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YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT (JAPAN EARTHQUAKE AND TSUNAMI) YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT.

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Presentation on theme: "YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT (JAPAN EARTHQUAKE AND TSUNAMI) YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT."— Presentation transcript:

1 YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT (JAPAN EARTHQUAKE AND TSUNAMI) YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT (JAPAN EARTHQUAKE AND TSUNAMI) BACKGROUND GOVERNMENT OF JAPAN INTERNATIONAL ORGANIZATIONS RELIEFWEB UNICEF International Nuclear Safety Center International Atomic Energy Agency Global Disaster Alert and Coordination System WHO US GOVERNMENT ORGANIZATIONS The Department of State U.S Embassy in Japan State Dept.'s DipNote on Twitter State Dept. Background Note U.S. Agency for International Development OFDA Library of Congress Country Study - Japan CIA World Fact Book The Department of Defense Pacific Command 7 th Fleet Yokota Air Base, Japan The Department of Homeland Security The Department of Health and Human Services Centers for Disease Control and Prevention CDC- Tsunami CDC-Earthquake CDC-Radiation Emergencies EPA FEMA Blog US Geological Survey NOAA Center for Tsunami Research NOAA Pacific Tsunami Warning Center PORTALS AND RESOURCES All Partners Access Network (APAN) Japan Disaster Wiki CATDAT and Earthquake Reports GDACS Center of Excellence – Disaster Management Humanitarian Assistance Earthquake Research Institute, University of Tokyo National Center for Disaster Medicine and Public Health Google Crisis Resources LIBRARY National Medical Library – Japan Earthquake Disaster Information Management Research Center Radiation Emergency Medical Management AS OF 1700 HRS EDT 5 APRIL 2011 UN RESPONSE UN RESPONSE UN RESPONSE UN RESPONSE GOVERNMENT OF JAPAN GOVERNMENT OF JAPAN GOVERNMENT OF JAPAN GOVERNMENT OF JAPAN KEY LINKS HEALTH CONCERNS HEALTH CONCERNS HEALTH CONCERNS HEALTH CONCERNS US RESPONSE US RESPONSE US RESPONSE US RESPONSE OTHER ORGANIZATIONS OTHER ORGANIZATIONS OTHER ORGANIZATIONS OTHER ORGANIZATIONS LOGISTICS & TRANSPORTATION LOGISTICS & TRANSPORTATION LOGISTICS & TRANSPORTATION LOGISTICS & TRANSPORTATION SHELTER JAPANESE RED CROSS JAPANESE RED CROSS JAPANESE RED CROSS JAPANESE RED CROSS CURRENT SITUATION CURRENT SITUATION CURRENT SITUATION CURRENT SITUATION PSYCHOLOGICAL IMPACT PSYCHOLOGICAL IMPACT PSYCHOLOGICAL IMPACT PSYCHOLOGICAL IMPACT A 9.0 magnitude earthquake hit Japan, unleashing a tsunami. ELDERLY ISSUES ELDERLY ISSUES ELDERLY ISSUES ELDERLY ISSUES HOSPITALS AND MED TEAMS HOSPITALS AND MED TEAMS HOSPITALS AND MED TEAMS HOSPITALS AND MED TEAMS

2 JAPAN EARTHQUAKE AND TSUNAMI BACKGROUND EARTHQUAKE AND TSUNAMI On 11 Mar :46 UTC, a 9.0 magnitude earthquake struck 400km north-east of Tokyo off the coast of Japan, triggering a tsunami that flattened parts of the northeast coastline. The earthquake’s hypocenter was 24.4 kilometers deep (shallow; most dangerous).The 9.0 magnitude makes it the fourth largest in the world since 1900 and the largest in Japan since modern instrumental recordings began 130 years ago. Researchers at the Yokohama National University and University of Tokyo say that the tsunami reached as high as 29.6 m in Ofunato City, Iwate. There were 7 tsunami waves over a 6 hour period after the earthquake. The first and the largest tsunami was recorded 26 minutes after the earthquake. Japan’s Geospatial Information Authority estimates that at least 443 square kilometers (equivalent of 53,000 football fields or five times the size of Manhattan Island) of coastline was inundated by seawater. In Fukushima and Miyagi, about 110 km of coastline was submerged and the water reached 5 km inland. Seawater has not receded in about 70% of the flooded areas. In Minami-soma, Fukushima, seawater covering about 350 hectares is being pumped. The Japan Meteorological Agency (JMA) warns of potential, further aftershocks and tsunami. On Mar 31, Iwate prefecture was hit by a 6.0-magnitude aftershock. The JMA says the frequency of aftershocks is decreasing but that aftershocks over magnitude 7 are still likely. DEATH AND DESTRUCTION Worst-affected areas are the prefectures (states) of Miyagi, Fukushima, Iwate, Yamagata, Ibaraki, Chiba, Akita and Aomori. The tsunami caused severe damage along 600 km of northeast coastal regions. The population in these areas before the disaster was estimated at over 14.8 million people, of which 1.6 million lived within 5 km of the coast. Areas near the coastal city of Sendai in Miyagi prefecture were the hardest hit, and had a population of some 1 million people. COE Update: 30 March 2011WHO-WPRO SitRep No. 23: 1 April 2011 US Geological SurveyOCHA SitRep No. 16: 1 April 2011 NOAA Center for Tsunami Research KEY FACTS 4th strongest earthquake worldwide since 1900 Tsunami up to 30 meters high inundated 433,000 square kilometers of land 492,000 people were evacuated Fatalities : 12,344 - Missing : 15, International Search & Rescue teams from 15 countries responded 17,000 homes and buildings destroyed, 138,000 damaged More than 119,000 emergency service personnel responded within 8 days Estimated damages of $US 309 billion More than $951 million has been donated bilaterally 291 schools unable to start new year in April KEY FACTS 4th strongest earthquake worldwide since 1900 Tsunami up to 30 meters high inundated 433,000 square kilometers of land 492,000 people were evacuated Fatalities : 12,344 - Missing : 15, International Search & Rescue teams from 15 countries responded 17,000 homes and buildings destroyed, 138,000 damaged More than 119,000 emergency service personnel responded within 8 days Estimated damages of $US 309 billion More than $951 million has been donated bilaterally 291 schools unable to start new year in April Alex Hofford)

3 SITUATION BY PREFECTURE 3,438 deaths and 4,560 missing 41,975 evacuees at 373 shelters 42,400 households out of water 31,216 households out of electricity 7,775 households out of gas. Iwate Pref. decided to build 8,800 temporary shelters starting on 19 Mar. Hanamaki Airport operates 24H since 17 Mar, Kamaishi port reopened on 16 Mar, Ofunato and Kuji open. Tohoku Express Way open to all vehicles. 1,064 deaths and 4,741 missing 22,796 evacuees 36,944 households out of electricity 37,000 households out of water. 8,288 households out of gas Evacuation advice within 30km is slowing the relief operation Number of evacuees is growing with the evacuation advice 7,058 deaths and 7,159 missing 70,020 evacuees currently in 550 shelters 118,000 households out of water Sendai city disclosed its rehabilitation plan 1,207 temporary shelters under construction, another 1,195 to start on 5 Apr Minamisanriku without any services, but electricity will be available in early April Sendai airport in recovery process SEEDs Asia SitRep No 11: 1 April 2011

4 SITUATION COE Update: 1 April 2011 USAID Fact Sheet #14: 31 March 2011 EMERGENCY RESPONSE JMA reports the weather has improved slightly in the Tohoku region, but lows remain near freezing. The GoJ says the need for further international assistance is limited and any support should be in accordance with the GoJ’s criteria. The GoJ welcomes financial donations and asks Member States to donate through the Japanese Red Cross (JRC). Countries, aid organizations, private individuals and private sector companies have contributed and pledged US$951 million to the GoJ, Red Cross Societies, international NGOs and other partners. Priority needs are: fuel, prefabricated housing, clothing and medicine. As rainfall increases in April and rainy season (starts in mid June) approaches in the Tohoku region, the coastal areas of Iwate, Miyagi, Fukushima and Ibaraki are preparing their early warning systems for flooding. The earthquake caused the land to sink, and tsunamis damaged coastal embankments. The vast majority of key infrastructure such as highways, ports and airports has been restored and there have been improvements in electricity, gas and water supply, but in the worst affected areas it could take some time before these vital services are up and running. Most of sewage systems in the affected area are still not functioning. BUILDINGS - Latest assessments report that 16,950 homes and buildings were destroyed and another 138,000 were damaged. ROADS AND TRANSPORTAION NETWORKS - At least 2,126 roads, 56 bridges and 26 railways have been destroyed. While key transport routes are open it is still impossible to travel on many of the smaller roads and there are reports that some areas remain cut-off from all assistance by road. SHELTERS There are currently 170,500 displaced people living in 2,230 evacuation centers in 17 prefectures. The number of people in evacuation centers is decreasing slightly whereas the number of evacuation centers has increased by 200 in the last two days. That is because 174 have opened in Aomori Prefecture in the north. WFP says it is ready to provide prefabricated housing to NGOs. SHELTERS (continued) Improving the living conditions at the shelters in the worst affected areas is the biggest priority; otherwise cases of cold and hygiene-related illnesses will increase It is estimated that around 74,000 children remain displaced. POPULATION NEEDS OUSIDE THE SHELTER It is still unknown how many people are living outside evacuation centers but the number is large. Many people who were originally living in evacuation centers have returned to their homes despite damage and no utilities. They do not receive basic supplies from the municipal authorities but are becoming the focus of attention by local NGOs and volunteers. RECOVERY OF REMAINS On 1 April the Japan Self Defense Force and the US military launched a three- day joint operation to recover the bodies of people still unaccounted for in the coastal areas of Miyagi, Iwate and Fukushima. More than 11,734 people have died and 16,375 remain missing. 2,766 were also reported injured. The operation does not include the 20 km exclusion zone around the Fukushima Nuclear Power Plant where it is believed there could be a large number of bodies. Many of the missing are feared to have drifted offshore. A total of 18,000 Self Defense Force personnel and 7,000 US military personnel will participate in this search on land, sea and from the air using 120 aircraft and 65 naval vessels. Diving units from the Japan Coast Guard will also be deployed to search in rivers and flooded areas. Recovering the bodies of the missing is seen as an important step in helping the country to move on. OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011

