In the United States and Australia the twentieth- and twenty-first-century health struggles of urban Indigenous communities demonstrate that settler-colonial violence continues today as abandonment. Settler-colonial violence persists through government policies that neglect, remain indifferent to, and perpetuate the struggles of Indigenous peoples. In matters of health, these forms of neglect have particular urgency, contributing to persistent health disparities and consistently lower life expectancies among Indigenous peoples in these nations. Historically, the unique problems of nonrecognition faced by urban pan-Indigenous communities have put them at special risk. Government funding for urban Indigenous health programs is in constant threat, requiring activists to remain vigilant in reminding the federal government that its responsibility for Indigenous welfare does not end at the reservation/reserve border. Three forms of medical neglect characterize the history of Indigenous health in both the United States and Australia: (1) duty-breaching omissions; (2) animus as indifference; and (3) harm as a tool of statecraft. The persistence of these forms of neglect is continuous with other forms of more explicit settler-colonial violence committed in the past and should be viewed as morally and conceptually on a par with violence.