Urban centers like Majuro and Ebeye are particularly vulnerable. They face not only climate-induced risks like coastal flooding but also challenges tied to rapid urbanization such as overburdened public services. Due to land elevations averaging below 6.5 feet (2m), even moderate sea level rises of 20” (0.5m) are projected to result in regular overwash events, which will challenge habitability. Internal migration from rural areas to cities further compounds these vulnerabilities p. 21

Another critical year is 2150, by which time a 6.5ft (2-meter) rise is currently projected. Whether it is practicable to provide for this or whether to look to other strategies including migration or seeking alternative land will have to be decided through the mid 2000s, prompting evaluations of ongoing protective measures, influencing choices between fortifying current communities or initiating relocations. p. 24

Furthermore, the Strategic Plan includes measures to prevent child abuse and neglect, reflecting concerns about family dispersion across islands or overseas. It details comprehensive procedures for adopting children, acknowledging that adoption might remain significant due to various social factors like dislocation, migration, livelihood stresses, and teenage pregnancies p. 59

The accessibility to services, particularly health, education, and transport in different atolls, has an essential impact on the population distribution, influencing their vulnerability. In addition, the level of investment varies locally to protect against extreme events and provide for economic development opportunities. It is lower in the more rural atolls, leading to internal migration to the urban or intermediate centers. p. 102

Many health facilities, particularly those located near the coasts, risk damage from extreme weather events. This puts a strain on healthcare accessibility. Access challenges are manifold - from high travel costs to infrequent transportation options and the reliability of ports. Climateinduced migration also disrupts established healthcare dynamics p. 118

Such a move may contribute to further out migration from small atolls and islands. Despite goals to maintain enrollment numbers, enrollments continue to decline at all levels, attributed to migration to the US. Such outmigration will likely continue to affect education services on the outer islands and in key population centers as students and their families migrate. The continued migration of people from the outer islands to the core areas will also cause population pressures on school rolls in these centers and student accommodation. It puts financial pressures on households (and extended social supportnetworks) forced to migrate p. 119

Health is one of the primary reasons for internal and external migration, particularly for senior citizens and those with underlying health conditions. The limited diet available, temperatures, and risk of extreme weather events may be things that this population cannot withstand and result in higher rates of morbidity amongst this population, increased health effects, or forced migration. p. 128

The Adaptation Pathway is characterized by a sequence of actions in the long-term, each triggered by a change in environmental conditions (for example, sea-level rise), social conditions (for example, out migration), or a combination of these p. 138

The first two decision points prioritize national decisions about Protection as a main adaptation strategy, while the next two decision points further along the timeline focus on national decisions about Planned Relocation and Migration as adaptation strategies p. 142

The decision here is to invest in further protection infrastructure of the already protected atolls/ areas or a combination thereof to confront the projected 2m sea level rise or shift the adaptation strategy to a priority of preparedness for migration of the population out of the RMI. p. 147

Population decline and internal migration to Ebeye and Majuro intensify pressures on their coastal fisheries, leading to overfishing and environmental degradation p. 164