5 FOOD - The Emergency Disaster Response Headquarters reports that an estimated 14 million meals have been delivered to evacuation centers and hospitals in the affected areas as of 1 April. Approximately 1.5 million meals were delivered on 30 and 31 March. In addition, approximately 3 million meals are in transit. The figure does not include distribution of food items by municipalities, NGOs, private sector, and Japan’s Self Defense Force. WATER – As of 1 April, 87.9 per cent of water has been restored to buildings and only 260,000 households in eight prefectures are still without running water. More than 400 water supply companies will shortly deliver water to those without access to tap water. ELECTRICITY - As of 1 April, 96.3% of electricity has been restored in Tohoku, leaving approximately 170,415 households without power. The Thai government is sending a power-generating facility with two gas turbine generators to Japan to help restore electricity supplies. The facility is capable of producing 240,000 kw of electricity, enough for between 80, ,000 households. The equipment will be set up at a TEPCO site and should be operational by August. DEBRIS - In Miyagi prefecture, there is approximately million tons of debris, which is roughly equivalent to 23 years worth of waste for the prefecture. The prefecture only has the capacity to dispose of 0.8 million tons per year and officials say it will take three years to remove all the debris, not including cars and boats. COMMUNICATIONS - As of 30 March: Some telephone lines remain out of service. (Some companies provide free "pay phone" and specially laid out "payphone" in 16 prefectures). A reported base stations of mobile companies are not working. Some mobile companies provide free satellite phone, cell phone and charger as well as disaster messaging services. EDUCATION – The academic year starts in April, but ~1,700 public schools (70%) have been damaged in the three most affected prefectures. Many schools and universities are still being used as evacuation centers. In the three worst affected areas, approximately 1,700 (70 per cent) of public schools have been damaged, and among them, 291 primary and junior high schools have so far no prospect of resuming their classes. SITUATION GAS AND FUEL Gas supplies have been restored to roughly 32 per cent of households and 340,000 households remain without. Because 4 out of 7 supply bases of liquefied petroleum (LP) gas are not operational, the Ministry of Economy, Trade and Industry will release 40,000 tons from the national reserve for the first time, beginning 4 April. The fuel shortage remains a serious issue in the affected areas, exacerbated by a limited number of operational fuel stations and increasing needs. The GoJ plans to spend US$210 million (1.7 billion JPY) to procure tankers and install makeshift fuel stations. RADIATION CONTAMINATION Japan’s Chief Cabinet Secretary Yukio Edano said Friday that the evacuation of residents within 20 km (12 miles) of the Fukushima Daiichi nuclear plant (FDNPP) would be “long-term” as the crisis continues with no definite end in sight. Around 78,000 people live in the mostly rural area. TEPCO conducted an analysis of soil, as part of monitoring activity of the surrounding environment, at five sampling points in the premises of the FDNPP. The soil samples on 21 and 22 March were analyzed and plutonium 238, 239 and 240 were detected. However, the concentration of plutonium does not threaten human health. The Japanese Ministry of Health, Labor and Welfare.(MHLW) reported: -98 of 111 samples of various vegetables, spinach and other leafy vegetables, fruit (strawberry), seafood, various meats (beef, chicken and pork) and unprocessed raw milk in eight prefectures (Chiba, Fukushima, Gunma, Ibaraki, Kanagawa, Niigata, Tochigi, and Tokyo), showed I-131, Cs134 and Cs-137 not detected or below regulation values set by the Japanese authorities. -in Chiba, Fukushima, Ibaraki and Tochigi prefectures, the remaining 13 of 111 samples of spinach and other leafy vegetables, parsley and beef exceeded I-131 and/or Cs-134 and Cs-137 regulation values. OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 COE Update: 1 April 2011 USAID Fact Sheet #14: 31 March 2011

6 HEALTH Emergency medical needs have decreased, as a number of medical teams are now active in the devastated sites. Focus is now turning towards care for the elderly, where hypothermia due to cold temperatures continues to be an issue. Tohoku University reports that pneumonia is increasing mong the elderly living in evacuation centers in Miyagi. During 20 to 26 March, the University received 40 referrals from two local hospitals;10 times above the average. Long term psychosocial support will be needed for survivors including emergency workers. Preliminary key mental health areas identified are pediatric mental health and survivor’s guilt. Continued assessment is necessary. As of 26 March, 52 deaths in shelters have been reported, particularly among the elderly. DRINKING WATER Media reports indicate radiation has been confirmed in ground water below Unit 1 in FDNPP Radioactive elements detected in the tap water in Iitate Village, Fukushima Prefecture have steadily decreased to a level acceptable for drinking. GoJ’s advice for not consuming tap water was lifted on 1 April for most areas. As of 2 April, most of the previously imposed drinking water restrictions have been lifted. In one village in Fukushima prefecture, restrictions are still in place as a precautionary measure by the local authority. FOOD SAFETY On 31 March, radioactivity in 25 of 76 food samples exceeded the provisional regulation values. Of the total 699 food samples that have been tested to date, 124 food samples from Chiba, Fukushima, Gunma, Ibaraki, Tochigi, Tokyo exceeded the provisional regulation values. Because of winter conditions, most cattle, pigs, and chickens are being kept indoors. Animals are primarily fed on stored dried grass, silage and grain that has not been contaminated by the releases from the Fukushima Daiichi NPP. According to WHO, media report cesium has been found for the first time in meat from Fukushima Prefecture. NOTE: Assessment estimates are for the impacted areas. The overall infrastructure outside of the affected areas remains strong. EVACUATION MED SUPPLY MORTUARY AFFAIRS HOSPITALS COMMUNICATIONS VETERINARY CURRENT ASSESSMENT JAPAN Not a Major Concern Currently Working But Inadequate Generally Ineffective Non-Functional Or Destroyed SITUATION Unknown RADIATION B SEWAGE WATER FOOD COMMUNICABLE DISEASES SURVEILLANCE WASTE\DEBRIS SANITATION R ELECTRICITY PRIMARY CARE MENTAL HEALTH PUBLIC HEALTH MEDICAL OPERATIONS AND PUBLIC HEALTH A A R R B B G G OVERALL PH/MEDICAL ASSESSMENT JAPAN A A R R R R A A A A R R SHELTER OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 IAEA Briefing on Fukushima Nuclear Accident 31 March 2011 AMDA Emergency Bulletin #12: Japan Earthquake and Tsunami 2 April 2011 A A R R R R A A A A FUEL/GAS A A A A A A A A A A A A A A A A

7 GOVERNMENT OF JAPAN RESPONSE WASH - As of 1 April, access to water had not been restored to approximately 260,000 households. A combined estimate of 98 sewage systems in Miyagi, Iwate and Fukushima have been damaged, and the GoJ’s Ministry of Land, Infrastructure, Transport &Tourism has deployed 210 professionals to repair the sewer systems. The Emergency Disaster Response Headquarters reports that approximately 5.5 million bottles of water have been delivered to evacuation centers in the affected areas so far, with another 1 million in transit. FOOD - The Emergency Disaster Response Headquarters reports that an estimated 14 million meals have been delivered to evacuation centers and hospitals in the affected areas to date. Approximately 1.5 million meals were delivered on 30 and 31 March and 3 million means are in transit. The figure does not include distribution of food items by municipalities, NGOs, private sector, and Japan’s Self Defense Force. AGRICULTURE - The Ministry of Agriculture, Forestry and Fisheries says 24,000 hectares out of 900,900 hectares of agricultural land in Iwate, Miyagi, Fukushima, Ibaraki, Chiba and Aomori have been damaged by the tsunami. An estimated 18,500 fishing vessels were reportedly damaged or lost. In the most affected prefectures of Iwate, Miyagi and Fukushima, 87.9% of vessels were significantly damaged. Agriculture & fisheries are among the biggest industries in Japan and aid to these sectors will be critical in reconstruction of livelihoods. EDUCATION – The GoJ seeks to vacate schools current serving as evacuation centers prior to the beginning of the school year in April. The Prefecture of Iwate and the Ministry of Education are considering establishing boarding schools for children orphaned by the disaster. FATALITY MANAGEMENT– A Japanese-US military operation is underway to recover the bodies of those still missing. 18,000 of Japan’s Self Defense Force personnel and diving units from the Japan Coast Guard will be deployed The MHLW is supporting local government in the management of the dead. COORDINATION The GoJ’s Emergency Management agencies are leading the response through the Emergency Response Team, headed by Prime Minister Naoto Kan. The Chief Cabinet Secretary’s office is coordinating volunteers and NGO’s through its Volunteer Coordination Unit. The Tokyo Metropolitan Government announced that it will deploy about 1,000 officials to Miyagi and Iwate to reinforce prefectural government offices involved in emergency response. The Metropolitan Government is planning to station at least 100 officers per day in the affected prefectures from 2 April until at least mid May to provide non-emergency services and manage evacuation centers. OCHA support to the GoJ Emergency Response Team ended 1 April. As rainfall begins to increase in April in the lead up to the rainy season, the coastal areas of Iwate, Miyagi, Fukushima and Ibaraki are preparing to tighten their early warning systems. LIVELIHOODS - Over 22,700 people (18,201 in Miyagi, 3,282 in Iwate and 1,243 in Fukushima) have gone to local employment offices for jobs and benefits. Prefectural governments say the roughly 800,000 displaced workers should be given priority for construction and debris removal work. SHELTER The number of shelters increased by 200 from 30 May – 1 April in efforts to improve living/sanitary conditions for evacuees. However, consolidation and movement from centers to temporary shelters will soon intensify, as the GoJ seeks to reduce the number of evacuation centers to increase sustainability and efficiency of assistance delivery. The GoJ is also beginning to accommodate evacuees in public housing. Starting in May, GoJ will provide $1 million JPY ($10,000) to each family who lost their homes. HEALTH & MEDICAL CARE The MHLW has coordinated the deployment of doctors, pharmacists, social workers, dentists, care managers, child welfare and psychological specialists from various medical institutions. 142 teams, consisting of 640 members, are responding in Iwate, Miyagi and Fukushima. WHO-WPRO SitRep No. 23: 1 April 2011OCHA SitRep No. 16: 1 April 2011 USAID Fact Sheet #14: 31 March 2011USAID Fact Sheet #14: 31 March 2011 COE Update: 30 March 2011COE Update: 30 March 2011 NOTE: People who are able to live in their homes still require assistance as they have no access to food, water and basic supplies. These people are no longer receiving supplies from local authorities but are becoming the focus of local NGO’s and volunteers.

