The descendants of the people of the Middle Missouri and Central Plains/Initial Coalescent cultures now live in North Dakota as the Mandan and Arikara nations, respectively, of the Three Affiliated Tribes (together with the Hidatsa).

[8] The characteristics of the remains at the site show they were killed in an overwhelming attack, which has been called the Crow Creek Massacre.

The remains of the villagers of Crow Creek were discovered in a fortification ditch, where they were buried during the mid-14th century and covered with a small layer of clay from the river bottom.

The bodies showed evidence of having lain out exposed to weather and scavengers for a period of time, becoming at least partly disarticulated before burial.

They also reveal other hardships of their lives: evidence of nutritional deficiencies and previous warfare, which suggest adaptations to the changes were more difficult.

According to Zimmerman's 1985 book, Peoples of Prehistoric South Dakota, the bones reveal several ailments related to chronic malnutrition.

[9] As stated in Zimmerman's book, "one of the most common characteristics was a pitting in the top of the eye sockets called cribra orbitalis.

In addition to these ailments, Harris lines (an indicator of insufficient amounts of protein and other essential minerals, as well as truncated episodes of growth) were discovered while specialists examined radiographs of several individuals.

Based on the evidence of "active and organizing subperiostial hematomas along with the other bony alterations" found while examining remains, they concluded that the villagers had long suffered malnutrition, in repeated episodes thought due to the unstable climate and drought, which reduced the crop yields and food supplies.

Willey and Emerson's article entitled "The Osteology and Archaeology of the Crow Creek Massacre" describes the presence of animal bones, specifically canine, within the fortification ditch.

According to the 1982 dissertation entitled Osteology of the Crow Creek Massacre by P. Willey, evidence of previous warfare is present in the skeletal remains of victims found in the mass burial.

[14] "Tongue removal, decapitation, and dismemberment of the Crow Creek victims may have been based on standard aboriginal butchering practices developed on large game animals".

As stated in Willey's dissertation, many of the mutilations suffered by the victims of the Crow Creek massacre could have been traumatic enough to result in death.

The most plausible is that this was internecine warfare, and that "overpopulation, land-use patterns, and an unstable climate caused the people to compete for available farmland" and other resources.

[17] Before the excavations could proceed, the Corps of Engineers and the University of South Dakota Archaeology Laboratory team consulted with the Crow Creek Sioux Reservation Tribal Council, as well as representatives of the Mandan and Arikara peoples, who now are based mostly on Fort Berthold Indian Reservation in North Dakota.

Some archeologists and human osteologists criticized the agreement at the time, "contending that new techniques would have allowed substantially more information to be gleaned from the remains if they had been curated for eventual restudy.

[20] Since the reburial, the US Congress and South Dakota legislature have passed laws governing consultation with tribes, and return of remains and artifacts of cultural importance.

The most far-reaching federal legislation was the 1990 Native American Graves Protection and Repatriation Act (NAGPRA) (Public Law 101–601).