In 1865, Lot Kapuaiwa (Kamehameha V) of the Kingdom of Hawai‘i signed into law An Act to Prevent the Spread of Leprosy. Subsequently, from 1866 to 1969, close to 8,000 individuals with Hansen's disease (leprosy) were sent to live in "quarantine" on the Makanalua peninsula (commonly known as Kalaupapa) which lies on the northern shore of the island of Molokai. From challenges wrought during the early decades of the leprosy settlement, to tsunami damage at some of the cemeteries, there remain approximately 1200 marked graves, along with several known un-marked burial sites.
The community that formed on the peninsula from 1866 onward included the kama‘āina (original inhabitants) of the ahupua‘a (land divisions) of Waikolu valley, Kalawao, Makanalua, and Kalaupapa, the patients, and the patients' kōkua (helpers who came with individual patients to care for them).