8 JAPANESE RED CROSS SOCIETY OCHA SitRep No. 16: 1 April 2011 COE Update: 1 April 2011 JRCS Emergency Relief 3: 23 March 2011 IFRC Info Bulletin 5: 28 March 2011 The Japanese Red Cross Society (JRCS) continues to conduct relief operations in its mandated role as auxiliary to the GoJ during disasters. They are providing medical relief, psychosocial support (PSP), ongoing provision of full blood services, distributing relief supplies, and are collecting voluntary donations.The Japanese Red Cross Society (JRCS) continues to conduct relief operations in its mandated role as auxiliary to the GoJ during disasters. They are providing medical relief, psychosocial support (PSP), ongoing provision of full blood services, distributing relief supplies, and are collecting voluntary donations. JRCS is concerned about the psychological well-being of the affected populations, especially of children. They assigned trained psychosocial support providers (PSP) to almost all deployed medical teams. The national society has 2,369 nurses trained to provide PSP services. In addition, some PSP teams were deployed to conduct assessments in the affected areas and support medical teams in conducting health checks. There are shortages of medicine for the treatment of chronic medical conditions.JRCS is concerned about the psychological well-being of the affected populations, especially of children. They assigned trained psychosocial support providers (PSP) to almost all deployed medical teams. The national society has 2,369 nurses trained to provide PSP services. In addition, some PSP teams were deployed to conduct assessments in the affected areas and support medical teams in conducting health checks. There are shortages of medicine for the treatment of chronic medical conditions. The Japanese Red Cross Society has received a record $725 million from more than 1.1 million local donations.The Japanese Red Cross Society has received a record $725 million from more than 1.1 million local donations. JRCS in-country capacity: 47 branches, each equipped with special equipment to with nuclear, biological, or chemical disasters, 92 Red Cross hospitals, 66 Blood centers; 26 nursing colleges, 60,000 permanent staff (50,000 working for Red Cross hospitals), 495 deployable medical teams; 2 million registered volunteers.JRCS in-country capacity: 47 branches, each equipped with special equipment to with nuclear, biological, or chemical disasters, 92 Red Cross hospitals, 66 Blood centers; 26 nursing colleges, 60,000 permanent staff (50,000 working for Red Cross hospitals), 495 deployable medical teams; 2 million registered volunteers. 346 domestic Emergency Response Units and medical teams of the Japanese Red Cross Society (JRCS) have completed their mission as of 01 April, 27 remain in the three most affected prefectures and 117 are on standby.346 domestic Emergency Response Units and medical teams of the Japanese Red Cross Society (JRCS) have completed their mission as of 01 April, 27 remain in the three most affected prefectures and 117 are on standby. A Family Links web site is operating in cooperation with ICRC (in Japanese, English, Chinese, Korean, Portuguese, and Spanish). As of 28 March, 5,619 people have been registered: Family Links web site is operating in cooperation with ICRC (in Japanese, English, Chinese, Korean, Portuguese, and Spanish). As of 28 March, 5,619 people have been registered: JRCS has also handed out more than 125,500 blankets, 26,100 emergency kits (including radios, flashlights and other supplies), 11,000 sleeping kits (including pillows, camping mats, ear plugs, etc.) and clothing to families in evacuation centers.JRCS has also handed out more than 125,500 blankets, 26,100 emergency kits (including radios, flashlights and other supplies), 11,000 sleeping kits (including pillows, camping mats, ear plugs, etc.) and clothing to families in evacuation centers. NOTE: Evacuees have been enduring bitterly cold weather with several sleet and snow storms. These conditions have also hampered emergency relief efforts. Priority needs are fuel, prefabricated houses, sanitation materials, clothing, medicines and household appliances. JRCS mobile medical team working in the high school evacuation centre in Ostuchi. (p-JPN0139) (IFRC) In order to reinforce and mobilize the network of volunteers, volunteer centers have been established at the headquarters of JRCS, and 4 branches in the affected prefectures. JRCS teams are also supporting local health facilities, and have mobile clinics serving remote and hard-to-reach areas. Media reports that the Ishinomaki Red Cross Hospital found that sanitation and hygiene environment is deteriorating in 30 per cent of the 314 evacuation centers that they have assessed in Ishinomaki, Higashi-Matsushima and Onagawa in Miyagi excrement disposal is a particular challenge. In response to damages caused to the Fukushima nuclear power plant, the JRC remains prepared to support those evacuated from the exclusion zone. All of the JRC branches (47) are equipped with special equipment to cope with nuclear, biological or chemical disasters.

9 UNITED STATES RESPONSE The USAID team is working to manage the overall USG response effort in Japan in coordination with the U.S. Embassy in Tokyo. The Disaster Assistance Response Team (DART) continues to engage at three levels to determine any possible humanitarian needs in Japan: nationally through Japan’s Ministry of Foreign Affairs, locally at the prefecture level and in coordination with U.S. Forces-Japan, and through Japanese civil society organizations. U.S. experts from the NRC, Department of Energy, Department of Health and Human Services and the U.S. military are in place in Japan, cooperating directly with Japanese authorities to help contain the damage at the Fukushima Daiichi reactors. They are monitoring technical aspects and engaging with Japanese officials on efforts to cool the reactors at Fukushima, as well as regarding the health impacts of radiation. U.S. Government officials are consulting with health experts and radiation experts, in both the United States and Japan, and are continuously monitoring tap water samples for radioactive iodine. In accordance with guidelines that apply to water in the US, and based on analysis of tap water samples for radioactive iodine on 24 March, the water in Tokyo is safe for drinking. 27 March, DART staff participated in an assessment of Miyagi Prefecture, with staff from OCHA, the U.N. World Food Program, and the GoJ. DART staff noted concerns regarding adequate access to sanitation facilities in evacuation centers; local officials reported plans to improve sanitation conditions, such as setting up portable toilets. USG Funding Announced and Committed as of 31 March 2011:: -USAID/OFDA Assistance =$6,825,286 -Department of Defense (DoD) Humanitarian Assistance = $63,051,000 -Total USAID and DoD Assistance for the Earthquake and Tsunami = $69,876,286. MESSAGES FROM US EMBASSY – JAPAN 31 March, In response to the situation at the Fukushima Daiichi Nuclear Power Plant, the United States Nuclear Regulatory Commission (NRC), the Department of Energy, and other technical experts in the U.S. Government have reviewed the scientific and technical information they have collected from assets in country, as well as what the Government of Japan has disseminated. Consistent with the NRC guidelines that would apply to such a situation in the United States, we continue recommending, as a precaution, that U.S. citizens within 50 miles (80 kilometers) of the Fukushima Daiichi Nuclear Power Plant evacuate the area or take shelter indoors, if safe evacuation is not practical. March 29 Update from Ambassador Roos (Video Update)March 29 Update from Ambassador Roos (Updated 31 March, 6 p.m. JST) The U.S. Embassy is continuing to make potassium iodide (KI) available to U.S. citizens who have not been able to obtain it from their physicians, employers, or other sources. It is not recommend that anyone take KI at this time, as there can be side effects from the drug. It should only be taken on the advice of emergency management or public health officials, or your doctor. For more information about KI, see this fact sheet from the Centers for Disease Control, or contact your doctor.Centers for Disease Control COE Update: 30 March 2011COE Update: 30 March 2011 USAID Fact Sheet #14: 31 March 2011USAID Fact Sheet #14: 31 March 2011 U.S. Embassy Tokyo News Update: 29 March 2011U.S. Embassy Tokyo News Update: 29 March 2011 U.S. Embassy Tokyo News Update: 31 March 2011U.S. Embassy Tokyo News Update: 31 March 2011 U.S. Embassy Tokyo News Update: 28 March 2011U.S. Embassy Tokyo News Update: 28 March 2011 U.S. Embassy Tokyo News Update: 31 March 2011U.S. Embassy Tokyo News Update: 31 March 2011

10 UNITED STATES RESPONSE (DOD-) UNITED STATES RESPONSE (DOD-OPERATION TOMODACHI) Dubbed Operation Tomodachi -- Japanese for "friendship" -- U.S. military assets mobilizing in the area include a wide range of equipment, air, sea, and ground capability and expertise. Up to 2 April, the DOD has contributed the following items: 185 tons food, 2,041,689 gallons water and 11,960 gallons fuel. U.S. Air Force PACAF has generated 389 sorties moving 1,311 passengers and more than short tons (6,135,800 lbs) of cargo in support of Japan Relief Efforts. Number of AF Personnel deployed in support of relief operations: 737 Number of PACAF aircraft deployed in support of relief operations: 4 Note: Distribution numbers have been adjusted to reflect only Operation Tomodachi airlift missions. U.S. Marines As of April 3, there are approximately 641Marines from III MEF/MCBJ in mainland Japan in support of Operation Tomodachi. As of April 3, 1st Marine Aircraft Wing units have flown 582 sorties, totaling 904 hours of flight time while delivering more than 511,400 pounds of cargo in support of Operation Tomodachi. Task Force Fuji and LTF 35 conducted bilateral training convoys to Manato Elementary School for debris removal/clean up at Watanoha Elementary as part of Operation Field Day. U.S. Marines delivered 205 backpacks from the Camp Zama community backpack project. Sendai aviation school and runway “A” cleanup continues. Installation of shower units is ongoing at Aoba. Joint Support Force Relief Update: 3 April 2011 NOTE: A key project of the U.S. Air Force and U.S. Marines has been the reopening of the Sendai airport, which has allowed extensive amounts of supplies to be distributed to hard hit areas. Marines and sailors with 31st Marine Expeditionary Unit, work with Japanese locals and Japan Ground Self Defense Force personal to clear a port in preparation for the landing of a Navy Landing Craft Utility carrying supplies. U.S. Marines Lance Cpl. Garrett Williams of the III Marine Expeditionary Force clears debris April 1 in the tsunami-ravaged city of Noda, Chiba, Japan. More than 80 sailors, Marines, airmen and civilians on Misawa Air Base participated in cleanup operations here as part of Operation Tomodachi. U.S. Marines

11 UNITED STATES RESPONSE 7 th FLEET Dubbed Operation Tomodachi -- Japanese for "friendship" -- U.S. military assets mobilizing in the area Seventh Fleet forces continued sustainment of life efforts in support of Operation Tomodachi. Currently, 14 ships, 130 aircraft and 13,893 personnel are in the area of operation. Seventh Fleet forces continue support of Japan Self Defense Force in Operation Tomodachi. Today’s focus of effort continues to be the search for human remains off the coast of Tohoku and clean up and clearance operations on the island of Oshima. Seventh Fleet ships, helicopters and aircraft are searching over 2,000 square miles of ocean in a concerted effort to find victims of the March 11 tsunami. USS Cowpens, USS Preble, USS Shiloh and USS Curtis D. Wilbur are searching for remains in specific zones off the north east coast of Honshu, with their helicopters, additional support helicopters from the USS Ronald Reagan and one P-3 Orion aircraft providing aerial reconnaissance support. 187 Sailors and Marines from the USS Essex Amphibious Ready Group, the 31st Marine Expeditionary Unit supporting Japan Ground Self Defense Forces began Operation “Field Day”, a clearing and clean up mission on the remote island of Oshima off the coast of Kessennuma. The first location slated for clean up is Uranohama harbor, the primary ferry harbor for Oshima island, to allow ferry services to begin. Also, water testing processes and specific locations to be tested were identified to determine the safety of island drinking water. USNS Safeguard, and USS Tortuga, Mobile Diving and Salvage Unit 1, Explosive Ordnance Disposal Mobile Unit 5 and Underwater Construction Team 2 are also enroute to Oshima to assist in port clearance operations. The island, which is dependent upon ferry service from the mainland, has been largely isolated since March 11 when the tsunami washed its ferries ashore. Cleaning and debris clearance has begun at Oshimatake Junior High School in preparation to begin the new school year. Since Operation Tomodachi started, U.S. 7th Fleet forces have delivered more than 260 tons of relief supplies to survivors of the tsunami and earthquake in support of Japan Self Defense Force efforts. To date, 148 aerial reconnaissance and search sorties have been conducted with more planned in the coming days. U.S. Navy barges containing 500,000 gallons of fresh water are moored at the Fukushima Dai-Ichi nuclear plant, adding this resource to the fresh water cooling efforts. Japanese authorities will use the fresh water to replace salt water currently in some of the reactors. NOTE: A video documenting the work of the Joint Support Force relief efforts is available on YouTube.YouTube NOTE: A video documenting the work of the Joint Support Force relief efforts is available on YouTube.YouTube Joint Support Force Relief Update: 3 April 2011 Marines assigned to the 31st Marine Expeditionary Unit depart the amphibious assault ship USS Essex aboard a landing craft utility, assigned to Assault Craft Unit 1. Essex, with the embarked 31st Marine Expeditionary Unit, is currently operating off the coast of Kesennuma, in northeastern Japan, in support of Operation Tomodachi. U.S. Navy

