In the early twentieth century, the colonial government of the United States in the Philippines confined people with leprosy on the island of Culion. Febe D. Pamonag examines claims that the policy protected public health while telling the stories of the affected men, women, and children. As Pamonag shows, Filipinos responded in many ways to the Segregation Law. Some resisted arrest and confinement. Others negotiated or complied because of family needs, fear, gender, class, and economic pressure. Rare archival documents reconstruct life inside Culion’s communities, where people fought for better food and living conditions, and used the courts to challenge their confinement and assert their rights. Pamonag also highlights previously untapped accounts that reveal how women navigated the stigma of the disease and the gendered restrictions imposed on them. A new chapter in the history of public health, Island of Pain, Island of Hope shows the courageous and creative ways Filipinos coped with life under colonial rule.