In Kalawao County, on the Kalaupapa Peninsula on the north coast, settlements were established in 1866 for quarantined treatment of persons with leprosy; these operated until 1969.

Today, East Molokai volcano, like the Koʻolau Range on Oʻahu, is what remains of the southern half of the original mountain.

The northern half suffered a catastrophic collapse about 1.5 million years ago and now lies as a debris field scattered northward across the bottom of the Pacific Ocean.

The low western half is very dry and the soil is heavily denuded due to poor land management practices, which allowed over-grazing by deer and goats.

The eastern half of the island is a high plateau rising up to an elevation of 4,900 ft (1,500 m) on Kamakou peak and includes the 2,774 acres (11.23 km2; 4.334 sq mi) Molokai Forest Reserve.

The high-elevation forests are populated by native ʻōhiʻa lehua (Metrosideros polymorpha) trees and an extremely diverse endemic flora and fauna in the understory.

[18] The first significant European influence came in 1832 when a Protestant mission was established at Kaluaʻaha on the East End of the island by the Reverend Harvey Hitchcock.

The first farmer on Molokai to grow, produce and mill sugar and coffee commercially was Rudolph Wilhelm Meyer, an immigrant from Germany who arrived in 1850.

Because of the islanders' lack of immunity to the new diseases, they suffered high rates of infection and death from smallpox, cholera, measles and whooping cough, as well as leprosy.

Sugar planters were worried about the effects on their labor force and pressured the government to take action to control the spread of leprosy.

[25] Pater Damiaan de Veuster, a Belgian priest of the Congregation of the Sacred Hearts of Jesus and Mary served as a missionary for 16 years in the communities of sufferers of leprosy.

Joseph Dutton, who served in the 13th Wisconsin Volunteer Infantry Regiment during the American Civil War and converted to Roman Catholicism in 1883, came to Molokai in 1886 to help Pater Damiaan and the rest of the population who suffered from leprosy.

Both Father Damiaan and Mother Marianne have been canonized as Saints by the Roman Catholic Church for their charitable work and devotion to sufferers of leprosy.

[26] In the 1920s, people confined in the leper colony were treated with a new method devised by Alice Ball and involving chaulmoogra oil.

[29] Modern Multidrug therapy (MDT) remains highly effective, and people are no longer infectious after the first monthly dose.

[31] In the 21st century, there are no persons on the island with active cases of leprosy, which has been controlled through medication, but some former patients chose to continue to live in the settlement after its official closure.

[32] Over the years Molokai Ranch has also acted as a developer, establishing hotels and related amenities for resort tourists on their property.

[34][35] In 2007, community residents organized the "Save Laʻau Point" movement to oppose Molokai Ranch's attempt to expand its resort operation.

[36] As a result, on March 24, 2008, Molokai Ranch, then the island's largest employer, decided to shut down all resort operations, including hotels, movie theater, restaurants, and golf course, and dismiss 120 workers.

In 2007, a panel of 522 experts in sustainable tourism and destination stewardship reviewed 111 selected human-inhabited islands and archipelagos around the world.

The survey cited Molokai's undeveloped tropical landscape, environmental stewardship, and rich, deep Hawaiian traditions (the island's mana).

Dave Jung attributed the closure to competition from federally subsidized commuter air travel and declining ridership.

Today Kalawao County is preserved by the Kalaupapa National Historical Park (accessible by guided mule or hiking tour).