12 UNITED NATIONS RESPONSE UN OFFICE FOR THE COORDINATION OF HUMANITARIAN AFFAIRS (OCHA) According to OCHA, the GoJ says the need for further international assistance is limited and any support should be in accordance with the GoJ’s criteria. OCHA’s support to the GoJ’s emergency response ended on 1 April WORLD FOOD PROGRAMME (WFP) WFP this week started the construction of five mobile warehouses and four prefabricated offices in Ishinomaki City in Miyagi Prefecture, which is estimated to have the highest death toll among all affected municipalities, with 20,000 people in evacuation centers. The warehouses and offices are for use by the city and various Japanese relief organizations that are delivering supplies to people who have been adversely affected by the disaster. WFP is planning to provide 20 mobile warehouses that will be used by the NGOs Peace Boat and JEN. WFP says it is ready to provide prefabricated housing to NGOs. WFP is also working in Sendai in Miyagi Prefecture, where the agency will support Japan Platform, a consortium of NGOs working closely together with the Japanese Government and business community. WFP is supporting the GoJ’s disaster response by the delivery of in-kind donations received from overseas, and assessing the need for logistics hubs in some of the other areas affected by the disaster across the stricken Tohoku region. INTERNATIONAL ATOMIC ENERGY AGENCY (IAEA) The Joint FAO/IAEA Food Safety Assessment Team has completed its mission and presented its report to the Japanese Cabinet Office, Ministry of Foreign Affairs, Ministry of Health, Labor and Welfare and the Ministry of Agriculture, Fisheries and Forestry on 31 March. The Agency, in agreement with the Japanese government, will dispatch two reactor experts to Japan. They will hold meetings with the Nuclear Safety Commission, NISA, TEPCO and other Japanese counterparts from Monday 4 April 2011 onwards. The objective of this visit is to exchange views with Japanese technical experts and to get first-hand information about the current status of reactors at Fukushima Daiichi, measures being taken and future plans to mitigate the accident. WORLD HEALTH ORGANIZATION-REGIONAL OFFICE FOR THE WESTERN PACIFIC (WHO-WPRO) IN MANILA WPRO Situation room is on 24/7 operation to collect information and to monitor the evolving events, in communication and coordination with MHLW (Ministry of Health, Labor and Welfare of Japan), WHO Kobe Center, the WHO Headquarters and partners. WPRO has been closely working with the National IHR Focal Point in Japan and the WHO Headquarter to facilitate sharing of information through the IHR Event Information Site (EIS) that is open to all the Member States. WPRO has been providing regular situation reports, including situation updates that have been posted on the WHO websites. "Forward" planning is ongoing to identify direct and indirect health and other impacts, expectations/concerns from the public/media, Member States, international communications and partners, and to prepare for possible WHO actions in responding to different scenarios. WHO reported some 142 medical teams, consisting of 640 members responding to Iwate, Miyagi and Fukushima Prefecture from the National Hospital Institution, JRCS, Japan Medical Association (JMA), etc. Additionally, there are 121 public health teams, 20 mental health care teams to provide psychosocial support, 634 pharmacists and 256 nurses providing assistance to affected areas. UN CHILDREN’S FUND (UNICEF) Working with local government, the Japan Committee for UNICEF has conducted a rapid needs assessment on the ground to better support children. In addition to the delivery of supplies, UNICEF relief workers have been working to ensure the support needs of children are met. A needs assessment has been conducted in collaboration with local governments. UNICEF workers are beginning to increase efforts on education and psychological support for women and children affected by the disaster. Eight Japanese experts have been deployed from their posts around the world to work with the Japan Committee. UN HIGH COMMISSIONER FOR REFUGEES (UNHCR) - At the request of the GoJ, UNHCR is providing 1,794 solar lanterns for Miyagi Prefecture. The GoJ has received 131 offers of assistance from countries as well as 33 offers from international organizations. It has accepted relief items from 17 countries. UNICEF Press Rel: 23 March 2011 UNICEF Press Rel: 24 March 2011 WFP News Rel: 01 April 2011 COE-DMHA Update: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 OCHA SitRep No. 16: 1 April 2011

13 OTHER ORGANIZATIONS OF INTEREST A network of NGO/volunteer organizations Japan Civil Network for Disaster Relief in East Japan has been established in order to facilitate the communication and exchange of information among the organizations working in Tohoku area to support the survivors. A website has been created where readers have access in Japanese to information on the activities each organization is carrying out. The aim of the network is to coordinate the assistance provided in Tohoku area by the NGO/volunteer organizations. (www.jpn-civil.net)(www.jpn-civil.net) The International NGOs which are requested to wait for the time being are strongly advised to inform and consult with a Pref. Disaster Volunteer Center prior to the commencement of their activities (communication to be made in Japanese language). The Pref. DVC may advice the NGOs about needs, local DVCs, etc. The GoJ is identifying the needs and trying to match the offers with the identified needs for efficient and effective delivery. As the transportation and storage capacity is still limited, it is strongly recommended not to send any relief goods without coordination with the GoJ or the local authorities. Due to the shortage of fuel and damage to infrastructure, international NGOs are recommended to wait until the situation improves before commencing services (that must be completely self-sustainable and coordinated with a local partner.) INTERNATIONAL MEDICAL CORPS reports health care priorities are the vulnerable in evacuation centers, those living at home, and mental health services for disaster victims. -IMC’s emergency response team is assessing the post-disaster needs of isolated coastal villages in north Sendai that have yet to receive humanitarian assistance. Information from assessments of evacuation centers has been communicated to the Japan regional office of International Medical Corps to facilitate coordination efforts. -Fatigue, stress and insomnia are being reported among many evacuees, while mental health and psychosocial support for children and adults is increasingly recognized as a major priority in the response. IMC is looking at how to support vulnerable displaced groups such as the elderly, single women, children and those who chose to stay in their homes in damaged areas rather than going to an evacuation center. -IIMC’s assessments include: Minami-Sanriku, Kesennuma, Riken-Takata, East Matsushima and areas north of Ishinomaki. -Visited East Matsushima on 27 March 2011 and found cell phone service operational and limited supplies available. AmeriCares delivery of supplies to shelters in Miyagi (Americares). SAVE THE CHILDREN estimates that about 100,000 children have been affected and 74,000 children remain displaced. As part of the relief efforts, they have opened 12 Child Friendly Play Spaces. Save the Children is also procuring 5500 back-to-school kits for primary students. 500 hygiene kits are ready for distribution at the Sendai warehouse. ASSOCIATION FOR AID AND RELIEF (AAR) delivered prepared-food pouches, toilet paper rolls, underwear, towels, and other necessary hygiene items to evacuation centers in Miyagi, Iwate and Fukushima. AAR also assisted a soup kitchen in Miyagi. AMERICARES is airlifting an emergency shipment of medical aid that contains: Antibiotics to treat 519 adults and children 630 course treatments of IV solutions Pain medicines to treat 480 people for one months 2,000 course treatments of anesthetics Sutures for as many as 2,510 procedures 859,458 units of bandages and wound dressings 11,460 masks 18,812 syringes An assortment of gloves, soap, hygiene kits, and flashlights OCHA SitRep No. 16: 1 April 2011 IMC: 29 March 2011 AmeriCares: 1 April 2011 April 2011 JPF & JPF & JANIC 23 March 2011

14 OTHER ORGANIZATIONS OF INTEREST AMDA International Emergency Bulletin 13: 2 April 2011 (Map) Seeds Sit Rep 11 : 1 April 2011 NOTE: All offers of assistance should continue to be directed to the GoJ. ASSOCIATION OF MEDICAL DOCTORS OF JAPAN (AMDA) ) has 108 relief personnel working in the impacted area: 39 doctors, 20 nurses, 2 midwives, 1 assistant nurse, 3 pharmacists, 2 psychotherapists, 39 coordinators, 2 caseworkers AMDA and its partners have decided to launch a scholarship program for the disaster programs. The scholarship is targeted to the high school students in the disaster- stricken areas who wish to become a doctor in the future. Besides financial assistance for three years, the scholarship aims to provide international cultural exchange opportunities through support organizations. Emergency medical needs have decreased as a number of medical teams are now active in devastated sites. Hence, along with the ongoing medical relief activities, AMDA has begun shifting its target to the highly-demanded elderly nursing from 1 April. AMDA is launching a nursing-assistance program that will send careworkers to AMDA’s work site to work with existing teams; providing the elderly nursing care in rotation. Iwate Prefecture (Kamaishi City and the town of Ohtsuchicho): Along with regular medical services, one of the AMDA doctors started to offer acupuncture treatments at Ohtsuchi High School. Miyagi Prefecture (the town of Minamisanriku-cho): It is forseeable that due to the relocation of the residents (1,100 people) the number of evacuees will decrease from now on. At the same time, the medical supplies have been currently fulfilled. AMDA held a briefing session on norovirus in preparation to the the potential risk of breakout as the sanitary condition in the shelter has been deteriorating due to the prolonged evacuation life. Photo: AMDA International

15 RELIEF OPERATIONS BY JAPANESE HUMANITARIAN ORGANIZATIONS IN MAJOR AFFECTED CITIES OTHER ORGANIZATIONS OF INTEREST Seeds SitRep 11 : 1 April 2011

16 RELIEF OPERATIONS BY JAPANESE HUMANITARIAN ORGANIZATIONS IN MAJOR AFFECTED CITIES OTHER ORGANIZATIONS OF INTEREST Seeds SitRep 11 : 1 April 2011

