Great East Japan Earthquake and Tsunami. Complete Record Document Covering from Relief Activities to Recovery Support

Transcription

1 Great East Japan Earthquake and Tsunami Complete Record Document Covering from Relief Activities to Recovery Support

2 Great East Japan Earthquake and Tsunami Complete Record Document Covering from Relief Activities to Recovery Support All figures, facts, etc., included in this document are a faithful translation of the Japanese version, which was published on November 29, In principle, this record document contains the results of operations carried out from the day of the earthquake and tsunami to December 31, 2012 (as of March 31, 2013 for figures related to the settlement of accounts).

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4 On the Publication of the Record Document The Great East Japan Earthquake and Tsunami(GEJET)caused tremendous damage, with a death toll of more than 15,000 lives. Local administrative agencies also suffered immense damage, leaving us completely unable to engage in disaster relief activities in response to their requests as we would normally do. Despite those circumstances, 55 of the Japanese Red Cross Society (JRCS) medical teams nationwide headed for the affected areas on the day of the disaster and immediately started relief activities. For the six subsequent months, JRCS put all its energy into carrying out the largest-ever relief activities. Not only did Red Cross Hospitals around the country provide medical relief, but the JRCS Blood Centers and Social Welfare Facilities also sent their personnel to the affected areas to provide support for the first time. The total number of personnel who participated in these activities exceeded 7,000. Many activities continued, meeting the needs of victims as they changed with the passage of time, and examples of these included psychosocial care, health counseling by nurses, and a wide range of services provided by JRCS volunteers and Red Cross Youth members from throughout the country as well as from the affected areas. Personnel at JRCS Headquarters struggled from day to day to provide logistical support for the dispatch of medical teams and received a large amount of Gienkin (cash grant scheme). We are proud that so many JRCS people joined forces in these activities, an experience unparalleled even in the history of JRCS. While we engaged in activities that befitted a Red Cross Society, there were many issues left for reconsideration since it was such a huge and unprecedented disaster. Our response to the accident at the nuclear power plant was not sufficient due to the lack of information and inadequate preparedness. We keenly realized the importance of independently assessing the situation without relying entirely on administrative agencies and swiftly establishing appropriate policies on how to respond to the situation. In particular, we received various opinions and critical comments from the nation about the fairness with which Gienkin were allocated and the speed with which they were delivered to the affected people. We are currently endeavoring to improve the way such Gienkin are allocated and delivered to the affected areas by sharing our experience of the problems involved with related organizations that receive contributions as well as with the national and local governments. The whole world paid attention to the recent disaster and up to now we have received Gienkin totaling over 320 billion yen, approximately three times the amount received after the Great Hanshin-Awaji Earthquake of 1995, and in addition 100 billion yen was contributed from overseas. In order to meet the expectations of people in Japan and abroad regarding JRCS and their trust, we must provide for dealing with emergencies in normal times and engrave this on our hearts. If a disaster of unheard-of dimensions caused many unexpected events, the response to such events would have to require an unexpected, enterprising spirit. This is exactly the role that Red Cross is expected to play. This document is intended to offer lessons for future improvements by faithfully recording all the activities of the JRCS after GEJET. I would like to take this opportunity to pray again for the souls of those who died in this earthquake and tsunami and express my deep sympathy with those who were stricken by the disaster. And I would like to conclude my comments on the publication of this document by thanking all of those who worked in the affected areas, supported the relief and recovery operation, and extended tremendous support. November 29, 2013 Tadateru Konoe President Japanese Red Cross Society

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6 Relief Activities of the Japanese Red Cross Society as seen in photographs

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8 At 2:46 p.m. on March 11, 2011, a massive earthquake occurred registering a magnitude of 9.0 on the Richter scale whose epicenter was off the Sanriku coast. The Headquarters of the Japanese Red Cross Society (JRCS) immediately established a third-level relief regine under which it would engage in nationwide relief activities. OTSUCHI, IWATE The Headquarters of Disaster Control (HDC) at the Headquarters 1

9 Preparations for Support Activities Immediately after the earthquake occurred, JRCS started to prepare for relief and support and dispatched medical teams to the affected areas, FUKUSHIMA, MIYAGI and IWATE. It also sent relief supplies such as blankets, emergency kits and sleeping kits to the affected areas. Personnel and volunteers loading boxes of blankets onto a 10-ton truck Official ceremony to dispatch a medical team A convoy of JRCS vehicles heading north on the New Tomei Expressway 2

10 An advance team of the Headquarters gained entry to the affected area 3

11 Emergency Relief activities Emergency Relief Self Defense Force (SDF) officials, Firefighters and Police officers from throughout the country also rushed to the affected areas to undertake emergency relief activities. JRCS worked with people from these disaster-response organizations on site to rescue the disaster victims. A child rescued by a SDF official A doctor watching the take-off and landing of a helicopter 4

12 Since the Ishinomaki Red Cross Hospital (RCHP), located in ISHINOMAKI, MIYAGI, was the only medical institution that escaped damage from the disaster in the Ishinomaki Medical Region, medical teams from around the country gathered there. In order to accommodate more patients, the hospital even used its lobby for medical care. It saved the lives of many victims. A scene of the medical relief activity at the Ishinomaki RCHP immediately after the occurrence of the disaster Medical teams gathered at the Ishinomaki RCHP 5

13 Medical Relief Activities Medical teams dispatched from around the country established emergency-aid stations at the evacuation centers to provide medical care while coordinating with local HDC. In addition, they visited the homes of affected people to diagnose and treat the victims who lived there. Traveling from shelter to shelter in the darkness with the aid of candle light to provide medical care Visiting the Iwate Prefectural Takata High School to provide medical care An emergency-aid station established at the Takata Municipal Daiichi Junior High School, IWATE A member of a medical team sorting out the sick and wounded in a triage process and SDF officials transporting the sick and wounded Relief activities associated with a temporary return to the caution zone designated after the nuclear power plant accident 6

14 A scene from an evacuation center in RIKUZENTAKATA, IWATE Emergency kits (including items such as a radio, a hand towel, a tooth brush and detergent) delivered to evacuees at an evacuation center 7

15 Supported by Volunteers Immediately after the earthquake and tsunami, JRCS volunteers from around the country started to engage in relief activities within and outside the affected areas in an effort to help the victims. By March 2012, a total of over 170,000 volunteers had joined activities such as calls for donation, the preparation of hot meals, cleaning, and psychosocial care. The activities of these volunteers are still continuing. Volunteers helping to remove mud from an affected store 8 A group of volunteers providing hot meals

16 Psychosocial Care Support In order to alleviate the psychosocial burden on the affected people as much as possible, JRCS nurses and volunteers visited evacuation centers and temporary housing. They not only listened to the troubles facing the victims, but also referred them to specialists as required. They also played the role of local public health nurses mainly through health counseling. JRCS nurses checking the health of victims at an evacuation center A JRCS volunteer on a visit to temporary housing regularly 9

17 Support from within the country and abroad News of the damage from the tsunami spread quickly around the world. Immediately after the disaster, the circle of supporters spread throughout Japan and abroad and JRCS received not only individual donations, but also about 59.6 billion yen in donations from organizations such as the 100 Red Cross and Red Crescent Societies around the world. The Kuwaiti government provided five million barrels of crude oil free of charge. Some 40.1 billion yen, equivalent to its purchase price, was donated to JRCS, and these donations have been appropriated for the recovery operations in the three affected prefectures. Fund-raising campaign by volunteers The official ceremony for the Kuwaiti government s contribution of five million barrels of crude oil 10

18 Junior Red Cross Members of Fukushima advertising agricultural products from FUKUSHIMA and appealing for cooperation in collecting donations in TOKYO Overseas young people supporting TOHOKU Representatives from Red Cross and Red Crescent Societies worldwide gathered to discuss how to use the donations collected. 11

19 Recovery Operations JRCS not only provided emergency relief, but also worked to establish recovery operations in order to assist recovery in the affected areas. The main pillars of the recovery operations based on international donations were to support the rebuilding of the lives of the victims, to provide education and welfare services, and give direct medical care as well as to take measures to cope with the nuclear power plant accident, and JRCS always stayed close to the victims. Donating a set of six electric household appliances School bus taking children to and from their schools Victims enjoying Nordic walking together with Ms. Norika Fujiwara, a public-relations ambassador Ichigo Sugawara A whole body counter installed at the Fukushima RCHP Nobuyuki Kobayashi 12 A temporary clinic built to support the collapsed Shizugawa Public Hospital A donated welfare vehicle

20 Nagaya style rows of connected housing, a public housing built in SOMA, FUKUSHIMA A temporary building of Naraha Municipal Aozora Child Care Center constructed within the campus of Meisei University in IWAKI, FUKUSHIMA 13

21 An event held to commemorate the re-opening of the Onagawa Community Medical Center, which completed work on its repair using international donation Ishinomaki Fishery Cooperative Association s laver farm was restored using donation from overseas to purchase laver seedlings 14

22 Indoor playground Smile Parks, which were installed to enable children in FUKUSHIMA to play to the full Summer Camping in a Cross Village Program, which invited children in IWATE, MIYAGI and FUKISHIMA to HOKKAIDO 15

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24 Contents Introduction 1.Overview of the earthquake 2 2.Damage 4 3.GEJET and the activities of the Japanese Red Cross Society (This section is omitted) 11 4.Movement of the Honorary President and Honorary Vice Presidents 11 Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities 1.HDC at the Headquarters of the Japanese Red Cross Society (JRCS) 14 2.The Iwate Chapter HDC 24 3.The Miyagi Chapter HDC 27 4.The Fukushima Chapter HDC 31 5.Other Chapters HDC 35 6.Initiatives of the national and local governments as well as other related organizations after the earthquake 39 Chapter 2 Provision of Medical Relief 1.Mobilization of Medical Teams 42 2.Activities of Chapters in All Prefectures Nationwide 51 3.Conditions of Hospitals in the Disaster-Stricken Areas 56 4.Support from Blood Centers in the Disaster-Affected Areas and Nationwide 78 5.Various Activities Responding to Needs 87 Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital 1.Damage due to the GEJET 94 2.Activities inside the Hospital 97 3.Joint Medical Team Activities in the Ishinomaki Area Approach from Before the Disaster 115

25 Chapter 4 Response to the Fukushima Daiichi Nuclear Power Plant Accident 1.Outline of the Accident JRCS Medical Services (Response to Radiation) Medical Services for Temporary Access to a Restricted Area Other Services 129 Chapter 5 Psychosocial Care 1.Development of the Psychosocial Care Program Activities in the three Chapters in the affected areas Cooperation with local government bodies and other parties concerned 144 Chapter 6 Distribution of Relief Supplies 1.The Situation in the Headquarters Activities in the three chapters in the affected areas Other support status Status of support from overseas 163 Chapter 7 Red Cross Volunteer Activities 1.Activities of the DRV center at the Headquarters Activities of volunteers in the affected areas Volunteer activities at various Chapters 179 Chapter 8 Recovery Assistance Program 1.Organizational regime of the recovery assistance program Implementation regime of the recovery assistance programs Actual achievements of the recovery assistance programs Assistance from Kuwait Accounting and audit 214 Chapter 9 Gienkin (Cash grant scheme) 1.Gienkin ; Cash grant scheme Handling of Gienkin Collection status of Gienkin Transfer and distribution status of Gienkin 223

26 5.Response system for the Gienkin Public relations activities and public opinion related to Gienkin Discussion about the future methods of handling Gienkin 230 Chapter10 Relationship with the International Red Cross and Red Crescent Movement 1.Liaison/coordination with the International Federation of Red Cross and Red Crescent Societies (IFRC), the International Committee of the Red Cross (ICRC) and the National Red Cross and Red Crescent Society (NS) etc., in the initial response Acceptance response to the declaration of relief Tracing service activity Response and accountability to donors Holding of various meetings and conferences Implementation of the evaluation by the IFRC evaluation team 263 Chapter 11 Public-Relations Activities 1.Early response (From the day of the disaster to the end of March) Domestic PR activities Effective use of the mass media International public relations Other PR activities 290 Chapter 12 Others (This section is omitted) 294 Chapter 13 Summary of Disaster Relief Services for the GEJET 1.Review (Examination) by Blocks Implementation of the Overall Summary of the JRCS Disaster Relief Services for the GEJET Reinforcement Plan of Medical Relief Equipment for strengthening institutional disaster preparedness 305 Chapter 14 Notes (This section is omitted) 310 Afterword How to operate DVD-ROMs

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28 Introduction

29 Great East Japan Earthquake and Tsunami Introduction Introduction 1.Overview of the earthquake At 2:46 p.m. on March 11, 2011, an earthquake occurred registering a magnitude of 9.0 on the Richter scale whose epicenter was off the Sanriku coast (38º06.2 north latitude and 142º51.6 east longitude, 24 km deep). The Japan Meteorological Agency called it the 2011 off the Pacific Coast of Tohoku Earthquake. In accordance with its cabinet decision on April 1, the government called the disaster caused by the off the Pacific Coast of Tohoku Earthquake and the one that had resulted from the nuclear power plant accident following the Great East Japan Earthquake and Tsunami(GEJET). GEJET is summarized as follows: (i) Time of occurrence 2:46 p.m. on March 11, 2011 (ii) Epicenter Off the Sanriku coast (38º06.2 north latitude and 142º51.6 east longitude) (iii) Depth of the epicenter 24 kilometers (iv) Magnitude of the earthquake 9.0 (v) Intensity on the Japanese scale of zero to seven measured at municipalities (5 lower or higher) The table below shows the maximum intensity observed in each prefecture and the points where it was observed. The maximum intensity observed was 7 as measured in KURIHARA, MIYAGI. An intensity of 5 lower or higher was observed in 17 prefectures, indicating that the earthquake caused damage to a wide range of areas in eastern Japan. Figure 0-1 Distribution of the Seismic Intensities of the Main Shock of GEJET Intensity 7 MIYAGI KURIHARA SHINCHI, NAMIE, FUTABA, OKUMA, TOMIOKA, NARAHA, KAGAMIISHI, FUKUSHIMA Intensity 6 NIHONMATSU, SUKAGAWA and SHIRAKAWA upper IBARAKI HOKOTA, CHIKUSEI and KASAMA TOCHIGI TAKANEZAWA, MOKA, UTSUNOMIYA and OTAWARA Intensity 6 OSHU, ICHINOSEKI, HANAMAKI, YAHABA, TAKIZAWA, KAMAISHI and IWATE lower OFUNATO SAITAMA MIYASHIRO GUNMA KIRYU CHIBA INZAI and NARITA AOMORI OIRASE, HASHIKAMI, GONOHE, TOHOKU and HACHINOHE Intensity 5 AKITA DAISEN and AKITA upper YAMAGATA YONEZAWA, OBANAZAWA, NAKAYAMA and KAMINOYAMA TOKYO NIIJIMA, EDOGAWA, ADACHI, ITABASHI, ARAKAWA, SUGINAMI, NAKANO, KOTO and CHIYODA KANAGAWA NINOMIYA, SAMUKAWA, KAWASAKI and YOKOHAMA s NAKA NIIGATA MINAMIUONUMA and KARIWA FUJI KAWAGUCHIKO, YAMANAKAKO, FUJIGAWA, CHUO, KOSHU, Intensity 5 YAMANASHI YAMANASHI HOKUTO, FUEFUKI, MINAMI ALPS and KOFU lower NAGANO NAGANO MINAMIMAKI and SAKU SHIZUOKA GOTEMBA Source: This table has been created using data from the Meteorological Agency s website. (vi) Tsunami The tsunami that ensued from the earthquake made the damage from the disaster even more serious. By 6:00 p.m. on March 11, the Meteorological Agency observed a tsunami that reached the eastern, central, and western parts of the Pacific coast of HOKKAIDO; the coast along the Sea of Japan of AOMORI and its Pacific coast; IWATE, MIYAGI, FUKUSHIMA and IBARAKI; the KUJUKURI, SOTOBO, and UCHIBO regions of CHIBA; coasts along Tokyo Bay; the IZU 2

30 and OGASAWARA Islands; SHIZUOKA; AICHI facing the open sea; the southern part of MIE; and WAKAYAMA TOKUSHIMA and KOCHI. Introduction [OTSUCHI, IWATE, which suffered devastating damage] Figure 0-2 Values Observed at Major Observation Points (as of 6:00 p.m. on March 11) First wave Largest wave Area Date Time Wave type Height Date Time Height SOMA FUKUSHIMA 2:55 p.m. Push 0.3 m 3:50 p.m. 7.3 m or more OARAI IBARAKI 3:15 p.m. Push 1.8 m 4:52 p.m. 4.2 m or more MIYAKO IWATE 2:48 p.m. Push 0.2 m 3:21 p.m. 4.0 m or more KAMAISHI IWATE 2:45 p.m. Pull 0.1 m 3:21 p.m. 4.1 m or more OFUNATO IWATE 2:46 p.m. Pull 0.2 m 3:15 p.m. 3.2 m or more AYUKAWA, MIYAGI 2:46 p.m. Push 0.1 m ISHINOMAKI March 11 March 11 3:20 p.m. 3.3 m or more HANASAKI, Slightly HOKKAIDO 3:34 p.m. Pull NEMURO higher 3:57 p.m. 2.8 m URAKAWA HOKKAIDO 3:19 p.m. Pull 0.2 m 4:42 p.m. 2.7 m HACHINOHE AOMORI 3:22 p.m. Pull 0.8 m 4:51 p.m. 2.7 m Tomakomai Higashi Port HOKKAIDO 3:40 p.m. Pull 0.2 m 4:17 p.m. 2.5 m Source: This table has been created based on the Japan Meteorological Agency s news release The 2011 off the Pacific Coast of Tohoku Earthquake (Fourth Report). Later, however, it became clear that there were points where the maximum tsunami level had not been obtained mainly because the measurement facilities there had been damaged, leaving subsequent tidal waves unobserved. Therefore, the Agency investigated the height of tsunami at these observation points from March 28 to April 2 using the traces of the tsunami and other types of evidence, and the height of tsunami thus estimated is as shown below. Figure 0-3 Values Observed at Major Observation Points Observation points Height of the tsunami estimated from its traces and other types of evidence Height of the largest tsunami based on tsunami recorders, etc. HACHINOHE AOMORI 6.2 m 2.7 m or more Kuji Port IWATE 8.6 m MIYAKO IWATE 7.3 m 8.5 m or more* KAMAISHI IWATE 9.3 m 4.1 m or more OFUNATO IWATE 11.8 m 8.0 m or more* AYUKAWA, ISHINOMAKI MIYAGI 7.7 m 7.6 m or more* Sendai Port MIYAGI 7.2 m SOMA FUKUSHIMA 8.9 m 7.3 m or more * This table is based on quick reports issued in the form of tsunami information and the results of analysis of records collected at tsunami observation points at a later date (marked with an asterisk). Some of the observation facilities were heavily damaged, and due to the effects of such damage, these facilities might not have been able to observe the height of the tsunami properly. Source: This table has been created based on the Meteorological Agency s press release The height of the tsunami near tsunami observation points based on field surveys (April 5, 2011). Great East Japan Earthquake and Tsunami 3

31 Great East Japan Earthquake and Tsunami Introduction 2.Damage The massive earthquake and tsunami, which occurred on March 11, 2011, caused tremendous damage to the Pacific coast the Japanese archipelago from HOKKAIDO to SHIKOKU. According to the data collected by the National Police Agency, as of October 31, 2012, 19 months after the disaster, the toll of casualties was extremely high with 15,872 dead, 2,769 missing, and 6,114 injured. In particular, serious damage was caused in Iwate, Miyagi, and Fukushima Prefectures with most human loss of life accounted for by these three prefectures. According to the figures collected by the Reconstruction Agency, the number of earthquake-related deaths 1 those who died for reasons such as health deterioration due to injuries suffered from the earthquake was 2,303 nationally as of September 30, By age group, the number of those who died according to these circumstances at the age of 66 or older was 2,070, accounting for a majority of the earthquake-related deaths. Meanwhile, as of October 31, 2012, the data collected by the National Police Agency on damage caused to buildings indicated that 129,591 buildings were totally destroyed and 266,231 half destroyed. In each of IBARAKI and CHIBA as well as IWATE, MIYAGI, and FUKUSHIMA, which suffered serious damage from the tsunami, the number of totally or half destroyed buildings reached tens of thousands to hundreds of thousands. Furthermore, if the number of buildings inundated below or above the ground floor level is included, a total of over 1.2 million buildings nationwide suffered a certain amount of damage. The damage caused to human lives and houses in the three prefectures (IWATE, MIYAGI, and FUKUSHIMA) in TOHOKU region and the northern part of the KANTO region was particularly serious, but a wide range of areas, including 22 prefectures nationwide, sustained damage from the disaster. Area Disaster types Figure 0-4 Damage Caused by GEJET, and the Measures Taken by the Police Dead persons People missing People injured Seriously injured Slightly injured Total Completely destroyed Half destroyed Washed away Building damage Totally destroyed by fire Half destroyed by fire People People People People People Buildings Buildings Buildings Buildings Buildings Buildings Buildings Buildings Buildings Locations Locations Locations Locations Locations HOKKAIDO AOMORI ,363 2 IWATE 4,671 1, ,199 5, , ,741 4, MIYAGI 9,529 1,359 4,140 85, , ,475 12, ,262 26, AKITA YAMAGATA FUKUSHIMA 1, ,014 71, , ,306 1, TOKYO ,847 1, IBARAKI ,620 24, , ,132 19, TOCHIGI ,109 72, GUNMA , SAITAMA , CHIBA , , , KANAGAWA NIIGATA YAMANASHI NAGANO 1 1 SHIZUOKA GIFU 1 MIE TOKUSHIMA 2 9 TOHOKU KANTO CHUBU SHIKOKU Inundated above the ground floor level Inundated below the ground floor level KOCHI Total 15,872 2,769 6, , , ,587 15, ,810 55,753 4, * This data includes unconfirmed information. * The damage caused by GEJET includes that caused by aftershocks such as the one that occurred on April 7 and whose epicenter was off MIYAGI, as well as the subsequent ones that occurred in FUKUSHIMA s Hamadori area on April 11 and 12, in the northeastern part of CHIBA on May 22, off FUKUSHIMA on July 25 and 31 and August 12 and 19, in the northern part of IBARAKI on September 10, off FUKUSHIMA on October 10, in the northern part of IBARAKI on November 20, 2011 and February 19, 2012, off IBARAKI on March 1, and off MIYAGI on June 18. Source: This table has been created based on the National Police Agency Emergency Disaster Countermeasures Headquarters news release Damage caused by the 2011 off the Pacific Coast of Tohoku Earthquake and the Measures Taken by the Police (October 31, 2012). Partially damaged Uninhabited houses damage Roads damage Bridge damage Landslides Collapsed banks Railways damage (1) According to the Reconstruction Agency s news release The number of deaths related to GEJET issued on November 2, 2012, earthquake-related deaths are defined as those who died for reasons such as health deterioration due to injuries sustained from GEJET and to whom disaster condolence money was paid in accordance with the Act on Arrangements Such as Payment of Disaster Condolence Money (including those to whom such money has actually not been paid). 4

32 Figure 0-5 Number of Deaths Related to GEJET (by Prefecture and by Age Group) as of September 30, 2012 Prefecture Total By age group 20 years old or less 21 years old or more and 65 years old or less 66 years old or more National total 2, ,070 IWATE MIYAGI YAMAGATA FUKUSHIMA 1, ,031 IBARAKI SAITAMA CHIBA TOKYO KANAGAWA NAGANO Source: This table has been created based on the Reconstruction Agency s news release The number of deaths related to GEJET (November 2, 2012). Introduction Figure 0-6 Trends in the Number of Evacuation Centers and Evacuees (Those Who Lived There) for GEJET Number of evacuation centers Day of the earthquake One week later Two weeks later Three weeks later One month later Two months later Three months later Four months later Five months later Six months later Seven months later Data collected by the National Police Agency Figures in parentheses indicate the number of evacuation centers in the three prefectures (IWATE, MIYAGI, and FUKUSHIMA) Number of evacuees (*1) Figures in parentheses indicate the number of evacuees in the three prefectures (IWATE, MIYAGI, and FUKUSHIMA) - 2,182 (1,874) 1,935 (1,335) 2,214 (1,240) 2,344 (1,063) 20, , , ,536 (1,198)(368,838)(216,963)(141,882)(124,450) 2,417 (897) 115,098 (94,199) 1,459 (799) - (536) - (334) - (112) - (73) 88,361 (67,073) Data collected by the Reconstruction Agency Number of evacuees staying at evacuation centers (community centers, schools, etc.) Figures in parentheses indicate the number of evacuation centers in the three prefectures (IWATE, MIYAGI, and FUKUSHIMA) Number of evacuees (*2) Figures in parentheses indicate the number of evacuees in the three prefectures (IWATE, MIYAGI, and FUKUSHIMA) ,143 17,798 (38,598)(16,138) 8,646 (7,379) 101,640 58,922 42,744 (75,215)(35,643)(20,659) 3,439 (2,468) 27,531 (7,583) 1,719 (921) 21,899 (3,432) *1 The data collected by the National Police Agency focused on evacuees who stayed at community centers, schools, and other public facilities as well as Japanese inns and hotels. *2 The Reconstruction Agency collected data at (1) evacuation centers (such as community centers and schools), (2) inns and hotels, and (3) other places (such as the houses of relatives and friends). Source: This table has been created based on the Reconstruction Agency s news release Trends in the number of evacuation centers and those who lived there (A comparison between GEJET, the Great Hanshin-Awaji Earthquake, and the Chuetsu Earthquake) (October 12, 2011). GEJET forced hundreds of thousands of people to evacuate. According to the data collected by the National Police Agency, one week after the earthquake, the number of evacuation centers was 2,182, and that of evacuees reached 387,739. According to the Reconstruction Agency, meanwhile, even seven months after the disaster, over 20,000 people had evacuated if those staying with relatives or friends were included (see Figure 0-6). According to the Reconstruction Agency s subsequent Great East Japan Earthquake and Tsunami 5

33 Great East Japan Earthquake and Tsunami Introduction announcement (see 2 below), as of August 2, 2012, the number of evacuees nationwide (including those who lived in temporary houses, etc.) was about 343,000. Of this number, about 210 persons were staying at evacuation centers such as community centers and schools while the majority of evacuees nationwide led their lives in temporary houses or similar accommodation. The evacuees lived in more than 1,200 municipalities of 47 prefectures nationwide. In particular, not only did the three prefectures have a large number of evacuees staying there, but they also had a total of a little less than 70,000 persons who evacuated to or were otherwise staying at places outside their jurisdiction. Immediately after the earthquake occurred, the power supply was cut off in a wide range of areas, mostly those served by the Tohoku Electric Power Company and Tokyo Electric Power Company, and the power failure affected some 7.6 million households on the day of the earthquake alone. Subsequently, power supply gradually returned to normal, and the power cut ended in the areas served by Hokkaido Electric Power Company on March 12 and in the areas covered by Tokyo Electric Power on March 19. But the power failure continued in the areas served by Tohoku Electric Power, affecting tens of thousands of households. Except for areas such as those where the houses and other buildings had been swept away, the power supply was fully returned to normal in the service areas on June 18. Areas Areas served by Hokkaido Electric Power Areas served by Tohoku Electric Power Areas served by Tokyo Electric Power Figure 0-7 Recovery of Power Supply Services 2011 March 11 March 12 March 13 March 14 March 31 Power supply Power supply Power supply Power supply returned to returned to returned to returned to normal normal normal normal About 2,000 households (at 5:00 p.m.) About 4.4 million households (at 9:00 p.m.) 3.18 million households (at 10:14 p.m.) About 3.15 million households (at 6:00 p.m.) About 500,000 households (at 6:54 p.m.) About 1.4 million households (at 7:00 p.m.) About 200,000 households (at 7:54 p.m.) About 940,000 households (at 5:00 p.m.) About 53,000 households (at 7:24 p.m.) About 170,000 households (at 10:00 a.m.) Power supply returned to normal Source: This table has been created based on the Ministry of Economy, Trade and Industry (METI) Nuclear and Industrial Safety Agency s Earthquake damage information (7th, 16th, 21st, 23rd reports), METI s new release The 2011 off the Pacific Coast of Tohoku Earthquake (March 31, 2011), and METI Nuclear and Industrial Agency s Earthquake damage information (201st report), issued on July 16, The supply of city gas (general and community gas) was cut mainly in MIYAGI, FUKUSHIMA, and IBARAKI immediately after the occurrence of the earthquake on March 11, 2011, affecting a total of about 420,000 households. Eventually, the city gas supply had been returned to normal in all service areas by May 3, 2011, but at the end of March, about three weeks after the disaster, gas supply to some 300,000 households mainly in MIYAGI was still suspended. Water supply was also cut in a wide range of areas immediately after the earthquake. On March 13, 2011, two days after the earthquake, the water outage affected over one million households. Later, the water supply gradually returned to normal, and by June 7, about three months after, it had returned to normal in all service areas except IWATE, MIYAGI, and FUKUSHIMA. And even in these three prefectures, which sustained heavy damage, the water outage ended in July to September except for some 45,000 households in areas where houses and other buildings had been washed away. Water supply was expected to return to normal, or new water supply systems were expected to be built, in the devastated areas of the three prefectures as reconstruction progressed in the future. (2) Number of evacuees nationwide announced by the Reconstruction Agency on August 8,

34 Figure 0-8 Recovery of City Gas Services Number of households affected by the gas cutoff City of Sendai Gas Bureau 268,398 Shiogama Gas (SHIOGAMA) 9,290 Kamaishi Gas (KAMAISHI) 5,613 General gas Joban Kyodo Gas (IWAKI) 5,627 Tohoku Gas (SHIRAKAWA) 12 Joban City Gas (IWAKI) 286 Kesennuma City Gas (KESENNUMA) 927 Ishinomaki Gas (ISHINOMAKI) 8,542 Community gas Miyagi Gas (SENDAI) 4,032 Source: This table has been created based on the METI s new release The 2011 off the Pacific Coast of Tohoku Earthquake (March 31, 2011), and METI Nuclear and Industrial Agency s Earthquake damage information (128th report), issued on May 7, Introduction Figure 0-9 Water Supply Cutoff and the Recovery of Water Supply Services (in Prefectures with 1,000 or More Affected Households) 2011 Period during which it was confirmed that the water supply was still cut Prefectures only in areas where houses and other March 13 March 31 June 7 buildings had washed away (number of houses that had been washed away) AOMORI About 1,800 households The services had already returned to normal - - IWATE About 80,000 households About 50,000 households About 20,000 households July 15, 2011 (21,116 houses) MIYAGI About 310,000 households About 130,000 households About 33,000 households September 2, 2011 (21,482 houses) FUKUSHIMA About 190,000 households About 50,000 households About 6,000 households September 2, 2011 (2,802 houses) AKITA About 1,700 households The services had already The services had already returned to normal returned to normal - YAMAGATA About 7,000 households 4 households The services had already returned to normal - IBARAKI About 470,000 households About 30,000 households The services had already returned to normal - TOCHIGI About 40,000 households About 590 households The services had already returned to normal - CHIBA About 300,000 households About 10,000 households The services had already returned to normal - NAGANO About 1,000 households About 250 households The services had already returned to normal - Source: This table was created based on the Ministry of Health, Labour and Welfare (MHLW) s news release Damage caused by and response to the 2011 off the Pacific Coast of Tohoku Earthquake (11th, 34th, 76th, 87th and 97th reports). Figure 0-10 Areas Where Water Cutoff Continued as of March 2012 (Areas Where Houses and Other Buildings Had Been Washed Away) Number of households affected by Prefectures the water outage (only areas where houses and other Municipalities, etc. buildings had been washed away) IWATE 21,161 households OFUNATO, RIKUZENTAKATA, KAMAISHI, OTSUCHI, MIYAKO, YAMADA, IWAIZUMI, TANOHATA, and NODA MIYAGI 21,317 households SENDAI, KESENNUMA, ONAGAWA, IWANUMA, NATORI, WATARI, SHICHIGAHAMA, YAMAMOTO, Ishinomaki District Water Supply Authority (ISHINOMAKI and MATSUSHIMA), and MINAMISANRIKU FUKUSHIMA 2,728 households FUKUSHIMA, MINAMISOMA, IWAKI, Soma District Water Supply Corporation (SOMA and SHINCHI), Futaba District Water Supply Corporation (HIRONO area) * Apart of those area have suspended activities such as damage surveys for reasons such as evacuation orders. Source: This table has been created based on the MHLW s news release Damage caused by and response to the 2011 off the Pacific Coast of Tohoku Earthquake (116th report) (March 23, 2012). Great East Japan Earthquake and Tsunami 7

35 Great East Japan Earthquake and Tsunami Introduction The communications and broadcasting infrastructures sustained considerable damage immediately after the earthquake but had returned to normal by the end of April The Ministry of Internal Affairs and Communications (MIAC) provided affected communication carriers and broadcasting stations with support such as lending satellite-based mobile phones and mobile communications equipment and distributing portable radios. Communications infrastructure Broadcasting infrastructure Figure 0-11 Recovery of Communications and Broadcasting Infrastructures Major damage caused Response Major damage caused Response Fixedline phones Mobile phones As for fixed-line phones (subscriber and ISDN circuits), about 11,000 lines (maximum: about one million lines) could not be used immediately after the earthquake. All exchanges for fixed-line phones (NTT East) had returned to normal by the end of April except for certain areas. Four mobile phone service providers stopped transmission at about 240 of their mobile base stations (maximum: about 14,800 stations). In all communications areas, the mobile phone services had returned almost to the pre-earthquake level by the end of April except for certain areas. - A total of 1,109 satellite-based mobile phones were lent (931 for communications carriers and 178 for the MIAC). - A total of 2,380 mobile communications devices were provided free of charge (985 for communications carriers and 1,395 for the MIAC). - About 140 special public phones were installed by communications carriers and other organizations. - In MIYAGI, one of the 56 TV relay stations stopped transmission because it was damaged. (This did not practically affect broadcasting services because houses and other buildings had been swept away in almost all of the areas covered by the damaged stations.) - At the request of 24 affected municipalities, the Ministry flexibly granted permission to set up temporary FM broadcasting stations (as of September 15). - On April 1, the MIAC requested NHK and the Japan Commercial Broadcasters Association (JCBA) in writing to swiftly provide the nation with detailed, accurate information on the disaster. - On March 11, the MIAC requested NHK, JCBA, and Tohoku s radio stations orally to provide substantial information on the disaster. - On March 16, at NHK s request, the MIAC approved measures to exempt the payment of viewing fees, and on June 24, it expanded the scope of areas covered by these measures. - With the cooperation of manufacturers, NHK installed 750 TV sets and 760 radio sets at evacuation centers. Over 40,000 radio sets from Panasonic, Sony, and other manufacturers were also provided through these centers. - The MIAC distributed 10,000 portable radios to the affected areas. Source: This table has been created based on the MIAC s announcement The Ministry s response to GEJET (as of 10:00 a.m. on August 28, 2012). In addition to the damage that the earthquake and tsunami caused directly, GEJET inflicted serious damage on transport networks in a wide range of areas due to the effects of the accident at the Fukushima Daiichi Nuclear Power Plant. Particularly in MIYAGI, the tsunami caused major damage to railways along the coastal areas and other means of transport, and even 18 months after the disaster, these transport facilities had not completely returned to normal. According to the Ministry of Land, Infrastructure, Transport and Tourism (MLIT), by November 5, 2012, about 20 months after the disaster, all roads (expressways and directly managed national highways), Shinkansen lines, and airports had returned to normal whether they were used for disaster countermeasures or general purposes. At the same time, however, train services still remained totally or partially suspended on eight lines of JR East railways and the Sanriku Railway, except for the sectors (66.8 km) in the precautionary and other zones designated due to the nuclear power plant accident. The proportion of ports restored from HACHINOHE to KASHIMA was 80% with some of these ports requiring repair work for most of their facilities even though they are still usable. For other facilities, restrictions were placed on the maximum drafts or maximum vertical loads when they were in use. 8

36 Figure 0-12 Damage Caused due to the Disaster Such as Damaged Roads Damage caused by the disaster Roads damaged Bridges damaged Landslides Collapsed banks Railways damaged Prefectures HOKKAIDO AOMORI 2 IWATE TOHOKU MIYAGI AKITA 9 YAMAGATA FUKUSHIMA TOKYO IBARAKI TOCHIGI GUNMA 36 9 SAITAMA 160 KANTO CHIBA 2, KANAGAWA NIIGATA YAMANASHI NAGANO SHIZUOKA CHUBU GIFU 1 MIE SHIKOKU TOKUSHIMA KOCHI Total 4, * The figures include unconfirmed information. * The damage caused by GEJET includes that caused by aftershocks such as the one that occurred on April 7 and whose epicenter was off MIYAGI, as well as the subsequent ones that occurred in FUKUSHIMA s HAMADORI area on April 11 and 12, in the northeastern part of CHIBA on May 22, off FUKUSHIMA on July 25 and 31 and August 12 and 19, in the northern part of IBARAKI on September 10, off FUKUSHIMA on October 10, in the northern part of IBARAKI on November 20, 2011 and February 19, 2012, off IBARAKI on March 1, and off MIYAGI on June 18. Source: This table has been created based on the National Police Agency Emergency Disaster Countermeasures Headquarters news release Damage caused by the 2011 off the Pacific Coast of Tohoku Earthquake and the Measures Taken by the Police (August 1, 2012). Introduction [A large vessel cast up on the shore in KAMAISHI, IWATE] Great East Japan Earthquake and Tsunami 9

37 Great East Japan Earthquake and Tsunami Introduction Figure 0-13 Recovery of the Transport Networks This figure is omitted. Figure 0-14 Trends in the Recovery of Transport Facilities Lines, etc. Damage caused Road to recovery [Roads] Expressways Tohoku Expressway Joban Expressway - The 150-km embankment of the Joban Expressway between the Mito and Naka interchanges subsided with its road surface undulated. - A total of 15 expressways were closed. - As of February 6, 2012, there were no longer any closed expressways (excluding sectors in the planned evacuation zones). Directly managed national roads National Route 4 National Route 45 National Route 6 - Girders of five bridges on National Route 45 running along the Pacific coast were washed away. Large portions of the embankment at the back of abutments were also swept away. - National Routes 45 and 6 were widely inundated with water, and waste and other objects brought by the disaster were deposited on the roads. - Irregularities such as differences in surface level and damaged joints occurred on roads such as National Routes 51 and A total of 69 sectors along national roads were closed. - Thanks to emergency recovery, all sectors of National Route 45 (478 km) had become passable by April 10, 2011, one month after the disaster. - In mid-july 2011, temporary bridges for the Kesen Bridge and the Koizumi Bridge were completed, making all wide-area detours unnecessary. - On February 3, 2012, National Route 45 came into service with one way open to traffic. With this resumption of its service, there were no longer any closed directly-managed national roads (excluding ones within the precaution zone designated after the nuclear power plant accident). Roads managed by local governments - Along the Pacific coast, a total of twelve bridges on roads managed by local governments fell down or were washed away for reasons such as the tsunami. In addition, there were various kinds of damage such as differences in levels, cracks, small collapses, and damaged bridges. - A total of 102 sectors on national roads managed by prefectural governments, etc., were closed. - As of February 6, 2012, two sectors of the roads managed by local governments were closed. [Railways] Shinkansen Tohoku, Yamagata, Akita, - By 3:16 p.m. on March 11, 30 minutes after the occurrence of the earthquake, 90 railways operators, including JR companies (Shinkansen and old lines) as - By November 5, 2012, all Tohoku, Akita, and Yamagata Shinkansen lines and 99% of the old track lines (on a working-kilometer basis) had returned to normal. Joetsu, Nagano, and Tokaido well as private and third-sector railway companies, had - The Tohoku Shinkansen resumed its services between suspended the operation of 267 of their lines due to the damage caused by the disaster. - The Tohoku Shinkansen was damaged at about 1,200 locations, and the damage caused included broken, leaned, or cracked electric poles (about 540 locations), cut power lines (about 470 locations), and damaged viaducts (about 100 locations). Tokyo and Nasu-Shiobara on March 15 and between Shin- Aomori and Morioka on March 22. Then its services were resumed between Nasu-Shiobara and Fukushima on April 12, between Morioka and Ichinoseki on April 23, and between Fukushima and Sendai on April 24. Finally, with the completion of the restoration work between Sendai and Ichinoseki on April 29, the Tohoku Shinkansen resumed operation for all its sectors. Old railroad lines - The major damage caused by the tsunami to seven lines (Hachinohe, Yamada, Ofunato, Kesennuma, Ishinomaki, Senseki, and Joban) included 23 railway stations washed away, about 60 kilometers of tracks washed away or buried by earth, and 101 bridge girders washed away or buried by earth. Old lines other than these seven were damaged at about 4,400 locations. - There is still no expected period for the railways in the coastal areas to return to normal and resume operations. - The operation of the Joban Line is still suspended between Hirono and Haranomachi and between Soma and Watari, including sectors located within 20 km of the Fukushima Daiichi Nuclear Power Plant where the nuclear power plant accident occurred. [Airports] Sendai Airport Hanamaki Airport Fukushima Airport Ibaraki Airport - Sendai, Hanamaki, Fukushima and Ibaraki Airports were hit by the earthquake. - An intensity of 6 upper was observed at Sendai Airport, which was stricken by the tsunami about one hour after the earthquake. The airport was closed with its basic and air navigation facilities and terminal buildings heavily damaged. - On March 15, at Sendai Airport, the operation of helicopters for relief activities was resumed, and airport restoration work began to facilitate the transport of relief supplies. On September 25, the full restoration of passenger terminal buildings was completed, bringing the airport into service. - Fukushima, Hanamaki, and Ibaraki Airports continued operations even from the day of the disaster by restoring the control tower and terminal buildings temporarily as an emergency stopgap. At Ibaraki and Hanamaki Airports, commercial airline companies resumed operation of their scheduled flights on March 14 and March 17, respectively. [Seaports] - All seaports along the Pacific coast from AOMORI s HACHINOHE to IBARAKI s KASHIMA were hit by the earthquake and tsunami. Breakwaters piers and other facilities were heavily damaged, causing all port functions to stop. - As of February 29, 2012, 275 of the 373 public piers at 21 ports were usable, and as of November 5 of the same year, 306 were usable. Source: This table has been created based on the MLIT s record document Record of GEJET: MLIT s response to the disaster (March 11, 2012) and MLIT s report Recovery of transport facilities (as of 10:00 a.m. on November 5, 2012). 10

38 3.GEJET and the activities of the Japanese Red Cross Society This section is omitted. 4.Movement of the Honorary President and Honorary Vice Presidents Since its foundation, the Japanese Red Cross Society (JRCS) has developed while maintaining close ties with the Imperial Family as exemplified by the fact that it had members of the Imperial Family as its Honorary President and Honorary Vice Presidents. JRCS s disaster relief activities began in 1888, when Mt. Bandai in FUKUSHIMA erupted. At the time, JRCS engaged in its first disaster relief activities on the orders of the then Her Majesty the Empress (later Empress Dowager Shoken). All members of the Imperial Family also worried about victims of GEJET, the most disastrous series of events that has ever been experienced. In particular, Their Majesties the Emperor and the Empress visited the affected areas many times on their own decision, encouraging many victims directly and addressing words of sympathy to them, and thanked those engage in disaster relief activities for their services. On March 17, one week after the occurrence of the earthquake, President Tadateru Konoe of JRCS, together with Vice President Yoshiharu Otsuka, visited the Imperial Palace to report to Their Majesties the Emperor and the Empress on the progress of disaster relief activities and other initiatives. Subsequently, as listed below, similar reports were submitted to other members of the Imperial Family as required. In addition, the same set of materials on the earthquakerelated activities of the Society that had been presented to Their Majesties the Emperor and the Empress was also delivered to each of its Honorary Vice Presidents through a secretary of their households. These lectures were given as follows: March 17, 2011, 10:00 a.m. Emperor and the Empress April 6, 2011, 3:30 p.m. Akishinonomiya, Imperial Prince Fumihito and Princess Kiko, as well as Princesses Mako and Kako April 28, 2011, 4:30 p.m. Crown Prince and Princess July 19, 2011, 2:00 p.m. Empress January 19, 2012, 11:30 a.m. Empress Introduction Great East Japan Earthquake and Tsunami 11

39

40 Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities

41 Great East Japan Earthquake and Tsunami Chapter 1 Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities 1. HDC at the Headquarters of the Japanese Red Cross Society (JRCS) (1) Establishment of its HDC system a. Response after the occurrence of the earthquake After the earthquake occurred at 2:46 p.m. on March 11, 2011, HDC at the Headquarters for the off the Pacific Coast of Tohoku Earthquake was established as the Society s second-level relief system at 3:00 p.m. Article 4 and Attachment 1 of the Guidelines for JRCS Headquarters Disaster Relief Systems (revised in March 2010) stipulate that a second-level relief system shall be established on the order of the Director General of the Disaster Management and Social Welfare Department in the following cases: - If a medium scale of damage is caused, and if the chapter in an affected area requires limited relief from organizations such as the Headquarters, blocks, or neighboring chapters - If advisory for a Tokai earthquake is issued Furthermore, at 3:30 p.m., the second-level system was upgraded to the third-level one. Article 4 and Attachment 1 of the Guidelines quoted above provide that a third-level relief system shall be established on the order of the Director General of the Disaster Management and Social Welfare Department with the approval of the President in the cases listed below. In this case, the HDC at the Headquarters shall be led by the President. - If a large scale of damage is caused, and if JRCS needs to engage in nationwide relief activities - If a serious accident such as a nuclear or aircraft accident occurs - If a wide-area, massive earthquake such as a Tokai earthquake occurs - If a warning for a Tokai earthquake is issued The HDC at the Headquarters subsequent response is chronologically summarized as follows: Figure 1-1 Major Moves of the HDC at the Headquarters and Other Organizations after the Occurrence of the Earthquake Date Major moves (14:46) The earthquake occurred. (15:00) HDC at the Headquarters for the off the Pacific Coast of Tohoku Earthquake was established (second-level relief system), a response that was comparable to the level of Headquarters disaster relief drills (in 2009) based on the response plans for a Tokai earthquake. (15:00) Preparations for the early dispatch of personnel began. (15:30) Preparations for using Conference Room 201 for the operations team of the HDC at the Headquarters, and it was announced to the entire Headquarters building through the public addressing system that the Headquarters had shifted to a third-level system. (15:30) The Headquarters instructed the block representative chapters to send a report on damage to chapters under its jurisdiction to the Headquarters. It also instructed each chapter to dispatch medical teams to the Miyagi Chapter. 3/11 (16:40) Six initial dispatch personnel were sent to the Miyagi Chapter (Director Iinuma of Ishinomaki Red Cross Hospital (RCHP) rode in the same car) (17:00) The operation team held its first meeting. (19:30) The first quick disaster relief report was compiled. The Headquarters worked with the International Committee of the Red Cross (ICRC) to set up the tracing services, the Restoring Family Links, which is a website to confirm the safety of people. Fifty-five medical teams from around the nation headed for the affected areas. The President was on a business trip to attend an official ceremony for the completion of the JRCS Wakayama Medical Center (Early morning on the following day, he returned to the Headquarters by air). (08:00) A six-member first contingent to investigate affected areas was additionally sent to the Miyagi Chapter. 3/12 (12:00) HDC at the Headquarters held its first meeting. (09:30) The President visited affected areas (3/13 to 14). The places visited included the Fukushima Chapter, the Miyagi prefectural government (to have a meeting with the Governor and gave a press conference), Ishinomaki RCHP, and first-aid stations and evacuation centers in MIYAGI and IWATE, and he was accompanied by a public-relations officer of the International Federation of Red Cross and Red Crescent Societies (IFRC) 3/13 and a Reuters news reporter. After Mar. 13, in addition to personnel to support the Miyagi Chapter s HDC, the Headquarters continued to dispatch Headquarters personnel to assist the Ishinomaki RCHP. 14

42 Date Major moves The Headquarters notified its medical-team dispatch policy. 3/13 Each block continued to dispatch personnel, who were accompanied by psychosocial care staff (whose working days were limited to three days or less, excluding travel time). (12:00) Two psychosocial care leaders were sent to ISHINOMAKI, MIYAGI. 3/14 The acceptance of Gienkin began with their handling outsourced to external organizations. 3/15 The disaster-response volunteer center was established (Conference Room 201 at the Headquarters). The Headquarters started to send personnel to support the Ishinomaki RCHP by chartered bus on the basis of a five-day shift. 3/16 A seven-member field investigation team with an IFRC representative as its leader headed for MIYAGI. 3/17 Medical teams were set to survey the needs of evacuation centers (to IWATE from Mar. 17 to 31 and to MIYAGI from Mar. 17 to 29). 3/18 Volunteer shuttle services between the Headquarters and the Miyagi Chapter began (and continued until May 7). By this day, over 100,000 donations were remitted to the JRCS account at the Japan Post Bank (6.653 billion yen). 3/20 The safety of personnel at chapters and facilities, including the Ishinomaki RCHP, was confirmed. An investigation team was sent to MIYAGI to support broken-up families (Mar. 20 to 25). The Vice-President visited the governors of affected prefectures, etc., at the Fukushima, Miyagi, and Iwate prefectural government offices (Mar. 22 to 24). 3/22 The Headquarters assigned radiation support personnel (emergency medical advisors on exposure to radiation) to the Fukushima Chapter (Mar. 22 to Apr. 28). The Headquarters decided and notified which block should send medical teams and where. By this day, a total of 574,520 donations totaling 22.8 billion yen had been received (quick report). 3/23 (16:00) The President visited Deputy Disaster Management Minister Tatsuo Hirano to request him to approach the governors of the affected prefectures to promptly set up a joint committee to allocate Gienkin. 3/25 The Executive Director General for the Operations Sector went to the Fukushima Chapter to support safety measures (Mar. 25 to 28). 3/28 A team dedicated to the handling of the donation from overseas was formed. The Miyagi Chapter established the HDC in the Ishinomaki RCHP. 3/29 By this day, a total of 1,128,434 donations totaling 59.4 billion yen had been received (quick report). 3/30 (14:00) Ms. Norika Fujiwara, a special public-relations ambassador, visited Headquarters, received explaining about the JRCS activities, presented the Gienkin and encouraging personnel at the HDC. 4/1 The national government decided to name the disaster the Great East Japan Earthquake and Tsunami. (GEJET) 4/3 The Headquarters notified the dispatch of assistants to disaster medical coordinators as part of its relief operations in ISHINOMAKI, MIYAGI. 4/6 The Headquarters sent of the needs survey project team, three personnel, including the Operations Sector s Medical Director from to MIYAGI (Apr. 6 to 9). 4/7 The operation of volunteer shuttle buses between the Headquarters and the Miyagi Chapter began (and continued until Jun. 26). (23:32) A M7.4 earthquake whose epicenter was off MIYAGI occurred. The Headquarters dispatched a three-member caring team to RIKUZENTAKATA, IWATE, for a field survey (Apr. 8 to 10). 4/8 (13:30) A committee to decide the percentage of Gienkin allocated held its meeting at the Ministry of Health, Labour and Welfare (MHLW), and the Director General of the Organizational Development Department attended it. 4/11 A team to survey the needs of the affected areas was sent to FUKUSHIMA (Apr. 11 to 15). Ms. Norika Fujiwara, a special public-relations ambassador visited ISHINOMAKI and HIGASHIMATSUSHIMA, MIYAGI (Apr. 12 to 13). 4/12 A conference of the Director General of Japanese Red Cross Blood Centers (RCBC) nationwide was held. The Headquarters sent a team of engineers to install water supply equipment at the evacuation centers in ISHINOMAKI (Apr. 12 to 17). 4/13 The remittance of Gienkin to the affected prefectures began. Three politicians, including the President of the Liberal Democratic Party, visited the Headquarters. After being briefed on JRCS s relief 4/14 activities, they visited the HDC there. The first caring team was dispatched to RIKUZENTAKATA, IWATE (Apr. 14 to May 13). 4/20 The Federation of JRCS Hospital Directors held an extraordinary plenary session for activity reports on the GEJET. 5/1 GEJET Recovery Task Force was established. 5/9 The partnership meeting for GEJET (PNS Meeting) was convened. 5/30 The organization of the operations team was reduced with its office moved from Conference Room 201 to the Disaster Management and Social Welfare Department s office on the fourth floor. Gienkin : It is donation which is distributed as cash to people in disaster area cash grant scheme. Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities Great East Japan Earthquake and Tsunami 15

43 Great East Japan Earthquake and Tsunami Chapter 1 b. Convocation of meetings In principle, the HDC held its daily regular meeting at 3:00 p.m., and the operations team did so at 1:00 p.m. The HDC consisted of the President, and the Director Generals of departments and offices. Members reported on the damage caused, the overall response to the disaster, JRCS s relief activities, the actions taken by departments and offices, and problems and the measures taken and determined relief operations policy, implementation procedures, and other important matters. A total of 34 meetings were held, and their agendas are as summarized below. Meeting number Figure 1-2 Date and time Mar. 12, 12:00 p.m. Mar. 14, 1:00 p.m. Mar. 15, 1:30 p.m. Mar. 16, 5:00 p.m. 5 Mar Mar Mar. 22 A Meetings Held by the HDC at the Headquarters Major agenda Assessment of the conditions resulting from the disaster and reporting on the response of the operations team as well as departments and offices Decision on the early establishment of first-aid stations, psychosocial care centers, and volunteer centers in preparation for medium to long-term operations and on policy toward personnel support for the Ishinomaki RCHP Decision to temporarily cancel meetings of the Board of Governors and the Board of Representatives and allow the Boards to deliberate on matters by circulating documents Report by the President on his visit to the affected areas, and reports by the personnel initially dispatched by the Headquarters on their local activities Consideration of ways to procure and distribute relief supplies for evacuation centers and the decision to set up an evacuation center support team Reports by the personnel initially dispatched by the Headquarters on their local activities Consideration of measures to secure gasoline Activity reports by the first contingent that surveyed the affected areas Consideration as to how to handle Gienkin funds and donation from overseas Analysis of the current status of relief activities and their systems Consideration of ways to step up public relations activities and countermeasures to deal with the nuclear accident 8 Mar. 23 Reports by the operations team as well as the departments and offices on their response 9 Mar. 24 Reports by the Headquarters medical coordinators on the current situation Report on its HDC organizational structure and safety systems in FUKUSHIMA Mar. 25, 4:30 p.m. Mar. 28, 11:00 a.m. Report by the Vice-President on support projects for the three affected prefectures (IWATE, MIYAGI, FUKUSHIMA) Report on the current situation based on surveys of the needs of the evacuation centers Consideration of the establishment of a team dedicated to the handling of donation from overseas Report on the organizational structure of the chapters HDC in the three affected prefectures 12 Mar. 29 Consideration of ways to use donation from overseas Report on the progress in the establishment of psychosocial care centers 13 Mar. 30 Revision of the structure for quick reports on disaster relief 14 Mar. 31 Consideration of safety measures for medical teams sent to FUKUSHIMA Overview of volunteer activities and the provision of relief supplies to evacuation centers, etc. 15 Apr. 1 Examination of ideas for the menu of JRCS program operations Apr. 4, 3:30 p.m. Apr. 5, 3:30 p.m. Apr. 7, 3:30 p.m. Updating the Headquarters website and making it more substantial Report on relief activities in the area of ISHINOMAKI, MIYAGI Analysis of JRCS s response to donation from overseas and consideration of the ways to use them Installation of a project team to survey the needs of the affected areas Consideration of draft business plans using donation from overseas as financial resources Decision on the implementation of projects to support aged persons requiring nursing care (caring team) Consideration of the policy on dispatching medical teams in the future 19 Apr. 8 Decision on dispatching personnel to support local public relations 20 Apr. 11 Report on the handling of domestic Gienkin funds, such as their allocation Report by the needs survey team of MIYAGI Report on the progress in the projects of the team dedicated to the handling of donation from overseas 21 Apr. 12 Consideration of a plan to hold a PNS meeting for GEJET 22 Apr. 13 Consideration of the policy on dispatching psychosocial care personnel 23 Apr. 14 Report on the dispatch of disaster-response volunteers and the handling of expressway tolls for Red Cross vehicles Report on the production of a 14-minute special video on the GEJET 24 Apr. 15 Consideration of the needs for psychosocial care Report on the procurement and distribution of relief supplies 16

44 Meeting number 25 Date and time Apr. 18, 3:30 p.m. Report by the team that surveyed the needs of FUKUSHIMA Major agenda 26 Apr. 19 Report on the progress in the compilation of an interim summary report on the GEJET 27 Apr. 21 Interim summary report on the GEJET (supervisory, medical, psychosocial care, and volunteer teams) 28 Apr Apr. 25, 4:00 p.m. 30 Apr Apr Aug. 30, 1:00 p.m. Interim summary report on the GEJET (information and logistics teams, the Medical Services Department, and the team dedicated to the handling of donation from overseas) Interim summary report on the GEJET (Planning and Public Relations Office, the Human Resources Department, and the Nursing Department) Interim summary report on the GEJET (Organizational Development Department, the General Affairs Department, the International Department, and the Blood Services Headquarters) Consideration of a plan to hold a PNS meeting for GEJET Decision on the implementation of programs at evacuation centers such as activities to express sympathy Summary of the relief activities that had thus far been carried out Consideration of long-term initiatives for radiation accidents 33 Oct. 17, 10:30 a.m. Consideration of issues to be addressed for the immediate future and improvement policies 34 Oct. 30, 10:30 a.m. Report on evaluations of the activities for the GEJET (third-party evaluations) (Note) Meetings whose time is not mentioned were held at 3:00 p.m. c. Organizational structure of the HDC at the Headquarters The organizational chart for the Headquarters is as shown in Figure 1-3. In accordance with Part 5 Section 3 of the Guidelines for JRCS Headquarters Disaster Relief Systems, the Operations Team worked with Conference Room 201 as its base. Under the Administration Team, which supervised the Operations Team, five sub-teams were formed: Medical, Information, Disaster-Response Volunteer, Relief Supplies, and Psychosocial Care Teams. The Headquarters made the most of the experience gained through the Headquarters disaster relief drills (those carried out in accordance with the Tokai earthquake response plan) conducted in FY2009 to swiftly organize the Operations Team consisting mainly of personnel who had already experienced these drills. Figure 1-3 Organizational Structure of the HDC at the Headquarters (Unit: persons) Team name Immediately after the earthquake occurred As of March 29 After April 1 Administration Team* Medical Team Information Team Disaster-response volunteer Team Relief Supplies Team Psychosocial Care Team Total (NOTE)* The Administraton Team does not include the Director General and Deputy Director General for the Disaster Management and Social Welfare Department. All figures include initially dispatched personnel and the chapters support personnel in the three affected prefectures. [Scene of the activities of the Operations Team of the HDC at the Headquarters established immediately after the earthquake (Conference Room 201)] The meeting of the Operations Team comprised the heads of its groups (administration, medical, information, disaster-response volunteer, relief supplies, and psychosocial) care and the Supervisory Directors of departments and offices and was presided over by the Director of the Disaster Manager Division. The first meeting of the Operations Team was convened at 5:00 p.m. on March 11, and following the decisions of the Headquarters, the Team s subsequent meetings exchanged information on, coordinated, and considered the operations of the Operations Team as well as departments and offices. The Operations Team left Conference Room 201 at the end of May and moved to the office of the Disaster Management and Social Welfare Department on the fourth floor. It was disbanded at the end of August. Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities Great East Japan Earthquake and Tsunami 17

45 Great East Japan Earthquake and Tsunami Chapter 1 Figure 1-4 Organizational Chart of the HDC at the Headquarters Head of the Headquarters (President) Deputy Head of the Headquarters (Vice-President) Executive Director General for the Operations Sector, Executive Director General for the Administration Sector, and the Head of the Blood Services Headquarters Local HDC Dispatched personnel Headquarters medical teams Directions, orders, replies, and reports Directions, coordination, replies, and provision Directions, requests, coordination, replies, and provision Directions, orders, replies, reports, and coordination Operations Team Head of the Operations Team (Director General for the Disaster Management and Social Welfare Department) Administration Team Information Team Special Mission Team Group 1 Medical Team Group 2 Disaster-Response Volunteers Group 3 Relief Supplies, etc. Group 4 Psychosocial Care Planning and Public Relations Office Medical Services Department General Affairs Department Nursing Department Human Resources Department International Department Organizational Development Department Blood Services Headquarters Compliance Office Chapters and facilities Government agencies Local governments Disaster-response organizations International organizations Corporations and business firms Local residents Other d. Handling of documents The Guidelines for the Handling of Documents at the JRCS HDC at the Headquarters for the off the Pacific Coast of Tohoku Earthquake, enforced on April 1, stipulate that all documents of the HDC at the Headquarters shall be approved as follows: Documents on matters such as basic relief policy, the organization of the HDC at the Headquarters, and Head of the Operations Team relief activities that are particularly important Documents on matters handled by Head of the team or group the HDCs Operations Team that are in the Operations Team regular or minor that is in charge It was decided that the titles of documents created by the HDC at the Headquarters should be prefixed with the term Honsai and that the issuer of documents should be the Operations Team (or its head) or the head of the team or group in the Operations Team that was in charge according to the categories of decision-making authority listed above. In practice, however, many of the documents were issued by departments or offices depending on the situation, such as the need for giving priority to a swift response, and as a result, there was some confusion between the Headquarters and chapters/ facilities at first because a reporting line was not unified at the Headquarters. In order to ensure proper document management, the Headquarters decided to provide the Administration Team with a ledger of issued documents to record all documents created by the HDC at the Headquarters, and personnel appointed by the Head of the Operations Team managed these documents. It also decided that all documents created by the Headquarters should be stored for ten years excluding regular and minor ones. The flow of information and information sharing in the Operations Team was as shown below. Information (Information Team) Distribution (to teams and groups concerned) and information sharing (other teams and groups) Response (each team and group) Confirmation of the results of the response (Administration Team) Input of the results of the response (Information Team) In order to ensure information sharing, personnel on day and night shifts took notes of matters to be taken over when they finished their work on their respective shifts and handed these notes over to those who took over the next shift and the Administration Team, which copied the notes and distributed copies to each team and group. 18

46 e. Dispatch of initial response, special missions, and other teams (a) Dispatch of initial dispatch personnel At 4:40 p.m. on the day of the earthquake, six initial dispatch personnel were sent to the Miyagi Chapter s HDC. The dispatch period was six days until March 16. In general, chapters in the three affected areas take leadership in JRCS disaster relief activities, but if, due to the magnitude of the disaster, it is determined that it is difficult to respond to it through the chapters involved alone, or if the disaster requires a unified response as in public relations, the Headquarters is actively engaged in support and other operations. Therefore, these personnel were dispatched promptly in accordance with the Guidelines for Initial Dispatch of Headquarters Personnel at the Time of Disaster. The aim was to establish systems early so that the Chapters in the three affected prefectures could effectively engage in relief activities for the victims. To this end, these personnel worked to assist the Miyagi Chapter in setting up its HDC and ensure that the Headquarters fulfilled its functions smoothly. Their specific duties were as listed below. Providing support in three areas: relief, volunteers, and public relations (Relief) - Support in drawing up activity plans for the immediate future - Drawing up plans to dispatch medical teams - Liaison and coordination with the HDC at the Headquarters (Volunteers) - Gathering information on volunteer activities - Support in setting up the Chapter s disaster-response volunteer center - Liaison and coordination needed to encourage volunteer activities such as cooperation with Social Welfare Councils (Public relations) - Gathering information and recording JRCS s disaster relief activities and the conditions of affected areas, evacuation centers, and related organizations - Communication of information inside and outside JRCS - Response to news gathering by the mass media The problems listed below emerged through the personnel s activities. - Contact addresses and phone numbers at the Headquarters as well as matters to be notified to the Headquarters were not clear. - There was confusion as to whether relief supplies should be addressed to the Miyagi Chapter or the Sendai RCHP. - Partly because of poor communications, the personnel could not communicate closely with the medical teams dispatched. - Tasks (such as relief work, public relations, and volunteer centers) were assigned to each of the six initial personnel in advance, but did not correspond to the actual conditions at the Chapter s HDC and its operational needs, preventing them from meeting such needs flexibly. Despite these problems, these personnel played their role in the initial relief activities to a certain extent. (b) Dispatch of the first contingent to survey the affected areas In order to assess the situation in the affected areas and identify the needs of the Chapters in the three affected prefectures, a team of six personnel with the Deputy Director General in charge of disaster management as its leader visited the Miyagi, Iwate, and Fukushima Chapters and affected areas in these prefectures from March 12 to 16. At the Chapters, in addition to gathering information from the Chapters Secretaries General and other personnel, they gave advice on the policy for relief activities as required. (c) President s visit to affected areas The President visited the affected areas for two days from March 13, two days after the earthquake occurred. He was accompanied by five persons: a Director from the International Department, an Assistant Director from the Secretarial Division, an IFRC public relations officer, a Reuters reporter, and a driver. On March 13, he headed for the Fukushima Chapter while listening to a radio broadcast reporting explosions at the Fukushima Daiichi Nuclear Power Station and was briefed by the Secretary General of the Chapter on the situation in the prefecture. Later, he headed for the Miyagi prefectural government (local HDC), where the Miyagi Chapter s Secretary General reported to him on the situation in the prefecture. At the government office, he also had a meeting with the governor. After these meetings, the President gave a press conference at the correspondents club of the government office. On the evening of the day, he arrived at the Ishinomaki RCHP, where he participated in joint briefing sessions with its medical staff and encouraged all its staff and all members of the JRCS medical teams who had gathered there from around the nation. On March 14, he visited ISHINOMAKI and the vicinity and travelled northward along the coast. On his way, he went through the affected areas in RIKUZENTAKATA, Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities Great East Japan Earthquake and Tsunami 19

47 Great East Japan Earthquake and Tsunami Chapter 1 KESENNUMA, and other cities and visited first-aid stations in KAMAISHI and OTSUCHI, IWATE, where he encouraged all members of the medical teams. His visits to these places were immediately reported by the Reuters reporter to the rest of the world. centers. As a result, they provided ISHINOMAKI with cold weather protection gear (such as heating apparatuses, kerosene, winter clothes) and goods to protect them from infectious diseases (such as masks and disinfectants) and the town of WATARI with clothing. [On March 14, the President saw the damage caused to OTSUCHI, IWATE, with his own eyes.] (d) Dispatch of personnel to survey the needs for relief supplies at the evacuation centers A team of personnel was formed for each of the three affected prefectures to survey the needs for relief supplies at each evacuation center. The three teams visited there and surveyed such needs to help distribute relief supplies efficiently. The two specific tasks were to decide areas to be supported by JRCS with the prior consent of local governments, and to identify supplies needed by evacuation centers in those areas and request the HDC at the Headquarters to procure such supplies. <IWATE> - Total number of personnel dispatched: 6 (up to Group 2) - Dispatch period: March 17 to 31 - Summary of activities: They investigated six relief supplies centers in MIYAKO, YAMADA, OTSUCHI, KAMAISHI, OFUNATO, and RIKUZENTAKATA and distributed partitions, temporary toilets, and goods to support the lives of victims from the viewpoint of protecting privacy at evacuation centers. <MIYAGI> - Total number of personnel dispatched: 4 (up to Group 2) - Dispatch period: March 17 to 29 - Summary of activities: They visited local governments (SHIOGAMA, TAGAJO, ISHINOMAKI, HIGASHIMATSUSHIMA, NATORI, WATARI, IWANUMA, and SHICHIGAHAMA) and evacuation centers in MIYAGI to hear from the local governments officials about the needs for relief supplies at evacuation <FUKUSHIMA> - Total number of personnel dispatched: 6 (up to Group 2) - Dispatch period: April 11 to 22 - Summary of activities: In addition to the Fukushima Chapter s HDC, they interviewed local government officials (KUNIMI, TOMIOKA, KAWAUCHI, IWAKI, and KORIYAMA) to identify goods needed at evacuation centers and temporary housing. In particular, some 1,800 evacuees lived at Big Palette Fukushima in KORIYAMA, and since this evacuation center was large, requiring certain sanitary measures, they provided support by meeting its requests for home appliances such as washing machines, driers, humidifiers, and vacuum cleaners. f. Response to donation from overseas (a) Team dedicated to the handling of donation from overseas in the Operations Team On March 28, a team dedicated to the handling of donations from overseas was formed in the Operations Team of the HDC at the Headquarters. This dedicated team was established to handle donations from overseas at the Headquarters because it was necessary to consider how to use the funds from Red Cross and Red Crescent Societies and similar organizations beyond the conventional framework while meeting the needs of the victims. The duties of the team were to: - Identify the needs of the victims - Draw up specific plans to utilize the funds - Coordinate with related administrative agencies (national and local governments as well as local HDC) - Give directions to order goods, etc., and confirm their delivery - Other tasks as required (b) Project to survey needs in response to donation from overseas The overseas fund team worked to take measures such as surveying and distributing goods needed by those living in temporary housing, but in order to further survey the needs of victims and identify them in more detail as their living situation at the 20

48 evacuation centers was becoming prolonged as well as to work actively to support the victims using overseas funds, it formed a four-member project team with the senior medical advisor as its leader. The team was sent to ISHINOMAKI, MIYAGI, from April 6 to 10, and the duties of the team were to: - Identify the needs of victims in more detail - Draw up plans to utilize the funds - Identify the needs of the Ishinomaki RCHP, related administrative agencies (national and local governments as well as HDC in affected area), and related organizations, and so forth - Other tasks as required As a result, it became clear that there were substantial needs in two respects. One was that the victims wanted medical support for them to continue and the sanitary environment to be improved as their living situation at the evacuation centers was becoming prolonged. The other was that they wanted ISHINOMAKI s social welfare and medical systems to be restructured as the city sustained devastating damage. Based on the results of the survey, the team proposed to take the following measures: - Install water tanks and simple faucets at the evacuation centers - Install prefabricated buildings in the precincts of the Ishinomaki RCHP to provide an activity base - Install a temporary municipal social welfare and medical center - Restore the tertiary emergency medical system with the Ishinomaki RCHP as its core and enhance the functions of the Ishinomaki RCHP as a disaster relief core hospital (c) Establishment of a special missions office to support recovery from the GEJET and the meeting to promote projects to support recovery from the GEJET In order to concentrate on projects to support recovery from the earthquake in a comprehensive manner using relief funds received from overseas Red Cross and Red Crescent Societies and similar organizations, the Special Missions Office to Support Recovery from the GEJET was established as a temporary organizational system based on the provisions of Article 3 of the Regulations for the JRCS Headquarters on May 1. The duties of the Special Missions Office were: - Planning for and general coordination of support projects - Coordination with related administrative agencies (national and local governments as well as HDC in affected area), related organizations, etc. - Conclusion of contracts, directions to order goods, etc., and confirmation of their delivery, etc. - Management of budget execution - Audits, reports on activities for overseas Red Cross and Red Crescent Societies, and financial reports - Other support projects In addition, on May 1, the Promotion Conference for the GEJET Recovery Support Project with the President as its chairman was established to discuss and decide on support projects. g. Summary of the activities In April, one month after the establishment of the HDC at the Headquarters, each the Operations Team as well as each department and office reviewed the activities they had carried out, summarized problems and issues to be addressed, and put together an interim report summarizing a future response policy. In July, they reviewed the activities they had carried out again and summarized problems and issues to be addressed. (2) Activities of the Operations Team a. Administration Team (a) Duties of the Administration Team Four groups were formed under the Administration Team and performed the following duties: Figure 1-5 Division of Duties in the Supervisory Team - Operation and coordination of the meetings of the HDC at the Headquarters and the Operations Team - Handling of projects shared by the Operation Team, departments, and offices - Coordination of and decision of dispatch of personnel and organization of the work shifts Supervisory Group Coordination Group Dispatch Group - Handling of projects (communication slips) to be covered by the Administration Team - Overall liaison and coordination with other groups - Overall preparations for dispatch and support for personnel who had returned from the work, preparation of lists of personnel dispatched and their contact addresses, and securing accommodations for personnel who had returned from the work - Collection of lists of personnel dispatched by other departments and teams and provision of information to personnel who were going to be dispatched and had already been dispatched Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities Great East Japan Earthquake and Tsunami 21

