On March 11, 2011, at 2:46 PM, a 9.0 magnitude earthquake (referred to as the 2011 Japanese Earthquake, the 2011 Tohoku Earthquake, or the Great East Japan Earthquake) occurred off the Pacific northeast coast of Japan, 250 miles north-east of Tokyo. A subsequent tsunami struck the coast minutes later, killing thousands of people and causing serious, widespread damage to the Fukushima nuclear power plant and to buildings, roads, and power lines, particularly along the east coast of the Tohoku region. As many as 4.4 million households in northeastern Japan were left without electricity and 1.5 million without water. In areas affected by the tsunami, it took one and a half months to restore electricity and four month to restore the water supply. The earthquake also triggered tsunami warnings and evacuations to countries across the Pacific Ocean.
The 2011 Japanese Earthquake was one of the most powerful earthquakes known to have hit Japan and was the fifth most powerful earthquake in the world since modern recordkeeping began in 1900. The tsunami that resulted from the earthquake brought extensive destruction along the Pacific coastline of Japan's northern islands, resulting in the death of thousands of people and the destruction of entire towns. In most areas, the tsunami reached the coastline 26 to 35 minutes after the earthquake occurred.
In addition to causing deaths and injuries and widespread property damage, this catastrophic earthquake and tsunami severely damaged the Fukushima Daiichi Nuclear Power Plant, resulting in the release of radioactive materials, thus adding to the public health concerns of the population. The tsunami overtopped sea walls and destroyed the diesel backup power systems that were needed to provide the cooling required to remove decay heat and to maintain spent fuel pools after shutdown. Salt water flooding of the reactors for cooling at Daiichi was delayed because it would ruin the costly reactors permanently. The reactors were flooded with seawater only after the government ordered that seawater be used, and at this point it was already too late to prevent meltdown of three of the reactors. Several explosions due to hydrogen gasair chemical reactions occurred, with subsequent venting of radioactive gasses. A state of emergency was declared, and approximately 140,000 residents within 20 (12.5 miles) were evacuated. A few of the plant's workers were severely injured or killed by the disaster conditions. There were no immediate deaths due to direct radiation exposures, but at least six workers exceeded lifetime legal limits for radiation and more than 300 received significant radiation doses.
The tsunami reached the entire Pacific Coast of North and South America, from Alaska to Chile. In Oregon and California. waves caused about $10 million in damages. A wave submerged the Midway Atoll National Wildlife Refuge, killing more than 100,000 nesting seabirds. Hawaii suffered millions of dollars in damages to private and public properties. In South America, there were many homes damaged along the coastline. In Antarctica, 13,000 kilometers away, the tsunami broke icebergs off the Sulzberger Ice Shelf.
The tsunami flooded an area of about 561 square kilometers (217 square miles). There were numerous areas affected by waves 1 to 3 meters (3.3 to 9.8) in height. Some areas experienced waves of 6.8 m (22 ft) or even higher. The highest wave was estimated to be 38.9 meters (127 feet) high, likely the record height for a Japanese tsunami wave. The three prefectures most affected by the tsunami were Fukushima, Miyagi, and Iwate, due to the geographical characteristics of deep bays and inlets and peninsulas.
A Japanese government study found that in the coastal areas of Iwate, Miyagi, and Fukushima prefectures, 58 percent of the people obeyed the tsunami warnings and fled to higher ground, and only 5 percent of those who fled were caught in the tsunami. However, of those who chose not to evacuate, 49 percent were caught in the waves. Of the total number of fatalities, more than 90 percent were from drowning. Relatively few people were killed by injuries suffered from the earthquake itself. Victims over 60 years old accounted for about 65 percent of the deaths, and 70 percent of the missing were over 60 years old.
The immediate effects after the earthquake occurred included environmental concerns, community health concerns, general public health concerns, and personal health concerns.
Environmental concerns for individuals consisted of hazards posed by their immediate surroundings. These hazards included gas leaks, floodwaters, downed power lines, wet electrical outlets, gasoline/oil spills, and hazardous debris.