17 HEALTH – CONCERNS OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 NISA –News Release No.61: 29 March 2011 CDC - Hypothermia Communicable Diseases There have been sporadic cases of influenza but no large outbreaks. An internet-based ad-hoc syndromic surveillance system has been developed by the Infectious Disease Surveillance Center, National Institute of Infectious Diseases (http://www.syndromic- surveillance.net/hinanjo/index.html )http://www.syndromic- surveillance.net/hinanjo/index.html Influenza viruses were detected in Sendai and surrounding areas. Based on a report, 21 out of 59 specimens were tested positive for influenza A (21 were positive for H3N2 and 2 were positive for pandemic influenza A (H1N1). Influenza rapid test kits were used at an emergency center in Sendai for the period March. Rapid test was conducted for 335 out of 1,180 patients ( 28.3%). Results are as follows: influenza A positive - 107(31.9%) and influenza B positive - 5(1.5%). Influenza-like-illness activity is being monitored in elderly populations due to their high risk status. There have been 2 cases of tetanus (one each from Miyagi and Iwate prefectures) and 2 cases of legionella from Miyagi prefecture (25 March). The diagnosis occurred between 17 and 21 March. A survey of sanitary situations in evacuation centers in Ishimaki, Higashi, Matsushima and Onogawa. Around 40% (107/272) toilets had sanitary-related problems. Acute gastroenteritis (50 cases of diarrhea and 20 of vomiting) and UTI such as cystitis have been reported by media. Non-communicable Diseases Priority high-risk conditions for NCD management include patients on dialysis, those with Type I Diabetes, those requiring respiratory support or acute coronary care and those post-organ transplant. Other priorities include patients with diabetes mellitus, heart disease, asthma, cancer and chronic lung disease. Patients with major NCD are particularly vulnerable to exacerbations of their conditions. Factors contributing to this include interruption of regular medical treatment, severe situational stress and anxiety, overcrowding and reduced living standards, shortages of water and regular food supplies, degraded environmental conditions and physical injuries. Tohoku University reports that cases of pneumonia among the elderly living in evacuation centers in Miyagi are increasing. Hypothermia People continue to face cold temperatures with insufficient heating. Hypothermia has been reported particularly among the elderly population in the evacuation centers. NOTE: Improving living conditions at shelters in the worst affected areas is the biggest priority to prevent continued increase in numbers of cold cases and hygiene-related illnesses.

18 INITIAL RISK ASSESSMENT OF INFECTIOUS DISEASE Conducted by the National Institute of Infectious Diseases (NIID) WHO – WPRO SitRep No. 21: 30 March 2011WHO – WPRO SitRep No. 21: 30 March 2011

19 DIARRHEA Gastroenteritis means inflammation of the stomach and small and large intestines. Viral gastroenteritis is an infection caused by a variety of viruses that results in vomiting or diarrhea. Many different viruses can cause gastroenteritis, including rotaviruses; noroviruses; adenoviruses, types 40 and 41; sapoviruses; and astroviruses. Diarrhea is the passage of loose or liquid stools more frequently than is normal for the individual. It is primarily a symptom of gastrointestinal infection. Diarrhea is a symptom of infection caused by a host of bacterial, viral and parasitic organisms most of which can be spread by contaminated water. Depending on the type of infection, the diarrhea may be watery (for example in cholera) or passed with blood (in dysentery for example). CDC Pre-decision Brief: AWD and Cholera Haiti FEB 2010 CDC: Viral Gastroenteritis WHO: Diarrhoea WHO – WPRO SitRep No. 21: 30 March Transmission of acute watery diarrhea occurs through consumption of sewage- contaminated water or food, contact with contaminated environmental surfaces, or direct person-to-person spread in conditions of poor hygiene. It is more common when there is a shortage of clean water for drinking, cooking and cleaning and basic hygiene Water contaminated with human faeces for example from municipal sewage, septic tanks and latrines is of special concern. Animal faeces also contain microorganisms that can cause diarrhea. Food is another major cause of diarrhea when it is prepared or stored in unhygienic conditions. Water can contaminate food during irrigation, and fish and seafood from polluted water may also contribute to the disease. Reported outbreaks of acute watery diarrhea (AWD) have been reported following disasters involving flooding or encampments for displaced persons; more than 20,000 cases of AWD were reported after the earthquake in Pakistan in NOTES: Confirmed cases of Acute Watery Diarrhea (AWD) and other diarrheal diseases indicate that the sanitary conditions in the evacuation centers are not sufficient. Early recognition of an outbreak and rapid implementation of control measures is critical to limit the impact of an outbreak of AWD. WHAT CAUSES DIARRHEA ? HOW DOES A PERSON GET DIARRHEA? WHAT ARE PRECAUTIONS FOR AVOIDING DIARRHEA? HOW DO YOU TREAT DIARRHEA HOW DO YOU TREAT DIARRHEA? Diarrhea due to infection may last a few days, or several weeks, as in persistent diarrhea. Severe diarrhea may be life threatening due to fluid loss in watery diarrhea, particularly in infants and young children, the malnourished and people with impaired immunity. Dehydration is the critical clinical issue. Key measures to treat diarrhea include: -Giving more fluids than usual, including oral rehydration salts -Continue feeding -Consulting a health worker if there are any signs of dehydration or other problems -Acquiring adequate supplies for oral and intravenous rehydration in affected regions before an outbreak occurs The most effective measures to prevent transmission of acute watery diarrhea are provision of safe (chlorinated) water; safe water storage; appropriate disposal of feces; and hand washing with soap after caring for patients, toileting, cleaning other persons after toileting, or before preparing, serving, or eating food. I Key measures to reduce the number of cases of diarrhea include: - Access to safe drinking water - Improved sanitation - Good personal and food hygiene - Health education about how infections spread

20 TSUTSUGAMUSHI DISEASE TSUTSUGAMUSHIO DISEASE (ALSO KNOWN AS SCRUB TYPHUS) IS AN ACUTE FEBRILE ILLNESS CAUSED BY ORIENTIA TSUTSUGAMUSHI According to the WHO SE Asia Regional Office: Scrub typhus is difficult to recognize and diagnose because the symptoms and signs of the illness are often non-specific. The non-specific presentation and lack of the characteristic eschar in 40% patients makes the misdiagnosis and underreporting of scrub typhus common. Obvious association with certain types of terrain Marked localization of many cases within certain small foci Large percentage of susceptible people, who may be infected simultaneously following exposure over relatively short periods Absence of a history of bites or attack by arthropods No vaccines or drugs are available to prevent infection. The best prevention is to minimize mite exposure: insect repellents, protective clothing, and avoidance of vector-infested areas. These precautions are especially important for persons with underlying conditions that may compromise their immune systems, as these individuals may be more susceptible to severe disease. Sources/Links: CDC Yellow Book, Chapter 5: Rickettsial and Related Infections FAQs: Scrub Typhus – WHO SE Asia Regional Office WHO-WPRO SitRep No. 21: 30 March 2011 CURRENT SITUATION: National Institute of Infectious Disease Risk Assessment updated March 24, 2001, rated tsutsugamushi disease a level 2 (medium risk) concern. The season for Tsutsugamushi is spring—early summer and fall—early winter Risk of exposure may increase due to displacement and inadequate shelter CURRENT SITUATION: National Institute of Infectious Disease Risk Assessment updated March 24, 2001, rated tsutsugamushi disease a level 2 (medium risk) concern. The season for Tsutsugamushi is spring—early summer and fall—early winter Risk of exposure may increase due to displacement and inadequate shelter Transmitted to humans and rodents through the bite of an infected trombiculid mite (or “chigger”). The mites are very small ( mm) and not easily visible to the naked eye. The mites serve as both the vector and the reservoir. Chigger Mite (WHO) Characteristic eschar in a patient (WHO) PREVENTION TSUTSUGAMUSI IS A ZOONOTIC DISEASE CHARACTERISTIC FEATURES OF SCRUB TYPHUS OUTBREAK

21 GENERAL INFORMATION - Tuberculosis (TB) is a disease caused by bacteria that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. A person with TB can die if they do not get treatment. WHAT ARE THE SYMPTOMS OF TB? The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB disease of the lungs also include coughing, chest pain, and the coughing up of blood. Symptoms of TB disease in other parts of the body depend on the area affected. HOW IS TB SPREAD? TB germs are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These germs can stay in the air for several hours, depending on the environment. Persons who breathe in the air containing these TB germs can become infected; this is called latent TB infection. HEALTH – TUBERCULOSIS OCHA Sit Rep 16: 1 April 2011 WHO-WPRO SitRep No. 21: 30 March 2011WHO-WPRO SitRep No. 21: 30 March 2011 MONTHLY TB REPORT JAPAN 2011MONTHLY TB REPORT JAPAN 2011 WHO-WPRO SitRep No. 23: 1 April 2011WHO-WPRO SitRep No. 23: 1 April 2011 CDC - Tuberculosis JATA TB Surveillance CenterCDC - Tuberculosis JATA TB Surveillance Center PREVENTION TB is a preventable disease, even in those who have been exposed to an infected person. Skin testing (PPD) for TB is used in high risk populations or in people who may have been exposed to TB, such as health care workers. A positive skin test indicates TB exposure. Discuss preventive therapy with your doctor. People who have been exposed to TB should be skin tested immediately and have a follow-up test at a later date, if the first test is negative. Prompt treatment is extremely important in controlling the spread of TB from those who have active TB. TUBERCULOSIS (TB) SITUATION – JAPAN Despite a decline after World War II, the rate of tuberculosis in Japan remains high. Infection is heavily concentrated in the >60-year age group, and 82% of patients are >40 years of age. The success rate for treatment of smear-positive patients is 78%. Multidrug-resistant strains of Mycobacterium tuberculosis are rare. Since the Earthquake and Tsunami the National Institute of infectious Diseases (NID) has conducted an initial risk and identified a medium level of risk of TB for the population and health care workers. TUBERCULOSIS (TB) SITUATION – JAPAN Despite a decline after World War II, the rate of tuberculosis in Japan remains high. Infection is heavily concentrated in the >60-year age group, and 82% of patients are >40 years of age. The success rate for treatment of smear-positive patients is 78%. Multidrug-resistant strains of Mycobacterium tuberculosis are rare. Since the Earthquake and Tsunami the National Institute of infectious Diseases (NID) has conducted an initial risk and identified a medium level of risk of TB for the population and health care workers.