49 Great East Japan Earthquake and Tsunami Chapter 1 General Affairs Group - Organization of work shifts and management of advance money for the Administration Team, and putting materials, whiteboards, and files in order - Creation of documents to be taken over and the management of each team s documents to be taken over - Collection of information from each team and the provision of information to each team (b) Free use of expressways Immediately after the earthquake, only vehicles to which a mark confirming that its holder was an emergency vehicle running for urgent purposes was issued were allowed to run on expressways, including closed sectors, free of charge, but after traffic restrictions were lifted, only vehicles engaged in disaster relief that had a certificate of a vehicle engaged in disaster dispatch, etc., issued by a local government were allowed to run on the expressways free of charge. For this reason, it was in fact difficult to have such certificates issued prior to relief activities, and in order to simplify administrative procedures, the Headquarters consulted with East Nippon Expressway Company. As a result, the Company considered JRCS as an organization similar to local governments and permitted it to issue such certificates in the name of its President or Chapter President so that Red Cross vehicles could use expressways free of charge. JRCS came to agreements with six expressway companies nationwide (East, Central, and West Nippon Expressway Companies, Metropolitan Expressway Company, Hanshin Expressway Company, and Honshu- Shikoku Bridge Expressway Company) on this system, which started on April 16. Later, JRCS applied for its extension for one month, and the system continued until the end of June. Records show that under this system, Red Cross vehicles used expressway free of charge a total of 1,664 times (523 for April, 776 for May, and 365 for June). This system was used when medical teams from western Japan flew to HANEDA, YAMAGATA, and AKITA. (d) Securing accommodations at the building of the Headquarters Conference Rooms 501 (for men) and 301 (for women) at the Headquarters were always available for accommodations and were mainly used as a stopover point for medical teams from the Kyushu region. Medical teams using these facilities traveled from their place of origin to Tokyo by air and moved from the Headquarters to the affected area by their Red Cross vehicle. They also contacted the Operations Team at Conference Room 201 for information before they departed. (e) Support for the Ishinomaki RCHP In order to provide the Ishinomaki RCHP with personnel support, the Headquarters started to operate shuttle buses between the Headquarters and the hospital on March 15. Personnel were dispatched by rotation. On Day 1 they left the Headquarters at 8:30 a.m. on the basis of fivenights-six-days shifts. They worked for five days. On Day 6 they left for Tokyo after they finished work, arriving at the Headquarters after 12:00 midnight. In order to meet the needs of the hospital, buses leaving the Headquarters carried as many daily necessities and relief supplies as they could. (c) Free flights for medical teams For one month from March 15 (March 14 for ANA) to April 15, airline companies provided a service of carrying free of charge individuals and members of organizations going to affected areas for recovery support who met certain requirements. A total of 6,558 JRCS personnel (991 times) used airlines (including Starflyer and Skynet Asia Airways), and 4,826 of them (745 times) used this system (1,248 persons (224 times) for JAL and 3,578 persons (521 times) for ANA). [A scene from the ceremony held in the front garden of the Headquarters for the first group of personnel heading for the Ishinomaki RCHP] (f) Lent vehicles Since immediately after the earthquake, many vehicles had been required for disaster relief work, the dispatch of support personnel, public relations, and various other activities. At first, as the five vehicles (three people carriers, one van, and one 22

50 truck) owned by the Headquarters were not enough, the Headquarters utilized rental vehicles (up to eleven vehicles when it was busiest). Due to this plight, automobile sales companies offered to provide cars, and the Headquarters borrowed large vehicles meeting its needs that were suitable for the transport of personnel and goods. Figure 1-6 Summary of Vehicles Lent Volkswagen Group Japan Company name Jaguar Land Rover Japan Co., Ltd. Co., Ltd. Number of vehicles lent Lending period Distance covered Uses Caravelle (three units) March 26 to August 25, 2011 (five months) 86,949 km (for three units combined) Relief activities and recovery programs in the three affected prefectures (shuttle service for disasterresponse volunteers, needs surveys, meetings with affected municipalities, etc.) Discovery (two units) Freelander (one unit) June 1, 2011 to March 31, 2012 (ten months) 45,734 km (for three units combined) Recovery programs in the three affected prefectures (needs surveys, meetings with affected municipalities, transport of blankets and other support supplies, accompaniment of representatives from overseas Red Cross and Red Crescent Societies during visits to the affected areas, etc.) b. Information Team The duties of the Information Team are summarized as follows: (a) Chronological organization of information The Information Team chronologically recorded the occurrence of the earthquake, the warnings and alarms issued, the meetings held, details of communication slips created, and so forth. (b) Compilation of quick reports on disaster relief (1 or 2 staff members) The Information Team gathered information at related places and compiled quick reports on disaster relief for internal and external use (website). In addition to posting these quick reports on the website through the Planning and Public Relations Office, the Team distributed them to all chapters via , circulated printed versions within the Headquarters, put up 20 copies at the entrance hall on the first floor, and uploaded them onto the intranet. Immediately after the earthquake, quick reports were compiled twice a day, but later, at 12:00 noon each day. Afterwards, they were gradually compiled less often, only on weekdays after April 16 and three times a week after May 12. After June 4, they were provided once a week. (c) Gathering information from government agencies, etc., and its dissemination The Information Team gathered the reports on the damage caused, infrastructure status, evacuation centers, traffic conditions, and so forth mainly through government agencies websites and the monitoring of radio messages and stored updated information. Based on the information collected, the Team updated the maps and quick reports on disaster relief posted in the center of Conference Room 201. In addition to gathering information on available facilities such as gas stations and accommodations by phone, it made a list of major evacuation centers and the routes to get there and provided such information to personnel dispatched by the Headquarters. Sources of information such as government agencies are as listed in Figure 1-7. Figure 1-7 Sources of Information, Including Government Agencies Information Sources of collected information Human casualties* Prime Minister s Buildings damaged* Official Residence Human casualties National Police Agency Buildings damaged Damage Nuclear power stations (evacuation areas)* Prime Minister s Official Residence (Nuclear Emergency Response Headquarters) Fire and Disaster Evacuation Management Agency Tokyo Electric Power Company (TEPCO)** Power failure Tohoku Electric Power Company Gas Japan Gas Association Subscriber phones, IP Ministry of Internal Affairs Infrastructures phones and Communications Water supply MHLW Ministry of Land, Infrastructure, Roads Transport and Tourism East Nippon Expressway Company MHLW Other Ministry of Internal Affairs and Communications * Information from the mass media was also referred to. ** TEPCO stopped information service one week after the earthquake because its information overlapped that provided by the Prime Minister s Official Residence. Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities Great East Japan Earthquake and Tsunami 23

51 Great East Japan Earthquake and Tsunami Chapter 1 (d) Recording of the minutes of the meetings The Information Team announced the convening of the meetings of the Headquarters and the Operations Team, prepared materials for such meetings, and recorded their minutes. It also stored the meeting materials and uploaded them onto the Headquarters intranet for information sharing. (e) Preparation of a list of medical teams It entered into Excel files lists of the names of the dispatched medical teams as reported by block representative chapters via facsimile and , etc. and distributed the files to the local HDC, the chapters, and other parties concerned each day via (at 8:00 a.m. until April 15). (f) Collection, storage, and dissemination of documents, etc. The Team collected and stored documents and other materials created by other teams and departments/ offices, and upon request, it distributed documents via and facsimile. At 11:00 a.m. every day, it also provided the MHLW with information on the medical teams by sending via a list of places to which they had been dispatched (prepared by the Medical Team). After April 16, it did so twice a week. (g) Other duties In addition to the foregoing, the Team performed the following duties: - Answering phone calls - Handling of mail received by the Headquarters (confirming the contents of mail received by the Headquarters that sought relief or made disasterrelated requests and transferring them or otherwise processing them as required. 2. The Iwate Chapter HDC (1) The Actions Taken at the Time of the Disaster About 20 minutes after the disaster occurred, the Iwate Chapter confirmed the safety of facilities within its jurisdiction and established its HDC. Since communications and power supplies were cut off in the city of MORIOKA, the Chapter immediately dispatched two of its personnel to the Iwate prefectural government to collect information. In IWATE, since coastal areas sustained immense damage, the prefectural government s HDC requested to use the heliport of the Morioka RCHP to convey sick and wounded persons, but at 6:37 p.m., the prefectural governments HDC decided to transport them to the Iwate Prefectural Fire-Fighting School in YAHABA, and the Chapter made preparations such as giving instructions to deploy Domestic Emergency Response Units (deru). Informed that the sick and wounded could not be transported by helicopter on that day, however, it only made such preparations. On the morning of March 12, at the prefectural government s request, the Chapter dispatched medical teams to the School in preparation for wide-area transport. At first, the Chapter gave instructions as to where medical teams should be dispatched and coordinated their dispatch, but at 7:00 p.m. on March 12, it left all decisions on the destination of the dispatch to the Morioka RCHP, which was suggesting that medical teams should be sent to coastal areas, and it was decided that later, the dispatch of medical teams should be coordinated not by the Chapter but by the hospital. Therefore, many medical teams, including those that had temporarily gathered at the Chapter, moved to the hospital, where they received instructions as to where they should go after they were briefed. On March 13, a HDC was established in KAMAISHI, and on March 15, one was set up in TONO, which served as a relay point for the affected coastal areas (The HDC in KAMAISHI was closed at the same time that the one was formed in TONO). [Map of the affected areas drawn up based on the information collected (Conference Room 201)] [Inside the Iwate Chapter on the evening of the day of the earthquake] 24

52 Figure 1-8 Major Movements of the Iwate Chapter s HDC, Etc., after the Occurrence of the Earthquake Date Time Description 3/11 3/12 2:46 p.m. 3:08 p.m. The earthquake occurred (The power, water, and city gas supply to the Chapter was cut off, forcing it to respond to the disaster using lighting from a power generator). The safety of Omeiso, JRCS Home for elderly, Morioka RCHP and the Iwate RCBC was confirmed. The Iwate Chapter HDC was established. The Chapter requested the Morioka RCHP to have two medical teams stand by. 3:20 p.m. Two chapter personnel were sent to the prefectural government s HDC. 3:37 p.m. The Chapter requested the Morioka RCHP to make preparations for receiving patients as a disaster relief core hospital. 3:58 p.m. The Morioka RCHP completed preparations for medical teams. 4:05 p.m. The Chapter received a request from the Japan Disaster Medical Assistance Team (DMAT) to dispatch medical teams. 4:46 p.m. A hotline with the prefectural government s HDC was set up. 5:02 p.m. The Chapter received the information that it appeared that the sick and wounded would be concentrated in inland areas because hospitals in the prefecture s coastal areas had difficulty in receiving patients. 5:18 p.m. The Morioka RCHP s heliport became usable. 6:30 p.m. The Chapter instructed the Morioka RCHP to set up derus at the Iwate Prefectural Fire-Fighting School. 6:37 p.m. The prefectural government s HDC decided to transport patients in the prefecture s coastal areas to the Fire- Fighting School by helicopter. 8:38 p.m. derus started to be set up. 9:25 p.m. The Headquarters confirmed with the Chapter as to how many medical teams it needed. 9:55 p.m. The Chapter requested the prefectural government to supply fuel oil. 11:10 p.m. The Emergency Medical Information System (E-MIS) became available for data entry. 5:19 a.m. The prefectural government s HDC ordered JRCS to dispatch two medical teams, and the Chapter instructed two of its medical teams to go to the Iwate Prefectural Fire-Fighting School. 6:15 a.m. A disaster-response volunteer was dispatched to the Fire-Fighting School. 6:40 a.m. The Chapter and the Morioka RCHP became unable to send and receive as the Internet access was interrupted. 8:10 a.m. The Musashino RCHP s DMAT arrived at Iwate Medical University and headed for OFUNATO by land. 8:12 a.m. 5:50 p.m. The Chapter strengthened the RCBC s supply system (24 hours) and decided to cancel all its blood collecting plans for Mar. 12 and 13. AKITA s first medical team set up a first-aid station at Daiichi Junior High School in RIKUZENTAKATA (The DMAT retreated). 6:25 p.m. Power supply returned to normal. 6:31 p.m. Water supply returned to normal. 7:00 p.m. 8:15 p.m. The Morioka RCHP suggested that it should dispatch medical teams to coastal areas. The Chapter responded that it had obtained approval from the prefectural government s HDC for the dispatch of medical teams to coastal areas and that it would leave all decisions on the destination of the dispatch to the hospital. The Headquarters told the Chapter that it had not received information on whether medical teams had arrived in the affected areas and how they were working. In response to these inquiries, the latter provided relevant information to the former. 3/13 1:50 p.m. The Chapter set up a local HDC in KAMAISHI. 3/14 3:00 p.m. The Chapter secured Tono Fukushi no Sato as a relay point for the affected coastal areas and a venue for its local HDC. 3/15 11:50 a.m. A local HDC was set up in TONO. (At the same time, the one in KAMAISHI was closed.) 3/16 3:00 p.m. A radio system was set up at the local HDC in TONO (with external antennas installed there). Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities Great East Japan Earthquake and Tsunami 25

53 Great East Japan Earthquake and Tsunami Chapter 1 (2) Establishment of the HDC Under its Head and Deputy Head as well as the Head of its administration team, the Iwate Chapter s HDC consisted of four teams: general affairs and relief supplies, medical relief, psychosocial care, and Gienkin and volunteers. It also appointed personnel attached to the prefectural government s HDC and set up a HDC. Immediately after the disaster, under this organizational system, it strove with all its resources to respond to the needs of the affected areas while obtaining support from the Headquarters. Figure 1-9 Organizational Structure of the Iwate Chapter HDC Hospital Director (attached to the HDC) Inside the HDC Chapter President (Head of the HDC) Secretary General (Deputy Head of the HDC) Director of the Operations Division (Head of the Administratoin Team) 5. Attached to the prefectural government s HDC 1. General Affairs and Relief Supplies Team Director of the General Affairs Division Deputy Director of the General Affairs Division 2. Medical Relief Team Director of the Operations Division (*) 3. Psychosocial Care team Director 4. Gienkin (donation) and Volunteer Team Director of the Organizational Development Division Director of the RCBC (attached to the HDC) 6. Local HDC Deputy Director of the Disaster Management Division Deputy Director of the Red Cross Membership Division (*) Depending on factors such as the magnitude of the disaster, in addition to mobilizing more personnel from the Chapter, the Chapter HDC requests support from other chapters and additional personnel were assigned to its organization. [A deru set up at the Iwate Prefectural Fire-Fighting School] The organizational structure chart for the Iwate Chapter HDC is as shown in Figure 1-9. (3) Reception of chapter support personnel The Chapter received a total of 114 chapter support personnel. They were assigned mainly to the Iwate Chapter HDC, the HDC set up in TONO, and in KAMAISHI. A total of 22 personnel were dispatched to the Iwate Chapter HDC mainly from the Headquarters. A total of 68 personnel were dispatched from the Hokkaido Chapter to HDC in TONO, which was established as a base for relief work in RIKUZENTAKATA and other coastal cities. The HDC in KAMAISHI received a total 23 personnel from the Tochigi, Gunma, Niigata, and Yamanashi Chapters in the 2nd Block. Figure 1-10 Number of Chapter Support Personnel by Destination of the Dispatch and Period of the Dispatch Period of the dispatch Destination of dispatch March April May June July August Total Iwate Chapter HDC Iwate Chapter HDC (in TONO) The 2nd Block Chapter HDC (SUZUKO, KAMAISHI) Other places Total Note 1: The periods of the dispatch are classified according to the day when the dispatch began. Note 2: As for the Iwate Chapter, ten of the eleven for March and three of the seven for April were sent from the Headquarters. (4) Damage to the Chapter At the Iwate Chapter, after the occurrence of the earthquake, power, water, and city gas supply was cut off, causing its personnel to secure only lighting through a power generator. Built in 1968, the building partly occupied by the Chapter did not have an aseismatic or seismically isolated structure and sustained damage such as broken window glass. Satellite-based mobile phones were mainly used as a means of communications. In MORIOKA, ordinary NTT DoCoMo mobile phones also could get through relatively easily. Disaster priority phones remained unstable. JRCS s business radio became unusable on the morning after the earthquake because a base station s battery line was cut off (It also became unusable when an aftershock occurred on April 7). Essentially, JRCS s business radio is not available in the entire prefecture because IWATE is large and has many mountains. 26

54 Building Electricity City gas Water supply Mobile phone Figure 1-11 Damage to the Iwate Chapter Item Damage Recovery Broken window glass, etc. Disaster priority phone, satellitebased mobile phone, etc. JRCS s business radio, etc. 3/11: Due to power failure, only lighting from a power generator was available. 3/11: No gas supply 3/11: No water supply In MORIOKA, NTT DoCoMo mobile phones remained relatively usable. Satellite-based mobile phones were mainly used as disaster wire phones remained unstable. 3/12: JRCS s business radio became unusable. (5) Cooperation and liaison with local governments and other related organizations In IWATE, emergency medical care was coordinated through DMAT in accordance with the prefectural government s request starting from immediately after the earthquake. Since confusion in affected areas continued even after 48 hours passed, which is the period of time for which DMAT is originally intended to work, thus the prefectural government applied for an extended dispatch of DMAT, and as a result, medical teams, including JRCS s, continued to work in the prefecture until March 19. On March 20, in order to meet medical relief needs at many evacuation centers set up in a wide range of areas, the prefectural government and five major support organizations, JRCS, Iwate Medical University, Iwate Medical Association, National Hospital Organization, and Iwate Prefecture Medical Service Bureau (prefectural hospitals), launched the Iwate Disaster Medical Support Network with Associate Professor Satoshi Takahashi of Iwate Medical University as its head. On March 22, the Network divided the prefecture into eight geographical areas and chose a principal organization that should take responsibility for coordination and other duties in each area. This made JRCS responsible mainly for RIKUZENTAKATA, KAMAISHI, and YAMADA (JRCS s medical teams continued to work in other areas, too). The Network held a meeting daily to exchange information on medical needs and other subjects in each area, coordinated offers from medical teams nationwide, and ensured that there were neither gaps in medical resources among the areas nor overlaps in the activities. It also exchanged information with fire-fighters, police officers, and Self- Defense Force (SDF) officials who stood by at the prefectural government s HDC. The participants from 3/12: The service returned to normal. 3/12: The service returned to normal. JRCS were the Director of the Operations Division at the Chapter and the Chairman of the Morioka RCHP s Emergency Medical and Disaster-response Committee, who served as a coordinator for JRCS medical teams in the prefecture. In principle, medical teams heading for the affected areas must be registered with the prefectural government, but this registration system was not thoroughgoing. [A scene from activities at the Fire-Fighting School] 3. The Miyagi Chapter HDC (1) The Action Taken at the Time of the Disaster Immediately after the earthquake, since the consolidated government offices building partly occupied by the Miyagi Chapter sustained damage, the Miyagi Chapter established HDC in the prefectural government too, and part of the personnel, including the Chapter Secretary General, moved to the prefectural government office building. Later, until March 22, the Chapter s HDC operated with its functions divided between the branch in the prefectural government and the Chapter. All sorts of information were gathered in the prefectural government s HDC and the SDF officials, police officers, and other parties concerned were stationed Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities Great East Japan Earthquake and Tsunami 27

55 Great East Japan Earthquake and Tsunami Chapter 1 there, and as a result, the Chapter could obtain information efficiently and liaised and coordinated with the parties concerned. Nonetheless, partly because the building where the Chapter was located sustained damage and a wide range of areas, particularly the three prefectures, were hit by the earthquake, the Miyagi Chapter could not function as a representative chapter for the 1st Block as a disaster activity base and consequently could not help but concentrate on disaster relief in MIYAGI. [The Miyagi Chapter HDC established in the prefectural government office building] At the Miyagi Chapter, a small number of personnel were being pressed to take many actions as they could not use PCs due to the power failure. Records of the day of the disaster are fragmentary with information on detailed movements of the Chapter HDC left unorganized. But according to the information received by the HDC at the Headquarters, at 3:35 p.m. the Fukushima Chapter informed the Headquarters that it had intercepted wireless communications between the Miyagi Chapter and the Ishinomaki RCHP, but it was at 4:50 p.m. that the Miyagi Chapter contacted the HDC at the Headquarters. Subsequent communications indicated that the Chapter was engaging in activities such as distributing relief supplies, confirming damage to hospitals, and gathering information on the needs of medical teams. Immediately after the earthquake, the top priority was given to maintaining the functions of the medical facilities and making effective use of the medical relief resources. Both the Sendai RCHP and the Ishinomaki RCHP requested the Miyagi Chapter to supply fuel oil within the day, and the Chapter managed to secure fuel oil by coordinating with the prefectural government and effectively using the procurement and logistic coordination capabilities of the prefectural government s HDC. This also applied to food, water, gas, and so forth. Goods saved for emergency were limited, requiring replenishment as needed. Another problem was how to secure food for hospitalized patients and hospital personnel. On the other hand, it was necessary to coordinate the destinations for the dispatch of medical teams heading northward to the affected areas. With communications disrupted, confusing information was flying around, and the damage in each area was unknown, there was no way of grasping the whole picture of the medical needs, and the Chapter asked medical teams heading for MIYAGI to move northward while confirming the medical needs of the coastal areas in the prefecture. As a result, these teams provided medical relief in municipalities such as NATORI, IWANUMA, and WATARI. In addition, derus were installed in front of the prefectural government office building to which many evacuees had rushed since the occurrence of the disaster, and at the same time, medical teams visited one evacuation center after another in SENDAI. Furthermore, medical teams that could serve as DMATs capable of wide-area transport were dispatched to the Ground SDF Camp Kasuminome in SENDAI. And other medical teams were instructed to head for the Ishinomaki RCHP. This was because it was determined that there should certainly be high medical needs as its buildings were not heavily damaged, making the hospital the only high-level medical institution that was functioning at that time while a wide area of the center of ISHINOMAKI where the municipal office was located had been inundated due to the tsunami and all other neighboring medical institutions were paralyzed. Subsequently, it was decided at a coordination meeting with health care workers in MIYAGI that all decisions on how to respond to medical needs should be left to the Ishinomaki area joint medical team based in the Ishinomaki RCHP. Meanwhile, it was decided that JRCS s medical teams should withdraw from other areas. 28

56 Figure 1-12 Major Movements of the Miyagi Chapter HDC, Etc. after the Occurrence of the Earthquake Date Time Description 3/11 3/12 3/13 3/14 3/15 3/16 2:46 p.m. 3:35 p.m. 4:50 p.m. 9:30 p.m. 10:05 p.m. 10:35 p.m. 0:37 a.m. 8:50 a.m. 11:33 a.m. 1:10 p.m. 8:30 p.m. 3:00 p.m. 6:10 p.m. 10:25 p.m. 1:00 a.m. 6:12 a.m. 9:04 a.m. 10:40 a.m. 10:45 a.m. 11:25 a.m. 2:20 p.m. 11:30 a.m. 3:00 p.m. 8:00 p.m. The earthquake occurred. The Fukushima Chapter intercepted wireless communications between the Miyagi Chapter and the Ishinomaki RCHP. The Miyagi Chapter was confirming the damage that had been caused. The Chapter contacted the Headquarters, providing information on the safety of personnel at the Ishinomaki RCHP. The Chapter contacted the Headquarters, saying that it needed 3,000 blankets; that all life lines had been disrupted; and that except for IP phones, fixed and satellite phones could get through. The Chapter contacted the Headquarters, explaining about the conditions it faced and requesting relief supplies. The Chapter instructed all medical teams currently heading for the Chapter to go to the Ishinomaki RCHP. The Yamagata Chapter contacted the Fukushima Chapter, saying that the life lines including the power supply of the Miyagi Chapter HDC had been paralyzed and that the Headquarters personnel had already joined the Miyagi Chapter. The Chapter held preliminary discussions for its HDC in the prefectural government office building. The prefectural government requested JRCS to deploy all DMATs, including non-jrcs ones, but the Chapter left such deployment to the prefectural government s medical coordination unit. The Chapter requested three medical teams to go to ISHINOMAKI (derus and 1 to 3 medical teams requested) and derus (Osaka) to be set up at the prefectural government office. It also planned to deploy derus in WATARI and requested three medical teams to head for IWANUMA. Medical teams from KYOTO and HIROSHIMA headed for ISHINOMAKI. The Ishinomaki RCHP informed the Chapter that it had not contacted all medical teams but that there were 40 to 50 evacuation centers and requested that at least 15 medical teams should be secured (for visits to evacuation centers and hospital support). The President arrived in SENDAI. Later, he met Internal Affairs and Communications Minister Yoshihiro Katayama, paid a courtesy call on the Governor, and gave a press conference. DMAT reported the Chapter the plan would change which is to withdraw on the morning of the following day to do so gradually. The Ishinomaki RCHP requested the Chapter to continuously send 20 medical teams a day (eight for hospital support and twelve for visits to evacuation centers) for the time being. The Chapter told medical teams working in FUKUSHIMA to head for the Ishinomaki RCHP because it could not guarantee safety due to the lack of information on the effects of radiation. DMAT in the prefectural government office requested the Chapter to install derus in the Ishinomaki Sports Park before 10:00 a.m. because disaster-prevention helicopters planned to start operations at 10:00 a.m., gather patients at the park by 3:00 p.m., and transport them to the Ground SDF s Camp Kasuminome. Transport of patients from ISHINOMAKI by disaster-prevention helicopters began. The Secretary General of the Tokyo Metropolitan Chapter informed the Miyagi Chapter that it had already coordinated with the parties concerned so that support personnel, who were currently being dispatched from the 2nd block s Chiba Chapter, would be sent from the 3rd block next. The Chapter was informed that derus had been set up at the Ground SDF s Camp Kasuminome. As a result of preliminary discussions with DMAT, it was decided that the triage team at KASUMINOME would retreat after the day s work was over. In order to reduce the burden on the activities of the Ishinomaki RCHP, it was decided that first-aid stations should be installed at Hebita Junior High School and Senshu University (each deru team). The telephone and Internet lines returned to normal (cut off again at 12:40 p.m. but returned to normal at 2:00 p.m.). Officials from the IFRC came to inspect the affected areas. A Staging Care Unit (SCU) operation conference was held at the prefectural government office. The SCU at the Ground SDF s Camp Kasuminome retreated on March 16. Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities (2) Establishment of the HDC With its small number of personnel assisted by the Headquarters and other chapters, under its Head and Deputy Head, the Miyagi Chapter s initial HDC installed a supervisor each in one of its two organizations and in the other, set up in the prefectural government office, and under each supervisor, it formed eight teams: relief coordination, relief supplies, volunteers, public relations, psychosocial care, recording, Gienkin, and communications. Great East Japan Earthquake and Tsunami 29

57 Great East Japan Earthquake and Tsunami Chapter 1 Figure 1-13 Organizational Structure of the Miyagi Chapter HDC (Immediately after the Occurrence of the Earthquake) Organizational Structure of the Miyagi Chapter HDC Head of the HDC Deputy Head of the HDC Secretary General Deputy Secretary General Headquarters in the prefectural government office Headquarters in the Chapter Supervisor : Director leading disaster response Supervisor : Director of the Operations Division Coordination with and delivery to Relief Coordination Team: Coordination of medical teams, etc. Relief Supplies Team : organizations such as municipalities Duties such as coordination with Relief Supplies Team : the Headquarters and prefectural Volunteers Team : Establishment and operation of the and municipal governments disaster-response volunteer center Gathering and communicating information Public Relations Team : mainly from/to public relations officers Coordination of psychosocial Psychosocial Care Team : care services at the Headquarters Recording Team : Recording events chronologically Gienkin Team : Reception of Gienkin funds Recording Team : Recording events chronologically * The Chapter responded to the needs of the affected areas by establishing the function of its HDC at two locations * It maintained the functions of its Headquarters by receiving support personnel from the Headquarters and other chapters. (3) Reception of chapter support personnel Initial support personnel from the Tokyo Metropolitan Chapter joined the Miyagi Chapter on the night of the day of the earthquake, and those from the Saitama Chapter on the following day. Later, support personnel from other chapters and the Headquarters continued to join the Chapter until April. In addition to the provision of support for hospitals by job type and the dispatch of assistants to medical coordinators as later described in Chapter 3, the Headquarters sent support personnel to the local HDC set up at the Ishinomaki RCHP. Figure 1-14 Number of Chapter Support Personnel by the Destination of the Dispatch and the Period of Dispatch Period of the Dispatch Destination of the dispatch March April May June July August Total Miyagi Chapter Ishinomaki RCHP Total Note 1: The periods of dispatch are classified according to the day when the dispatch began. Note 2: As for the Miyagi Chapter, 12 of the 35 for March, 4 of the 13 for April, and all of the 4 for May were sent from other chapters with the remainder dispatched from the Headquarters. (4) Damage to the Chapter The ground around the consolidated prefectural government offices building (separate from the main building) part of which was occupied by the Miyagi Chapter subsided, and the building was cracked in places, but there was no problem with using it. Immediately after the earthquake, the power supply was cut off, forcing the Chapter to use an emergency power source, but by around 10:30 p.m. on the day of the earthquake, the power source became unusable as the Chapter ran out of fuel oil. For this reason, the Chapter also established its HDC in the prefectural government, which had no problem with its life lines. Thus it decided to respond to the disaster at these two locations. Figure 1-15 Damage to the Miyagi Chapter Item Damage Recovery, etc. Building Collapsed walls, etc. Elevator Suspended operations Electricity 3/11: Power failure The service returned to normal at 7:40 a.m. Power generator fuel (fuel oil) 3/11: Around 10:30 p.m., the generator stopped working due to lack of fuel oil. Unusable Fuel (gasoline) Insufficient Support from contract gas stations and support teams City gas Unusable 4/9: The service returned to normal. Water supply and sewage Only water left was in the rooftop tank 3/15: The service returned to normal at 3:00 p.m. Fixed phone Only analog lines were usable. The optical line returned to normal at the same time as the electricity. Mobile phone Mobile phones could not get through easily. Disaster priority phone, satellite-based phone, etc. JRCS business radio, etc. Internet Disaster priority phones and satellite-based phones were usable. Part of the JRCS business radio was usable (The Chapter s base stations could only receive radio waves while its mobile stations remained usable). Unusable (for reasons on the part of the provider) Part of the radio system remained unusable in some buildings and other places (not connected in the prefectural government s auditorium). MCA wireless JRCS did not use MCA radio. The system was effectively used between the prefectural government, medical associations, and major medical institutions. Food (for the HDC) Insufficient Support from the Yamagata Chapter 30

58 The Chapter used satellite-based and disaster priority phones for communications. JRCS business radio could not be used because radio waves could not be received in the prefectural government s auditorium where the Chapter s HDC was located. The Chapter s base stations could only receive radio waves and could not transmit them. In-vehicle mobile stations were usable. The MCA wireless system, which had been deployed since the Iwate-Miyagi Nairiku Earthquake of 2008, was used between the prefectural government and local medical associations and major hospitals. (5) Cooperation and liaison with local governments and other related organizations In MIYAGI, DMATs were dispatched until March 16, and after March 17, they were replaced by medical teams. When DMATs worked, the supervisory DMAT gave instructions on matters such as where DMATs should be sent. On the other hand, disaster medical coordinators joined the prefectural government s HDC, starting to gather information on medical institutions in the prefecture and coordinate activities such as the transport of patients. The disaster medical coordinator is the Miyagi prefectural government s system, commissioned by the governor, to coordinate the parties concerned so that medical care and relief are provided swiftly and appropriately if a massive disaster occurs in the prefecture. In addition to the six coordinators who had already been commissioned, six new coordinators were commissioned after the earthquake. As of April 2013, there were twelve commissioned disaster medical coordinators. Commissioned by the respective medical regions in the prefecture, disaster medical coordinators coordinate medical service at the prefectural government s HDC or affected areas when a disaster occurs. Dr. Tadashi Ishii of the Ishinomaki RCHP had been commissioned to work as such just before the earthquake, an arrangement that greatly helped him to serve as a supervisor of the Ishinomaki area joint medical team after the occurrence of the disaster. At the prefectural government, a meeting of the government s related divisions, disaster medical coordinators, JRCS, SDF, medical associations, Tohoku University, National Hospital Organization and other parties concerned was convened to share information on and coordinate medical relief activities. The number of medical teams required for medical relief was adjusted mainly through the prefectural government, JRCS, medical associations and Tohoku University. Information on medical teams dispatched by prefectural [Personnel who coordinated the transport of the sick and wounded with other organizations at the prefectural government office] governments nationwide was put together by the Miyagi prefectural government for its sharing. Many medical teams were continuously sent to the Ishinomaki region, supervised by Dr. Ishii, a disaster medical coordinator, by other prefectural governments support teams, National Hospital Organization, Japan Medical Association Team (JMAT), and so forth under the leadership of JRCS. The Chapter HDC received a request from the Ishinomaki RCHP for the transport of the sick and wounded each day and coordinated the means of transport on a daily basis with senior officers of the SDF with whom the Chapter had established favorable relationships since before the earthquake. Thus the favorable relationships that had been built with other organizations during normal times worked effectively and were helpful at the time of the disaster. Except for those associated with the temporary return of residents to the off-limits area in FUKUSHIMA, medical relief activities continued until October 2011, when they were taken over by a temporary clinic set up in ISHINOMAKI s OGATSU area--the place where medical relief teams worked until most recently. 4. The Fukushima Chapter HDC (1) The Action Taken at the Time of the Disaster The Fukushima Chapter established a HDC immediately after the earthquake, at 2:50 p.m. Fixed and mobile phones could not be used, but there was no problem with its building. The Headquarters began to gather information and distribute relief supplies. The Chapter planned to gather information from municipalities and other organizations making the most of the prefectural government s disaster-prevention system, but due to damage to the government s building and communications lines, the system did not work immediately after the disaster. In addition, there was Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities Great East Japan Earthquake and Tsunami 31

59 Great East Japan Earthquake and Tsunami Chapter 1 conflicting information at the prefectural government s HDC, and it was also difficult to obtain information on medical institutions from the personnel dispatched. The Chapter obtained information through TV and other media, and after the telephone lines returned to normal, it surveyed the needs of the affected areas by making phone calls to municipalities in HAMADORI, the eastern part of the prefecture which were likely to be directly hit by tsunami. As a result, at 4:45 a.m. on March 12, it requested the Headquarters to dispatch twelve medical teams (including one Fukushima team) to the prefecture. Since medical teams had already been dispatched from various chapters or were heading for affected areas without waiting for requests for support. The Fukushima Chapter gave instructions to medical teams who had arrived in the prefecture as to their specific destinations (such as SHINCHI) mainly through wireless system for professional use. Later, the information circulated that a serious accident had happened at a nuclear power station. As it did not have enough time to obtain knowledge of and equipment for radiation medicine as well as accurate information on the accident, the Chapter, which was not sure whether it could maintain the safety of medical teams working near the power station, had medical teams working in SHINCHI temporarily move to SHIROISHI, MIYAGI, and those in MINAMISOMA and SOMA to KAWAMATA. After they moved to KAWAMATA, these medical teams provided medical care to many people who had evacuated by supporting hospitals and visiting evacuation centers. As medical teams continued to work in other areas, the Chapter received many inquiries about how to operate in emergency clinical settings exposed to radiation (such as the anxiety of team members about exposure to radiation and the risk of continuing to work near the power station). It consulted with Headquarters and the Fukushima prefectural government about the possibility of wearing protective clothing during medical relief activities, but with the opinions of the three parties left uncoordinated, the Chapter cancelled its requests for medical relief activities in the prefecture at 7:30 p.m. on March 13. Later, except for the activities of medical teams from the Yamagata Chapter on March 15 and 16, support from other chapters medical teams was temporarily suspended, and only the Fukushima Chapter s medical teams continued to work. Subsequently, when relief activities were resumed, medical teams located their base in FUKUSHIMA and AIZUWAKAMATSU, visiting scattered evacuation centers for medical care. Figure 1-16 Major Movements of the Fukushima Chapter HDC, Etc. after the Occurrence of the Earthquake Date Time Description 2:46 p.m. The earthquake occurred. 2:50 p.m. The Fukushima Chapter HDC was established. 2:50 p.m. The Chapter could get through to its counterpart in MIYAGI on the radio system. 3:01 p.m. The Chapter established (wireless) communications with the Ishinomaki RCHP. 3:20 p.m. A Cable No. 2 system was established with the Headquarters Disaster Management Division. The Niigata Chapter requested the provision of information, but the Fukushima Chapter replied, 6:16 p.m. We, too, have not been able to assess the degree of damage caused to the prefecture. 6:30 p.m. The Fukushima RCHP dispatched its DMAT to Fukushima Medical University. 3/11 8:04 p.m. TV news reported that the Fukushima Daiichi Nuclear Power Station had automatically stopped its operation, declaring a nuclear emergency. 8:55 p.m. The Tokyo Metropolitan Chapter called the Fukushima Chapter to gather information, saying that it could not contact its medical teams. The latter asked the teams to provide their sender with information on their condition. The Chapter received a phone call saying that the Fukushima RCHP DMAT planned to return to the hospital 9:15 p.m. and head for the Minamisoma City Hospital after preparations were over. TV news reported that Chief Cabinet Secretary Yukio Edano had urged local residents to evacuate because radiation might 9:55 p.m. have leaked from the Fukushima Daiichi Nuclear Power Station s Unit 2, and that evacuation orders were issued for those who lived within 3 km of the power station with those who lived within 10 km instructed to remain indoors. 10:05 p.m. The DMAT of the Fukushima RCHP returned to the hospital and stood by. 11:45 p.m. The Fukushima RCHP s DMAT arrived at the Minamisoma City Hospital. 2:00 a.m. The Ishinomaki RCHP requested the Chapter to provide oxygen, gas cylinders, and blankets in large quantities. The Chapter contacted the Hamadori municipal HDC to find out how much damage had been caused and whether 4:00 a.m. support such as medical relief teams was needed. Requests included two medical teams for the Iwaki Fire-Fighting Headquarters, one for MINAMISOMA, three for NAMIE, three for SHINCHI, and two to three for NARAHA. 3/12 4:12 a.m. The Chapter requested the HDC at the Headquarters to send eleven medical teams for support. 4:45 a.m. The Chapter requested the HDC at the Headquarters to send twelve medical teams for support. Personnel sent to the prefectural government s HDC contacted the Chapter, saying, Since five of the DMATs that 4:55 a.m. had arrived in the prefecture have already been dispatched to the SOSO area, it is difficult to meet the Fukushima Chapter s request for medical teams. Tell us how urgently the Chapter needs medical teams. 5:40 a.m. A medical team from the Narita RCHP reported that its helicopter had arrived at Fukushima Airport. 32

60 Date Time Description 7:10 a.m. The Headquarters requested the Chapter to provide information, asking it about the prefectural government s policy toward relief activities near the nuclear power station. 9:00 a.m. The Chapter received the information that an SCU had been installed at Fukushima Airport as a base to transport critically ill patients to other unaffected areas. 3/12 4:40 p.m. The Chapter instructed medical teams engaged in relief work in SHINCHI to move to SHIROISHI, MIYAGI, through the Niigata Chapter s medical team. 4:50 p.m. The Chapter s HDC in the prefectural government office directly instructed medical teams working in SOMA to move to KAWAMATA for relief work, and at the same time, the government declared a nuclear emergency. 10:20 p.m. The Kochi Chapter s medical team inquired to the Fukushima Chapter about how to handle those exposed to radiation. 10:55 p.m. The Chapter inquired to a doctor at Fukushima Medical University, who advised it not to handle those exposed to radiation but to leave them to the national and prefectural governments. It instructed the Kochi and Okayama Chapters to return their medical teams. 11:30 p.m. The Shiga Chapter s medical team contacted the Fukushima Chapter, saying that its members might have diagnosed and treated patients suspected of exposure to radiation. Through the Headquarters, the Chapter requested medical teams departing from that time onward to bring protective 9:05 a.m. clothing with them because it was expected that those suspected of exposure to radiation were scattered in various places. 10:20 a.m. The Fukushima RCHP s DMAT, which was working at Fukushima Medical University, was requested to take over the duties of the prefectural government s DMAT supervisory Headquarters. 10:45 a.m. The Chapter requested the HDC at the Headquarters to advise those who planned to come to help its relief activities to bring protective clothing with them for caution s sake. 10:50 a.m. The Chapter HDC requested the HDC at the Headquarters for support personnel. 3/13 11:03 a.m. In response to the HDC at the Headquarter s inquiry, the Chapter requested it to continue the dispatch of seven of the twelve medical teams currently at work (The remaining five were working in SHIROISHI). 12:45 p.m. The President visited the chapter. The Chapter held a meeting to consider how medical teams should work in the radioactive environment (Participants included the Chapter s personnel and medical teams; the Niigata Chapter coordinators; and doctors, head nurses, and administrators from medical teams). It asked the Headquarters to 5:45 p.m. determine whether JRCS should provide medical relief in the radioactive environment but did not receive a reply to the question. As it was unable to maintain the safety of medical teams in the radioactive environment, the Chapter canceled its request for relief and support activities under its jurisdiction. For further instructions, the medical teams contacted the chapters and hospitals that had dispatched them. 8:30 p.m. The Fukuoka and Saga Chapters medical teams, which had been scheduled to arrive in FUKUSHIMA, were redirected to ISHINOMAKI. 3/14 6:45 a.m. The Kagawa Chapter s medical team left for ISHINOMAKI, followed by teams from the Hiroshima, Kochi, Ehime, and other Chapters. 12:55 p.m. With the prefectural government s HDC confused, the activities of medical teams in the prefecture were unknown as no information was obtainable. 3/15 1:30 p.m. The Yamagata Chapter s medical team arrived. 3/16 2:50 p.m. The Chapter s personnel left for the Azuma Gymnasium. They transported materials and installed a first-aid station there. 3:40 p.m. The Chapter requested the Aizu RCBC to survey evacuation centers, including Aizu Tsurugajo Gymnasium. (2) Establishment of the Fukushima Chapter HDC Immediately after the occurrence of the earthquake, the Fukushima Chapter set up six teams under its Head and Deputy Head. After April, it slightly reviewed its organizational structure. (3) Reception of the Chapter support personnel On the day of the earthquake, support personnel from the Niigata Chapter joined the Fukushima Chapter, and later, those from chapters, blood centers, and other JRCS organizations also continued to join the Fukushima Chapter. The activity bases for medical teams in the prefecture were divided into two cities: FUKUSHIMA and AIZUWAKAMATSU. For this reason, the Chapter sent coordinators to AIZUWAKAMATSU, and other chapters and organizations also assigned support personnel there. These support personnel were indispensable to the Chapter as it engaged in relief work at two locations though it had only a small number of personnel. Figure 1-17 Organizational Structure of the Fukushima Chapter HDC <Day of the earthquake to the end of March> Head Hisao Ota Deputy Head Shinichiro Watabe Relief and Information Team Relief Supplies Team Volunteer Team Logistic Team (The names of team members are omitted.) Gienkin Team Ordinary Business Coordination Team <After April 1, 2011> Head Hisao Ota (Left the Chapter on July 20, 2012) Masayuki Anabuki (after July 21, 2012) Deputy Head Director Saito Recovery Support Promotion Team Medical Team Coordination Team Relief Supplies Team (The names of team members are omitted.) Volunteer Team Gienkin Team Ordinary Business Coordination Team Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities Great East Japan Earthquake and Tsunami 33

61 Great East Japan Earthquake and Tsunami Chapter 1 Figure 1-18 Number of Chapter Support Personnel by Destination of the Dispatch and Period of the Dispatch Period of the dispatch Destination of the dispatch March April May June July August Total The Fukushima Chapter Fukushima Prefecture Aizu Health and Welfare Office AIZUWAKAMATSU Total Note: The periods of dispatch are classified according to the day when the dispatch began. Building Electricity Figure 1-19 Damage to the Fukushima Chapter Item Damage Recovery No particular problem for business Parts of the inner walls collapsed slightly, but this had no direct effects on the Chapter s operations. No problem Power generator fuel (fuel oil) Water supply Sewage Fixed phone Mobile phone Disaster priority phone, satellitebased mobile phone, etc. JRCS s business radio, etc. Not activated Water supply was cut off for about one week. No problems Satellite-based and disaster priority mobile phones could not get through easily. JRCS s business radio could get through easily. The administrative agency continued to supply water, and about one week later, the water supply returned to normal. Fixed-phones could not get through easily during the several days after the earthquake, but later the service returned to normal. Same as above As time passed, mobile and other phones gradually came to get through. Starting immediately after the earthquake, JRCS s business radio was very helpful in communicating and coordinating with medical teams. (4) Damage to the Chapter The Fukushima Chapter occupied a relatively new, independent building, nor was the power supply cut off. Therefore, it also functioned as a base of assembly for medical teams. At the Fukushima Chapter, satellite-based mobile and disaster priority mobile phones could not get through easily, but JRCS s business radio could get through easily though it was sometimes affected by weather conditions. (5) Cooperation and liaison with related organizations such as local governments In FUKUSHIMA, the dispatch of DMATs was extended to March 21. After March 22, medical relief was provided separately by various groups: medical teams requested by the prefectural government, JMATs served as the organization to contact, JRCS s medical teams, and organizations the prefectural government did not know (including activities by medical associations in the prefecture). The Fukushima prefectural government launched the Fukushima Prefecture Disaster Medical Support Network, which consisted of the government, Fukushima Medical University, Fukushima Medical Association, and other organizations, to gather information on evacuation centers and local communities, ensure information sharing among the parties concerned, register and receive human resources in medical care, and coordinate the destinations of medical teams dispatched. The Network set up a general meeting to coordinate medical care related to the GEJET. The meeting comprised organizations such as the prefectural government, Fukushima Medical Association, Fukushima Medical University, Fukushima Dental Association, Fukushima Hospital Association, Fukushima Nursing Association, and Fukushima Pharmaceutical Association, and its purpose was to share information among its members. Meanwhile, the prefectural government requested medical teams to voluntarily submit completed medical support registration forms. The prefectural government divides the prefecture into seven livelihood zones, and in the northern part of the prefecture and in the Aizu area, JRCS s 34

62 medical teams played a leading role in medical relief activities. The balance of supply of and demand for medical teams was also adjusted on an area-by-area basis, and the prefectural government s HDC obtained information on each zone through health and welfare offices and adjusted the balance by requesting local governments, hospitals, and other organizations that offered to dispatch medical teams to do so if it received requests for the dispatch of such teams through health and welfare offices. Starting from immediately after the earthquake, the Fukushima Chapter sent personnel to the prefectural government s HDC to cooperate with the Network mentioned above and the Fukushima Prefecture Emergency Radiation Exposure Medical Coordination Headquarters & Fukushima Prefecture DMAT Coordination Headquarters. It also cooperated with local health and welfare offices mainly by sending personnel to meetings held at the Northern Fukushima Health and Welfare Office to coordinate the dispatch of medical teams when engaging in relief activities in northern FUKUSHIMA and AIZU and by sending personnel to operate the Aizu Area Disaster Medical Care Coordination Headquarters, which was set up at the Aizu Health and Welfare Office. [The Fukushima Chapter HDC (March 15)] 5. Other Chapters HDC Sections 2-4 above described the HDC in the major affected areas, but other Chapters HDC also responded to the disaster in their respective prefectures. (1) AOMORI a. The Action Taken at the Time of the Disaster Soon after the earthquake occurred, the Aomori Chapter established its HDC, which gathered information by sending personnel to the prefectural government s HDC, made preparations for medical teams, chapter support personnel, and the transport of blankets, and took other necessary measures. Figure 1-20 The Aomori Chapter s Activities Immediately after the Earthquake Date Time Description 3/11 2:46 p.m. The earthquake occurred. 3:03 p.m. The Aomori Chapter HDC was established. 3:20 p.m. One officer was dispatched to the prefectural government s HDC for communication and coordination. 3:23 p.m. The Hachinohe RCHP put one medical team on standby. 5:00 p.m. The chapter transported blankets to HIGASHIDORI. 5:12 p.m. The Hokkaido Chapter requested the Aomori Chapter to dispatch one medical team to support the Miyagi Chapter. 6:10 p.m. The Hachinohe RCHP s medical team was dispatched. 6:45 p.m. The Chapter support personnel were dispatched. 3/12 00:30 a.m. The chapter instructed the Hachinohe RCHP s medical team to head for ISHINOMAKI. 02:22 a.m. The Hachinohe RCHP s medical team arrived at the Ishinomaki RCHP, where it merged with the chapter support personnel. <Major activities> In the prefecture, the Aomori Chapter engaged in the following activities: Visiting various places in Starting on the day after the earthquake HACHINOHE for care occurred, the Hachinohe RCHP voluntarily organized teams of nurses to visit various places in the city. Period: March 12 to 16 (five days) Total number of nurses mobilized: 244 Number of patients tended to: 323 Distribution of relief supplies From the day of the earthquake to the following day, the Chapter distributed 937 blankets to seven municipalities in the prefecture. (2) IBARAKI a. The Action Taken at the Time of the Disaster After the earthquake occurred, the Ibaraki Chapter established HDC. While the Mito and Koga RCHPs made preparations to dispatch medical teams, the HDC gathered information on disaster-response volunteers and other matters. Later, medical teams from within and outside the prefecture were sent to the affected areas. Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities Great East Japan Earthquake and Tsunami 35

63 Great East Japan Earthquake and Tsunami Chapter 1 Figure 1-21 Ibaraki Chapter s Activities Immediately after the Earthquake (Chronological) Date Time Description 2:46 p.m. The earthquake occurred. 2:50 p.m. The Ibaraki Chapter HDC was established. 3:00 p.m. The Mito RCHP put medical teams on stand by. 3:45 p.m. The Koga RCHP became ready for receiving patients. The Koga RCHP sent personnel to JR Koga Station 6:07 p.m. to gather information. 3/11 The HDC started to distribute disaster relief supplies 8:35 p.m. such as blankets to the affected municipalities. Disaster-response volunteer leaders started to 10:00 p.m. work at the Kitaibaraki municipal office (to gather information). Volunteer amateur radio operators started to 11:20 p.m. work at the Kitaibaraki municipal office (to gather information). The Koga RCHP s medical team started to work at 1:05 a.m. Oarai Minami Junior High School. The Haga RCHP s medical team started to work at 3:40 a.m. the Kitaibaraki municipal office. The Headquarters requested the Tokyo Metropolitan 9:00 a.m. Chapter to dispatch a medical team for support. As the Mito RCHP was unable to dispatch its 10:00 a.m. medical team, the HDC requested the Koga RCHP to dispatch its second medical team. Disaster-response volunteer leaders and area leaders 3/12 gathered, starting activities such as bringing in relief 10:30 a.m. supplies, and the Ibaraki Chapter volunteer center was set up. The Headquarters requested the Tokyo Metropolitan 12:03 p.m. Chapter to send 8, ml bottles of water. The Yamanashi RCHP medical team arrived at the 12:30 p.m. Chapter HDC. The HDC requested Consumer Cooperative Union 3:50 p.m. (Coop) to cooperate in transporting relief supplies. The prefectural government informed the HDC that 10:40 p.m. scheduled blackouts would begin on the following day 3/18 4:00 p.m. Medical relief activities in the prefecture ended. b. Medical relief activities In addition to the Mito RCHP s and the Koga RCHP s medical teams, the HDC sent medical teams from the Tochigi, Tokyo, Yamanashi, Shimane and Yamaguchi Chapters to evacuation centers in various places of the prefecture, including OARAI in order to provide relief to evacuees. Medical relief activities in the prefecture ended on March 18. Figure 1-22 Results of the Activities of the Medical Teams in IBARAKI (Seventy-eight doctors from 11 medical teams) Facility name Destination Dispatch period Haga RCHP Mar. 11 to 13, 2011 Omori RCHP Mar. 13 Yamanashi KITAIBARAKI Mar. 15 to 17 RCHP Mito RCHP Mar. 17 to 18 Facility name Destination Dispatch period Yamanashi RCHP Mar. 12 to 13 Matsue RCHP HITACHINAKA Mar. 13 to 15 Masuda RCHP Mar. 15 to 17 Koga RCHP Mar. 11 to 13 OARAI Koga RCHP Mar. 13 to 14 Yamaguchi RCHP Mar. 13 to 15 MITO Yamaguchi RCHP Mar. 15 to 17 c. Distribution of relief supplies Starting on the day of the earthquake, the Ibaraki Chapter delivered relief supplies stored in its warehouse and municipal governments to evacuation centers in various places of the prefecture. Figure 1-23 List of spot to which Relief Supplies (Blankets) Were Distributed Distribution destinations Number of blankets distributed MITO 100 HITACHI 1,000 TSUCHIURA 20 KOGA 500 ISHIOKA 720 RYUGASAKI 500 SHIMOTSUMA 230 TAKAHAGI 1,340 KITAIBARAKI 1,980 KASAMA 480 TSUKUBA 20 HITACHINAKA 3,340 HITACHIOMIYA 500 NAKA 300 CHIKUSEI 800 KASUMIGAURA 70 SAKURAGAWA 50 KAMISU 500 NAMEGATA 500 HOKOTA 1,000 OARAI 1,220 SHIROSATO 10 DAIGO 270 AMI 1,000 Mito RCHP 700 Total 17,150 In addition to the foregoing, the HDC distributed 1,060 sets of daily necessities (such as towels, bars of soap, and tooth brushes) stored in the Chapter s warehouse to five areas in the prefecture. (3) TOCHIGI a. The Action Taken at the Time of the Disaster In the Tochigi Chapter s jurisdiction, the Otawara RCHP was heavily damaged, and medical teams from within and outside the prefecture were dispatched to the hospital. 36

64 Figure 1-24 Tochigi Chapter s Activities Immediately after the Earthquake (Chronological) Date Time Description 2:46 p.m. The earthquake occurred. An order for a third-level relief regime was issued (The Tochigi chapter HDC was established). 3:26 p.m. An order to dispatch members of DMAT was issued. The Otawara RCHP reported the damage caused to 3:28 p.m. its facilities by wireless. The damage, including water leaks, was immense. The Otawara RCHP informed the HDC that nobody was injured with little damage to its building. It also 4:02 p.m. reported that in cooperation with the Otawara municipal government, it had evacuated its patients to a gymnasium in the city and requested 250 blankets and drinking water. The HDC confirmed with the Otawara RCHP as to whether it could dispatch its medical team. The 4:26 p.m. hospital replied that it could not because it was fully occupied with the caring of its patients and there was 3/11 no time for anything else. Preparations for the transport of the Chapter s 4:32 p.m. supplies were completed. These supplies left for the Otawara RCHP. The Otawara RCHP informed the HDC of its condition: its functions stopped due to a water cutoff; new patients could not be accepted; preparations 5:13 p.m. for transferring its patients to Otawara City s and Otawara High School s gymnasiums were under way; and all hospital staff members were joining forces in caring for its patients. The Haga RCHP was evacuating its patients as its north 7:00 p.m. building wards had become unusable. All critically ill patients were transferred to the south building. At the prefectural government s request, the 7:36 p.m. Ashikaga RCHP dispatched a DMAT to the Otawara RCHP. The Kyoto Chapter s medical team took a nap at 5:30 a.m. JRCS s conference room (and left for the Morioka RCHP at 7:30 a.m.). 3/12 1:59 p.m. The Headquarters requested the Otawara RCHP to receive a medical team from the Mie Chapter s Yamada RCHP, and the Head of the Administrative Department at the hospital informed the Tochigi Chapter that the Hospital Director consented to its reception. 9:40 p.m. The HDC set up rest areas in the conference room and the lecture room so that 20 persons could take a nap. 3/13 8:10 a.m. The Tokyo Metropolitan Chapter asked the Tochigi Chapter whether in terms of equipment and facilities, the latter could be used as a collection and distribution center for relief supplies in the months to come. The Chapter replied that it could if its vehicles were removed from the garage. The prefectural government s disabilities and welfare division advised the Chapter s Secretary General that 10:10 a.m. its arena could be used from the day, adding that it would let other organizations cancel their reservations for the subsequent ten days or so. b. Medical relief activities Two medical teams were dispatched to TOCHIGI: a DMAT sent by Ashikaga RCHP to the Otawara RCHP and a medical team from MIE s Yamada RCHP. Since its building sustained damage, the Otawara RCHP temporarily evacuated its patients to parking lots in front of its building and other places, and on the night of the day of the earthquake, it evacuated some of its patients to Otawara City s and Otawara High School s gymnasiums. And four DMATs (one of them was a team from the Ashikaga RCHP) gathered at the hospital. On March 12, hospital personnel cleaned up the wards that were in a mess and made preparations for health care and transported the evacuated patients back to the hospital by city buses and ambulances. All patients retreated from the evacuation centers within the day. On the night of the day, a medical team from the Yamada RCHP arrived in OTAWARA, and on the following day, it visited various places of OTAWARA and NASU to provide medical care. c. Distribution of Relief Supplies Relief goods were supplied to JRCS branches, facilities, and so forth in TOCHIGI. Figure 1-25 Supply of Relief Goods to JRCS branches, Other Facilities in TOCHIGI Recipient Number of blankets supplied Number of emergency sets (daily necessities) supplied Number of bedding (futon) sets supplied UTSUNOMIYA 20-7 NIKKO OYAMA 20-7 MOKA YAITA SAKURA NASUKARASUYAMA 7-2 SHIMOTSUKE 19-8 MASHIKO MOTEGI TAKANEZAWA 20-7 NAKAGAWA 10-5 NASU 10-3 Tochigi prefectural government 10, Otawara RCHP simple beds (Note) Except for the Tochigi prefectural government and the Otawara RCHP, relief goods were supplied on a JRCS branches (4) CHIBA a. The Action Taken at the Time of the Disaster Immediately after the occurrence of the earthquake, in an effort to provide relief to victims, the Chiba Chapter started to dispatch medical teams, first contingents, and derus to the Tohoku region, which it assumed had sustained Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities Great East Japan Earthquake and Tsunami 37

65 Great East Japan Earthquake and Tsunami Chapter 1 immense damage. At the same time, at the request of the prefectural government and municipal ones, it urgently delivered blankets and other goods that it had stored to the affected areas in the prefecture with the cooperation of Chiba Coop (The Chiba Chapter has entered into an agreement with the Coop on the transport of goods at the time of a disaster). In addition, having obtained information on many stranded people, it sent a medical team each to Tokyo Disneyland and Narita Airport from the Narita RCHP in order to look after the sick there. Figure 1-26 Chiba Chapter s Activities Immediately after the Earthquake (Chronological) Date Time Description 3/11 2:46 p.m. The earthquake occurred. 3:00 p.m. The Chapter sent personnel to the prefectural government s Fire-Fighting and Earthquake Disaster Prevention Division to obtain information. 3:15 p.m. The Chapter sent personnel to the Chiba Municipal government to obtain information. 3:15 p.m. The Chiba Chapter HDC was established. 3:55 p.m. The HDC held its first meeting and decided to request two medical teams to get ready for dispatch. 4:13 p.m. At the Narita RCHP, two medical teams completed preparations and waited for instructions. 5:25 p.m. The HDC requested the Coop in Chiba to transport relief supplies. 7:20 p.m. The HDC held its third meeting and confirmed the information that there were 40,000 to 50,000 evacuees at Tokyo Disneyland and 2,000 at the airport. 10:10 p.m. Four medical teams arrived at Narita Airport. 3/12 0:58 a.m. Three medical teams arrived at Tokyo Disneyland. 1:40 a.m. Personnel dispatched to URAYASU to gather information joined the Urayasu Municipal HDC b. Distribution of Relief Supplies The amount of supplies distributed to the prefecture alone is unknown, but relief goods such as blankets, including those delivered to prefectures other than CHIBA, were distributed as follows: Figure 1-27 Distribution of Relief Supplies from the Chiba Chapter after the GEJET (Including Those Delivered outside the Prefecture) Item Number of items distributed Recipients KATORI, NARITA, FUTTSU, TOGANE, CHOSHI, YOKOSHIBAHIKARI, KUJUKURI, Blankets SAMBU, ASAHI, KATSUURA, 15,670 ISUMI, ONJUKU, MINAMIBOSO, ICHINOMIYA, SHIRAKO, NARASHINO, and Narita Airport MIYAGI Set of daily necessities 2,120 CHOSHI and KUJUKURI MIYAGI Gauze sets 930 CHOSHI and SAMBU Bath towels NARITA, SAMBU, CHOSHI, 1,010 KUJUKURI, and ISUMI Bed sheets 700 ISUMI and SAMBU Sleeping sets 1,000 MIYAGI Emergency kits ASAHI, ISUMI, MINAMIBOSO 366 MIYAGI and FUKUSHIMA (5) TOKYO On the day of the earthquake, mainly due to the suspension of public transport services, there were over 3.5 million stranded people in TOKYO. Many public facilities provided lavatories and rest areas, and the Tokyo Metropolitan Chapter also opened its building to the stranded, distributed food and beverages to them in cooperation with volunteers, and provided road information and places for sleeping. At first, the Tokyo Metropolitan Chapter opened only its lobby on the first floor to help the stranded, but around at 5:00 p.m., in order to prevent confusion, it decided to receive them in its other facilities in the building. It let the stranded use lecture rooms on the second floor, an arrangement that continued until 10:00 a.m., when the last of the people who stayed there left. Over 2,000 people used the lavatories and other facilities, and about 120 stayed overnight. In addition, at the Shinjuku ward office s request, the Chapter delivered relief supplies (Ritz crackers and drops) to Okubo Elementary School, where 150 to 160 evacuees had gathered, at 11:30 p.m. on the day of the earthquake. Moreover, at 0:10 a.m. on March 13, it sent volunteers (relief volunteers and Red Cross youth volunteers) to Okubo and Hanazono Elementary Schools and Nishiwaseda Junior High School. And after it guided the evacuees from Okubo Elementary School to Okubo Junior High School, the Chapter distributed blankets at the elementary school. It also installed aid stations along trunk roads in CHOFU on the night of March 11 and in KOKUBUNJI on the following morning. At these 38

66 stations, volunteers helped stranded people mainly by providing road information and supplying drinking water. [A lecture room on the second floor was provided as a lodging place] (6) NAGANO a. Earthquake Situation Immediatly after the Disaster Occured At 3:59 a.m. on March 12, 2011, an earthquake registering a magnitude of 6.7 on the Richter scale whose epicenter was TSUNAN occurred in northern NAGANO, and a seismic intensity 6 upper was registered in SAKAE and 5 lower at NOZAWAONSEN. The damage caused by this earthquake in the prefecture was as listed below. Figure 1-28 Casualties and Damage to Houses Casualties Three persons died. Twelve persons were slightly injured (ten in SAKAE, one in NOZAWAONSEN, and one in NAGANO). Damage to houses Thirty-three houses were totally destroyed in SAKAE and one in IIYAMA. A total of 169 houses were half destroyed in SAKAE. A total of 486 houses were partly destroyed in SAKAE, 14 in IIYAMA, and one in NOZAWAONSEN. Figure 1-29 Evacuation (as of 2:00 p.m. on March 14) Number of 1,630 (from the entire village of SAKAE, excluding evacuees the AKIYAMA area) Evacuation Francaise Yusakae (home for elderly people centers requiring special care), Mitsukuri community center, Sakae village government office, Hokushin Elementary School, Kitanotenman hot spring resort, Sakae Junior High School cafeteria, and Tobu Elementary School b. The Action Taken at the Time of the Disaster Immediately after the Northern Nagano Earthquake of March 12 occurred, the Nagano Chapter HDC was established and dispatched personnel to the affected areas. Meanwhile, the Azumino and Iiyama RCHP sent medical teams to SAKAE, where the team members visited various places in the village for medical care. The team worked there from March 12 to 14. In SAKAE, the Chapter distributed 4,200 blankets, 210 sleeping sets, and 108 emergency kits. Figure 1-30 Dispatch of Medical Teams, Etc. Number of Facility name Description Destination personnel Azumino RCHP 8 Medical team members Iiyama RCHP 7 Personnel from 3 The Nagano Chapter the local HDC 5 Personnel to The Nagano Chapter s transport relief 2 medical team supplies Total 25 SAKAE 6. Initiatives of the national and local governments as well as other related organizations after the earthquake (1) Central Disaster Management Council After the earthquake, the Central Disaster Management Council held its meetings at the Prime Minister s Official Residence on April 27, October 11, and December 27, 2011, and on March 29 and September 6, 2012, and the JRCS President, a Council member, attended these five meetings. Taking into consideration the fact that the GEJET was of a far greater magnitude and caused far more serious damage than had been assumed, the Council established the Committee for Technical Investigation on Countermeasures for Earthquakes and Tsunamis to examine how disaster-prevention measures should be reviewed, including whether sufficient preparations had been made for disasters. Based on the final report of the committee, the Council set up Committee for Policy Planning on Disaster Management and reviewed the related legal systems such as the Disaster Countermeasures Basic Act as typified by the revision of the Basic Disaster Prevention Plan. (2) Committee to Examine How Disaster Medical Care, Etc. As it was recognized that disrupted life lines, lack of fuel, and other factors affected the diagnostic and therapeutic functions of some medical institutions as they responded to the GEJET, this Committee was established to further improve the disaster medical care system in the future as the government was Chapter 1 Establishment of the Headquarters of Disaster Control (HDC) and Its Activities Great East Japan Earthquake and Tsunami 39

67 Great East Japan Earthquake and Tsunami Chapter 1 faced with issues to be addressed in disaster medical care, etc., including the necessity of building systems to support medical care, nursing care, and so forth over a period of several months. Chaired by Prof. Yasuhiro Otomo of Tokyo Medical and Dental University Graduate School, the Committee consisted of representatives from medical organizations as well as municipalities and medical institutions in the affected areas. JRCS was represented by Dr. Masafumi Naito, Head of the Emergency and Critical Care Center at the Nagaoka RCHP and Mr. Daisuke Takakuwa, Director of the Procurement Division at the Musashino RCHP. The Committee held its first session at the MHLW on July 23, 2011, followed by three sessions in subsequent months. In October, it submitted a report on how disaster core hospitals should be, including their facilities and functions, and on medical care delivery systems at the time of disaster. The results of these examinations were reflected on the FY2011 supplementary budget related to recovery from the earthquake. (3) Liaison Council to Support the Health of Victims In order to support the health of victims of the GEJET, the Liaison Council to Support the Health of Victims, which comprised medical and nursing care organizations, was set up in April The Liaison Council was established under the government s special response Headquarters to support the lives of victims, and at the Headquarters request for cooperation, it is engaged in initiatives required to (1) ensure the medium- to long-term dispatch of medical teams to the affected areas in order to meet their medical needs and (2) identify health needs in the affected areas, particularly in the evacuation centers, and maintain the health of the victims, including protection from infectious diseases. As of March 2012, it consisted of 18 medical organizations (34 groups), including the Japan Medical Association. JRCS had not participated in the council since its establishment, but determined that it was beneficial to cooperate with other medical organizations, including through information sharing, thus it sent Dr. Atsushi Katsumi, Head of the Emergency Department 2 at the Musashino RCHP, to serve on the council starting from its ninth session. (4) The Council for the Alleviation of Subterranean Urban Earthquake Commuter Distress The Council for the Alleviation of Subterranean Urban Earthquake Commuter Distress was established in September In order to ensure that comprehensive measures would be taken through self-help, mutual help, and public help to cope with Council for the Alleviation of Subterranean Urban Earthquake Commuter Distress, it aimed to share information on the initiatives of the national and local governments as well as businesses and other organizations and examine cross-sectional issues that should be addressed through mutual cooperation and collaboration. Co-chaired by the Director General for Disaster Management at the Cabinet Office and the Vice Governor of Tokyo, the Council consisted of related government agencies, local governments, economic organizations, public means of transport, and so forth, and JRCS was represented by the Executive Director General for the Operations Sector. Based on the results of the verification of the effectiveness of measures taken to cope with stranded people after the GEJET, the Council considered the current specific initiatives and cooperative measures in various areas such as controlling number of people who try to return home simultaneously and securing temporary facilities to allow them to stay on. In September 2012, it put together a final report. 40

68 Chapter 2 Provision of Medical Relief

69 Great East Japan Earthquake and Tsunami Chapter 2 Chapter 2 Provision of Medical Relief 1. Mobilization of Medical Teams (1) Policy of Dispatching Medical Teams and their Initial Mobilization a. Relief Services by the Japanese Red Cross Society (JRCS) The JRCS provides medical relief services as the prime activity of its disaster relief operations. To this end, the JRCS Headquarters and chapters organize medical teams consisting of registered medical team staff engaged in relief operations. In principle, a medical team consists of 6 staff (i.e., 1 doctor, 1 nurse leader, 2 nurses, and 2 administration staff). The number of care staff is likely to increase or decrease due to requirements for additional staff, including pharmacists, midwives, etc. The medical teams are dispatched for the following three purposes within the scope of their activities; i.e., medical aid, midwifery care, and cadaver processing. They also provide medical relief at makeshift aid stations while setting up a mobile clinic to provide medical care in the disaster-affected areas and disaster shelters, etc. To provide medical and midwifery care services for disaster victims needing medical care ASAP, as well as cadaver processing (excluding temporary storage) in the disaster-affected areas. To fill the void of medical care for local medical establishments undergoing a loss of functions due to the disaster. To operate a mobile clinic to provide medical care, etc. and provide emotional support for the evacuees. others with 7 teams (TOCHIGI with 1 team, IBARAKI with 4 teams, and CHIBA with 2 teams). (b) Questionnaire Surveys of the Initial Medical Teams A series of questionnaire surveys of the initial medical teams were carried out between August and September teams responded to this survey. According to the survey results, the mobilization order was released mostly by the chapter that the respondent belonged to (65%), followed by the sole discretion of the hospital (25%). However, these respondents also selected other choices, while only 6% (3 teams) chose only the sole discretion of the hospital. On the other hand, a few respondents selected the chapters in the disaster-affected areas and Headquarters, which suggests that many of the teams seem to have decided on the mobilization according to the chapter or block representative chapter that they belonged to. Almost half of them knew their dispatch destination, etc., at the time of mobilization, and the remaining half started without knowing their destination. As for the role of the initial medical teams, 91% of respondents answered it was highly significant to carry out the operations while collecting information. Asked about the role or skills of the initial medical teams that should be improved in the future, many answered to secure information communications equipment (49%), and to define the line of communications (39%). b. Initial Mobilization (a) Number of Medical Teams Initially Mobilized The medical teams provided medical aid services at the disaster sites on and after March 11, the day the Great East Japan Earthquake and Tsunami (GEJET) occurred. 55 initial medical teams were mobilized on March 11, including 22 JRCS Disaster Medical Assistance Teams (DMATs). The sites of services included IWATE with 11 teams, MIYAGI with 24 teams (the majority were assigned within the Ishinomaki limits), FUKUSHIMA with 7 teams, transferring from FUKUSHIMA to IWATE with 1 team, from MIYAGI to IWATE with 1 team, from FUKUSHIMA to MIYAGI with 4 teams, and [Departure ceremony for the medical teams] 42

