Camp Smith is located on the ridge that divides the traditional ahupua‘a (traditional Hawaiian land division) of ‘Aiea and Hālawa, but falls within Hālawa. Ancient Hawaiians traveled up to this area for forest collection, which was an important activity as indicated by the presence of an important temple named Keaīwa located on the adjacent ridge to the northwest.
By the end of the 19th century, the area that is now Camp Smith was owned by the Bishop Estate and was under sugar cultivation.
The property was acquired by the US government in 1941 for construction of Aiea Naval Hospital. The large multi-wing hospital building was designed by C.W. Dickey and President Roosevelt and Vice Admiral Ross T. McIntire contributed to the preparation of the plans. The facilities were constructed under the supervision of the Bureau of Yards and Docks.
During construction, the doctors assisted in the construction of the facility: the chief surgeon became the head plumber; the psychiatrist took charge of laying foundations; the ear, nose, and throat specialist was assigned to string light poles; and other doctors became temporary carpenters, masons, and mechanics (Honolulu Advertiser 3 May 1942). The project was completed in December 1943 due to extremely rapid and efficient construction. The hospital staff created an occupational therapy program for patients that included participation in farming, carpentry, mechanics, clerical duties, laundry, and other similar duties. Patients were also encouraged to participate in recreational activities such as painting or drawing, music, bowling, swimming, and baseball. By 1944, the hospital was the largest outside of the continental United States.
In 1949, the hospital was deactivated. In 1955, the Marine Corps selected the site for the Home of the Fleet Marine Force Pacific. At this time it was named Camp H.M. Smith in honor of General Holland McTyeire “Howlin’ Mad Smith.”