Four Years After Japan’s Great Earthquake & Tsunami

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Credit NHK News – Fukushima evacuation zone March 2011

 

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This week marks the fourth anniversary of Japan’s greatest modern natural disaster, and as the following Red Cross summary shows, thousands of (mostly elderly) people are still displaced, and for many life remains far from normal.  

 

First the statement, then I’ll be back with more on the long-term effects of disasters.

 

Great East Japan Earthquake and Tsunami – 4 years on. Despite progress in recovery, Red Cross continues to address high levels of vulnerability amongst survivors

2015/03/09

Four years have now passed since the Great East Japan Earthquake and Tsunami devastated large areas of Eastern Japan and while much progress has been made in overall recovery, there are serious delays in rebuilding communities, and the Red Cross continues to support thousands of mainly elderly survivors who still live in temporary housing. The tsunami also caused meltdown at the Fukushima Daiichi nuclear plant forcing the evacuation of large numbers of people who will not be able to return home in the foreseeable future because of radioactive contamination.

“There has been considerable progress in overall recovery from the devastation,” said Tadateru Konoe, President of the Japanese Red Cross (JRCS) and of the International Federation of Red Cross and Red Crescent Societies (IFRC), “however, there have been critical delays in rebuilding communities back and particular attention must be given to the needs of many elderly and other vulnerable people who have been unable to get back on their feet. The Red Cross will continue to support them.”

Clean-up efforts have reduced the levels of radioactivity around the Fukushima nuclear power plant, but areas close to the reactor will remain uninhabitable for years to come. With support from the IFRC and national Red Cross & Red Crescent societies around the world, the JRCS continues to provide extensive support to those displaced by the Fukushima meltdown, including health services and psychosocial support. Meanwhile the IFRC is supporting the newly established JRCS Nuclear Disaster Resource Center, which operates a digital library that collects information and experiences related to the nuclear disaster. The center has also drafted an operational manual which will be referred to in developing the IFRC’s guideline for nuclear emergency preparedness.

The Japanese Red Cross has been instrumental in the rebuilding of hospitals, nursery homes, and other vital institutions, and most of these large scale projects are either finished or nearing completion. The rebuilding of permanent homes for the affected population has not progressed as quickly, mainly due to constraints in land acquisition, but several Red Cross supported housing projects for elderly people have been constructed.

Whereas the living conditions of younger generations have by now mostly returned to normal, the situation is more serious for a large number of elderly people who lack a supporting family network and have not yet been able to restore their lives. The Red Cross maintains a focus on providing services to displaced elderly people who need assistance. This includes organizing social activities for residents of both temporary and permanent housing projects.

In addition to the mostly completed large scale construction projects the Japanese Red Cross Society continues to provide medical services, psychosocial support and other assistance to affected people in Iwate, Miyagi and Fukushima prefectures.

(Continue . . . )

 

Although a relatively rich country, Japan is still rebuilding after the devastation of the earthquake/tsunami/nuclear accident four years later, and the decommissioning of the Fukushima plant will take many more years.   

 

In Haiti, which suffered a horrific 7.0 earthquake in January of 2010, at last report more than 80,000 people still live in makeshift tent cities, often without running water or adequate sanitation (see USA Today Voices: Haiti, still suffering 5 years after earthquake).  

Although news headlines, and the public’s interest in disasters tend to wane and move to the next big story relatively quickly, recovery from disasters like these - and others like Hurricane Sandy in New York & New Jersey, tornadoes in Joplin and Tuscaloosa, and typhoons in the Philippines – can often take years.

 

Underappreciated is the toll these disasters can have on the mental and physical health of those heavily affected, and that those effects can continue for years. 

 

• We’ve looked at the post-disaster (often stress related) effects on human health previously, including a year ago in Tulane University: Post-Katrina Heart Attack Rates – Revisited, where heart attack rates remain elevated by 300% in New Orleans six years after that hurricane struck.
• Also last year, in The Long Term Effects Of A Major Disaster, we looked at the post-tsunami deaths due to stress and displacement that exceeded – at least in one prefecture – those experienced during the initial earthquake and tsunami. 
• And in the fall of 2013 - in Sandy 1 Year Later: Coping With The Aftermath - we looked at the lingering psychological effects of New England’s brush with that late season super storm of 2012.

 

While often hidden from view, the psychological impact of a disaster can be enormous and ongoing.

 

Three years ago, in  Post Disaster Stress & Suicide Rates we looked at the impact of disaster-related PTSD (Post Traumatic Stress Disorder). This has been recognized as such a pressing problem that in 2013 the World Health Organization released a comprehensive Guidelines For Post-Trauma Mental Health Care book on the treatment of PTSD, acute stress, and bereavement:

While the psychological impact of a major disaster cannot be completely mitigated, encouraging individual, family, and business preparedness can go a long ways towards reducing the impact of any disaster.