70 Figure 2-1 Summary of the Initial Medical Teams Block / Destination Facility Name Team Type No. of Staff Prefecture Prefecture Site of the Services Headquarters JRCS Medical Center deru-1 Team 14 MIYAGI Ishinomaki Red Cross Hospital (RCHP) Headquarters Medical Center DMAT-1 Team 5 FUKUSHIMA / MIYAGI Minamisoma Municipal General Hospital, Shinchi Shiraishi 1 AOMORI Hachinohe RCHP Medical-1 Team 9 MIYAGI Ishinomaki RCHP IWATE Morioka RCHP deru-1 Team 14 IWATE Yahaba Prefectural Fire Academy MIYAGI Ishinomaki RCHP Medical-1 Team 5 MIYAGI ISHINOMAKI MIYAGI Ishinomaki RCHP Medical-1 Team 3 MIYAGI ISHINOMAKI MIYAGI Sendai RCHP Medical-1 Team 4 MIYAGI Sendai Medical Center Akita Akita RCHP Medical-1 Team 8 MIYAGI / IWATE Information gathered at MIYAGI - IWATE FUKUSHIMA Fukushima RCHP DMAT-1 Team 5 FUKUSHIMA Minamisoma Municipal General Hospital 2 IBARAKI Furukawa RCHP Medical-1 Team 8 IBARAKI OARAI TOCHIGI Ashikaga RCHP DMAT-1 Team 4 TOCHIGI Otawara RCHP TOCHIGI Haga RCHP Medical-1 Team 7 IBARAKI Kita-Ibaraki City Office TOCHIGI Haga RCHP DMAT-1 Team 5 MIYAGI Sendai Medical Center TOCHIGI Ashikaga RCHP Medical-1 Team 7 MIYAGI Ishinomaki RCHP and shelters around the affected area GUNMA Maebashi RCHP DMAT 1 Team 8 FUKUSHIMA Fukushima Medical University SAITAMA Saitama RCHP DMAT-1 Team 6 MIYAGI Sendai Municipal Nanagou Elementary School SAITAMA Fukaya RCHP DMAT-1 Team 6 MIYAGI Sendai Medical Center / Sendai City Municipal Hospital SAITAMA Fukaya RCHP Medical-1 Team 7 MIYAGI Ishinomaki RCHP CHIBA Narita RCHP Medical-1 Team 7 MIYAGI Ishinomaki RCHP CHIBA Narita RCHP Medical-3 Team 7 MIYAGI Tokyo Disneyland CHIBA Narita RCHP Medical-4 Team 7 CHIBA Narita Airport TOKYO Omori RCHP Medical-1 Team 7 IBARAKI KITA-IBARAKI TOKYO Musashino RCHP DMAT 1 Team 7 FUKUSHIMA / IWATE Fukushima Medical University Iwate Medical University Iwate Prefectural Ofunato Hospital KANAGAWA Minato RCHP DMAT 1 Team 5 FUKUSHIMA Fukushima Prefectural Medical University KANAGAWA Hatano RCHP DMAT 1 Team 8 MIYAGI Sendai Medical Center KANAGAWA Minato RCHP Medical-3 Team 7 MIYAGI Ishinomaki RCHP NIIGATA Nagaoka RCHP Medical-1 Team 7 MIYAGI Ishinomaki RCHP NIIGATA Nagaoka RCHP DMAT-1 Team 7 FUKUSHIMA / MIYAGI Fukushima Prefectural Medical University Shinchi Shiraishi 3 TOYAMA Toyama RCHP DMAT 1 Team 6 MIYAGI Ishinomaki RCHP FUKUI Fukui RCHP DMAT-1 Team 8 MIYAGI Sendai Medical Center / Sendai Municipal Komatsushima Elementary School FUKUI Fukui RCHP Medical-1 Team 7 IWATE MORIOKA, Rikuzentakata Daiichi Junior High School YAMANASHI Yamanashi RCHP DMAT-1 Team 8 IBARAKI Hitachinaka Shiawase Plaza NAGANO Suwa RCHP DMAT-1 Team 6 IWATE Kamaishi Citizen Hospital NAGANO Nagano RCHP DMAT-1 Team 7 FUKUSHIMA Fukushima Prefectural Medical University GIFU Gifu RCHP Medical-1 Team 8 IWATE Rikuzentakata Daiichi Junior High School GIFU Takayama RCHP Medical-1 Team 8 IWATE Rikuzentakata Daiichi Junior High School SHIZUOKA Shizuoka RCHP Medical-1 Team 12 IWATE KAMAISHI / OTSUCHI SHIZUOKA Hamamatsu RCHP Medical-1 Team 8 IWATE KAMAISHI / OTSUCHI AICHI Nagoya Daiichi RCHP Medical-1 Team 6 MIYAGI Shiraishi City Office / Ishinomaki RCHP AICHI Nagoya Daini RCHP DMAT-1 Team 5 IWATE Hanamaki Airport SCU AICHI Nagoya Daini RCHP Medical-1 Team 6 MIYAGI Shiraishi City Office / Ishinomaki RCHP 4 SHIGA Otsu RCHP DMAT-1 Team 6 FUKUSHIMA Fukushima Airport SHIGA Nagahama RCHP Medical-1 Team 8 FUKUSHIMA Hamanasu-kan, etc. KYOTO Kyoto Daiichi RCHP DMAT-1 Team 8 MIYAGI Around Ishinomaki RCHP OSAKA Osaka RCHP deru-1 Team 15 MIYAGI In front of the MIYAGI Prefectural Office HYOGO Kobe RCHP deru-1 Team 13 IWATE Suzuko Plaza First-Aid Station WAKAYAMA Wakayama RCHP Medical-1 Team 10 IWATE MIYAKO / YAMADA TOTTORI Tottori RCHP DMAT-1 Team 6 FUKUSHIMA Fukushima Airport 5 SHIMANE Matsue RCHP DMAT-1 Team 10 MIYAGI Ishinomaki RCHP SHIMANE Masuda RCHP DMAT-1 Team 5 IWATE Hanamaki Airport OKAYAMA Okayama RCHP Medical-1 Team 7 FUKUSHIMA Koseikai Kawamata Hospital HIROSHIMA Hiroshima Genbaku RCHP Medical-1 Team 9 MIYAGI Ishinomaki RCHP KAGAWA Takamatsu RCHP deru-1 Team 14 FUKUSHIMA / MIYAGI Tamura City Gymnasium / Self Defence Force (SDF) Kasuminome Air Field KOCHI Kochi RCHP Medical-1 Team 9 FUKUSHIMA / MIYAGI TAMURA / Ishinomaki RCHP 6 KUMAMOTO Kumamoto RCHP Medical-1 Team 10 MIYAGI Ishinomaki RCHP Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 43

71 Great East Japan Earthquake and Tsunami Chapter 2 Figure 2-2 Mobilization order to the initial medical teams (multiple answers) (n=49) Block representative chapter 0% 20% 40% 60% 80% 20.4% Figure 2-5 Role and skills of the initial medical teams that should improve in the future (Multiple answers) (n=49) To clarify the reporting line on site 0% 10% 20% 30% 40% 50% 60% 38.8% The Chapter 65.3% To cooperate with DMAT 18.4% Judgment at the hospital s own discretion 24.5% To cooperate with local medical institutions 22.4% The Chapter in the disaster-affected area 4.1% To provide safety equipment for the team members 18.4% Headquarters 8.2% To clarify the service criteria at Nuclear, biological and chemical (NBC) disasters (including nuclear accidents) 18.4% Integrated DMAT Headquarters 10.2% To secure information communications equipment 49.0% Others 16.3% To liaise and coordinate with the related local organizations 30.6% DK 0.0% To liaise and coordinate with the related JRCS staff 16.3% To understand / assess the situation of the evacuation shelters, etc. 12.2% Figure 2-3 Destination of the initial medical teams at the time of calling-out To understand / assess information on the site / people requiring first aid after the initial service 32.7% To have skills/equipment for triage 4.1% (n=48) Others 22.9% Only instructed to head for the Tohoku District. 18.8% DK 0.0% The destination hospital or shelter, etc., had been instructed. 47.9% Necessary medical tool to be secured Patient transfer methods Others DK 12.2% 8.2% 2.0% 0.0% Destination that the prefecture had instructed without any further specific information. 8.3% Figure 2-4 (n=44) A few medical teams called out initially in order to collect information** 6.8% Destination city / town / village had been instructed, although without any further specific information.2.1% Role of the Initial Medical Teams, etc. Others 2.3% DK 0.0% First called out, although with insufficient information collected* 90.9% * It was highly significant for the teams to be called out to provide services while collecting information, although with insufficient information collected at that time. ** A more desirable arrangement was to call out a few teams to collect information, and then to deploy more teams after collecting a certain amount of information. c. Deployment of deru JRCS owns 20 units of domestic Emergency Response Unit (deru); 14 of which were used in GEJET. In addition, the Kumamoto Chapter also dispatched medical teams include large special vehicles for medical care ( Disaster Rescue ), wing box trucks carrying large tents and relief supplies, and crane trucks loaded with forklifts, etc. d. Deployment of Air Ambulances On the day following the disaster, responding to a request from DMAT Headquarters, a Dohoku air ambulance was called out from Asahikawa RCHP to Hanamaki Airport, IWATE, the hub point for DMAT. The air ambulance from the same hospital transferred 10 patients, responding to requests for deployment from outside IWATE, including ISHINOMAKI (Municipal Hospital), SENDAI (Tohoku University Hospital), etc. In the morning of the same day, March 12, an air ambulance was dispatched by Maebashi RCHP, GUNMA to Fukushima Medical University Hospital, then further to Hanamaki Airport where the Staging Care Unit (SCU) was set up. The air ambulance from the same hospital served from March 12 to 15, providing intra-regional transfer service for 13 patients. 44

72 e. Announcement of the Policy and Outline of Medical Teams Deployment (a) Policy for the deployment of medical teams After the disaster, each chapter dispatched medical teams to the disaster affected areas at their own judgment and discretion. On March 13, the Headquarter of Disaster Control (HDC) at the Headquarters published a notice to the Block Representative Chapters (BRC), entitled, Policy for the Future Dispatch of Medical Teams to the Pacific Coast of Tohoku Earthquake Disaster-Stricken Areas (Draft) with the following policy. To provide continuous deployment in order to ensure a nationwide medical service by block. For the time being, the teams served mainly in IWATE and MIYAGI (and FUKUSHIMA depending on local needs) which suffered serious damage. As long as they are available, counselors for psychosocial care staff will accompany the teams. The actual working days per unit shall not exceed 3 days (excluding the transfer). (b) Outline of the Deployment of Medical Teams As the means of communication was restored by March 18, HDC at the Headquarters released notifications, entitled, Outline of the Dispatch of Medical Teams to the Pacific Coast of Tohoku Earthquake Disaster-Stricken Areas for FY2011 to require the medical teams to submit their activity reports, etc. The outline defined the following. Each BRC shall send a list of its medical teams to the HDC of the three disaster-affected Chapters (IWATE, MIYAGI, FUKUSHIMA) as well as the HDC at the Headquarters upon the departure of such medical teams. Each medical team shall report their arrival to the Chapter HDCs in the three disaster-stricken prefectures upon arriving at the service sites. A half-day briefing shall be arranged to hand over duties by the medical teams returning to the Headquarters. Each medical team shall report the number of people it provided services to from 0:00 to 24:00 on the previous day to the Chapter HDC in the three affected prefectures by 20:00 the next day, using the form of the Activity Report by JRCS Medical Teams for the Pacific Coast of Tohoku Earthquake for FY2011. Each medical team shall report the time of departure from the local site to the HDC of three affected chapters at the end of the services and return to the Headquarters. The HDC of the three affected chapters shall provide periodical reports submitted by each medical team, reporting them to the HDC at the Headquarters by 22:00. In addition, the April 7 notification, stipulated that medical teams shall successfully submit their activity reports. Figure 2-6 Form of the Activity Report by JRCS Medical Teams for the Tohoku District-Off the Pacific Ocean Earthquake for FY2011 Figure omitted As the relief activities were expected to extend over a long period of time considering the magnitude of the disaster, JRCS explored the possibility of establishing, in addition to hospitals and disaster shelters, independent RC First Aid Stations at the hub points of the relief activities, similar to those established in the Great Hanshin Awaji Earthquake. The Society initially sought to establish a Station in Ishinomaki District, one of the hardest-hit areas, but never put it into practice because many medical teams and related entities other than JRCS joined forces to provide services. Since then, the First-Aid Station set up at Suzuko Plaza, KAMAISHI, IWATE has carried out this function. f. Deployment of Medical Coordinators The HDC at the Headquarters released a notice as of March 18, entitled Dispatch of Medical Coordinators from the HDC at the Headquarter (Request), that Dr. Atsushi Katsumi of Musashino RCHP to be asked and deployed affected area as a medical coordinator for the medical team newly set up at the HDC. According to the notice released, the medical coordinator will play the following three roles. To liaise and coordinate with respect to the disasteraffected areas and medical needs To request deployment and examine the details To provide guidance and advice on deployment policy The deployment was determined to start on March 18, 2011,. The medical coordinator communicated with local government authorities and medical professionals in the affected areas, ensuring liaison and coordination to provide advice and guidance with respect to medical services. On the other hand, local medical professionals in the affected areas, including Dr. Naohiko Kubo (Director of the HDC, Morioka RCHP, IWATE), Dr. Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 45

73 Great East Japan Earthquake and Tsunami Chapter 2 Yoichi Watanabe (Assistant Director of Fukushima RCHP, FUKUSHIMA) and, Dr. Ishii (Director of the Medical Social Services Department, Ishinomaki RCHP, MIYAGI) played the role of such a medical coordinator for JRCS medical services. (2) Number of Deployed Medical Teams a. Changes in the Number of Deployed Medical Teams (a) Deployment of Medical Teams by Blocks Subject to the notice released by the HDC at the Headquarters on March 15, entitled, Medical Team Activities for the Tohoku Earthquake Disaster-Stricken Areas, it was decided to continue the following scheme for medical teams at their destinations considering the deployment status of deru. to shelter to provide medical care and psychosocial support in the recovery period. In addition, each prefecture shall continue its current structure until the end of May. Figure 2-8 Deployment system after April Figure omitted The notice released on May 13, titled, Future Policy to Dispatch JRCS Medical Teams to GEJET Disaster- Stricken Areas laid out the direction to phase down their medical services in all three prefectures. Figure 2-9 Deployment system after May Figure omitted Figure 2-7 Deployment status of deru and its subsequent deployment scheme Deployment areas IWATE Representative chapter Chapter of affiliation 1B-IWATE 4B-HYOGO In the future 1B 4B (HYOGO) 2B-TOKYO 2B-SAITAMA 2B MIYAGI 3B-AICHI 3B (excluding 4B-OSAKA 4B (OSAKA) Ishinomaki HP) 5B-KAGAWA Ishinomaki RCHP Headquarters 6B-FUKUOKA 6B-KUMAMOTO 6B FUKUSHIMA Consultation with BRC as necessary. (Note) B stands for Block The notice released on June 14, entitled Policy to Dispatch JRCS Medical Teams to the GEJET Disaster- Stricken Areas after July, indicated a plan for the withdrawal from some of the areas because of the decreasing need for their medical services. Figure 2-10 Deployment system after July Figure omitted The notice released on July 14, titled, Policy to Dispatch JRCS Medical Teams to the GEJET Disaster- Stricken Areas after August, was released to inform that more coordinated efforts shall be made to withdraw the teams from the disaster-stricken areas, except some of the areas. On March 22, the destinations of the medical teams were reviewed and coordinated by block to ensure their continued services; specifically, as follows. To IWATE, medical teams from the 1st, 2nd and 4th blocks will be dispatched. To MIYAGI, medical teams from the 3rd, 5th and 6th blocks will be dispatched. To FUKUSHIMA, medical teams will be dispatched from all blocks. Figure 2-11 Deployment system after August Figure omitted The notice released on August 19, entitled Activities by JRCS Medical Teams at the GEJET announced the following information that Disaster Management and Social Welfare Department at the Headquarters shall be made responsible for the services. (b) Cutting down to smaller medical teams The notice released on April 8, entitled Future Policy to Dispatch JRCS Medical Teams to GEJET Disaster- Stricken Areas, announced the following deployment system considering the need for continued services by medical teams, mainly including traveling from shelter 46

74 IWATE - All of the medical services shall be completed as of July 30. MIYAGI - Deployment of the medical teams from other blocks shall be completed by the end of July. - At present, one medical team (3 staff consisting of a doctor, a nurse and a administration staff) of the Miyagi Chapter provides services at OGATSUCHO only 3 days a week. - The team will be withdrawn upon completion of the temporary clinic established by Ishinomaki city government in September. FUKUSHIMA - In August, the 2nd block and the Fukushima Chapter will serve refugees who make a temporary entry into the evacuation zone after the nuclear power plant accident. - In September, the 1st block will mainly serve them in response to their request for medical services. b. Trends in the Number of Deployed Teams As mentioned above, 894 medical teams with 6,492 staff in total were deployed for about half a year until September. Even after this, medical operations continued in relation to the refugees temporary entry into the evacuation zone in response to the Fukushima Daiichi Nuclear Power Plant Accident. According to the breakdown of the number by destinations deployed, IWATE had 345 teams, MIYAGI had 383 teams, FUKUSHIMA had 136 teams, and others had 30 teams (including 7 teams deployed to the more than one prefecture in the affected area). As for the destinations cities, IWATE including RIKUZEN- TAKATA with 176 teams, KAMAISHI and OTSUCHI with 93 teams, MIYAKO and YAMADA with 56 teams, and MIYAGI including ISHINOMAKI and HIGASHIMATSUSHIMA with 358 teams accounted for the majority of the destinations. FUKUSHIMA, etc. had 71 teams and AIZU 54 teams. With regards to the breakdown by month, March, the disaster month, recorded the highest with 379 teams. The medical services provision other than for IWATE, MIYAGI and FUKUSHIMA were completed within March, phasing down to 257 teams for April, 142 teams for May, and 68 teams for June. The services were completed in May for YAMADA and June for KAMAISHI, and July for RIKUZEN-TAKATA in IWATE, and June for the entire FUKUSHIMA (however, the services in relation to temporary entry to the evacuation zone remained even after the withdrawal). The teams of Ishinomaki in MIYAGI, serving the longest, left in September. All medical teams deployment was arranged by the Headquarters and 47 Chapters. As for the 1st Blocks medical teams, in addition to the activities for affected areas within their own prefectures, the Hokkaido and Akita teams mainly served RIKUZEN-TAKATA, and the Yamagata team mainly served AIZU. Many teams from the 2nd Block served in KAMAISHI, ISHINOMAKI, the northern area of FUKUSHIMA and AIZU. The 4th block mainly provided services in YAMADA, IWATE; while the SHIGA and KYOTO teams were engaged in many activities in AIZU. The 3rd, 5th and 6th Blocks mainly served in ISHINOMAKI, MIYAGI. As mentioned in the previous paragraph, these characteristics were due to the reorganization of the destinations by Block on March 22. In addition to the JRCS, many medical teams from other organizations/institutions were also deployed in recovery from this disaster, including the Japan Medical Association and the Japan DMAT. Among these, the JRCS showed its presence by dispatching the largest number of staff of all entities. For example, according to a document released by the Ministry of Health, Labour and Welfare (MHLW) in 2011, the JRCS accounted for the majority with 6,541 individuals, of the total number of 12,115 medical staff deployed to the three affected prefectures. Figure 2-12 Trends in the number of deployed medical teams by month and destination March IWATE 113 MIYAGI 178 FUKUSHIMA 58 Others 30 Total 379 April May June July August September Total (Note 1) The date refers to the date of departure. (Note 2) Medical services provided in more than one area are included in Others. Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 47

75 Great East Japan Earthquake and Tsunami Chapter 2 Figure 2-13 Medical team staff number to the three affected prefectures (actual performance) Nationwide JRCS (percentage accounting for the entire nation) 12,115 staff 6,541 staff (54.0%) Source: Prepared from the document published by MHLW (September 30, 2011) Figure 2-14 Medical support staff number from major entities for1 month from the Disaster day JRCS Japan Federation of Democratic Medical Institution Japan Medical Association DMAT Tokushukai Group and associated organizations Japanese Nursing Association (Staff) 0 1,000 2,000 3, ,500 1,840 1,800 2,700 Japan Dental Association Japan Pharmaceutical Association National Hospital Organization University School of Medicine Source: Prepared from Yomiuri Shimbun (Newspapers) (morning edition of April 16, 2011) Figure 2-15 Number of dispatched JRCS Medical Teams by chapter and by destination (prefecture/area) Destination IWATE MIYAGI FUKUSHIMA RIKUZEN- KAMAISHI, MIYAKO, Others Total Others ISHINOMAKI Others FUKUSHIMA, AIZU Others Headquarters/Chapter TAKATA OTSUCHI YAMADA etc Headquarters 17 FUKUSHIMA / MIYAGI 1 18 Hokkaido HOKKAIDO 5 43 Aomori Iwate Miyagi Akita 42 MIYAGI / IWATE 1 43 Yamagata YAMAGATA 1 27 Fukushima Ibaraki IBARAKI 3 11 Tochigi TOCHIGI 1 / IBARAKI 1 27 Gunma Saitama Chiba 8 9 CHIBA 2 19 Tokyo IBARAKI 1, FUKUSHIMA / IWATE 1 31 Kanagawa Niigata FUKUSHIMA / MIYAGI 1 13 Toyama Ishikawa Fukui Yamanashi 1 5 IBARAKI 2 8 Nagano NAGANO 2 30 Gifu Shizuoka Aichi Mie 10 TOCHIGI 1 11 Shiga Kyoto Osaka Hyogo Nara 3 3 Wakayama Tottori Shimane 1 12 IBARAKI 2 15 Okayama The 1st Block The 2nd Block The 3rd Block The 4th Block The 5th Block 48

76 Headquarters/Chapter The 5th Block Destination RIKUZEN- TAKATA IWATE MIYAGI FUKUSHIMA KAMAISHI, MIYAKO, Others ISHINOMAKI Others FUKUSHIMA, AIZU Others OTSUCHI YAMADA etc Others Total Hiroshima Yamaguchi 9 IBARAKI 2 11 Tokushima Kagawa 11 1 FUKUSHIMA / MIYAGI 1 13 Ehime 10 FUKUSHIMA / MIYAGI 1 11 Kochi 11 FUKUSHIMA / MIYAGI 1 12 Fukuoka Saga Nagasaki 9 9 Kumamoto Oita Miyazaki Kagoshima Okinawa 6 6 Grouped by district Grouped by prefecture The 6th Block Source: Report on JRCS Medical Services for the recovery from GEJET (September, 2011) Data aggregated by the Disaster Management and Social Welfare Department, JRCS Administration Sector (Note 1) Data shows the total number of departures aggregated by the end of September 2011 (Note 2) Services provided in some areas are included in Others. (Note 3) Data do not include the number of teams deployed in relation to the temporary entry into the evacuation zone after the Fukushima Daiichi Nuclear Power Plant Accident. (3) Number and Trends of Patients Receiving Services a. Total number and trends of patients receiving services According to the Activity Report by JRCS Medical Teams which was to be submitted by the medical teams every day, the number of patients treated by the medical teams amounted to 75,892 in total by August 31. March 20 saw the peak with 2,462 patients. As for the breakdown by month, the number phased down with 32,035 in March, 24,010 in April, 14,394 in May, and 180 in August. Figure 2-16 Number and trends regarding patients treated by medical teams (No. of patients) 35,000 32,025 30,000 25,000 20,000 15,000 10,000 5, ,010 14,394 3,998 1, March April May June July August b. Trends by age group The Activity Report by JRCS Medical Teams requires, for convenience, data input by age group as follows; infants (0-4 years of age), adults (5-74 years of age), and senior citizens (75 years of age or older). According to the survey results, infants accounted for 5.8%, adults for 72.7%, and senior citizens for 21.5%. In the three disasteraffected prefectures, infants accounted for 4.0%, adults for 83.1% and senior citizens for 12.9%, which shows a higher percentage of elderly people compared to their demographic percentage composition. c. Trends by symptom severity In regards to symptom severity, serious patients accounted for 0.2%, moderate for 3.7%, and mild for 96.0%; it was unique for the percentage of seriously injured victims to be so low in spite of the devastating damage from the disaster. Transformed time-series data shows a tendency for the percentage of mild cases to be higher. The breakdown by disease is characterized by many cases of upper respiratory tract infections (23.8%), high blood pressure (19.7%) and others (33.3%). On the other hand, the proportion of external injuries was low, accounting for 4.7%, which was also only 5.1% even immediately after the March disaster. Transformed time-series data shows lower percentages for upper respiratory tract infections, external injuries and bowel movement disorders, while others tended to increase. Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 49

77 Great East Japan Earthquake and Tsunami Chapter 2 Figure 2-17 March 4.2% April3.2% May 4.3% June - August 5.8% Total 5.8% Reference: 4.0% Population Figure 2-18 Percentage of patients receiving the services by month and by severity group 0.2% March 0% 20% 40% 60% 80% 100% 7.4% 0.2% April 2.4% 0.2% May 1.8% Percentage of patients receiving the services by month and by age group 0% 20% 40% 60% 80% 100% 71.7% 75.2% 71.9% 72.7% 72.7% 83.1% 92.4% 97.3% 98.0% 24.1% 21.6% 23.9% 21.5% 21.5% 12.9% Infants Adults Senior citizens (Note 1) Age unknown group is not included. (Note 2) Infants are aged 0-4; adults 5-74, senior citizens 75 or over. (Note 3) The percentage is based on the populations of IWATE, MIYAGI, and FUKUSHIMA (National Census, as of October 1, 2010). 0.2% June - August 3.3% 96.4% 0.2% Total 3.7% 96.0% Severe Moderate Mild It is characteristic that medical services for GEJET were related to more cases of chronic diseases than external injuries directly caused by the disaster. In other words, disaster victims who were unable to receive the medical services from their primary care physicians that had been available before the disaster and came to see the medical teams. In this context, many respondents may have chosen others (other than those we determined as a category), and the percentage seemingly increased over the course of the time. Figure 2-19 Percentage of patients receiving the services by month and by disease March April May June - August Total 0 20% 40% 60% 80% 100% Upper High respiratory blood tract infections pressure 5.1% 29.4% 19.9% 4.4% 8.6% 27.8% 4.9% 4.4% 26.4% 17.9% 3.6% 10.2% 33.9% 3.6% 4.3% 19.6% 20.9% 4.6% 12.9% 34.9% 2.8% 5.7% 17.3% 22.0% 3.1% 12.5% 36.7% 2.6% 4.7% 23.8% 19.7% 3.9% 10.9% 33.3% 3.5% External Stress Other Others injuries symptoms diseases Bowel movement disorders (Note) Other diseases include the following: pneumonia, asthma, abdominal pain, cardiovascular disease, cerebrovascular disorder, low back pain, neuralgia, obstetrics and gynecology diseases (delivery). (4) Coordination with Related Entities, etc. a. Information Sharing among Medical Teams Due to the significant size and long duration of the deployed medical teams, and to many medical teams dispatched by organizations/entities other than JRCS for GEJET how to hand over and share information among the medical teams was particularly important. Coordination meetings were held among local medical professionals daily in many of the affected areas for information sharing among the medical teams, according to the notice by HDC at the Headquarters dated March 18, entitled Activity Report by JRCS Medical Teams for the Tohoku District-off the Pacific Ocean Earthquake for FY2011" and medical records. Some local teams also used locally-specific reports prepared by Health Centers, etc. in ISHINOMAKI and KAMAISHI, etc., assessment sheets were used to record the state of hygiene, etc., of the disaster shelters. Staff members of the National Workshop for Medical Teams (a.k.a.: JRCS DMAT Workshop) organized since 2009 had their own mailing lists used in normal times, which they shared and used to exchange information since the disaster took place. b. Withdrawal of Medical Teams and the Coordination With regards to the withdrawal of medical teams, Section 3.1 of Article 3 of the JRCS Disaster Prevention 50

78 Plan provides that Head of the Chapter in a disasteraffected zone shall, considering the recovery status of medical functions within the area, decide when to withdraw its medical teams after completion of the services based on discussions with the local government, local medical associations, etc." As mentioned above, the HDC at the Headquarters reported on the status of medical services and the policy of each district after the disaster and updated it almost every month. Based upon these reports the Chapter made a decision as to when to withdraw from each district based on discussions with the related organizations, including local Medical Associations, Health Centers, etc. 2. Activities of Chapters in All Prefectures Nationwide (1) Overview of Support Services a. Deployment of Support Staff from the Headquarters In addition to the medical teams, 465 staff members in total were deployed from the Headquarters to support the activities of the Chapters in the three disasteraffected prefectures for the term March September. Among the staff, 98 chapter support members were engaged in supporting the Chapter HDC, conducting surveys on the needs of the evacuees in disaster shelters, etc. Another 367 staff members were also deployed in the disaster-affected regions for the purposes of promoting public relations, providing reconstruction support and psychosocial care, etc., and other related activities. According to the breakdown of prefectures, MIYAGI was ranked 1st with 208 staff, followed by IWATE with 202 staff and FUKUSHIMA with 120 staff. b. Deployment of Support Staff from the Chapters Chapters other than those in the disaster-stricken areas also deployed 235 support staff in total in order to support services for the three prefectures for the March July term. On a prefectural basis, 101 staff went to IWATE, 20 to MIYAGI, 113 to FUKUSHIMA and 1 to YAMAGATA. Chapter 2 Provision of Medical Relief Chapter support Others By prefecture By service/activity By prefecture *** Figure 2-20 Number of Staff Deployed from the Headquarters (Number. of staff) March April May June July August September Total IWATE Chapter HDC Surveys on the needs of evacuees in disaster shelters Chapter HDC MIYAGI Chapter HDC at ISHINOMAKI * Surveys on the needs of evacuees in disaster shelters FUKUSHIMA Chapter advisors Survey on the needs Total (Overlapping** excluded) Site visits (accompanying overseas RCRC, etc.) Public Relations Staff Reconstruction assistance, Full-time team for donation from overseas overseas support projects Others Psychosocial care Care management Blood Service Others Total (Number. of staff) March April May June July August September Total IWATE MIYAGI FUKUSHIMA Others Total * Medical teams deployed Ishinomaki RCHP before establishing the Local HDC of the Ishinomaki Chapter included. ** Three staff deployed to each of the MIYAGI Chapter HDC and HDCs in affected area included. *** The figures shown in By prefecture do not add up to the total because, when the same staff were dispatched to several prefectures, it was counted as a dispatch by each prefecture. Great East Japan Earthquake and Tsunami 51

79 Great East Japan Earthquake and Tsunami Chapter 2 Figure 2-21 Number of staff deployed by chapter (Number of Staff) The terms of the deployment March April May June July Total Destination Iwate Chapter IWATE Iwate Chapter HDC (TONO) nd Block Local HDC (SUZUKO, KAMAISHI) Others Subtotal MIYAGI FUKUSHIMA Miyagi Chapter Fukushima Chapter Aizu Ward Public Health and Welfare Office, FUKUSHIMA AIZU WAKAMATSU Subtotal YAMAGATA Yamagata Blood Center Total Note: The terms of the deployment were categorized by that on the starting day of the service. c. Support to Ishinomaki RCHP Many medical teams from throughout the nation, including JRCS, took part in supporting Ishinomaki RCHP and Ishinomaki Joint Medical Teams that served areas around a hospital as the hub point. For example, 3,633 medical teams in total (including 1,011 JRC medical teams: 357 teams in actual performance) were deployed with 1,501 HDC staff in total (including 206 doctors) and 4,874 in-hospital support staff in total (including 1,477 doctors). (2) Logistic Support Activities by Chapters Roads, railroads, airports, harbors, etc., in the disaster-affected areas suffered tremendous damage, with a long way to go before their recovery. For one and a half months until the whole line was opened to traffic on the Tohoku Shinkansen (April 29), medical team members, psychosocial support staff, etc., in remote areas handed over their duties at airports (Akita, Yamagata, Hanamaki, etc.) that were free from the after effects of the disaster, and the Tochigi Chapter played a role as a hub station, etc. For approximately one month from the impact phase of the disaster (until April 15), the medical team members, etc., were able to move to the hub airports free of charge thanks to the full support of All Nippon Airways, Japan Airlines, etc. Logistical support services were provided for the medical teams gathering from throughout the nation Figure 2-22 Support situation in ISHINOMAKI Category Size Medical Medical service teams gathering 3,633 teams from throughout the nation teams (total Including JRCS teams 1,101 teams number in * Number of medical teams in service) 357 teams actual performance Doctors (Disaster Response Medical 42 staff Assistant Coordinator), (206 staff) HDC staff Nurses, clerical staff (including 287 staff volunteers) (1,295 staff) Total 329 staff (1,501 staff) Ishinomaki Joint Medical Team Ishinomaki RCHP Category In-hospital support Doctors Nurses, Midwives (Assistance in hospital wards, triage services, area support, and support at nursing school) Pharmacists Clinical engineers Size 147 staff (1,477 staff) 421 staff (2,426 staff) 107 staff (839 staff) 20 staff (132 staff) Administration staff / volunteers 695staff Total (4,874staff) Note 1: The numerical figure in parenthesis in the bottom row of each box represents the total number of active staff. Note 2: Those other than JRCS teams and doctors are included in the number of medical teams and HDC doctors. Note 3:* The number of deployed administration staff / volunteers is included in the Ishinomaki Joint Medical Team. 52

80 at the Chapters of the prefectures adjacent to the three disaster-stricken area. a. Transfer station for medical teams set up by the Tochigi Chapter The Tochigi Chapter, situated at the southern entrance to the three disaster-affected prefectures, discussed the availability of logistical services for the medical teams, and decided to play the role of a transfer station that allows liaison between the disaster-affected sites and the medical teams. The transfer station provided the following three services. Temporary rest areas Vehicle-keeping facility Courtesy bus service Providing facilities for rest and meals for the medical team staff from throughout the nation when visiting and returning from the three disaster-affected prefectures. The Tochigi Chapter kept the vehicles of medical teams from the western part of Japan so that they could access TOCHIGI via air and rail, and then use the vehicles in the disaster-stricken areas. To reduce the burden of transfers for the medical teams serving IWATE, Chapter staff and disaster-response volunteers drove a trailer bus to pick up and set down the medical team staff. Figure 2-23 Performance of the transfer station services of the Tochigi Chapter Availability of rooms for rest As a transfer station, number of vehicles kept for medical services March 210 staff 10 April 24 staff 32 May - 13 June - 4 July - 1 Total 234 staff 60 Figure 2-24 The Tochigi Chapter s large-sized shuttle bus service for medical team staff Bus routes From the Tochigi Chapter to KAMAISHI From KAMAISHI to the Tochigi Chapter No. of times 8 times 8 times No. of staff transferred 168 staff 162 staff Drivers (in Volunteers 10 staff 10 staff total) Chapter staff 7 staff 7 staff A variety of support services were provided by the disaster response volunteers and Red Cross Volunteers Corps (i.e., setting up comfortable beds for taking a rest, refueling vehicles at gas stations by hand, driving buses, etc.). b. Departure stand-by place for medical teams provided by the Niigata Chapter As with the Tochigi Chapter, the Niigata Chapter also provided temporary accommodation for those who have arrived at night and were awaiting departure on location. c. Logistical Support Activities by the Yamagata Chapter Adjacent to the three prefectures seriously damaged by the disaster, the Yamagata Chapter decided to provide medical care services mainly including logistical support, while carrying out liaising and coordinating duties with the Chapters in these three disaster-affected prefectures. In the first place, many medical teams headed for the disaster-affected areas by way of YAMAGATA, adjacent to these disaster-affected areas and serving as a hub point for logistical and personnel transfer services. The Yamagata Chapter arranged accommodation and refueled vehicles for the medical teams. It also provided refueling service for the medical teams dropping into the Yamagata Chapter due to lack of gas even on their way from the disaster areas to home. In the second place, the Yamagata Chapter arranged accommodation for 19 medical teams from 4 Chapters in total. Because many of the medical teams left for the disaster-affected areas early in the morning when a regular breakfast service was not available, the Chapter staff prepared light meals, such as rice balls, etc., with the cooperation of the lodging services. In the third place, as a mountain area covered with some compacted snow even in March borders YAMAGATA and MIYAGI, the Chapter staff helped attach tire chains to the vehicles owned by medical teams who were not used to driving on snow-covered roads. d. Securing Airport Parking Lots by the Akita Chapter Some medical team staff coming from the western part of Japan moved to Akita Airport via air, and then to their destination sites by road using vehicles that the previous teams had left at the airport parking lots. Due to an arrangement made by the Akita Chapter, these vehicles were allowed to be stationed at the airport parking lots for free. And this information dated March 15 was disseminated to the chapters nationwide via HDC at the Headquarters. On March 16, they faxed maps of the free parking Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 53

81 Great East Japan Earthquake and Tsunami Chapter 2 lots at Akita Airport as well as of gas stations for emergency vehicles in AKITA to the HDC at the Headquarters Information Teams to be shared with the Chapters nationwide. (3) Other Services at First-Aid Stations a. Major Activities at Primary First-Aid Stations: RIKUZEN-TAKATA, IWATE JRCS medical teams arrived at RIKUZEN-TAKATA, IWATE, setting up the first-aid station in a disaster shelter at Rikuzen-Takata Daiichi Junior High School to launch medical operations. Since June 24, the first-aid station had been moved to a prefabricated house built on the grounds of the school to provide primary care services for local residents until it closed on July 29. b. Setting up the First-aid Station House in KAMAISHI, IWATE Medical services in the Kamaishi District, including KAMAISHI and OTSUCHI, were provided mainly at a first-aid station as a hub point set up in Suzuko Plaza, near Kamaishi Station. Initially air tents were set up; however, the tents were damaged by strong winds, thus it was difficult to maintain a medical care environment. On April 25, 2011, prefabricated houses were constructed free of charge through cooperation from the Tohoku Branch of Komatsu House Co. These prefabricated houses, acting as a hub point, functioned as first-aid stations and as relaxation rooms for psychosocial support and as the coordination headquarters, as well as storage space for medical equipment and materials. The 2nd block Chapters, serving these first-aid stations as a hub point, shared their responsibilities with the Chapters, including for logistics (accommodation and transportation for medical team staff), food procurement, etc., to enable the successful deployment of the medical teams. Since the recovery of local home delivery services, the goods and logistics management system (SPD) 1 of the Musashino RCHP enabled blanket procurement and the smooth arrangement of medical equipment and materials, office supplies, etc., which saved the medical teams from bringing them in. [Prefabricated houses set up at the Suzuko Plaza in KAMAISHI as a local medical headquarters / station] c. The Kumamoto Chapter Deployment of Medical Teams Although a long way from the disaster-affected areas, the Kumamoto Chapter was engaged in the largescale delivery of a substantial amount of equipment and supplies for medical care service in the disasteraffected areas. Medical teams-1 and -2 started on the disaster day on board special vehicles, etc. They traveled 1,600 km by land, taking approximately 40 hours to provide their medical services. The Teams-3 and -4 that started on the next day and 2 days later delivered many supplies using 10 ton trucks. Such delivery of relief supplies continued, amounting to 90 tons of supplies from KUMAMOTO. [First-aid center and a materials and apparatus set up in front of Ishinomaki RCHP] (1) Referring to goods and logistics management systems that control the flow of goods (logistics flow), trading (commercial flow) and information (information flow) using computer systems for logistics control, including the selection of articles used and consumed in the hospitals (mainly medical materials, including medical products, ME apparatus (Medical Engineering apparatus), office supplies and commodities, etc.), the setting up of procedures for procurement, purchasing, ordering, inventory, releasing, usage, consumption and supply, in order to ensure medical safety (i.e., traceability), cost reduction and control that contributed to improving and sustaining efficient hospital management. 54

82 Figure 2-25 Outline of the initial medical teams from Kumamoto Chapter Team-1 Team-2 Team-3 Team-4 Departure time 3/11 21:00 3/11 24:00 3/12 17:00 3/13 11:00 Arrival time 3/13 12:00 3/13 16:05 3/14 02:30 3/13 17:00 Organization of medical teams Equipment Three doctors, three nurses, four management staff and others One leading car (vehicle for communications and instructions) Two land cruisers Two doctors, three nurses, eight management staff and others One special medical service vehicle, Disaster Rescue (large vehicle) Two large vehicles: crane trucks (equipped with forklifts, heavy industrial machinery, etc.), wing box trucks (ERU (emergency response units), beds, desks, wireless equipment, satellite phones), one doctor car d. Medical Teams Deployed by Chapters without RCHP Among the chapters, Yamagata, Nara and Miyazaki do not have any Red Cross Hospital or Clinic in their area; they concluded an agreement so that they could serve as JRCS medical teams in cooperation with public hospitals in these prefectures in order to meet disaster relief needs. Uniquely enough, all the Chapters deployed medical teams for this disaster; even the chapters without a RCHP dispatched 36 medical teams in total. Figure 2-26 Deployment of medical teams by the chapters without a RCHP Figure omitted The Miyazaki Chapter deployed 6 medical teams in total to ISHINOMAKI and FUKUSHIMA with the understanding and cooperation of Miyazaki University Hospital. It was the first time that such large-scale disaster relief operations were provided beyond prefectural borders. The Chapter had tried to establish communication with the university hospital (especially, the emergency department) by establishing a program of emergency drills and exercises, etc. the Director of the Hospital expressed his willingness the hospital s personnel to contribute in the future deployment of a JRCS medical teams. The organized team was a mixed group consisting of hospital and chapter staff. It was the first experience Two management staff and others Five 10-ton vehicles (trucks), relief supplies, materials and apparatus including tents (water supply systems, water, tents, food, blankets, toilets with a purified water tank, shower room), and daily commodities. * Provided by transport companies. for all members of the team staff to be dispatched to remote areas on such a significant scale. Witnessing the devastating effects of the disaster before their very eyes, they say they have fully understood what is required to take responsibility as medical professionals, reaffirming their mission to rescue as many disaster victims as possible. e. Medical Teams Posting Postcards Written by the affected people Zero staff (Material support) One 10-ton vehicle Relief supplies People in some disaster stricken-areas completely lost their means of communication, including mail delivery. MIYAKOJIMA Shelter in HIGASHI MATSUSHIMA, MIYAGI, was in one of these areas. The only one bridge connecting the island and the mainland was damaged, and medical teams from Nagano RCHP were forced to reach the island by helicopter in late March. In such circumstances, the medical team members purchased as many postcards as possible at post offices they happened to drop by at on their way to the mission in YAMAGATA. They distributed one postcard per family in the disaster shelters in MIYAKOJIMA, and some 50 cards were collected and posted by the staff. All of the cards were telling their acquaintances inside and outside the prefecture that the senders were fine, and asking if the recipients were well. Although some zip codes were missing or unknown because they were living in shelters, the staff wished Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 55

83 Great East Japan Earthquake and Tsunami Chapter 2 to send them as soon as possible and so checked and added the code numbers, and posted them in a nearby post box on their way back to the hospital. This demonstrates that the medical team staff even acted as messengers on behalf of disaster victims. 3. Conditions of Hospitals in the Disaster- Stricken Areas (1) The Morioka RCHP a. Damage to Buildings and Lifelines and the Progress of Restoration The Morioka RCHP is a 438-bed, 566-staff Disaster Relief Core Hospital situated in the center of IWATE. Situated inland, about 100 km from the coast, MORIOKA (IWATE) suffered from disruption due to power outages but there was no collapse of buildings. Figure 2-27 shows the damage to hospital buildings and the progress of the restoration. Figure 2-27 Damage to the Morioka RCHP and the progress of the restoration Items Damage Progress of the restoration Buildings No damage to structures Damage to building structural joints No problem for use Planned to be repaired in FY2012 Water leaking from water tanks Electricity March 11: Switch to emergency power system due to the power outage Restored at 16:10, March 12 Fuel for power generation (heavy oil) Utility gas Water system Sewage system Fixed-line phones Cell phones Wireline phones for use in a disaster As supplies had been unstable until the end of March, the local government procured them As aftershocks followed, the supply was stopped. In combination with a well in the site, water was pumped up and distributed using an in-house power generator. No damage Difficulty in communications due to the limits of the communication system Priority telephone links in a disaster were available for use; however, there was no connection in the coastal zone at all. Satellite-based mobile phones Satellite-based mobile phones brought by the medical teams were the only means of communication for people living in the coastal zone. JRCS wireless system for professional use Residual volume of 27,000 liters on March 11 Refueling 22,000 liters on March 12 Resumed for use at 6:30, March 12 The system was down around 5:00 AM on When it will be restored is unknown March 12 due to the lack of batteries at the transmission station. Medical gas (liquid oxygen) No damage 1,600 m 3 refilled on March 18 Medical gas (liquid nitrogen) No damage Elevators Stopped in general at an intensity 4 or higher Manufacturer checking within hours after discontinuance in order to resume b. Actions Taken at the Time of the Disaster The Morioka RCHP established a HDC within some minutes after the disaster occurred, while immediately collecting information on their patients whereabouts and safety, and the status of damage to the hospital building. Later on, they cancelled the day s general outpatient consultations and surgical appointments in order to prepare for accepting the sick and wounded from the disaster-stricken areas and deploying deru teams. The Iwate Chapter HDC instructed the 56

84 deployment of deru teams and organized a SCU at a prefectural firefighting school on March 11. In citywide total darkness due to the power outage, many evacuees gathered outside the hospital with its Red Cross signboard lit up. However, the staff asked those other than the sick and injured to move to acceptable shelters based on information on the fast-changing situation obtained from Morioka local government. The next day on March 12, 2 medical teams with deru were dispatched to the coastal zone at 6:00 in the morning on instructions from the Iwate Chapter. However, only 2 physicians flew to the area by helicopter. Following this, the Iwate Chapter also ordered the addition of SCU to the deployment, sending 57 JRCS staff including those from 3 teams (Gifu, Takayama and Fukui). On the day, they had only 8 sick and wounded patients transported by helicopter from the disaster stricken sites. Meanwhile, Akita Chapter Medical Team (Team-1) which had started services in RIKUZEN-TAKATA reported more manpower for the medical teams is needed. Thus, the HDC deployed the Akita Chapter Medical Team (Team-2) and the Fukui Chapter Medical Team, recommending the prefecture to dispatch teams to the coastal areas by land. Combined with approval from the prefecture for their deployment to the coastal areas, the Iwate Chapter answered, the hospitals will be authorized to decide their destination. However, there was no communication with the local government having jurisdiction over the coastal site, as well as almost no information required for the deployment. On March 13, the HDC instructed the SCU to continue their services, and the Medical Teams to secure safety, start operations after reporting to the local authorities, etc., and provide updates on the situation, etc., to hospitals using satellite-based mobile phones for the deployment services at the coastal sites. As the Akita Chapter Medical Team requested replacement teams on the previous day, 2 teams from GIFU (Gifu, Takayama) were deployed to RIKUZEN-TAKATA. Due to the information that the bridge connected to Shin Sennin Hill had collapsed, three teams from HYOGO, SHIZUOKA were assigned to the southern prefectural coast, the Wakayama Team transferred from inland by road to serve in MIYAKO, and Nara Chapter Medical Team to KUJI. 2 teams (Ishikawa and Tokushima) following the previous teams were asked to join the Wakayama Team in MIYAKO in according to satellite phones from Wakayama and Nara Medical Teams. Figure 2-28 shows the progress in the situation over one week after the disaster. Chapter 2 Provision of Medical Relief Figure 2-28 Major Responses of the Morioka RCHP after the disaster Date Time Events 3/11 14:46 Disaster occurred 14:50 HDC established In-hospital damage status identified 15:00 Disaster damage status identified. No human suffering. In-house power generation used after a power outage. Elevator and central heating systems stopped functioning. Only portable X-ray available. TV not available. Internet not available. 15:00 Designating Disaster Response III regime (General outpatient service discontinued; medical teams organized; triage center established; beds for disaster victims secured; testing / surgery operations cancelled) 15:50 14 deru team staff waiting completed 16:00 Triage center setting up completed 16:17 CPA patients were brought in. The medical team staff claimed that the phone line cannot be connected to the hospital ; thus transportation of the patients was allowed without reservation. 17:01 The fire station requested to be ready for helicopter transportation services to the hospital ; a hospital ambulance was prepared for patient transportation. 17:04 The Iwate Chapter instructed, Hospitals in the coastal areas were not available for hospitalization. No deployment of medical teams. Prepare for accepting the sick and injured from the disaster. 18:00 The elevator stopped functioning and staff carried emergency food to each floor 18:25 The Iwate Chapter instructed the deployment deru to the Iwate Firefighting School and to establish an SCU 19:30 Discussion about in-hospital nighttime shifts at the Headquarters meeting Great East Japan Earthquake and Tsunami 57

85 Great East Japan Earthquake and Tsunami Chapter 2 Date Time Events 3/11 21:00 The victims from MIYAKO visited the hospital. The staff checked the shelter locations in MORIOKA, handing them a map. (Later on many patients visited us but we explained the situation at the front entrance of the hospital). 22:27 The Iwate Chapter told us that there were no helicopters available until tomorrow morning ; deru returned from the SCU and stood by in the hospital. 3/12 1:40 The Iwate Chapter requested the SCU to accept deru as soon as the dawn broke, and deployed three medical teams to the coastal areas by helicopter. 1:48 The staff carried up newly hospitalized patients to the 5th floor on stretchers. 6:00 deru and 2 medical teams left for SCU. 6:30 Gas and heating systems restored 7:42 Two doctors (Dr. Kawamura and Dr. Shimatani) moved to the coastal areas from the SCU using an SDF helicopter. 7:47 Reporting to the Iwate Chapter that DMAT arrived at the SCU. The Chapter replied, SCU shall be commanded by Nagano DMAT. 8:00 A hospital HDC meeting was held. For the time being, it is expected to be held at 8:00 and 16:30 every day. 10:01 Minami Fire Station requested the acceptance of 140 moderately affected patients from RIKUZEN- TAKATA. We answered to accept 70 patients" After seeing them, we requested the City (shelters) to arrange vehicles available to bring them from their homes. 10:01 The Iwate Chapter instructed SCU to add 2 medical teams Deploying medical teams. 12:10 We decided to discontinue general outpatient consultations after March 14 (Monday), sending out a fax to the mass media. 12:33 Morioka team reported, No food available in the city stores ; the staff made rice balls with only salt as a condiment (this service continued until March 27) 14:20 Fukui RCHP returned to the hospital and starting traveling from shelter to shelter to provide medical care in MORIOKA. 15:01 The Iwate Chapter instructed the deployment of the Akita RCHP Team-2 to RIKUZEN-TAKATA 15:42 The Akita RCHP Team-1 requested another 2 teams. We answered, the Akita RCHP Team-2 is on the way. The Fukui medical team is to be deployed. 16:10 Electricity restored. 18:05 The Iwate Chapter instructed the deployment of replacement teams to RIKUZEN-TAKATA. We decided to deploy 2 teams ( Gifu and Takayama) the next morning. 18:05 The medical teams serving as SCUs reportedly returned with 8 patients transported by helicopter", advising that the Iwate Chapter deploy vehicles to the coastal areas. 18:40 The Iwate Chapter answered, We authorize the deployment of medical teams to the coastal areas; their destination shall be designated by the hospitals. 19:06 A joint meeting of the medical teams with regards to SCU service reports and deployment to the coastal areas the next day. 20:45 Accommodation requested for staff to serve at Hanamaki Airport; 100 staff members were to be accepted. 20:50 19 patients visited for medical care from KESENNUMA, mainly complaining of hunger and fatigue We requested shelter at the Shinjo Water Purification Facility to provide meals to them. They were transported to the shelter after medical check-ups. 3/13 5:00 2 teams, Gifu and Takayama, headed to RIKUZEN-TAKATA for service. 5:40 The Morioka team (17 staff) headed to the SCU at the Firefighting School for service. 7:20 3 teams ( Kobe, Shizuoka and Hamamatsu) headed to KESEN for service. 9:35 The SCU Morioka team requested additional medical teams; requested the Kanazawa medical team for support. 9:45 The Iwate prefectural Ofunato Hospital, IWATE, requested us to pick up premature infants and TPL (Threatens Premature Labor) patients We dispatched our doctors on board of our ambulance with incubator sets. 11:40 The Shizuoka team: SDF told us that they found no medical teams in KAMAISHI. It is accessible by road, so we are going to head for KAMAISHI with SDF. 11:45 From the Wakayama team: 8,000 evacuees from MIYAKO, no other medical teams the Kanazawa team joined forces to serve in MIYAKO 14:46 From the Nara; No medical teams needed in KUJI; we are heading for NODA. 14:50 From the Wakayama team: Many shelters accommodating patients; no other medical teams the Tokushima team changed its destination from KUJI to MIYAKO. 16:15 From Nara team; Many evacuees in Noda Village. Few injured. Many request medicines for chronic diseases, and unrest and insomnia. No cell phone service available regardless of the carrier. Satellite phones only. 16:55 From the Iwate Chapter, The Iwate Prefectural HDC ordered to withdraw from SCU 58

86 Date Time Events 3/13 18:55 From Iwate Prefectural Ofunato Hospital an ambulance arrived with Dr. Kawamura and Dr. Shimatani on board 19:20 The Morioka team dismantled the deru and returned. 44 accepted for today. 20:37 The Iwate Chapter requested accommodation for DMAT; available for up to 100 staff. 3/14 0:20 Kobe, Shizuoka and Hamamatsu teams returned to the hospitals, reporting the situation in KAMAISHI and OTSUCHI. Many patients requested medicines in regular use and there is a scarcity of drugs. Late night meals, Hitsumi (vegetable soup with noodles) and rice balls, were served at soup kitchens set up. 0:45 Situation in MIYAKO was reported using a satellite phone from the Wakayama team. Joining the Kanazawa and Tokushima teams, we took a rest inside junior high school classrooms. At 5:30 a.m. a meeting was held among the city officials of MIYAKO, Firefighters, SDF, DMAT and JRCS medical teams. There were few surgical cases; many cases needing oral medicines were reported. 6:10 Kobe, Shizuoka and Hamamatsu teams supplied pharmaceuticals, etc., leaving for KAMAISHI. 7:20 Responding to an inquiry from the Firefighting Headquarters, accommodation available for 100 inpatients. No general outpatient practice available for today to focus on disaster victims 9:22 A deluge of patients with appointments. We explained that no service would be available in order to respond to disaster victims. 9:40 There was an explosion on the underground floor of Nakasan Department Store. Twelve injured in total, including one with a red tag and one with a yellow tag, were accommodated. 10:51 The Iwate Prefectural HDC informed reflected waves Provided information to the medical teams in the coastal zones. 15:17 The Iwate Chapter instructed to deploy 2 Morioka Teams to RIKUZEN-TAKATA for 3 days and 2 nights from tomorrow We answered, now 24 hours into the operation; the teams will replace the local team and stay there 2 days and 1 night 16:30 The hospital HDC meeting. Two teams will be deployed to RIKUZEN-TAKATA from tomorrow. We ll accept no general outpatients but disaster victims tomorrow as well. 17:35 Receiving an inquiry from the Director of Hachinohe RCHP. We shared information on RCHP medical team activities in IWATE, including Nara s team at NODA in the northern part of IWATE. 3/15 0:05 Kobe, Shizuoka and Hamamatsu teams returned to the hospital. After refilling pharmaceuticals, stoma materials, etc., they headed for KAMAISHI at 5:55. 6:20 Two Morioka medical teams headed for RIKUZEN-TAKATA 8:00 The Hospital HDC meeting. We ll accept no general outpatients but only disaster victims tomorrow as well. 11:40 From Morioka medical teams, The local manpower is insufficient for some districts due to traveling from shelter to shelter to provide medical care. Also running out of drugs for chronic diseases We requested Okayama team to supply pharmaceuticals and deploy manpower. 13:45 From SDF, There s an overflow at prefectural Ofunato Hospital, we need more information on Morioka RCHP We provided copies of the hospital s brochure and answered, medical care is available excluding serious burns and circulatory organ surgery cases 13:52 The disaster in-patients claimed that they had No money. Needed money Secretary General of the Iwate Chapter requested a financial institution to make arrangements. 17:55 The Iwate Chapter requested to deploy deru from the HDC of Iwate Chapter to the Firefighting school again Answer: We have already started deployment of the medical teams to the coastal areas. Will you please discuss again if you really think you need them. 20:10 The Date team Supervisor serving in KAMAISHI visited the hospital, claiming that they cannot obtain antihypertensive drugs in KAMAISHI ; supplied from the Morioka RCHP. 23:25 Asking Iwate Chapter if Morioka RCHP should deploy a medical team, they answered, Ofunato Hospital, IWATE, is functioning with support from DMAT so that the RCHP don t need to deploy it. 3/16 8:15 The hospital HDC meeting. We resumed accepting outpatients with appointments for medical services. 16:30 The Wakayama team arrived. Brought in Mt. Kitakami, the only person out of the crew of 3 vehicles had who experience in driving on snowy roads. At sunset it began sleeting in MORIOKA. Route 106 had a high risk of icy road conditions, we decided to have the cars driven by Morioka local government officer s tomorrow morning. 17:30 From the Iwate Chapter: manpower will become scarce tomorrow due to the replacement of teams in KAMAISHI One team was deployed from MORIOKA RCHP. 21:10 Fujisawa team leader, it is necessary for MORIOKA RCHP medical teams to manage Red Cross relief activities in RIKUZEN-TAKATA Sugimura Surgery Director departed for RIKUZEN- TAKATA for the coordination on behalf of alternate chapter staff. 3/17 2:31 Mr. Sugimura, Director of the Iwate Chapter, manpower becomes scarce at tomorrow night A team serving in KAMAISHI was moved to RIKUZEN-TAKATA in the evening. Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 59

87 Great East Japan Earthquake and Tsunami Chapter 2 Date Time Events 3/17 7:33 Mr. Sugimura, Director, expected that the Morioka teams will serve for 24 hours and replace the local teams on the site. OK. A 24-hour shift and replacement arrangement was established on site. 9:15 Mr. Sugimura requested that send stoma and ostomy care products every day Responding individually, we will identify the brand for each patient and, until then, prepare the stocks at each shelter. 10:00 From the Facility Management Department: No response about heavy oil supply from the manufacturer We requested Fuel Team at the Iwate prefectural HDC for mediation 10:54 From the Nara Chapter: We are asking for the Aomori Chapter to transport us from Misawa Airport to NODA 15:05 The Iwate Chapter reported, the Local HDC was established at Tono Health and Welfare Village 16:30 At the Hospital HDC Meeting, it was reported: 118 staff requested accommodation inside the hospital due to a lack of gas and difficulty in commuting. Mr. Kubo, Chairperson of the HDC, requested Iwate Medical Association to provide information on prescribed drugs based on the data from medical fee receipts from the next day, March 18, the Social Insurance Medical Fee Payment Fund and the All Japan Federation of National Health Insurance Organizations established a contact service to refer to prescription drugs. c. Status of supplied items, medical appliances/ equipment, etc. After the disaster, in-house departments, medical institutions, private companies, local governments, etc. provided various relief supplies, including food, sanitary, pharmaceutical products, medical equipment, etc. Figure 2-29 Main relief supplies Support supplies Quantity Support groups / supporter Water 90 boxes Direction Co., AICHI Water (550 liters) One box Pepsi Cola Milk, labor and delivery products Individual in MORIOKA Milk 9 boxes Direction Co., Ltd, AICHI 25 milk powder cans, 15 baby food meals Iwate Branch, Japanese Midwives Association Allergy-free curry for children Japan Pediatric Society Allergy-free meat sauce for children Japan Pediatric Society Eggs 60 kg Koiwai Farm Apples 5 boxes Morioka Yuai Hospital Sweet buns 50 boxes Family Mart Boiled rice packs 13 packs Rice gruel in retort pouches 2 packs Retort curry 9 packs Public Health and Welfare Dept., IWATE Canned barbecued chicken 3 cases Canned fruit 9 cases Jelly 10 cases Glutinous rice 210 kg Takajo Elementary School, MIYAKONOJO, MIYAZAKI Biscuit 3,120 cans Daihatsu, IWATE Drugs (4 items) 1,000 tablets each Hirayama Clinic, KUMAMOTO Kindary 3E (3 cases) 30 boxes Saline 1 liter (10 cases) 100 boxes Disopa 3.8 liters (4 cases) 2 boxes Cidex 3.8 liters (4 cases) 1 box JRCS Hyporite 20 Suppositories (PARACETA 100 mg/ 200 mg) for children A variety of concentrated fluid diet Pulse oximeters 40 units Fukuda Denshi Echography systems 2 sets Toshiba Medical Systems X-ray equipment for hospital rounds 1 set Shimazu Corporation Portable X-ray digital equipment 1 set Canon 2 respirators 2 units Sawai Pharmaceutical 60

88 Support supplies Quantity Support groups / supporter 1 portable first aid monitor Sawai Pharmaceutical Defibrillator 1 unit Sawai Pharmaceutical Nebulizer 10 units Electrocardiograph equipment 3 units Thermometer 1,000 sets Omron Colin Inhaler 10 sets Sphygmomanometer 20 sets Blood pressure notebooks 400 books Pfizer Blood pressure notebooks 1,000 books Omron Salon Deluxe 60 sets Al- Care Co., Ltd. Adhesive plasters (expansion and contraction surgical tape) 5 boxes Al- Care Co., Ltd. The Japanese Society on Clot Hemostasis, the Elastic stockings 3 boxes Japanese Society of Phlebology, the Japanese Society of Pulmonary Embolism Research Paper stretchers 100 pieces Fukuda Denshi Camp beds 30 units Paramount bed Stretchers 5 units Sawai Pharmaceutical Paper diapers 22 boxes Environmental and Life Dept., IWATE Diapers 66 boxes Direction, Co., Ltd. (AICHI) Diapers 70 packs Sawai Yakushido Temple Masks 1 box Kowa Co., Ltd. Masks 70 boxes Prefectural Chapter Masks Direction Co., Ltd. (AICHI) Towels 5 dozen Kyowa Hakko Co., Ltd. Towels 120 Kowa Yakuhin Towels / Towel blankets Patients family Tissue boxes 12 boxes Kyowa Hakko Co., Ltd. Wet tissues 1 bag Kyowa Hakko Co., Ltd. 5 shampoos, 15 soaps and others IWATE Chapter, Japanese Midwives Association Battery cells Environment and Life Dept., IWATE 7 boxes Prefecture Blue sheets 11 boxes Cassette cookers 19 boxes Cassette cylinders 26 boxes Direction Co., Ltd. (AICHI) Clothes for cold weather 25 boxes Socks, boots, batteries, futons, etc. 30 underwear shirts, 6 socks Iwate Chapter, Japanese Midwives Association Rubber glove 1,000 boxes The Chinese Government Floodlights 2 sets Loudspeakers 2 sets Large heaters 2 units Sawai Pharmaceutical Uniform vests for medical professionals in disasters 140 vests Alfard HV 1 vehicle Portable toilets, notebook PCs, cameras, etc. Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 61

89 Great East Japan Earthquake and Tsunami Chapter 2 d. Accommodation Status of the Sick and Injured in the Disaster-Stricken Areas The following Figure 2-30 and 31 show the accommodation status of the sick and wounded by Morioka RCHP and other surrounding medical facilities. Figure 2-30 Secondary emergency hospitals in MORIOKA No. of patients accommodated (March 11 17) Secondary emergency hospitals in MORIOKA Within IWATE (other than Morioka) Outside IWATE Total Morioka RCHP Iwate Medical University Hospital Iwate Prefectural Central Hospital Morioka Yuai Hospital Kawakubo Hospital Morioka Municipal Hospital Tochinai Hospital Morioka Tsunagi Hot Spring Hospital National Hospital Organization Morioka National Hospital Total Figure 2-31 Destinations of patients carried by SCU at Hanamaki Airport / Firefighters School Name of the Patient Accepting Facility Morioka RCHP Iwate Prefectural Chubu Hospital General Hanamaki Hospital Iwate School of Medicine Fuzoku Hanamaki Hot Springs Hospital Iwate Prefectural Central Hospital Iwate Medical University Hospital Kitakami Saiseikai Hospital Iwate Prefectural Isawa Hospital Morioka Yuai Hospital Iwate Prefectural Towa Hospital Morioka Municipal Hospital Morioka National Hospital Tochinai Hospital No. of patients accepted Remarks 44 MORIOKA 25 KITAKAMI 22 HANAMAKI 20 HANAMAKI 12 MORIOKA 11 MORIOKA 9 KITAKAMI 9 OSHU 5 MORIOKA 4 HANAMAKI 2 MORIOKA 2 MORIOKA 2 MORIOKA Oji General Hospital 1 Teine Keijinkai Hospital 1 Wide area transfer Megumino Hospital (Shin Chitose) 1 Sapporo Medical University Hospital 1 Tokyo Medical University Hospital 1 Showa University Hospital 1 Tokyo Metropolitan 1 Hiroo Hospital Wide area transfer Tokyo Medical Center, National (Haneda) 1 Hospital Organization Omori Hospital, Toho University 1 JRCS Medical Center 1 Akita Kumiai General Hospital Nakamichi General Hospital, AKITA Akita University Hospital Research Institute for Brain and Blood Vessels-Akita Akita RCHP Wide area transfer (Akita) Akita Municipal General Hospital 1 Hanamaki City Gymnasium 1 HANAMAKI Hanamaki Nahan shelter 1 HANAMAKI NA 6 Total 191 e. Special notes on other responses to disaster control (a) Issuing external prescriptions by medical teams Medical institutions in Kamaishi District (KAMAISHI and OTSUCHI) and RIKUZEN-TAKATA suffered from severe damage, and it was impossible for only local doctors to issue prescriptions for drugs that the disaster victims used daily. Therefore, the medical teams also in both districts issued external prescriptions. (b) Obtaining information on prescription data for payments for medical services The main medical need of the evacuees was for drugs they had taken every day; however, it was extremely difficult to issue prescriptions due to the lack of drug information on individual patients. In this context, on March 17, we requested the Prefecture Medical Association to provide data on medical fee receipts (prescription) data. From the next day, March 18, the 62

90 Health Insurance Claims Review and Reimbursement Services and the National Health Insurance Organization established a consultation desk that was able to provide information on the drugs that were being prescribed prior to the disaster. (c) Brokerage of external prescription drugs in RIKUZEN-TAKATA It was impossible to obtain medicines within RIKUZEN-TAKATA because all nine pharmacies in the city were affected by the disaster. Therefore, we established a system, through cooperation with Iwate Pharmaceutical Association, where JRCS medical teams could collect external prescription data issued in the city every day, and carry such data to Morioka RCHP. These prescribed drugs were also prepared at pharmacies in MORIOKA and delivered to medical institutions and disaster shelters in the city. In total, 5,329 external prescription documents were processed through brokerage until the pharmacies in the city resumed service on May 15. (d) Nighttime Medical Service System in RIKUZEN- TAKATA As the Prefectural Takata Hospital had totally collapsed, JRCS medical teams played a role in providing nighttime medical service in RIKUZEN- TAKATA from the next day of the disaster. As of March 16, 5 JRCS teams serving at First-Aid Stations set up in Takata Daiichi Junior High School were reportedly uncontrollable, and the Chairman of general surgery visited the site for coordination by proxy. Morioka RCHP, a local hospital, was in charge of the nighttime medical services every night. Medical teams also joined forces with the staff at nighttime, to replace local teams based on a 24-hour shift on site. This allowed JRCS medical teams serving in RIKUZEN-TAKATA to supply pharmaceutical products and medical materials to medical teams. (e) Free Bus Program for Medical Checkup Service from RIKUZEN-TAKATA In RIKUZEN-TAKATA, no medical institutions were available for disaster victims diagnosed as needing a more detailed medical check-up, who had no transportation means to outside the city either. Therefore, the prefectural HDC provided a shuttle bus a day service between RIKUZEN-TAKATA and Morioka RCHP on weekdays for free medical checkup services until May 6, which 302 patients in total took advantage of. (f) Brokerage at Disaster Shelters On the night of disaster, in the total darkness that enfolded the whole town following the power outage, the evacuees gathered outside the hospital with its signboard, Red Cross, being lit up from the coastal sites and inside the city. In order to maintain our medical services, we had liaised with the Morioka local government, and referred those who did not have to be hospitalized to shelters set up in the city. (g) Accommodation for DMAT staff On March 12, responding to a request from the Chapter HDC for accommodation for DMAT staff serving at Hanamaki Airport SCU, Morioka RCHP accepted 100 staff by converting the chairs in the outpatient waiting room into beds for rest. The hospital also had a request on the following day, March 13, and accepted 100 staff. (h) Procurement of Emergency Vehicles The RCHP had only one ambulance vehicle for emergencies, which affected our relief activities. Thus, we asked the Morioka Red Cross Blood Center (RCBC) to rent us 2 emergency vehicles for medical services. (i) Distribution of Relief Supplies Relief supplies provided for disaster victims at Morioka RCHP were stored in the Disaster Relief Center (one basketball court in the gym), distributed to medical teams, etc., heading for the coastal areas. (j) Health Counseling at the Disaster Shelters in MORIOKA Medical Checkup Director, with public health nurses, visited the disaster shelter set up close to Morioka RCHP for the purpose of providing health care and counseling to disaster victims evacuating from the coastal areas in MORIOKA. They visited the shelter 41 times in total until the number of evacuees using the shelter was down to zero on June 27. Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 63

