La'Miyah Hildreth, 5, wears a nebulizer in the kitchen of her grandmother Siobhan Washington. | Ami Vitale/Panos Pictures The Marathon Petroleum oil refinery in southwest Detroit, which abuts River Rouge. As part of a $2.2 billion expansion that will enable it to process tar sands oil from Canada, Marathon has been buying homes adjacent to the plant. | Ami Vitale/Panos Pictures In front of her River Rouge home, Siobhan Washington hugs granddaughter Marianna Hildreth while some of her other grandchildren play. "I don't understand why more people aren't concerned about it," she said of her hometown. "People are dying off, slowly but surely, in their 20s, 30s, 40s, and 50s." | Ami Vitale/Panos Pictures Siobhan Washington checks the breathing of granddaughter Mariyah McGhee, 1, in her River Rouge, Michigan, home. | Ami Vitale/Panos Pictures Fishing on the Detroit River, with the steel-making facilities of Zug Island in the background. | Ami Vitale/Panos Pictures Just across the water from the intensely industrialized Zug Island, Kevin Morris shows off the bass he caught in a Detroit River canal. "Driving here, it's like entering another world," said Morris, who lives in Detroit. "It's almost what a Third World country would look like." | Ami Vitale/Panos Pictures At Belanger Park, Jada Lyons watches friends fish in the Detroit River. The coal-fired River Rouge Power Plant looms in the background. | Ami Vitale/Panos Pictures Sunday services at the Union Second Baptist Church in River Rouge, Michigan. | Ami Vitale/Panos Pictures A resident peaks through the screen door of her River Rouge, Michigan, home. | Ami Vitale/Panos Pictures Alisha Winters, 31, takes son Robert Connor, 13, and daughters Myshelle James (with bike), 4, and Deborah Smith, 5, to volunteer at a local farmers' market. "I'm very hopeful," Winters said. "In 10 years I picture Rouge being a very clean, safe environment for our children to live and work." | Ami Vitale/Panos Pictures Myshelle James, 4, rides her bike in River Rouge's Memorial Park while her brothers play basketball in the background and her mother, Alisha Winters (not shown), helps at a nearby farmers' market. | Ami Vitale/Panos Pictures

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