 

FEMA, Ready.gov, along with organizations like the American Red Cross (and indeed, this blog), spend a great deal of time trying to convince individuals, families, businesses and communities of the value of preparing for a wide variety of emergencies and disasters.

Basic kit : NWS radio, First Aid Kit, Lanterns, Water & Food & cash

 

Having a modest supply of food, water, and medicine – and a workable family or business disaster plan – can go a long ways toward reducing both stress and hardship during and after a disaster. The standard advice is that everyone needs to be prepared to deal with a disaster for at least 3 days (meaning having a first aid kit, emergency supplies, and a plan) before help arrives.

 

Sure . . .  they’d like you to be prepared for longer . . .  but 72 hours is a reasonable start. I personally advocate having 2 week’s worth of supplies, but then I live in the heart of hurricane country, and have a fondness for eating regularly (see NPM11: Living The Prepared Life). 

 

Although a good disaster plan and emergency kit are imperative to get you through the opening hours, days, or even weeks of a disaster, knowing how to help friends, family, and neighbors deal with the psychological effects of a disaster can be equally important.

 

A few resources you may wish to revisit:

 

In Psychological First Aid: The WHO Guide For Field Workers we looked a simple guidebook anyone can use to help others in emotional distress.

 

The CDC also provides a website which contains a number of resources devoted to coping with disasters.

Coping With a Disaster or Traumatic Event

Trauma and Disaster Mental Health Resources

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.

 

For more on disaster preparedness, you may wish to revisit:

 

When 72 Hours Isn’t Enough

In An Emergency, Who Has Your Back?

An Appropriate Level Of Preparedness

The Gift Of Preparedness – 2014 Edition

Disaster’s Hidden Toll

 

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Credit NHK News – Fukushima evacuation zone March 2011

 

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With our short attention span, and the news media’s proclivity for moving on to the next big disaster or story, we often don’t closely follow the struggle to rebuild disaster stricken communities, which can take months or even years.

 

And for some caught in harm’s way, whose homes and businesses were destroyed - and loved ones lost - there is no going back to the way things used to be.

 

Not surprisingly, that can produce significant mental and physical health challenges for those affected.

 

Today we’ve a report out of Japan showing that the earthquake/tsunami of March 2011 that killed more than 20,000 people in Japan also had a long-term, largely unseen, effect on nursing home patients who were forced to evacuate to temporary facilities.

 

A study shows a 2.4 fold increase in deaths during the 8 months following the earthquake.  Deaths not caused by the quake, tsunami, or radiation release itself – but likely brought on by the stress of having to live in make-shift emergency shelters.

 

A unusually large number of these excess deaths were due to pneumonia or bronchitis, which many attribute to insufficient emergency shelters provided for the elderly and frail.

This report from the Ashasi Simbum.

 

Death rates spike among elderly evacuees from Fukushima

January 11, 2013

By YURI OIWA/ Staff Writer

Former residents of nursing homes near the Fukushima No. 1 nuclear plant died at a higher rate than usual in 2011, a study has shown, likely because of the stress of evacuation and having to live in temporary accommodations such as draughty school gyms.

 

Researchers from the Fukushima Medical University studied reports submitted to the Fukushima prefectural government by 34 institutions for the elderly and found that the death rate over eight months in 2011 was 2.4 times that of the same period in 2010.

(Continue . . . )

 

A similar result was found in this study of nursing home evacuations from the University of South Florida.

 

The Effects of Evacuation on Nursing Home Residents With Dementia

Lisa M. Brown, PhD, David M. Dosa, MD, MPH, Kali Thomas, MA, Kathryn Hyer, PhD, MPP, Zhanlian Feng, PhD, Vincent Mor, PhD

Background: In response to the hurricane-related deaths of nursing home residents, there has been a steady increase in the number of facilities that evacuate under storm threat. This study examined the effects of evacuation during Hurricane Gustav on residents who were cognitively impaired.

 

Conclusions: The findings of this research reveal the deleterious effects of evacuation on residents with severe dementia. Interventions need to be developed and tested to determine the best methods for protecting this at risk population when there are no other options than to evacuate the facility.

 

 

We’ve looked at other post-disaster health impacts in the past, such as in Post Disaster Stress & Suicide Rates. One disaster discussed was a 1999 7.3 earthquake that struck in Chi-Chi, Nantou county in central Taiwan killing more than 2,300 people.

 

A study that subsequently appeared in the Taiwan Journal of Medicine (Disease-specific Mortality Associated with Earthquake in Taiwan Hsien-Wen Kuo, Shu-Jen Wu, Ming-Chu Chiu) found `a considerable increase in the number of suicides after the earthquake’.