91 Great East Japan Earthquake and Tsunami Chapter 2 (2) Sendai RCHP a. Damage and Restoration Status of Buildings and Lifelines Sendai RCHP is a hospital with 400 beds and 554 staff, situated in the southwestern part of SENDAI and halfway up Yakiyama hill. Figure 2-32 shows the status of the damage and restoration of the buildings, etc. YAKIYAMA saw relatively less damage, including the collapse of buildings. Figure 2-32 Damage and restoration status of Sendai RCHP Items Damage status Restoration status No damage to structures Buildings Damage to old/new ridge joints Sprinkler damaged, water leaking during operations Electricity 3/11: Following the power outage, switch to emergency power 3/14: Restored Generator fuel (heavy oil) 3/11: 13,000 liters of residual oil 3/12: Refueling 14,000 liters City gas 3/11: Supply discontinued 3/31: Portable PG set up 4/15: Restored 3/12: Starting water wagon Waterworks 3/11: Damage to plumbing system in the site, services, repairs for plumbing at city water pipes, water restrictions and saving the site 3/30: Water serviced restored Sewerage system 3/11: Unavailable until the completion of 3/30: Drainage in the plumbing checks (Portable restrooms to be used) enlargement of the building 3/30: Damage to the drainage system in the repaired extensions to buildings Fixed-line phones (Relatively well connected in Sendai) Cell-phones 3/11: Non-connected Priority telephone links in a disaster, satellite-based mobile (Few satellite-based mobile phones) phones JRCS wireless for business use, etc. (MCA radio was less well connected) Medical gas (liquid oxygen) 3/13: 500 m 3 refilled 3/14: 3,000 m 3 refilled Medical gas (liquid nitrogen) 3/11: Damage to plumbing systems 3/11: Repair work on the plumbing system completed 3/15: 3,000 m 3 refilled b. Response Status at the time of the Disaster Sendai RCHP established a Hospital HDC some 10 minutes after the disaster took place, closing general outpatient services for the day to prepare for accepting disaster victims and maintaining lifelines for disaster control, etc. On March 12 it started accepting patients from DMAT, while deploying the medical teams to Ishinomaki RCHP which suffered tremendous damage. A medical treatment meeting, a general meeting consisting of representatives of the hospital, was held nine times from March 15 to 28. Figure 2-33 shows the status of the response for about 1 week after the disaster occurred. 64

92 Figure 2-33 Main activities by Sendai RCHP after the earthquake took place Date Time Description 3/11 14:46 Occurrence of the disaster 14:58 The Hospital HDC was established (Level 3 (Intensity 5 upper; hospital controllable for disaster management services) 1st in-hospital broadcasting system Three engineers confined in Clinical Pathology Department; no injury, escaping No confinement in the elevator while evacuation. 15:10 Triage / treatment sections successfully set up. 15:22 With the announcement to close general outpatient services, a new section was launched. Functions confirmed between hub hospitals via EMIS input / MCA radio 15:33 Sendai Firefighting Station requested to provide transport for the injured; answered to accept some 50. Ready to serve meals prepared with food stocks in an emergency. 15:43 The HDC was moved to the Nursing Department. 15:55 2nd in-hospital broadcasting announcement instructions to discontinue medical gases, suspend water supplies, restricted restroom use. Not available for absorption from the central plumbing system; instruction to use a syringe pumps or portable electric evacuators 16:15 Portable toilets set up in the hospital wards, and simple toilets for outpatients. 16:25 Major tsunami warning was received. Some testing equipment was confirmed to be successfully functioning. Emergency surgery (cesarean operations) available in the operating room. 16:51 Administration staff deployed for inspection to confirm the damage status around the hospital. 17:00 Data on in-hospital storage was successfully collected / evaluated. 19:15 Reporting to the Sendai Environment Agency about the portable toilets set up; Water Department about arrangements for water wagons. 22:20 Accommodating 4 injured and pregnant women 22:30 Connection with the Miyagi Chapter and Headquarters by phone for the first time 23:15 Deploying Information Collection Team to DMAT Integrated Headquarters (Sendai Medical Center) Night Starting deployment of the teams travelling from shelter to shelter to provide medical care / mobile clinic 3/12 Morning Starting to accept patients from DMAT Starting to request food procurement 13:45 Requesting Ishinomaki RCHP to deploy medical teams 14:30 Medical teams leaving for Ishinomaki RCHP 3/13 Morning A nearby hospital requested accommodation for patients needing dialysis facilities according to the unit 3/14 Afternoon Absorption restored from the central piping system 3/15 The 1st medical treatment meeting (general meeting consisting of representatives from each inhospital department) carried out every day until March 18. Chapter 2 Provision of Medical Relief c. Status of Supplied Items, Medical Equipment / Apparatus, etc. After the disaster, in-house departments, medical institutions, private companies, local governments, etc., provided various relief supplies, including food, sanitary, pharmaceutical products, medical equipment, etc. Figure 2-34 Main relief supplies Relief supplies, etc. Quantity Support group, supporter Heavy oil A 14,000 L JRCS* Akita Gasoline 100L Shimizu Corporation Food (canned food, vegetables, packed rice, and confectionery) Osaka RCHP Food (frozen vegetables, etc) Ecchuya Meal service Center Food (frozen lunch boxes) 2,000 meals Joint Co., Ltd. Food (no-wash rice) Health and Hygiene Division, Health and 150kg Welfare Department of Sendai Food (rice) 320kg Ecchuya Meal service Center Great East Japan Earthquake and Tsunami 65

93 Great East Japan Earthquake and Tsunami Chapter 2 Relief supplies, etc. Quantity Support group, supporter Food (rice) 210kg Ground SDF Food (retort Chinese food rice porridge) JRCS Packed rice Medical Service Affairs Div., Health, 1,620 meals Welfare and Environment Dept. of Miyagi Packed rice 100 meals Koyo Co., Ltd. Food (rice ball) 2,000 Fukui RCHP Rice balls 250 Akita RCHP Medical Service Affairs Division, Health, Rice balls 1,500 Welfare and Environment Department of Miyagi Soup kitchen sets Gomoku rice (assorted rice with meat and vegetables) 40 Aichi Chapter Rice porridge 500 Aichi Chapter Food (bread) 9,225 Ashikaga RCHP Restoration Support Section, Disaster Food (bread) 320 boxes Prevention Planning Bureau, Hyogo Planning and Public Life Department Medical Service Affairs Division, Health, Bread 2,000 Welfare and Environment Department of Miyagi Sweet bun 1,000 Akita RCHP Canned bread (muffins, chocolate and panettone) 2,592 in total Aichi Chapter Steamed yakisoba (chow mein) 648 meals Taihaku Health and Welfare Center, Sendai Calorie Mate 540 Aichi Chapter Calorie Mate 1,500 Otsuka Pharmaceutical Co., Ltd. Food (frozen chicken breast and wings, pork sausages) 500 kg in total Andes, Asia Food (curry roux) 40kg Ecchuya Lunch Center Food (Sasakamaboko or bamboo-grass kamaboko) 10,000 pieces Abe Kamaboko-ten Co. Soup kitchen sets 100 brown alga sets Aichi Chapter Side dishes in a lunchbox 384 Aichi Chapter Fruit and boiled beans cans 168 cans Red snow crab 888 cans Koyo Co., Ltd. Light Flaked Tuna 624 cans Pickles, deli, etc. 17 cases Cheese Sendai Meal service Center Candy cheese Health and Hygiene Section, Sendai Health and Welfare Bureau Fruits Sendai Meal service Center Kiyomi oranges Health and Hygiene Section, Sendai Health 108kg and Welfare Bureau Oranges Health and Hygiene Section, Sendai Health and Welfare Bureau Dry milk (Rakuraku Cube) 768 bags Meiji Co., Ltd. Dry milk (Hohoemi) 32 cans Meiji Co., Ltd. Dry milk (E Akachan, MA-1, Hagukumi) 44 cans in total Morinaga Milk Industry Co., Ltd. Dry milk (Sukoyaka, pm) 28 cans in total Bean Stalk Snow Co., Ltd. Various brands of baby food 96 bags Morinaga Milk Industry Co., Ltd. Various brands of baby food Bean Stalk Snow Co., Ltd. Restoration Support Section, Disaster Food (baby food) 7,500 Prevention Planning Bureau, Hyogo Planning and Public Life Department Corn soup 360 bags Aichi Chapter Corn cream soup 1 kg x 18 packs Koyo Co., Ltd. Pumpkin soup 780 Aichi Chapter Carrot soup 870 Aichi Chapter 66

94 Relief supplies, etc. Quantity Support group, supporter Restoration Support Section, Department Beverages (water, tea and sports drinks) Disaster Prevention Planning Bureau, 27,264 bottles Hyogo Planning and Public Life Department Drink (drinking water) 106,890 bottles Costco Wholesale Snow Co., Ltd. Drink (drinking water) 8 boxes Tohoku Branch, Suntory Foods Co., Ltd. Drink (drinking water) 10t A STYLE Drinking water 55 boxes MIYAGI Children s Hospital Mineral water MIYAGI Health, Welfare and Environment 1,020 bottles Department Medical Service Affairs Division Mineral water 330 bottles Aichi Chapter Mineral water Health and Hygiene Division, Health and Welfare Department of Sendai Crystal Geyser 500 ml X 1,980 Otsuka Pharmaceutical Co., Ltd. Milk 1,135 bottles Ashikaga RCHP Pocari Sweat 500 ml x 1,392 Otsuka Pharmaceutical Co., Ltd. bottles Yakult LT 525 Yakult Daily necessities (blankets) 150 pieces Osaka RCHP Daily necessities (electric rice cookers) 2 units Osaka RCHP Daily necessities (electric rice cookers) Health and Hygiene Division, Health and 2 units Welfare Department of Sendai Restoration Support Section, Department Daily necessities (polyethylene tanks) Disaster Prevention Planning Bureau, 444 sets Hyogo Planning and Public Life Department Restoration Support Section, Department Daily necessities (bags of non-common use drinking Disaster Prevention Planning Bureau, 1,000 pieces water) others Hyogo Planning and Public Life Department Daily necessities (movable AV tables) 5 sets Audio Visual Communications Ltd. Daily necessities (face towels) Sendai Branch, Meiji Yasuda Life Insurance 300 Company Daily necessities (air cleaners) 18 units Bridge Industry Co., Ltd. Daily commodities (work gloves, toilet paper, towels, wet tissues) Kyowa Hakko Kirin Co., Ltd. Disposable baby bottles 500 bottles Mita Rika Kogyo Co., Ltd. Underwear for neonates 1,000 pieces Silk Mulberry Co., Ltd. Sanitary materials (wet towels) 6 boxes JRCS Sanitary materials (skin cleanliness cotton) 30 boxes Sendai Branch, Eisai Co., Ltd. Restoration Support Section, Department Sanitary materials (nursing bottle cleaner) 200 Disaster Prevention Planning Bureau, Hyogo Planning and Public Life Department Restoration Support Section, Department Sanitary materials (paper diapers) others 297 Disaster Prevention Planning Bureau, Hyogo Planning and Public Life Department Diapers 12 boxes Tohoku University Hospital Sanitary materials (medical alcohol gel CB) 10,000 Cocokarafine Group Sanitary materials (masks) 7,500 pieces Sendai Branch, Hogy Medical Co., Ltd. Surgical masks Tohoku University Hospital Sanitary materials (disposable gloves) 3,300 pieces Sendai Branch, Hogy Medical Co., Ltd. Baby wipes Tohoku University Hospital Pharmaceutical products (saline) 100 boxes JRCS Pharmaceutical products (saline) Medical Service Affairs Div., Health, 2,000 boxes Welfare and Environment Dept. of Miyagi Pharmaceutical products (Tamiflu) 970C Fujimoto Hospital, Ichiyukai Pharmaceutical products (Tamiflu Capsule 75) 440C Miyabi Pharmacy Watanabe Cyozai Pharmacy Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 67

95 Great East Japan Earthquake and Tsunami Chapter 2 Relief supplies, etc. Quantity Support group, supporter Pharmaceutical products (Isodine Gargle) 200 Miyabi Pharmacy Watanabe Cyozai Pharmacy Pharmaceutical products (Relenza) 156C Fujimoto Hospital, Ichiyukai Medical materials/equipment (crutches) 20 sets JRCS Medical materials / equipment (aluminum light weight crutches) 30 sets Hitsujigaoka Hospital, Yujinkai Medical materials / equipment (digital automatic sphygmomanometer) 5 units Sendai Branch, Omron Colin Co., Ltd. Medical materials / equipment (digital automatic sphygmomanometer) 100 sets Sendai Branch, Omron Health Care Co., Ltd. Medical materials / equipment (electronic thermometers) 30 sets Sendai Branch, Omron Colin Co., Ltd. Medical materials / equipment (electronic thermometer) 200 sets Omron Health Care Co., Ltd. Medical equipment (X-ray equipment for rounds) 2 units Shimazu Corporation Medical equipment (ultrasonic diagnostic equipment) 2 units Toshiba Medical Systems Co., Ltd. d. Medical services Figure 2-35 shows the status of patients accepted at first-aid stations set up after the disaster. The number of patients peaked on March 13. By age group, groups under 10 years and those above 61 years of age were characteristically higher. By disease, respiratory and digestive diseases, and other internal diseases exceeded 40% of the total. Figure 2-35 Status of patients accepted at Sendai RCHP for in-hospital medical care No. of patients visiting the hospital per day Percent of patients per disease Number of patients visiting the hospital by age group 68

96 e. Working status of hospital staff and the damage situation Immediately after the earthquake took place, many staff on duty, as well as even those taking days off, voluntarily attended the hospital for service. None of the staff were injured or died after the disaster; however, some lost family members due to the tsunami. Many staff also stayed at the hospital overnight to provide services because their houses were damaged by the earthquake and tsunami, and in-hospital care was needed immediately after the disaster. It was also difficult to commute due to the lack of fuel. They also set up temporary nursery schools and rest spots so that they might feel secure in providing the services. Service description Deployment of medical teams Deployment of support staff from the Headquarters at Ishinomaki Area Joint Medical Team Deployment of support staff from the Headquarters at Ishinomaki Area Joint Medical Team Support for pharmacist duties f. Services outside the Sendai RCHP Although situated in the disaster-stricken area, Sendai RCHP deployed medical teams to Sendai Medical Center and Ishinomaki RCHP on the day and the day following the disaster, and to Ogatsu District from August to September. It also dispatched support staff for the Ishinomaki Joint Medical Team Headquarters, for pharmacist duties, as well as for medical services at MINAMI SOMA after the Fukushima Daiichi Nuclear Power Plant accident. Figure 2-36 List of services provided outside the hospital Destination Deployment term Job title Sendai Medical Center 3/11 Director of Pediatric Surgery, Nurse Manager, Administration staff Ishinomaki RCHP 3/12-13 Director of the Medical Social Services Department, Deputy Director of the First Orthopedics Department, Nurse manager, Nurses (2), Assistant Manager of the 2nd Radiation Technology, Administration staff (2) ISHINOMAKI 3/25-28 Director of Pediatric Surgery 4/ / /8-12 4/ / / /30-4/1 4/4-6 4/ /6 5/ / /8-12 5/1-2 5/9-10 4/ / / / /1-4 4/6-8 4/ /7-8 5/19-20 ISHINOMAKI 4/ / /25-27 Director of Medical Social Services Nurse Manager Nurse Manager Chief Nurse Chief Nurse Nurse 4/20-25 Nurse 5/3-6 5/ /25-28 Administration staff Ishinomaki RCHP 3/19-21 Section Manager of Formulations 3/21-23 Pharmacist 3/ /6-15 6/29-7/8 Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 69

97 Great East Japan Earthquake and Tsunami Chapter 2 Service description Deployment of Ogatsu, Ishinomaki medical teams Medical services after the Fukushima Daiichi Nuclear Power Plant accident Destination Deployment term Job title ISHINOMAKI 8/11-13 Director of Pediatric Surgery, Nurse, Administration Staff 8/25-27 Director of Medical Examinations, Nurse, Medical technologist (Administration Staff) 9/1-3 Director of the Medical Social Services Department, Nurse, Pharmacist 9/15-16 Surgery Doctor, Nurse, Social Worker (Administration Staff) MINAMISOMA 10/21-23 Director of Pediatric Surgery, Nurse Management (2) 12/15 Surgery doctor, Nurse Deputy Manager, Chief Nurse 10/21-23 Director of the Medical Social Service Department 12/15 (Administration Staff) (3) Fukushima RCHP a. Damage and Restoration Status of the Buildings and Lifelines Fukushima RCHP is a hospital with 359 beds and 482 staff, located in Fukushima Nakadori District that is the prefectural capital of FUKUSHIMA. Figure 2-37 shows damage to the hospital buildings and their restoration status. Fukushima suffered from almost no collapse, etc., of buildings. Figure 2-37 Damage and Restoration Status of Fukushima RCHP Items Damage status Restoration status Buildings No damage to the structures Damage to the structural joints of the former main building Cracks in the wall, distorted floors Elevated water tank damaged; boiler facilities partly damaged Electrics 3/11: Switched to the emergency power system (in-house power generation) in the blackout 3/12: Restored in the evening Gas 3/11: Supply disruption 3/12: Restored Waterways 3/11: No breakage of the pipes on the premises Municipal water outage (To examine the status of the piping breakage) 3/14: 20t water supplied by a Fukushima city water wagon 3/15: Water services restored Possible to save drinking water in the main building until the pipe in the main building system was examined. 3/16: Water services restored No use of water in the former building (used portable toilets, etc.) in the former building For water intake and savings Fixed-line phones Paralyzed communication network (due to restrictions) Cell phones Same as above Wireline phones in times of a disaster, Satellite-based mobile phones JRCS wireless system for professional use A few phone calls available during restrictions (Satellite-based mobile phones were not available) (No particular communication network problem in the Fukushima Chapter) b. Response to the Disaster The Fukushima RCHP set up the HDC in the 5th floor of the Administration Office of the main building about 20 minutes after the disaster took place. Subsequently, they stopped providing general outpatient services to prepare for accepting disaster victims and secure inhospital lifelines against power outages, etc. At 18:30 on the same day DMAT was called out, heading for MINAMISOMA via the Integrated HDC at Fukushima Medical University. At 10:40 on March 12, the next day, patient information from DMAT was obtained. At the request of the Fukushima Chapter, Medical-1 Team was deployed to Minamisoma Hospital, which had suffered from significant damage. Starting on March 14, a general meeting was held for representatives from each in-hospital department and various reports and information on the availability of clinical services, disaster data, etc. were shared among them. Figure 2-38 shows the response status over about 1 week after the disaster occurred. 70

98 Figure 2-38 Main responses of Fukushima RCHP after the disaster occurred Day Time Description 3/11 14:46 Disaster occurred Evacuation Hospital guidance to outpatients, confirmation of damage status to inpatients 15:05 Setting up the HDC Closing outpatient services (except first aid practice); suspended some accounts Providing the first in-hospital broadcasting; confirmed the damage status of each department via extension telephone No confinement in the elevators Evening Transfer of patients in the former building to the quake-resistant main building for temporary evacuation Nutrition Department distributing temporary prepared food 17:00 Request for DMAT deployment 18:30 Deploying DMAT (Fukushima Medical University MINAMISOMA) 3/12 10:30 1st Medical Team, leaving for Minamisoma Municipal Hospital 15:36 Hydrogen explosion took place in the building housing reactor 1 of the Fukushima Daiichi Nuclear Power Plant 17:30 Fukushima Chapter ordered the Medical-1 Team to move (from MINAMISOMA to KAWAMATA) After moving, started a medical care / mobile clinic from shelter to shelter. 18:30 Electricity restored; requested Fukushima prefectural government to procure 20 t water wagon 23:00 DMAT returned 3/13 7:00 DMAT left again 11:30 Instructing to restrict the use of toilets due to the lack of water 19:30 Fukushima Chapter informed, drugs for 7 days available for purchase from Primary Medical Doctor (PMD) without prescription 22:00 Fukushima RCHP DMAT returned 3/14 6:05 Requested to supply water and resume water services with 20 t water wagons from Municipal Waterworks Dept. 8:00 2nd Medical Team left Based on instruction from the Fukushima Chapter, mobile clinic services traveling from shelter to shelter started (many refugees within a radius of 5 km from the Plant) Instructions from the Prefecture about how to treat patients suspected of being exposed to radiation. 8:30 First Medical Treatment Meeting (General meeting with representatives of each in-hospital department). Since then, negotiating with the Gasoline Stand contractor as for strategies to cope with fuel scarcities every day 10 liters refueling available if a staff identification card of the Hospital is presented ; provided, however, it is only when the residual amount is low. 11:01 Hydrogen explosion took place in the building housing reactor 3 of the Fukushima Daiichi Nuclear Power Plant 14:00 Medical-2 Team received radiation measurements at the Fukushima Gender Equality Center (NIHONMATSU) No abnormality was detected for all the teams. 16:30 Medical Team-3 left for Azuma General Gymnasium The 2nd Medical Treatment Meeting (with representatives) Appointment for stable outpatients for the next day will be canceled to accept emergency patients 22:00 After the measurement of radiation exposure, Medical Team-3 returned 3/15 8:30 The 3rd Medical Treatment Meeting (with representatives) As the municipal water system was restored, it was decided this day to resume medical services for outpatients, although at a lower level. Prescriptive drug was delivered for at least a week for the present. Medical care expenses of 3,150 yen (healthcare services provided combining insurance-covered and non-covered services covering for the end of March) are not to be paid. 8:50 Medical Team-4 leaving for Azuma General Gymnasium 16:30 The 4th Medical Treatment Meeting (with representatives) Treating patients from the Soso District in the special care room due to the risk of radiation exposure 3/16 7:45 Medical-5 Team leaving for Iwaki Municipal Junior High School Gymnasium, Big Palette Fukushima 8:30 The 5th Medical Treatment Meeting (with representatives) Instructions on how to respond to patients or suspected patients exposed to radiation Screening of those living within a radius of 20 km from the Fukushima Daiichi Nuclear Power Plant 15:00 The 6th Medical Team leaving for Azuma General Gymnasium 16:30 6th Medical Treatment Meeting (with representatives) 18:00 The team reported that about 35 patients from Futaba Hospital being transported to Azuma Gymnasium were in a very serious condition (out of which, 3 died, 4 were urgently transported to the Fukushima RCHP and others to other clinics) 3/17 0:30 Medical Team-6 returned 8:00 Medical Team-7 leaving for Azuma General Gymnasium 8:30 7th Medical Treatment Meeting (with representatives) Briefing on how to respond to the explosions at the nuclear reactors Requesting Fukushima Prefectural Kenhoku Public Health Center to provide iodine agents for disaster medical assistance team staff To ensure indoor evacuation and sealing up of the hospital to prepare for another explosion, and discuss moving patients from the former building to the main building 16:30 The 8th Medical Treatment Meeting (with representatives) Obtained 250 tablets of potassium iodide from Fukushima government 3/18 8:30 The 9th Medical Treatment Meeting (with representatives) Ministry of Economy, Trade and Industry requiring oil supply businesses to refuel vehicles for emergencies preferentially (cooperation obtained for emergency vehicles of Fukushima RCHP by our Gasoline stand contractor) Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 71

99 Great East Japan Earthquake and Tsunami Chapter 2 c. Status of Relief Supplies, Medical Equipment, etc. After the disaster, various relief supplies including food, sanitary materials, pharmaceutical products, medical equipment, etc., were provided from medical institutions, private corporations, local governments, etc. Figure 2-39 Main relief supplies Relief supplies, etc. Quantity Support organization / supporter Medical care Inhalers 20 sets / welfare apparatus Nebulizers 20 sets Portable electrocardiographs 10 sets Electronic sphygmomanometers 100 units Headquarters Toshiba s portable ultrasound machines/viamo 2 units Nitrile gloves 500 boxes Electronic thermometers 3000 sets Citizen Astral lamps 1 unit Maquet Japan X-ray equipment for rounds 1 unit Shimazu Corporation Pulse oximeter 30 units Konica Minolta Automatic resuscitators 1 unit City Medical Association Wheelchairs 9 units Kirayaka Financial Group Bedside tables 132 units Toyovending Over tables 63 units Toyovending Air mattresses / Advan 2 sets Molten Medical care mats 14 pieces Fukuda Denshi Pharmaceutical Skin washing cream sprays 11 pieces products Multi-fix rolls (medical transparent waterproofing film) 2 pieces JWOCM Wound treatment ointment 30 pieces Wound protection, adhesive plaster system, agents for covering pressure sores 652 pieces JWOCM/ Japanese Society of Pressure Ulcers Tapes 1,008 pieces JWOCM/ Japanese Society of Pressure Ulcers Antibacterial sanitization (bubble) 16 pieces Eisai Japan Haru-onpax 60 pieces Eisai Japan Toromismile (2kg/700g) 2 bags each Koyo Surgical masks 2,038 boxes Koyo / Eisai Japan / Sumitomo 3M Sanitary Toothbrushes 16 pieces Eisai Japan materials Antibacterial cotton swabs 600pieces Eisai Japan Hand gels 4,920 pieces Sumitomo 3M Baby wipes, wet towels for adults 340 bags Koyo Urine collecting pads for men/ paper underwear for adults 95 pieces Eisai Japan Sanitary goods 2,396 bags Koyo / Eisai Japan Food Koyo / Kyowa Hakko Kirin / Nestle Japan / Otsuka Beverages 418 boxes Pharmaceutical / Toyovending / Yakult Foodstuffs (onions, carrots, potatoes, cabbage) 19 containers Suzusho green Dry milk 6 boxes Koyo / Morinaga Milk Industry / others Food (cup noodles, CalorieMate) 1,138 boxes Koyo / Otsuka Pharmaceutical / Kyowa Hakko Kirin Food (freshly baked bread, financier) 3,300 pieces Clothing / others Underwear, night clothes, T bandage 70 boxes Deodorant 2,100 pieces Koyo Umbrella 294 pieces Alkaline AA batteries 600 pieces Plastic bags (45 liters, 90 liters) / shopping bags 2,400 pieces Koyo / Eisai Japan Box tissues, pocket tissues, wet tissue 756 pieces Eisai Japan / Kyowa Hakko Kirin Towels 220 pieces Style heart / Kyowa Hakko Kirin Medical equipment Gratuitous rental support Quantity Support organization / supporter Sterrad plasma sterilizers 1 unit Sterrad hydrogen peroxide cassettes 100S 1 case Indicators (for inside CI) 1 box Indicators (for outside CI) 1 box J&J Incubators 1 unit Cyclesure 24 biological indicators 1 box Sterile packs 5 boxes Dispensers with purification function 2 units TMC 72

100 d. Medical Services Figure 2-40 shows the numbers of outpatients / inpatients of Fukushima RCHP over the 1 week after the disaster occurrence. evacuate with their family. Those whose family members still stayed far apart due to the nuclear disaster commuted from rental housing from outside the Prefecture that they had evacuated to. Figure 2-40 Number of outpatients / in-patients of Fukushima RCHP per day Outpatient services Hospitalization Service description March 11 (Fri) 575 patients 281 patients General outpatient services discontinued after the disaster took place at 14:46. March 12 (Sat) 35 patients 250 patients March 13 (Sun) 77 patients 250 patients March 14 (Mon) 85 patients 216 patients General outpatient services temporarily closed. March 15 (Tue) 92 patients 214 patients General outpatient services resumed, although on a smaller scale. March 16 (Wed) 363 patients 223 patients March 17 (Thu) 415 patients 230 patients March 18 (Fri) 538 patients 240 patients e. Working status of hospital staff and the damage situation None of the staff were injured or died after the disaster; however, many had their houses half or partially destroyed. Some of our staff evacuated to distant places using their paid vacation until the situation of the nuclear accident settled down. In particular, some staff with a small child or children even retired in order to (4) Otawara RCHP *Since July, 2012, the name was changed to Nasu RCHP. a. Restoration and Damage Status of Buildings and Lifelines Otawara RCHP is a hospital situated at the northern part of TOCHIGI. TOCHIGI, situated in the northern part of the Kanto Region, without any coastline on its border, suffered no Tsunami damage. However, the Disaster Relief Act applied to as many as 15 cities and towns (26 in total for the entire prefecture) with human suffering (4 deaths, 134 injuries) and house damage (260 houses totally destroyed, 2,109 houses half destroyed, 72,143 houses partially destroyed). This affected the restoration of lifelines and prolonged the duration of power and water outages, etc. Figure 2-41 shows the damage and restoration status of the hospital buildings, etc. Chapter 2 Provision of Medical Relief Figure 2-41 Damage and restoration status of Otawara RCHP Item Damage status Restoration status Many cracks in the pillars and walls of the entire Building C (RC pillar structure) 3/11 No entry due to serious damage First floor tilted with the walls fallen D700 H900 W4500 to Building C Water leakage due to damage to the pipes on the 2nd, 4th and 5th floors Office of the Nutrition Section 150 mm gap 3/14 Recovery using tarpaulins Wall fallen in the Outpatient Section, on the 2nd floor of Building A D150 H2500 W4000 3/11 Prevention against falling of the construction scaffold bridge Water leaking due to broken hot/cold water pipes at the 1st, 3rd, 4th, 5th Fl. of Building A 3/11 Repair water leaking from hot / cold water pipes Water leaking due to broken water pipes around the toilets 3/14 Repair to water pipes around the toilets Building at the 1st floor of Building A Corridor slope broken outside Building A side 3/18 Slope available for use after quick repair Partition broken and ceiling fallen in the Dialysis Room of the Central Ward 3/13 Partitions and ceilings repaired 50 mm gap between the ICU of Building B and the OP Room 3/14 Recovery using tarpaulins All joint covers fallen in the Emergency Ward Building 3/15 Covers restored Ceiling covers fallen in the Emergency Center; uneven floor surface at 50 mm in the central part of the floor 3/13 Slope installed as quickly repaired No vehicle entry or exit available due to the uneven surface being 100 mm at the entrance / exit for ambulances Treating the slope with asphalt All joints of both old and new buildings broken, or with uneven surface created 3/13 14 Quick repair Great East Japan Earthquake and Tsunami 73

101 Great East Japan Earthquake and Tsunami Chapter 2 Item Damage status Restoration status 3/11 No blackouts Electricity 3/15 24 Rolling blackouts; switch to emergency power generators 3/11 Heavy fuel oil A 34,000 liters remaining 3/11 Kerosene for heating was not available from nearby 3/11 Procuring 120 liters of kerosene stands; one of the stands provided fuel by hand for heating Fuel Propane gas 3/15 22 Medical Welfare Division of the Prefecture provided fuel stockpiles for emergencies and light fuel oil for generators 3/11 Serious damage to Building C; not available for use 3/15 Refueling 550 liters of light oil 3/17 Refueling 734 liters of light oil 3/18 Refueling 256 liters of light oil 3/22 Refueling 138 liters of light oil 3/11 Temporally installing propane gas devices; setting up portable PG in the three-multilevel car parking garage 3/11 Municipal water pipe broken 3/15 Municipal water piping restored Waterworks 3/11 Tap water not available due to serious impurities; 3/20 Partially starting to use municipal switched to groundwater water 3/11 Using broken water tank although water leaking 5/20 Repairing water leaking Sewage system 3/11 Using broken pipes as they are in Building A 6/30 Restoration of sewerage system completed 3/11 Stopping the use of broken pipes in Building C 3/11 No entry to Building C Steam 3/11 Stopping the use of broken boiler pipes 3/11 Restoration of steam pipes completed Telephone 3/11 Fixed phone available intermittently 3/11 Cell-phone interruption 3/11 Trying to use cell phones, although only 3 units or so were JRCS wireless 3/12 Some two devices available after available at nighttime due to few available battery chargers and system charging with a battery a shortage of batteries Medical gas 3/11 No damage to the plumbing and cylinders 3/11 50 cylinders (500l) supplied 3/11 Vehicle traffic not available with an uneven surface 3/25 Repair work completed The exterior of 150 mm at the front rotary 3/11 Terribly uneven floor around Building C; only possible to walk 3/27 Repair work only partial b. Response Status at the time of the Disaster At Otawara RCHP, with damage to the building and aftershocks, doctors and nurses carried out triage and guided the patients outside the hospital. They moved the patients having difficulty in moving outside the hospital to an earthquake-resistant building, allowed some mildly ill patients to go home, or evacuated them to public facilities by municipal bus with the cooperation of Otawara municipal government. The next day, March 12, they added beds in hospital wards still available for use in order to accept patients evacuating from the affected region. There was a kitchen in the damaged building, which significantly affected the service of serving meals to patients. To cope with the situation, we provided a soup kitchen service and used the dining room for outpatients (deli or prepared food via an outsourcer). We eventually remodeled the warehouse into a kitchen. Figure 2-42 shows the disaster response status for about one week after the disaster took place. Figure 2-42 Major response at Otawara RCHP after the disaster Date Time Description 3/11 14:46 Disaster took place (Northern part of TOCHIGI: intensity 6 upper) 14:50 Hospital HDC established. (Due to the risk of a building collapse, we instructed patients and their families and all staff to evacuate the building) 15:15 Temporarily evacuated inpatients able to walk to a parking lot (front, bank over the river). Inquired from each department in regard to the number of patients within the hospital, those hospitalized, and the damage status. 74

102 Date Time Description 3/11 15:30 Transferred seriously injured patients from the collapsed building to the emergency ward Due to the significant degree of damage in the hospital ward, we secured temporary evacuation spots for inpatients and requested transportation vehicles (Otawara local government). Emergency food and other items were collected at the first floor entrance 16:00 As an evacuation place for mildly-injured patients, the City Gymnasium and Otawara Senior High School s gymnasium were designated. Inputting EMIS and requesting DMAT Soup kitchen and emergency food prepared (as the kitchen unavailable, hot meals were served by the Nutrition Section staff). 16:30 After triage, transferred the patients one by one by municipal bus (113 patients) Other patients with difficulty in walking were transferred by our two ambulance vehicles 16:55 No entry to Building C (due to a risk of collapse): 3/12 Results of the Imminent Risk Assessment 18:00 Doctors, nurses and administration staff were placed at 2 points of the gymnasium for the night shift. 18:10 DMAT team of Dokkyo Medical College Hospital started services at the ICU, etc. 20:10 DMAT Teams (2 teams) of Uenomiya Koga General Hospital started services at the gymnasiums 22:25 DMAT team of Ashikaga RCHP arrived 3/12 06:05 Staff preparing breakfast for evacuees to the gymnasiums and inpatients (as the kitchen was unavailable, hot meals were prepared by the Nutrition Section staff) 07:30 Dokkyo Medical College Hospital informed us that they could accept some 50 inpatients (regardless of internal or surgical departments) 07:25 Two pharmacists were assigned to each gymnasium. 07:45 Soup kitchen service completed. Serving meals to evacuating patients and inpatients. 08:29 Patients on dialysis evacuating to the city gymnasium were transferred to clinics in the city (accompanied by nurses) 09:00 The general meeting started (with participants including government authorities, DMAT teams) Otawara RCHP:Report about the patients, building status, etc. Government authorities : Report about damage status, etc., in the region. 09:45 Identifying the status of empty beds and adding beds at hospital wards available 10:25 Determining of ward allocation for the patients accommodated at our hospital (evacuating patients to each gymnasium) 10:55 Started to transfer patients one by one by municipal bus and ambulance car. Ended at 15:30; withdrawal from the gymnasiums 11:19 Started to transfer 14 serious patients to 4 facilities in the prefecture, including Dokkyo Medical College Hospital (accompanied by DMAT Teams: by air ambulance / ambulance vehicle) 16:30 Started general meeting (including government authorities and DMAT Teams) *Determining of the future direction 23:00 Two staff from the Mie Chapter and 6 medical team staff from Yamada RCHP arrived. 3/13 09:00 Started the general meeting. 12:13 Transferred two serious patients to Saiseikai Utsunomiya Hospital (accompanied by Yamada RCHP medical team staff) 15:55 Medical teams from Yamada RCHP started medical services by traveling from shelter to shelter 22:35 Closed the service for the day 16:00 The general meeting started. * Confirmed patients about medical care and meal services from March 14, etc. 22:25 Prefectural Medical Welfare Division answered questions about preparations for the planned (rotating) power outage from March 14 23:30 Briefed by Tokyo Electric Power Company (TEPCO) about the planned (rotation) power outage schedule (hours) 3/14 08:30 In-hospital liaison conference held (at 8:30 15:30) until March 19 3/16 17:00 Medical teams and administrative support staff deployed to Ishinomaki RCHP 18:00 Joint meeting with participants including prefectural and local government authorities, medical associations from each city, etc. 2 Chapter 2 Provision of Medical Relief (2) Discussion about medical services for those evacuating to disaster shelters (2 accommodations) Great East Japan Earthquake and Tsunami 75

103 Great East Japan Earthquake and Tsunami Chapter 2 c. Status concerning supplied materials, medical equipment, etc. Various relief supplies, including food and sanitary materials, medical equipment, etc. were provided by local governments, medical institutions, local companies, JRCS Headquarters and Chapters, etc. Figure 2-43 Main relief supplies Random order Support supplies, etc. Quantity Support groups / supporters Rice (retort) 4,000 meals Rice (polished rice) 99 meals Miso soup 1,158 meals Bowls 1,600 pieces Plates 4,000 pieces OTAWARA Spoons 2,000 pieces Forks 1,000 pieces Disposable chopsticks 4,000 sets Cups 1,000 pieces Flashlights 20 pieces Fire and Disaster Management Section of Tochigi Dry rice porridge 1,000 meals Fire and Disaster Management Section of Tochigi Water (500 ml) 120 bottles Morinaga Milk Industry Disposable paddles 4 sets Nihon Kohden Bedside monitors 50 sets Nihon Kohden Food (biscuit) Tannobe Prefectural HDC Rice porridge with plum 1,000 meals TOCHIGI Jelly for deglutition 288 pieces Vegetable juice (100 ml) 25 packs Ryoshoku Service Co., Ltd. Wafers 5 bags Egg rice crackers 1 bag Crackers for emergencies 1,260 meals TOCHIGI Hamburgers 400 pieces MOS BURGER Yogurt 1,000 pieces Glico Orange juice 1,000 packs Glico Disposable wood chopsticks 1,000 sets Nikkane Rice (retort) 720 pieces Tochigi CO-OP Sweet bun 23 Bread 4 loaves Pia Disposable tableware Gasoline 20 liters Nasu Town Office Blankets 255 pieces Cots 189 units Tochigi Chapter First-aid kit 1 set Futon set 5 sets Simple toilets 300 units TOCHIGI Milk conditioning water Morinaga Milk Industry d. Situation (Response) of Medical Service Functions, etc. We evacuated the patients outside/inside the hospital immediately after the disaster took place. On the next day, all patients were accommodated inside the hospital, and the hospital wards were reorganized. From March 14, our general outpatient medical care restarted. <Outpatient Service> Our general outpatient consultations resumed on March 14. Although it was impossible for us to provide our normal service menu due to the effect of the rolling power outage, we wrote prescriptions and test request sheets in handwriting during the blackout. From around March 16, people evacuating from FUKUSHIMA (radiation originating from the nuclear accident) increasingly visited us for medical care. <First Aid> On the day of the disaster, we temporarily stopped providing emergency outpatient services, although 17 patients visited us until 21:00. They included 10 injury cases due to head banging, bone fracture, etc., 2 serious 76

104 cases (2 patients with subarachnoid hemorrhage were transferred to the university hospital after the first aid treatment) being hospitalized [one with chronic respiratory failure of at-home oxygen therapy, and one with myocardial infarction (cardiac catheterization provided at midnight) ]. Subsequently, we stopped, in principle, emergency outpatient services for one week although several patients visited us per shift, and a few were hospitalized. <Surgery> On the disaster day, 4 patients in the hospital room managed to evacuate from there safely. From the next day, 2 rooms were made available providing only in-hospital emergency and C-section surgery for one week, and surgery appointments already made were rescheduled until after March 22. <Dialysis> We deployed our nurses to nearby clinics and asked them to take care of our patients for 3 days from March 12. We resumed only maintenance dialysis therapy for patients needing it from March 15. <Hospital Ward> On the disaster day, we closed 4 wards (180 beds unavailable). From the next day, March 22, and April 18, with the hospital resuming its functions, we reopened the wards that were closed and added another 100 beds to cope with the increasing number of patients. <Meal Service> On the night of the disaster day, we served emergency food, sweet rolls and water. From the next morning to March 13 we were able to provide hot meals prepared at the soup kitchen. From March 14 meal service program started by outsourcing. From April 1, staple food was provided at the hospital (using a dining room for hospital staff and outpatients), and side dishes were procured from outside. All staff hoped to resume meal services as soon as possible, and remodeled the warehouse to construct a makeshift kitchen. From July 13, full meal services began at the hospital. e. Medical service and Staff Support There were some 400 patients and staff on the disaster day inside the Otawara RCHP and, fortunately, our patients and staff managed to evacuate without anyone being injured. One of the factors that allowed us to provide evacuation guidance and stand-by outside the hospital relatively smoothly were our repeated disaster drills held on a relatively large-scale for the past 7 years. This helped every staff member to act voluntarily without direction, while assessing the the situation. The second factor is our determination, wisdom and leverage where every one of the staff members came together, considering the patients first to protect the patients. Furthermore, it is essential to have the cooperation of the local government and the Medical Association on a daily basis. Cooperation carried out on daily basis helped alleviate the effects of the sudden disaster, which made the medical team staff determined to further develop this circle of cooperation and promote deployment. On March 14 the Tochigi Chapter requested Otawara RCHP to deploy medical teams, although the hospital put off responding to its request as the hospital had been being functioning insufficiently. On March 15 they again requested the hospital to deploy teams, and it made a decision to meet the request. One of the major factors that encouraged the hospital to make the decision was a conversation between staff members in the locker room in the morning, Why don t we rush into ISHINOMAKI to provide medical services?, We got enough support from others too. It will be all right if all of us come together. When we approached some of the staff, asking, will you be able to come and join forces for medical care at... 2 out of 3 had been already been prepared to head for the area with their necessary belongings in their cars. This is the spirit of Otawara RCHP. It s the time to rise to the occasion, playing our role as Red Cross hospital staff, every member thought at this moment. Services provided by 79 staff in total included 10 team staff to Ishinomaki RCHP, Suzuko Plaza at IWATE, Azuma Sports Park in FUKUSHIMA from March 16 to July 27; 9 psychosocial care staff; 12 support staff to Ishinomaki RCHP (ER support, ward support, doctors, pharmacists, administration staff). This was the largest force among the 3 hospitals in TOCHIGI, providing long-term support. After the disaster this time, some staff claimed mental illness, and those missing their hospital ward Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 77

105 Great East Japan Earthquake and Tsunami Chapter 2 had a feeling of loss. There was a feeling of guilt because I was not able to come to the hospital at the disaster time, I hurried to the hospital, leaving my child who said, Don t go! And there was a feeling of fear that I might die with the patients together. With these feelings some staff lost their mental stability, which resulted in the temporary retirement of 2 staff members, and the permanent retirement of 1 staff member. For psychosocial care: 1Initially the clinical psychologist staff went around the ward and listened to the staff talking about their experience; 2A poster was put up to send a message from the Nursing Department, What you are feeling now is normal ; 3Try to write down the feelings you had at the time (and it has now been compiled as a file) 4Personal interviews (superiors, clinical psychologists, etc.) 5People who had the same experience at the same place should come together to talk about how they felt about it 6Support for middle managers by the Liaison Clinical Nurse Consultants In the above mentioned order, if necessary, a patient was referred to a psychiatrist through a clinical psychologist in a step by step process. When returning to work, we provided support with regards to the timing, work shift (no nighttime, no after work, shorter work hours). At this time all staff thought, the new hospital building should have been constructed a year earlier!! We have no choice but to recover from the situation for another one and a half years. Although the building became obsolete and vulnerable after this earthquake disaster, there was no human suffering, which allowed us to resume medical services from an early stage. This enabled cooperation by various people, including the staff, contracted staff, local people, OB / OG, volunteers, staff at the construction site (moving and newly constructing), and staff newly employed in April. 4. Support from Blood Centers in the Disaster- Affected Areas and Nationwide (1) Status of Blood Centers in the Disaster- Affected Areas a. Damage Situation after the Disaster (i.e., lifelines, whereabouts of the victims, etc.) Some local blood centers were also damaged by this disaster. The Miyagi Blood Center (BC) building experienced a main shock of intensity 6 upper where testing and formulating apparatus was moved, fallen or damaged, and pipework equipment, etc. was broken. Koriyama Supply Branch and Koriyama Blood Donation Room (BDR) buildings in FUKUSHIMA were also damaged, and the Haramachi Supply Branch was forced to withdraw after the Fukushima Daiichi Nuclear Power Plant accident. As for lifelines, power outages took place in some northeastern centers (except Fukushima BC). There was water outage in Miyagi and Fukushima BCs, and a lack of vehicle fuel throughout the region which caused a significant problem. Outside the Tohoku region, Omiya Station BDR of Saitama BC was unavailable for service due to water leakage from the plumbing system, while Yokohama Higashiguchi BDR of Kanagawa BC and Hitachi BDR of Ibaraki BC were unable to provide services due to broken blood collection devices, etc. b. Situation of Blood Collection, Testing and Preparation (until Restored) Figure 2-45 shows BC functions from immediately after the disaster to March 14. Originally, Miyagi BC had been a hub for five Tohoku BCs; Aomori, Akita, Iwate, Yamagata and Fukushima even before the disaster. Likewise, the preparation function of Iwate and Yamagata BCs had been concentrated in Miyagi BC. Miyagi BC suffering from a water outage stopped the services including testing and X-ray irradiation of blood components. It also stopped its testing and preparation services since it was unable to control the temperature after the municipal gas supply stopped, the need for revalidation for instrument gaps, and concerns about aftershocks, etc. In Fukushima BC, X-irradiation to blood products was not possible due to the suspension of water-supply. On the next following the disaster, it also put off providing blood collection services at all of Tohoku 78

106 Figure 2-44 Damage situation of BCs at TOHOKU 3 prefectures (Immediately after the disaster - March 14) Iwate BC Miyagi BC Fukushima BC Aomori BC Akita BC Yamagata BC 5 upper 4 (5 upper at 5 upper Intensity 6 upper 6 lower at Iwaki C 5 upper 4 Hachinohe C) 5 upper at Aizu C Main shock intensity Whereabouts of the staff Damage status of the main facilities Electricity Water supply Gas Fuel All staff identified on the night of 3/11 Nothing in particular In-house power generation 〇 All staff identified in the morning of 3/14 OA equipment fallen or damaged; testing equipment and pharmaceutical manufacturing apparatus fallen or damaged Plumbing system, etc. of the facility damaged In-house power generation 〇 All staff identified in the afternoon of 3/13 Damaged so that narrow boards anchored in ceilings are flaked Koriyama Supply Branch: Possibility of building collapse Koriyama BDR Possibility of collapse of the beam under the roof Hara Supply Branch: withdrawn due to the nuclear plant accident All staff identified All staff identified on on the night of 3/11 the night of 3/11. Hachinohe C: Land sinking on the premises In-house power generation 〇 Nothing to be noted. In-house power generation 〇 All staff identified on the night of 3/11 Nothing to be noted. In-house power generation 〇 Water outage Water outage Discontinued 〇 〇 Stock Stock Stock Stock Stock Stock insufficient insufficient insufficient insufficient Reference: Damage situation of BCs at other Tohoku 3 Prefectures (Immediately after the disaster - March 14) (Note) : Functions, etc., discontinued, : Functions, etc., partly discontinued, 〇 : Normal condition, : Changes in the conditions Chapter 2 Provision of Medical Relief Figure 2-45 BC function in the six Tohoku prefectures (from immediately after the disaster until March 14) Iwate BC Miyagi BC Fukushima BC Aomori BC Akita BC Yamagata BC BDR Blood Manufacturing Preparation Aggregation Aggregation function Test Aggregation Aggregation Aggregation Aggregation Aggregation (Note) : Functions, etc., discontinued, : Functions, etc., partly discontinued, 〇 : Normal condition, : Changes in the conditions of the Blood Donation Room (BDR) means some of the rooms currently discontinuing services due to the disaster. BCs because: Miyagi BC, a hub for blood product preparing, was affected; there were plenty of blood product stocks nationwide; a higher priority was placed on identifying the damage situation and restoring the administrative functions; there was concern about aftershocks, etc. Aomori, Akita and Yamagata BCs resumed accepting blood donations from March 13. Iwate, Miyagi and Fukushima BCs suffered from significant damage and there was no idea as to when they could resume the service. In this context, the supply and demand was to be adjusted over a wider area. Subsequently, with the restoration of lifelines, each BC restarted services one by one as shown in Figure Figure 2-46 Restoration of the lifelines of Tohoku BCs and resumed the dates of services Restoration of lifelines Electiricity Gasoline Water service Resuming date Resuming date to accept blood for testing and donation formulating drugs Fixed facilities Bloodmobile service Testing Preparation AOMORI 3/ /13 3/14 HACHINOHE 3/ /14 ** 3/13 IWATE 3/ /20 4/ MIYAGI 3/12 3/27 3/22 4/18 5/1* 4/13 4/13 AKITA 3/ /13 3/14 ** 3/13 YAMAGATA 3/ /13 3/14 ** *** FUKUSHIMA - - 3/18 4/18 AIZU /25 5/1* - 4/18 IWAKI - 3/14 4/8 4/26 * Resuming BC as soon as ready ** Until the Miyagi Center reopens, blood collection and testing services for Aomori and Akita will be carried out at the Tokyo BC, and for Yamagata at the Saitama BC. *** Produced at the Niigata BC until the Miyagi BC reopens. Great East Japan Earthquake and Tsunami 79

107 Great East Japan Earthquake and Tsunami Chapter 2 c. Medical Activities, etc. Engaged by BC Staff in Disaster-Stricken Prefectures BCs in disaster-hit prefectures temporarily discontinued blood collection services, etc. after the disaster, and some of the staff were deployed to support medical services in the prefectures. Their specific services are shown below. Requested by Iwate Chapter, Iwate BC deployed 265 staff in total mainly to the coastal zone for the purpose of supporting medical relief services and conveying supplies to disaster shelters. Figure 2-47 Main disaster-support services by Iwate BC (March 14 - April 17) and total number of staff deployed Destination No. of staff deployed and the services and purpose Administration staff Nurses Tono HDC staff 51 staff (Acceptance of medical teams, etc.) - Support to the 18 staff (Delivery of 2 staff (Services as a Iwate Chapter disaster supplies, etc.) medical team) Support to the Iwate 8 staff (Testing, blood 13 staff (Records, etc.) Chapter HDC collection, etc.) Support to Morioka 173 staff (Blood collection, - RCHP hospital wards, etc.) In response to a request from the Miyagi Chapter JRCS to support Ishinomaki Joint Medical Team that had provided services at Ishinomaki RCHP, a hub point, the Miyagi BC helped conveying supplies and other duties for the Team. At Fukushima BC nurses, traveled from shelter to shelter to provide medical care from March 25 to April 16, provided health counseling to 3,000 patients in total (10 disaster shelters). (2) Support System of the Blood Service at Headquarters (BSH) a. Precedent Service for Providing Supplies through the Wide-Area Supply-Demand System We provided the service for supplies in advance as was planned to be introduced in the wide-area supplydemand system from April As a result, although it was quite difficult to continue blood donation acceptance / testing / preparation services, this supply-demand system allowed us to secure constant supplies, responding to medical demand from disasterstricken sites based upon the nationwide support system. One of the main factors in the success of this operation was that, including the blood amount needed in the disaster stricken areas, blood was collected and processed in non-disaster stricken areas, transferred to TOKYO, and then delivered to the disaster areas every day using available transportation means. Specifically: (a) Securing Replacement Facilities for Those in Disaster Areas for Testing / Preparation Services After the disaster took place, BSH reviewed all substitute facilities for testing / preparation services, and the delivery and transportation routes for source blood components, samples for testing, and blood products to the substitute facilities. The samples for testing for Aomori and Akita BCs were delivered to the Tokyo BC via air, and those for Yamagata BC were delivered to the Saitama BC via land (through the Niigata BC). Aomori and Akita BCs could produce source blood components in-house, while those for Yamagata BC were delivered to Niigata BC by land transport. [Conveying supplies using a bloodmobile] (b) Securing an Appropriate Amount of Stock Because some BCs in the disaster areas found it difficult to accept blood donors, others increased their blood collection estimate by 20% more than usual for the service. In addition, they decided to maintain more stocks of red blood cell products than the optimum quantity of stocks in normal times in order to respond to medical demand nationwide, including from the disaster-stricken zones. The stock quantity of red blood cell products as of March 11 (6:00 AM), the disaster day, was 183% (corresponding to 5.5 days of normal use) of the optimum amount of stocks; thus, it was considered that a constant supply of the products would be 80

108 available for the time being. However, because the TOHOKU and KANTO regions had repeated aftershocks, which caused a danger to buildings, it was considered difficult for BDRs, etc., to receive platelet apheresis in a constant way. In this context, BSH instructed blood centers in non-disaster areas to focus more on procuring platelet apheresis for all blood types in their service for the entire day of March 12. With all these efforts, there was no trouble in securing or constantly supplying blood components in the three disaster-affected prefectures although they were forced to discontinue their own blood collection practice. Figure 2-48 Trends in the optimum inventory rates of blood products (red blood cell products) (as of 6:00 in the day) (Unit:%) No. of blood donors March y/y Blocks 3/11 3/21 3/31 4/ ml of blood donation Platelet apheresis HOKKAIDO MIYAGI TOKYO AICHI OSAKA OKAYAMA FUKUOKA Total nationwide situation. Blood for platelet products was collected at BCs other than the Tokyo BC, delivered to the BCs of TOHOKU, and supplied to the medical institutions after adjustment for the supply and demand from local medical institutions. Figure 2-49 Delivery and receipt status between the Blocks after the disaster (Red cell products) Figure omitted Figure 2-50 Delivery and receipt status between the Blocks after the disaster (Platelet products) Figure omitted (d) Review of the Supply Support System The Sub-Committee on a Stable Blood Supply established in the BSH provided a support system to provide blood products for transfusion, i.e., updating the inventory status per product and blood type for the blocks and nationwide BCs every week, responding to changes in the supply status and medical demand, and reviewing the blood collection plan according to the above. As the blood centers in disaster areas resumed their blood collection functions, the Committee reviewed the first plan as needed, increasing/decreasing the amount until the end of May. Chapter 2 Provision of Medical Relief From March 19, Blocks other than TOHOKU/ KANTO/KOSHINETSU collected blood by blood type in an amount that corresponds to 90% more of the number of blood units on average supplied by that day of the week in the Tohoku Block, and provided constant units of blood to the Block to secure blood for platelet products needed in the Tohoku Block. Red blood cell products were also supplied to the Tohoku Block from March 20. The number of units needed for red blood cell products per day (764 units) was determined for each blood type in IWATE, MIYAGI, FUKUSHIMA and YAMAGATA. [Support from BCs nationwide (Miyagi BC)] (c) Wide-Area Transportation System As for the supply blood products secured for transfusion, red blood cell products were delivered via the Tokyo BC to the medical institutions in IWATE, YAMAGATA, MIYAGI and FUKUSHIMA after adjustment of the nationwide supply-demand Great East Japan Earthquake and Tsunami 81

109 Great East Japan Earthquake and Tsunami Chapter 2 ati n ide Figure 2-51 Number of blood donors before / after the disaster T 82

110 Figure 2-52 Figure Omitted b. Support System for the blood centers in the Disaster-Stricken Areas (a) Personnel Support (Staff in Charge of Supply, Preparation, and Testing) As for personnel to support the facilities, etc., in disaster-stricken areas, it was required to ensure coordination between the Blocks and the deployment of support staff and vehicles based on the information collected by the Miyagi BC, a hub center. BSH at the Headquarter Office deployed 2 staff (1 team), 12 staff in total to the Miyagi BC HDC for liaison and coordination duties. Tokyo, Aichi, Osaka and Fukuoka Blocks deployed 60 delivery staff and 7 vehicles in total for delivery support services to the Miyagi BC. These staff carried out coordination in advance with staff in charge of liaison and coordination dispatched from BSH at the Miyagi BC HDC. They were deployed by shuttle vehicles or directly from the disaster sites via airports available by the most convenient route on a case-by-case basis. The Hokkaido Block also dispatched 2 staff who were in charge of the restoration of the integrated system of blood services and maintenance control at the Miyagi BC. As delivery staff and supply support vehicles for the Yamagata BC, 14 staff and 1 vehicle were dispatched by the Aichi Block, engaged in the delivery of source blood and samples for testing collected at Yamagata BC to Niigata BC. Okayama Block deployed 4 preparation staff in total to the Niigata BC to process source blood for the Yamagata BC. Fukuoka Block deployed 8 testing staff in total to the Tokyo BC to test samples for Aomori and Akita BCs. Combined with the number of BSH staff for about a month, 100 support staff and 8 support vehicles were dispatched. Chapter 2 Provision of Medical Relief Figure 2-53 Status of personnel support for the facilities, etc., of the disaster-stricken areas Destination facilities for support MIYAGI YAMAGATA NIIGATA TOKYO Section Integrated control Support items Liaison between BSH at the Headquarters Office and facilities Control of support staff No. of dispatched staff (no. of vehicles) Dispatching Block Deployment term 12 staff BSH 3/17-4/16 Delivery staff 22 staff TOKYO 3/17-4/16 Coordination of supply / demand adjusted products 8 staff AICHI 3/17-4/4 throughout the TOHOKU region (TOKYO, TOCHIGI, 20 staff OSAKA 3/17-4/15 Supply FUKUSHIMA, MIYAGI) Distributions to medical institutions in prefectures 10 staff FUKUOKA 3/17-4/6 Emergency vehicles for supporting supplies TOKYO, AICHI, (7 vehicles) delivery OSAKA, FUKUOKA 3/17-4/16 Administration Maintenance of unified system for blood service 2 staff HOKKAIDO 3/22-3/26 Delivery staff Supply Delivering duties of source blood and samples to Niigata BC 14 staff AICHI 3/18-4/11 Supply support emergency vehicles (1 vehicle) AICHI 3/18-4/11 Preparation staff Processing duties using source blood from blood Preparation collected at the Yamagata BC 4 staff OKAYAMA 3/18-4/14 Testing staff Testing staff Testing Testing duties for blood collected at Aomori 8 staff FUKUOKA 3/11-4/14 and Akita BC Total 100 staff Approx. one (8 vehicles) month (b) Support for Restoration After the disaster, the Miyagi BC had difficulties in providing preparing and testing services, and the Fukushima BC in providing preparing services. Thus, information in relation to the following was collected as that required for resuming the services. Restoring daily life for the staff and ensuring stable commuting Restoring capabilities for providing the necessary lifelines and wastewater treatment Ensuring stable routes to deliver source blood and/ or testing samples Great East Japan Earthquake and Tsunami 83

111 Great East Japan Earthquake and Tsunami Chapter 2 To ensure appropriate preparation and quality controls at preparation plants, BSH deployed four technical staff in total to support checking the instruments and the operating status at each site. Figure 2-54 Personnel support for the restoration of testing / production duties at facilities in the disaster-hit areas Destination facilities Services for support Deployment term Miyagi BC preparation/ testing services 4/12-15 Fukushima BC preparation services 4/18 c. Supplies Procurement for Supporting the Disaster-Stricken Areas Liaison and coordination staff deployed to Miyagi hub BC HDC were engaged in coordinating support requests for food and supplies at the other BCs. Based on this information, the staff requested the procurement of food and supplies from hub BCs (other than those in the disaster-stricken areas), loading them into vehicles used for the deployment of the support staff on site. The supplies procured and delivered include: food (packed rice, cup noodles, cup-o-soup, canned food, etc.), sanitary goods, fuel, portable fuel cans, tableware, etc. [BC staff loading kerosene onto a blood donation vehicle] d. Response to the Nuclear Accident On March 12, BSH, in expecting already an expansion of the evacuation zone following the Fukushima Daiichi Nuclear Power Plant accident, withdrew the Hara Supply Branch which stands within 25-km from the plant, so that to ensure the safety of its staff and blood components. The stock of the blood were then transferred to and stored at the Fukushima BC and the Center took care of the orders which had been received by the Hara Supply Branch. As one of the measures to deal with radioactive substance leaks, BSH at the Headquarters procured direct reading dosimeter devices in order to control the staff dose exposure to radiation, and delivered them to Fukushima BC on March 13. Based on the Guidelines on Risk Management by BSH, they instructed, when delivering blood components within a 30-km radius zone around the Daiichi Nuclear Plant, that the staff must carry a dosimeter for personal exposure control so that the cumulative dose will not exceed 20 msv. Furthermore, assuming the possible expansion of the evacuation zone, coordination was made between the receiving and delivery agents for some 6,500 units of fresh frozen plasma stored at Iwaki BC, FUKUSHIMA, within the 45-km radius zone from the Fukushima Daiichi Nuclear Plant. On March 16, the Fukushima BC was instructed to transfer them to the Kyushu BC. e. Damage and Destruction of the Koriyama Supply Branch The Koriyama Supply Branch of the Fukushima BC suffered severe damage to its building due to the earthquakes, and was suggested to withdraw from the resident building manager because of the risk of collapse. However, because the Branch deals with 35% of the supplies within the prefecture, the Fukushima BC expected the Branch to continue supplying blood components (only administrative staff and a night watchman s functions to be transferred). For the time being, on March 24, 292 units of fresh frozen plasma (FFP) stored at the Branch were transferred to the Fukushima BC, and the building of the Branch remained in use together with the vehicle lot secured on the opposite side for parking blood transport vehicles as a hiding place. To respond this, BSH advised the Fukushima BC on April 4 that the possible separation of the administrative office and the blood storage facility would not be desirable in terms of management, requesting the Center to temporarily close the Branch and to discuss the possibility of providing services based in the Fukushima BC as a hub of these services. However, concerned about claims for any delay in delivery from the medical institutions within the Koriyama Branch territory, the Fukushima BC hoped 84

112 to continue providing the service, even temporarily, through the Branch. And it did not make any changes in the supply system where the Fukushima BC served as a hub. With severe aftershocks continuing on April 11 and 12 BSH at the Headquarters instructed the Fukushima BC to supply necessities on April 13, and to identify and present problems they found in the supply system from Fukushima BC to the medical institutions in the Branch territory on April 15. It also instructed that the Branch building should again be provided with some expert assessment and report on the current status. Based on the building research report that the Fukushima BC sent on April 18, the following suggestions were made to the Fukushima BC: 1) to find a new place for relocation, and move to the site as soon as possible, 2) until the relocation, to maintain the current system and supplies from the Branch. A suitable site was later found in KORIYAMA for the relocation and the Branch resumed services at the new location on and after March 5, f. Organization of BSH at the Headquarters (Staff Replacement) Immediately after the disaster, the Emergency Blood Management Committee was established in BSH in accordance with the Procedures for Crisis Management on BSH at the Headquarters to cope with around-the-clock operations. On March 13, 3 teams (general response, supply and demand, and technical teams) were organized to introduce a 2-shift working system starting on 9:00 and 17:00. It also deployed staff to HDC at the Headquarters to share the related information. Since April 1, night-shift operations were discontinued. (3) Other Special Remarks a. Document Preparation (a) Reporting on the Current Status of the Blood and Blood Products Division, Pharmaceutical and Food Safety Bureau, MHLW. In response to a referral on the damage status on an hourly basis, etc., made by the Blood and Blood Products Division, Pharmaceutical and Food Safety Bureau, MHLW for the announcement of a government report, press release, etc., we reported via phone and in regards to updates on damage to blood centers, stocks of remaining blood components, blood donation, supplies to medical institutions, etc. As the inventory of red blood cell products had been stably secured since March 18, one daily periodical reporting was provided regarding the Supply status of blood components, etc. and List of blood components stocks (for each BC). (b) Press Release Requests for news coverage and inquiries immediately after the disaster (3/13-24) included 12 newspaper publishers in total, 9 TV stations in total, 4 other news related entities in total, and 2 overseas entities in total (BBC from Britain and Russia). Most of these inquiries related to whether or not blood stocks are sufficient and successfully supplied. Thus, we made efforts to publicize and explain the situation on our website that there was no difficulty in obtaining a constant supply of the stocks, and that we hoped for long term cooperation in blood donations to avoid any temporary concentration of blood donors. The following information was placed on our website as shown in Figure Chapter 2 Provision of Medical Relief Figure 2-55 Other Information provided from BSH at the Headquarters entered in the disaster-related web pages Date Title Description March 14 March 20 April 19 Constant Supply of Plasma Derivatives Responding to Misinformation on Insufficient Blood Consultation Service for Earthquake Exposed Hemophilic Patients Plasma derivatives are processed at a plant in CHITOSE, HOKKAIDO, which was free from damage and any problems regarding the manufacturing system due to the earthquakes. In addition, we explained that there were plenty of the product stocks and we were able to provide a constant supply and meet any emergency delivery requirements. Informing that, although rumors regarding a shortage of blood components for transfusion and plasma derivatives have been circulated, the stock has been constantly secured, thus successfully responding to orders from medical institutions. Informing that the Japanese Society on Thrombosis and Hemostasis began consultation services for patients and their families in the disaster-stricken areas. Great East Japan Earthquake and Tsunami 85

113 Great East Japan Earthquake and Tsunami Chapter 2 Date Title Description June 7 Responding to false news that, at Responding to misleading news placed in newspapers and magazine articles a blood donation station in Tokyo, as if people living in the disaster areas had been refused to give blood some people were refused blood donation on the grounds that they came from the evacuation donations. Informing that we accept blood, as usual, donated by people living in the evacuation zone after the Fukushima Daiichi Nuclear Power Plant accident. zone in FUKUSHIMA. June 7 Acceptance of Blood By informing the public that as usual we accept blood donated by those from Donated by Evacuees from the Evacuation Zone, Planned Evacuation Zone and Emergency Evacuation the Nuclear Accident Preparation Zone. However, among the workers/operators in the Fukushima Daiichi Plant those whose accumulated exposure dose exceeded 100 msv since the disaster took place should refrain from blood donations considering any possible impact on the health of the donor for the time being, at least for 6 months from the last day of radiation exposure. b. Response to Planned Power Outages (a) Outline From March 15 planned power outages were carried out throughout the TEPCO supply area in the wake of the Fukushima Daiichi Nuclear Power Plant accident. BSH at the Headquarters obtained information regarding the effect on blood centers services by the planned outage from the web sites of TEPCO, and Tohoku Electric Power, MHLW, and provided information to the related blood centers for services. It was reported to the MHLW that the effect on blood services would be severe and requested the related government agencies to exclude blood centers from the planned power outage coverage. The blood collection centers changed and shortened their open hours, testing/preparation facilities extended their working hours to provide nighttime services, with supply facilities for power generated in-house to refrigeration facilities to keep the products in cold storage. These efforts helped avoid any major trouble. As Tokyo s 23 wards were excluded from the coverage, there was no significant impact on the services provided by the Tokyo BC. (b) Procedure for Exemption from the Application of the Ordinance to Restrict Power Consumption To be exempted from application of the Ordinance to Restrict Power Consumption, as requested by MHLW, we prepared and submitted a list of facilities we expected to be excluded from application of the law, the reasons for this, for power consumption from July to September last year, the feasible power saving plans, electricity distribution images at the facilities, etc. from April On April 21, we were informed that the restrictions on power consumption under the Ordinance to Restrict Power Consumption would be eased from 25% to 15%, and required submission of the documents again based upon the revision. In particular, with regards to three facilities whose contracted power was over 500 kw, (SAITAMA, TOKYO, KANAGAWA), the Ministry subsequently requested us to submit information on the background to the centers established to date, the number of the staff (by section and by composition), annual quantity/number of the production/tests/supplies, number of voluntary blood donors (annually and daily), as well as power saving measures that the three centers had normally taken, the number of in-house power generation units, power generation capacity, connection status, and operating hours during full gas tanks, and we responded to these inquiries. On May 26, the Ministry of Economy, Trade and Industry published the Power Consumption Restrictions Subject to Article 27 of the Electrimunicipal Business Act. According to the Ordinance, large consumers of electricity with over 500 kw that directly contract with Tokyo and Tohoku Electric Power Companies will have to put restrictions on power; while, demand facilities essential for human life and health do not need to mitigate restrictions. As a result of a subsequent inquiry to the MHLW, it turned out that a large consumers of electricity with over 500 kw of contracted power supply (Tokyo, Saitama and Kanagawa BCs) had the measures to put restrictions (reduction rate: 0%) applied to them. (Headquarters Building was not eligible.) On June 16, we submitted an application form pertaining to the mitigation of power restrictions with the necessary documents to the Ministry of Economy, Trade and Industry (documents to explain that the facility is applicable, and documents with proof of the power ratio shared by pharmaceutical manufacturers 86

114 at each facility). Subsequently, the Ministry of Economy, Trade and Industry released a notice as of June 22, 2011 on measures to mitigate restrictions on power consumption to three blood centers. On July 1, the three blood centers submitted their energy-saving action plans in relation to the measures to mitigate restrictions on power consumption to the MHLW. c. Cooperation in Identifying Unidentified Persons The National Police Agency asked JRCS for technical advice and guidance regarding the identification of many unidentified persons in the GEJET. JRCS stores some blood samples from donors in the refrigerator for 11 years with the aim of conducting cause studies, such as for transfusion-transmitted infectious diseases, and for retrospective studies on prevention of the expansion of infections. We decided to submit the stored blood samples in cooperation with the National Police Agency and provide a DNAtype examination to identify unidentified persons. In principle, stored blood samples should not be used for purposes other than the original purpose; however, because proof of the identification of victims had been lost due to the tsunami and earthquake, the samples were needed for the identification of unidentified persons. Considering the fact that the request was coming from the families and relatives of the victims, we decided to cooperate with them as an exceptional measure. The conditions of cooperation were as the following. To be a missing person in GEJET To be requested by the victim s family members or relatives To be used in DNA analysis only for the purpose of identifying the person To dispose of the blood after use To avoid affecting the purpose of specimen storage (the supplied blood must be of a small amount) The blood to be supplied is only a portion of the stored blood (a very small amount), which will not affect, if any, retrospective studies (3) in the future. Through this cooperation agreement, as of October 10, 2012, the National Police Agency asked the JRCS for cooperation concerning 1,785 missing persons, and 35 victims were identified out of the 144 blood samples JRCS presented to the Agency. 5. Various Activities Responding to Needs (1) Medical Activities Engaged in by Teachers and Students of the JRCS Ishinomaki School of Nursing Situated at a little less than 2 km from the coastal zone, the JRCS Ishinomaki School of Nursing had their graduation ceremony on the previous day of the disaster. On the day the disaster occurred, there were 94 people in total; including 39 first and second graders each, 6 third graders, 8 teachers and 2 school staff. After the disaster took place, some neighboring people gathered at the school. However, they found that the tidal wave was almost hitting the school, so they decided to take shelter at the Minato Elementary School with the residents, leaving some teachers and staff behind. The students were also among the victims; however, people at the shelter welcomed them, saying, We ve got nurses!. And what with the request from a responsible person (School Minister), the teachers and students started providing medical services at the isolated elementary school. Evacuees from around the shelter continued to gather around Minato Elementary School. Some patients were carried to the school building by ambulances because they were unable to be transferred to a hospital. The number of evacuees swelled to approximately 1,200 at the peak time. In this situation, the teachers and students provided medical care for those who suffered bone fractures, had mud all over their bodies, were elderly or bed-ridden, etc. Furthermore, they provided services including assistance with restroom use for Parkinson s disease patients, exchange of diapers and changes in the posture for bedridden elderly people, guiding children to the restroom, caring for those with dementia loitering around. They even scooped up feces from the toilet when people complained that the restroom was dirty, arranged that water, if any, was distributed first to children and elderly people, and provided assistance if the air-ambulance was available. Without sufficient water or food, shivering with cold, not knowing when a rescue team would come, the students continued providing services beyond the scope of rescue/nursing or care. On March 14, doctors and pharmacists finally began traveling from shelter to shelter to provide medical care, and ambulance helicopters for the sick and injured brought food and water one by one. In a short Chapter 2 Provision of Medical Relief (3) If a donor is suspected of being infected, his/her blood previously donated should also be studied to confirm the safety of the blood component. Great East Japan Earthquake and Tsunami 87