Community health was impacted by the breakdown in communication services, including telephone, Internet, and fax. For two weeks after the disaster, only satellite mobile phones worked, and those not always reliably. With this communication breakdown, there were little to no means of arranging for emergency medical needs, and emergency response personnel and first responders were unable to expeditiously aid victims. As the transport network suffered severe disruption, individuals had to transport victims themselves to medical facilities. Aid from the inland to the coast took between two and three hours. There was an initial lack of gasoline, and health care workers who had trouble getting gasoline supplies were hindered in their efforts to provide medical support. Medical facilities were limited by inadequate medical supplies and drugs and inadequate numbers of medical personnel.
Lack of food and water within the affected and unaffected areas led to general public health concerns. There were also legitimate as well as mediadriven fears about radioactive contamination of food, water, dairy products, and fresh vegetables. The Japanese government developed policies and protocols concerning the handling, treating, and disposing of food in the areas affected by radioactivity. Since Japan had been the site of two nuclear bombs during World War II, citizens were especially apprehensive and frightened about radioactive contamination.
Personal health concerns were widespread. The floodwaters were contaminated with pathogens, and individuals were advised not to drink the floodwaters due to the risk of illness. Many deceased individuals had not been found and buried properly, which also added to the potential for water contamination from decomposing bodies.
Individuals working in radioactive contamination had to be especially careful, as the contamination can be ingested or inhaled. Protective gear was required to be worn in contaminated zones, and citizens were cautioned to stay within designated safe zones by local law enforcement personnel or public health officials.
The first victims of the earthquake and tsunami were primarily those who were drowned. Other victims that were treated in the days following the earthquake were those with aspiration-related illnesses, trauma, and crush wounds. There was also a threat of disease spread by contaminated water. As the victims left evacuation centers, respiratory diseases decreased as the opportunities for airborne droplet transmission decreased.
The medical teams over the course of the disaster had to treat trauma; wounds; hypothermia, especially in the elderly; tsunami-associated pneumonia; and other respiratory ailments. During the recovery phase, the medical teams had to address a gradual increase in noncommunicable diseases due to risk factors such as lack of exercise, poor diet, and high stress levels. It is expected that long term psychosocial treatment will be required for mental health illnesses.
The earthquake, tsunami, and nuclear power plant accident resulted in a massive humanitarian crisis, to which the nation of Japan and the world responded. Japan had a Basic Disaster Management Plan that included plans for four natural disasters and eight accidental disasters, but a disaster plan combining more than one disaster at a time had not been developed.
The tsunami resulted in over 340,000 displaced people and shortages of food, water, shelter, medicine, and fuel. The Japanese government mobilized the Japanese Self-Defense Forces to aid in the recovery, and the Japanese Red Cross sent thousands of relief teams to the affected areas. First responses included search and rescue missions, assessment of damages, evacuation of residents, and distribution of first aid to victims.
Evacuation shelters faced a lack of food, water, blankets, heat, and hand washing and bathroom facilities. Although the Japanese government arranged quickly for these supplies to be brought in from unaffected parts of the country and from other countries, the victims struggled to cope with freezing weather, a lack of medicines, and unsanitary conditions. Victims also suffered from insomnia and constipation. Fortunately citizens cooperated with infection prevention measures, and in most cases, no widespread infectious disease outbreaks occurred.
The public health workforce was severely affected by the disaster, as many of the workers themselves were victims, and those who could work faced extremely difficult conditions. In some areas, these health care workers as well as relief workers were provided with on-going psychological care.
Another public health challenge was to provide emergency medical assistance to patients in damaged hospitals undergoing treatment for chronic diseases, such as those requiring dialysis treatment. Some damaged hospitals transported their patients to hospitals in unaffected areas, while others were given aid through teams of medical professionals sent to provide medical and public health assistance to evacuees and victims. The hospitals that continued operations faced continued challenges due to blackouts, water outages, and fuel shortages. The Japanese Ministry of Health, Labour, and Welfare ensured that victims could receive medical care without health insurance cards and waived co-pays.
Medical staff tried to salvage medical products from damaged hospitals. However, patients lost their prescriptions, and records of prescriptions may have been destroyed, hindering replacement of needed medicines. As a result of this information loss, a recommendation has been made that backup systems exist for storage of medical charts and prescription histories.