22 Hypothermia results when the body loses more heat than can be replaced by increasing metabolism (through exercise) or by increasing warming from external sources, such as a fire or the sun. Wind increases heat loss, as does sitting or lying on a cold surface or being immersed in water. Sudden immersion in very cold water may cause fatal hypothermia in 5 to 15 minutes. However, a few people, mostly infants and young children, have survived for as long as 1 hour completely submerged in ice water. The shock can shut off all systems, essentially protecting the body. Hypothermia may also occur after prolonged exposure in only moderately cool water.. HEALTH – HYPOTHERMIA HYPOTHERMIA AND THE ELDERLY HYPOTHERMIA AND THE ELDERLY Aging takes a toll on the body's ability to adapt to the cold. With aging, the body becomes less efficient at shivering or at diverting blood away from the surface of the body. Also, the layer of fat just under the skin thins, so there is less insulation to prevent heat loss. The body's ability to produce heat is decreased by diseases that commonly affect older people, such as hypothyroidism. The body's ability to retain heat is decreased by diseases such as diabetes. A person who is less able to move around because of an injury or a disease such as a stroke or arthritis is at a greater risk of dangerous cooling, because the decreased movement generates less heat- producing muscle activity. Alcohol and certain drugs, such as antidepressants, increase the risk as of hypothermia. WHAT IS HYPPPPOTHERMIA WHAT IS HYPPPPOTHERMIA WHO IS AT RISK? WHO IS AT RISK? People at greatest risk are those who are lying immobile in a cold environment—such as people who have had a stroke or a seizure or who are unconscious from intoxication, a low blood sugar level, or an injury. Because they are not moving, these people generate less heat and also are unable to leave the cold environment. Such people are at risk of becoming hypothermic even when the surrounding temperature may be only as cold as 55 or 60° F (about 13 to 16° Celsius [C]). The very young and the very old are at particular risk. People in these age groups often do not compensate for cold as well as young adults and are dependent on others to anticipate their needs and keep them warm. Very old people quite often become hypothermic while indoors from sitting immobile in a cold room for hours. Infants lose body heat rapidly and are particularly susceptible to hypothermia. Sometimes a disorder, such as a widespread infection or an under functioning thyroid gland, causes or contributes to hypothermia. SYMPTOMS SYMPTOMS HYPOTHERMIA AND THE ELDERLY HYPOTHERMIA AND THE ELDERLY Initial symptoms include intense shivering and teeth chattering. As body temperature falls further, shivering stops and movements become slow and clumsy, reaction time is longer, thinking is blurred, and judgment is impaired. These symptoms may develop so gradually that people, including companions of the affected person, do not realize what is happening. People may fall, wander off, or simply lie down to rest. When shivering stops, people become more sluggish and slip into a coma. The heart and breathing rates become slower and weaker. Eventually the heart stops. The lower the body temperature is, the higher the risk of death. Death may occur at body temperatures below 88° F (about 31° C) but is most likely to occur below 83° F (about 28° C).

23 CURRENT SITUATION Hypothermia has been reported, particularly among the elderly in evacuation centers, increasing their vulnerability. The temperature is dropping to minus 6 degrees Celsius overnight and authorities in Miyagi Prefecture say the lack of fuel means they cannot use heaters. 210,000 households (516,600 people) do not have electricity and one million people are without gas. The UN reports that it is unknown how many are living outside of evacuation centers in affected areas as many who were in shelters have chosen to return home even though they may not have water or electricity. In the northeast Tohoku region (Iwate, Miyagi and Fukushima prefectures), the weather is sunny on 1 April, turning mostly cloudy on 2 April. While the weather has improved, the lows remain near freezing, with the temperature ranging from 1 to 16 degrees. Overall, the wind is blowing from the west. HYPOTHERMIA AND THE JAPAN EATHQUAKE AND TSUNAMISUNAMI HYPOTHERMIA AND THE JAPAN EATHQUAKE AND TSUNAMISUNAMI MONTHLY MEAN DAILY MINIMUM TEMPERATURE YearMarApr C2.1 C MONTHLY MEAN DAILY MAXIMUM TEMPERATURE C13.3 C FUKUSHIMA - MEAN TEMPERATURES HEALTH – HYPOTHERMIA Environmental factors that likely contributed to the contributing to the cases of hypothermia during the Japan Earthquake and Tsunami were the: -Temperatures of the sea water -Air temperatures and the wind chill factors -Inclimate weather -Snow -Freezing rain The sea surface temperatures in the vicinity of Sendai around the time of the tsunami were 9-10°C, or around 48-50°F. In addition to the time of year, the waters are particularly cold in the vicinity of Sendai due to its location on the northern side of the Kuroshio Current, the North Pacific Subtropical Gyre's analog of the Gulf Stream in the North Atlantic. This strong western boundary current separates the very warm, central gyre waters from those to the north. This is why the ocean near Sendai is significantly colder than that around Tokyo Bay, less than 400 km (~250 miles) to the south. In the following days after the initial earthquake and tsunami, the lack of adequate shelter and fuel shortages, electrical outages, lack of clothing and blankets, all contributed to an environment that produced hypothermia. Japan Metrological Agency Map generated from the AVHRR and AMSR remote sensing instrument passes on March 11, 2011 (Mike Bueti)

24 Skin protects the body from infection, however when individuals are injured through punctures, scrapes, scratches, or tears of the skin, that protection is compromised & infection can occur leading to serious health complications if untreated. As of 30 March the GoJ has reported 2,778 injuries with thousands more still unaccounted for. Injury-Related (IR) Infections remain a serious concern. WHO reports IR infections likely endemic in quake zone, with the potential for acute impact on population. Risk of IR Infections among rescue workers is HIGH. Wound Depth – the deeper the wound the more likely complications such as infection will occur Size of object – Larger or longer objects can penetrate deeper into tissue increasing risk of infection. “Cleanliness” of Penetrating Object – Dirtier objects (including rust) are more likely to deposit dirt & debris into wound increasing risk of infection. Redness, warmth, tenderness & soreness Swelling or discharge from wound Fever Immediate Emergency Attention is needed if wound smells bad, discharge is thick & brown/gray, tissue around wound discolors, or if swollen glands in armpits or groin can be felt. INJURY-RELATED INFECTION Older Age & individuals with chronic conditions including diabetes & cancer. Individuals with Immune system disorders & malnutrition. Paralysis or other limited mobility. Note: hospitalization may increase the risk for infection by some antibiotic resistant organisms. Common complications range in severity and may include: Death of surrounding tissue (muscle, connective tissue & bone). Spread of infection to the bloodstream & other organs. Septic shock, organ failure, & death. JAMA PATIENT PAGE- Vol. 294, No. 16 WHO-WPRO SitRep No. 21: 30 March 2011 AMERICAN COLLEGE of FOOT & ANKLE SURGEONS MEDICAL ASPECTS OF RADIATION INCIDENTS Handbook BACKGROUND EVALUATING SEVERITY OF WOUNDS (A SIMPLIFIED APPROACH) SIGNS OF INFECTION RISK FACTORS ASSOCIATED WITH INCREASED RISK OF INFECTION POTENTIAL COMPLICATIONS ASSOCIATED WITH INFECTION

25 INJURY-RELATED INFECTION Treatment depends on type of wound, degree of infection, & type of bacteria responsible for infection. All wounds should be thoroughly cleaned, foreign objects should be removed, and any pus drained. Laboratory tests may be required and are used to diagnose bacterial wound infections, to identify the microorganism responsible for infection, and to determine susceptibility to specific antimicrobial agents. Prescription antibiotics may be necessary to treat infection. ALWAYS finish antibiotics prescription even if infections seems to have cleared up. WHO-WPRO SitRep No. 21: 30 March 2011 JAMA PATIENT PAGE- Vol. 294, No. 16 MEDICAL ASPECTS OF RADIATION INCIDENTS Handbook NLLIC Easy Read Fact Sheet: Wound Care & Preventing Infection Radiation damage to cells occurs within microseconds of exposure. Cellular damage is generally most severe in rapidly reproducing cell types including: stem cells and lymphocytes (a type of white blood cell that functions in the immune system). Open wounds can allow radioactive contamination to enter the body. Among individuals with high exposure to radiation, a condition called Neutropenia is common. It is a condition in which white blood cell counts, an important component of normal immune system function, is low. These individuals are therefore at increased risk of injury related infection. Individuals contaminated by radioactive materials who have sustained injuries requiring medical care should immediately receive all necessary and life-saving actions, without regard to healthcare worker contamination. Living patients who have been exposed to radioactive contamination due not pose an acute threat to health care providers. The WHO considers risk of injury related infections to be HIGH among rescue workers NOTES: Injuries involving open wounds (including punctures, abrasions, and lacerations) should be cleaned thoroughly and covered with sterile bandages. Medical attention should be sought if there are signs of infection. INJURY-RELATED INFECTION & RADIATION EXPOSURE TREATMENT OF INJURY-RELATED INFECTION

26 ACUTE RESPIRATORY INFECTION Source: WHO Measles WHO Acute Respiratory Infections WHO Acute Respiratory Infections in Children WHO Leading Causes of DeathWHO MeaslesWHO Acute Respiratory InfectionsWHO Acute Respiratory Infections in ChildrenWHO Leading Causes of Death WHAT IS ACUTE RESPIRATORY INFECTION? The disease burden for Acute Respiratory Infections (ARI) is estimated at DALYs (WHO, 2002 ) and 3.9 million deaths (WHO, 2002 ). ARI are among the leading causes of death in children under 5 years but diagnosis and attribution are difficult and uncertain.WHO, 2002 In low-income countries, lower respiratory infections are the leading cause of death worldwide, in high-income countries they are the fourth main cause of death, and world-wide they are the third cause of death with over 4 million deaths each year according to the World Health Organization (WHO) The main diseases that cause ARI are: Streptococcus pneumoniae Respiratory syncytial virus Parainfluenza virus type 3 Influenza MEASLES AND ARI ARI is often associated with other life-threatening diseases such as measles. A study reports 62% of all deaths are attributable to ARI but most of these were associated with measles. When measles deaths are excluded the proportion falls to 24%. Measles is a highly contagious viral disease, which affects mostly children. It is transmitted via droplets from the nose, mouth or throat of infected persons. Initial symptoms, which usually appear 8–12 days after infection, include high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards. There is no specific treatment for measles and most people recover within 2–3 weeks. However measles can cause serious complications, including blindness, encephalitis, severe diarrhea, ear infection and pneumonia. The Measles, Mumps, and Rubella vaccine (MMR) can prevent infection. About 20% of all deaths in children under 5 years are due to Acute Lower Respiratory Infections (ALRIs - pneumonia, bronchiolitis and bronchitis); 90% of these deaths are due to pneumonia. Signs on an ARI are cough and difficulty breathing. Young infants with fast breathing or chest indrawing should be suspected to have serious bacterial infection. HOW DOES ARI AFFECT CHILDREN? Characteristics of Measles

27 ACUTE RESPIRATORY DISEASE IN JAPAN Source: Respiratory illness and hypothermia MSF Respiratory Illness Elderly Respiratory InfectionRespiratory illness and hypothermiaMSF Respiratory IllnessElderly Respiratory Infection HOW COULD ARI AFFECT THE DISASTER? Acute Respiratory Infection (ARI) is a significant threat in shelters. Evacuees in the shelters are in close proximity to each other and it is very easy for the disease to spread. Hypothermia may amplify respiratory illness, increasing the risk for those in Japan who do not have proper shelter. WHAT ARE PRECAUTIONS FOR ARI? ARI AND THE JAPAN EARTHQUAKE Doctors Without Borders/Médecins Sans Frontières (MSF) has found respiratory illness in the crowded living conditions found in the shelters. The elderly and children are often more at risk for respiratory infection. With Japan’s high population over the age of 65 it is important to take preventative measures for reducing the risk of disease. This image shows healthy people wearing masks to prevent disease.image The following precautions should be used to help prevent ARIs: Facemasks for both the healthy and the sick Alcohol disinfectant easily available Increased hand washing Notes: Availability of appropriate medical equipment (masks, alcohol wipes) and sanitary conditions are part of an effective strategy to prevent the spread of ARI