115 Great East Japan Earthquake and Tsunami Chapter 2 while, it turned out that JRCS medical teams would visit from shelter to shelter to provide medical care. The teachers and students of the Nursing School concluded their services after 4 days. Duration Figure 2-56 Activities of caring team 1st deployment 2nd deployment From April 14, 2011 to May 13 From May 31 to July 1, 2011 (2) Nursing Teams In the disaster areas, support for the elderly people who required nursing care was an urgent problem, and there was also a need to support welfare evacuation centers, special nursing homes for the aged, long-term care health facilities, etc., in the disaster-hit areas. They newly organized a care team consisting of care workers to cope with services in response to nursing needs, and a notice dated April 8, entitled Dispatch of Caring Teams to the GEJET Disaster-Affected Areas (Request) was released from the HDC at the Headquarters. To dispatch nursing care workers for institutional support to replace those who work at special nursing homes, geriatric health services facilities, welfare evacuation centers in the disaster areas. Assuming the support mentioned above in principle, support measures for elderly people in the shelters, including organizing classes mainly for volunteer instructors for the Healthy Life Support Class, assisting with bathroom use for the elderly and handicapped people using the bathing support equipment of the SDF, etc. (Support for disaster shelters, etc.) Service area Deployed staff No. of deployed teams Service descriptions Destinations RIKUZEN-TAKATA, IWATE 32 staff 35 staff Care giving staff 22 staff Healthy life support volunteers 4 staff Coordination / liaison staff 6 staff OTSUCHI, KAMIHEIGUN, IWATE 4 teams 11 teams Care giving staff 26 staff Liaison / coordinating staff 9 staff Institutional support (1 special care nursing home and 1 geriatric Institutional support health services (1 special care nursing facilities) home and 1 geriatric Support for the health services facility) disaster shelters, etc. Kojuen, Special Care Nursing Home Matsubaraen, Geriatric Health Services Facility Laughter Hills, Special Care Nursing Home Care Plaza Otsuchi, Geriatric Health Services Facility The services included the following two programs. In principle, one team served for 9 days (including 2 days of movement and transfer). One team consisted of 6-7 staff (including 4-5 caregivers, 1 volunteer instructor for the Healthy Life Support Class, 1 staff in charge of liaison and coordination). In fact, the care-giver teams provided services for two terms (1st term and 2nd term of deployment). 88

116 Figure 2-57 List of destination facilities for the JRCS care team staff In addition, the staff in charge of liaison and coordination provided services in cooperation with RC volunteers and Tono Magokoro Net organized by Tono Social Welfare Council that JRCS also participates in, supported disaster victims at the shelters in OTSUCHI, providing supplies (hot towels, etc.) at the Magokoro Plaza. Figure 2-58 Support for disaster victims in shelters, etc. Service areas No. of No. of service staff participants Cooperation with Tono Magokoro Net Healthy Life Support Class at shelters, etc [Feeding in an elderly care facility [RIKUZEN-TAKATA] (April 16, tweet page of the Mainichi shimbun (Newspapers))] The Office for the Establishment of Nursing Care Insurance Facilities in Hiroo (Project Office for the Establishment of Japanese Red Cross Welfare Complex Center), Disaster Management and Social Welfare Department at the Headquarters, carried out care-needs surveys of the elderly who required nursing care in RIKUZEN- TAKATA (April 8-10) and OTSUCHI (May 20-21). The survey topics included the actual situation of the support needs, a review of what was needed for the support, and a study of the services the care staff who did not to be trained could provide. JRCS runs special nursing homes for the aged at 8 places throughout the country. Deployment of the care giving team should be considered a new approach by taking advantage of JRCS human resources. (3) Nursing Care For several months after the disaster day, people gradually moved the basis of their daily life from the disaster shelters to temporary housing. Since June 1, 2011, nursing care teams were deployed mainly in disaster shelters at the Rikuzen-Takata Daiichi Junior High School, IWATE, engaged in services including health guidance such as prevention of the worsening of chronic disorders of the victims, health counseling, and elderly people s care. Changes in both mental and physical health conditions were expected in this whole new environment for senior citizens. It was important to support the health and 1 Chapter 2 Provision of Medical Relief Great East Japan Earthquake and Tsunami 89

117 Great East Japan Earthquake and Tsunami Chapter 2 life of those living alone or in two-person households. Nursing care teams continued their services until the end of August through cooperation with medical teams, psychosocial support teams, and health support teams. A nursing care team consisted of two experienced nurses, including certified nurses, certified instructors for the Healthy Life Courses, etc., and each team served for 5 days in principle. Their main services were as follows. <Everyday Life Support> Assistance with clean-up, excretion, and foot care for those staying in a room for senior citizens in a disaster shelter <Health Guidance / Education> Visit the at-home or temporary housing facilities. Conducting surveys on health and living conditions, identifying those who need support (requests from the health nurse team) Guidance on medication for the at-home or temporary housing facilities of evacuees, diet advice, living guidance, psychosocial care, health consultations Assessment of ADL (Activities of daily life) for senior citizens moving to temporary housing facilities and cooperation with the rehabilitation teams Figure 2-59 Results of nursing care team deployment Deployment term Fr. May 20, 2011 to the end of May (including the survey) Fr. June 1, 2011 to the end of August On the other hand, from October 2011 to March 2012, 6 branches of the JRCS Colleges of Nursing provided a nursing care project to support nursing practice over the medium and long term. Before the project, at the end of June, the college members were dispatched to RIKUZEN-TAKATA to discuss the role and activities to be provided by the above-mentioned nursing care teams, the significance of the nursing care project by these six colleges, and the future. In August, the members deployed by the colleges discussed with the public health team of RIKUZEN-TAKATA about their services and methods for the nursing care project. The project activities were carried out ten times intermittently in October. With the goal of contributing to support for the healthy life of disaster victims both mentally and physically, they provided various services including diet nutrition guidance, exercise instruction, health counseling, blood pressure measurement, gross movement, massage and stretching. Each team served for 2-5 days. Figure 2-60 Dispatch performance of the Nursing Care Project Dispatch term Service site Hub for services June, 2011 and August (for discussion) October 3, March 22, 2012 RIKUZEN-TAKATA, IWATE Temporary housing, employment promotion housing in RIKUZEN-TAKATA Service sites Hub points Deployed staff Dispatching hospital No. of staff providing services in total RIKUZEN-TAKATA, IWATE Disaster shelter at Rikuzen-Takata Daiichi Junior High School and other shelters, temporary housing facilities and evacuee houses in the neighborhood 17 teams (35 staff in total) Asahikawa RCHP (4 staff), Date RCHP (4 staff), Kitami RCHP (4 staff), Kushiro RCHP (4 staff), Hachinohe RCHP (6 staff), Akita RCHP (6 staff), Morioka RCHP (7 staff) 818 (including 695 or 85% of those 60 years or older) (No. of those serviced / surveyed by health nurses: 547) Deployed staff Dispatching college 10 teams (29 staff) JRCS Hiroshima College of Nursing (7 staff), JRCS Toyota College of Nursing (6 staff), JRCS College of Nursing (6 staff), JRCS Akita College of Nursing (3 staff), JRCS Hokkaido College of Nursing (4 staff), JRCS Kyushu International College of Nursing (3 staff) (4) Team for Setting up Small-Scale Water Systems The hygiene environment seriously deteriorated in disaster shelters and the repair of water and sewage systems was not successfully completed in ISHINOMAKI, MIYAGI. In particular, many disaster shelters did not have hand-washing stations around the temporary toilets, and the provision of antiseptic 90

118 liquid was insufficient. This needed to be immediately taken care of. To improve the hygiene environment of the disaster shelters, we decided to install stations for hand-washing, etc., around the toilets in the shelters of ISHINOMAKI. The Headquarters Office procured 12 water system units (water tanks and faucets for small water-supply systems), 9 units of which were installed at disaster shelters that had been identified as having need for support. (The remaining 3 units were stored by Ishinomaki RCHP). Installation of the water systems was coordinated in advance with the Ishinomaki Water Department. The Municipal Waterworks Bureau was in charge of filling water in the tanks. After installing the units, it was agreed to supply water after requests that the Municipal Waterworks Bureau received from the disaster shelters, or periodically when water trucks traveled from shelter to shelter. Water system facilities (including water tanks, and the faucets of small-scale water system) were assigned to ISHINOMAKI, and the management was in the charge of the representative of the disaster shelters. This water system was one usually used by Emergency Response Units (ERUs) in their overseas services and was used for the first time in Japan. (5) Services for Disaster Shelters in Non-disaster Stricken Areas a. Services for Evacuees to former Grand Prince Hotel Akasaka Many disaster victims evacuated from FUKUSHIMA to TOKYO due to their fear of the Fukushima Daiichi Nuclear Power Plant accident. The Tokyo Metropolitan Government designated the former Grand Prince Hotel Akasaka, which had closed its hotel business on March 31, 2011, as the second disaster shelter in order to accommodate the evacuees to TOKYO. As a result, the peak time saw 800 people staying at this hotel from April 19 to June 30. JRCS Medical Center, a hospital near the hotel, provided medical services for the evacuees, including a 24-hour hot-line service for 20 people, psychosocial care for 40 people, visiting senior citizens for medical care for 26 households, general outpatient consultation services for 121 people, and aromatherapy for 200 people. b. Deployment of Medical Teams to Kose Sports Park Budokan in YAMANASHI A disaster shelter at the Kose Sports Park Budokan in YAMANASHI was constructed by the prefecture. Dr. Toshio Inoue from the Inoue Internal-Pediatric Clinic, a leader of Medical Team-6 of the Yamanashi Chapter, offered medical services including health counseling. Reporting to the Manager in charge of the service (responsible person at the temporary disaster shelter) of the Prefectural Social Welfare Council, it was decided to provide the health counseling service. The health counseling service was provided four times to some 50 evacuees in total on March 27, April 3, 10, and 17, including a blood-pressure check, urinary test, etc. Chapter 2 Provision of Medical Relief nobuyuki kobayashi [Children hand-washing at a water system installed in a disaster-shelter] Great East Japan Earthquake and Tsunami 91

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120 Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital

121 Great East Japan Earthquake and Tsunami Chapter 3 Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital This chapter describes medical relief services provided at the venue of Ishinomaki RCHP, MIYAGI. Medical relief activities in ISHINOMAKI are characterized by the extensive number of its medical teams deployed for long periods and, more remarkably, through cooperation with medical institutions other than JRCS within/outside the region. In this context, this whole chapter introduces the medical relief services for Great East Japan Earthquake and Tsunami (GEJET) as they clearly show the characteristics of the services. Figure 3-1 Profile of Ishinomaki RCHP Situated in the northeastern part of the coastal area of MIYAGI (Relocated from the coastal site and newly constructed in May 2006) 26 clinical departments, 402 beds (10 beds for Critical Care Center) No. of staff: 901 (as of March 1, 2011) Main fanction certificated as below, etc. Disaster Relief Core Hospital (designated in 1997) Regional Emergency and Critical Care Center (established in 2009) Regional Medical Association Hospital Designated Regional Cancer Centers and Hospitals Miyagi Maternal and Perinatal Care Center Designated Hospital for Postgraduate Clinical Training Designated Hospital for Category 2 Infectious Diseases Facility for organ donations following brain death Ishinomaki medical service area (ISHINOMAKI, HIGASHI MATSUSHIMA, ONAGAWA): Approx. 220,000 residents, surrounding area: approx. 100,000 residents, Total: approx. 300,000 residents [Damage status in ISHINOMAKI (taken from the side of Hiyoriyama Park) ] 1. Damage due to the GEJET (1) Damage Status in ISHINOMAKI The earthquake was significant in scale with a tremor of an intensity of 4 upper lasting about 160 seconds, as well as 2 jolts of intensity 6 lower. 1 The quake subsequently caused a massive tsunami that devastated the coastal regions. In the 40 minutes after the earthquake occurred, a very high tide of about 8.6 meters was observed at AYUKAWA, ISHINOMAKI. 2 In ONAGAWA, adjacent to ISHINOMAKI, Onagawa Municipality Hospital situated some 16 meters above sea level was inundated with about 2 meters of water. The tsunami swept the buildings across coastal lands, leaving behind debris. In the central part area of ISHINOMAKI, 73 km2 of the site (or 13.2% of the town or approx. 30% of the plain) was flooded. Ishinomaki municipal government office, Firefighting Head office, Fire House, Police Station, etc., were within the flooded areas. Water did not recede around Ishinomaki municipal government office for 3 days, which was temporarily isolated. Furthermore, 20 fires occurred in the territory of the Ishinomaki Firefighting Headquarters'. In KADOWAKI and MINAMIHAMA, situated to the west of Kitakami River, a large-scale fire occurred immediately after the tsunami and kept burning for 2 days. The number of fatalities in ISHINOMAKI, HIGASHI MATSUSHIMA and ONAGAWA reached 5,224, and the number of missing persons was 744 (as of February 28, 2013). It is also estimated that some 42, 000 people took refuge at more than 300 evacuation center in ISHINOMAKI in the initial phase of the disaster. Figure 3-2 Human suffering in ISHINOMAKI (Unit: Number of casualties) No. of fatalities Number of Direct cause Indirect cause Total of death of death missing persons ISHINOMAKI 3, , HIGASHI MATSUSHIMA 1, , ONAGAWA Total 4, , Source: Prepared by Damage Situation of the GEJET, MIYAGI (1) Earthquake and Tsunami Warning for a Disaster Zone (2011) prepared by the Meteorological Agency (2) 2011 off the Pacific Coast of Tohoku Earthquake (it was renamed GEJET later), prepared by the Extreme Disaster Management Headquarters, Cabinet office (17:00, December 27, 2011). 94

122 Amid this turmoil, every single medical institution in the Ishinomaki area, except for Ishinomaki RCHP, suffered severe damage. Only 5 institutions in the area were available to provide medical services immediately after the earthquake. Ishinomaki Municipal Emergency Medical Clinic and Ishinomaki Municipal Hospital (206 beds for general patients) which had played a central role in primary and secondary emergency care were also unavailable to provide medical services. Ishinomaki RCHP was left as the only available hospital to respond to primary to third level emergency care services, resulting in a situation in which patients in the area were concentrated on the hospital. Figure 3-3 Comparison between the flooded areas of GEJET and the Tsunami Hazard Map in ISHINOMAKI A Map by Geospatial Information Authority of Japan Ishinomaki Tsunami Hazard Map Source: Report of the Committee for Technical Investigation on Countermeasures for Earthquakes and Tsunamis Based on the Lessons Learned from the 2011 off the Pacific coast of Tohoku Earthquake by the Cabinet Office (2) Damage to Ishinomaki RCHP a. Damage to the Building/Equipment, etc. (a) Building Following the unprecedented damage in the entire the Ishinomaki area, Ishinomaki RCHP suffered minor damage to its building and machinery, including cracks on the road in front of the entrance, precision instruments for testing broken in exam rooms on the first floor, documents scattered from the open shelves of the fifth floor ward staff station without any major damage to the building and machinery. As background to this and as mentioned later, the hospital was relocated and newly constructed as a seismic structure to prepare for protecting the local community from a disaster at a site 4.5 km inland from the coastal zone in (b) Elevators The hospital has 11 elevators, including 5 units designed to include a generator backup system. These units allowed additional setting up with a monitoring device. However, all of the hospital's 11 elevators stopped working due to the power outage. And from a legal point of view, once an elevator stops, it is not allowed to be restarted until a nationally certified technician (elevator test technician) checks it to ensure safety. As the elevator company employees in charge of ISHINOMAKI were also victims of the disaster they were unable to conduct repair work for the elevators. On the evening of March 13, a testing staff member from the elevator company came to the hospital from Tokyo, although he came to the conclusion that they would stop the elevators as they are considering possible aftershocks. As a result, required to take the stairs to carry both patients and meals. It required a certain number of peoples to carry the patients up the stairs (each wheelchair took 4 people to carry it up, and a stretcher required 6 ). Food and medicines were carried in bucket brigade fashion, including some that were relatively heavy. The work was extremely difficult because the stairs were also too narrow to carry patients and supplies. From March 14, 8 elevators came into operation, the responsibility for which was shouldered by the hospital (3 elevators remained stopped until March 21 when the failure of their seismoscopes was repaired). (c) Hospital Information System, etc. With an in-house power generator, the hospital information system (HIS) for electronic charts or medical affairs accounting worked normally. However, the only available systems were those connected to emergency power outlets by way of the in-house power generator; and the following devices were available for service. One room (out of 3) for general radiography Three portable (out of 3) radiography units One CT unit (out of 2) One MRI unit (out of 1) One X-ray fluoroscopy unit (out of 2) Two angiography units (out of 2) Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital Great East Japan Earthquake and Tsunami 95

123 Great East Japan Earthquake and Tsunami Chapter 3 PACS (an image database system where medical video diagnostic devices such as CT and MRI are connected to computers via a network, and test images are electronically stored, searched and analyzed) was available for use. However, the images that were taken could not be stored or delivered for several days after the disaster; there was no choice but to handle film input. b. Damage to Lifelines (a) Electricity Although the power outage lasted 2 days, the power switched to an in-house power generator, then there was no major disruption until it was restored on March 13. In order to reduce the risk of power outages, we received power from 2 transformer substations of the electric power company so that we could use a standby power system even when the main line was off. On March 13 at 12:00 the main line was restored and the standby line was restored on March 19. Two in-house power generators were installed on the roof, while an uninterruptible power supply (UPS) was available for important units such as the operation room, switching to in-house power generator settings without a power outage. The heavy oil to operate the generator for 3 days was stored (20,000 liters; 1,500 kw/h - 1,000 kw/h/day). However, because insufficient fuel remained to continue, we requested Ishinomaki municipal and Miyagi prefectural governments and JRCS Headquarters to supply heavy oil. On March 14, a private tanker from NIIGATA supplied 8,000 liters of heavy oil. Electricity was prioritized for medical purposes and some lighting equipment. Blood tests were only provided for emergency cases, while radiographic examinations were available, including X-ray photography, CT and MR images. PCs were also available, the staff could send test results and instructions for drug prescriptions to the related Departments via the ordering system and provide medical, testing and accounting services as usual. (b) Water and Sewage The water system is divided into 2 types; drinking water and general services water. In addition, 2 water receiving tanks had been installed for each line to spread the risk. Water outages lasted 5 days due to this earthquake disaster. The amount of clean water stored was only 190 t, a half-day s worth of stock (as instructed by the Health Center). People were alearted to save water throughout the hospital and asked the Waterworks Department of the City to supply water via the community wireless system. A water truck (10 t) arrived from ISHINOMAKI in the afternoon of March 12, and a private water wagon of 20 t capacity came to supply water. On a preferential basis, the city government supply was restored at 17:00, March 16. The amount of water for general use (mainly for restrooms) was 470 t, 3-days worth of stock. Artificial dialysis, requiring 10 t a day, was carried out using the water for miscellaneous use. As the stock of general service water was running out, 400 t of water was transferred for firefighting into the water tank from March 13. There were 3 water tanks for Firefighting with 600 t of water in total usually stored; therefore, it was possible to leave 200 t in the event of a fire even when 400 t of water was used for general service purposes. Sewage functions remained because there was an inland sewage disposal plant in the western district of the city (cf. the sewage disposal plant of the eastern district was damaged by the tsunami). Inside the hospital, the sewage functions were maintained although subsidence of the land had caused part of the sewage pipe around the entrance to incline in reverse. (c) Utility gas To prepare for an earthquake, the city gas was supplied using supposedly quake-resistant, low- and medium-pressure gas pipeline networks. However, Ishinomaki Gas Co., the supplier, located close to the port, was affected by the tsunami and immediately discontinued supplying utility gas in the wake of the disaster. On March 23, Ishinomaki Gas borrowed a mobile gas generator from Shizuoka Chubu Gas, installing it in the premises of the hospital. We brought in technicians from a boiler company in OSAKA to have it remodeled by midnight on March 23 so that it could supply low-pressure gas using a boiler for a midpressure gas network. Liquid gas was vaporized using several tankers and employing 2 men for 24 hours, and was then directly delivered to the hospital. With the low-pressure gas supplied, it was temporarily restored from March 24 and fully restored on April

124 (d) Medical Gas A stock of medical gas (oxygen) for 2 weeks was available, although it was used 30 to 40% higher than usual. While we were unable to get in touch with the supplier, a gas tanker carrier came from AOMORI and AKITA on March 15 to provide us with a supply. Until returning to normal operation on April 11, we filled liquid oxygen tanks with liquid oxygen six times (more times were needed due to the unstable supply; a single time filling did not make the tank full). Liquid nitrogen was filled one time. Nevertheless running short of the small medical gas cylinders, local companies were also suffered in affected area so that the headquarter supported to collect them. (e) Communication As shown in the following table, fixed-line phones and cell-phones were not usable, and community wireless systems and satellite-based mobile phones were only available for service. PHS phones were available within the hospital. Type Fixed-line phones Cell phones Satellite-based mobile phones Situation Both of the two NTT base stations were affected and their landline had been disconnected for 10 days. It was restored in the evening of March 20. Not connectable some 2 hours after the earthquake. Staff from DoCoMo Shop Ishinomaki Branch, under contract to Disaster Recovery and Support Services, brought us 10 cell phones on the day of disaster. However, they had connection problems even though they had priority telephone links in a disaster. Therefore, we requested them to establish a base station on March 16. After negotiations with the Sendai Branch, a station was set up, standing on high ground, close to the hospital and the connection was restored. Connectable. However, it interrupted the voice communication due to inaudibility. We had borrowed one set of satellite-based mobile phone from DoCoMo Shop Ishinomaki Branch before the disaster, and one more set was delivered on the disaster day. (Later, we borrowed additional sets). Multi-Channel We had agreed to use this system at the time of Access (MCA) disaster with our neighboring hospitals but it was not Radio System 3 available in this time to connect with the hospitals that had been affected by the disaster. Community Wireless System PHS Internet The Community Wireless System directly connected to the municipal government was available for service. A Self Defense Force (SDF) Advance Unit, unable to arrive at City Hall, also used it when they came to the hospital. The general switchboard, connectable to the PHS handy nurse call system, was available within the hospital. Not available for 10 days. c. Human Suffering There were no injuries to about 1,000 staff who were working inside the hospital on the day of the disaster. There were also no injuries or fatalities to some 380 inpatients in the wards or about 100 outpatients in the outpatient departments. On the other hand, 32 staff lost their relatives within the second degree (9 were missing), 383 staff had their homes completely or partially destroyed, partially damaged, or flooded above the ground floor level. 2. Activities inside the Hospital (1) Response in the Acute Phase by Timeline Order a. Situation Immediately after the Disaster Occurred At 14:50, immediately after the disaster occurred, the Ishinomaki RCHP Headquarters for Disaster Control (HDC) was established. Then a lifeline check was completed in some 20 minutes. At 15:03, Dr. Kaneta, HDC Assistant Director, assessed the situation as Level 3 considering the size of the disaster, which was informed via in-hospital broadcasting. The Disaster Response Manual of the hospital assumes 3 levels depending on the degree of the disaster. Level 3, the highest level, refers to a situation in which medical services in normal times become unavailable, and all of the staff have to be engaged in disaster response for the long term. At 15:12, all surgical operations were stopped in the operating room. To classify patients by priority for treatment, a Green area (patients with mild conditions or F/ U) was established around the front entrance of the waiting hall in the lobby, and a Yellow area (patients with moderate conditions or those on stand-by treatment) in the waiting room for outpatients in the lobby. A Red area (patients with serious conditions/ first priority for treatment) was established in the Regional Emergency and Critical Care Center so that the patients might be easily transported by land or air ambulance crews from a heliport site. A Black area (for the deceased) was established in the Rehabilitation Department at the end of the 1st floor hall. Because it was as cold as a midwinter day, the location of the triage post (to classify patients according to their condition) was changed to around the entrance of the hospital. The triage area had been set up by 3:25p.m. and staff were assigned at 3:43p.m. The parking lot Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital (3) MCA Radio System refers to a communication system for professional use that allows many users to share a multiple frequency band (phone line channel) of the 800 MHz range for the efficient use of radio waves. It has resistance to interference and need no certificate for use. Great East Japan Earthquake and Tsunami 97

125 Great East Japan Earthquake and Tsunami Chapter 3 for use as a temporary heliport was also immediately closed to all vehicles and was made ready to serve as a heliport. b. Timeline of the Day of the Disaster At 3:23p.m. the first patient with a mild injury was carried to the hospital. An ambulance vehicle from Ishinomaki District Wide Area Firefighting Headquarters Guard Division carried the first patient classified into the Red area at 4:20p.m. As one of the ambulance crews said, ISHINOMAKI is severely damaged by the tsunami. The staff members voluntarily came in one by one, reporting the same. However, the rescue operations did not go smoothly with 2 out of 3 ambulance service groups for Firefighting being affected by the disaster, and 12 out of 17 ambulance vehicles in ISHINOMAKI swept away. The number of ambulance transported patients to the hospital ended up being 9 vehicles on the day of the disaster. At 4:25p.m. the in-house broadcasting system provided the instruction that those on the day shift should not go home, but just stand by. At 6:37p.m. the leaders of each Department at HDC were convened and shared information with the instruction to divide the teams into 3 shifts so they could take a rest because an avalanche of patients was expected from the next day. At 8:00 p.m. assuming the situation was to become prolonged, it was instructed that two thirds of the staff may go home because our emergency state will be lifted by 8:00a.m. the next morning. However, the staff found on their way home that roads and bridges were covered with debris and water, and many of them returned to the hospital. Furthermore, bus and taxi services were unavailable for people supporting inpatients, as well as for outpatients; thus they remained in the hospital as returner refugees. While the whole city was engulfed in darkness due to the power outage, an increasing number of people came on foot or by car to the hospital, which was the only building lit up due to the lighting provided by the in-house power generator. At 9:43p.m. the Ground SDF arrived. based on a request for disaster relief operations, an SDF Advance Unit was leaving for Ishinomaki City Hall from Tagajo Army Post, TAGAJO. However, they were unable to reach the City Hall due to the flooding and dropped by at Ishinomaki RCHP where the community wireless network was installed. And then for 4 days they stayed at the hospital, communicating with the municipal governors to provide relief activities. At 2:26a.m. on March 12, the first rescue team arrived from Hachinohe RCHP, followed by a medical team from Nagaoka RCHP at 3:30a.m. [Staff gathering at Ishinomaki RCHP HDC from each Department] c. The Next Day and Thereafter On the day following the earthquake, 17 medical teams (13 JRCS medical team and 4 DMAT teams) came together from across the nation. However, the roads were covered with debris and land subsidence was found in the roads, which did not allow the medical teams to travel for long distances. On the other hand, in order to cope with the increasing number of patients, some teams provided in-hospital support services for the patients, rather than traveling from shelter to shelter to provide medical care in the neighborhood. On the second day after the disaster, an Emergency Fire Response Team joined forces with other rescue teams, and the number of ambulance for transporting patients to the hospital surged to 109. In the 48 hours after the disaster, the number of serious cases that were transferred to the Red area totaled 115. Some people suffered from tsunami pneumonia, which resulted from swallowing saltwater mixed with oil and dirt. Many elderly people had aggravation of their chronic condition. To cope with the increasing number of inpatients, we increased the number of beds by up to 50. On the day following the disaster, 779 patients, and on the 3rd day, 1,251 patients were transferred to the hospital, which at normal times has 60 emergency patients a day on average. Helicopters from the SDF, the Coast Guard and the Police were waiting in the air, which numbered 63 on the 3rd day alone. There was a deluge of patients inside the hospital. Running out of food in storage, we managed to eat the food and 98

126 supplies sent from the Headquarters and brought in by the medical teams. What had worsened the situation was an increase in number of people who, other than patients, visited the hospital for non-medical services, to ask for drugs, to find their families, or for the purpose of using the toilet, shelter, etc. And once they were in, many of them wanted to stay in the hospital to take refuge. If this situation had continued, it would have become more difficult for the hospital to accept severely affected patients. Thus, the hospital set up a guidance desk to ask the purpose of their visit prior to triage, this was a Triage before the Triage Service. The Green area was moved to deru established by the JRCS medical Center at the front entrance outside. (2) Triage Area Established a. Triage Post The triage post, where patients are to be diagnosed and firstly classified into the Red, Yellow, Green, or Black areas after examining their physiological condition, was set up at around the entrance of the hospital and later moved to the front entrance outside the building. Doctors, interns, nurse managers, nurses, clinical engineers and administration staff were engaged in the triage practice in rotation every 3 to 4 hours. On the first day, there were not many patients, approximately 100. However, on the day following March 12, we dealt with close to 800 cases for triage. At the triage post, patients were classified by color according to their priority for treatment, tags with the appropriate color coding were attached to their wrists, and they were guided to each area. At the reception desk the staff always served to provide dedicated IDs by recording the reference ID for an outpatient on the surface of his/her triage tag and issuing a disasterrelated clinical records. (There were so many patients in the Green area that specific reference numbers were unaccountable.) By using the electronic medical record system, the number of patients were managed subsequently in order to maintain and store medical records, including tags and charts, and to enable the Medical Affairs Department to easily handle the documentation work. Approximately 12,000 disasterrelated clinical records were generated up to the end of March. As mentioned before, only 9 ambulance services would be provided on the day of the earthquake disaster; however, the number surged on the next day and thereafter, peaking at 150 vehicles on March 14 with 689 vehicles in total over the 7 days after the disaster. These transportation services also included those provided by the SDF, or by helicopters, and the staff were busy responding to them. Over the one week after the disaster (as of 14:46, March 18) we had accepted 4,181 patients. In these circumstances, the Ishinomaki Wide-Area Fire Department accepted/handed over ambulance vehicles, handed over duties, recorded, and liaised with DMAT. It deployed two emergency medical technicians until April 20, two coordinators resided at the heliport in order to support safety management around the clock. [Hospital staff providing medical services in the hospital lobby flooded with patients] b. The Red area Patients triaged to the Red area numbered only 17 on the first day, but the number peaked at 74 on the next day, adding up to 283 patients in total for a week after the disaster. Exogenous diseases accounted for a majority of the 48-hour (from the disaster) patients and, remarkably, many cases showed hypothermia in which rectal temperatures (anal temperature measurement) range below 35 degrees Celsius. This was because many people had been soaked in snowy seawater for many hours, or were wet through and waiting for help in places without any heating. Many people suffered from so-called tsunami pneumonia, chemical pneumonia, that resulted from swallowing saltwater mixed with foreign objects and oil after the tsunami carried away ships and machinery, while there were few external injury cases. It was about 48 hours after the disaster that some changes were noticed in the condition of the patients who had been brought in the hospital; the number of exogenous disease cases (i.e., external injuries, Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital Great East Japan Earthquake and Tsunami 99

127 Great East Japan Earthquake and Tsunami Chapter 3 hypothermia, etc.) decreased and the number of endogenous disease cases increased. This is presumed to be because elderly people, as well as patients suffering from diabetes and heart disease, lost their medicines and their health condition deteriorated. The number of emergency patients, even for those in a chronic phase, did not decrease. There were some 100 patients in the hospital as compared to 64 a day on average before the disaster. In total, 2,290 patients had been brought in for 3 months. Many of them were transferred from disaster shelters. As for the breakdown by symptom, there were many cases of pneumonia, digestive organ disorders, and cardiovascular diseases. Those suffering from infections or dehydration also came to us over a period of one to two months. Potentially lethal patients had been brought in to the Red area one by one. The staff members focused on making empty beds available for incoming patients, moving mildly affected patients to the Yellow area, or to the hospital wards once the treatment methods for them were identified. In the 48 hours after the disaster, 118 patients triaged to the Red area included 64 (54.2%) hospitalized patients and 40 (33.9%) patients transferred to Yellow and Green areas. Later on, the staff members identified patients (supposedly) transferrable by the Regional Medical Liaison Office and collected information on their potential destinations, prepared a list of patients, and had emergency physicians in charge of the Red area arrange transfer methods for the patients. c. The Yellow Area The Yellow area was for moderately ill patients who are conscious, verbally responsive when asked their name, or otherwise those who are waiting for hospitalization. This area was established in the outpatients room on the first floor. Due to the large number of patients, the medical teams joined forces for in-hospital support. For one week after the disaster the patients numbered 1,050, many of whom did not need to be hospitalized and were able to go home as soon as the treatment was over. However, many people had lost their homes they could return to or their vehicles. There was a concern that, if the present situation were to continue, many patients would stay inside the hospital, disrupting our care for severely ill patients. Therefore we talked with the City Hall officials for the arrangement of bus services to the disaster shelters. The patients transferred on the second day also included elderly people requiring nursing care who were at their homes or nursing facilities when caught in the tsunami, and patients receiving HOT (home oxygen therapy) at their homes. They were brought into us due power outages and medical device breakdown. The so-called disaster challenged needed more space for medical care and medical transportation. In view of the situation, we established an Outpatient Treatment Room in the Outpatient Chemotherapy Center, a special department available for the addition of beds as designated in the Disaster Response Manual. For 12 days from March 12 to March 24 when the medical transportation service was completed, the Outpatient Chemotherapy Center with 15 beds for medical services accepted a peak number of 47 patients daily, which was 2 to 3 times the number of beds. With regards to the breakdown of patients, the proportion of HOT patients accounted for approx. 50%, and those requiring nursing care for some 30%. After March 19, electricity was restored; and the number decreased with people getting home or using medical transportation. After April 4, the services were handed over to JRCS medical teams gathering across the nation for support. The Yellow and Green areas were integrated to form a Yellow-Green area. d. The Green area The Green area was for patients with mild illnesses/ injuries who were able to walk. Initially the temperature was cold and the area was set up in the Waiting Hall, immediately close to the front entrance of the hospital. The disaster day saw only 47 patients arriving. On the second day they numbered 552, and on the third day 1,037, many of whom stayed inside the hospital. In order to prioritize severe patients triaged to Red and Yellow areas, There was no choice but to set up deru at the front entrance, moving the Green area from the Waiting Hall inside the hospital to outside the building. On March 23 the deru was withdrawn. On April 4 medical teams took over the services of the Yellow area, which was integrated with the Green to Yellow- Green area. 100

128 e. The Black area The Black tagged corpses lay in repose for a short duration in the Black area. A team consisting of 10 professional staff, including doctors, nurses, clinical psychologists, laboratory technicians, rehabilitation staff and administrative staff was organized to provide services on a round-the-clock basis. They had to face the sorrow of the bereaved, which was a grueling duty in both mental and physical terms. Most of those transferred to Black area were chronic pulmonary aspergillosis (CPA) cases (dead-on-arrival). The day of the disaster saw 2 patients, the second day 11, and the third day saw the largest number of transferred patients, 23 patients. On around the fourth day we began to see patients who had died of pneumonia. Until April 5, the day of the withdrawal, 131 corpses had been brought in, including 70 bodies accepted by their families and funeral service agencies, and 61 bodies transferred to a designated morgue facility. The Rehabilitation Room at the end of the first floor was used as the morgue room. They were supposed to be placed for a short duration until being accepted by the funeral service agencies; however, the duration was prolonged because the agencies themselves were affected. The designated morgue room was sunny with higher temperatures, which generated an offensive odor. With an increase in the number of corpses, the morgue room on the basement floor of the hospital was also used. The road was also so flooded that ambulance service teams were unable to carry the corpses to the gymnasium, designated as a morgue, brought the dead bodies to the hospital. The number of corpses went on increasing as those who died in the hospital wards were added. On March 14 we managed to carry the 17 corpses that had been placed in the hospital into the morgue of the City Hall. On March 15, the crematory services were restored. Figure 3-4 Triage results for the week after the disaster (until 14:46 of March 18) The Green area 2,769 patients 66% The Black area 79 patients 2% The Red area 283 patients 7% The Yellow area 1,050 patients 25% (3) Responses by Each Department a. Dialysis Treatment Center In Ishinomaki Medical Service Area, all dialysis treatment centers except the Ishinomaki RCHP were affected by the disaster. Therefore, the hospital accepted all of the 540 patients on dialysis therapy in the area. In 2008, the Disaster Networking System for the Ishinomaki Medical Service Area with the related facilities in the Ishinomaki Area, sharing information on the number of beds, etc., had already established to cooperate with each other in the event of a disaster. On the day following the earthquake, clinical engineers from 2 institutions came over to the hospital, attending to the patients. On the second day, the peak number, 124 patients were accepted. Dialysis patients were provided with therapy for 3 hours, 2 times a week instead of for 4 hours, 3 times a week in normal times; and with 5 courses instead of 3 courses daily. To secure materials and drugs necessary for the dialysis was the key to controlling the flood of patients. Dialysis materials for 240 occasions, assuming 2 courses for 4 days had been prepared and ones on a regular service a periodic basis just delivered for the day. However, it was difficult to obtain more because all effective means of communication were cut off and the wholesalers were affected by the disaster. In order to procure the materials and drugs, the hospital made contact with the manufacturers and wholesalers by using satellite-based mobile phones, and requested the JRCS medical teams to bring the materials and drugs needed for dialysis as relief supplies. In addition, a facility in SENDAI accepted about 40 patients, and other facilities in HOKKAIDO, YAMAGATA, etc., accepted those who were able to stay for a long duration. RCHPs across the nation provided support to the Dialysis Treatment Center. They included, as hemocatharsis therapy, assembling/priming the blood circuit, assistance for needle puncturing/blood returning, preparations for devices and drugs in use, etc. This assistance allowed the Center staff to take a temporary break from providing the services. b. Outpatients Receiving HOT Therapy and the HOT Center Patients on home oxygen therapy (HOT) cannot survive without using such medical devices as a respirator, oxygen/transfusion pump for the home, etc. Once these become unavailable due to a power outage or other causes, the situation is lethal and those patients will die Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital Great East Japan Earthquake and Tsunami 101

129 Great East Japan Earthquake and Tsunami Chapter 3 within a few hours. While Ishinomaki RCHP normally deals with 88 patients, it is estimated that there were approximately 200 patients in the entire Ishinomaki area. (Many people were expected to die due to the shortage of oxygen, or because they were unable to move and escape.) On the earthquake disaster day nine patients came to the RCHP for oxygen. Those who visited the hospital to ask for oxygen were triaged to the Yellow area, guided to the Waiting Hall in the hospital. Designated as a treatment area in the event of a disaster, this area has a medical gas system to supply oxygen installed in the wall with medical power supplies. We gathered the patients at a spot with the central plumbing system for the oxygen service. It was expected to have a flood of patients coming in who were unable to use their oxygen concentration devices at home due to the tsunami and prolonged power outage. So on the next day, March 12, a HOT Service for Outpatients was established temporarily to provide oxygen at the Chemotherapy Center and other hospital rooms. There were 26 patients on March 12, and 29 patients (the peak number) on March 13. On March 16, a HOT Center was established at the Rehabilitation Center with 50 oxygen condensers borrowed. Because only up to 30 amperes were available, 30 oxygen condensers were only set up. This was not enough, therefore the patients ware asked to directly lay blankets on the floor between the beds in a fourbed room of the ward or Chemotherapy Center. Owing to malnutrition and the poor environment, 20% of the patients had exacerbation. On March 25 electricity was restored. The patients who were able to get home was asked to move to other hospitals, thus transferring 29 patients. On this day, there was no patients on home oxygen therapy. c. Midwives Center In regards to obstetrics and gynecology department or midwives facilities, all of the four institutions in Ishinomaki area, except Ishinomaki RCHP, were affected by the disaster. Thus, expectant mothers were concentrated in the hospital. Sixty-one pregnant women in the first 2 weeks, and 110 over one month were delivered. At normal times there are some 50 deliveries a month; thus, it was more than double. On the night of the disaster day, a Midwives Center was established and integrating outpatient services and the ward were under the control of a Maternity Ward Manager. At normal times they may be discharged from the hospital in 5 days after a spontaneous delivery, but the number of days was changed to 3 days. Devices used for delivery were also in short supply, which were borrowed from hospitals in the Sendai Medical Service Area. At the impact phase milk and diapers were running out as well, but they were supplied by the related manufacturers. To arrange and control those relief supplies was also one of the major services. On March 16, ten nurses and eight midwives were dispatched through the JRCS Headquarters. The service was provided on a rotation basis until May 14. In total 105 nurses were deployed for the ward's support and care services, and 100 midwives for delivery support. The hospital also arranged for obstetricians to be available on a weekly rotation for some 2 months until September. d. Responding to an Increase in the Number of Pneumonia Cases After the disaster, the number of patients suffering from endogenous diseases, mainly pneumonia, increased enormously. For 2 months from March 11 to May 9, those emergency patients hospitalized in Respiratory Medicine numbered 316, 3 times the total for the whole of the previous year (105 patients). They included 190 pneumonia cases, accounting for 60% of the total. There were three possible causes of pneumonia as follows. [A view of the HOT Center] Aspiration pneumonia: Insufficient oral care due to the water outage may increase bacteria in the saliva, which flows into the trachea and triggers aspiration pneumonia. Tsunami pneumonia: Caused by swallowing sludge in the seawater, oil generated from vehicles and machinery, and chemical substances from factories. Dust pneumonia: Bacterial pneumonia caused by inhaling dust containing chemical substances generated decades ago in sludge brought by the tsunami. 102

130 Asbestos was also a concern as well. Under cosponsorship with the Fit Test Workshop, the Ishinomaki RCHP organized a Special Local Seminar on the Use of Respiratory Protective Equipment (Protective Gear) for Professionals Engaged in Disaster Restoration/ Rehabilitation Work two times in May and June, when demolition and the removal of damaged houses started on a full scale for disaster rehabilitation. Participants in the seminar included volunteer doctors and nurses belonging to local NPOs, nurses from Ishinomaki Municipal Hospital affected by the disaster, health center staff, local government site managers, company managers in charge of debris removal, Firefighters, nursing teachers of high schools adjacent to debris-collection points, RCHP related staff, etc. Figure 3-5 Acceptance of Patients Requiring Nursing Care e. Response by the Hospital Pharmacy (a) Response to the Acute Phase Pharmacies in ISHINOMAKI suffered from major damage; out of 97 pharmacies in total, 38 were totally destroyed, and 31 were half destroyed. The Ishinomaki Pharmacist Association did not function at all. In these circumstances people who lost their medicines due to the tsunami flooded into the Ishinomaki RCHP from the early morning of the day after the disaster. Thus, the Pharmacy Department began providing medical services at about 7:30 a.m. Immediately after the earthquake, 3 staff were assigned to the triage area, and 1 staff at a temporary pharmacy established inside the hospital. The appropriate prescription for drugs was issued regardless of whether the patient had a primary care doctor (PMD). In order not to disrupt other medical services in the hospital, we established a Temporary Prescription Counter with a LAN cable with a length of 50 meters connecting three PCs for ordering prescriptions online at the front entrance. However, as the temperature dropped significantly, the Counter was moved inside the hospital from the second day, with two more PCs to alleviate congestion. The day after the disaster, the duration of a prescription for medication was limited to 3 days. On the disaster day and the following day, medicine stocks for about 3 days, and borrowed some from 4 general pharmacies around the hospital if insufficient inventory was in stock. Due to the power outage, medications that should be stored in a cool place were also stocked in the Pharmacy Department, such as insulin from the 4 general pharmacies around the hospital, for delivery to the patients. Drug stocks were running out for the first three days because the wholesalers were affected and due to the lack of gasoline; however, the necessary medicines were provided by sending out requests nationwide. Specifically, these supplies were from the Headquarters, Tohoku University Academic Society, Miyagi Local Government, private doctors, business entities, etc. Medical teams across the nation, including JRCS. The staff members were on three-shift work schedules from March 13 to 16, and on two shifts from March 17 to April 3. Because the Ishinomaki RCHP staff alone was not sufficient to meet the shortage of personnel, pharmacists were delegated from Tohoku University, Japan Pharmaceutical Association, Japanese Society of Hospital Pharmacists, Sendai RCHP, and JRCS Headquarters. Pharmacists from JRCS medical teams joined forces as well. As of August 15, 1,203 support staff in total had been assigned. (b) Mobile Pharmacy, Team Melon-Pan The next problem was how to deal with patients in the disaster shelters. The identified problems were shared with the Ishinomaki Pharmacist Association; We want to deliver medicines to patients with chronic diseases who are not able to visit us, the drugs brought in by the medical teams are not sufficient to cover the range of chronic diseases, etc. In this context, the concept of pharmacist teams traveling from shelter to shelter to provide medicines started. The Disaster Relief Act was to be applied to normal medical services, as well as disaster medical relief, covering free medications until the end of June. A Team Melon-Pan consisting of doctors from Ishinomaki RCHP, pharmacists and the Pharmacist Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital Great East Japan Earthquake and Tsunami 103

131 Great East Japan Earthquake and Tsunami Chapter 3 Association staff was organized to provide mobile pharmacy services, traveling from shelter to shelter to provide medicines. The Team Melon-Pan delivered prescribed drugs provided by Ishinomaki RCHP to chronic disease patients at the disaster shelters. The team was named due to their hope to deliver joy to people like a mobile bakery that sells melon-pan (a melon-shaped and melon-flavored bread roll). At the most difficult time after the earthquake disaster, day after day those melon-shaped bread rolls just before their best-before date had been delivered as meals for the staff, which also contributed to the name. they also provided guidance on medication, collected information on the hygiene conditions in the disaster shelters, produced Okusuri-Techo (Drug Passbooks) that are indispensable when handing over information on a patient's drugs to other medical institutions. They produced Okusuri-Techo that covers the history of a patient's prescription drugs for all of the patients at the disaster shelters so that the passbooks might be used for those without prescription records or who were running out of medication. Figure 3-6 Outline of the services provided by Team Melon-Pan Participants: 143 staff Ishinomaki RCHP pharmacy staff (20), and doctors (3), JRCS Support Team (99), General pharmacies around the RCHP (5), Japan Pharmaceutical Association supporters (16) Total mileage: 15,880 km No. of disaster shelters visited: 161 sites (683 sites in total) No. of drug prescription sheets: 4,273 [Team Melon-Pan] The Team Melon-Pan traveled from shelter to shelter, obtaining information on the patients in order to write their prescriptions. They prepared the drugs according to the prescriptions at the Ishinomaki RCHP, delivering them to the disaster shelters including those prescribed by the medical teams. In some cases the medical teams dropped by the hospital to pick up the medicines and then brought them to the disaster shelters. The medical teams, including JRCS Medical Team, brought medical prescription sheets from their hospitals whose formats were not common. Then the medical teams and the Team Melon-Pan integrated the formats of the prescription to prevent omissions in the necessary records, and to alleviate stress when preparing the drugs. From April, three to four pharmacists and one driver (hospital staff) started traveling from shelter to shelter in the city every morning and evening. Because there were too many kinds of medicines for chronic diseases including diabetes, they produced and took the prescription to the hospital and delivered the prescribed drugs. Not only delivering the drugs, f. Psychosocial Support Services (a) Responses to Patients in the Acute Phase and affected people The earthquake dealt a heavy blow to people not only physically but also mentally. As Ishinomaki RCHP does not have a Psychiatry Department, psychiatrists from outside the hospital provided medical services. In cooperation with local government officials, JRCS Psychosocial Care staff also pitched in until the patient care could be provided by psychiatrists. Ishinomaki RCHP has Psychology Department with one clinical psychologist and two clinical development psychologists in service. On the disaster day, immediately after the HDC was established, they went on duty in the whole hospital on rotation, caring for those in a panic state, with hyperventilation syndrome, strong anxiety, etc., including among inpatients and outpatients staying inside, and their attending family members. On and after the second day, patients triaged to the Yellow and Green areas included those who lost their house or family due to the tsunami, or those who were at a loss searching for their family members in vain, those who kept crying or had difficulty in maintaining verbal communication, etc. In the same way as other patients, mental disorder patients were transferred to Ishinomaki RCHP, the only functioning hospital for psychiatric patients; we asked their doctors 104

132 to generate documents on their information and handed them over to public health nurses and local government officials. Before long psychiatrists from Tohoku University Hospital came to provide support, responding to the bereaved and assisting to carry corpses in the Black Area. (b) Responding to the Staff The HDC focused on psychosocial care, establishing a Refreshing Room for staff personnel at the reception room and deployed psychiatric doctors. On March 16, a Refreshing Room was established next to the Hospital Director s Room. For four months until July 18, footbaths and hand massage services, active listening, etc., were provided by support teams, mainly JRCS Psychosocial Support Teams. These services were used by 134 people in total from March 16 to 31, 252 in total in April, 104 in total in May, 20 in total in June, 45 in total in July; adding up to 555 in total. Also, those who hoped to receive psychiatric care from the beginning, or claimed chronic sleep loss and strong anxiety were referred to psychiatric doctors providing assistance. (c) Responding to Patients and Disaster affected populations in chronic stage As for psychosocial care support many organizations cooperated in providing services. On March 14, the JRCS Psychosocial Care Support Teams joined forces for the program, and 38 teams with 365 staff in total provided services until September 1st. The services provided mainly included support for the evacuees. The teams periodically visited three to five shelters that seemed to have many patients with psychosocial problems. They also sometimes dropped by the shelters that did not have enough support from the local government. They also responded to individual cases that had been requested by the Joint Medical Teams, referring them to psychiatric doctors as needed, and were engaged in social welfare management services including life support. They also helped supporters (local government officials who managed the disaster shelters and the supporting volunteers) and hospital staff. The psychiatrists received support from Tohoku University Hospital, providing medical services and drug prescriptions at the Emergency Medical Department in the hospital and the disaster shelters. Subsequently, from April 7, each psychiatrist from RCHPs across the nation pitched in for in-hospital support on a weekly shift rotation. Until October 14 they dispatched 30 staff in total, providing medical services to about 140 patients. Mental health care for the hospital staff was also provided in cooperation with industrial doctors. After the in-hospital needs decreased, two staff of the Clinical Psychology Department shared information with public health nurses and travelled from shelter to shelter to provide medical care with the Psychosocial Support Team. In cooperation with the JRCS Psychosocial Support Team and the Joint Medical Team they visited patients in the community (at disaster shelters or their houses) if necessary. (d) Cooperation with Local Communities We maintained close communication and cooperation with local government officials, public health nurses who were familiar with the local situation, and Clinical Psychology Department. Psychiatric Medical Teams of Tohoku University Hospital, JRCS Psychosocial Care Team, and the public health nurses of ISHINOMAKI and HIGASHI-MATSUSHIMA at Ishinomaki RCHP as a hub hospital gathered to hold a psychosocial care support joint meeting where they reported on what they had done and what the disaster victims needed, discussing mental consultations for the disaster victims, and taking up active listening requests and challenges, etc. The meeting was held once daily in the acute phase of the disaster, once every two days from late March, once a week from April, and once every other week from August. After September, psychiatrists in the Ishinomaki Medical Area, Miyagi Welfare Office joined forces for a monthly meeting, Joint Meeting on Psychosocial Care Support for the Ishinomaki Medical area. g. Food Procurement/Provision Following the earthquake, a Level 3 was declared and the use of the kitchen was restricted. Gas was not available either, and water had to be saved for medical use on a priority basis. The emergency food that had been stocked for disasters was served. The elevators were not working and it was hard to deliver the emergency food, water pet bottles that had been stored in the second basement floor to each ward of the hospital. Although there was no food stored for the staff, the Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital Great East Japan Earthquake and Tsunami 105

133 Great East Japan Earthquake and Tsunami Chapter 3 supplier of the hospital store was supposed to provide merchandise to them in times of an emergency, so they received sweet buns and sweets sold at the store. (In fact, the staff were in service at their workplaces and had no time to eat; only a small portion of them managed to have time to eat them). 150 kg of rice in stock was boiled over 2 days using cookers from midnight on the day of the disaster, preparing rice balls throughout the night. On the following day, boiled rice was available. However, it was impossible to use plates; the amount available for each staff was one rice ball at breakfast, lunch and dinner. From March 12, relief and food supplies were delivered from RCHPs across the nation and the Headquarters, etc. Because those food items would expire in another 2 days at the most, food items were delivered within the expiration dates to the patients, and those just before or with ambiguous expiration dates to the staff. Subsequently, a disconnection in the communication lines prevented us from ordering more food (in two weeks food delivery was available). JRCS medical teams were asked to bring the necessary supplies. On March 16 water services were restored, which allowed them to cook food materials. However, on March 17, the relief supplies that had been periodically provided stopped, leaving food stocks (except rice) only for another 2 days. On March 18, the hospital asked for the public to help them cope with food shortages in an interview televised live. Following this, relief supplies began to be delivered from across the nation, which enabled them to solve the inventory problem of the shortages on March On April 12 about 80% of the meal services were restored and by May 11 they were fully resumed. hospital for an interview, repeatedly broadcasting that they were reporting from Ishinomaki RCHP, the only functioning hospital in ISHINOMAKI. In using media, many people got info about the hospital. The shortage of medicines, fuel and food supplies that was talked about was written in articles, resulting in more support over time. On March 18, after a dietitian claimed, the remaining food will last only one day in a live televised interview, many supplies were sent from the neighborhood and across the nation. These PR activities may have sometimes helped patients and affected people. The hospital staff asked a local FM radio station, Radio Ishinomaki, to make an announcement that oxygen was provided to patients receiving HOT therapy. The whole of the radio station of Radio Ishinomaki was affected by the disaster and yet they managed to continue broadcasting services using a microphone on an apple crate at the top of Mt. Hiyori, where a transmission station was located. Before the disaster it was talked about cooperation at the time of an emergency, and so their 10:30 radio program was available to provide information for local people on medical services at Ishinomaki RCHP, disease prevention and other precautions. h. Public Relations For this earthquake disaster, the Ishinomaki RCHP was willing to receive media exposure. However, immediately after the disaster no mass media asked for an interview. This was because the hangar for helicopters used for media coverage at Sendai Airport was swept away by the tsunami. The first reporter that visited us was from Kyodo News Enterprise. After the interview, an article was produced, titled, As If in A Field Hospital, which was delivered through local papers. On March 14, a popular anchorman and TV station crew came to the [Providing information at a press conference with a flood of news reporters] (4) Transportation and Transfer Support for Patients and Evacuees Immediately after the disaster, the Ishinomaki RCHP accepted all patients who flooded to the hospital, including those who had completed receiving medical care, no place to go after being released from the hospital, returner refugees. On March 13, It was begun to sort the people lying on the floor into patients and evacuees. Acute patients who needed treatment at the hospital were transferred to 106

134 medical and nursing facilities, and people who visited the hospital for evacuation purposes were transferred using a shuttle bus connecting the hospital and the disaster shelters. On the other hand, people seeking information on the safety of their family members still came to the hospital. a. Transportation of the Patients Among nearby medical institutions affected by the disaster, Ishinomaki RCHP, a critical emergency center, was the only hospital in the area that had accepted many patients. However, the number of beds of the hospital was limited to 402 beds plus an additional 50 temporary beds. The problem was how the hospital could maintain its functions as an acute-phase hospital. Thus, transportation service was started for the patients. An interview survey was carried out to identify patients who were able to transfer to another hospital. However, it was hard to deal with many patients who were unable to say their names, those who had no family left to care for them, or whose triage tags were removed in the hospital. Because communication tools were unavailable, the staff visited medical institutions and nursing facilities within the range of a 30-minute walk, and tried contacting the hospitals in remote areas using satellite-based mobile phones for the purpose of asking whether or not they could accept our patients. However, their reactions were not very favorable. From March 13 to 15 we managed to transfer only 16 patients. From March 16, emergency physicians was invited in the Red area integrate and control the list of transferable patients for the arrangement of transportation methods, which allowed the staff to efficiently identify the potential patients transferable to other hospitals. That Tohoku University Hospital mainly accepted those transportation cases accelerated finding recipient hospitals for these patients. The transportation process for the patients went smoothly because, at Tohoku University Hospital, the procedures had been integrated by their HDC, not by each department as usual. Also, thanks to the efforts by Yamagata Prefectural Central Hospital, Geriatric Health Services Facilities, etc., in YAMAGATA accepted many seniors requiring nursing care. More than 500 patients for March and April in total were transported those facilities. Figure 3-7 Breakdown of transportation cases b. Support for the Transfer of Evacuees Some patients needed hospitalization, some outpatients had already completed their treatment, or those accompanying the patients, evacuees, etc. stayed inside the hospital, claiming they had no place to go home to, no means of moving (by vehicle or by bus). They numbered 600 at the peak time, lying on the floor for accommodation. In order to keep the hospital working, these people had to be moved from the hospital. The Ishinomaki RCHP asked local HDC for a shuttle bus service to the disaster shelters, which became available for two weeks from March 14. People on the list to be moved included those who had supposedly completed treatment and returner refugees staying inside the hospital. The staff tried persuading them, one by one, to move from the hospital because we are unable to even serve meals. However, few people accepted the request at first, and many of them vented their frustration because few bus services were available with limited destinations. Thus the hospital tried to locate Welfare Shelters that would accept those who needed nursing support (such as helpers) for assisted living and, after discussions with the City Hall, Yugakukan, a communication facility serving multiple purposes, accepted people from March 16. c. Whereabouts information room On March 11 an Whereabout infomation room was established in the Medical Center next to the Emergency and Critical Care Center. However, telephones and the internet were unavailable, and people flooded the Office asking whether or not their family members were receiving medical care there. In these circumstances, the room was moved the office to a tent outside the hospital on March 14, and Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital Great East Japan Earthquake and Tsunami 107

135 Great East Japan Earthquake and Tsunami Chapter 3 added a second tent on March 16. On March 18, it was moved to a large-sized tent (air tent). Subsequently, as telephone lines and the internet were resumed, the room was closed on April 4. Initially it aimed to collect and post information on our patients. However, responding to an increase in the needs of the visitors, the service expanded and gradually shifted its focus to setting up and maintenance of the message board and collecting and providing shelter lists outside the hospital. (5) Deployment of Support Staff from the Headquarters As discussed in above, Ishinomaki RCHP had to deal with the patients and affected people flooding to the hospital from the entire Ishinomaki Medical Area under a very difficult situation in the wake of the disaster. Therefore, in addition to the medical teams, the Headquarters dispatched the support staff mainly from RCHPs across the nation based on a request from Ishinomaki RCHP. Doctors belonging to the medical teams provided in-hospital support as necessary until the end of March before a full-scale adjustment/arrangement began with a formal notice from the Headquarters. Addressed official dispatch letters to the chapters and facilities across the nation, as of March 25 were sent to the relevant pharmacists, nurses, midwives, nursing teachers, as of March 28 to internists, as of April 4 to psychiatrists, and as of April 8 to clinical engineers and administration staff. The physicians mainly provided medical services at the Regional Emergency and Critical Care Center. Due to an increase in the number of patients in the General Medicine and Respiratory Department during the Japanese long holiday season on May or summer season, human resources were arranged for each department to cope with the situation apart from the support for the Regional Emergency and Critical Care Center. The nurses and midwives supported the ward, triage, and nursing school teaching. The pharmacists mainly assisted in the preparation of medicines in the hospital. The clinical engineers provided hemocatharsis therapy and cardiovascular related services, and the administration staff were engaged in assessment duties in Ishinomaki Joint Medical Team. The support services at each department were completed, one by one, by around the end of August. However, the psychiatrists continued their services until March 31, 2012, because the need for mental care for these patients continued for a long period of time. Arrangements or adjustments to be made for staff deployment were based upon a request from Ishinomaki RCHP and the Headquarters informed the Block Representative Chapters of the requested number of dispatched staff per job title and their service duration. Under the scheme, the Block Representative Chapters requested the deployment of staff to each medical institution, mainly RCHPs, via the each chapter of each prefecture. Most of the dispatched workers were RCHP staff. The Chapters, Blood Centers, and the Headquarters also provided for cooperation in deploying administrative staff. While responding to the needs for manpower, the dispatching side gradually found it difficult to secure human resources. In addition, it was sometimes unable to provide the requested number of staff and extend their service duration. Therefore, in order to appropriately identify the local needs and smoothly coordinate staff deployment, two Headquarters staff, in principle, resided at the hospital on a rotation basis until the end of July. The staff dispatched from each medical facility across the nation gathered at the Headquarters to have a briefing, and then they entered the disaster area by using a large chartered bus. Because the Tohoku Shinkansen service was restored from the middle of May, it was possible to enter the area directly from the facilities they belonged to using the public transportation system. It was necessary to keep in mind when the staff was dispatched that they provide information to the next staff about psychosocial care for the staff, useful tips for the staff s activities, etc. The support staff took a land route to ISHINOMAKI. They arrived at the city in the evening where the sky was dusky due to the power outage and were unable to directly witness the miserable situation of the damaged coastal area. Ishinomaki RCHP did not suffer from major damage. Other than the large number of injured and sick, the situation looked as if there had been no disaster at all. And one of the major characteristics of this disaster was that even support staff member assigned to the hospital found it difficult to have a sense of reality that they were in a disaster area. Therefore, there was a huge gap between the image of medical services, their sense of exaltation and mission before their deployment, and the sense of accomplishment and fulfilment they actually obtained 108

136 from the support services; the deployed staff tended to wonder and question whether or not they really contributed to the support. Therefore, it was a point of providing a careful explanation on how the hospital and the staff was functioning. Initially they used meeting rooms in the Ishinomaki RCHP for lodging, but increasingly used accommodations in the city from around May or June. For approximately one year, more than 1,000 staff from across the nation provided support services to Ishinomaki RCHP, which was a large-scale, sustainable and unprecedented project combining the deployment of medical team staff and support to the disaster facilities. Through the coordination work by the Headquarters, 4,874 staff in total (1,477 physicians, 2,426 nurses, 839 pharmacists and 132 clinical engineers) had been dispatched for hospital support from March 12 to July 31 (or March 31, 2012 for psychiatrists) from RCHPs across the nation. 3. Joint Medical Team Activities in the Ishinomaki Area At the Ishinomaki RCHP many medical teams including JRCS medical teams gathered, where the medical functions including traveling from shelter to shelter to provide medical care were integrated as the Ishinomaki Area Joint Medical Team. As the City Hall was damaged by the disaster, the Joint Medical Team was engaged in not only medical services, but also public health and welfare activities that were otherwise provided by the local government. It is considered this is a rare example of where many medical institutions, including JRCS, cooperated with each other, serving a large-scale project over a long period of time in various areas such as medical and other services. The services provided by Ishinomaki Area Joint Medical Team are described as follows; (1) Assessment and Improvement in the State of the Disaster Shelters a. Background to the Assessment Services The HDC staff of the hospital waited until the water receded from the road, and visited Ishinomaki City Hall to assess the damage and obtained a list of 328 disaster shelters. It was estimated that approximately 42,000 people had evacuated. However, the list only covered the names of the shelters and number of people accommodated; no details were available about the needs of each shelter. Therefore, the assessment to identify the number of injured and sick was needed in order to determine which disaster shelters should be prioritized. The assessment was expected it would take a lot of manpower and so that fewer personnel would be left for traveling from shelter to shelter to provide medical care. After a discussion on whether or not the assessment is needed, finally we came to a conclusion and decided to go ahead with it because we should clearly identify the status, identifying shelters with emergency needs, and go to these first. For three days from March 17 to 19, while the medical teams traveled from shelter to shelter to provide medical care, the staff members evaluated the level of medical needs, etc. As a result of the calculation using the assessment sheets during the night of March 19, although more than one week had passed since the disaster took place, people at 35 shelters were living with a shortage of supplies of food. About 100 shelters had sanitation problems with their toilets not flushing properly. Subsequently, data of these disaster shelters was to be updated every day, posted and stored in chronological order. The data helped to determine the deployment strategies for the medical teams and to take the following measures for the deteriorating hygiene conditions within the shelters. b. Assessment Method The assessment covered the following items: the number of people accommodated in the entire shelter, the number of patients in total receiving medical services and the number according to the disease (fever: 38 C or more, coughing, vomiting, diarrhea, influenza, respiratory illness, breathing difficulty), evaluation of lifelines and the hygiene environment (water, food, electricity, blankets, heating, hygiene status/toilets), and the needs from each department (pediatric needs, psychiatry needs, obstetrics and gynecological needs, and dentistry needs). Among the above items, the lifelines/hygiene status related items and the needs per department were evaluated at four levels,,,, (Very Good, Good, Fair and Poor). There is a rough indication in the explanatory notes: (Very Good) refers to all, (Good) to 50% or more, (Fair) refers to less than 50%, and (Poor) to zero. However, the staff did not necessarily have to evaluate the items based on strict standards. What was more important to locate the shelters evaluated as (poor), and it was considered Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital Great East Japan Earthquake and Tsunami 109

137 Great East Japan Earthquake and Tsunami Chapter 3 that there would be no significant difference among those judged as (Poor). It was also necessary to avoid causing additional stress on the evaluators with excessively detailed standards. The results of the assessment sheets were input as electronic data every day. The input work was initially provided by a Kokushikan University team and, later, it was handed over to JRCS Headquarters and Ishinomaki RCHP HDC support staff. The data was also published on the Internet with the support of Google Japan. Figure 3-8 Assessment sheet format Format omitted The data results helped to examine chronological changes in each disaster shelter. It was examined the number of people accommodated by the shelter, the number of patients receiving medical services, the changes in the ratio of patients receiving medical services (the number of patients receiving the services out of the number of people accommodated by the shelter) or the number of patients by symptom, such as coughing, etc. Discussions were held to determine the factors, if any, that caused a surge of patients at the shelter in order to increase the visits. c. Response after the Assessment Dr. Tadashi Ishii, the Coordinator controlling the Ishinomaki Area Joint Medical Team (discussed below) went to Ishinomaki City Hall for the purpose of coping with the shortage of food supplies at the disaster shelters. He also participated in a Medical Coordination Council held at the Miyagi Prefectural Office to ask for food supplies for the disaster shelters. The medical teams also arranged the delivery of food supplies to the shelter. In regards to improvements in the hygiene environment, it was difficult for the traveling medical teams from shelter to shelter to even prevent infectious diseases. Public sanitation services should essentially be the responsibility of local government officials, including public health nurses. However, both the City Hall and Health Center were affected and not functioning properly. Therefore, an Infection Control Team (ICT) from the Ishinomaki RCHP was deployed. This team carried out staff education to prevent infectious diseases from spreading within the hospital and maintained a normal hospital environment. Initially, one doctor and one nurse specialized in infectious diseases (and later, two nurses) traveled from shelter to shelter to prevent infectious diseases. First of all, ICT carried out risk assessment of the disaster shelters. They asked the medical teams traveling from shelter to shelter to roughly investigate whether or not water was available, sewage in the toilets was properly disposed of, the number of portable toilets was sufficient, etc. And based on the results, they identified which disaster shelter was facing a serious condition, and provided the necessary supplies (masks and hand disinfectants) to prevent infectious diseases with instruction on how to use them. The supplies distributed to the shelters also included masks, disinfectants, hand disinfectants, etc. As followed identifying the infectious diseases on site, lifeline availability and the number of evacuees, it was decided what should be allocated where. The team gathered these supplies by supporting from the Headquarters and personal connections. From morning to the evening, asking it was investigated how the toilets were used and cleaned as part of instruction on hygiene management with visiting up to 4 to 5 disaster shelter a day. As there was no sewage, four lots of wrap-type toilets 4 were found from the warehouse of the Ishinomaki Government Office and distributed 90 units to the disaster shelters. it was informed that alcohol disinfectant could not kill norovirus; the effective way would be hand-washing with water. In order to prepare tap water for hand-washing, tanks for smallscale water systems that are used in developing countries were provided at 11 disaster shelters through cooperation with the International Red Cross and Red Crescent. From the examination of the assessment data on the shelters that was updated every day, a follow-up the survey was conducted about coughing, fever, digestive cases, and intervened with the patients as necessary. For example, when one of the shelters had 20 diarrhea cases, ICT immediately went over there to deliver soap and focused on hand-washing instructions. (4) A portable, deodorized legless chair type toilet. One can urinate or defecate on a vinyl mat prepared in advance, then push the button to have it disposed in the sewage and have the next vinyl mat charged automatically. 110

138 d. Installation of a Short-Stay Base Patients with infectious diseases become more prevalent in the chronic phase. When it became warmer, there were more cases of chicken pox, mumps, streptococcus hemolyticus infection and handfoot-and-mouth diseases. In normal times, most of the patients would have recovered by taking a rest at home. However, there is a risk of them spreading the infection in the setting of a disaster shelter. To provide a facility for patients to stay until their recovery and in order to prevent contagious diseases (such as influenza) from spreading, a short-stay base was installed with about 20 beds on the fourth floor of Ishinomaki Royal Hospital. This was established as a high quality disaster shelter, not as a hospital, based on the following concepts. Preparing for accepting patients whose condition may worsen in the setting of a disaster shelter although they would otherwise be allowed to go home in normal times Isolating people from the shelters where infectious diseases could spread When things settled down, patients awaiting to be transported to other hospitals may be accepted (2) Assessment for Patients Requiring Nursing Care The environment of disaster shelters gradually improved, and no serious events (such as outbreaks of infectious diseases) occurred. However, the number of emergency patients did not decrease even in the chronic stage, and patients visiting the hospital numbered some 100 a day, almost double the 60 patients on average at normal times. Figure 3-9 Trends in the Number of Emergency Patients Patients rat (80 days) ta 17,344 people he e area 2,290 peopl he er e er e pat e t re a e the a e Total number The Red area a a ter the a ter and aspiration pneumonia patients due to their prolonged stay at the shelters. In particular, it was the big issue that elderly people who had been able to walk before the disaster lost their capability to walk, and those who had been independent in going to the toilet became all-day diaper users. Therefore a project was established with the city officials to focus on a welfare-shelter in order to maintain the degree of independence that the elderly people had because it was more efficient to concentrate the public health nurses and care managers who traveled from shelter to shelter at a single site. The assesment was conveyed about patients requiring nursing care at 132 disaster shelters in the former Ishinomaki area (except HIGASHI MATSUSHIMA and ONAGAWA) in a week, identifying 76 relevant patients. Out of these patients, almost half needed nursing care, and one quarter of them could move to welfare-shelters, etc. Through cooperation with the city government officials, Yugakukan was also used as a welfare shelter. This facility accommodated 358 people in total, including elderly people, infants/pregnant women, and their family members. In addition, ICT recommended that the City Hall specify the Monou Farmers Training Center as a welfare evacuation center, which was so designated on April 29. In ISHINOMAKI ICT established welfare evacuation centers at 12 sites in total one by one from the disaster day. The above centers included 10 facilities for elderly people, none of which had been designated as such before the disaster. However, the number of users of the welfare evacuation centers and welfare shelters was limited because many gave the reasons I would like to stay as close as possible to my home, I don t want to live where public transportation is limited, I do not want to be apart from my family, etc. Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital At this stage, the increasing visitors included vulnerable groups (children and elderly people) claiming ill health, pneumonia patients supposedly caused by dust, [Welfare Shelter Established for People Requiring Nursing Support (Yugakukan)] Great East Japan Earthquake and Tsunami 111

