An Act of Congress on 17 March 1941 had approved purchase of the site, then a sugar cane field, for a Navy Hospital.

Hospital activity peaked following the battle for Iwo Jima in February and March, 1945, when 5,676 patients received medical care simultaneously.

In 1950, the Territory of Hawaii began negotiations to obtain the Aiea facility for a tuberculosis sanitarium.

The first Marines took up residence in October 1955; the headquarters staff placed the camp in full operation just two weeks before its dedication on January 31, 1956.

In April 1994, Marine Corps Base Hawaii assumed operational responsibility for Camp H. M. Smith.