lights can emit volatile organic compounds (VOCs). Larger flares spew black carbon. Methane can leak from equipment throughout the production process. Studies show that methane exposure can cause headaches and dizziness. VOCs can damage kidneys and the nervous system and cause vision and respiratory problems. Some VOCs cause cancer.

Mixed with sunlight, some VOCs form ground-level ozone, which accelerates climate change. Respiratory distress triggered by ozone causes roughly 150,000 deaths each year. A nationwide study, published in 2016, found ozone pollution from oil and gas production causes more than 750,000 summertime asthma attacks in children.

One source of pollution in the region is flaring that burns off excess natural gas during the extraction process at oil facilities. These stacks can emit volatile organic compounds and black carbon, a short-lived climate pollutant, that can damage health. Credit: Sabrina Shankman/InsideClimate News

And then there's the black carbon in fine particulate matter, or PM 2.5. The microscopic particles can lodge deep in the lungs, aggravating asthma and breathing problems and contributing to heart disease. A 2015 study by the World Health Organization found that regular exposure to outdoor PM 2.5 causes an estimated 3.7 million premature deaths each year.

"It's the long-term exposure that causes the more serious cardiovascular, cancer and chronic respiratory conditions," said Susan Anenberg, a public health professor at George Washington University studying health effects of air pollution in the Arctic.

Oil spill response teams stationed in the region are a reminder of another environmental risk. Credit: Sabrina Shankman/InsideClimate News

Kerri Pratt is an atmospheric chemist who studies pollutants in the Arctic, and she's been trying to find funding to study Nuiqsut's air quality. "The preliminary data we looked at said they go out of compliance every so often, but I think there are a lot of open questions," Pratt said.

Until Pratt and others began their work, decades had passed with little research on North Slope air pollution. In the early 1990s, atmospheric scientist Dan Jaffe, then at the University of Alaska-Fairbanks, found that emissions from Prudhoe Bay were similar to those in Washington, D.C. He also found that pollutants were travelling hundreds of miles west to Utqiagvik, right over Nuiqsut.

Ice road trucks that run in and out of the oil facilities along the North Slope add more pollution to the air. Credit: Sabrina Shankman/InsideClimate News

Research shows the closer people live to oil and gas drilling, the more likely they are to suffer health effects. But in the Arctic, certain climate phenomena could mean those living further away might also be affected, according to Julia Schmale, an atmospheric scientist with the Paul Scherrer Institute in Switzerland.

Cold Arctic air can sit near the surface, with warmer air higher in the atmosphere. This can trap pollutants closer to ground level causing them to build up over a wide area. "You have a situation where a village 10 miles away will really feel or be exposed to the emissions," she said. This could pose a double whammy for Nuiqsut, with oil fields in its backyard and also for hundreds of miles.

Schmale and Anenberg have teamed up to study the intersection of public health, climate change and air pollution in the Arctic, an area Schmale said features "a huge gap of knowledge."

"Normally people think of the Arctic as a very clean environment—it's remote, it's sparsely inhabited," she said. "But if there is human activity, there are human emissions."

Sympathy for Villagers and Their Cloud of Fear

Despite the fear of reprisal, some concerned residents in Nuiqsut have spoken out.

Ahtuangaruak has taken their stories to national audiences—like the American Public Health Association, the Centers for Disease Control and Prevention, and to Congress, where in 2011 she testified before a subcommittee of the House Energy and Commerce Committee. Itta and others have sought help within Alaska, including a lawsuit that successfully delayed an oil project while demanding further evidence that the benefits outweighed potential impacts. Although the project was completed, Itta and her neighbors discovered they could fight back.

Alaska Gov. Bill Walker met with residents in Nuiqsut in March. He talks about the need to address climate change but supports drilling for more oil. Credit: Sabrina Shankman/InsideClimate News

But as residents seek answers, they have learned that when it comes to industrial pollutants and health, drawing connections between symptoms and causes is difficult.

Barbara Trost, who manages the air monitoring and quality assurance program at the Alaska Department of Environmental Conservation, said she and other state officials are well aware of the concerns in Nuiqsut.

ConocoPhillips runs the air monitoring station in Nuiqsut, Alaska. Credit: Sabrina Shankman/InsideClimate News

Trost was in Nuiqsut last summer for a public meeting organized by the federal Bureau of Land Management. "I was really stunned when I was up there in July to hear the fears that are so pervasive in the community that it even impacts the teenagers," she said. "I get it. I don't think any one of us would want to live in an environment where we're surrounded by industry."