139 Great East Japan Earthquake and Tsunami Chapter 3 Welfare Evacuation Centers These are institutions designated under the Disaster Relief Act. According to the Guidelines on the Establishment/Administration of Welfare Evacuation Centers prepared by JRCS, people eligible to attend such a center include those who have special needs regarding their living shelter (such as elderly people, challenged people, pregnant women, infants and sick people), and those who do not need to be hospitalized at care insurance facilities or medical institutions but require home nursing care. The prefectures, cities, towns and villages shall establish these centers at designated disaster shelters (elementary and junior high schools, public halls, etc.), welfare facilities for the aged (day service centers, etc.), welfare facilities for the disabled (both public and private), health centers, schools for disabled children, lodging accommodations (both public and private) and provide the following services. One life consultant staff for every 10 evacuees was assigned Consumption items including paper diapers, stomas were secured in addition to portable toilets, handrails, temporary slopes, information transmission systems, and partitions (3) Providing Medical Services for Diseases Caused by Conditions in the Disaster Shelter The newly established welfare evacuation centers, etc., allowed for a decrease in the number patients requiring nursing care to some extent. However, if the same conditions remain, it is considered that it will have some impact on their health, including muscle weakness. Those staying in the shelters for a prolonged period had a higher risk of developing or worsening diseases due to the aggravation of the living environment, climatic and psychological factors. a. Locomotive Syndrome, Aspiration Pneumonia, etc., in Elderly People People in a disaster shelter have decreased mobility, sitting or lying down even in the day. In particular, elderly people are unwilling to move because of the difficulty of getting up from the floor, which results in a loss in muscle strength. An investigation of independence ability targeting about 1,000 elderly people staying at the shelters over the one month after the disaster was conveyed with the cooperation of Miyagi Physical Therapy Association/Association of Occupational Therapists. According to the results, people who were bedridden or close to bedridden status almost doubled in number compared to before the disaster. Those who needed assistance reached 2.3% of the total. Aspiration pneumonia cases due to being bedridden increased (one of the causes was insufficient oral care because people were unable to brush their teeth due to water shortages in the areas where water services had not been restored), and the number of people that had to be transported to the hospital increased. Coughing, sputum, breathlessness and dyspnea cases increased as well. b. Improvement of the Deep Vein Thrombosis (DVT) Positive Rate Immediately after the disaster, the shelters became densely crowded. This increased the positive rate of DVT; however, it decreased gradually. On April 21 the schools resumed activities and those sheltered in schools had to move to gymnasiums and local community centers. The evacuees cleaned their houses in the day time and returned to their accommodation at night. Thus, some of the shelters were again densely crowded. The shelter space per person was about a single bed or smaller in which they were unable to move or sleep well. This may have affected the increasing positive rate of DVT, along with a higher risk of cerebral infarction. c. Information on Economy-Class Syndrome (ECS) to Raise Awareness Ishinomaki RCHP asked the medical teams visiting the disaster shelters on March to remind people about the ECS. The instructions included taking enough water, eating and exercising, etc. However, due to the poor conditions in the shelters, such health tips were far from accepted. From March 23 compression stockings (500 pieces each of S, M, L and LL sizes) were distributed to prevent ECS at the shelters. Also, as for the prevention of ECS, test apparatuses were collected and using lower limb venous ultrasonography was started from March 27 at the shelters. This examination revealed that there were many patients suffering from ECS. The Ishinomaki RCHP staff visited disaster shelters with physical therapists to recommend that the evacuees be physically active and conducted exercises with them. d. Influence on Chronic Diseases The stress of life in a shelter can change the conditions of patients with chronic diseases, causing high blood pressure, myocardial infarction, etc. Some of them who were taking Warfarin were transported due to cerebral hemorrhaging although 112

140 they had taken the same dose of this anticoagulant drug (that can help prevent blood coagulation) before the disaster, and even lethal cases were observed. As the result of the test of the anticoagulant effects of Warfarin in the patients taking the medication, it was found that some of them indicated obviously higher values. It is considered that the unbalanced diet at the shelter had affected their health. Thus, the medical teams decided to provide the above test once a month when adding the prescription of Warfarin at the shelters. Some of the patients taking Warfarin even self-adjusted the dose when the drug was scarce. In this case, too, their test results were considered and re-established the doses. Some people were unable to report that they were taking Warfarin. Therefore, the RCHP staff asked the patients in the inquiry, did your doctor tell you not to eat natto (fermented soy beans)? 5 in order to acquire information on their medication history management. An unbalanced diet may also affect the blood sugar control of diabetes mellitus patients, and the medical teams had to provide a service for blood sugar control. (4) Services by the Ishinomaki Area Joint Medical Team On March 20, MIYAGI and ISHINOMAKI local government officials gave Dr. Ishii a free hand in establishing the Ishinomaki Area Joint Medical Team, a team organized by staff across the nation with an integrated chain of command. [Staff meeting of the Joint Medical Team] a. Administration of the Teams Based on the philosophy of offering hygiene, health care and mental stability through medical services to all people living in the Ishinomaki Area, the Ishinomaki Area Joint Medical Team provided medical services and surveillance on medical needs in the Ishinomaki Area, and medical support to Ishinomaki RCHP, a hub hospital for disaster response. The participating medical teams are listed below. Japan Medical Association and Japan Dental Association Medical Care Teams Tohoku University Medical Team, Ishinomaki Municipal Hospital (local) University Medical Teams dispatched under contract with Tohoku University Hospital Medical Teams dispatched under contract between the prefectures JRCS medical teams Psychiatrist Groups SDF Medical Teams Doctors familiar with disaster medicine joined forces on a rotation basis immediately after the disaster in order to support Dr. Ishii, a commander of the Joint Medical Team, coordinating the orientation for the medical teams, assigning service areas and providing advice and guidance on the decisions on service strategies. More personnel were needed to handle a great deal of administration work and maintain the functions of the headquarters, thus nine staff, in addition to two assistants of Dr. Ishii, were in charge of administration services for the newly established department. Registration/erase of the medical teams (maintenance, management, listing of them) Management/maintenance of assessment data updated daily Data control, including daily reports on the condition of each patient and the number of visiting patients Control and delivery of supplied materials Maintenance and store of the Daily Records of the medical teams Preparation and control of a Line Table Acquisition, organization and delivery of various documented information (traffic conditions, gas station locations, etc.) Daily update of documented meeting references and minutes A great deal of coordination with the organizations deploying the medical teams Preparation of a chronology (recording of a timeline or sequence of events) Maintenance of supplies lent to the teams However, due to the heavy workload, nine staff on a 24- hour basis was not enough to deal with the data, including data management. Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital (5) Because natto containing high Vitamin K counteracts the effects of Warfarin. Great East Japan Earthquake and Tsunami 113

141 Great East Japan Earthquake and Tsunami Chapter 3 In these circumstances, JRCS continuously deployed 1,501 support staff in total to the headquarters from March 12 to July 31 (including 206 doctors and 1,295 nurses / administration staff / volunteers). They were in charge of collecting information on the support teams, carrying out assessments and registering the Daily Records of the medical teams. Four nurse managers from the Sendai RCHP were also engaged in recording a range of negotiations and the preparation of team lists on a rotation basis. Furthermore, staff from the Headquarters and Chapters resided for liaison and coordination. This support enabled the administrative staff in the hospital to focus on secretarial duties (accompanying meetings, preparation of minute summaries, preparation/management of documents for media interviews, preparation of the chronology, scheduling, etc.) This enabled the staff to handle a great deal of information on time, providing such information to doctor leaders immediately. The leaders assessed the current situation to decide on their service strategy. Under the Area / Line System, considering the number of disaster shelters, etc., the areas around ISHINOMAKI were devided into 14 zones, and appointed medical teams available for long-term service as Area Leaders, leaving the management of the areas in their hands. The medical teams were divided into a Line, medical teams that provided support for one month or longer, and a Spot, support teams active for a short duration of time. Figure 3-10 Organization of the Area / Line System Figure omitted The necessary number of Line teams under an Area Leader was allocated, adjusting it for each area depending on whether or not a clinic was resumed or disaster shelters were consolidated/abolished. This aimed at providing long-term, stable medical support by subdividing, consolidating and abolishing the areas themselves. The number of medical teams to be deployed was decided based on the results of the assessments made at the shelters. [Staff supporting the Joint Medical Team] b. Introducing Area / Line System Almost two weeks had passed since the disaster. However, staff at the Ishinomaki RCHP were extremely exhausted, what with inquiries about the medical teams and supplies night and day, the staff registry ceremony from arrival to leaving. Because of the high turnout of medical teams, the assignment work became more complex, and until midnight every day the staff had to decide on the service site assigned to each team for the following day. Also, a problem that was very time wasting was that many medical institutions managed their services at their own discretion. In this context, it was decided to introduce a system that was to be called Area / Line System later, in which a team serving for a long period of time should be responsible for its own management to some extent. c. Toward Reviving Community Heath Care The services provided by the medical teams gradually improved the environment of disaster shelters, avoiding serious consequences such as the spread of contagious diseases. As the number of shelters was decreasing and the local medical institutions resumed their functions, the services provided by the medical teams gradually declined. However, the number of emergency patients transferred to Ishinomaki RCHP did not return to the level of before the disaster due to the significant impact of the Ishinomaki Nighttime Emergency Center and Ishinomaki Municipal Hospital, which had been heavily damaged and had no prospect of resuming services. Support was also sought for OGATSUMACHI and KITAKAMICHO, which were severely damaged by the tsunami. The medical teams had been dispatched to the Ishinomaki Medical Area until September 30. One problem in particular was that KITAKAMI and OGATSU/OSU became areas without a doctor. Another problem was the collapse of the Kitakami Bridge, which caused ambulance vehicles to take time to get access. To cope with this problem, first-aid stations were established in the areas without a doctor (including Hashiura First Aid Station in a flooded area where 114

142 one team was dispatched per day, while practicing evacuation drills). The Ishinomaki RCHP negotiated an increase in the shuttle bus services and appealed to the related agencies to secure transportation means for the elderly people who had lost their vehicles or their family members who could drive them by car. The First-Aid Stations continued to be run until September 30. In this chronic phase, the focus was on how to connect to and revitalize local medical services, and how to make a soft-landing to restore them to their previous state. To this end, the goal of our services was to achieve independence support whereby people could find and visit their own primary care physician and not be too dependent on the medical teams. And the following strategies for our services were established until the withdrawal. To inform people that the teams would be active for a limited time (so that people did not take it for granted that the medical teams will be always available) To provide information on practitioners that had resumed their services and recommend people to visit them To reduce the frequency of visits to the shelters; i.e., from every day to once a week. To have people secure their transportation means (such as a shuttle bus service) in rural medically underserved areas and to get medical services for themselves. Four fixed-point medical stations were established with free shuttle bus services for a limited time that traveled between the City Hall, private clinics, JRCS, shopping centers and the shelters. To take continuing measures to provide for patients in need of nursing care since the shelter accommodating these patients will not be closed. To provide health and safety management for disaster victims To keep providing services at fixed medical stations in rural medically underserved areas, the goal of which was to establish clinics. Finally, to ensure that the clinics provide medical services under the health insurance. As mentioned above, the Joint Medical Team was designed only to play the role of revitalizing the collapsed local medical services. Figure 3-11 Changes in the number of Ishinomaki Area Joint Medical Teams Note) Teams serving for more than one day were counted as one per day. Therefore, the number of medical teams is not the same as those in Chapter Approach from Before the Disaster As discussed in the above, Ishinomaki RCHP was able to maintain its functions at the time of the disaster, providing medical services on an extensive scale. This is because the hospital had been engaged in a range of activities toward creating a disaster-proof hospital even in normal times. (1) Preparation of the hardware parts of Supporting Hospital Functions a. Location The Ishinomaki RCHP, which was relocated from Minato District (to the east of Kitakami River) in the coastal area to Abuta District (about 4.5 km directly from the sea) in an inland area in 2006, avoided any impact from the tsunami this time. Situated at the site where the former Ishinomaki RCHP used to be five years ago, the flood water reached the ceiling of the first floor of the Ishinomaki Red Cross Nursing School building. b. Quake-Absorbing Structure As the hospital adopted a quake-proof structure absorbing the level of energy released by an earthquake due to its base-isolated layer, there was no significant damage to the building and medical equipment. The quake-absorbing structure protected the information system as well, allowing electric charts and ordering systems to be used just by inputting patient data on the PC. For diagnosis and testing services, it was important to be able to obtain patient information just by viewing the monitor. If the system had been down, the hospital would have had to use paper slips that we had not used on a daily basis amid the turmoil with the Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital Great East Japan Earthquake and Tsunami 115

143 Great East Japan Earthquake and Tsunami Chapter 3 flood of patients after the disaster. Not only would this have caused chaos, it was expected that it would have increased the burden of manually inputting the medical data. could be liquefiable in the wake of a major earthquake. As a result, the tsunami water flooded the rice fields around the site through agricultural waterways and other routes. In the morning of March 12 the water fulfilled the rice fields; however, the site was saved from flooding. [126 units of quake-proof equipment supporting 35,000t building] Figure 3-12 Outline of the Ishinomaki RCHP building Structure 7th floor 1st basement 1st floor of the tower Rabar Structure (Specialized Structure), Quake-Absorbing Structure Completion year May 15, 2006 Site area 69, m 2 Building area 101, m 2 (including the main hospital ward/accessory ward) 32, m 2 (including the main hospital ward/accessory ward) Total floor space 32, m 2 Quake-proof equipment Laminated rubber: 6 units, steel L-type damper devices: 16 units Seismic isolation rubber integrated U-type damper devices: 30 units Elastic sliding bearings: 74 units c. Banking for the Foundations and Sand-Piles As the hospital is situated in the watershed areas of the former Kitakami River basin, we designed the landscape expecting flooding, raising the ground level higher than the flood level in the past. There is a diluvial formation 60 meters underground, thus friction piles were used for the foundation structure. This includes a mixture of clay layers in the middle which may sink or subside under strong pressure, and sand layers through which strong acid groundwater flows. A Piled Raft method was adopted to help relieve the burden on the piles. Also, sand-piles were used because the sand in the superficial layer (up to 10 meters under the surface) d. Turnaround Drive and Large Eaves The space before the front entrance prepared as a turnaround drive was not used other than for events. However, it was effectively used for parking the vehicles of the JRCS medical teams, setting up tents for living and for information on the whereabouts of the affected people. The large eaves (roof set before the front entrance for the turnaround drive) were about an area of 25 m 15 m and 5m in height without an uneven surface between the road and the building. In the event of a disaster this allowed for flexible use of services, such as triage, the setting up of a tent for medical practice, etc. e. Heliport Located at Ground Level Considering the convenience for the SDF and Fire Fighters, one unit of a heliport located at the ground level was established, the cost of which was lower compared to that of a heliport located on the roof top. The ground was also improved so that an air ambulance could move horizontally along the route connecting the heliport and the emergency entrance, allowing for the more efficient transportation of patients. This was very effective at the time of the disaster when many injured people had to be transported. Since the elevators had stopped, it was hard work to move the patients manually from the rooftop heliport to the Red area on the 1st Floor. Emergency entrance Heliport [Bird s eye view (aerial photograph) of the hospital building and heliport] 116

144 In order to identify the achievements of the seminar, in January 2008 a tabletop exercise was provided that assumes how the hospital should respond to a largef. Underground Service Yard Cots, mattresses, etc., were stored in a storage warehouse in the parking lot. However, the stockpile was not enough to meet the demand. The underground service yard (which had been always used for the transportation of supplies from chapters and facilities around nation) had a wide space for transportation and storage, allowing smooth and efficient transportation using trucks. g. Outdoor Electrical Outlets and Medical Gases in the Waiting Hall It was useful to have installed "outdoor electrical outlets for external generators at the pillar of the front entrance. The number of patients increased on the third day after the disaster, on March 13. The patients who could walk in the Green area were moved to the deru of the JRCS Medical Center set up outside for medical services. At this time, the electrical outlets installed outdoors were very useful. On the wall of the east side of the Waiting Hall, which had been used for treating patients triaged to the Yellow area, we installed and effectively used corridor wall-mounted medical gases (four oxygen outlets) which had not been used at normal times, as well as medical outlets for patients using oxygen inhalers. [Medical gases and electric outlets installed in the corridor of the Waiting Room] (2) Inprovement of the Disaster Regime and Human Development Having not experienced a massive earthquake since 1978, Miyagi prefecture estimated that major earthquakes would occur at a likelihood of 70% in 10 years, 90% in 20 years, and 99% in 30 years After the relocation, Ishinomaki RCHP focused on disaster countermeasures, including working on a full-scale revision of the Disaster Response Manual) in a. Preparation of the Disaster Response Manual Due to changes in the building and facilities of the hospital, which was relocated and newly constructed in May 2006, the Ishinomaki RCHP decided to work on a full-scale revision of the Disaster Response Manual prepared in In February 2007, a Subcommittee on the Disaster Response Manual was organized as a sub-organization of the the Disaster Preparedness Committee (chaired by the Hospital Director). With reference to the disaster manual by the Disaster Medical Centers of TACHIKAWA, TOKYO, a team consisting of three doctors, six nurses, and two paramedics (pharmacists, radiography and laboratory technicians, etc.) gathered every other week for one year, sharing their responsibilities according to their job titles to produce the manual. In preparing the manual, the names of the managers of each department (updated upon every transfer) were included, because not only what to do but also who to do it was considered important. The hospital also interviewed the staff to find out their views and reduced the amount of text so that it was more readable. b. Seminars and Training Participants in the seminars were mainly members of the six medical teams with a high level of awareness of disaster medical services, but it had to be expanded to involve more staff. To this end, a seminar on disaster management for all of the staff was started in A Program for Basic Seminar was developed to allow the participants to study from the basics, and those who took the seminar once may then become an instructor of the Basic Course, to pass on the knowledge to the staff within the hospital. As a result, the number of participants in the seminar increased to 723 in FY2007 from only 73 in FY2001. The RCHP developed an annual plan for the Medical Seminar Program, which was about an hour session that started at 17:30 every Wednesday. Figure 3-13 Attendance at the seminar on disaster Management FY2001 FY2006 FY2007 FY2008 FY2009 FY participants participants participants participants 611 participants 523 participants Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital Great East Japan Earthquake and Tsunami 117

145 Great East Japan Earthquake and Tsunami Chapter 3 scale disaster, and in July we held a disaster drill. On June 6, 2010, we developed and carried out the Disaster Drill to Respond to Large-Scale Earthquake Disasters, together with the Miyagi Prefectural Disaster Drill with an Air Ambulance Med-Helicopter and Ishinomaki city Emergency Drill to strengthen cooperation with the related organizations. (3) Liaison with External Organizations At the disaster time, it is essential to cooperate with external organizations, thus the Ishinomaki RCHP has the following relationship a. Establishing Relationships with Disaster Medical Experts The Ishinomaki RCHP deployed one medical team in the event of the Iwate-Miyagi Nairiku Earthquake in June 2008; however, it had no experience in dispatching Japan DMAT which had been organized to serve in the disaster impact phase (approximately within 48 hours). So several members of the staff participated in a Japan DMAT Seminar held at the Disaster Medical Center in TACHIKAWA, TOKYO in November of the same year. From 2009, they participated in the JRCS DMAT Seminar hosted by the Headquarters once every three months with the aim of acquiring technical skills and have a deeper understanding so that the JRCS Medical Team can cooperate with Japan DMAT in the impact phase. This allowed them to develop personal relationships with disaster experts. These people rushed to ISHINOMAKI at the time of the disaster time, staying at the HDC on a rotation basis, and supported us with their know-how over a long period of time. b. Establishing Relationships in the Community (a) Establishing the Ishinomaki Disaster Medicine Representative Network Council On January 22, 2010, Dr. Ishii called on Fire Department, Health Center, the police, the SDF, Medical Associations, neighborhood hospitals as it was essential to cooperate not only with the government but also with the related organizations in the event of a major disaster. In particular, it is important for disaster medicine representatives to be meeting faceto-face from before a disaster. And he established a Council consisting of these representatives. They had met once every three months to discuss how to respond to an earthquake disaster and cooperate with each other. The 6th Meeting was scheduled for March 22, The relationship developed through this Council effectively led to a more efficient disaster response. Figure 3-14 Organizations participating in the Ishinomaki Disaster Medicine Representative Network Council Eastern Region Public Health and Welfare Office, MIYAGI Disaster Prevention Office, General Affairs Department of Ishinomaki Ishinomaki Medical Association Higashi-Matsushima Department of Health and Welfare Matsushima Air Base Tohoku Area Hygiene Squad, Ground Self-Defense Force Ishinomaki Coast Guard Ishinomaki Police Station Ishinomaki Wide Area Fire Department Japanese DMAT (Director of the Tohoku District) Neighborhood hospitals (Ishinomaki Municipal Hospital, Onagawa Municipal Hospital, Senseki Hospital, Makabe Hospital, etc.) Ishinomaki Dialysis Network (b) Concluding Support Agreements for Disasters with Private Enterprises and Entities In September 2010, a support agreement in relation to disasters was concluded with three entities consisting of the DoCoMo Shop Ishinomaki Store, Sekisui House Sendai Branch, Shisuikai (volunteers from restaurants in ISHINOMAKI). It provides for these entities to rush to the hospital to provide support services in the event of a large-scale disaster. Aiming at the improvement of the support technology for disaster response and smooth cooperation, the agreement also provides that the staff shall participate in disaster drills and events held by the hospital more than once a year. At the time of the earthquake, DoCoMo Shop Ishinomaki Branch rented satellite-based mobile phones and cell-phones. At the request of Dr. Ishii via a text message, a transmission station for cell phones was established near the hospital, which improved the communication environment. The Sekisui House Sendai Branch set up a tent in front of the front entrance. Shisuikai prepared a soup kitchen service inside the hospital, providing meals to the staff. (c) Cooperation with Ishinomaki city The Ishinomaki Regional Disaster Prevention Plan 118

146 provided that the Ishinomaki Municipal Hospital shall play a pivotal role. However, just when the earthquake occurred, the Ishinomaki RCHP aimed at preparing a more practical plan in which the Ishinomaki RCHP, a hub hospital in the event of a disaster, should have a pivotal role, and almost completed the discussion with the City staff in charge of disaster prevention for its enforcement from April Based upon the plan, the City officials provided a shuttle-transportation service for water for artificial dialysis to the Ishinomaki RCHP which was expected to be in need of the water supplied by water truck (10t vehicle). Because problems of communication environment were identified when the City participated in the tabletop simulation that Ishinomaki RCHP first carried out in 2003, three months later a disaster community wireless system was set up for the first time other than in municipal facilities. Since then, cooperation through municipal training was developed, which had a positive effect at the time of this disaster. (d) Commissioning of a Miyagi Disaster Medical Care Coordinator In February 2011, the Miyagi Governor appointed Dr. Ishii as the Miyagi Disaster Medical Care Coordinator, the sixth in the prefecture. Dr. Ishii was in charge of disaster response since he took office as Director of the Medical Social Services Department of the Ishinomaki RCHP in April His work was highly evaluated, such as for establishing and practicing a mechanism for disaster response at the hospital, gaining experience of disaster relief services, setting up the Ishinomaki Area Disaster Medicine Representative Network Council, and concluding disaster agreements with business entities. He was recommended by the local Medical Association, etc. Responsible for the coastal block, the coordinator shall be engaged in disaster control when a disaster occurs in the area. If a disaster takes place in other areas, the coordinator shall join the prefectural office. The Ishinomaki Joint Medical Teams made good use of the title Disaster Medical Care Coordinator when establishing disaster relief coordination. The public title enhanced negotiations with the authorities, allowing for smooth coordination between the organizations. Chapter 3 Development of Disaster Relief Activities with Ishinomaki Red Cross Hospital (RCHP) as a Hub Hospital Great East Japan Earthquake and Tsunami 119

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148 Chapter 4 Response to the Fukushima Daiichi Nuclear Power Plant Accident

149 Great East Japan Earthquake and Tsunami Chapter 4 Chapter 4 Response to the Fukushima Daiichi Nuclear Power Plant Accident One of the characteristics of the Great East Japan Earthquake and Tsunami (GEJET) was not only its significant damage in the wake of the earthquake, but also that it caused a nuclear plant accident that generated a tremendous and long-term impact on the country. In these circumstances, the Japanese Red Cross Society (JRCS) had to provide medical services at a level that it had never experienced in a disaster response situation domestically. At normal times there were no assumptions or preparedness, or insufficient information, for this level of natural disaster, and it was with the utmost difficulty that medical activities were able to be provided. Radioactive contamination caused by the accident reached a significant level not only in the short term, but it has remained for a long period of time and is yet to be solved. The JRCS will still need to keep responding to the nuclear plant accident. It should be noted that the record on the response to the Fukushima Daiichi Nuclear Power Plant Accident described below only serves as an intermediate record, and our services still have a long way to go. 1. Outline of the Accident (1) Situation Immediately after the GEJET 1 Nuclear reactors No.1-3 of the Fukushima Daiichi Nuclear Power Plant and all reactors of the Onagawa Nuclear Power Plant automatically stopped operating in the wake of the earthquake. With the automatic halt to power generator, the Emergency Diesel Generators (EDG) started to maintain the functions of reactor cooling and cooling of the pools used to store used nuclear reactor fuel. However, the EDG were stopped due to the tsunami that followed the earthquake, and all of the reactors from No.1 to No.5 of the Fukushima Daiichi Nuclear Power Plant lost all AC power. Through cooperation with the government, Tokyo Electric Power Company (TEPCO) took some measures to restore power. However, the work was very challenging. The isolation condenser (IC) of Reactor No. 1 was crippled, and Reactors No. 2 and 3 lost DC power (battery) and their cooling water supply; which caused Figure 4-1 Situation of the nuclear power plants immediately after the disaster (Number of reactors that were automatically shut down: 10 reactors (as of 18:45, March 11) Nuclear plant TEPCO Tohoku Electric Power Fukushima Daiichi Nuclear Power Plant Fukushima Daini Nuclear Power Plant Onagawa Nuclear Power Plant PWR (kw) Reactor No.1 460,000 Reactor No.2 784,000 Reactor No.3 784,000 Reactor No.4 784,000 Reactor No.5 784,000 Reactor No.6 1,100,000 Reactor No.1 1,100,000 Reactor No.2 1,100,000 Reactor No.3 1,100,000 Reactor No.4 1,100,000 Reactor No.1 524,000 Reactor No.2 825,000 Reactor No.3 825,000 Situation Automatic shut down Suspended for periodic maintenance Automatic shut down Source;"Report on Earthquake Damage (5th)" by the Ministry of Economy, Trade and Industry, the Nuclear and Industrial Safety Agency (As of 20:00, March 11) their core cooling function to stop working. Lowering of the water level in the reactor and the exposed reactor core triggered damage to the core, leading to a meltdown over time. This was followed by an explosion in the upper part of the reactor building, possibly due to combustion of hydrogen that leaked out from a storage container of the nuclear reactor No.1 and 3. This destroyed the operational floors of the reactor buildings, releasing a great deal of radioactive materials into the air. Following the explosion at Reactor No. 3, there was also an explosion possibly due to accumulated hydrogen in the building of Reactor No. 4, destroying the upper part of the reactor building. In this reactor all the core fuel had been transferred to the used fuel pool for the periodic inspection. At this time, a hydrogen explosion also took place somewhere supposedly adjacent to the suppression chamber in Reactor No.2, possibly damaging it. On the day of the disaster, the Government issued a Declaration of a Nuclear Emergency Situation (on the Events Involved in the Fukushima Daiichi Nuclear Power Plant), which provided a Prime Minister s (1) Report of Japanese Government to the IAEA Ministerial Conference on Nuclear Safety - The Accident at TEPCO's Fukushima Nuclear Power Stations June, 2011 issued by Nuclear Emergency Response Headquarters 122

150 Decree ordering the residents within a 3-km radius of Fukushima Daiichi Nuclear Power Plant to evacuate and residents within a 3-10 km radius to stay indoors. On the second day, the Government issued a further Declaration of a Nuclear Emergency Situation (on the Events Involved in Fukushima Daini Nuclear Power Plant), which provided a Prime Minister s Decree ordering residents within 3-km radius of Fukushima Daini Nuclear Power Plant to evacuate and residents within a 3-10 km radius to stay indoors, and residents within a 20-km radius of Fukushima Daiichi Nuclear Power Plant to evacuate. On March 15, the Government issued a Prime Minister s Decree to the residents within a km radius of Fukushima Daiichi Nuclear Power Plant ordering them to stay indoors. (2) Designation of the Evacuation Zone, Planned Evacuation Zone, and Emergency Evacuation Preparation Zone In the evacuation zone beyond the 20-km radius of the Fukushima Daiichi Nuclear Power Plant, if radioactive materials locally accumulate and the residents continue to live within the zone, the cumulative dose could increase to a higher level. In addition, there was deep concern that the accident status of the Plant was still unstable. On April 21, according to Article 20.3 of the Act on Special Measures Concerning Nuclear Emergency Preparedness (Act No. 156 of December 17, 1999), the Head of the Nuclear Emergency Response Headquarters (Prime Minister) issued an order addressed to the related prefectural and city governments to designate the area within a 20-km radius of the plant as an Evacuation Zone and to prohibit residents other than those who are engaged in Emergency Response Measures to enter and/or exit the Nuclear Evacuation Zone. On the following day, April 22, the indoor evacuation order within the range of a radius of km from Fukushima Daiichi Nuclear Power Plant was lifted, and the Planned Evacuation Zone and Emergency Evacuation Preparation Zone were established. The Government also issued an order to the residents of the Planned Evacuation Zone and Emergency Evacuation Preparation Zone to make a planned withdrawal for evacuation, or always be prepared for a withdrawal or for indoor evacuation at the time of an emergency. a. Evacuation Zone Some people were identified who still stayed in or entered the designated zone for withdrawal and evacuation. Because it was difficult to ensure the safety of these people, and some impact outside the zone was also feared. The zone was newly designated as an Evacuation Zone to prevent a risk to the lives and health of the residents. Based upon the provision of Article 20.3 of the Act on Special Measures Concerning Nuclear Emergency Preparedness, the Head of the Nuclear Emergency Response Headquarters shall notify local government authorities of the zone that the residents must evacuate (including the area and waters within a 20- km radius of the Fukushima Daiichi Nuclear Power Plant). b. Planned Evacuation Zone In consideration of radiological protection reference values ( msv a year) defined in the International Commission on Radiological Protection (ICRP) and the International Atomic Energy Agency (IAEA), the area where the cumulative quantity of radioactive materials might reach 20 msv within a period of one year from the disaster was designated as the Planned Evacuation Zone. In principle, the residents within the Zone must be evacuated to outside the Zone within approximately one month for the Planned Evacuation. The designated areas included KATSURAO, NAMIE, IIDATE, and part of KAWAMATA and part of MINAMI-SOMA, other than those designated for the evacuation and withdrawal as of March 12 (within a 20-km radius of the Fukushima Daiichi Nuclear Power Plant). c. Emergency Evacuation Preparation Zone Because the accident had yet to settle down, most of the area in the km range was designated as an Indoor Evacuation Zone. The possibility could not be ruled out that indoor evacuation and shelter services would be still in high demand in the future. Therefore, in principle, the former Indoor Evacuation Zone other than the above mentioned Planned Evacuation Zone was designated as an Emergency Evacuation Preparation Zone. The residents in the Zone were required to follow the following points. Chapter 4 Response to the Fukushima Daiichi Nuclear Power Plant Accident Great East Japan Earthquake and Tsunami 123

151 Great East Japan Earthquake and Tsunami Chapter 4 To be always prepared for an emergency evacuation or indoor evacuation at the time of an emergency To continue self-evacuation; in particular, children, pregnant women, people requiring nursing care, and inpatients, etc., should not access the Zone To close nursery schools, kindergartens, elementary and junior high schools, and high schools It was inevitable that some residents needed to access the Zone for unavoidable reasons due to their job. However, in these cases, they also had to be sure to be always prepared for self-evacuation and indoor evacuation by themselves. The population of the Evacuation Zone was approximately 78,000, the Planned Evacuation Zone" approximately 10,000, and the Emergency Evacuation Preparation Zone" approximately 58,500. On the other hand, within some areas outside the Planned Evacuation Zone and the Evacuation Zone, which was not wide enough to be designated as the Planned Evacuation Zone, there were some spots where the cumulative quantity ratio of radioactive materials one year after the disaster was estimated to be more than 20 msv in the air. These areas were designated as the Specific Spots Recommended for Evacuation to warn people residing there of the risk, and to provide and promote support for evacuation. On June 16 a policy based on these measures was released. These Specific Spots Recommended for Evacuation included part of DATE, MINAMI-SOMA, and KAWAUCHI (3) Lifting the Designated Zone Status, etc. On September 30, the Government held a meeting at the Nuclear Emergency Response Headquarters in the Prime Minister's office, and decided on and officially announced the lifting of part of the designated Emergency Evacuation Preparation Zone. The Government took all measures to support people in order for them to return home, including restoration of the schools that had been closed. In accordance with the restoration plan stipulating how municipal governments should provide decontamination and other services, the evacuating residents were to be encouraged to return home if they were ready. It was also decided to rearrange the Exclusion and Evacuation Zones included in the following cities and villages: KAWAUCHI, TAMURA and MINAMI- SOMA according to the decision as of March 30, 2012; IIDATE as of June 15, NARAHA, TOMIOKA, OKUMA, FUTABA and NAMIE as of July 31; OKUMA as of November 30; and KATSURAO, TOMIOKA, and NAMIE as of March 7, The rearranged zones were designated as "zones in preparation for the lifting of the evacuation order," "restricted residence areas," and "difficult-to-return zones. Figure 4-2 Outline of the "zones in preparation for the lifting of the evacuation order," "restricted residence areas," and "difficult-to-return zones Zones in Areas where the annual cumulative preparation for quantity of radioactive materials was the lifting of the evacuation order confirmed to be 20 msv or less Restricted residence areas Difficult-to-return zones Referring to areas where the cumulative quantity of radioactive materials could exceed 20 msv annually, and people residing in these areas had to continue to be evacuated from the viewpoint of reducing their exposure to radioactive materials. These are areas where the annual cumulative quantity of radioactive materials could not be less than 20 msv even when five years have passed, and the current annual cumulative quantity of radioactive materials is more than 50 msv. Figure 4-3 Conceptual diagram of the Exclusion and Evacuation Zones (as of March 7, 2013) Figure omitted 2. JRCS Medical Services (Response to Radiation) (1) Policy for Response to Radiation On March 15, a policy that at present, all activities in an area within a radius of 30 km from the nuclear plant in question (where the disaster occurred) in accordance with the government s response status was determined by a notice given from the Headquarters of Disaster Control (HDC) at the Headquarters to the Secretary General of the Block Representative Chapters. Subsequently, on March 19, a notice on safety measures for medical services in FUKUSHIMA was given by the HDC at the Headquarters to the Secretary General of the Representative Chapter and the other chapters in the 1st Brock. This notice stipulated that a sufficient care should be taken to provide guidance given by the Medical Coordination Headquarters for Emergency Exposure in FUKUSHIMA. And on March 22, a notice was given by the HDC 124

152 at the Headquarters to the Secretary General of the Representative Chapter and the other chapters in the 1st Brock to inform them of the following: 1 For medical teams dispatched to FUKUSHIMA to be accompanied by radiological technicians, if at all possible. 2 To dispatch experts from Hiroshima and Nagasaki Genbaku Red Cross Hospitals (RCHP) and establish a system for providing information and advice on safety measures for medical services. 3 To maintain supplies of protective materials, including dosimeters, protective clothing and medical supplies, etc. On April 22, including the above measures, the following service strategies for medical teams in FUKUSHIMA were issued with a notice from the HDC at the Headquarters. Figure 4-4 Safety measures for medical teams in FUKUSHIMA (April 22, 2011) Safety measures Medical services shall not be provided within the range of 30 km from the Nuclear Plant (changed to within the range of 20 km from June 6). Each medical team shall ensure safety in accordance with the JRCS Radiation Safety Manual (developed through cooperation of both Hiroshima and Nagasaki Genbaku RCHPs) and be provided with a briefing at the time of handover. Emergency and other advice, etc., shall be provided by the Fukushima Chapter / Department of Radiology, Fukushima RCHP. Personal dosimeters (100 sets in total) will be lent to medical teams on active Free rental of service. The alarm shall be set so that it will dosimeters, etc. set off if the cumulative radiation dose reaches 1 msv, and people shall be evacuated if it exceeds this value. Maintenance of protective materials, etc. Recording of the exposure dose For any emergency, protective clothing sets (protective clothing, goggles, N95 masks, gloves) shall always be prepared at the Fukushima Chapter, Aizu Wakamatsu Red Cross Blood Center (RCBC). Geiger counter devices shall be prepared at the Fukushima Chapter. Iodine agents shall always be prepared at the Fukushima RCHP. To record the exposure dose at the time of service, assess human safety based on the recorded data at the end of the service, and manage the record at the Headquarters. (2) Medical Team Services in FUKUSHIMA Initially, after the disaster, medical teams started medical services in various areas in FUKUSHIMA, including the cities and villages along the coast, including MINAMI-SOMA. However, after the news release about the nuclear plant accident, the medical teams that were not prepared for protection from radioactive materials were not assured of their safety. Until March 15, no JRCS policy had been established. Due to these circumstances, Fukushima Chapter, the medical teams belonging to the Fukushima Chapter, coordinators belonging to the Niigata Chapter, doctors, nurse managers and administration staff of the medical teams gathered at the Fukushima Chapter in the evening of March 13 to hold a Medical Team Action Meeting on the radioactive environment. In this meeting, the Fukushima Chapter HDC canceled their medical services under the control of the Head of the Fukushima Chapter due to the fact that the current conditions did not allow them to secure the safety of the medical teams. In the wake of this decision, the medical teams contacted the chapters and hospitals from which they were deployed for instruction. As a result, the teams dispatched outside the FUKUSHIMA were withdrawn from there on the following day. [The Fukushima Chapter HDC and medical teams discussing the services under the radioactive environment (in the evening of March 13 at the Fukushima Chapter)] Firstly, news about the nuclear plant accident was provided to the cities and villages surrounding the plant, and whether or not the medical teams should continue their services was discussed. However, the local medical teams were not equipped with protective gear for providing services in a radioactive environment, and they did not have a policy on how to provide safety measures for the medical services, either. Thus, the deployment of support teams from other Chapters to Fukushima Chapter was forced to be temporarily suspended. Chapter 4 Response to the Fukushima Daiichi Nuclear Power Plant Accident Great East Japan Earthquake and Tsunami 125

153 Great East Japan Earthquake and Tsunami Chapter 4 Figure 4-5 By service day/region/chapter of affiliation Medical team services in FUKUSHIMA (March, 2011) (Note)The Soso Area, others include those other than north part of FUKUSHIMA and those other than the AIZU Area (SOMA, MINAMI-SOMA, IWAKI, Fukushima Airport, etc.), and those covering some areas within the prefecture, and those covering areas within and outside the prefectures. If a medical team had provided services covering within and outside the prefectures, but is not sure when and where (within or outside the prefecture) they provided those services, it shall be deemed that they had served within the prefecture for all service days. Source: Report of the JRCS medical services for the GEJET (As of September 2012) From March 19, Medical Coordination Headquarters for Emergency Exposure in FUKUSHIMA started providing information so that information on safety measures for the medical services within the prefecture was available, along with advice and guidance directly given from experts at the Medical Coordination Headquarters, which was notified from the HDC at the Headquarters as of the same date. The Fukushima Chapter HDC started stationing Medical Advisors for Emergency Exposure from March 22, with protective materials (including dosimeters, protective clothes and medical supplies) prepared from March 25. In other words, when the medical teams provided the services in FUKUSHIMA, they were to receive lectures on basic knowledge regarding radiation and take advice and guidance on how to use the protective gear from Medical Advisors at Fukushima Chapter. The medical teams serving AIZU WAKAMATSU, traveling far from Fukushima City, only received a briefing at the time of the handover among the teams. Figure 4-6 Outline of medical team guidance by the Medical Coordination Headquarters for Emergency Exposure in FUKUSHIMA Services and Responsibilities Safety control Reporting of registration Services Responding to exposed/contaminated patients: Emergency exposure medicine teams Responding to residents: Screening/medical teams Responding to inpatients for transportation: DMAT Zoning: No service within a range of 30 km from the Fukushima Nuclear Power Plant Protection from radiation damage Space dosimeter: More than 20 μsv/h (Evacuation if reaching 100 μsv/h: to inform the headquarters for instruction) Use of a personal dosimeter: To evacuate if it reached 1 msv/h* Measures against internal contamination To wear Tyvek suits To keep iodine tablets in reserve for those under 40 years of age To keep a supply of N95 breathing protection apparatus in reserve Registration using a reporting form Meeting time: 8:00, 20:00 In principle, to withdraw in time for the 20:00 meeting Reporting the contact address to the headquarters; to send a blank to the emergency address to resist to get information. Screening Filling in the Service Report Form These measures allowed the medical teams from outside the prefecture to serve FUKUSHIMA again. Azuma General Gymnasium (in FUKUSHIMA) and Kawahigashi Public Gymnasium (in AIZU WAKAMATSU) functioned as hub facilities for JRCS medical teams services, including those from the Fukushima Chapter. (3) Radiation Advisor Medical Advisors on Emergency Exposure from both the Nagasaki and Hiroshima Genbaku RCHPs permanently stationed at the Fukushima Chapter HDC for a program developed to provide information and advice on safety measures. 126 * The value was mentioned in a notification issued by the HDC at the Headquarters during the disaster. Afterwards, the JRCS s Manual for Relief Activities under Nuclear Disasters was created, in which the description of the value was revised to: To evacuate if cumulative doses reach 1 msv during an activity.

154 Figure 4-7 Services provided by Medical Advisors on Emergency Exposure Duration of Affiliation of Medical Advisor Services 3/22-3/24 Nagasaki Genbaku RCHP 3/25-3/28 Nagasaki Genbaku RCHP Hiroshima Genbaku RCHP 3/28-4/3 Nagasaki Genbaku RCHP 3/28-4/1 Hiroshima Genbaku RCHP 4/3-4/5 Nagasaki University 4/1-4/5 4/5-4/9 4/10-4/13 4/14-4/17 4/17-4/21 Hiroshima Genbaku RCHP 4/21-4/25 Hiroshima Red Cross Blood Centre (RCBC) 4/26-4/29 Hiroshima Genbaku RCHP *Duration of services refers to the service days in FUKUSHIMA. Medical Advisor on Emergency Exposure provides the following services: Radiation Safety Specialists 〇 Briefing before the services on safety measures related matters for medical teams Basic knowledge on radiation How to wear/take off protective suits How to use a dosimeter 〇 Briefing after the services to medical teams on safety measures Health management based upon the dosimeter data Points to remember for life in the future 〇 General advice on radiation to the medical teams 〇 Instructions at the time of an emergency Instructions on wearing protective clothing Evacuation orders 〇 General advice on radiation to the Fukushima Chapter Support staff for Radiation Safety Specialists 〇 Management of protective clothing, dosimeters, etc. The appropriate size for each medical team individual must be available. The protective clothing, dosimeters, etc., shall be on loan, not given. Once a medical team ends its services, these devices should be available for the next medical team Recording of pickup/return Identifying the damage status, etc. 〇 Specific explanation on how to adjust and use dosimeters 〇 Recording of various data from dosimeters To record various data from dosimeters by the medical team staff 〇 Other supporting duties Medical Advisors on Emergency Exposure also instructed seminars four times for evacuees from the earthquake and nuclear accident, volunteers and the press in order to provide correct basic knowledge on radiation. (4) International Committee of the Red Cross (ICRC) Support Experts from ICRC on radiation disasters visited Japan on March 19, providing advice on how the JRCS should respond to the Fukushima Daiichi Nuclear Power Plant accident. The following is the specific advice: the advice included those that had not received radiation hazard training who shall be deemed as amateurs in accordance with the ICRC standards; In this case, they should be told that the maximum permitted value of radiation is 1 msv per service; the medical team staff shall carry a personal dosimeter when providing services; the medical team staff shall take a rest in TOCHIGI or other prefectures at night in order to shorten the period of stay in the radiation affected areas; a system shall be established where advice and guidance from experts is always available; the records shall include how long each staff stayed where, as well as their radiation exposure dose, etc. ICRC also provided 80 units of portable dosimeters for detecting radiation. Figure 4-8 ICRC experts visiting JRCS Mr. Gregor Malich (Head of Nuclear Radiation Biochemistry Operatinal Response Project, ICRC) Mr. Steve Donelly (Technical Advisor of Nuclear Rediation Biochemistry Operational Response Project, ICRC) 3. Medical Services for Temporary Access to a Restricted Area (1) Background until Services Started a. Summary of the Support Project for Temporary Access by Residents The Nuclear Disaster Response (NDR) Local Headquarters established at the Fukushima local government in May 2011 started a support project for local people to gain temporary access to their homes in the Evacuation Zone (restricted area within a radius of 20 km from the Fukushima Daiichi Nuclear Power Plant). For this project, the NDR Local Headquarters established a transfer station within the area and Chapter 4 Response to the Fukushima Daiichi Nuclear Power Plant Accident Great East Japan Earthquake and Tsunami 127

155 Great East Japan Earthquake and Tsunami Chapter 4 within a range of km (the Planned Evacuation Zone, and the Emergency Evacuation Preparation Zone). The residents accessed the Evacuation Zone through the transfer station by bus, and returned to the transfer station again. There were 4 hub stations in total (Bajikoen in MINAMI-SOMA, Kodo- Gymnasium in TAMURA, Kawauchi Municipal Athletic Center, Chuo Gymnasium in HIRONO). The medical teams of the NDR Local Headquarters provided health checks, briefings on health concerns, testing of radiation values after their return from outside the Evacuation Zone, and the checking of the exposure dosage of the residents. They also provided medical services for the injured, if any, at the transfer stations. b. Why JRCS was Involved The medical teams of the NDR Local Headquarters were requested to provide medical services at the transfer stations so that the residents might temporarily access the Evacuation Zone (to temporarily return to their homes). On May 22, one medical team from the Fukushima Chapter was dispatched for this service, which was reported from the Fukushima Chapter to the HDC at the Headquarters on March 17. This also included a request to the Headquarters to provide support because temporary entry into the Evacuation Zone was planned to continue, and other prefectures could be asked to deploy their medical teams if the Fukushima Chapter could not handle the situation. Based on these circumstances, on May 22 one medical team was dispatched to provide medical services for temporary access from the Fukushima Chapter to the public-gymnasium in TAMURA. On the other hand, on May 24, the Ministry of Health, Labor and Welfare made a phone call to the HDC at the Headquarters to report that: Japan DMAT and National Disaster Medical Center were providing medical services for temporary access, and Fukushima RCHP had also deployed medical teams. However, there were increasing opportunities for those in the three local governments to work together and this permitted the residents to access their homes temporarily. Including for the care of elderly people, they requested an increase in the number of the JRCS teams to be assigned. Responding to the above, the HDC at the Headquarters and the Medical Department decided to assign the Fukushima Chapter deal with it after discussions between them. The Fukushima Chapter then deployed medical teams on May 25, 26 and 27 as well. And on June 1, the Fukushima Chapter again requested the HDC at the Headquarters to adjust and coordinate the deployed teams in all blocks since medical services support in a sustainable way was necessary for those accessing the Evacuation Zone in which it was expected there would be challenges to face in the future. From the above circumstances, the HDC at the Headquarter was to deploy medical teams serving to support temporary access to the restricted areas. On June 6, the restriction area for medical services was revised to the 20 km-zone, which made it possible to expand services at the transfer stations established within the km zone. [Medical services for temporary access to restricted areas (Bajikoen, MINAMI-SOMA)] c. Outline of the Medical Services In principle, a JRCS medical team deployed to Bajikoen in MINAMI-SOMA, consisted of four staff (one doctor, two nurses, and one administrative staff). (However, we asked for the dispatch of two administrative staff if the team uses a vehicle owned by the Chapter deploying the medical team). A medical team also organized after February 2012, was to consist of three staff (two nurses and one administrative staff) in principle, excluding cases where a doctor was to be deployed, because the medical transportation system was already redeployed to local sites. According to the itinerary, the staff should enter the Fukushima Chapter by 16:00 on the day prior to the service, receive a briefing at the Chapter, then move to their accommodations (within Fukushima city). After providing the services for a couple of days, the staff returned to Fukushima Chapter, going to the Fukushima Station then home after being picked up/ 128

156 returned by the Chapter. As conditions for the service, the following points were presented in a notice issued by the HDC at the Headquarters. Medical equipment that the medical teams bring Medical equipment and materials owned by the Fukushima Chapter shall be used; only personal equipment shall be brought (helmets, lace-up shoes are not necessary) Relief uniform and plain clothes Radiation materials/equipment (dosimeters, etc.) had already been prepared at the Fukushima Chapter Vehicles used by medical teams Vehicles in service will be those used by medical teams of the Fukushima Chapter Medical care sets used for medical services shall be loaded onto the vehicles (2) Service Performance Medical services had been repeatedly provided for temporary access to the restricted areas. JRCS medical teams were dispatched for the 1st round (May - August, 2011), 2nd round (September December, 2011) and 3rd round (February March 2012). In total, 87 JRCS medical teams were engaged in these services totaling 132 days. A support project for temporary access to the restricted areas had been decided on and implemented considering the opinions of the local residents. Accordingly, the requested days for deployment by the residents gradually increased. However, because the medical teams of the NDR Local Headquarters did not present any requests for a planned deployment, it was difficult to adjust and coordinate the deployment services. Initially, Fukushima Chapter deployed medical teams. This coordination was carried out within the 1st Block Chapter to cope with the increasing number of requests for their services. However, as it became difficult to keep responding to these requests after July in the 1st round, HDC at the Headquarters requested the 2nd Block to deal with the deployment of services. A 2nd round was provided by the 1st Block, mainly from the Fukushima Chapter. A 3rd round was again carried out by 2nd Block. And those that had urgently determined and requested the deployment of services on and after March 10 were dealt with by the medical teams deployed by the Miyagi and Fukushima Chapters. Figure 4-9 Medical services for temporary access to a restricted area May 10 - December 31, 2011 (1st -2nd rounds) February 11 - March 31, 2012 (3rd round) Chapter name No. of medical No. of medical Days of service teams dispatched teams dispatched Days of service HOKKAIDO 2 3 AOMORI 5 10 IWATE 1 2 MIYAGI AKITA 3 5 YAMAGATA 3 6 FUKUSHIMA Subtotal IBARAKI TOCHIGI GUNMA SAITAMA CHIBA TOKYO KANAGAWA NIIGATA YAMANASHI 2 4 Subtotal Total The 1st Block The 2nd Block 4. Other Services (1) Humanitarian Response Project In 2011, the International Federation of the Red Cross and Red Crescent Societies secretariat to prepare a "Humanitarian Response Project" (tentative name) to examine specific concepts towards implementing the Human Impact of a Nuclear Accident (Draft)" at the IFRC General Assembly (2011) was set up on September 1, The secretariat had provided study sessions three times concerning the radiation impacts, etc. On November 2, 2011, we invited Dr. Ivan Ushichenko, President of the Ukrainian Red Cross Society and two other members of their staff to Japan. He gave a presentation entitled, Chernobyl Humanitarian Support and Rehabilitation Projects, to the JRCS staff, to explain how the Ukrainian Red Cross Society had responded to the Chernobyl Nuclear Accident. Chapter 4 Response to the Fukushima Daiichi Nuclear Power Plant Accident Great East Japan Earthquake and Tsunami 129

157 Great East Japan Earthquake and Tsunami Chapter 4 In addition, financial support from overseas shall be allocated to the budget required to administer the secretariat. [Mr. Ushichenko, President of the Ukrainian Red Cross Society (JRCS Headquarters)] On January 6, 2012, we invited Mr. Akira Sugaya, Mayor of MATSUMOTO, NAGANO, to give a presentation on "Nuclear Hazards and Radiation Exposure Lessons Learnt from Medical Support after the Chernobyl Accident", as a mayor struggling with disaster prevention and local medical care to protect the life and property of the citizens, and as a doctor who had been involved in providing medical services in Chernobyl and still had a good knowledge of local information. Furthermore, on February 16, 2012, we invited Ms. Tomoko Kusama, Dean of the Oita University of Nursing and Health Sciences to give a presentation on "Lessons Learnt from an INES Level 7 Nuclear Accident, as a promoter of disaster prevention, including nuclear disaster control measures, and nursing education. On April 1, 2012, the Secretariat for Nuclear Hazard Measures was established at the Disaster Management and Social Welfare Department of the Headquarters in order to prepare for the same project. The duties of the secretariat were to discuss the implementation of the humanitarian response after a nuclear accident, Humanitarian Response Project after a Nuclear Accident (tentative title) as follows. (1) Development of universal guidelines on humanitarian support after a nuclear hazard (2) Following up monitoring, etc., on the health of victims, etc. (3) Studying the environmental impacts after a nuclear accident (4) Establishing a Data Center for a nuclear accident (5) Other training functions, maintenance of Memorial Hall functions, etc. (2) Contribution to Nuclear Disaster Control Measures of the International Red Cross and Red Crescent Movement (RCRC) In order to contribute to following up the Resolution on the Humanitarian Impact of a Nuclear Accident" at the IFRC General Assembly in 2011, we held a "National Society Consultation Meeting on Nuclear Disaster Preparedness" at the JRCS Headquarters for three days from May 14, 2012, to identify the importance of developing international guidelines for supporting nuclear disaster victims. (3) Response to Nuclear Hazards through the Project for Support for Post-Disaster Recovery from the GEJET JRCS is now engaged in improving the environment based upon a good knowledge of radioactive exposure impacts, as well as contributing to a project in order to alleviating the situation of people with unease concerning the nuclear accident /radiation doses through a Project on Support for Post-Disaster Recovery from the GEJET and other services provided by the related Departments. a. Contributing to Health Management for the Fukushima People As a means of support for medical equipment (whole body counters (WBC), etc.) used for Surveys on the Prefectural Residents Health Management Program by Fukushima Medical College, we donated a set of testing equipment/apparatus to the College, as well as installing a WBC at the Fukushima RCHP. From April, 2012, we conducted surveys on health management as a delegated task from Fukushima city. b. Responding to a Survey on Health Management for Evacuees living outside FUKUSHIMA As a survey on health management for evacuees living outside FUKUSHIMA, 17 RCHPs across the nation provided health care support in 2012, continuing the service from c. Donation of Devices to Measure Radiation in Materials Used for Meal Services and Domestic Cooking To measure the radiation dosage from food, we donated 77 devices to FUKUSHIMA, 29 devices to NIHONMATSU and KAWAUCHI, and 3 to MIYAGI. 130

158 d. Summer Camp Program Inviting children from the three disaster-affected prefectures (IWATE and MIYAGI, FUKUSHIMA), we organized a summer camp program for 4 days and 3 nights, 11 times from July 21 to August 23, 2012, to promote children s mental stability and healthy growth. e. Construction of a Temporary Gymnasium To help promote education for children in the evacuation areas, we constructed a temporary gymnasium in IIDATE to support the construction of temporary gymnasiums around schools in the disaster affected areas that had been completed by April f. Play Areas inside Buildings To provide a space to play for children who feel uneasy and cannot play outside, we established a Smile Park in FUKUSHIMA in February 2012, followed by 6 sites in 4 cities (including those planned) within the prefecture in FY2012. g. Health and Safety Seminars and Exchange Meeting for Evacuees from the Nuclear Accident To promote mental and physical health for evacuees living in temporary housing, we organized workshop of health and safety and exchange parties such as a Red Cross Health Class in temporary accommodations, etc. h. Lectures on Health Related Matters For the 160,000 Fukushima people who had been evacuated within and outside the prefecture, we invited instructors from the Louis Pasteur Center for Medical Research to give lectures that helped improve their knowledge of radiation and health care. i. Child Safety Course (Short Course) including Basic Knowledge on Radiation and Prevention Measures In order to provide correct knowledge on radiation and prevention measures for families with small children as part of the short-term workshops for infant safety, we organized Child-Raising Support Network Programs in cooperation with the Co-op at 14 Chapters totaling 27 times (including those scheduled). services and behavioral standards for medical teams, as well as a Code of Conduct for medical teams, focusing on conformity with the behavioral standards provided by Japan DMAT and the ICRC in order to contribute to improving the disaster preparedness capacity of the medical team staff. In addition, we will strengthen the equipment and materials required, provide an environment for training or seminars, promptly deploy Emergency Radiation Exposure Advisors to the Chapters HDC in the three disasteraffected areas, and provide appropriate advice and guidance to the medical team staff. k. Training for Experts We concluded an agreement with Hiroshima University to promote cooperation on the education and study areas regarding emergency radiation exposure, and promoted these achievements. This agreement also aims at improving the expertise of JRCS professionals in radiation and disaster medical care. We are now working on promoting the attendance of medical staff in a leading program in doctoral education at the graduate school at the same university. l. Introduction of Nursing Education to Cope with Nuclear Accidents We are now reviewing the current disaster nursing education, and discussing the addition of a seminar program on nuclear plant accidents in order to develop basic knowledge on radiation among medical team staff through RCHP nurses seminars at the Japanese Red Cross Institute for Nurse Manager and related facilities. m. Response to Healthcare Needs in IWAKI Nurses, public health nurses and other related professionals deployed by the RCHP and the Japanese Red Cross College of Nursing visited about 2,000 NAMIE residents currently evacuated to IWAKI to research their healthcare needs, making proposals on healthcare and welfare measures based on the results. Chapter 4 Response to the Fukushima Daiichi Nuclear Power Plant Accident j. Developing a Code of Conduct for Medical Services in the Event of a Nuclear Hazard In preparation for the occurrence of a nuclear hazard, we are currently developing guidelines for medical Great East Japan Earthquake and Tsunami 131

159 Great East Japan Earthquake and Tsunami Chapter 4 b. Timing of its Establishment Planned for the second half of FY2013. [Nurses conducting an interview survey on the health condition of the residents] (4) Establishment of the Red Cross Nuclear Disaster Resources Center As part of the main program of the Human Response Project in the event of a Nuclear Accident, we are now planning/preparing a Red Cross Nuclear Disaster Resources Center. c. Organization This center shall be established in the JRCS Headquarters. In the Fukushima Chapter, a local office to collect and file information sent from FUKUSHIMA shall be established. In addition, "Radiation Protection Advisors shall be appointed to provide advice and guidance on information and achievements pertaining to the nuclear disaster. These Advisors shall be appropriately selected from among those with a good knowledge of radiation risks other than the JRCS, medical professionals from Hiroshima and Nagasaki Genbaku RCHPs and Fukushima RCHP. a. Purpose of the center Establishment JRCS shall establish a Nuclear Disaster Resources Center to disseminate information on nuclear disaster control measures including, in particular, disaster relief services, radiation prevention measures and healthcare management, and to provide recommendations to governments, as well as to disseminate information that can contribute to guidelines for National Red Cross and Red Crescent Societies (NS) in other countries. This center has the following four roles. To record and file JRCS services pertaining to nuclear disaster management in FUKUSHIMA (disaster relief and health care for children) To disseminate local information based on interview surveys conducted by JRCS staff and volunteers; cooperate with local governments and promote rehabilitation support programs and seminars, etc. Based on this information and data, to collect and file information obtained by organizing symposiums, participating in related meetings, and communicating with other institutions. In particular, to disseminate information pertaining to nuclear disaster control measures; specifically disaster relief or on how to protect people from radiation, promote healthcare management and conduct archiving. To assess the aspects of the response to a nuclear disaster that JRCS should deal with in future for all of its services, make recommendations to governments, and disseminate information that needs to be provided to NS in other countries. 132

160 Chapter 5 Psychosocial Care

161 Great East Japan Earthquake and Tsunami Chapter 5 Chapter 5 Psychosocial Care 1. Development of the Psychosocial Care Program (1) Psychosocial Care of the Japanese Red Cross Society (JRCS) a. Concept and Scope of the Psychosocial Care Program of the JRCS The psychosocial care program of the JRCS is based on the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings of the Inter-Agency Standing Committee (IASC), which is composed of United Nations agencies and various other humanitarian support organizations. These guidelines provide direction on both mental health (psychiatric care) and psychosocial support (psychosocial support and other forms of support). The psychosocial care provided by the JRCS adopts the latter concept of psychosocial support from the International Federation of Red Cross and Red Crescent Societies (IFRC). The classification between psychiatric care and psychosocial care of the JRCS is listed below: Figure 5-1 Classification of Psychological Care Psychological care in a broad sense Mental health Psychosocial support Psychiatric care Psychological therapy Social support Psychological support Psychiatrist Psychotherapist Health nurse Psychological care staff of the JRCS Other Psychosocial care Psychosocial care of the JRCS The psychosocial care program of the JRCS does not aim at treatment by providing such psychiatric care, but at a) listening to the sufferings of the affected people and establishing a sense of safety by talking about the stress they feel and how to cope with it, b) taking responsible for referring the affected people to psychiatrists if it is considered that they need the help of specialists, and c) supporting the work of the health nurses in the affected communities through these activities. Besides the psychosocial care team of the JRCS, teams dispatched from national and prefectural government staff and form hospital staff within and outside the regions engage in the psychosocial care work in the affected areas. While centering on their role as psychiatrists, these teams implement care similar to psychiatric care; the psychosocial care of the JRCS also needs to take responsibility for referring the affected people to psychiatrists if they are considered to need the help of specialists. b. The rule for the psychosocial care staff Psychosocial care staff members are dispatched on the basis of the decisions made by the Head of the Chapter in the affected area in principle, and the dispatched staff operates under the leadership of the Head of the Chapter in the affected area. The Headquarters for Disaster Control (HDC) of the Chapter in the affected area quickly identifies the situation and needs of the affected people, develops an action plan for psychosocial care work, conducts the management and coordination of this work, and technically supports the psychosocial care staff 1. Figure 5-2 JRCS Guidelines on Psychosocial support at the time of disaster. (Decisions regarding psychosocial care implementation) 4. In principle, whether the psychosocial care work is conducted or not at the time of a disaster is determined by the Head of the Chapter quickly and voluntarily. (Management of the staff) 6. The staff operating in an affected area shall be under the leadership of the Head of the Chapter in the affected area. (Implementation requests from the Headquarters) 8. When a chapter in the affected area is required to conduct psychosocial care over the long term and requires the dispatch of psychosocial care staff from chapters outside the affected area, the Headquarters coordinates the dispatch from chapters throughout the country while maintaining close contact with the receiving chapter. Moreover, the staff of the (1) Chapter 2, 2 (Psychosocial Care Implementation Manual) 134

162 Headquarters can also be dispatched as required. (Psychosocial Care Center) 12. The Head of the Chapter in the affected area shall establish a Psychosocial Care Center as part of the Chapter HDC, and is required to integrate it with the overall care work. Note that any chapter can request the dispatch of psychosocial care staff members from other chapters throughout the country if there are not enough staff members in the affected chapter due to the large scale of the disaster. The Headquarters coordinates the dispatch in this case. The Head of the Chapter in the affected area can establish a Psychosocial Care Center in order to integrate overall psychosocial care work as required. (2) Decision on the action policy for the Great East Japan Earthquake and Tsunami (GEJET) The JRCS conducted the full-fledge practice of psychosocial care in the Niigata Chuetsu Earthquake of October Since the scale of the disaster in the case of the GEJET was far larger than this one, large-scale activities were developed, such as the long-term, wide-ranging nationwide coordination of the dispatch of personnel. As for the dispatch of psychosocial care staff involved in the GEJET, the psychosocial care was mainly conducted to accompany medical teams immediately after the disaster in response to the Policy for the Future Dispatch of Medical Teams (Draft) released on March 13, 2011, which notes that the medical teams to be dispatched shall be accompanied by psychosocial care staff as far as possible and carry out meticulous relief activities according to the needs. The psychosocial care staff members, most of whom were nurses, were often dispatched as part of the staff members of medical teams, especially immediately after a disaster. On the other hand, on March 13, two psychosocial care instructors immediately headed to the Ishinomaki Red Cross Hospital (RCHP), and started psychosocial support for the disaster victims around ISHINOMAKI, MIYAGI, separately from the activities involved in accompanying the medical teams. They were supposed to be dispatched to a site in New Zealand from March 11 to 22 in order to support the people affected by the New Zealand Earthquake. In addition, independent psychosocial care teams were dispatched to ISHINOMAKI from the 2nd block at almost the same time. Along with these actions, on March 15, in the Ishinomaki RCHP expart of phychosocial and health care team gatherd from the Hospital in and outside of MIYAGI and started operations in the Ishinomaki Medical Region. In addition, in IWATE, although the psychosocial care had initially been conducted by accompanying the medical teams, a Psychosocial Care Center was established at the HDC in the Iwate Chapter on April 9, and independent psychosocial support activities were launched. In IWATE, the Center tried to coordinate with each organization concerned, as well as conduct needs assessments, including the propriety of continuation in the areas where psychosocial support activities had been deployed. Besides this, it dispatched Dr. Makishima of the JRCS Medical Center as a psychosocial care coordinator 2 from April 8 to August 12, aiming at providing advice and guidance on psychosocial support. Furthermore, based on the Policy for the Future Dispatch of Psychosocial Care Staff to the GEJET Disaster-Stricken Areas, the HDC at the Headquarters provided notification to each chapter that in principle the medical teams to be dispatched should be accompanied by two or more psychosocial care staff members (if it is impossible to be accompanied by psychosocial care staff in an individual medical facility, the staff shall be coordinated and dispatched within a chapter and a block, and it shall arrange cars to travel to the site in case the psychosocial care staff members need to operate independently away from the medical teams. Along with the activities of the independent psychosocial care teams, the psychosocial care staff continued to operate to accompany medical teams in IWATE and MIYAGI as well. The dispatch was conducted based on coordination by a block according to the policy for dispatch. Chapter 5 Psychosocial Care (2) A psychosocial care coordinator was appointed in order to avoid confusion over information caused by the input of psychosocial care staff from different regions for short periods, and to coordinate local psychosocial care by staying in the region for a long period. Until the end of November, Dr. Makishima was requested to work as a psychosocial care coordinator and took part in the activities in the Chapter, the project, Kokoro no Kizuna and the like, after the withdrawal of the psychosocial care teams. Great East Japan Earthquake and Tsunami 135

163 Great East Japan Earthquake and Tsunami Chapter 5 However, it faced difficulties to ensure sufficient staff to form a balance with the medical team staff, since most of the care staff were nurses, and to provide liaison/coordination staff for the dispatch of independent teams. In this earthquake disaster, the activities of the psychiatrist teams and various bodies dispatched at the national level were deployed based on requests from the affected prefectures, etc., besides the JRCS, which left many issues such as confusion caused by differences in the perception of the role of operations and activity areas. (3) Overview of the psychosocial care activities a. Number of staff operating in Psychosocial Care In total, 1,016 people were engaged in the psychosocial care activities of the JRCS from March 11 to September, 2011 (Figure 5-3). Of these, there were 288 staff accompanying medical teams and 728 staff in independent psychosocial care teams. In addition, besides those reporting from the Headquarters, all medical teams of the Fukushima Chapter were engaged in psychosocial care activities. Figure 5-3 Number of Staff Operating in Psychosocial Care Accompanying type Team type (Number of teams) Total IWATE (39teams) 560 MIYAGI (87teams) 439 FUKUSHIMA TOCHIGI 1 1 TOTAL (126teams) 1,016 Souce: Prepared by the Relief Activities Reports of the JRCS in GEJET (As of September 2012) b. Number of staff operating in Psychosocial Care The cumulative number of psychosocial care staff was 4,058 (Figure 5-4). From March to April many staff operated to accompany medical teams, but subsequently, the psychosocial care was gradually activated as independent psychosocial care teams partly because a Psychosocial Care Center was established in IWATE. The most active month was June, with the cumulative number of working staff at over 1,000 for the month. In August, the number gradually declined. On September 1, the dispatch of psychosocial care teams ended from the non-affected prefectures. During this period, the teams provided 14,039 disaster victims with psychosocial care in the three affected prefectures, MIYAGI, IWATE and FUKUSHIMA as a whole. Figure 5-4 Number of Staff Operating in Psychosocial Care (Unit: Cumulative number of staff) Team type Accompanying type IWATE MIYAGI FUKUSHIMA IWATE MIYAGI FUKUSHIMA TOCHIGI IWATE MIYAGI FUKUSHIMA IWATE March April May June July August September MIYAGI FUKUSHIMA IWATE MIYAGI 0 47 Source: Prepared by the Relief Activities Reports of the JRCS in GEJET (As of September 2012) FUKUSHIMA IWATE 228 MIYAGI FUKUSHIMA IWATE MIYAGI FUKUSHIMA 136

164 Figure 5-5 Number of Staff Operating in Psychosocial Care by Block IWATE MIYAGI FUKUSHIMA TOCHIGI 1B 548 2B 1,090 3B 539 4B 702 5B 6B ,000 1,200 (Unit: Cumulative number of staff) Source: Prepared by the Relief Activities Reports of the JRCS in GEJET (As of September 2012) Furthermore, the activity performance in each prefecture was as follows: cumulative total of 2,205 staff in IWATE, 1,803 staff in MIYAGI, 49 staff in FUKUSHIMA and 1 staff person in TOCHIGI. In addition, as for each block unit of dispatched resources, many staff members were dispatched from the 2nd block close to the three affected prefectures, which involved a cumulative total of 1,090 psychosocial care staff. Moreover, under the coordination of the JRCS Headquarters, the 1st, 2nd and 4th blocks conducted their activities around IWATE, and the 3rd, 5th and 6th blocks operated around MIYAGI. Furthermore, as for the block units, each block dispatched almost equal numbers of staff to the disaster areas and provided psychosocial support (Figure 5-5). (4) Psychosocial care for the staff dispatched to the site and the Headquarters staff a. Preparation of a mental health support flow chart for the dispatched staff of the JRCS Before the disaster occurred, there were no JRCS guidelines concerning psychosocial support for the staff in advance of and after their dispatch to the affected areas, and organizational efforts lagged behind. Therefore, the JRCS prepared a mental health support flow chart for the dispatched staff with advice from Mr. Sota Shimozono of the Japanese Ground Self Defense Forces (SDF) Medical School immediately after the GEJET (Figure 5-6). The completed flow chart was distributed to JRCS facilities nationwide through the Headquarters and block representative chapters in March 17, after being put to a HDC meeting at the Headquarters and gaining its approval. There were no guidelines on days off after completing the tasks, etc., up to then. Thus the completed flow chart helped to integrate the JRCS as a whole, including psychosocial support for the dispatched staff after the completion of their tasks. b. Preparation of messages for the staff Ishinomaki RCHP established a room for refreshing and relaxation for the hospital staff and sent messages to them. This was introduced by the Headquarters as well, allowing for the fact that even staff members who were not dispatched to the affected areas may feel much stressed. In March 25 the message made in the hospital was modified for the Headquarters, and displayed in the lavatories in order to draw attention of every staff member (Figure 5-7). [A psychosocial care staff member listens to the voices of children] Chapter 5 Psychosocial Care Great East Japan Earthquake and Tsunami 137