 

PTSD (Post Traumatic Stress Disorder) can often occur in the wake of a disaster or traumatic experience. Symptoms may include anxiety, depression, suicide and PTSD may even lead to drug and alcohol-related disorders.

 

Victims of personal violence, rescue and medical workers, victims of disasters, terrorism, physical or psychological trauma, and/or a combat zone are all at risk of suffering some level of PTSD.

 

In Psychological First Aid: The WHO Guide For Field Workers we looked at the need for, and a guide for providing psychological first aid (PFA) in a post-disaster environment.

 

The CDC also provides a website which contains a number of resources devoted to coping with disasters.

 

Coping With a Disaster or Traumatic Event

Trauma and Disaster Mental Health Resources

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.

 

As does the National Center For PTSD - including videos - on how to provide Psychological First Aid.

A reminder that a disaster’s impact can linger long after the story has fallen off the front pages, and that indirect casualties can follow months after the initial event.

A Worrisome Mid-Week Forecast

Source NOAA HPC

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The very last thing that the residents of New England and the Mid-Atlantic states need right now is another storm to deal with, but early indications from NOAA’s HPC (Hydrometeorological Prediction Center) suggest a Nor'easter could be in store by the middle of next week.

 

The two forecast models above show the model runs for November 7th and November 8th. 

 

They show a low pressure area – potentially a winter storm – moving up the eastern seaboard during that time frame.

 

While six days out is a long way off, and the forecast could certainly change, any deterioration in the weather will make the recovery efforts in New York, New Jersey, and surrounding areas that much more difficult.

 

 

PRELIMINARY EXTENDED FORECAST DISCUSSION

NWS HYDROMETEOROLOGICAL PREDICTION CENTER COLLEGE PARK MD

947 AM EDT THU NOV 01 2012

VALID 12Z MON NOV 05 2012 - 12Z THU NOV 08 2012

...NOR'EASTER POSSIBLE FOR MID-ATLANTIC/NEW ENGLAND STATES BY ELECTION DAY INTO NEXT THURSDAY...

<SNIP>

GUIDANCE STILL HAVE SOME TIMING/STRENGTH ISSUES BUT COMMONLY AGREE THAT DEEPER LOW DEVELOPMENT WOULD OCCUR MON-THU AS A FRONTAL WAVE OFF THE SOUTHEAST MOVES SLOWLY OFFSHORE AND UP OFF THE EAST COAST.
THIS WOULD BRING BEST ORGANIZED RAINS FROM THE ERN MID-ATLANTIC TO COASTAL NEW ENGLAND.

 

A TRACK IN THIS VEIN OFFERS POTENTIAL FOR
HEAVIER SNOWS ACROSS INTERIOR NEW ENGLAND WEDNESDAY/THURSDAY AS THE LOW WRAPS INLAND.  INCREASING WINDS ALONG COASTAL NEW ENGLAND (AND POSSIBLY THE COASTAL MID-ATLANTIC STATES IF A MORE WESTERLY
TRACK VERIFIES) TUESDAY ONWARD MAY LEAD TO SOME COASTAL FLOODING AND BEACH EROSION.

 

IT SHOULD BE NOTED THAT THIS SYSTEM IS
EXPECTED TO BE MUCH WEAKER THAN HURRICANE SANDY AND PRODUCE IMPACTS MUCH LESS EXTREME AND MAINLY AWAY FROM THE REGION MOST
STRONGLY IMPACTED BY SANDY.

Obviously we’ll be watching these developments with keen interest, and the fervent hope that this storm fails to materialize.

The Ripple Effect

 

 

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In a bit of a follow up to yesterday’s blog OECD Report: Future Global Shocks and one from last week called Estimating The Economic Impact Of A San Andreas Quake we’ve a report out of New Zealand (h/t Sally Furniss, Managing Editor of FluTrackers) on the nationwide economic impact of the three recent Christchurch earthquakes.

 

The article, by Marta Steeman of BusinessDay.co.nz, describes how 2/3rds of all businesses in New Zealand have been economically impacted by these quakes – even those well beyond the damaged areas.

 

Quakes affect two-thirds of NZ businesses

MARTA STEEMAN

Last updated 11:22 28/06/2011

The September and February earthquakes have affected nearly two-thirds of New Zealand businesses, according to a 2011 Grant Thornton international survey.

 

The survey indicated 18 per cent of businesses had suffered long-term impacts, 26 per cent medium-term impacts and 20 per cent a short-term hit.

(Continue . . . )

 

 

Businesses in Christchurch, at the center of the quake damage, are the most severely affected with 18% of business establishments destroyed.  Half of businesses cited a fall in demand for their goods and services as being the most significant impact.