The financially strapped state can't afford to conduct its own monitoring in Nuiqsut, according to Trost, but she occasionally sees data from ConocoPhillips' air monitoring station.

That data shows occasionally heightened levels of larger particulate matter (PM10), which Trost attributes to natural sources, and levels of other pollutants that are far below EPA standards. She knows the community doesn't trust air monitoring by ConocoPhillips, but said there is no reason to believe it's inaccurate.

For years, community members asked for monitoring of VOCs like benzene, which can cause cancer. In response, ConocoPhillips began a VOC monitoring study in 2014, and, like its other air monitoring, found nothing alarming.

At the request of InsideClimate News, Trost reviewed a report of the VOC monitoring that covered April to August 2017. She found that the methodologies used in the lab analysis were in line with EPA standards, but pointed to some differences in how ConocoPhillips monitors VOCs in Nuiqsut versus standard practice in the lower 48 states.

Pipelines and oil production facilities follow the ice roads along the North Slope, including around Nuiqsut. Credit: Sabrina Shankman/InsideClimate News

"Sampling is conducted only for two to three hours," Trost said. In the rest of the country, she said, samples are typically taken for a 24-hour period. The shorter sampling period was probably the only option, Trost said, due to costs and difficult weather in Nuiqsut.

Schmale, the atmospheric scientist, also reviewed the report and said that from a scientific perspective, the monitoring "would ideally be done with real-time instrumentation" so it could capture variability over time.

Lowman, of ConocoPhillips Alaska, said the company is confident in its sampling, adding that there are technical problems with 24-hour sampling during the Arctic winter.

Unclear Why Respiratory Sick Visits Increasing

The state has twice studied Nuiqsut clinic visits to see whether cases of respiratory illness were on the rise—and if so, why. It found no clear evidence that pointed to the oil industry.

Each study examined the visits differently—the first looked at aggregated data from 1998 to 2002, while the second looked at just the first four months in 2011 and 2012.

Breaking all the visits down into monthly averages, the number of monthly clinic visits in 2011 and 2012 were, respectively, 10 and 14.5 times higher than the earlier study. The state report attributed the 2012 numbers to a particularly bad flu season, but did not explain why the 2011 were also high.

"The development has proceeded too rapidly, without enough care for the health of the people from an air quality and subsistence perspective," said Pamela Miller, the executive director of Alaska Community Action on Toxics. "And now they’re virtually surrounded." Credit: Sabrina Shankman/InsideClimate News

Yoder said the two studies can't be directly compared because they were looking at different things. "The methodology was different," she said, though she could not point to specific differences.

In the years between the state's studies, ConocoPhillips' Alpine oil field hit its stride. After beginning regular production in 2000, the field grew to include more than 135 wells by the time the second study was taking place.

Worries Mount in Nuiqsut

A few days after the Repsol blowout, Sam Kunuknana remembers his then-wife and young daughter arriving home after a short walk from the teen center. It was a cold, February day—33 below and foggy, with a wind coming from the direction of the well, which still hadn't been fully plugged.

"It was just like a 10-, 15-minute walk," said Kunuknana. "They came home and they got really sick." His daughter's temperature spiked, her ears hurt and she was in a lot of pain. They raced her to the clinic, where they received a diagnosis of the common flu or cold. ConocoPhillips' monitor began taking continuous measurements again the evening after the blowout, following its scheduled maintenance. The pollutants it was monitoring were at near-normal levels, the state reported.

Sam Kunuknana remembers how after the Repsol blowout, his young daughter became ill after walking outside. Credit: Sabrina Shankman/InsideClimate News

It took more than a month for both Kunuknana's daughter and former wife to feel better. "To this day, I think my ex still has that cough," he said. He believes it was the blowout that made them sick, just as he believes the flaring and haze that settles over town makes it harder to breathe some days.

In December 2017, there was a massive lease sale in nearby state lands and the National Petroleum Reserve-Alaska. The big winners were ConocoPhillips and Repsol. Those lease sales, along with other recent discoveries around Nuiqsut, have landed the region the nickname "the new Prudhoe Bay."

"When you talk about environmental justice, you talk about human rights, about future generations that will be dealing with industry as they move forward," Kunaknana testified recently at the Permanent Peoples' Tribunal, an international human rights forum where Nuiqsut's concerns were discussed. "I don't have a degree in anything, but I do understand what's going on."