165 Great East Japan Earthquake and Tsunami Chapter 5 Figure 5-6 The JRCS Mental Health Support Flow Chart for the Dispatched Staff Figure 5-7 Messages for the Staff members 138

166 c. Mental health of the initial medical teams A questionnaire survey was conducted to understand the mental health of staff members who were engaged in relief activities of the initial medical teams in the areas affected by the GEJET (Figure 5-8). In addition, as a result of asking what they did to relieve stress after being dispatched, nearly half of the respondents stated took time off and talked to friends, colleagues or family members about my own experience (Figure 5-10). Figure 5-8 Outline of the Survey on Mental Health Name: Questionnaire Survey on Mental Health (1) Purpose of the survey Understand the stress levels of the JRCS staff who are engaged in relief activities for in GEJET and consider psychosocial support for the dispatched staff during relief activities. (2) Period of the survey August 5-September 22, 2011 (3) Subjects of the survey -Staff members of the initial medical teams (medical teams including deru and DMAT) *In this survey, the initial actions are intended for those in attendance on March 11, Staff members of the independent psychosocial care teams dispatched to MIYAGI in March. -Psychosocial care staff accompany the medical team dispatched to IWATE in March (4) Number of questionnaire respondents Number of questionnaire respondents (percent of respondents): 363 respondents (including psychosocial care staff: 98 persons) (5) Attributions Gender: Male (197 persons), Female (163 persons), Not given (3 persons) Age: 20s (52 persons), 30s (131 persons), 40s (121 persons), 50s (59 persons), Unknown (0 person) Occupation: Doctor (45 persons), Nurse (164 persons), Clerical position (113 persons), Pharmacist (18 persons), Others (20 persons), Not given (3 persons) Respondents evaluated the stress in the operations (pain) using an 11-point scale, rating from not painful at all (0) to very painful (10). The whole average score was 4.96 and one third of the respondents indicated each of the ranges of 0-3, 4-6 and 7-10 (Figure 5-9). Figure 5-9 Stress during the Operations (pain) (n=356) (Average: ) (Person) Figure 5-10 Talked with the members dispatched together Talked with one's superior or manager of the facility Talked with friends, colleagues or a family member about my own experience Received counseling Things the members did in order to Relieve Stress after the Dispatch (Person) Took time off 193 Did nothing much 355 respondents (including multiple answers) Others The results showed the current situation that some staff members felt stress during the relief activities, In adittion, it revealed to cope with the stress after these activities. (5) Psychosocial care activities by the trainees of the JRCS Institute for Nurse Managers In GEJET, since prolongation of the disaster response activities was expected due to its scale and range, the dispatch of trainees had been considered early in the JRCS Headquarters. However, the dispatch of trainees was rejected once, because the trainees are required to attend four-fifths or more in the class for each subject in the Nurse Administrator Training I (April 12-July 22, 2011), a course to gain a qualification for the first level of Certified Nurse Administrator. On the other hand, the psychosocial care coordinator engaging in care support in IWATE reported that it was difficult to obtain the number of psychosocial care staff required despite the rising need for psychosocial care at that time. Thus, in order to find a way to dispatch trainees to the disaster areas while assuring their training, only applicants was dispatched during the early May holiday season. Nineteen trainees applied for this, and the psychosocial care center in the Iwate Chapter was asked to coordinate the activities as well as prepare the good required for the activities such as uniforms, the necessities for the work, the means of transportation, accommodation and the like. As a result of this coordination, it was decided to send the trainees to RIKUZENTAKATA with three psychosocial care instructors, including full Chapter 5 Psychosocial Care Great East Japan Earthquake and Tsunami 139

167 Great East Japan Earthquake and Tsunami Chapter 5 time teachers of the Institute for Nurse Managers. The trainees, divided into three groups, flexibly operated to suit the requirements of the affected people, etc., at various places such as evacuation centers and the geriatric health services facility in RIKUZENTAKATA. The contents of the operation were: to provide health counseling and a mobile clinic, to provide massages to the support staff, to set up a place to relax, to active listening to the affected people while helping them with their moving to temporary housing; and to support the cleaning of the body for people in nursing homes and the like. Approximately 300 staff members were involved over three days from May 1 to 3. This was also a valuable experience for the trainees. 2. Activities in the three Chapters in the affected areas (1) Activity status in the Iwate Chapter a. Activity status of the psychosocial care staff in IWATE In IWATE, the psychosocial care staff started operations in March 13 by accompanying medical teams. From April 4 to August 12, Dr. Makishima of the JRCS Medical Center was dispatched as the psychosocial care coordinator. On April 9, a Psychosocial Care Center was established and an independent psychosocial care teams also started operations. Until the end of March, the psychosocial care staff had operated by accompanying medical teams and a cumulative total of 187 staff were engaged for that month. From April, the activities of the independent psychosocial care teams had increased (the activities of accompanying medical teams decreased because of this). From April to July, the cumulative number of staff was about 400 per month. Figure 5-11 (Unit: Cumulative number of staff) Number of Staff Operating Psychosocial Care in IWATE Team type Source: Prepared by the Relief Activities Reports of the JRCS in GEJET (As of September 2012) 66 Accompanying type March April May June July August September In IWATE, the JRCS was responsible for RIKUZENTAKATA, YAMADA and KAMAISHI. The psychosocial care coordinator and the Iwate Chapter dispatched clinical psychotherapists, who are psychosocial care instructors of the JRCS, as coordinators for each district in operation and put them in charge of the overall coordination. The staff dispatched as coordinators were clinical psychotherapists who belong to the Psychosocial Support Center for GEJET. This organization was established by the Japanese Society of Certified Clinical Psychologists and the Association of Japanese Clinical Psychology. In an agreement between the JRCS and the Japanese Psychological Support Center for The GEJET, they were dispatched as psychosocial care volunteers of the JRCS to each district within IWATE. (The agreement of the JRCS and the Japanese Psychological Support Center for GEJET is described later.) b. Distinctive activity status of the Iwate Chapter After the withdrawal of the psychosocial care teams, the Iwate Chapter started psychosocial care in cooperation with the Society of Certified Clinical Psychologists in IWATE. While the movement of persons from the evacuation centers to temporary housing was proceeding, concern about the collapse of traditional communities and the lack of communication among the residents was raised. Thus, this activity was conducted aiming at strengthening the local communities and promoting recovery through the formulation of communities, the establishment of mutual support among the affected people, and support for independence. Every Saturday the support team visits the temporary housing and tried to make the evacuees feel relaxed by listening to them while having tea with them or measuring their blood pressure. The psychosocial support activities of the Iwate Chapter started on September 10, 2011, and were held a total of 50 times and engaged a cumulative total of 1,276 people up to September 22, The location of the activities held was at the Nakasato temporary housing in Miyako, but moved to the Takahama temporary housing in the same city in July, (From July to August the care activities were conducted at the Nakasato and the Takahama temporary housings every other week, and in September moved completely to the Takahama temporary housing.) 140

168 In addition, the clinical psychotherapists belonging to the Society of Certified Clinical Psychologists in IWATE, as well as the staff of the Iwate Chapter and the JRCS volunteers, participated in these activities. The cumulative total number of participants reached 283. Psychosocial Care Center of the Miyagi Chapter as the base, which was established in the Ishinomaki RCHP. Dr. Makishima, who had operated as the psychosocial care coordinator in IWATE from April, joined those in MIYAGI and provided guidance from May. The Psychosocial Care Center of the Ishinomaki RCHP coordinated not only the JRCS teams, but also other teams and appointed a clinical psychotherapist of the hospital as a coordinator. The coordination had the difficult task of smoothly coordinating all the psychosocial care teams, partly because it was necessary to coordinate with psychiatrists who had medical knowledge. Figure 5-12 Number of Operating Staff in Psychosocial Care in MIYAGI [Psychosocial support activity at the former Kamaishi Daiichi Junior High School] (2) Activity status in the Miyagi Chapter a. Activity status of the psychosocial care staff in MIYAGI IIn MIYAGI, on March 13, two psychosocial care instructors arrived at the Ishinomaki RCHP. At the almost same time, the psychosocial care teams from the 2nd block started operations, and on March 15, the independent psychosocial care teams took over its work. From April to August, a cumulative total of over 200 staff per month were engaged in psychosocial care activities. [A psychosocial care staff member listening to a disaster victim at the evacuation center within ISHINOMAKI] The JRCS psychosocial care teams jointly operated as members of the psychosocial care team with the support teams of the prefectural organizations, doctors, universities and other organizations with the (Unit: Cumulative number of staff) Team type Accompanying type March April May June July August September Source: Prepared by the Relief Activities Report of the JRCS in GEJET (As of September 2012) b. Distinctive activity status of the Miyagi Chapter On June 18, 2011, the Miyagi Chapter started operations by organizing a unique psychosocial care team that put volunteers (including the Society of Certified Clinical Psychologists in MIYAGI) at the center of the activities, in parallel with the operation of the psychosocial care teams dispatched from each chapter. Every Saturday and Sunday they operated at evacuation centers in ISHINOMAKI and ONAGAWA, and listened attentively, and provided consultations while performing relaxation. For the children recreational spaces were provided, which they enjoyed. The Specific Red Cross Volunteer Corps such as the Nursing Volunteers (health counseling, etc.) and the Beauty Care Volunteers (hot compress treatment, etc.) entered the evacuation centers and listened attentively to the disaster victims in order to help them to relieve stress, whereas the Community Red Cross Volunteers Chapter 5 Psychosocial Care Great East Japan Earthquake and Tsunami 141

169 Great East Japan Earthquake and Tsunami Chapter 5 Corps provided something cold such as shave ice, and the Youth Volunteers were enjoying recreational activities with the children outside the centers. These activities were conducted through cooperation among the Specific, Community and Youth Red Cross Volunteers Corps. At the evacuation centers, these activities were conducted 33 times in total and provided psychosocial care for 1,776 people up to October 15, The Nursing and Youth Volunteers, and clinical psychotherapists belonging to the Society of Certified Clinical Psychologists in MIYAGI were involved in these activities. The cumulative number of participants reached 336. (3) Activity status in the Fukushima Chapter a. Activity status of the psychosocial care staff in FUKUSHIMA In FUKUSHIMA, the psychosocial care staff started operations from March 20 by accompanying medical teams. Since the disaster situation in the Fukushima Chapter was different from that in IWATE and MIYAGI, a cumulative total of only 49 staff were involved in psychosocial care in the Fukushima Chapter. A Psychosocial Care Center was not established in the Fukushima Chapter. Figure 5-13 Number of Operating Staff in Psychosocial Care in FUKUSHIMA (Unit: Cumulative number of staff) Team type Accompanying type March April May June July August September Souce: Prepared by the Relief Activities Reports of the JRCS in GEJET (As of September 2012) [Scenes of psychosocial support activities by the Miyagi Chapter] Moreover, even after the activities ended at the evacuation centers, the psychosocial care started at temporary housing from October 22, They initially prepared hot meals, and provided relaxation and recreation opportunities, etc., but gradually increased consultation activities by visiting people from house to house. When the staff distributed pamphlets to inform people of the weekend activities, staff members listened attentively to the people they spoke to as well. At the temporary housing, a total 23 periods of activities were carried out, providing psychosocial care for 931 people until the end of September A cumulative total of 243 participants, including Red Cross Volunteers and clinical psychotherapists, were involved in the same way as in the activities at the evacuation centers. FUKUSHIMA has the characteristics of the disaster such as the large number of evacuees and small number of injured people due to the impact of the Fukushima Daiichi Nuclear Power Plant Accident, and the long distance between the disaster areas and the evacuation centers. Thus many of consultations received by psychosocial support operations concerned health issues associated with the nuclear accident. Furthermore, in the Fukushima Chapter, all staff members of the medical teams provided psychosocial support as well as relief activities. Besides, based on the status of local evacuation centers that the Chapter knew about, the Chapter also requested the HDC at the Headquarters to dispatch psychosocial care staff in a document of March 27, b. Distinctive activity status of the Fukushima Chapter The Fukushima Chapter also has carried out various distinctive activities, after the end of the psychosocial support activities by the teams dispatched from various areas. One of these activities was the Red Cross Health Class at the evacuation centers in 142

170 FUKUSHIMA, which started from September 9, These are intended to prevent disuse syndrome and provide care prevention for people with concerns about the health of their mind and body due to the difficult living conditions, as well as to reduce the feeling of isolation and loneliness caused by the collapse of communities. Mainly the Red Cross Volunteers organize activities such as health checks, healthy life courses and fun parties. The Red cross Health Class was held total 21 times, 8 times in FY 2011 and 13 times before September 11 in FY 2012, involving a cumulative total of 1,017 paticipants. In addition, the Red Cross Health Lectures were held for Fukushima residents who were concerned about their health due especially to the Fukushima nuclear power plant accident, which included lectures by doctors and specialists on radiation, and relaxation activities provided by the Red Cross Volunteers. A cumulative total of 470 people participated in these lectures, which were conducted one time in FY2011 and four times as of September FY2012. Figure 5-14 Activities by the Fukushima Chapter Name The JRCS Nordic Style Walking Movie screenings The JRCS Workshops for protecting life and health Smile Parks in FUKUSHIMA Summary The practice of Nordic Style Walking, walking using two poles, which helps increase whole body endurance and strengthens the muscles of both the upper and lower body, as well as reducing stress and overcoming a lack of physical exercise by walking outside while chatting with others. Screening of movies suitable for recovery support Holding workshops on first aid (e.g. methods of cardiopulmonary resuscitation and defibrillation through the use of an AED [automated external defibrillator]), a healthy life course, and a life course for the elderly at the time of a disaster Provision of places to have good fun and get exercise for preschool children who lack exercise and bear a psychological burden because of the limited opportunities for outside activities due to concerns about radiation exposure from the nuclear power plant accident; Provision of permanent playground equipment (e.g. a ball pool, cyber wheel and air track) and various programs (e.g. a kids exercise club, storytelling using picture books, information panel exhibitions of the JRCS projects, and hometown art). Chapter 5 Psychosocial Care [Relaxation activities by nurses of the Red Cross Blood Center - Azuma Gymnasium] Other activities were carried out mainly by the Fukushima Chapter as follows. Social events for residents in the evacuation area Organize events (single-day) to provide opportunities for the residents evacuated from NAMIE (aged 65 years or more) who are living in the temporary housing to communicate with the residents still in this area before GEJET. Great East Japan Earthquake and Tsunami 143

171 Great East Japan Earthquake and Tsunami Chapter 5 3. Cooperation with local government bodies and other parties concerned (1) Cooperation with local government bodies and health care centers a. Activities of the psychosocial care teams dispatched by the Ministry of Health, Labour and Welfare (MHLW) Under Article 30 of the Basic Law on Natural Disasters, the affected local municipalities shall request the Government of Japan (GoJ) to arrange the dispatch of psychosocial care teams (in relation to the GEJET, IWATE, MIYAGI, FUKUSHIMA and SENDAI requested the dispatch of psychosocial care teams) and accept psychosocial care teams from other prefectures through the MHLW. A cumulative total of 57 teams and 3,498 staff were dispatched to the affected areas through the MHLW (as of 14:00, March 23, 2012, according to the 2011 Disaster Situation and Response to the GEJET by the MHLW <116th Report> ). The psychosocial care teams that were dispatched based on requests to the GoJ fully coordinated with the prefectures (a mental health and welfare center in each prefecture handled this) before deciding which local municipalities that they will take charge of. The GEJET: Psychosocial Care Team Activity Manual in the Affected Areas Ver. 2 published by the National Institute of Mental Health, the National Center of Neurology and Psychiatry (NCNP) describes the psychosocial care teams dispatched to the affected municipalities. In the section on the Structure of Psychosocial Care Teams, it defines them as a team composed of multiple staff who are from various professional backgrounds as follows (the appropriate number in the team should be considered in light of its ability to travel by car). -Psychiatrist, -Nurse, Public health nurse, -Psychiatric social workers, -Child Mental health specialist (e.g. pediatric psychiatrist, clinical psychotherapist), and -Due to the assurance of communications with the staff and logistics, it is useful if a driver and clerical staff accompany them. Besides, including those from the JRCS not all teams that operated in the disaster area as psychosocial care teams were dispatched through the MHLW. In some cases the prefectural government directly requested medical institutions to dispatch psychosocial care teams. For example, IWATE accepted teams dispatched through personal communications with doctors within the prefecture. These teams were registered as psychosocial care teams at the Iwate Figure 5-15 Flow of the Dispatch of the Psychosocial Care Team (2) Matching between the affected government bodies and the dispatching institutions by the MHLW based on a request for the dispatch Dispatching Institutions of the 各都道府県の心のケアチーム Psychosocial Care Teams in each prefecture 派遣機関 (3) Dispatch the teams after coordinating with the local government bodies in the affected area. 厚生労働省 The MHLW (1) Local government bodies in the affected area request the MHLW to dispatch teams Local Government 被災地の行政機関 Bodies in the affected ( 各都道府県の精神保健福祉センター areas (e.g. mental health and welfare centers in など each ) prefecture) (4) Allocate the teams to each area after coordinating with a health care center and local municipalities, etc. in each area. Evacuation Centers or Psychiatric 被災地の避難所 精神科医療 Care Organizations, etc., in the affected 機関など areas Source: Prepared by partly adding to and modifying the GEJET: Psychosocial Care Team Activity Manual in the Affected Areas Ver. 2, the NCNP 144

172 Mental Health Welfare Center and operated in the allocated areas on an equal basis with teams dispatched through the GoJ. b. Cooperation between the JRCS and local government bodies/health care centers The psychosocial care teams dispatched to the affected areas through coordination by each prefectural government are to operate by sharing roles and information under rules set by the health care centers or local municipalities in the appropriate area by region. It is important to establish this cooperation not only among the dispatched psychosocial care teams, but also with local public health nurses who travel to evacuation centers and housing within the affected areas, as well as others. Thus the activities proceeded through sharing information on evacuees who have a possible problem. For example, in the Ishinomaki region, a clinical psychotherapist from the JRCS coordinated the psychosocial care teams as a liaison. In the early period after the disaster they had a meeting every day and shared the information with the public health nurses of the city and the psychosocial care teams. Through these opportunities, the leaders of the evacuation centers or health care nurses traveling to the evacuation centers and housing within the disaster areas continually provide information to the psychosocial care teams when they recognized evacuees with a problem. In addition, in IWATE, the psychosocial care liaison provided coordination for the Iwate prefectural government or local municipalities regarding the dispatch destination at the start of the psychosocial support activities of the JRCS. The Iwate prefectural government or local municipalities also adjusted their activities in order to gain further understanding of the JRCS psychosocial support activities, as well as to support them in the most suitable way in each municipality. As a result of these consultations in advance, in MIYAKO, IWATE the psychosocial care teams of the JRCS were able to operate as health support teams. Since they could operate in a way that was suitable for the municipal governments (framework), as the accepting site, the Miyako Health Care Center also could respond smoothly, resulting in very high reputation for the activities of the JRCS. (2) Cooperation with the Japanese Society of Certified Clinical Psychologists, etc. In case of the GEJET disaster, the JRCS concluded an agreement with the Japanese Psychosocial Support Center for GEJET ( the Psychosocial Support Center ), which was established by the Japanese Society of Certified Clinical Psychologists and the Association of Japanese Clinical Psychology, and operated the psychosocial care in collaboration with them. In March 15, 2012, the JRCS offered the Psychosocial Support Center cooperation in the psychosocial care activities, and then the care activities were able to start collaboratively on March 20. Moreover, from March 23 to 27, the JRCS psychosocial care teams and the Psychosocial Support Center jointly dispatched an advance team and visited the affected areas in MIYAGI and IWATE (ISHINOMAKI, MORIOKA, MIYAKO, YAMADA, KAMAISHI and RIKUZENTAKATA) and evacuation centers in the affected areas. As a major activity through cooperation between the JRCS and the Psychosocial Support Center, joint psychosocial care teams were deployed five times in the Ishinomaki area in MIYAGI and RIKUZENTAKATA in IWATE from April 7 to June 30. The joint psychosocial care teams included one or two staff so that a clinical psychotherapist joined in the JRCS psychosocial care team as a care volunteer of the JRCS psychosocial care. While measuring blood pressure, etc., the JRCS nurse provided the care, whereas the accompanying clinical psychotherapist listened attentively especially to people who seemed to have a problem. In addition, the clinical psychotherapist not only listened, but also provided professional care where needed. The joint team operated 21 days in total and a cumulative total of 60 clinical psychotherapists of the psychosocial support center engaged in these activities. Furthermore, at the start of the dispatch of clinical psychotherapists to the disaster areas, the JRCS and the Psychosocial Support Center jointly held training workshops on psychosocial care at the time of a disaster. A total of three workshops, two in IWATE and one in AKITA, were held with approximately 160 participants. Through these activities, the Psychosocial Support Center appreciated the opportunity to gain know-how on JRCS activities at the time of a disaster. There are other on-going forms of collaboration among each prefecture. In IWATE in cooperation between Chapter 5 Psychosocial Care Great East Japan Earthquake and Tsunami 145

173 Great East Japan Earthquake and Tsunami Chapter 5 the Iwate Chapter and the Society of Certified Clinical Psychologists in IWATE, psychosocial care was conducted at evacuation centers in MIYAKO from April to August. It operated 58 days in total and a cumulative total of 130 clinical psychotherapists were dispatched from the Society of Certified Clinical Psychologists in IWATE and other areas. After the withdrawal of the JRCS psychosocial care teams, the Society of Certified Clinical Psychologists in IWATE conducted the psychosocial support in cooperation with the Iwate Chapter. Also in MIYAGI, the Society of Certified Clinical Psychologists in MIYAGI provided psychosocial support in collaboration with the Miyagi Chapter. From June to August, 2011, a cumulative total of 38 clinical psychotherapists were involved. In addition, after the withdrawal of the JRCS psychosocial care teams, the Society of Certified Clinical Psychologists in MIYAGI also conducted psychosocial care at evacuation centers and temporary housing in collaboration with the Miyagi Chapter and this collaboration continues. [A scene of the civic medical symposium for citizens - Iwate Prefectural Hall] (3) Participation in the Kokoro no Kizuna Project The JRCS participated in the project, Human-care: Kokoro no Kizuna Project. This project was developed mainly by GlaxoSmithKline plc, a major global pharmaceutical company, through industry-governmentacademia collaboration for the purpose of providing psychosocial support for people in disaster areas. From July 23 to September 4, 2011, the project traveled to a total of 56 places for temporary housing, community centers and meeting places in IWATE, MIYAGI, and FUKUSHIMA, involving 1,633 participants. This project conducted health seminars and held tea parties. In the health seminars, clinical psychotherapists provided lectures on stress prevention and opportunities for participants to get exercise. In addition, in the tea parties, clinical psychotherapists or nurses who had been trained in psychosocial care listened to the participants and provided the care in a professional way where needed. Other than the health seminars or the tea parties, they conducted sport seminars, harp performances, concerts by professional singers, storytelling or drawing parties for children and oil massages for staff of the municipalities. 146

174 Chapter 6 Distribution of Relief Supplies

175 Great East Japan Earthquake and Tsunami Chapter 6 Chapter 6 Distribution of Relief Supplies 1. The Situation in the Headquarters (1) Outline of the Distribution of Relief Supplies by the Japanese Red Cross Society (JRCS) The JRCS stocks relief supplies and distributes them at the time of a disaster, based on the JRCS Disaster Relief Rules and Operations Planning. Relief supplies for the affected people are categorized as blankets, emergency kits, sleeping kits and other items. An "emergency kit" is a set of goods that are deemed necessary for daily life immediately after a disaster, such as a portable radio, an electric torch, bandages, paper plates, eating utensils, a booklet entitled "Health Symptoms You Should Pay Attention to at the Time of a Disaster". A "sleeping kit" is a set including a camping mat, a pillow, an eye mask, a set of earplugs, and a pair of slippers and socks. The "blankets", "emergency kits" and "sleeping kits" are stocked at the Headquarters and at all chapters. The "other items" include additional supplies that are stocked in individual chapters, such as mats in the Fukushima Chapter and bath towels in the Iwate Chapter. Although it does not provide water, food, clothing, etc., as relief supplies, the JRCS also procured and distributed these goods based on requests from local municipalities, including ISHINOMAKI, in this earthquake disaster. As for distributing relief supplies such as necessities for [Blankets] [Emergency kits] [Sleeping kits] daily life, the Regional Disaster Prevention Plans of the three affected prefectures, such as IWATE, MIYAGI and FUKUSHIMA, state that; (i) local municipalities shall identify the requirements of the affected people, and then procure, and distribute the supplies; (ii) if it is not possible for local municipalities to procure these supplies, they shall request the prefectural government to procure them or nominate agencies to supply them. The prefectural government shall secure supplies after coordinating with the national government, the traders concerned and other entities. The JRCS also operates its relief activities based on the Regional Disaster Prevention Plan adopted by each municipality. Each chapter continually maintains a stock of a given amount of relief supplies for every branch within the prefecture. If the scale of the disaster is small enough to be dealt with using the existing stocks of its own, the chapter distributes supplies to the branches close to the affected areas, based on requests from the departments of municipalities or the Social Welfare Council. If, however, the scale of the disaster is too large to be handled using its own stocks the chapter in the affected area also mobilizes supplies from the stocks of chapters within the block, in coordination with the representative chapter of the block. Furthermore, the chapters in the affected areas can request the Headquarters to coordinate the supplies if the scale of the disaster is much greater. Meanwhile, whenever such requests were made, the Headquarters coordinates supplies that are stocked in the Headquarters and chapters throughout the nation through the representative chapters of the blocks. Then the relief supplies are delivered from the Headquarters and directly from chapters throughout the country to the chapters, local municipalities and distribution points for in the affected areas. In this mega disaster, the Headquarters, coordinated the supplies of the Headquarters and chapters through the representative chapters of the blocks, and then delivered them to the requesting chapters in the affected areas. The delivery was conducted by private companies that had stand-by agreements with the Headquarters to provide transportation for relief supplies at the time of a disaster. As a general rule, any chapter in a block that includes 148

176 the chapters of affected prefectures supports the work of the transportation of supplies through the representative chapter of its own block. In this disaster, however, the Miyagi Chapter, which is the representative chapter for the first block covering the HOKKAIDO and TOHOKU regions, was itself affected by the disaster, so that chapters in the unaffected prefectures within the block and neighboring chapters outside the block made direct contact with affected chapters without going through the Miyagi Chapter and delivered the supplies to the affected chapters that had made the requests. following the disaster (GoJ distributed the largest number of blankets on March 16). This shows that the JRCS distributed blankets very quickly. 400, , , , ,000 Figure 6-2 Trend in the cumulative Total Number of Distributed Blankets Number of pieces GoJ JRCS (2) Distribution of relief supplies a. Distribution track record of relief supplies In the JRCS relief activities related to this disaster, a total of 148,493 blankets, 38,437 emergency kits and 15,406 sleeping kits were distributed, of which 105,510 blankets, 28,818 emergency kits and 12,500 sleeping kits were distributed to the three prefectures of IWATE, MIYAGI and FUKUSHIMA ,000 80,000 60,000 40,000 20,000 Figure 6-1 Number of Distributed Relief Supplies (Coordinated by the Headquarters) 0 1,000 88,490 42,983 16,020 IWATE MIYAGI FUKUSHIMA Other prefectures 16,398 10,920 9,619 6,000 1,500 5,000 1,500 2,906 Blankets (pieces) Emergency kits (kits) Sleeping kits (kits) A large contribution of relief supplies supported by the JRCS involved the distribution of blankets for the initial response. The JRCS distributed approximately 88,000 blankets over five days from March 11 to 15. This accounts for approximately 60% of the total number of blankets distributed by the JRCS. In comparison with this, the Government of Japan (GoJ) distributed approximately 97,000 blankets over the initial five days. This accounts for only 24% of the total (409,672 blankets) distributed by the GoJ. Furthermore, the largest number of blankets distributed by the JRCS was on March 12, the day 150, ,000 50, /11 3/12 3/13 3/14 3/15 3/16 3/17 3/18 3/19 3/20 3/21 (Note) The data for March 15 of the GoJ is the total number of blankets distributed from March There was no daily data before March 14. Source: Prepared from the data of the General Affairs Department at the Headquarters and data of the healthy life support team for the affected people b. Evaluation of relief supply distribution by affected people A questionnaire survey was conducted six months after the disaster as follows to obtain feedback on JRCS activities from affected people. Figure 6-3 Summary of the Questionnaire Survey of the affected people Name: Survey on the Great East Japan Earthquake and Tsunami (GEJET) of 2011 (1) Purpose of the survey Obtain feedback from the affected people on JRCS activities (2) Period of the survey September 10-25, 2011 (3) Subjects of the survey The affected people of evacuation centers or temporary housing in KAMAISHI and RIKUZEN-TAKATA, IWATE, KESENNUMA and ISHINOMAKI, MIYAGI, and FUKUSHIMA, FUKUSHIMA (4) Numbers of questionnaires distributed/respondents Questionnaires distributed: 874 Questionnaire respondents (percent of respondents): 474 (54%) (5) Attribution Sex: Male (193 persons), Female (251 persons), Not given (30 persons) Age: 20s (9 persons), 30s (30 persons), 40s (65 persons), 50s (78 Chapter 6 Distribution of Relief Supplies (1) These figures do not include the distributed relief goods to the affected areas that had been stocked in the affected prefectures for a disaster, whereas they include the goods in stock at each chapter. Great East Japan Earthquake and Tsunami 149

177 Great East Japan Earthquake and Tsunami Chapter 6 persons), 60s (106 persons), over 70s (165 persons), Not given (21 persons) The survey shows that over 90% of the respondents indicated that all the relief goods such as blankets, emergency kits, and sleeping kits were very useful or relatively useful, suggesting that the relief goods were helpful for the affected people. Over 80% also reported that those goods were distributed at the time they were required or distributed at the time required to some extent, suggesting that they were mostly distributed at the time they were needed. (3) Status of support for facilities In the event of a natural disaster, it is also necessary to supply daily necessities for the activities of chapters, Red Cross Hospitals (RCHPs) and Red Cross Blood Centers (RCBCs). Especially for RCHPs in the affected areas, in addition to the necessities including medical supplies, food, water and fuel for the RCHP staff and inpatients at ordinary times, there is a growing need for goods in order to accept injured people from the disaster. When it is difficult to procure these goods in the affected areas, the Headquarters and neighboring chapters support the facilities. Figure 6-4 Results of the Questionnaire Survey of Affected People Relatively useful as a relief supply:21% Usefulness of the blanket (n=263) A little useful as a relief supply:2% No idea:1% Not useful as a relief supply:1% Timing of the distribution of the blanket (n=262) Blankets were distributed at no particular time, 11% Few blankets were distributed at the time they were needed, 8% No idea:1% Blankets were distributed in a sufficient number and at the time they were needed, 28% Very useful as a relief supply:75% Usefulness of the emergency kits Blankets were distributed at the required time to some extent, 52% Timing of the distribution of the emergency kits (n=170) Not useful as a relief supply, 2% A little useful as a relief supply:3% Relatively useful as a relief supply 31% No idea1% (n=157) Emergency kits were distributed at no particular time, 12% Few emergency kits were distributed at the No idea:2% time they were needed, 3% emergency kits were distributed in a sufficient number and at the time they were needed, 25% Very useful as a relief supply 63% emergency kits were distributed at the required time to some extent, 58% (n=105) A little useful as a relief supply:6% Relatively useful as a relief supply :28% Usefulness of the sleeping kits Not useful as a relief supply:0% No idea:2% Very useful as a relief supply:64% Timing of the distribution of the sleeping kits Few sleep kits were (n=110) distributed at the time they were needed, 3% Sleep kits were distributed at no particular time,13% No idea:1% Sleep kits were distributed in a sufficient number and at the time they were needed30% Sleep kits were distributed at the required time to some extent, 53% 150

178 In the three affected prefectures by this disaster, there are four RCHPs, such as the Morioka, Ishinomaki, Sendai and Fukushima and three RCBCs, of which three facilities including the Ishinomaki RCHP, Sendai RCHP and Miyagi RCBC accepted supports from the Headquarters for their facilities. Among these facilities the Ishinomaki RCHP could barely escape from the disaster because it is located on the coast and could maintain its function, so that a large number of patients and affected people were taken in at the time of the disaster, and afterwards the hospital continued to accept emergency patients totaling several times the number in ordinary times. At peak times, 70 teams of medical and nursing staff were staying there, thus the need for large quantities of various goods arose. Furthermore, even though the Ishinomaki RCHP managed to obtain relief goods, including medical goods from MIYAGI, and received generous donations from all over the country, they were not always sufficient. Thus the Headquarters provided relief goods, such as blankets and food, based on the requests from the RCHP. Figure 6-5 Track record of support for facilities Distribution destinations Ishinomaki RCHP Sendai RCHP Arrival date Items Procurement method Packages of instant Donation noodles (27,000 meals) Mar. 12 Food (e.g. Retort-pouch rice 1,000 meals) Donation Instant cup noodles (1,500 pieces) Donation Blankets (2,000 pieces) Stocks Mar. 13 Formula (144 cases) Diapers (244 cases), etc. Donation Mar. 15 Blankets (3,000 pieces) Stocks Mineral water (4,300 bottles) Donation Emergency kits (2,100 kits) Stock Mar. 17 T-shirts (900 pieces), underpants (1,300 pieces), sanitary goods, etc. Purchased Mar. 18 Cooked and dried packed rice (20,000 meals), crackers (10 boxes), Donation water (120 boxes), etc. Mar. 19 Instant noodle (30,000 pieces) Donation Mar. 22 Blankets (380 pieces) Stocks Mar. 23 Food Donation Mar 30 Retort-pouch curry (1,000 meals) Donation Mar. 31 Rice (1,200 kg) Donation Mar. 31 Various foods (e.g. canned food) Purchased Apr. 2 Emergency toilets (200 units) Stocks Apr. 2 Nursing bottle antiseptic Purchased solution (200 bottles) Apr. 12 Water tanks (12 pieces) Purchased Mar. 13 Heavy oil (14 kl) Purchased Mar. 19 Mineral water (2 10t-trucks) Donation Mar. 26 Frozen food (2,000 meals) Purchased Distribution destinations Miyagi RCBC Arrival date Mar. 21 Items Gasoline, Kerosene, (1,170 L in total) Procurement method Donation Mar. 27 Gasoline (400 L) Donation Source: Prepared from the data of the General Affairs Department at the Headquarters (4) Procurement of goods a. Procurement from stocks The JRCS mainly stores principal items around the country. Before the disaster, at the end of December 2010, the total inventory of stocks was approximately 210,000 blankets, approximately 80,000 emergency kits, and approximately 30,000 sleeping kits. The 84.4% of total blankets (105,510 pieces) that were distributed to the three affected prefectures through the Headquarters were procured from the stocks of the Headquarters and chapters in non-affected areas. Emergency kits and sleeping kits were procured from the stocks. Comparing the inventory number by block before the disaster to the number of released goods related to the disaster, the percent of blankets released in the 1st and 2nd blocks was higher because these blocks are largely covered the affected areas. In the 2nd block, part of CHIBA and IBARAKI were damaged; blankets were supplied within the prefecture, as well as were preferentially distributed based on their proximity to the affected areas (IWATE, MIYAGI, FUKUSHIMA). In view of the percent of contributions by item, blankets were procured mostly from nearby blocks. On the other hand, as for sleeping kits and emergency kits there is no association between the distance and the percentage of the release. Approximately 70% of the blankets and approximately 50% of sleeping kits and emergency kits in stock were distributed during this relief activity. b. Procurement by purchasing In order to meet the needs immediately after the disaster, blankets, which were requested in large numbers at the initial stages of the disaster event, were partly procured by purchasing from distributors instead of waiting for delivery from the chapters. Other items were also purchased including various foods, fuel and commodities for facilities support, and clothes, portable gas cooking stoves, commodities, partitions and the like for the evacuation centers depending on the needs at the site. Major procurement Chapter 6 Distribution of Relief Supplies Great East Japan Earthquake and Tsunami 151

179 Great East Japan Earthquake and Tsunami Chapter 6 goods and distribution destinations by purchasing are described as Figure 6-7. The JRCS could not ensure that the requested commercial products could be made available in this disaster, despite agreements on commodity procurement (with charge) with Ito- Yokado Co., Lawson, Inc. and Familymart Co. the JRCS, and coordinated their delivery to the affected areas. It had no choice but to reject many offers because it was impossible to develop a system for the timely distribution of a large variety of relief goods except for blankets, emergency kits and sleeping kits in accordance with the needs in the disaster areas. Figure 6-6 Numbers of Relief Goods in Stock before the GEJET and Release Goods related to the Disaster in each chapter Stock before the disaster 2 (at the end of Dec. 2010) (pieces, kits, sets) Blankets Emergency kits Sleeping kits Number of Release related to the disaster (pieces, kits, sets) Blankets Emergency kits Sleeping kits Headquarters 25,660 7, ,521 7, st block 15,437 12,958 3,392 15,851 6, nd block 49,874 13,430 6,942 57,804 5,340 2,682 3rd block 33,629 13,647 6,992 17,640 4,113 6,140 4th block 33,230 9,913 4,045 19,241 6,253 2,000 5th block 25,729 12,959 3,360 8,950 6,849 2,010 6th block 27,449 10,424 5,333 5,486 1,884 1,960 Total 211,008 80,409 30, ,493 38,437 15,406 (Note) Includes release supported by other blocks. Source: Prepared from the data of the General Affairs Department at the Headquarters Figure 6-7 Distributed Goods Procured by Purchasing Arrival date Items Amount Delivery places Mar. 21 Clothes Approx. 14,000 pieces Ishinomaki Sports Park Mar. 25 Partitions Evacuation centers in 350 sets IWATE (6 places) Portable gas Mar. 26 cooking stoves 1,400 sets Ishinomaki Sports Park Mar. 31 Handbarrows 800 units Ishinomaki Sports Park (Note) Excludes relief goods for facilities support. Source: Prepared from the data of the General Affairs Department at the Headquarters c. Procurement by donation As the JRCS does not in principle accept the donation of goods, it did not encourage people to provide support through the donation of goods at the time of this disaster. This is because it is difficult to distribute donated goods to meet the needs of the affected people as the timing is critical. In the case of this disaster, however, the JRCS accepted the donation of goods that matched the needs and that were available in certain quantities among those goods that were requested to be directly donated to Figure 6-8 Distributed Goods Procured by Donation Arrival date Mar. 19 Item Mineral water Mineral water Amount 1 10t-truck 4 10t-trucks Mar. 20 Mineral water 2 10t-trucks Distribution destinations Fukushima Medical University Kikuta Terminal (FUKUSHIMA) Sasaya Warehouse (FUKUSHIMA) Mar. 22 Mineral water 6 10t-trucks Sendai Unyu Soko K.K.. Mar. 25 Mar. 26 Masks Toothbrushes Clothes (underwear) Clothes (underwear) Sanitary goods, Dry-cell batteries Alcohol disinfectant gel 10,000 pieces Ishinomaki Sports Park 10,000 pieces Ishinomaki Sports Park 22,000 pieces 15,000 pieces 1 10t-truck 50,000 pieces Approx. 10,000 pieces Rikuzen-takata Yokota Elementary School Ofunato Takkon Elementary School Thermal, sweatabsorbent underwear Ishinomaki Sports Park 2,500 pieces Mar. 29 Clothes 120,000 pieces Mar. 30 Rice 10t Mar. 31 Light oil, Kerosene 300 L Apr. 11 Dry-cell batteries Approx. 130,000 pieces (Note) Excludes relief goods for facilities support. Source: Prepared from the data of the General Affairs Department at the Headquarters d. Procurement from each chapter Besides blankets, emergency kits and sleeping kits, the goods that were procured by each chapter itself in the prefectures were delivered to the affected areas. Mainly the chapters that were close to the disaster areas, such as those in the HOKKAIDO, TOHOKU and KANTO regions sent various goods including food, drinking water and commodities to the affected areas. Above all, YAMAGATA sent many goods to affected areas mainly MIYAGI locating next to YAMAGATA. (2) Since the chapter s own procurement goods were not included in this inventory list, the actual stocks were more than is shown. 152

180 Figure 6-9 Distributed Goods Procured by each chapter Hokkaido Chapter Iwate Chapter Akita Chapter Yamagata Chapter Items Release date Release amount Release places Disposable diapers, masks, gowns, etc. Mar ,416 pieces Ishinomaki RCHP Disposable diapers Mar ,440 pieces Ishinomaki RCHP Disposable diapers Mar. 18 9,802 pieces Nodamura village Council Bio air refresher Mar. 24, pieces Masks Mar ,900 pieces Cassette cooking gas cylinders, dry-cell batteries, etc. Mar. 27, pieces Nurse shoes Apr pairs Cassette cooking gas cylinders, dry-cell batteries, etc. Solar charging systems for mobile phones Apr. 15 May 12 4,001 pieces LED desk lumps May pieces Kamaishi Daiichi Junior High School Kamaishi Daiichi 25 units Junior High School and other 3 places Kamaishi Daiichi Junior High School and other 3 places Ofunato Support Network Masks Jun. 17 4,577 pieces Center Bottled water (500 ml) Mar. 14 2,310 bottles Iwate Iwate Headquarter of Disaster Control(HDC) Energy-supplement food Calorie Mate Mar. 14, 5,520 pieces Iwate local HDC Beach towels Mar pieces HANAMAKI, YAMADA, etc. Dust masks Apr. 9 10,000 pieces Iwate local HDC Storage of goods whose destination was not yet determined Masks Apr ,000 pieces Morioka RCHP Sleeping bags Apr. 15 1,698 pieces Rikuzen-takata Daiichi Paper fans 13:00, Jun pieces Junior High School T-shirts 13:00, Jun. 16 Rikuzen-takata Daiichi 1,627 pieces Junior High School Clothes Aug. 6-7 Moving Star Festival 100 pieces hall, RIKUZEN-TAKATA Festive red rice Mar. 13 2,000 pieces Miyagi Chapter Rice balls Mar pieces Miyagi Chapter Rice balls Mar pieces Drinking water (1L) Mar. 14 4,350 bottles Pocket warmer Ishinomaki RCHP Mar. 14 2,400 pieces Hokkairo Cooked rice by a Mar kg soup kitchen Chinese dumplings Mar meals Tsurumaki Child s Bread rolls Mar. 18 House (SENDAI) 800 pieces Snacks, candies (3 pieces) Mar packs Yamagata Chapter Items Release Release Release date amount places Bottled tea (345 ml) Mar. 18 Tsurumaki Child s 1,080 bottles House (SENDAI) Snacks, candies (3-5 pieces) Mar. 18 2,714 sets White rice Mar. 18 1,000 meals Rice Mar kg Miyagi Chapter Packed meal Mar packs Snacks, candies (3-4 pieces) Mar sets Bread (2 pieces/pack) Mar packs Packed meal Mar packs Snacks, Candies (3-4 pieces) Mar. 19 Bread (2 pieces/pack) Mar packs 31 sets Miyagi RCBC Packed meals Mar packs Miyagi Chapter Packed meals Mar packs Miyagi RCBC Packed meals Mar packs Miyagi Chapter Packed meals Mar packs Miyagi RCBC Packed meals Mar packs Miyagi Chapter Packed meals Mar packs Miyagi RCBC Bottled tea (345 ml) Mar. 22 1,008 bottles Miyagi Chapter Bread (2 pieces/pack) Mar packs Miyagi Chapter Kesennuma Social Cooked rice Mar. 23 1,020 meals Welfare Council Bottled tea (345 ml) Mar. 23 Kesennuma Social 1,080 bottles Welfare Council Snacks, Candies Mar. 23 Kesennuma Social 13,200 packs Welfare Council Packed meals Mar packs Miyagi Chapter Packed meals Mar packs Miyagi RCBC Packed meals Mar packs Miyagi Chapter Packed meals Mar packs Miyagi RCBC Packed meals Mar packs Miyagi Chapter Packed meals Mar packs Miyagi RCBC Rice snacks, Candies Mar. 25 (3 kinds, 500 cases) Cooked rice (60 Mar. 25 pieces 17 cases) 10,000 packs 1,020 pieces Bread (2 pieces/pack) Mar packs Kesennuma Social Welfare Council Chapter 6 Distribution of Relief Supplies Great East Japan Earthquake and Tsunami 153

181 Great East Japan Earthquake and Tsunami Chapter 6 Items Margarine (20 pieces 18 boxes) Release date Mar. 25 Release Release amount places Kesennuma Social 360 pieces Welfare Council Packed meals Mar pieces Miyagi Chapter Packed meals Mar pieces Miyagi RCBC Release Release Release Items date amount places Kesennuma Social Socks Apr. 16 5,295 pairs Welfare Council Chinese rice porridge (360 g 12 pieces) Apr. 16 1,135 cases Kesennuma Social Welfare Council Packed white rice Mar meals Ishinomaki RCHP Canned rice porridge Apr ,920 cans Kamaishi HDC Yamagata Chapter Snacks, Candies (8 kinds, 585 cases) Bread (2 pieces/ pack) Jam (20 piece 8 boxes) Mar. 27 Mar. 27 Mar ,020 packs Ishinomaki RCHP 350 packs Packed meals Mar pieces 160 pieces Miyagi Chapter Packed meals Mar pieces Miyagi RCBC Packed meals March pieces Miyagi Chapter Packed meals Mar pieces Miyagi RCBC Packed meals Mar pieces Miyagi Chapter Packed meals Mar pieces Miyagi RCBC Packed meals Mar pieces Miyagi Chapter Packed meals Mar pieces Miyagi RCBC Azulene mouthwash solution Azuleone Gargle liquid 1% Fluticasone Nasal Solution 25 μg for Pediatric Isei 56 sprays Mar. 30 Mar bottles Ishinomaki RCHP 300 bottles Ishinomaki RCHP Surgical masks Mar. 30 2,000 pieces Fukushima Chapter Azulene mouthwash solution Azuleone Gargle liquid 1% Mar. 30 9,680 bottles Fukushima RCHP Packed meals Mar pieces Miyagi Chapter Packed meals Mar pieces Miyagi RCBC Cheese sausages Apr cases Cooked rice (200 g 20 pieces) Sea bream rice (375 g 20 pieces) Chicken fried rice (375 g 20 pieces) Rice boiled with edible wild plants (180 g 20 pieces) Apr. 16 Apr. 16 Apr. 16 Apr cases 55 cases 6 cases 75 cases Kesennuma Social Welfare Council Yamagata Chapter Fukushima Chapter Ibaraki Chapter Canned rice porridge Apr ,920 cans Kesennuma HDC Relief Goods Coordinating Canned rice porridge Apr ,360 cans Group at Miyagi HDC Wheel chairs May units Fukushima Chapter Rice (30 kg 35 sacks, 10 kg 33 May 17 sack, 5 kg 7 sacks, 2 kg 4 sacks) Milk Cake (50 May 17 packs) Nabisco RITZ May 17 Crackers (6 pieces) Canned rice porridge Jun. 2 Canned rice porridge Jul. 8 Aluminium mats Disposable masks Living ware (towels, work gloves, disposable chopsticks) Disposable masks Mar. 11- Mar. 15- Mar. 19- On a continuing basis Commodities sets Mar. 14 Commodities sets Mar. 17 Commodities sets Mar. 17 Commodities sets Mar. 18 Commodities sets Mar. 28 1,423 kg Watari HDC, MIYAGI Watari HDC, 20 boxes MIYAGI Watari HDC, 50 boxes MIYAGI 624 cans Fukushima Chapter 1,248 cans Fukushima Chapter 1,000 pieces FUKUSHIMA and 7 other places 864,800 pieces KORIYAMA, IWAKI, etc. Little by little Evacuation centers in FUKUSHIMA, SOMA, etc. 235,200 pieces FUKUSHIMA, etc. 30 sets CHIKUSEI 650 sets KITAIBARAKI 20 sets NAKA 330 sets TONE 30 sets TSUKUBA 154

182 Tochigi Chapter Chiba Chapter Tokyo Chapter Kanagawa Chapter Items Release date Release amount Release places Portable beds Mar units Otawara RCHP Futon bedding sets Mar sets Evacuation centers within TOCHIGI Futon bedding sets Mar sets Otawara RCHP Dry shampoo Mar pieces Haga RCHP Hardtack Mar pieces Fukushima Chapter Drinking water Mar L Fukushima Chapter Rice Mar kg Rice Mar kg Ishinomaki RCHP Retort curry Mar. 18 1,500 meals Cup miso soup Mar. 18 1,500 meals Dried Udon noodles Mar. 31 1,200 meals Fukushima Chapter Dried Somen noodles Mar meals Fukushima Chapter Commodities sets Mar sets TOGANE Commodities sets Mar. 25 1,500 sets YAMAMOTO Commodities sets Mar sets Places within CHIBA Gauzes Mar pieces TOGANE Gauzes Mar pieces Places within CHIBA Bath towels Mar pieces TOGANE Places within Bath towels Mar pieces CHIBA Places within Linen sheets Mar pieces CHIBA Compressed towels Mar. 14, etc. 1,552 pieces ISHINOMAKI, KAMAISHI Hand sanitizers As needed (from Diversey Co.) Water purifier (from Grand Dukes As needed Corporation) Candies (from Eitaro Sohonpo Co.) As needed Specified low-power Nothing in transceivers (from the particular Tokyo Chapter) 6,000 pieces 8,000 units 70,000 pieces 30 units Evacuees in municipal housing Evacuees in municipal housing Distributed mainly during mobile clinics in KAMAISHI Nothing in particular Toyama Chapter Aichi Chapter Items Release date Xylocaine spray Mar. 15 Xylocaine jelly Mar. 15 Volmagen Suppositories 25 mg Release amount 6 pieces 30 pieces Mar pieces Novolin R Mar pieces Anhiba 100 mg Mar pieces Insulin Syringes Mar packs Warfarin Mar tablets Bayaspirin Mar tablets Solita-T 500 ml Mar boxes Oxygen cylinders Mar tanks Diapers (for Adults) Mar packs Diapers (for Children) Mar packs Plastic gloves L Mar. 15 Plastic gloves M Mar. 15 Ethanol for disinfection Mar boxes 1 boxes 2 boxes Surgical mask III Mar cases Urine absorbent pads Mar packs Sanitary napkins Mar packs Oolong tea Mar boxes Retort rice porridge Okayukko Mar. 15 1,200 packs Corn soup Mar. 15 1,200 packs Water 2L Mar bottles Magic rice (rice) Mar. 12 Magic rice (rice porridge) Mar. 12 Emergency Canned food Mar meals 500 meals Canned bread Mar pieces Canned crackers Mar pieces Release places Ishinomaki RCHP 328 pieces Sendai RCHP Chapter 6 Distribution of Relief Supplies Great East Japan Earthquake and Tsunami 155

183 Great East Japan Earthquake and Tsunami Chapter 6 Aichi Chapter Mie Chapter Items Release date Release amount CalorieMate Mar pieces Drinking water for storage Mar. 12 Canned bread Mar cases Juice Mar bottles Soup Mar. 12 1,740 meals Sweet bean jelly Apr. 13 Helmets Mar. 21 Medical masks Mar. 22 Gas cylinders Mar tanks Release places 2,592 pieces Sendai RCHP 5,000 pieces Ishinomaki RCHP Iwate Chapter: 100 pieces 1,000 pieces OKAYAMA (50 cases) Affected areas: 900 pieces 100 cases Iwate (50,000 pieces) Chapter (5) Delivery of goods The delivery from the Headquarters or the chapters to the affected areas was conducted by requesting the transport operators who had concluded an agreement on the delivery of goods in the event of a natural disaster (Sagawa Express Co. and Nippon Express). The volunteers, including mainly nursing students, helped to get the relief goods out from the Headquarters warehouse at the JRCS College of Nursing for dispatch. The relief goods were smoothly delivered to municipalities, storage areas and large evacuation centers in three affected area. Okayama Chapter Tokushima Chapter Generators Mar units Disposable underpants/ Mar. 27 Disposable pads Cup noodle Mar pieces Medical goods Mar. 19 Masks (adult/ children) Mar. 19 Toothbrushes Mar boxes Towels Mar boxes LED pen lights Mar. 17 Headquarters 6 packs Neo Umor 500 g Cerocral tablet 100 tablets Amaryl 100 tablets Cabagin KOWA Rikuzen-takata 1,000 tablets Daiichi Junior High School 13 boxes 400 pieces Yamada local HDC (Yamada-minami Elementary School) (Note) Excludes blankets, emergency kits, and sleeping kits Source: Prepared from the Report on JRCS Medical Activities at the Great East Japan Earthquake and Tsunami (As of September 2012) [Loading relief goods from the warehouse to a truck (the JRCS College of Nursing)] 2. Activities in the three chapters in the affected areas (1) Activity status at the Iwate Chapter a. Information collection and transmission In past natural disasters, the Councils of Social Welfare of the cities or towns and the welfare divisions of municipalities, which serve as the contact point for the Branches, directly informed the prefectural need for relief goods through the HDCs. In this case, however, the power and communications blackout in MORIOKA and the affected areas prevented them from contacting the chapters. At 15:00, March 11, two Iwate chapter staff joined the Iwate HDC in order to gather information. They, however, could not initially identify the disaster situation of the severely affected coastal areas, such as RIKUZEN- TAKATA OFUNATO, KAMAISHI, OTSUCHI and YAMADA, due to the enormous damage caused by the tsunami in the coastal areas of IWATE. On the day of the tsunami, the Iwate Chapter accepted distribution requests for relief goods only from the domestic Emergency Response Unit (deru) of Morioka RCHP operating at the JR and fire academy in the city. The next day, March 12, there were requests for relief goods from city offices, such as HANAMAKI and KUJI. 156

184 Within a week after the disaster, the many requests that the Chapter received were for food, gasoline, medical goods, materials and other supplies from the medical teams operating within its jurisdiction. The 10 staff of the Iwate Chapter were not sufficient to conduct the needs survey. On March 17, eight staff in two teams from the Headquarters joined to support the Iwate Chapter, of which one team conducted the survey on the need for relief goods and on the establishment of an operating base. The needs survey team traveled to six cities and towns including MIYAKO, YAMADA, OTSUCHI, KAMAISHI, OFUNATO and RIKUZEN- TAKATA over nine days and interviewed people in charge of relief supplies at the municipalities. Through these interviews, they identified what was most essential among the three relief goods that the JRCS stocks and other goods required by these people. As for relief goods, they obtained the needs information, which was informed to the Chapter and the Headquarters. As for other needs for goods, the Chapter contacted Iwate prefectural HDC. If the prefecture replied that it wanted to request the JRCS to supply the goods, the Chapter reported this to the Headquarters. After determining the supply, then the Headquarters contacted the local government. In YAMADA, RIKUZEN-TAKATA and MIYAKO, the support staff from the Headquarters were present when the relief goods arrived on site. While helping to unload the goods, the staff members were talking with people in the evacuation centers, and identified further needs, such as for partitions, water and underwear other than the immediate relief goods. b. Procurement and delivery Before the disaster, the Iwate Chapter decided to store relief goods in several places in the prefecture in order to diversify the risk and accelerate the provision of supplies, and sited the warehouses for stocks in the coastal area, such as MIYAKO, KAMAISHI and OFUNATO, separate from the Chapter that was located in inland. Unfortunately, those stocks were washed away by the huge tsunami. At 0:00, March 13, the stock of blankets almost completely vanished except for those that had been scheduled to be distributed the next day. In addition, the electrically-driven shutters of warehouses did not operate due to the power outage immediately after the disaster, which also created an unanticipated situation in that it had to request the fire brigade to supply blankets on the day of the disaster. The delivery from the Chapter was conducted in a way that the transport operator (Akabou), the staff of RCBC and volunteers delivered the goods and the municipalities picked them up. As buildings that had served as landmarks were washed away by the tsunami, only the RCBC staff with knowledge of the local landscape were the right persons to conduct the delivery. When the medical team on the way to the affected areas requested the delivery of gasoline, the volunteers, who were also familiar with the region, played an important role. The goods distributed based on the needs survey by support staff dispatched from the Headquarters were directly delivered from the Headquarters and Chapters to the evacuation centers, municipalities and other sites. The trend in the relief goods distribution by the Iwate Chapter is shown in the figure on the following page. Within five days after the disaster the distribution had only been conducted in HANAMAKI, KUJI and MORIOKA, etc. From March 19, the direct delivery of the emergency kits and the sleeping kits from the Headquarters to the municipalities on the coastal area obviously increased. A total of approximately 5,000 sleeping kits and approximately 12,000 emergency kits were distributed by May 24. On the other hand, the blankets were not distributed until March 28, since they had been distributed to MORIOKA, KUJI and HANAMAKI up to March 14. This was because the Iwate prefectural HDC that received the donations of blankets, and the Chapter did not receive any requests. Only approximately 900 blankets in total were distributed by the Chapter from March 12 to May 24. The distribution after March 28 was used for people in secondary evacuation centers including the residents of employment promotion housing, which was used as an evacuation center. The number of blankets distributed each time was few; 10 to 43 pieces. The Iwate Chapter exceptionally has a stock of bath towels, which other Chapters did not have. 215 bath towels in total were distributed from March 28. [Distribution of sleeping sets within IWATE] Chapter 6 Distribution of Relief Supplies Great East Japan Earthquake and Tsunami 157

185 Great East Japan Earthquake and Tsunami Chapter 6 Figure 6-10 Distribution destinations Trend in Relief Goods Distribution by the Iwate Chapter Blankets (pieces) Emergency kits (kits) Sleeping kits (sets) Bath towels (pieces) Others Procurement resources Morioka RCHP 70 Fire academy Mar. 12 KUJI 200 Chapter stocks HANAMAKI Iwate Prefectural HDC Water, CalorieMate Tokyo Chapter IWAIZUMI 90 Relief center Otsuchi High School 216 Chapter stocks 18 Otsuchi Community Center 138 Emergency center Otsuchi Laughter Hills 72 Tanohata Village Office 150 SHIWA 42 Chapter stocks 19 KAMAISHI 2,004 Tokyo Chapter MIYAKO 1,380 Headquarters (direct delivery) HANAMAKI Beach towels 20 YAMADA Beach towels YAMADA 930 RIKUZEN-TAKATA 2, NODA 162 MIYAKO 1,450 Rikuzen-takata Kezoji 300 Rikuzen-takata Marunaka warehouse Rikuzen-takata Chouenji 125 Rikuzen-takata Hirota Elementary School 525 Ofunato Takkon Elementary School 2,220 Ofunato Takkon Elementary School 1,500 Otsuchi Sports Park 1, Otsuchi evacuation center 1,140 Yamada Town Office 492 RIKUZEN-TAKATA Partitions OFUNATO Partitions KAMAISHI Partitions 25 OTSUCHI Partitions YAMADA Partitions MIYAKO Partitions 28 MORIOKA ICHINOSEKI HIRONO Apr. 8 MORIOKA Fudai Village Office 72 Fudai Elementary School 432 ESASHI, OSHU MAESAWA, OSHU ISAWA, OSHU HIRONO 30 Headquarters (direct delivery) Headquarters (direct delivery) Chapter stocks Headquarters (direct delivery) Chapter stocks 20 Kamaisi Sea Plaza Yu Chinese rice porridge Yamagata Chapter (direct delivery) 24 TONO May 17 TAKIZAWA ICHINOSEKI HANAMAKI Total ,999 5, Source: Prepared by the Iwate Chapter s inventory Chapter stocks 158

186 (2) Activity status at the Miyagi Chapter a. Information collection and transmission As for the relief goods, the Miyagi Chapter transmitted the information to the Headquarters on the needs that had been identified through coordination with the prefectural HDC and the affected municipalities, and the Headquarters procured and arranged the delivery except to the extent that the Chapter managed to respond to. At midnight on March 11 when the Miyagi Chapter staff including the Headquarters support staff joined in the prefectural HDC, it had already prepared a list of needs for water, food, blankets and other supplies (hereafter referred as the needs list ) as well as the number of evacuees by each city, town and village, but not covering all cities, towns and villages. As the local HDC was in turmoil, the Chapter had arranged to receive offers of possible goods and the amount made by providers rather than that the prefecture would request the related facilities to distribute them. The support staff who were gathering information made an offer of blankets to people in charge of the prefecture after reading the needs list. When they obtained the prefecture s agreement, the staff informed the Headquarters and then it coordinated and arranged the delivery for distribution. In the early period this method was conducted smoothly, but over the following days, the growing number of offers to provide supplies from the GoJ and other organizations and the absence of the personnel in charge made it difficult to understand the updated descriptions of the needs list. Thus the information sent to the Headquarters decreased and the task ended on March 14. The Miyagi Chapter was distributed the greatest number of blankets among the three affected prefectures. This is largely because they started to gather the needs information the night of the disaster and started acting faster than other providers and the JRCS staff could conduct the procurement and coordination of the delivery by staying at the local HDC. b. Procurement and delivery In response to requests, the Headquarters conducted procurement and coordination of the delivery of stocks from chapters around the country. Then the goods were directly delivered from the Headquarters and chapters to the evacuation centers and municipalities within MIYAGI. Approximately 88,000 blankets and approximately 16,000 emergency kits and 6,000 sleeping kits were distributed from March 12 to April 14. [Delivering relief goods into the evacuation center in MINAMISANRIKU] Figure 6-11 Distribution of Relief Goods by the Miyagi Chapter (Chapter stocks) Blankets (pieces) Emergency kits (kits) Sleeping kits (kits) Within MIYAGI 6, Miyagi government office 2,130 Tohoku University Hospital/Tohoku Pharmaceutical 500 University Hospital ISHINOMAKI SHIOGAMA 1, KAKUDA KURIHARA 19 SENDAI 30 RIFU 20 MINAMISANRIKU 588 Discharge (Stock of JRCS Ishinomaki 2,076 School of Nursing) Total 9,302 4, Source: Prepared according to the Miyagi Chapter s withdrawal slip of relief goods Furthermore, there were the goods that were distributed based on direct requests to the prefectural government office and other places to which many affected people rushed, as well as the Miyagi Chapter. In the Miyagi Chapter, approximately 9,000 blankets, approximately 5,000 emergency kits and approximately 100 sleeping kits were distributed by the end of May. Based on the agreement with the Trucking Association, the Miyagi government entrusted the transport operators belonging to the association with the delivery from the Chapter to the affected areas. Without access to a means of delivery in the initial stage of the response, the Chapter staff also delivered the goods themselves. The support of volunteers was part of this effort, however, they were also affected and it was difficult to contact them to request the initial activity. Chapter 6 Distribution of Relief Supplies Great East Japan Earthquake and Tsunami 159

187 Great East Japan Earthquake and Tsunami Chapter 6 Figure 6-12 Trend in Relief Goods Distribution to the Miyagi Chapter (Coordinated by the Headquarters) Arrival Blankets Emergency Sleeping kits Distribution destinations date (pieces) kits (kits) (kits) Name of supplying Chapters, etc. Mar. 11 Miyagi East Regional Promotion Office 700 YAMANASHI Miyagi Regional Promotion Office 13,450 The Headquarters Shiroishi City Office 1,020 SAITAMA 12 Tomiya Town Office 1,470 KANAGAWA, NIIGATA Natori City Office, Iwanuma City Office 9,810 MIE, SHIGA, KYOTO, OSAKA Iwanuma City Office 2,400 The Headquarters Ishinomaki RCHP 2,000 The Headquarters Rifu Town Office 1,190 SAITAMA 13 Tomiya Town Office 980 TOKYO Natori City Office 9,090 TOKYO Tagajo City Office 3,000 KANAGAWA Natori City Office, Iwanuma City Office 4,690 AICHI, HYOGO, NARA, WAKAYAMA Iwanuma City Office, Watari Town Office 5,000 CHIBA Yamamoto Town Office, JGSDF TOTTORI, OKAYAMA, 14 4,500 Kasuminome Army Camp HIROSHIMA, YAMAGUCHI Matsushima Town Office, Kurihara City Office 4,000 TOKUSHIMA, KAGAWA, EHIME, KOCHI Ishinomaki RCHP 3,000 Tokyo Chapter 15 SHIGA, KYOTO, OSAKA, NARA, Kesennuma City Office 11,690 2,490 WAKAYAMA/Headquarters 16 Higashimatsushima City Office 3,680 Purchased Ishinomaki Sports Park 2,300 Donation 17 Ishinomaki RCHP 2,100 The Headquarters 18 Ishinomaki Sports Park 1,500 Purchased Miyagi Prefectural HDC 2,000 Purchased Natori City Office 1,074 TOKYO 19 Tagajo City Office 966 TOKYO Yamamoto Town Office 1,302 The Headquarters Ishinomaki RCHP 380 YAMAGATA 22 Oomagari Elementary School, HIGASHIMATSUSHIMA 370 GUNMA Kesennuma Gymnasium 2,700 HIROSHIMA, OKAYAMA 23 Ishinomai Sports Park 2,000 Nagano Chapter 29 Minamisanriku Bayside Arena 2,040 HIROSHIMA, OKAYAMA, YAMAGUCHI 30 Minamisanriku Bayside Arena 2,000 OSAKA 31 Watari Sato Memorial Gymnasium 2,004 TOTTORI, SHIMANE, TOKUSHIMA, EHIME, KAGAWA, 1,400 KOCHI, OKAYAMA, HIROSHIMA, YAMAGUCHI Total 88,220 16,676 3,400 (Note) Excludes the distribution to the Miyagi Chapter Source: Prepared from the data of the General Affairs Department at the Headquarters (3) Activity status at the Fukushima Chapter a. Information collection and transmission Immediate after the disaster, information was gathered from the news on TV, etc., because there was no access to landline phones as well as difficulties of access to mobile phones for emergencies. Radio transmission was available, which allowed communication within the JRCS. Since the Miyagi Chapter of the 1st block representative chapter was unable to serve as the leader due to the damage from the disaster, Chapters in the 1st block had to operate independently. At 17:00 on March 11, the Fukushima Chapter staff were dispatched to the prefectural government office and started to gather information and then transmit the damage situation to the Chapter and the Headquarters. At 17:10 on March 11, the first request for blankets arrived from neighboring cities, towns and villages, and at 18:00, the Chapter stuff left their Chapter to deliver them. From around 21:00 of the same day, request for blanket distribution arrived continuously received. b. Procurement and delivery On March 12, the blankets were delivered from the Niigata Chapter (1,000 pieces) and the Headquarters (approximately 5,000 pieces). All the blankets from the Niigata Chapter were sent to TOMIOKA. The Fukushima Chapter had a limited number of blankets, only approximately 2,000 pieces, even with the addition of the stock at the Branches. Expecting that the disaster damage would be spread over a large area, distribution of blankets was conducted as arranged with the prefecture for fear of the shortage. 160

188 As for the blankets, the advance notice said that the donated goods were to be delivered to the prefectural government office. Thus, as the requests from cities, towns and villages were concentrated at the prefectural HDC, the prefecture and the JRCS were to take charge of part of the provision. In that context, the information on the needs and flow of goods in FUKUSHIMA was the closest to the basic flow that had been simulated in the Regional Disaster Prevention Plan. From March 11 to 14, up to 1,500 blankets were distributed to 18 cities, towns and villages in FUKUSHIMA. And the mattresses were also distributed from the stock at the Fukushima Chapter, although the number was limited. Preservation of extra JRCS blankets was required by the prefecture in order to set up the secondary evacuation centers. Owing to the reactor explosion at the Fukushima Daiichi Nuclear Power Plant, a secondary evacuation was implemented, using Ryokans (Japanesestyle hotels), hotels and facilities outside the prefecture as secondary evacuation centers, so that the demand for blankets reached a limit. After the donated blankets arrived at the prefectural government on March 15, blanket provision by the JRCS was limited. The activities of relief supply distribution by the Fukushima Chapter reached a peak from March 12 to 14 and approximately 80% of the blankets from the Fukushima Chapter were distributed in this period. Activities were still conducted at a low level after April, but the distribution of relief goods was almost completed by the end of March. The shipping from the Fukushima Chapter to cities, towns and villages was conducted through three means: delivery by transport operators belonging to the Trucking Association with whom the prefecture had concluded an agreement, delivery by the Chapter staff, and pickup by other parties including municipalities. [A volunteer carrying blankets] Figure 6-13 Trend in Relief Goods Distribution by the Fukushima Chapter Distribution Procurement Distribution Blankets Mattresses Blankets Other items Suppliers destinations (pieces) (pieces) (pieces) Shinryou Branch Niigata Chapter 1,000 Mar. 11 SHIRAKAWA 200 SUGAKAWA Fukushima prefectural HDC 1,500 TOMIOKA 1,000 Headquarters 4,816 NAMIE MINAMISOMA 1,000 Water, towels Costco Wholesale Japan, LTD* Water ONO 150 TAMURA 1,500 NARAHA 700 NAKAJIMA 60 Motomiya High School Ishikawa Town Office 400 AZUMA (within FUKUSHIMA) 200 Tamakawa Village Office 50 Asakawa Town Office 100 Furudono Town Office 20 Hirata Village Office 30 FUKUSHIMA 30 Other items Chapter 6 Distribution of Relief Supplies Great East Japan Earthquake and Tsunami 161

