Petrol has been extracted from Achuar territory in the Northern Peruvian Amazon since the 1970s. In spite of early identification of negative impacts on the environment and repeated attempts by the Achuar to improve conditions, very little research has been done on specific environmental and health impacts. Some recent governmental studies have shown extremely high blood lead and cadmium levels in Achuar communities. In this paper we apply an environmental justice framework to review the evidence of pollution and health status available in existing studies, as well as government and operating company actions over the last 30 years. We identify gaps in our knowledge which hamper efforts to respond to the environmental and health situation, as well as negligent actions on the part of the State and petrol companies.