Increase in disaster-related deaths: risks and social impacts of evacuation

In response to the Great East Japan Earthquake and the accident at Fukushima Daiichi nuclear power plant on 11 March 2011, evacuation zones were established around the plant, affecting 12 municipal districts in Fukushima Prefecture. Evacuation peaked at >164,000 residents. Even today, 5 years after the accident, >100,000 people are still forced to live in temporary accommodation. The number of disaster-related deaths has reached almost 2000, which exceeds the number of Fukushima residents who were killed directly by the Great East Japan Earthquake and tsunami. Disaster-related deaths are undeniably an element of man-made disaster, as these individuals were saved by emergency evacuation and subsequently lost their lives due to insufficient measures to support them. Although this topic has not been discussed in detail during the ICRP dialogue that started in November 2011, this article will address the issue of effective radiological protection and evacuation planning.

In contrast to direct death (e.g. being crushed by a collapsing building or drowned by a tsunami), disaster-related death is characterised as indirect death resulting from poor health and exhaustion experienced during evacuation. Disaster-related death is covered by the Government’s condolence money policy, paid in the case of natural disasters. The condolence money policy works as follows. Once the examination committee, formed of a group of intellectuals, recognises that the cause of death is due to indirect factors, municipal governments treat it in the same way as a direct death and pay condolence money to the bereaved. This policy has been applied mutatis mutandis to the disaster in Fukushima that was a combination of an earthquake, tsunami, and nuclear accident, and disaster-related deaths have been included in the statistics. The data show that disaster-related deaths are much more common in Fukushima Prefecture than in other affected prefectures (e.g. Iwate and Miyagi Prefectures). This situation is an ongoing issue that is unique to nuclear disasters, and campaigns are being run to advocate for the improvement of evacuees’ lives and prevent disaster-related deaths.

According to the survey of the Reconstruction Agency, by March 2015, there had been 1914 disaster-related deaths in Fukushima Prefecture; corresponding figures for Miyagi Prefecture and Iwate Prefecture were 910 and 452, respectively. The number of disaster-related deaths in Fukushima Prefecture was equivalent to 60% of the total count for the three prefectures. Compared with a survey undertaken 6 months earlier, the total number increased by 121. Ninety percent (n = 1728) of all disaster-related deaths were among people aged >66 years. This trend continues today, and the number of disaster-related deaths reached 1991 by 3 December 2015. The percentage of disaster-related deaths within the total death toll is >50% in Fukushima Prefecture, compared with 8–9% in Iwate and Miyagi Prefectures. The number of disaster-related deaths now exceeds the number of direct deaths related to the disaster.

While most deaths occurred in the first 6 months after the disaster in all three prefectures, the number of people who died <1 year or >1 year after the disaster was strikingly high in Fukushima Prefecture, showing a difference from Iwate and Miyagi Prefectures. As such, disaster-related death is said to be an ongoing issue in Fukushima Prefecture.

As shown in the breakdown by municipal district (Fig. 1), disaster-related deaths were concentrated around the coastal area of Fukushima Prefecture (Hama-Dori area). Among the municipal districts designated as ‘restricted zones’, both direct deaths and disaster-related deaths were high in the towns of Minamisoma and Namie, which were heavily damaged by the tsunami. The disaster-related death rate was much higher in areas such as the towns of Naraha, Tomioka, and Okuma, and the villages of Futaba and Iitate, and the number of direct deaths was relatively low.

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Fig. 1. Ratio between direct deaths and disaster-related deaths by municipal district.

According to the report by the Reconstruction Agency issued in the early postaccident period (Table 1), the main causes of disaster-related death were ‘physical and mental exhaustion due to evacuation’, ‘physical and psychological exhaustion through travelling to evacuation areas’, and ‘worsening of pre-existing illnesses due to hospitals not being able to operate’. These situations imply that disaster-related death is derived from nuclear accidents, and that emergency evacuation and subsequent life in evacuation have a substantial impact on individuals, both physically and mentally.

Table 1. Major causes of disaster-related death.

Table 1. Major causes of disaster-related death.

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The bereaved families of four people who have committed suicide since the accident raised a lawsuit against Tokyo Electric Power Company Inc. (TEPCO), the owners of Fukushima Daiichi nuclear power plant, for damage compensation. For two of these four cases, the court recognised the relationship between suicide and the nuclear accident, and the company was required to pay damages. The causal link between disaster-related death and nuclear accidents has also come to be acknowledged by the judiciary.

