genetic effects, etc. These arguments are difficult to substan- tiate or refute, but will certainly continue to be raised. It is widely accepted that the secondary and selected tertiary care for the affected people will be provided by the hospitals on Majuro and Ebeye. (The population numbers on Rongelap, Utirik, Kili (for Bikini people) and Enewetok are not sufficient to either justify or support more than primary care provided by a medical assistant on the individual atolls). This will require a major improvement in the services provided by these two hospitals. It is ethically impossible to provide improved health care for the affected peoples and deny it to their neighbors and even families because they do not qualify. This means that the primary care developed on all atolls (approximately 50%) with affected people, as well as the secondary care in the hospitals should be designed for and available to other Marshallese citizens. The only other alternative, a duplicate health care system throughout, is both unrealistic and politically and economically unacceptable. The Marshallese Government officials have made clear their desire for the Burton BiT1 impact to be a national? one, rather that treating parts of their newly emerging state preferentially. logic is understandable. Their While trying to unify rather diverse island people into a new nation, it is not helpful to have the U. S. continue to deal independently with some atolls or people. Health care systems become less cost-effective the smaller the population they serve. The 30,000 population of the Marshall Islands is already so smal] as to raise economic issues. Further reducing this to the approximately 2,000 people "directly" affected will only marginally reduce the total costs. In other words, a