28 According to OCHA, hospitals providing emergency response services in the three most affected prefectures are gradually building back capacity. -Of the 33 major hospitals in these prefectures, 26 are now accepting both inpatients and outpatients. -Media reports that sufficient medical supplies are now reaching key hospitals. -The challenge is the onward distribution to a network of local hospitals and clinics, which is being hampered by a lack of pharmacists. In the non-affected prefectures, there are over 390 public hospitals (about 3,400 available beds). 690 elderly people and people with disabilities in evacuation centers have been moved to special facilities (e.g. nursing homes). Standby beds have been prepared in special facilities : 35,557 beds for elderly, 8,756 beds for people with disabilities, 7,148 beds for children with disabilities. Additionally, 919 beds are available in shelters. The Ministry of Health, Labor and Welfare, in cooperation with the Japan Association of Dialysis Physicians, requested prefecture and city governments to set up a system for accepting dialysis patients outside of affected areas.. HEALTH – HOSPITALS OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 An elderly patient gestures thanks to her staff after being hand-fed at the Senen General Hospital in Miyagi Prefecture. Photo: Mark Baker/AP A father holds his daughter as she is screened for radiation exposure. Photo: Kyodo News/AP No. of hospitals capable of receiving patients for hospitalization No. of hospitals capable of receiving patients for check up Miyagi (14 hospitals)1211 Fukushima (8 hospitals)77 Iwate (11 hospitals)88 SITUATION OF HOSPITALS DESIGNATED IN DISASTER (31 MARCH):

29 HEALTH – MEDICAL TEAMS The MHLW has coordinated the deployment of doctors, pharmacists, social workers, dentists, care managers, child welfare and psychological care specialists to Iwate, Miyagi, and Fukushima. Japan Red Cross Society teams, Japan Medical Association teams, and teams from All Japan Hospital Association are also operational in the affected areas. 142 teams, consisting of 640 members are responding to Iwate, Miyagi and Fukushima from the National Hospital Institution, Japan Red Cross Society, Japan Medical Association, etc. 634 pharmacists are deployed to Miyagi (427), Fukushima (144), Iwate (59), Ibaragi (3) by the Japan Pharmaceutical Association and Japanese Society of Hospital Pharmacists. The Japanese Nursing Association has dispatched 256 nurses to Iwate (27), Fukushima (2) and Miyagi (49). 30 Nurses have been mobilized to Iwate and Miyagi. 1 dentist, 1 dental hygienist and 1 driver for a round clinic will be dispatched to Iwate from 31 March to 14 April. Some 280 caregivers (home helpers) for elderly people and people with disabilities are in Iwate (89), Miyagi (98) and Fukushima (93). 8,126 caregivers are on standby. OCHA SitRep No. 16: 1 April 2011COE Update: 30 March 2011 SEEDS SitRep #10: 29 March 2011SEEDS SitRep #10: 29 March 2011 WHO-WPRO SitRep No. 23: 1 April 2011WHO-WPRO SitRep No. 23: 1 April 2011 Some 121 public health teams have been deployed to evacuation centers and public health centers in Fukushima, Iwate, Sendai and Miyagi. An additional 10 teams have been mobilized or on standby for health-related services. As of 31 March, a total of 20 mental care teams of 95 members have been deployed to support Iwate (7), Miyagi (10), Sendai City (2) and Fukushima (1). Some 17 pediatric mental care providers have been dispatched by Ministry of Health, Labor and Welfare to Iwate, and 396 pediatric psychological care providers are on standby Local medical associations have reported out of 231 hospitals in Iwate, Fukushima and Miyagi, 121 (52%) are unable to accept new patients, and 33 (14%) are unable to accept any patients due to lack of resources, including staff. 22 “Kokoro no kea” (“Care of the Heart [for mental wellbing]” ) teams (106 workers) are working on the ground in Iwate, Miyagi, Sendai city, and Fukushima). Various free telephone and consultation services have been set up for mental health and psychological support. Regarding identified non-communicable disease needs, facilities for supporting dialysis and rheumatism patients, and telephone consultation services for cardiologists, have been put in place. Some 270 bags of dialysis liquid and 2,000 dialyzers have been delivered to Miyagi Prefecture. MSF medical teams continue to work in evacuation centers in Minami Sanriku in Miyagi, and have started to support a Japanese doctor in the town of Taro in Iwate prefecture. MSF reports the main activity continues to be consultations with elderly patients suffering from chronic diseases. NUMBER OF TEAMS LOCATION Responding111Iwate(37), Miyagi(50)+Sendai city(21), Fukushima(3) Mobilizing1Sendai city (1) Standby9Iwate (2), Fukushima (5), Miyagi (2) Total121Iwate (39), Miyagi (52)+Sendai City(22), Fukushima(8) PUBLIC HEALTH CARE TEAMS DEPLOYED TO EVACUATION CENTERS AND PUBLIC HEALTH CENTERS AS OF 29 MARCH

30 HEALTH – PSYCHOLOGICAL IMPACTS IFRC Information Bulletin No.5: 28 March 2011 WHO-WPRO SitRep No 21: 30 March 2011COE-DMHA Update: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011COE-DMHA Update: 30 March 2011 A survey on mental health issues in Iwate Prefecture found that around 60% of the 73 shelters investigated had patients who needed immediate psychosocial support. The MHLW has prepared a mental care guidebook that is being distributed to affected municipalities; a website has been set up to provide information for counselors and teachers.website 17 pediatric mental health care providers have been dispatched by MHWL to Iwate, and 396 pediatric psychological care providers are on standby. The GoJ has also deployed 23 psychosocial support teams, as the specific area becomes an increasing need. Based on the identified mental health and psychosocial needs, several response activities have been coordinated. Official government information indicate that, as of 29 March, 22 "Kokoro no kea" ("Care of the Heart [for mental wellbeing]") teams (106 workers) are working on the ground (7 in Iwate, 11 in Miyagi [3 in Sendai city], and 1 in Fukushima). Some 17 pediatric mental health care providers have been dispatched by the Ministry of Health, Labor and Welfare (MHLW) to Iwate (as of 31 March). Psychosocial support to disaster victims is important to reduce morbidity, disability, and social problems. Those delivering psychosocial support services need to be familiar with victims’ culture and way of life. NOTE: As response and recovery operations continue, the need for long term medical and psychological support will increase for pre-existing conditions as well as those caused by the disaster. A long-term strategy will be required to support these conditions as well as to transition response assets into the recovering infrastructure as appropriate. NOTE: As response and recovery operations continue, the need for long term medical and psychological support will increase for pre-existing conditions as well as those caused by the disaster. A long-term strategy will be required to support these conditions as well as to transition response assets into the recovering infrastructure as appropriate. The Japanese Red Cross Society (JRCS) says the disaster has psychologically affected children. The National Society has 2,369 nurses who are trained and ready to provided PSP services. In addition, some PSP teams were deployed to conduct assessments in the affected areas, as well as to provide support. MSF plans to support a team of 6 psychologists, from the Japanese Society of Certified Clinical Psychologists, who will treat victims of the disaster. Currently, it is difficult to make complete estimates of the disaster impact on mental health. Rapid surveys are being prepared/sent to Japan to identify mental health needs. Preliminary key mental health areas identified are pediatric mental health and survivor's guilt. Based on evolving situation on the ground, continued assessment is necessary Coordination meeting of relevant MHPSS NGO agencies will be called in the second week of April in Sendai. This meeting is planned to be called by the government, the Ministry of Health, Ministry of Social Welfare, and others As of 30 March, 22 mental health care teams with 166 members have been deployed to provide psychosocial support to Iwate, Miyagi, Sendai City and Fukushima. According to the WHO as of March 31, a total of 20 mental health care teams (95 members) have been deployed to provide psychosocial healthcare to affected areas, including Iwate, Miyagi, Sendai City and Fukushima. (WHO, April 1)

31 Japan is one of the oldest countries in the world. About 23 percent of Japan's 127 million people are age 65 or over In the coastal areas struck by the tsunami, that number rises to nearly 30 percent. The elderly are particularly vulnerable to disruptions in food, water, medical services, and regular schedules of essential medication. They are also highly susceptible to hypothermia and pneumonia—significant risks due to heating interruptions and blanket shortages in some shelters and hospitals. Those remaining in their homes are faced with no electricity, shortages of fuel and kerosene, and are struggling to run heaters and cook hot meals. With less resilience and weakened immune systems, the elderly are at a much higher risk than others to falling ill. Japanese Red Cross medical teams have been treating the elderly for hypothermia and infectious diseases such as influenza. There were 15 out of 170 elderly who died within one week after evacuation. ELDERY ISSUES OCHA SitRep No. 16: 1 April 2011 AMDA SitRep No. 12: 2 April 2011AMDA SitRep No. 12: 2 April 2011 CSIS 31 March 2011CSIS 31 March 2011 COE-DMHA Update: 1 April 2011WHO-WPRO SitRep No. 23: 1 April 2011 NOTE: The elderly are particularly vulnerable to illness due to preexisting chronic diseases, weakened immune systems, and susceptibility to infectious diseases. Cases of pneumonia, influenza & hypothermia among the elderly are increasing. NOTE: The elderly are particularly vulnerable to illness due to preexisting chronic diseases, weakened immune systems, and susceptibility to infectious diseases. Cases of pneumonia, influenza & hypothermia among the elderly are increasing. Social welfare facilities have identified accommodation facilities for at least 35,000 elderly. Around 280 caregivers for the elderly and people with disabilities are responding in Iwate, Miyagi and Fukushima. Another 8,126 caregivers are on standby. The Association of Medical Doctors of Asia (AMDA) has begun shifting its target to the highly-demanded elderly nursing from Apr. 1 st. According to the WHO, as of 31 March, beds in special facilities have been prepared for standby. Around 35,557 beds for the elderly have been prepared. An elderly woman cries in the devastated town of Rikuzentakata in Iwate prefecture. People on their wheelchairs rest at an evacuation center in Kesennuma, Miyagi Prefecture in northern Japan, after an earthquake and tsunami struck the area, (REUTERS/Kyodo)