The private sector provided a significant amount of aid. Google created software that was used to compile information about conditions in the emergency shelters and the number of people assessed. Other companies providing significant support with regards to medical equipment and supplies included AEON, Nohon Kohden, Medical Expert, Seimens, Shigadry with Earth and M-Cube and Associates. Aid to the Japanese people also came from all over the world, with the Japanese Red Cross reporting $1 billion in donations.
The response to the damage to the Fukushima Daiichi Nuclear Power Plant involved evacuation of citizens living within 20 kilometers (12 miles) of the plant and a “stay indoors” instruction for those living between 20 kilometers (12 miles) and 30 kilometers (19 miles). About 1,700 people were evacuated from hospitals and nursing homes. Food and water safety was secured by establishing a monitoring system for food; setting provisional regulatory values for food; adopting indices for limits on food and drink ingestion, as set by the Nuclear Safety Commission of Japan; and regularly inspecting radioactivity levels in tap water to restrict the intake of radioactive-contaminated water. Some local governments provided bottled water for babies and asked citizens not to use tap water for babies.
Several days after the radioactive release, the government distributed potassium iodine tablets to residents who may have been exposed to radiation from the nuclear power plants damaged by the earthquake. Potassium iodide helps protect against thyroid cancer, which is a major risk following radiation exposure, by reducing the amount of radioactive iodine absorbed by the thyroid gland.
The long-term cost of rebuilding has been estimated at amounts ranging from $122 billion to as high as $300 billion. The manufacturing industries, farmland affected by salinity from the ocean water, fishing boats, transportation, and electrical production were all severely impacted by the earthquake and tsunami and require long-term rebuilding efforts. However, the number of construction and cleanup jobs greatly increased as reconstruction activities proceeded.
The Japanese authorities are monitoring the long-term health risks of persons living near the areas affected by the nuclear power releases. One study is monitoring 360,000 children in the Fukushima Prefecture over 20 years to look for health effects, especially for thyroid cancers. Other long-term health effects might result from exposure to hazardous materials from shredded buildings, industrial parks, and petroleum sites.
Even though the Japanese government acted quickly to help the victims, long-term mental health effects are likely, as people have lost their friends and families, their homes, and their livelihoods. Dislocation, uncertainty, and concern about toxic substances and radiation can lead to physical illnesses such as heart failure, acute coronary syndrome, stroke, cardiopulmonary arrest, and pneumonia. Unhealthy behavioral changes may also be seen, such as poor dietary choices and lack of exercise and sleep. Many survivors were elderly and lost their spouses or other family members. The Japanese government provided housing for these elderly people, but as it has been said, “the government can't buy you a new family.” Because of the stoicism that the Japanese people prize, they may not seek the physical or mental health care that they need.
It will also be necessary to provide support to bereaved children and orphans as well as health care workers, local government officials, fire and police service personnel, and teachers who participated in recovery activities but who were also victims themselves.
The publication of an independent government-backed audit in October 2012 described how the recovery was proceeding. The audit found that a quarter of Japan's tsunami relief fund has been spent on projects unrelated to the disaster. More than 20,000 people are still displaced or living in temporary housing. Victims were allocated around $40,000 per household to rebuild their homes, which in most cases is not sufficient, especially if the victims also lost their jobs. Cities on the coastline remain disaster areas, with administrators and former inhabitants unsure they will ever be rebuilt. Two hundred and forty ports, which are often economic hubs for smaller Japanese towns, remain closed. Across the disaster zone, 60 percent of applications from businesses seeking help to reopen have been rejected by authorities due to insufficient funds and red tape. Businesses have to reopen first before they are given financial aid and have to be judged as essential by a local administrative panel. In addition, half of the relief fund has not been distributed at all, due to a lack of suitable applicants and procedural delays. Overall, the recovery is being hindered by bureaucratic slowness in making decisions as well as local authorities having little experience in managing large-scale construction projects.
There is no way to prevent an earthquake and tsunami. However, well-developed disaster plans can aid with immediate and long-term public health response to disasters.
See also Earthquakes ; Radiation ; Radiation exposure .
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Judith L Sims