 

Another concern - as we saw in New Orleans after Hurricane Katrina – is that many skilled workers have left the Christchurch area since the quakes, further hindering the recovery.

 

But the repercussions have been felt across New Zealand.

 

While not in the category of a `future global shock’, the Christchurch quakes demonstrate how a local disaster can economically impact a much larger area.

 

Just as individuals and families need to be prepared for the immediate impact of a disaster, businesses need to have a robust and practical disaster plan that will keep them functioning during, or shortly after, a crisis.

 

While fortune 500 companies spend big bucks on disaster preparedness and recovery, Small businesses – those with fewer than 20 employees – make up nearly 90% of the companies (that have employees) in the United States.  

 

In 2004 they numbered over 5.2 million firms, which employed nearly 25 million people.In addition, there are nearly 22 million non-employer firms (as of 2007) – essentially self-employed individuals.

 

And these are the business enterprises that are the least likely to be prepared for a local, or global, disaster.

 

Ready.gov, the Small Business Administration,  and the American Red Cross are just a few of the agencies working to help small businesses prepare to survive the next disaster.

 

If you value your job, or your business, you owe it to yourself, and your employees to visit:

And

 

And to avail yourself of the free 123 point assessment survey at the American Red Cross’s Ready Rating Program.

 

 

And of course, National Preparedness Month isn’t just for agencies, families, and individuals.

 

It is for businesses as well.

 

 

Like death and taxes, disasters are inevitable. 

 

We may not always be able to prevent them, but we can be better prepared to deal with them when they happen.  

And that can make all the difference whether your business ultimately survives or fails.

Post-Katrina Heart Attack Rates

 

 

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A fresh look at heart attack rates after Hurricane Katrina devastated New Orleans shows - much to the surprise of researchers - that coronary events continue at a sharply elevated rate even four years after the flood waters receded.

 

In March of 2009, in a study led by Dr. Anand Irimpen - associate professor of clinical medicine at Tulane – it was disclosed that residents of New Orleans saw a 300% increase in heart attacks in the first 2 years after hurricane Katrina.

 

The study also found that these heart attack victims were more likely to receive angioplasty to reopen clogged coronary arteries, suggesting more severe coronary artery disease.

 

The Tulane University news NEW WAVE carried this report in 2009.

 

Post-Katrina Stress, Heart Problems Linked

March 30, 2009

(Excerpt)

There were 246 admissions for heart attacks, out of a total census of 11,282 patients, post-Katrina compared with 150 admissions out of a total 21,229 patients in the two years before the storm. In addition to a three-fold increase in heart attacks and a 120 percent increase in coronary interventions, the post-Katrina group had significantly higher prevalence of unemployment, lack of medical insurance, medication noncompliance, smoking, substance abuse, first-time hospitalization and people living in temporary housing. There were no significant differences in the racial, gender or age distribution of the two groups.

 

 

Today, an update to this study which shows that four years post-Katrina the effects continue, and that heart problems have extended well beyond the expected high risk cohorts.

 

 

Study: Katrina Took Toll on Hearts, Too

April 4, 2011

Keith Brannon
kbrannon@tulane.edu

The post-Katrina increase in heart attacks among New Orleans residents persisted even four years after the storm, according to a new study by researchers from Tulane University School of Medicine.

 

“To our surprise, the increase has occurred in the absence of any change in traditional risk factors — for example, age, high blood pressure, obesity and diabetes,” says lead researcher Dr. Anand Irimpen.

(Continue . . . )

 

 

While we think of disasters as being short-term events, and recovery something that might take weeks or months, this study shows some of the long-term effects of a major disaster.

 

Unemployment, financial woes, ruined businesses, destroyed homes, busted plans, the loss of friends and loved ones (through death or simply moving away), and uncertain futures all contribute to ongoing stress and can promote poor health habits.

 

Of course, there is no reason to believe that these effects are limited to the residents of New Orleans or the Gulf Coast survivors of Katrina. 

 

The quake & tsunami ravaged residents of Northern Japan are probably in store for similar effects, with the added stress of long-term, unknown, and invisible radiation exposure added to the mix.

 

Similarly, those who live in Haiti, New Zealand, Chile, or any place else recently struck by natural disasters continue to deal with enormous physical, emotional, financial, and sociological impacts.

 

The burden of a disaster isn’t over just because floodwaters recede, buildings are replaced or repaired, and relief workers have moved on to the next scene.

 

All of which suggests that a greater emphasis on social and psychological healing may be needed in the aftermath of a major disaster.

 

Disasters are always heartbreaking.

 

Now we have evidence to show that it is literally true.