32 245,508 people are displaced and/or evacuated and there are currently 170,500 displaced people living in 2,230 evacuation centres in 17 prefectures mostly in the north of Japan. In Miyagi, Iwate and Fukushima, 146,628 evacuees are living in some 1,245 evacuation centers The number of people in evacuation centers is decreasing slightly whereas the number of evacuation centers has increased by 200 in the last two days, as174 have opened in Aomori Prefecture in the north. Improving the living conditions at the shelters in the worst affected areas is the biggest priority, otherwise there will continue to be an increase in the number of cases of cold and hygiene-related illnesses. OCHA reports that there are still significant humanitarian needs that are not being met because of coordination and logistical issues. The biggest concern is the extremely poor sanitation conditions at the evacuation centers. Local media has also reported that hospitals in the areas are reporting a steady increase in cases of nausea, gastroenteritis, and diarrhea which is evidence that sanitary conditions are deteriorating in the centers. The shortage of fuel is still an issue and as soon as it is readily available it is expected that people in shelters will move out of the centers and into non- affected areas. Fuel is being provided to evacuation centers by freight train and tankers from areas both north and south of the affected Tohoku region. While basic needs for food, water, toiletries and medicines are being met the situation is serious and more sustainable solutions are being sought. In addition, there are still thousands more that are living in their cars and who have returned to their homes even though there is no electricity or water. These people do not receive basic supplies from the municipal authorities but are becoming the focus of attention by local NGOs and volunteers. Authorities are trying to consolidate the number of evacuation centers and move people into bigger shelters in order to provide a more efficient and sustainable way of providing assistance. They also need to empty the 345 schools currently serving as evacuation centers in time for the academic year, which begins in April. The Tokyo Metropolitan Government announced it will deploy 1,000 officials to Miyagi and Iwate from 2 April until at least mid May to help manage evacuation centers. In Tokyo prefecture, 600 families have been allocated vacant public housing units on March 31 free of charge, for a period of 6 months. Starting in May, the GoJ will provide US$10,000 (1 million JPY) to each family who lost their homes. SHELTER AND EVACUATION OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 COE-DMHA Update: 1 April 2011IFRC Info Bulletin: 28 March 2011 The Socioeconomic Effects of the 2011 Tohoku Earthquake - Daniell, Vervaeck, Wenzel - CATDAT

33 The evacuees have established managing committees in the evacuation centers to assist with distribution of food and relief items, cleaning, water supply, and allocation of individual living spaces. A municipal official acts as the liaison between the committees and the municipality. This practice of self-management will continue when the evacuees are relocated to planned housing. The GoJ wants to keep people from the same evacuation centers together so bonds formed since the earthquake can be maintained. Save the Children, reports that it estimates around 74,000 children remain displaced and that it plans to open 12 Child Friendly Spaces so far to assist those displaced children. They also are procuring 5,500 back-to- school kits for primary students who have lost everything, and have completed putting together 500 hygiene kits based at the Sendai warehouse for distribution. Hypothermia has been reported particularly among the elderly population in the evacuation centers. SHELTER AND EVACUATION For the thousands of people who are living in their homes without electricity and water, there is no access to basic supplies unless they are able to receive it from one of the bigger evacuation centers. The local municipality for Minamisanriku-town in Miyagi Prefecture has plans to relocate some of its evacuees to other prefectures due to poor sanitation conditions in the evacuation centers and to allow children and the elderly to have better access to basic services. But a recent survey indicated that around 2/3 are not willing to move. The municipality planned to relocate evacuees to seven towns but a large number of evacuees prefer to remain where they are as many of them are still looking for family members. Many evacuees have been moved several times. This is taking a toll on the evacuees, especially the elderly. Majority of evacuation centers reported availability of three meals a day. Japan’s Chief Cabinet Secretary Yukio Edano said evacuation of residents within 20 km of Fukushima nuclear plant would be “long-term.” Around 78,000 people lived in the mostly rural area, while another 62,000 lie within the km radius. (CNN, BBC, Reuters) At least 20,000 foreign nationals have left Japan since the disaster - over 9,000 Chinese, 2,000 Australians, and 2,000 French citizens have left Japan, while more than 7,400 members of families of US military in Japan were also evacuated. IFRC Info Bulletin: 28 March 2011 OCHA SitRep No. 16: 1 April 2011COE-DMHA Update: 1 April 2011 SEEDS ASIA SitRep No. 11: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 NOTE: The transition of evacuees from shelters into planned housing will support the improvement of the health concerns associated with mass sheltering, including some psychological concerns. The number of evacuees is reportedly growing with new pressures mounting on the government to expand the 20km evacuation zone surrounding the Fukushima power plants. NOTE: The transition of evacuees from shelters into planned housing will support the improvement of the health concerns associated with mass sheltering, including some psychological concerns. The number of evacuees is reportedly growing with new pressures mounting on the government to expand the 20km evacuation zone surrounding the Fukushima power plants. Residents living between 20 and 30 km from the wrecked Fukushima No. 1 nuclear power plant were urged to evacuate. AP Photo.

34 The Special Task Force for Livelihood Support of the Affected Population says 40,500 government apartments and 19,500 public housing units are available for displaced families, making a total of approximately 60,000 apartments. Among them, 42,145 are immediately available. 70,409 evacuee families are currently living in evacuation centers. The Ministry of Land, Infrastructure and Transportation says that only 8% of the land needed for the construction of temporary shelters has been secured. The construction of temporary shelter is underway but far below the number requested by prefectures. The GoJ plans to have 30,000 houses built in the next two months. So far, land has been allocated for only 2,645 shelters. A lack of clean water for evacuees’ personal hygiene is posing public health risks in some evacuation centers. Media reports that the Ishinomaki Red Cross Hospital found that sanitation and hygiene environment is deteriorating in 30 per cent of the 314 evacuation centers that they have assessed in Ishinomaki, Higashi-Matsushima and Onagawa in Miyagi. Excrete disposal is a particular challenge. The local social welfare office is conducting a training on drainage work and maintenance of toilets. Ministries such as the Ministry of Defense have provided bathing services to 1.2 million people so far. For evacuees, not being able to wash regularly or change their clothes is a particular hardship. Iwate Prefecture announced that they are increasing the number of temporary shelters from 8,800 to 18,000, to cover 40,000 to 50,000 people. Miyagi Prefecture has announced that construction of 1,195 shelters will start on April 5 in 11 towns and cities. SHELTER AND EVACUATION Rikuzentakata is the first municipality in the earthquake/tsunami area to start the registration process. The media is reporting mixed feelings towards the registration as while evacuees are keen to leave the evacuation centers where access to basic services is extremely limited, they are also concerned about remaining in the areas destroyed by the tsunami. At least 8,800 temporary housing units will be built in the prefecture. An association of landlords, the Zenjyu Association, has established a system to help landlords across the country offer vacant apartments at a discounted rent to the people affected by the disaster. 418,000 vacant apartments have been offered so far. Also, The Ministry of Agriculture, Forestry and Fisheries is looking at available accommodation in Japan’s fishing and farming villages as the population in these villages has been steadily decreasing over the years. The Ministry is collecting detailed information from local municipalities in order to make an allocation plan. Local authorities are facing difficulties in finding suitable land, as the coastal area in Tohoku is mountainous, making it difficult to find flat land, and a large part has been damaged by the tsunami. The Ministry is also considering purchasing material for the construction of temporary shelters from abroad, if they have the same cost, size and design specifications as Japan. After the 1995 Kobe earthquake, 3,300 temporary shelters were imported, as they could not all be procured in-country. OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 COE-DMHA Update: 1 April 2011 IFRC Info Bulletin: 28 March 2011 Elderly people in the high school evacuation centre in Otsuchi. Photo: IFRC

35 LOGISTICS AND TRANSPORTATION LOGISTICS The shortage of fuel is the biggest obstacle to delivering relief supplies and keeping people warm. Up to 700 tanker trucks have been mobilized from other parts of the country to ease the situation. Because 4 out of 7 supply bases of liquefied petroleum (LP) gas are not operational, the Ministry of Economy, Trade and Industry will release 40,000 tons from the national reserve for the first time from 4 April. Although 88% of gasoline, diesel and kerosene shipments have resumed to Tohoku region, there is still a serious fuel shortage. The areas surrounding the Fukushima Power Plants are also receiving emergency fuel. The number of fuel stations operating is still limited and needs have increased due to the disruption in public transport and increased number of emergency vehicles. There are long lines and the public is restricted to 20 liters of fuel a day. The GoJ says it will spend US$209.9 million (JPY1.7 billion) to solve the emergency fuel shortage. Disruption in supply chain sources many of which were concentrated in the east as well as significant shifts in demand patterns had an impact on the supply of certain essential items such as bottled water and fuel. The GoJ says 11,257,000 liters of fuel have been delivered to the affected areas to date. Another 29,000 liters is in transit. Approximately 1 million liters arrived on 28 March. GoJ has made progress in establishing the supply chain of petroleum to the Tohoku region, securing a supply of 22,000 kiloliters per day. The areas surrounding the Fukushima Power Plants are also receiving emergency fuel. The Japan Medical Association started to ship insulin to affected sites but there has been difficulty in reaching the affected areas because of bad road conditions and lack of fuel. Relief items are being delivered on foot in some places. A logistics concept of operations to strengthen and enhance JRCS logistics capacity has been shared with the National Society but has yet to be discussed in detail. A more detailed plan of action is currently being developed, including enhancing logistics infrastructure, information flows, creating a logistics hub, shipping by sea/air options and increasing warehouses in the field. OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 21: 30 March 2011 IFRC Info Bulletin No.5: 28 March 2011 MLIT 2011 Earthquake Outline 36 th Report: 28 March 2011 TRANSPORTATION The Ministry of Land, Infrastructure and Transport reports that 99% of highways and main roads have been repaired, excluding those near the Fukushima Nuclear Power Plant. Traffic on some main thoroughfares such as the Tohoku expressway has increased to 1.3 times traffic before the quake due to the large number of emergency vehicles. ROADS: As of 1 April, 2,126 damaged roads have been reported from 11 prefectures (Aomori, Miyagi, Yamagata, Akita, Tokyo, Ibaragi, Tochigi, Saitama, Gunma, Chiba and Iwate). There were reports of 56 damaged bridges in four prefectures. Although almost all main roads have been cleared, many local and residential roads are still impassable due to debris. More than 37,200 vehicles are now passing through the Tohoku Expressway per day, which is 1.3 times more traffic than before the disaster struck. AIRPORTS:13 airports in the affected areas are open for scheduled and chartered flights. Sendai Airport is open 24-hours for humanitarian flights, but has inadequate warehousing for relief needs. The World Food Programme (WFP) has been asked to assist in improving warehousing. 71% of domestic flights have resumed in Japanese airports. SEA PORTS:15 of 15 ports in the affected area are usable. (multipurpose piers are partly available (Excluding Aomori Port). RAILWAY LINES: Railway lines are still under repair. As of 1 April, 26 railways have been reported as destroyed. Railway service has resumed for 62% of bullet trains and 60% of local trains. The interim assessment of the East Japan Railway Company has assessed half of the total railway tracks and found that 23 train stations and 22km worth of railway tracks have been completely washed away in the region. According to NHK, the Tohoku bullet train is expected to resume full service in late April. The route runs through affected regions, and repair work will take more than a month, but the line sustained minor damage.


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