Given the situation, the Reconstruction Agency compiled a report on considerations to prevent disaster-related deaths in Fukushima Prefecture in March 2013. The report states different support measures, such as supporting restoration of evacuees’ living conditions, prevention of isolation, and mental care. Nevertheless, as mentioned above, the disaster-related death rate is increasing and one of the reasons for this is prolonged life in evacuation.

In June 2014, the number of evacuees peaked at 164,218; this number has been decreasing since 2012, a year after the nuclear accident (Fig. 2). However, >100,000 people are still unable to return to their hometowns. Among municipalities designated as evacuation zones, the evacuation order has not been lifted in some areas. Some municipalities aim to lift the evacuation order and enable the inhabitants to return home by March 2016, other municipalities plan to do so in 2–3 years, and other municipalities have no plans at all.

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Fig. 2. Transition of number of evacuees.

Fukushima Centre for Disaster Mental Health supports disaster victims, and 20,000 people attended the Centre between 2012 and 2014. Among them, most patients (n = 4900) attended due to physical symptoms caused by mental instability, followed by irritation and emotional issues, and difficulty sleeping. Not all symptoms have shown an increasing trend; some have actually decreased, which shows that the nature of evacuees’ suffering has been changing and growing more complex over time.

Living conditions are becoming worse as life in evacuation is prolonged. In Fukushima Prefecture, there are still 16,400 temporary residences, housing 19,800 people. Many residents, such as the elderly and vulnerable, have lost vitality and the will to earn their own living. The Disaster Relief Act limits the duration for living in temporary accommodation to 2 years. However, this has been extended due to delay in the construction of temporary public housing. Extended use of temporary accommodation is naturally leading to damage, such as corrosion of the base pile and slopes, termite damage, blocked gutters, and damage to external television antennae, doors, and woodwork. The physical and mental impacts on evacuees are immeasurable. These people are full of resentment about being forced to leave their home towns, being deprived of work, splitting up of families, separation from friends, and being forced to live in poor-condition temporary housing in an unfamiliar place. It is now 5 years since the nuclear accident, and although many victims are restoring their lives successfully, one must not forget that stress factors lead to feelings of isolation in vulnerable people that often go unnoticed.

In order to prevent disaster-related deaths, including suicide, the Government and relevant institutions and groups are taking pro-active action by providing consultation and keeping watch over the evacuees. As mentioned earlier, the nature of evacuees’ suffering is changing and growing more complex over time. It is doubtful that supportive care, such as keeping watch, can improve the situation. As the number of disaster-related deaths keeps increasing, it is questionable if simple treatment of symptoms can improve the situation. The suffering of evacuees will not be eliminated unless national and prefectural governments, municipalities, and TEPCO work together to solve the issue of temporary housing, prevent isolation of the inhabitants, clearly indicate the possibility and timing of returning home, support rebuilding individual lives, and solve the issue of compensation.

Some may wonder how the above is relevant to radiological protection. After all, the cause of disaster-related death is concerned with how affected people are evacuated in the case of a nuclear disaster, and how they are treated after evacuation. Following the accident in Fukushima, the emergency evacuation was successful insofar as direct fatalities. However, when viewed in hindsight, risks during the evacuation were not considered thoroughly. There is no denying the element of man-made disaster in disaster-related death, as those lives that were saved by evacuation were subsequently lost. The author believes that insufficient measures were put in place to implement seamless support during the transitional period between the emergency phase and the reconstruction phase.

Dr Tsubokura of Minamisoma City General Hospital has presented findings that show a large difference in mortality rate between those who evacuated from care homes for the elderly and those who did not following the nuclear accident. This type of research achievement should be used for future evacuation planning so that the rest of the world can learn lessons from Fukushima. In addition, the author believes that public authorities need to review the effectiveness of treatment of inhabitants following evacuation, together with experts from different domains.

The Nuclear Regulatory Authority has compiled guidelines for response measures concerning nuclear emergency on the basis of the accident at Fukushima Daiichi nuclear power plant. Municipal governments with nuclear power stations in Japan are reviewing their own disaster plans in accordance with these guidelines. Some nuclear power plants have resumed operations; however, their evacuation plans are not sufficient when viewed by individuals who have actually experienced the accident. The residents of Fukushima were thrown into this disastrous event, and are now making extraordinary sacrifices in the form of disaster-related deaths. This experience cannot be wasted. It is the author’s strong hope that this experience is disseminated to the rest of the world, and that better disaster prevention schemes are established.