189 Great East Japan Earthquake and Tsunami Chapter 6 Distribution Procurement Distribution Blankets Mattresses Blankets Other items Suppliers destinations (pieces) (pieces) (pieces) 15 Kumamoto Chapter 1,300 Fukuoka Chapter 2, Medical Schools, Chapters, etc. Water Miyazaki Chapter 1, Azuma Gymnasium The Headquarters 6, DATE Aizu Center 300 Masks 24 Other items Azuma Gymnasium Disposable diapers International Rotary* Disposable diapers SAGA* Masks Rotary* Cup noodles 25 KORIYAMA/TAMURA/IWAKI Masks System TALKS Inc.* Dosimeters 26 SOMA 220 Masks 30 SOMA, SHINCHI Masks Subtotal 8, ,876 Total 10, ,876 (Note) *Represents donors. The total includes delivery with an uncertain delivery date. Source: Prepared according to the Fukushima Chapter diary (4) Activity status at the Yamagata Chapter The Yamagata Chapter, which is adjacent to the disaster areas, played an important role as a hub for relief goods support. From March 13, two days after the disaster, the Yamagata Chapter started to transport food and drinking water to the Miyagi Chapter, Miyagi RCBC and Ishinomaki RCHP, which had a shortage of food due to the cutting off of lifelines. In addition, it transported packed meals for staff that were rushed to MIYAGI from across the nation, as well as a total of 833 meals for the staff of the local HDC and RCBC. Furthermore, a relief supply delivery center was established in Yamagata as a hub warehouse from March 30, 2011, to the end of March, This was intended for the storage of relief supplies from abroad, entrusted by GoJ, and then shipped to the three disaster areas in response to requests from the Headquarters. This center, which was a rented private warehouse, had 826 square meters of floor area with a storage capacity for a substantial amount of goods was located approximately five kilometers from the nearest highway interchange within a 10-minute drive. As a large amount of relief goods were sent to this center, the athletic club students (baseball and soccer clubs) of the high schools belonging to the junior Red Cross helped to load and unload them. Based on the needs survey by the liaison/coordination staff dispatched to the site from the Headquarters, Yamagata Chapter staff shipped the stored goods to the evacuation centers, temporary housing, meeting places and other sites in the affected areas of IWATE, MIYAGI and FUKUSHIMA. The relief goods had been delivered until April of 2012 to 128 places in total, including 33 places in IWATE, 46 places in MIYAGI, 20 places in FUKUSHIMA and 29 evacuation centers set up in YAMAGATA. The number of relief goods from the Yamagata Chapter to various places reached 26,840 blankets, 41,790 bottles of drinking water, and 198,212 meals, even primary ones. [The relief supply delivery center (YAMAGATA)] Figure 6-14 Delivery Status of Relief Goods from Yamagata Chapter Delivery places Blankets Drinking wate Food IWATE 33 places 12,308 pieces 11,088 bottles 34,200 meals MIYAGI 46 places 7,270 pieces 26,010 bottles 159,920 meals FUKUSHIMA 20 places 4,117 pieces 4,692 bottles 4,092 meals YAMAGATA 29 places 3,145 pieces Total 128 places 26,840 pieces 41,790 bottles 198,212 meals Source: Prepared from the data of the Yamagata Chapter 162

190 (5) Activity status at the Osaka Chapter The Osaka Chapter had improved its disaster relief warehouse in Takatsuki RCHP, aiming at strengthening the disaster relief structure in March On March 13, 2011, two days after the disaster, the disaster relief warehouse in Takatsuki RCHP was requested by the HDC at the Headquarters to be a collection base for relief goods from the 4th block, and to conduct carry-in and carry-out of supplies with the support of Red Cross disaster-response volunteers. 8,690 blankets, 2,490 emergency kits and 750 sleeping kits were sent to the affected areas from the disaster relief warehouse in Takatsuki RCHP. staff. Thus, through the Fukushima Chapter, the JRCS requested Mr. Akira Kozakura, a Board of Governors of the JRCS and the Chief Executive Officer (CEO) of Sakura Kotsu, Co., to arrange buses to secure a means of transportation between the Headquarters and the affected areas. From March 30, 2011, the bus service started between the Headquarters and Ishinomaki RCHP to dispatch the staff (mainly medical staff) to provide support for the hospital. In addition, the JRCS asked Sakura Kotsu to run volunteer bus trips to remove debris and rubble within MIYAGI. A total of 27 bus trips were offered for the dispatch of staff and volunteers, which provided smooth transportation to Ishinomaki RCHP and the affected areas in MIYAGI. [Red Cross disaster prevention volunteers sorting out the relief goods] 3. Other support status (1) Priority supply of gasoline from JX Nippon Oil and Energy Corporation Immediately after the disaster, the disaster areas faced a severe gasoline shortage, which posed an obstacle to relief activities carried out by the JRCS. Thus, the JRCS asked JX Nippon Oil and Energy to accommodate the JRCS with a gasoline supply through Mr. Fumiaki Watari, a member of Board of Governors the JRCS and Adviser of JX Holdings, Inc. This enabled the JRCS to receive refueling services preferentially at gas stations (Ishinomaki Akebono SS) in ISHINOMAKI from March 18. (2) Securing the means of transportation for the disaster areas by Sakura Kotsu In its efforts to support Ishinomaki RCHP, the shutdown of the Tohoku Shinkansen line immediately after the disaster had created a challenge for the JRCS to secure the means of transportation for support (3) Donation of medical equipment, etc. Mainly hospitals in the affected areas accepted donations of medical equipment and for purchasing equipment related to medical operations from various companies through the Headquarters. These are listed in Figure Status of support from overseas (1) Background to receiving relief goods support from overseas There were numerous offers from Red Cross and Red Crescent Societies worldwide to support the affected people in GEJET. Since it would take a lot of time for shipping to Japan and could not fit to the needs in affected area, the JRCS had to decline the receipt of relief supplies from abroad in principle. On the other hand, more than 60 countries and international organizations offered to provide relief goods to GoJ immediately after the disaster. In consideration of the standards, packing units, transport period to Japan and the like, the Ministry of Foreign Affairs of Japan (MOFA) selected items to meet the needs, and approached these governments for support with four relief items; blankets, mattresses, bottled mineral water and plastic containers. In March 15, the Humanitarian Assistance and Emergency Relief Division, International Cooperation Bureau of MOFA approached the JRCS regarding the acceptance of these relief supplies. At the same time, MOFA referred to fire stations, Self Defense Force (SDF) and police stations and others regarding their needs, besides the JRCS. It later asked non-governmental organizations (NGOs) in the country about the acceptance of relief supplies. Chapter 6 Distribution of Relief Supplies Great East Japan Earthquake and Tsunami 163

191 Great East Japan Earthquake and Tsunami Chapter 6 Figure 6-15 List of Donations of Medical Equipment, etc. Donors Description Amount Equivalent or amount of the donation (yen) Deployment locations Mochida Siemens Ultrasonic diagnostic Medical Systems Co. equipment 5 units 6,500,000 Ishinomaki RCHP Shimadzu Corporation Nihon Kohden Corporation Toshiba Medical Systems Corporation Canon Inc. X-ray systems for mobile clinics Tents, outside heaters for tents Ultrasonic diagnostic equipment Movable X-ray equipment 10 sets 183,200,000 Sendai RCHP Ishinomaki RCHP Akita RCHP Hachinohe RCHP Morioka RCHP Fukushima RCHP 1 set 7,085,000 Ishinomaki RCHP 10 sets 32,000,000 Sendai RCHP Ishinomaki RCHP Hachinohe RCHP Morioka RCHP Fukushima RCHP Ishinomaki RCHP Iwate Medical Notes Goods donations Goods donations Association Takata Clinic Leasing 5 sets 60,000,000 Hachinohe RCHP Goods donations Morioka RCHP Akita RCHP The Rotary Club of Tokyo Purchase of highstandard ambulances Setagaya South Japan 1 unit 10,000,000 Ishinomaki RCHP Destruction restoration work for buildings, etc., purchase of 50,000,000 Sendai RCHP medical equipment Renewal of air conditioning Sawai Pharmaceutical Co. and the purchase of medical 25,000,000 Morioka RCHP equipment Rescue vehicles, medical equipment and equipment 25,000,000 Fukushima RCHP maintenance Source: Prepared from the data of the Organizational Development Department at the Headquarters Money donations (2) Acceptance of blankets a. Action in acute phase As of March 15, the Headquarters received requests for 65,000 blankets (55,000 in MIYAGI and 10,000 in FUKUSHIMA) from the HDCs in the affected prefectures. In addition, through the Chapters it obtained the information on the requirement for 50,000 blankets in IWATE and 20,000-30,000 blankets in order to wrap the bodies of deceased victims in MIYAGI. Thus, it replied to the MOFA that it would accept blankets from GoJ to dispatch to the affected areas. As a storage area for the goods, MOFA secured a 330 square-meter warehouse with a capacity of 100 tons from the JICA (Japan International Cooperation Agency). The first cargo of the arranged blankets arrived at 8:00, March 16, and finally approximately 49,000 blankets were received from India, Canada, Thailand and the Ukraine. The United Nations World Food Programme (WFP) Japan Relations Office was in charge of conducting domestic customs procedures and shipping to the designated areas and the JRCS was in charge of the unloading and distribution in the affected areas. The Tochigi Chapter rented an adjacent gymnasium and received 10,000 relief blankets from Thailand for the evacuees from FUKUSHIMA on March 19. Although the shipment of 10,000 blankets for the Iwate Chapter, 21,000 for the Miyagi Chapter and 10,000 for the Fukushima Chapter were initially arranged, this was suddenly canceled in response to a notice that blankets were no longer required since the needs of the affected areas were met as of March 19. Therefore, the destination of 5,000 blankets, part 164

192 of the shipment of blankets that was supposed to be destined for the Iwate Chapter, was changed to the Yamagata Chapter for the affected people who had to be evacuated from FUKUSHIMA and these arrived on March 21. Whereas the blanket supply was concentrated on the prefectural HDCs in the affected areas from municipalities or private companies around the country, the need for these rapidly came to an end. (3) Other support Chinese companies announced that they would provide a concrete pumping vehicle to be used as an aerial platform vehicle in order to respond to the Fukushima Daiichi Nuclear Power Plant Accident. In response to the announcement by the Tokyo Electric Power Company (TEPCO) that they would accept this offer, the vehicle was delivered from the Red Cross Society of China to the JRCS through the Red Cross route. This vehicle was presented to TEPCO on March 23, 2011, and used on site. The relief goods from overseas are listed as follows. [Blankets being delivered to the Tochigi Chapter] b. Distribution of blankets in the recovery period The JRCS sought other needs for 28,598 relief blankets from overseas that had not been delivered to the affected people, and after gaining agreement through discussions with MOFA decided to use the blankets for disaster relief activities in Japan without limiting their use for recovery support in the affected areas or GEJET. It referred the blanket needs to IWATE, MIYAGI, FUKUSHIMA and SDF, etc. as stock for the recovery period or in preparation for a possible disaster in the future, but no facilities receive the blankets. Therefore, the GEJET Recovery Program Headquarters and the three affected Chapter staff conducted door-to-door checks to ask residents whether they needed blankets while showing a sample blanket in the three prefectures of IWATE, MIYAGI and FUKUSHIMA. Many residents needed them, and 13,892 blankets were distributed from September 2011 to February 24, As for the distribution to the residents, the finely tuned responses were appreciated by them, such as checking individual intentions and delivering directly. The blankets that remained were stocked at the branches, etc., in preparation for a possible disaster in the future by repacking them individually for easy management. Figure 6-16 List of Relief Goods from Overseas Supporting Items Amount countries Blankets Vehicle to respond to the nuclear accident (concrete pumping vehicle) Medical rubber gloves India Canada Thailand Ukraine Red Cross Society of China China 21,238 pieces 5,460 pieces 19,900 pieces 2,000 pieces 1 unit 3,250,000 pairs Temporary toilets China 60 units Happo porridge China NGO 77,568 cans T-shirts Tea (tea bags) Philippine Red Cross Bangladesh Red Crescent Society 5,000 pieces 600 kg (Note) Blankets, Medical rubber gloves and Temporary toilets were provided through MOFA. Chapter 6 Distribution of Relief Supplies Great East Japan Earthquake and Tsunami 165

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194 Chapter 7 Red Cross Volunteer Activities

195 Great East Japan Earthquake and Tsunami Chapter 7 Chapter 7 Red Cross Volunteer Activities Red Cross disaster-response volunteers (DRV) register themselves with the chapters of the Japanese Red Cross Society (JRCS) in accordance with the Regional Disaster-Prevention Plans and the JRCS Disaster- Prevention Operation Plans, and if a disaster occurs, they engage themselves in activities such as first aid for victims as well as recovery through coordination by the JRCS. If a disaster occurs, DRV centers are also established in the affected areas and at the chapters of the JRCS, and act as bases to gather information on and assess the needs of the victims, ensure information-sharing between Headquarter for Disaster Control (HDC) and Red Cross DRV, coordinate activities among the volunteers, including Red Cross Volunteer Corps, and take other necessary measures. However, the volunteer centers could not be set up in the coastal areas hit by the disaster because of the devastating impact inflicted in these areas, a situation that also made it difficult to carry out the activities of the centers of the chapters in the three affected prefectures (IWATE, MIYAGI, and FUKUSHIMA). For this reason, the JRCS established a volunteer center at the Headquarters for the first time in its history and provided support such as coordination to dispatch volunteers registered with its chapters nationwide to the volunteer centers of the chapters in the three affected prefectures. All practical operations related to the establishment and operation of the volunteer center at the Headquarters were undertaken by personnel such as Red Cross volunteer leaders registered with chapters, and the JRCS Headquarters personnel were engaged in activities such as coordination with the receiving chapters and the provision of logistic support so that these volunteers could effectively carry out their job. 1. Activities of the DRV center at the Headquarters (1) Establishment and operation of the DRV center at the Headquarters a. Starting up the DRV center at the Headquarters Immediately after the disaster occurred, chapters of the JRCS in the three affected prefectures were unable to promptly establish a DRV center due to the immense amount of damage caused by the disaster. Therefore, HDC at the Headquarters staff who belong to volunteer section which coordinate volunteers considered supporting the three affected prefectures on a block-by-block basis, that is assigned 2nd Block to take responsibility for IWATE, 3rd Block for MIYAGI, and 4th Block for FUKUSHIMA, and sounded out the chapters on the possibility of helping set up a volunteer centers in the affected prefectures by dispatching Red Cross volunteer leaders and other personnel from each of these blocks. But this plan could not be implemented mainly because, in addition to the fact that there was no such precedent, the chapters in these blocks did not assume that they would have to send their Red Cross volunteers to other prefectures and were concerned about ensuring their safety in the affected areas as they did not know what the situation was immediately after the occurrence of the disaster. The next step taken was to establish a volunteer center at the Headquarters, and this center considered helping set up a volunteer center in each of the three affected prefectures. This plan was approved at a meeting at the Headquarters on March 14. At that time, since only MIYAGI needed support, the volunteer center at the Headquarters was organized on March 15 under the leadership of DRV leaders from chapters in Greater Tokyo area for the main purpose of helping to operate a volunteer center in MIYAGI. The major duties of the center were to: Provide support for the operations of the Headquarters Support the operations of medical teams in the affected areas Perform duties as Red Cross DRV at the volunteer centers of the chapters in the three affected prefectures The priority tasks expected for the immediate future were to: 168

196 Choose Red Cross DRV leaders and district s ones and dispatch them to the volunteer center of the chapter in MIYAGI through the HDC at the Headquarters and the chapters Define the duties of the volunteers Organize the rotation of personnel at the volunteer center at the headquarters On March 16, the Headquarters issued a document to the chapters to: operation. Member volunteers took responsibility for various kinds of coordination under the leadership of its head, who supervised them. Duties such as decisions on policies and other principles of action as well as notifications to Chapters were performed by the personnel of the Volunteer Team. The Head of the Center was responsible for coordination with JRCS personnel and other members for liaison with affected areas and coordination and communication related to various kinds of dispatch. Announce the establishment of the DRV center at the Headquarters Preliminary request the dispatch of DRV to the volunteer center at the Headquarters and in the affected areas b. Organizational structure of the DRV Center at the Headquarters The Red Cross DRV Center at the Headquarters was organized so that Red Cross DRV leaders and district leaders from nationwide played a central role in its [DRV Center set up at the Headquarters] Figure 7-1 Organization of the Headquarters DRV Center for the Great East Japan Earthquake and Tsunami (GEJET) Operations Team (Volunteer Team) Head of the Volunteer Team Members General Affairs Liaison and coordination with the Headquarters Volunteer Team Response to inquiries from the general public Management of vehicles and equipment Organization of expense statements from DRVs who returned and handing over duties to the Headquarters Volunteer Team Taking out insurance policies for DRVs dispatched (including the reception of insurance benefits) and handing over duties to the Headquarters Volunteer Team Communications Headquarters DRV Center Sending volunteer rotation lists to the Headquarters Volunteer Team, Chapters in the affected areas, and local volunteer centers daily Receiving and putting together journals of local volunteer centers and identifying local needs via Gathering information on local traffic conditions Updating the website of the Headquarters Volunteer Center (local information, recruitment of new volunteers, rotation lists, and the posting of information on points to note) Center head Training Registration of DRVs Pre-dispatch orientation for DRVs to be dispatched Reception of reports and expense statements from DRVs who returned Meetings to hear the reports of DRVs who returned and confirmation of whether they were mentally and physically sound Dispatch of DRVs Processing requests made by Chapters for dispatch and their registration with PC Confirmation of whether volunteers could be received by local volunteer centers as requested by the Chapters Preparation of dispatch rotation lists Creation of notices to Chapters of decisions on dispatch Chapter 7 Red Cross Volunteer Activities c. Cooperation among Red Cross DRVs The contact addresses and phone numbers for Red Cross DRVs registered with Chapters were unknown, but the Volunteer Center established means of communications by gathering information mainly through the list of participants in DRV leader training, which was resumed in FY2010, mailing lists, and networks of personal connections among Red Cross DRVs. At first, the Center provided support mainly to Miyagi Chapter and built a support system for Iwate while assessing the local situation. But with respect to Fukushima, it was difficult to do so partly because of the effects of the nuclear accident. In addition, based on the information that a communications environment was not available in the affected areas, the Center prepared PCs and mobile Great East Japan Earthquake and Tsunami 169

197 Great East Japan Earthquake and Tsunami Chapter 7 terminals dedicated to Chapter DRV centers in the three affected prefectures and delivered them there using shuttle bus services, thus maintaining lines of communication. Furthermore, in order to provide information on matters such as the recruitment of volunteers, some DRV leaders launched a website dedicated to the Center. JRCS s ordinary reporting line requires going through Chapters and the Headquarters, but the dedicated website enabled volunteers to respond swiftly to the situation, which was changing every moment, by interacting directly with each other through the website. On March 21, the dedicated website started operation after consultations with the Headquarters. d. Operation of shuttle bus services In terms of access to the affected areas, there was no hope of railways such as Shinkansen and air services returning to normal, and the only way to send personnel and goods to those areas was to enable JRCS vehicles to pass through expressways as persons engaged in disaster dispatch, etc. Therefore, the Volunteer Center started to operate shuttle buses. It rented a minivan for eight passengers, secured a driver from among Red Cross DRVs, and dispatched the first shuttle bus on March 18. Since the affected areas lacked gasoline supplies, the shuttle bus took with them gasoline in portable cans in addition to food and other supplies. Later, until the lack of gasoline in the affected areas settled down, the HDC at the Headquarters instructed not only shuttle buses, but also all other vehicles leaving the Headquarters for the affected areas to carry gasoline in portable cans. Shuttle buses were scheduled to make a round-trip in two days, spending the first day heading for TOHOKU and the second returning from there, and various clever ideas were used to make the scheduling of the dispatch of Red Cross DRVs easy. In addition to Red Cross DRVs, shuttle buses carried personnel and goods if there were empty seats. At first, the Volunteer Center considered extending the shuttle bus services to IWATE, but except for some departures, shuttle buses did not go as far as IWATE because a trip to IWATE placed a heavy burden on the driver in terms of distance and time and because other routes such as air transport became available. Furthermore, as time passed, there were growing activity needs not only among Red Cross DRV leaders, but also at the disaster volunteer centers established by Social Welfare Councils. For this reason, the Volunteer Center considered expanding the scale of shuttle bus services to transport Red Cross DRVs (such as Red Cross volunteers) other than Red Cross DRV leaders. These shuttle buses started to be operated in the name of recovery support buses on April 7, and their operation ended on May 7 as the Shinkansen and other public means of transport returned to normal. e. Method of recruiting Red Cross DRVs The Headquarters requested all Chapters to collect Red Cross DRVs wishing to work for TOHOKU from among their registered ones, and each chapter replied to the DRV Center at the Headquarters by facsimile. Based on these replies, the DRV Center at the Headquarters confirmed with the applicants and dispatched them while coordinating with the volunteer centers of the Iwate and Miyagi Chapters. But since the approval procedures at the Headquarters and Chapters required some time, it actually took time before relevant information reached Red Cross DRVs. In addition, due to changes in the method of recruitment and the extension of deadlines for the acceptance of applications, several notifications were simultaneously issued, giving rise to some confusion among applicants. Therefore, the Center communicated the latest information as much as possible by posting it at the dedicated website. [Recovery support bus schedule] 170

198 f. Operation of the DRV Center at the Headquarters and the rotation of volunteers The DRV Center at the Headquarters was operated mainly by Red Cross DRV leaders from chapters throughout nationwide, and these leaders took turns to serve as the Head of the Center, which coordinated all volunteer operations and performed duties such as entering data in various PCs and answering telephone calls and facsimile messages. At first, many volunteer leaders gathered from across the country, but mainly because replacing the head of the Center with a new one once every five to six days caused problems with the operation of the Center, a volunteer leader from Tokyo, Saitama, Chiba, or Kanagawa Chapters was in principle appointed as head of the Center and replaced by a new one once every seven days. In addition, since it was difficult to secure volunteers for the operation of the Center outside the Japanese long holiday season (April 29 to May 5), the Chapters of these four prefectures continued to supply volunteers by rotation while figuring out how to secure a minimum number of volunteers. Volunteer activities included the collection of data on volunteer needs to identify them and coordination with the HDC of the three affected prefectures and the HDC at the Headquarters concerning volunteer activities. Moreover, another major requirement for activities was the ability to use a PC such as coordinating, confirming, and communicating with volunteers dispatched, as well as creating documents and keeping records using a PC. g. Evaluation of the DRV Center at the Headquarters Two meetings, one in November 2011 and the other in March 2012, were held for Red Cross DRV leaders and staff of the Headquarters, both of whom were engaged in the Center s activities, to evaluate the DRV Center at the Headquarters. (2) Dispatching Volunteers to the affected areas The first step for dispatching volunteers to the affected areas was to collect Red Cross DRVs leaders who served as coordinators to support the Chapter DRV center in the three affected prefectures. Meanwhile, as time went by, Red Cross DRVs were also needed in the direct services to the affected people. Partly because there were times when it failed to make appropriate decisions on, or did not have sufficient information on, the needs had been changing for survivors, the Headquarters dispatched Red Cross DRV leaders in the hope that they would be coordinators to support for the Chapter DRV center as the same as it was expected in the beginning, but the dispatch gave rise to confusion as the part of the Red Cross DRVs who were believed to give services directly in affected areas. Since the areas hit by the earthquake were far away from TOKYO, and public means of transport were disrupted, it was extremely difficult to reach the affected areas. Therefore, the Volunteer Center provided shuttle services by minivan and a large bus between the Headquarters and the affected areas, maintaining a means of transport for Red Cross DRVs from the Headquarters and the Chapters. This idea was proposed by the Head of the DRV Center at the Headquarters, and all arrangements, including the procurement of vehicles and drivers, were made by volunteers with briefings for Red Cross DRVs to be sent by shuttle bus given by the volunteers. 1. Operation of shuttle services by minivan (March 18 to May 7) There were a total of 25 departures with a minivan leaving once every two days. The total number of users was 224 (including drivers). 2. Operation of shuttle services by bus (April 7 to June 26) There were a total of 11 departures with a large bus leaving every Thursday and returning on Sunday. The total number of users was 419. This shuttle service represented the first recovery support volunteers dispatched by the JRCS to the affected areas. On April 4, the Headquarters requested section managers responsible for Red Cross volunteers at 2nd Block chapters (Tochigi, Saitama, Chiba, Tokyo, and Kanagawa) to recruit and dispatch recovery support volunteers as below. Purpose Three weeks have passed since the occurrence of the disaster, but the areas hit by the tsunami need the help of many volunteers. Therefore, we want to recruit recovery support volunteers from among Red Cross volunteers and so forth. They will work only during the weekend. Details of activities (1)Removal of mud from houses and stores in areas hit by the tsunami (2)Removal of debris, etc. Activity area MIYAGI s TAGAJO, HIGASHIMATSUSHIMA, IWANUMA and WATARI Means of transport A chartered bus will be used for both ways. Chapter 7 Red Cross Volunteer Activities Great East Japan Earthquake and Tsunami 171

199 Great East Japan Earthquake and Tsunami Chapter 7 [Shuttle bus heading for the affected areas with volunteers on board] The figure below indicates the number of Red Cross DRVs sent by chapters at the Headquarters request. In Figure 7-2, the Headquarters show the number of Red Cross DRVs who joined the DRV Center at the Headquarters, where they coordinated and supported the dispatch of Red Cross DRVs. Miyagi shows that of Red Cross DRVs who were sent to the DRV center established at the Miyagi Chapter, KESENNUMA that of Red Cross DRVs who were sent to the DRV center established in KESENNUMA, and TONO that of Red Cross DRVs who were sent to the DRVs center that worked with the Tono Magokoro Network. Drivers refers to the number of volunteer drivers for shuttle services between the Headquarters and the three areas mentioned above. A look at the number of volunteers by month shows that from March to June, many volunteers were sent Figure 7-2 Trends in the Total Number of DRVs, etc., Dispatched at the Request of the Headquarters (March to August 2011) Headquarters Miyagi Chapter KESENNUMA TONO Drivers to the Miyagi Chapter and KESENNUMA because the Volunteer Center s policy was to send them mainly to MIYAGI, but that the dispatch of volunteers to MIYAGI stopped at the end of June with the destination of dispatch shifting to TONO, IWATE after July. As of August 31, the total number of volunteers who, at the Headquarters request, gathered from various chapters to support victims was 3,636, including the chapters DRVs; recovery support volunteers, the first to be dispatched to the affected areas; personnel of the Headquarters; and shuttle bus drivers. 2. Activities of volunteers in the affected areas (1) IWATE MORIOKA, where the Iwate Chapter is located, suffered only relatively little damage. Around 5:00 p.m. on March 11, Red Cross DRV leaders gathered and established a DRV center at the Chapter. Eight Red Cross DRV leaders had been registered with the Chapter, but only two of them could actually work as such because the other six were aged or victims of the earthquake. Nearly 80% of First Aid Volunteers Corps consisted of nurses, police officers, fire fighters, nursing care givers, etc., and could not join Red Cross DRVs in their activities because they were busy with their own duties. Meanwhile, in the four coastal areas of RIKUZEN- TAKATA, OFUNATO, KAMAISHI, and OTSUCHI, which had been struck a disastrous blow, Red Cross DRV leaders could not establish a DRV center, nor could they assess the situation there and identify the needs of the victims. After a DRV center was set up in TONO, located almost halfway between MORIOKA and the coastal areas, on April 8 it became possible to provide support effectively using the center as a relay point. On March 28, about two weeks after the earthquake, the Tono Magokoro Network was organized under the leadership of the Social Welfare Council of TONO in accordance with the city s disaster-prevention plan. The Tono Magokoro Network cooperated with many volunteers and organizations such as NPOs, NGOs, Nippon Foundation, the JRCS Headquarters, the JRCS Iwate Chapter, and JICA to provide support to RIKUZEN-TAKATA, OFUNATO, KAMAISHI, and OTSUCHI. Immediately after the network was formed, Red Cross DRVs hardly participated in the organization except for some of the local Red Cross Community Volunteer Corps who provided hot meals 172

200 to the victims. The Network soon faced difficulties in coordinating volunteers by matching their abilities with local needs. On April 7, a DRV leader from the Kanagawa Chapter who visited TONO learned about the difficult situation that the Network was faced with and requested Headquarters to dispatch DRV leaders skilled in coordinating volunteers. On April 8, Red Cross DRV leaders sent by the Headquarters took leadership in establishing a Tono DRV center, which served as a subordinate center to support the coastal areas. A succession of Red Cross DRV leaders entered TONO and matched the abilities of the volunteers with local needs, thus gradually building a system that fully worked only if DRVs were dispatched rather than their leaders. The Tono Magokoro Network served as a rear base for volunteers in the four coastal areas, and the dispatch of volunteer leaders through the Headquarters continued until the end of August. In summer, during which the dispatch of volunteer leaders was concentrated, they joined satellite bases (local activity centers) as their operations staff members, engaging in support activities such as reminding victims that they should be careful not to develop heatstroke, get hurt, or step on nails. [Establishment of a volunteer center on the day of the earthquake] a. RIKUZEN-TAKATA The contact address for JRCS in RIKUZEN-TAKATA was the city government office, but the government office did not work because its building had been washed away. The building of RIKUZEN-TAKATA s Social Welfare Council had also been washed away with six of its 15 personnel, including the chairman, missing, but on March 15, four days later, the Council built a temporary office at the Rikuzentakata Driving School, where a DRV center was set up on March 17. In late April, two Red Cross DRVs, one from the Kanagawa Chapter and the other from the Chiba Chapter, joined the volunteer center in its activities. The Red Cross DRVs that had joined the Tono Magokoro Network moved to urge other Red Figure 7-3 Organizational Chart for the JRCS Iwate Chapter DRV Center (Shared by the Tono Social Welfare Council) Tono Magokoro Network Representative and deputy representative Secretary-general Volunteer coordinators (DRV leaders sent by the Headquarters) Affected areas RIKUZEN-TAKATA OFUNATO KAMAISHI OTSUCHI [Division of roles] lodging Relief supplies (procurement, management, and delivery) Vehicle team (transfer (bus) and transport) Work team (cleaning up and materials and equipment) Care team (dipping legs in hot water, giving a bath, and the distribution of food) Information team (identification of needs and public relations) JRCS Iwate Chapter Head of the DRV center (DRV leader) One official from the Tono city government Assistance in the operation Tono Red Cross Volunteer Corps Hanamaki Red Cross Volunteer Corps Former firefighters Ordinary volunteers (In charge of supporting the Chapter and medical teams) Two officials from the Morioka city government, One official from the Oshu city government Assistance in the operations Volunteers from municipalities in the prefecture Volunteers from locations nationwide First Aid Red Cross Volunteer Corps Morioka Red Cross Volunteer Corps Former firefighters Ordinary volunteers Chapter 7 Red Cross Volunteer Activities Great East Japan Earthquake and Tsunami 173

201 Great East Japan Earthquake and Tsunami Chapter 7 Cross DRVs to come to RIKUZEN-TAKATA. Red Cross DRV leaders performed duties such as making the need to gargle and wash their hands known to the evacuees. Those stationed permanently at the Tono volunteer sub-center often visited RIKUZEN-TAKATA to perform duties such as reminding ordinary volunteers that they should be careful not to get hurt. After a while, at places other than the DRV center as well, Red Cross DRVs individually started their activities. In some areas of the city, the process of setting up a base, receiving volunteers, conducting needs surveys, and dispatching volunteers based on the identified needs was being established. b. OTSUCHI The building of the Otsuchi Social Welfare Council had been washed away, leaving several of its personnel missing. The Otsuchi town government set up the HDC at the central community center, which had escaped damage, and the town s administrative functions such as the temporary Headquarters of the Social Welfare Council were gathered at the community center, which also served as an evacuation center. At first, only one person was responsible for the town s DRV center, but later, around ten officials sent by the governments of Nagoya City as well as MIE, GIFU and other prefectures at the Japan Council of Social Welfare s request joined the center, and on March 20, they started preparations to set up a volunteer center. On March 26, the center began to receive volunteers, and around 20 volunteers worked in the town each day. Two Red Cross DRVs entered OTSUCHI when the contact address for the Social Welfare Council still remained at the central community center. The Otsuchi town government had decided since early on that a volunteer center should be established solely by the Social Welfare Council when a disaster occurred, but Red Cross DRV leaders set up a Red Cross DRV center earlier than the Council, giving rise to confusion for some time. They put up a tent in front of the community center, and using it as their center, they started to receive and dispatch volunteers around the clock. Members of TONO s civic groups, school teachers, and officials from municipalities, all of who had assembled to work as volunteers as soon as possible, gathered at this center, began to work as its operation staff members such as coordinators and liaison personnel, and received similar organizations that came later. Thus these people and the Red Cross DRV leaders jointly operated the volunteer center. This caused confusion for some time, but on March 26, with the establishment of the Otsuchi DRV center, the Red Cross DRV center was closed, and all Red Cross volunteers withdrew from the town. (2) MIYAGI The Miyagi Chapter established a DRV center on March 14, three days after the occurrence of the earthquake. Immediately after the earthquake occurred, Red Cross DRV leaders in the prefecture gathered at the Chapter, but had difficulties in setting up a DRV center because it was their first time to do so when a large disaster occurred. Therefore, experienced Red Cross DRV leaders from other prefectures rushed to the Chapter via the Headquarters for support and undertook almost everything needed to set up such a center. Several days later, they handed the volunteer center over to the Miyagi Chapter without problems. These leaders from outside assisted in setting up a volunteer center in various parts of the prefecture while supporting the Chapter s volunteer center. Immediately after the disaster, the needs of affected areas were unknown because the communications environment broke down, causing great confusion. The Chapter sent Red Cross DRV leaders from MIYAGI and those from other prefectures, who had been dispatched via the Headquarters, to affected areas to identify their needs and reflect the identified needs in the activities of its volunteers. Soon many Red Cross DRVs sent by shuttle minivan and bus joined the Chapter s volunteer center, and volunteer activities unfolded without major confusion as their abilities were matched with the needs of victims. [A scene from the meeting at the DRV center] 174

202 At first, however, the Headquarters could not identify the needs of the DRV center of the local Social Welfare Council in detail and dispatched many Red Cross DRV leaders to the volunteer center to assist its operations. But most of the work actually needed was to clean up houses hit and damaged by the tsunami and remove mud from them, and such a gap bewildered some of the DRV dispatched from the Headquarters. Among the municipalities of MIYAGI, only KESENNUMA established a Red Cross DRV center at the local level. In KESENNUMA, there were also first-aid stations set up by the city government, and nurses and other personnel treated injured people. Red Cross DRVs also provided support making effective use of the training and experience they had previously received and acquired. Red Cross DRV leaders qualified as first aid instructors performed duties such as administering first aid and reminding victims that they should be careful not to develop heatstroke. In ISHINOMAKI, a major base specializing in medical relief was being built under the leadership of the Ishinomaki Red Cross Hospital (RCHP). A DRV leader went to the aera as thinking about the possibility of supporting it, but a considerable number of NPOs nationwide had dispatched their members to ISHINOMAKI by the thousands. Therefore, Red Cross DRVs worked at both the hospital and the Social Welfare Council s DRV center. Meanwhile, Red Cross Community Volunteers Corps organized locally in each municipality effectively used the training and experience they had received and gained on a daily basis to carry out relief activities independently in their respective communities in a way that met the needs of the communities. Community Volunteer Corps Figure 7-4 Activities of Red Cross Volunteer Corps under the Miyagi Chapter (as of the End of March 2012) Total number of Corps Number of Corps that actually worked ,723 Number of volunteers who actually worked Major activities Distribution of cooked rice and food and support for such distribution, the distribution of relief supplies, visits to evacuation centers for inspection, water supply, the provision of shaved ice at evacuation centers, etc. Specific Volunteer Corps Support for exercises, massaging the palms, the operation of volunteer centers, etc. Youth Volunteer Corps Transport of relief supplies, the operation of volunteer centers, psychosocial care, etc. Total ,416 Figure 7-5 Activity System for the JRCS Miyagi Chapter s DRVs and the Social Welfare Council s Volunteers e Cr a ter e a er e a Chapter C Chapter 7 Red Cross Volunteer Activities Great East Japan Earthquake and Tsunami 175

203 Great East Japan Earthquake and Tsunami Chapter 7 a. HIGASHIMATSUSHIMA The Higashimatsushima City Social Welfare Council (located in the city s welfare center for the aged) was not a designated evacuation center, but immediately after the earthquake, due to the heavy damage caused by the tsunami, many residents evacuated to public facilities, including the Council s building. These facilities received them because they had a certain amount of space and a certain number of blankets stored for emergencies. During the first week after the earthquake, priority was given to life-saving operations, but preparations for a DRV center were made in parallel with these activities. On March 19, such a center was established on the second floor of the health center. Red Cross DRVs joined the volunteer center after March 20, and until that time, they had participated in volunteer activities mainly through the prefectural Social Welfare Council. Since the city s Council did not have a sufficient number of personnel, they joined the DRV center as its staff members and performed duties such as listening to the victims concerning their needs in the affected areas. The section for JRCS to contact at the Higashimatsushima city government was its Health and Welfare Department s Health and Welfare Division, but this division was responsible for relief work and psychosocial care and served as the section for Red Cross Community Volunteer Corps to contact for activities such as the distribution of food while volunteer activities were the responsibility of the Social Welfare Council. In fact, most of the need for volunteers was for the removal of mud from houses, an important job to maintain the spaces for people to live in, and in most cases Red Cross DRVs were engaged in this type of activity. b. WATARI In WATARI, the Miyagi prefectural and Watari town governments and the Watari Social Welfare Council had concluded a three-party agreement and even decided specifically where the DRV centers should be set up. On March 12, a temporary reception desk for a DRV center was installed at the community center s parking lot, and volunteers worked there for about one week. On March 19, a DRV center was established at the community center s Nisshukan building, but the volunteer center had difficulties in recruiting volunteers because it was hard to make its existence known to those who needed it. Around that time, the personnel of the JRCS Miyagi Chapter and Headquarters visited the volunteer center to provide cooperation. Since it had difficulties in conducting its operations due to the lack of personnel, the volunteer center asked the Chapter and the Headquarters to dispatch Red Cross DRVs, and around three of them took turns in helping to operate the volunteer center. In particular, Red Cross DRVs made all-out efforts to remind victims of the need for hygiene maintenance and the danger of injury and infections. In addition, they assisted in activities such as cleaning houses in the affected areas. Until the end of June, they came to the volunteer center periodically in order to support the volunteer center. In WATARI, Red Cross Community Volunteer Corps were not engaged in activities such as the distribution of food. There was a Red Cross Entertainers Volunteer Corps (usually engaged in volunteer activities such as recreation), but they also helped remove mud from houses. In WATARI, the section for JRCS to contact in the town government was the Health and Welfare Division, but since immediately after the earthquake this division had been so busy with its diverse original duties that it was not in a situation that enabled it to request the Red Cross Community Volunteer Corps for support. (3) FUKUSHIMA At 2:50 p.m., immediately after the earthquake, the Fukushima Chapter established a HDC and installed one of its personnel as the person in charge of volunteers. For this disaster, the Chapter did not set up its own DRV center. Depending on the contents of the requests, its Operations Division took responsibility for coordination, and its personnel communicated with Red Cross DRVs as requested, and in addition, the above-mentioned person in charge responded to inquiries about volunteers from prefectural residents (some inquiries from outside). From 10:00 a.m. on March 14, three days after the earthquake, the Fukushima Prefecture Disaster Volunteer Liaison Council held a meeting and decided to establish a Fukushima Prefecture Disaster Volunteer Center in accordance with the guidelines for receiving disaster volunteers it had formulated. The Fukushima Chapter was a member of the center, and Red Cross DRVs worked closely with the Fukushima Prefecture Social Welfare Council s Disaster Volunteer Center. The Volunteer Center could not communicate with the affected coastal areas for about one week. During that interval, it strove to assess the situation in such areas 176

204 Figure 7-6 Organizational Chart of the Fukushima Chapter HDC Figure 7-7 Organizational Chart of the Fukushima Prefecture Disaster Volunteer Center and its Duties based on information provided by municipal Social Welfare Councils to their prefectural counterparts as well as the information received from DRVs and members of Red Cross Safety Volunteer Corps (first aid instructors) who had reached the coastal areas. Information from the municipal HDC in the affected areas was sometimes provided to the Chapter through the prefecture s HDC or directly. Those ordinary people who wished to work as a volunteer were introduced to evacuation centers in the city, the section of the prefecture s HDC that was responsible for volunteers and other relevant organizations. The Fukushima Chapter neither recruited DRVs nor collected volunteers from the general public and dispatched them to affected areas on its own initiative. Most of the activities of Red Cross Community Volunteers Corps were carried out at the request of administrative agencies with which they were registered. Immediately after the earthquake, some groups distributed cooked rice and other food independently. Nine Red Cross Community Volunteer Corps were formed and registered with six of the city government s 16 branches. In the prefecture, 106 such Corps were formed in 59 municipalities. Local governments and Red Cross Community Volunteer Corps work with each other to conduct drills for food distribution, disaster prevention, etc., on a daily basis. On March 11 and 12, some Red Cross Community Volunteer Corps joined local governments in distributing relief supplies such as blankets. [Members of a Red Cross Community Volunteer Corps who distributed hot noodle dishes at the Azuma Gymnasium] a. AIZUWAKAMATSU In AIZUWAKAMATSU, there was no totally destroyed house with the damage caused remaining relatively moderate. Examples included fallen house Chapter 7 Red Cross Volunteer Activities Great East Japan Earthquake and Tsunami 177

205 Great East Japan Earthquake and Tsunami Chapter 7 walls, tilted warehouses, collapsed brick fences, and damaged roads. Those who lived at the evacuation centers in the city came from the HAMADORI area. They were hit by the tsunami or forced to flee due to the nuclear accident. In AIZUWAKAMATSU, an administrative member of the JRCS Aizuwakamatsu Branch at the city government served as the person to contact for Red Cross affairs. This administrative member, who is also a Red Cross DRV district leader, was responsible for planning volunteer activities after the disaster. Red Cross DRV activities mostly consisted of the distribution of cooked rice and other food by Red Cross Community Volunteer Corps at the evacuation centers. On March 16, an evacuation center called Fureai Taiikukan (contact gymnasium) was set up, and Red Cross Female Volunteer Corps in AIZUWAKAMATSU was responsible for the distribution of food. Several evacuation centers were built in the city, and the city government assigned volunteers to these evacuation centers. In dividing the roles at the gymnasium, taking into consideration factors such as sanitary requirements, the number of volunteers needed, and experience, it was decided that Red Cross Community Volunteers Corps should be fully responsible for the distribution of food, and its district subgroups took turns to perform this work. Formed based on the city s 14 administrative sections, these subgroups distributed food to victims smoothly without any confusion. At the gymnasium, the volunteers paid close attention to sanitation since a kitchen was built in a tent put up outdoors. The reason why only this Volunteer Corps was responsible for food distribution was that it was assumed that such arrangements would enable it to pay full attention to sanitation. The city government was also confident that the Volunteer Corp s experience in annual food distribution drills would allow it to demonstrate its abilities to the full. The members of the Corps always used disposable gloves and sterilized the dishes and other utensils in a boiling water bath. Those who worked as volunteers at the gymnasium consisted of various people such as Red Cross DRVs, Social Welfare Council volunteers, members of women s associations, district welfare commissioners, and other individuals, and they worked together by dividing roles among them. For example, the Social Welfare Council volunteers matched volunteers with needs and dispatched them to the disaster volunteer center set up by the city s Social Welfare Council. At the gymnasium, they sorted out relief supplies and helped distribute them. The Red Cross DRVs listened to evacuees telling their stories while giving them a palm massage. b. YABUKI In YABUKI, about 3,000 houses collapsed, some were totally destroyed and others half or partially destroyed, and the roads were made impassable at many places. The water supply was cut off at about 4,000 locations. Unlike AIZUWAKAMATSU, the town sustained serious damage. Evacuation centers were set up at safe places in the affected area, local residents evacuated to the centers, and local volunteers, who were also victims, supported the evacuees. Thus all relief activities in the community were carried out by its members. The Yabuki Town Social Welfare Council sought support from Red Cross Volunteer Corps in the Nakahata, Mikami, and Yabuki areas. Local Red Cross DRV leaders played a pivotal role in making preparations to establish a disaster volunteer center. On March 14, having taken over the disaster volunteer center set up at the Yabuki municipal government immediately after the earthquake, they set up a new disaster volunteer center within the town s Social Welfare Council. The Red Cross DRV leaders, who were engaged in the establishment and operation of the center, had experience in participating in the activities of disaster volunteer centers after the torrential rainfall in SHIRAKAWA in 1998 and the Niigata Chuetsu Earthquake in 2004 and were qualified as disaster prevention specialists. [Members of a Red Cross Community Volunteer Corps from YABUKI who distributed food] The volunteer center, which was viewed as the disaster volunteer center of the Yabuki Town Social Welfare Council, participated in volunteer activities in the town first. Those who wished to work as a volunteer were all required to register with the disaster volunteer center. Red Cross DRV leaders made the most of their knowledge and experience to hold pre-dispatch 178

206 orientation sessions for the registered volunteers, reminding them that they should be self-sufficient when participating in volunteer activities. Thus they provided guidance similar to that provided for Red Cross disaster relief work. Immediately after the establishment of the center, due to the limited workforce, personnel of the Yabuki Town Social Welfare Council and DRV leaders gave top priority to visiting aged persons who lived alone for inspection and investigated the damage caused and the needs of the victims. They also visited evacuation centers in the town to back up volunteer activities by, for example, determining the person responsible for the management of each of them and laying down rules for the centers. The water supply was cut off at many locations, and a temporary water supply was established by the town government, but they supported this service on a voluntary basis. Furthermore, in order to ensure that the establishment of the disaster volunteer center was widely known to local residents, they made announcements through the town s disaster-response wireless system and the public address system of the fire brigade s waterpump vehicles. After the earthquake, the town government left the distribution of food in the town to the three district Red Cross Volunteer Corps. Since it supervised the evacuation centers, the government was responsible for food distribution too. Many members of these groups were also victims of the disaster. At first, with their houses destroyed, the heads of the three groups were engaged in volunteer activities while living at an evacuation center. Since the town s government and Social Welfare Council had no food stored for emergencies, members of the volunteer groups offered for distribution some of the rice, vegetables and other ingredients that they had. 3. Volunteer activities at various Chapters (1) Number of Red Cross Volunteer Corps etc., that operated at each Chapter and their activities JRCS divides the 47 prefectures into six blocks. Since the earthquake of March 11 caused enormous damage to a wide range of areas centered on the 1st Block, the functions of Chapters in the block declined, but many Red Cross Volunteer Corps and DRV groups operated in the three affected prefectures: 229 for IWATE, 127 for MIYAGI and 124 for FUKUSHIMA. In the 2nd Block, in order to help the 1st Block Chapters, the largest number of Volunteer Corps among the six blocks operated; in five of 2nd Block nine Chapters, the number of Red Cross Volunteer Corps and DRVs that worked exceeded 100 each. The largest number of such Corps operated under the Saitama Chapter (225), followed by the Kanagawa (223), Tokyo Metropolitan (188), Chiba (162) and Ibaraki (104) Chapters in the stated order (Numbers in parentheses indicate the number of Red Cross Volunteer Corps DRVs that worked). Figure 7-8 Number of Red Cross Volunteer Corps, etc. that Operated at Each Chapter and Their Activities (1) (Period covered by the reports: March 11, 2011 to March 31, 2012) Chapters The 1st Block The 2nd Block Total number of Red Cross Volunteer Cops, etc. Community Volunteer Corps Youth Volunteer Corps Specific Volunteer Corps DRVs, etc. Junior Red Cross Number of volunteers Food distribution Relief supplies Activities Support for medical teams Duties at the volunteer centers Collection of Gienkin Other duties Remarks HOKKAIDO Support for Chapters in the affected areas and investigation of the needs of such areas AOMORI Visits to aged persons to talk to them IWATE ,735 Investigation of the need for volunteers, psychosocial care, driving services, tidying up of goods, etc. MIYAGI ,934 Massage service for evacuees, investigation of the safety of people, etc. AKITA ,613 Investigation of the needs of the affected areas and blood donations Investigation of the needs of the affected areas, reception YAMAGATA ,891 of Gienkin and hair cutting FUKUSHIMA ,686 Information gathering and investigation of the needs of the affected areas Investigation of the needs of the affected areas, road IBARAKI ,252 cleaning, cleaning up of houses, and listening to aged persons at facilities for them Visits to the children of families living at evacuation TOCHIGI centers to tell stories with picture cards and play with them GUNMA Information gathering using amateur radio and preparations to dispatch medical teams Providing amazake, green tea, and other beverages to SAITAMA ,299 the evacuees, playing musical instruments, and putting up carp streamers (koinobori) Chapter 7 Red Cross Volunteer Activities Great East Japan Earthquake and Tsunami 179

207 Great East Japan Earthquake and Tsunami Chapter 7 Chapters The 3rd Block Total number of Red Cross Volunteer Cops, etc. Community Volunteer Corps Youth Volunteer Corps Specific Volunteer Corps DRVs, etc. Junior Red Cross Number of volunteers Food distribution Relief supplies Activities Remarks CHIBA ,369 Removal of debris, lectures to support the daily life of the victims, etc. TOKYO ,994 Support for stranded people and the transport of materials and equipment for medical teams KANAGAWA ,337 Support for the Chapter s HDC, public relations for blood donation, and support for psychosocial care NIIGATA ,626 Psychosocial care, reception of evacuees, etc. YAMANASHI Support for the Chapter s HDC and medical care for evacuees TOYAMA Mailing of receipts for Gienkin ISHIKAWA Charity bazaars and the removal of mud FUKUI ,383 Driver services for the relief work sites and cooking NAGANO ,415 Lectures to support the affected people lives, etc. GIFU ,864 Sorting of goods and the collection of Gienkin SHIZUOKA ,277 Visits to evacuation centers for inspection, support for psychosocial care, and accompaniment for medical teams AICHI ,974 Collection of Gienkin sorting of relief supplies, and deru cleaning and maintenance MIE Mailing of receipts for Gienkin support for medical teams, and the transport of relief supplies Support for medical teams Duties at the volunteer centers Collection of Gienkin Other duties The second largest number of Volunteer Corps came from 4th Block, an area where the Great Hanshin Awaji Earthquake of 1995 led residents to develop an extremely high level of awareness about DRVs. A total of 580 Volunteer Corps worked under the Osaka Chapter. In general, a smaller number of Volunteer Corps operated in areas that were further away from the affected areas, but in OKINAWA in 6th Block, the southernmost of all the blocks, 98 Volunteer Corps worked. The 47 Chapters combined had a total of 4,624 Red Cross Volunteers Corps and DRVs in which a total 179,517 people worked as volunteers. Figure 7-9 Number of Red Cross Volunteer Corps, etc. That Operated at Each Chapter and Their Activities (2) (Period covered by the reports: March 11, 2011 to March 31, 2012) Chapters The 4th Block The 5th Block Total number of Red Cross Volunteer Corps, etc. Community Volunteer Corps Youth Volunteer Corps Specific Volunteer Corps DRVs, etc. Junior Red Cross Number of volunteers Food distribution Relief supplies Activities Support for medical teams Duties at the volunteer centers Collection Other of Gienkin duties SHIGA ,145 KYOTO OSAKA HYOGO ,926 Remarks Transport of relief supplies, collection of Gienkin and support for the Chapter s operations Support for medical teams, removal of materials from the affected areas, and procedures for certificates to confirm vehicles for use as emergency vehicles Information gathering, visits to evacuation centers, support for the Chapter s reception desk, fund-raising, and messages of encouragement Driving services and activities at volunteer centers in the affected areas NARA Answering phone calls and mailing receipts for Gienkin WAKAYAMA ,162 TOTTORI ,464 Collection of Gienkin SHIMANE ,262 OKAYAMA ,216 Mailing of receipts for Gienkin support for medical teams, and support for the Chapter as communications and liaison officers Duties at the Miyagi volunteer center, investigation of needs, collection of Gienkin and messages of encouragement for the affected areas Reception of Gienkin and activity funds and duties at the volunteer centers (communications by phone and reception of applications for registration) HIROSHIMA ,640 Transport of goods and the collection of Gienkin YAMAGUCHI TOKUSHIMA KAGAWA ,536 EHIME ,517 Collection of Gienkin KOCHI Psychosocial care for volunteers, medical care for the wounded, and the filing of newspaper articles Dispatch of volunteer groups for food distribution in KESENNUMA Reorganization of medical equipment and volunteer work in ISHINOMAKI Preparations for the transport of goods and the collection of Gienkin 180

208 Chapters The 6th Block Total number of Red Cross Volunteer Corps, etc. Community Volunteer Corps Youth Volunteer Corps Specific Volunteer Corps DRVs, etc. Junior Red Cross Number of volunteers Food distribution Relief supplies Activities Remarks The table below indicates the breakdown of Red Cross Volunteer Corps, etc., at each chapter and the number of volunteers in the groups. Support for medical teams Duties at the volunteer centers Collection Other of Gienkin duties FUKUOKA ,326 Charity concerts and calls for blood donations SAGA Reception of Gienkin support for the Chapter s operations, and cleaning campaigns NAGASAKI Charity swimming meets and the mailing of receipts for Gienkin KUMAMOTO Mailing of receipts for Gienkin presentation of toasted laver (support supplies), and the creation of messages of encouragement for the affected areas OITA Loading of sets of emergency supplies and the operation of volunteer centers MIYAZAKI ,288 Collection of Gienkin and the transportation of goods KAGOSHIMA OKINAWA Total (47 Chapters) 1, ,014 4, , Creation of messages of encouragement for the affected areas, support for the Chapter s operations, and the collection of vehicles used for medical teams Collection of Gienkin coordination at volunteer centers, and support for the Chapter s operations Chart 7-10 Breakdown of Red Cross Volunteer Corps, etc. at Each Chapter and the Number of Volunteers in the Corps Community Youth Specific DRVs, etc Junior Red Cross Total Chapters Number of Number of Number of Number of Number of Number of Number of Number of Number of Number of Number of Number of Corps volunteers Corps volunteers Corps volunteers Corps volunteers Corps volunteers Corps volunteers 1 HOKKAIDO AOMORI IWATE 69 1, , ,735 4 MIYAGI 98 8, ,934 5 AKITA 39 3, , ,613 6 YAMAGATA 52 1, ,891 7 FUKUSHIMA 111 6, ,686 8 IBARAKI ,252 9 TOCHIGI GUNMA SAITAMA 155 2, , CHIBA 129 5, , , TOKYO 51 1, , KANAGAWA 40 1, , , NIIGATA , TOYAMA ISHIKAWA FUKUI , YAMANASHI NAGANO 119 5, , GIFU 162 3, , SHIZUOKA , , AICHI 44 1, , MIE SHIGA , KYOTO OSAKA HYOGO 38 6, ,926 Chapter 7 Red Cross Volunteer Activities Great East Japan Earthquake and Tsunami 181

209 Great East Japan Earthquake and Tsunami Chapter 7 Community Youth Specific DRVs, etc Junior Red Cross Total Chapters Number of Number of Number of Number of Number of Number of Number of Number of Number of Number of Number of Number of Corps volunteers Corps volunteers Corps volunteers Corps volunteers Corps volunteers Corps volunteers 29 NARA WAKAYAMA 4 2, , , TOTTORI 39 1, , SHIMANE , , OKAYAMA 79 1, , , , HIROSHIMA 7 10, , , YAMAGUCHI TOKUSHIMA KAGAWA , , EHIME , , KOCHI FUKUOKA , , SAGA NAGASAKI KUMAMOTO OITA MIYAZAKI , , KAGOSHIMA OKINAWA Total 1,928 72, , , ,014 1,014 91,517 4, ,517 (2) Initiatives at each Chapter a. Support for food distribution by Red Cross Volunteer Corps from TOKUSHIMA and YAMAGATA and personnel of the Tokushima and Yamagata Chapters 1 Red Cross Volunteer Corps from TOKUSHIMA and YAMAGATA and personnel of the Tokushima and Yamagata Chapters helped distribute cooked rice and other food in KESENNUMA and ONAGAWA, MIYAGI. <First round> May 11 to 14, 2011 Date * Food was distributed at the place mentioned below from May 12 to 13. Evacuation center at Koharagi Place Junior High School in KESENNUMA, MIYAGI 15 from the Tokushima Chapter 10 members from Community Red Cross Volunteer Corps 5 personnel of the Tokushima Chapter Volunteers 12 from the Yamagata Chapter 8 members from Community Red Cross Volunteer Corps 4 personnel of the Yamagata Chapter Date Place Volunteers <Second round> September 17 to 20, 2011 *Food was distributed at the place mentioned below from September 18 to 19. Evacuation center at a gymnasium in ONAGWA, MIYAGI 13 from the Tokushima Chapter 8 members from Community Red Cross Volunteer Corps 5 personnel of the Tokushima Chapter 15 from the Yamagata Chapter 10 members from Community Red Cross Volunteer Corps 5 personnel of the Yamagata Chapter [Food distribution using a portable rice cooker during disasters] (1) Tokushima Red Cross Volunteer Corps GEJET: A report on the food distribution group s activities 182

210 b. Food distribution and recreation by a Red Cross Volunteer Corps from NOSHIRO, AKITA 2 A Red Cross Volunteer Corps and DRVs from NOSHIRO, AKITA and personnel from the city government and other public institutions distributed cooked food and offered recreation at SAKARI in OFUNATO, IWATE. Date 10:00 a.m. to 3:00 p.m. on March 24, 2012 Emergency temporary houses at Place SAWAKAWA in OFUNATO, IWATE 19 members of the Noshiro Red Cross Volunteer Corps Volunteers 3 personnel of the city government, etc. 5 Red Cross DRVs, etc. [Recreation exchanges ] c. Exchanges between a Red Cross Volunteer Corps from KIMITSU, CHIBA and victims through home-cooked meals KIMITSU received evacuees from prefectures such as FUKUSHIMA, and a Red Cross Volunteer Corps invited them to lunch to entertain them with meals and promote deeper interaction. Outline of "the invitation to lunch" Have evacuees spend their time in leisure activities Promote deeper interaction by serving Purposes personally prepared meals Have evacuees feel that it was a good experience to come to KIMITSU The first exchange was held on April 20, A similar program was implemented twice a month until September of the same year. Seven community centers in the city took Description turns to offer a place for interaction. The program lasted from 11:00 a.m. to 3:00 p.m. Volunteers entertained the evacuees with home-cooked meals using local ingredients. The participants spent the day happily. Operations Points to note The city government was responsible for announcements, confirmation of those who wished to attend, and their reception. Ten subgroups of the Red Cross Volunteer Corps took turns to prepare the meals. All expenses were borne by the Volunteer Corps. Since the target was the victims of the disaster, all group members paid close attention to the participants they entertained and the arrangements they made. The group members entertained the participants just like Red Cross volunteers by offering personally prepared meals. Schedule Date Hosted by Venue April 20 Headquarters Yaehara community center May 11 Obitsu Obitsu community center May 27 Kimitsu Fureaikan, first floor June 15 Sadamoto and Sunami Sadamoto community center June 22 Koito Koito community center Agricultural July 7 Kururi, Matsuoka and Environment Kameyama Improvement Center July 20 Seiwa community Akimoto and Mishima center August 10 Obitsu Obitsu community center August 24 Headquarters September 9 September 21 voluntary members Headquarters Hotel Sennari Koito community center Shinshoji Temple and near Narita Airport d. Activities by Red Cross Youth Volunteer Corps from SAPPORO and KUSHIRO 3 to support the affected areas in MIYAGI Voluntary members of Red Cross Youth Volunteer Corps from SAPPORO and KUSHIRO participated in emergency psychosocial care sessions held by Volunteer Corps under the Miyagi Chapter at evacuation centers in the affected areas. Prior to their participation, at the Miyagi Chapter they received advance training in detail through lectures on aged persons who had experienced a disaster. Chapter 7 Red Cross Volunteer Activities (2) Noshiro Red Cross Volunteer Corps: Support for victims through food distribution, etc. (3) Daiki Ichinoseki, Records of activities of the Sapporo and Kushiro Youth Volunteer Groups after the GEJET: Implementation by Red Cross Community Youth Volunteer Corps of activities in remote affected areas, May 1, 2012 Great East Japan Earthquake and Tsunami 183

211 Great East Japan Earthquake and Tsunami Chapter 7 Date and time and place Participating Volunteer Corps Details of activities Day 1 Date and time: August 20, 10:00 a.m. to 3:00 p.m. Place: Evacuation center at the Ishinomaki Municipal Minato Elementary School Day 2 Date and time: August 21, 10:00 a.m. to 2:00 p.m. Place: Onagawa Municipal Daiichi Elementary School Onagawa gymnasium Sapporo Youth Volunteer Corps (5 persons) Kushiro Youth Volunteer Corps (1 person) Miyagi Nurse volunteer Corps and the Reijinkai Volunteer Corps Miyagi Youth Volunteer Corps Community Volunteer Corps Emergency psychosocial care Participants used the manual relaxation techniques learned from the lectures to support aged persons who experienced the disaster (methods for supporting a healthy life) to provide psychosocial care to those who lived at the evacuation center. They also offered ice cream and shaved ice at the evacuation center. friendship city with FUKAYA. The carp streamers raised in the wind in this project were collected by the Volunteer Corps from the city s residents to encourage people to overcome obstacles like the carp fighting its way upstream, and a total of 227 carp streamers were offered by 44 donors. The residents of KAWAGUCHI offered the carp streamers that were put up in NIIGATA after the Chuetsu Earthquake in the hope that the thoughts of those who had formerly experienced a similar disaster would be conveyed to TOHOKU through the 227 carp streamers. These carp streamers were temporarily collected from NIIGATA and erected in TANOHATA. The Japan Koinobori Association also offered to donate some carp streamers. Fukuya citizens wrote warm messages of encouragement on these carp streamers to support the reconstruction efforts. [Activities to provide emergency psychosocial care] [Empathetic carp streamer project] e. Carp streamer project by a Red Cross Volunteer Corps from FUKAYA, SAITAMA 4 When the Niigata-ken Chuetsu Earthquake occurred, the Fukaya Red Cross Volunteer Corps, which currently has 466 members, implemented a project for putting up carp streamers prepared with the heartfelt contributions of Fukaya citizens at the Kawaguchi Elementary School in KAWAGUCHI, NIIGATA, which was the epicenter of the earthquake. At that time, the Corps received many comments from the students, who said, The carp streamers cheered us up, and We were happy. Therefore, after the March 11 earthquake, they flew similarly prepared carp streamers in TANOHATA, IWATE, which is a f. Junior Red Cross (JRC) member schools in WAKAYAMA presented albums to encourage elementary school students in the affected areas 5 Students at the Wakayama Municipal Higashisando and Nagusa Elementary Schools, both were with the JRC member schools, voluntarily discussed what they could do for children of the same age in the affected areas and produced albums to encourage them referring to those that they exchanged with overseas children through inter exchange and friendship programs. Each of the students wrote a message in which they put their thoughts as a JRC member and delivered them to children at the Yamada Municipal Osawa Elementary School, located in YAMADA, (4) Red Cross Community Volunteer Corps of FUKAYA, SAITAMA, Let s put up carp streamers in TANOHATA: An empathetic carp streamer project (5) JRC member schools presented an elementary school in an area hit by the Great East Japan Earthquake and Tsunami with albums to encourage them 184

212 SHIMOHEI, IWATE, where the Wakayama Chapter s medical team had installed a deru for medical relief. In the Osawa area, where the elementary school is located, 60% of the houses were totally or partially destroyed due to the tsunami, and there was also a heavy toll on its residents, but the elementary school, which stands on a hill, served as an evacuation center, receiving hundreds of victims. Later, they lived there together for five months. Fortunately, all the children who were at the school when the earthquake occurred were safe, but some of them suffered from the loss of their family members due to the tsunami and supported each other while facing lots of trouble and grief. The Osawa Elementary School was the first to receive encouraging albums from WAKAYAMA, and they were long displayed in the teachers room, cheering up the children and teachers of the school. These albums led to continued exchanges between the Osawa Elementary School and WAKAYAMA s two elementary schools. and other people watched, a box of pharmaceuticals such as painkillers and 19 boxes of sanitary supplies such as syringes and masks were loaded onto the Okayama unit s airplane. Furthermore, on March 24, 100 helmets and 15,000 masks were flown to Hanamaki Airport. On March 27, the Head of the Kokura unit handed the 4,700 tooth brushes (the remaining 1,300 were delivered to the affected areas later) collected by Angel Wings, an NPO led by one of the unit s members, over to the Okayama unit by flying back and forth, and the Okayama unit s airplane carrying the tooth brushes headed for Hanamaki Airport. In these operations, the Okayama unit received support and cooperation from other units: relief supplies from the Kokura unit, the airplane from the Kumamoto unit, and fuel from the Okinawa unit. [Albums of encouragement delivered to the Osawa Elementary School] g. Red Cross Squadron Okayama unit 6 On the morning of March 19, 2011, the Red Cross Squadron Okayama unit left Konan Airport (URAYASUMINAMI, MINAMI, OKAYAMA) for Hanamaki Airport in IWATE. The objective was to urgently supply pharmaceuticals and other goods to the JRCS Okayama Chapter s medical team working in RIKUZEN-TAKATA, IWATE, which had been hit by the massive tsunami, and among the 38 units of the Red Cross Squadron the Okayama unit was the first to be mobilized to areas stricken by the earthquake of March 11. At Konan Airport, as Chapter personnel [Activities of the Red Cross Squadron Okayama unit] Chapter 7 Red Cross Volunteer Activities (6) Aeronca, No. 521, May 1, 2011 Great East Japan Earthquake and Tsunami 185

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214 Chapter 8 Recovery Assistance Program

215 Great East Japan Earthquake and Tsunami Chapter 8 Chapter 8 Recovery Assistance Program Since the occurrence of the Great East Japan Earthquake and Tsunami (GEJET) on March 11, 2011, the Japanese Red Cross Society (JRCS) has received huge sums of donation from overseas Red Cross and Red Crescent Societies, etc. Financed by these overseas donation, JRCS began to promote recovery assistance programs for the affected areas of the GEJET following emergency relief as well as the collection and reception of Gienkin. The cases in which JRCS had previously implemented projects for recovery support were mainly for largescale disasters occurred in emerging and developing countries. This recovery assistance program is part of assistance activities for the largest scale of natural disaster that has ever occurred in a developed country, and it is thus extremely important to share our experience of this event internationally. 1. Organizational regime of the recovery assistance program (1) Background to establishing a dedicated team for overseas donation and the development of an overall proposal for the assistance program On March 14, 2011, JRCS had the first teleconference with the International Federation of Red Cross and Red Crescent Societies (IFRC) after the disaster. JRCS reported on the situation of the affected areas, the activities of the Japanese Government and JRCS and discussed what kind of support IFRC could provide. In the course of the discussions, it was revealed that the donation from the overseas National Societies had reached 30 billion yen. As the amount of overseas donation collected in the Great Hanshin-Awaji Earthquake was approximately 1 billion yen, this amount is far larger than ever before. The donation sent from each National Society should be used for purchasing the equipment and materials necessary for the disaster relief activities implemented by JRCS as well as for the direct costs of the other relief activities, in accordance with the Principles and Rules for RCRC Disaster Relief. However, in order to make maximum use of the huge sum of donation from overseas collected this time, it was required to appropriately understand the needs of the three affected prefectures (IWATE and MIYAGI, FUKUSHIMA) and develop an efficient large-scale assistance program in addition to the traditional individual projects. The scheme for understanding the needs of the affected areas and reflecting them in the projects was the very first attempt for JRCS. As a first step from March 21, the Vice-President, Director General of the Compliance Management Office (Then:Director General of the Great East Japan Earthquake and Tsunami Response Task Force) and the Director General of the International Department made visits to the Governors of IWATE, MIYAGI and FUKUSHIMA. (They visited the Deputy Governor of MIYAGI instead of the Governor who was out attending the prefectural assembly.) They explained that JRCS was ready to provide recovery assistance programs utilizing the donation collected from the overseas National Societies, and introduced, as examples of assistance programs, the provision of electrical household appliances for temporary housing as well as the vehicles needed for activities on site. The purpose of these visits was to coordinate views with the government, but as it was a period when the Prefectures were still in a state of confusion trying to assess the damage, there were no specific requests or other responses at that point. On March 28, a dedicated team for responding to the donation from overseas was established in the Headquarters of Disaster Control (HDC) at the Headquarters. The dedicated team consisted of 8 members, and the members were called to come together in the President s office and explained about the aims of establishing the dedicated team for responding to the donation along with its roles. In the afternoon of the same day, the donation of electrical household appliances to people evacuated to temporary housing was decided on as a assistance program financed by the donation from overseas in the meeting of the Executive Director General of the Administration Sector, Director Generals of the Compliance Management Office, the Planning and Public Relations Office, the International Department and other executives. The electrical household appliances package was composed of 6 electrical household appliances; a 188

216 refrigerator, a TV set, a washing machine, microwave ovens, a rice cooker and an electric hot water dispensers. JRCS offered the local governor in affected prefectures the donation of electrical household appliances package for temporary housing via the Chapter in each prefecture, and with their willing consent JRCS started the project. Early in April, the members of the dedicated team were dispatched in turns to the three affected prefectures with the aim of on-site coordination and needs surveys for the project for the donation of electrical household appliances packages. Based on the needs survey conducted by the dispatched members, an assistance program plan with a budget of 30 billion yen was finalized on April 22 as the Draft proposal for an overall plan for the GEJET relief and recovery project (financed by donation from overseas). The contents were as follows. (Draft) GEJET Relief and Recovery Plan (financed by donation from overseas) Distributing of emergency relief supplies; Purchase and replenishment of relief supplies Emergency medical service; Dispatching medical teams Improving the living condition of evacuation centres and temporary housing (installation of portable toilets, kitchens and shower facilities, provision of psychosocial care services and medical care, establishment of volunteer centres, provision and installation of electric household appliances, establishment of community centres) Rehabilitation and strengthening of health infrastructure: Rehabilitation of health system and strengthening of medical response capacity in disasters of the Ishinomaki area in MIYAGI. Social welfare, care for the elderly: provision of nursing beds and vehicles to social welfare institutions/ dispatch caregiving staff Improving the living conditions of affected people: Nordic walking to compensate for a lack of exercise Children s education support: special assistance to the children in affected areas. Capacity building of JRCS national disaster preparedness: strengthening of JRCS Headquarters, Chapters and facilities. JRCS/IFRC s programme support cost (public relations, reporting, management): salaries, external audit, etc. (2) Establishment of a Promotion Committee for the GEJET Recovery Assistance program JRCS established a Promotion Committee for the GEJET Recovery Assistance program in the Headquarters to discuss and determine the details of the GEJET recovery assistance program financed by the donation collected through overseas Red Cross and Red Crescent Societies, etc. From the time of its establishment, a total of 13 meetings were held up to the end of December In addition, a total of 11 preliminary meetings among the Chapters in the three affected prefectures were held from September 2011 through December Guidelines for the Establishment of the council for the GEJET Recovery Assistance Program Article 1. Establish the council for the GEJET Recovery Assistance Program (hereafter the Council ) to make consultations and to deliver operational decisions upon the recovery programmes supported by the donations from overseas societies and other institutions. Article 2 The council for the GEJET Recovery Assistance Program shall be comprised of the members stated below: (1) President (2) Vice President (Full-time) (3) Executive Director General (Administration Sector) (4) Executive Director General (Operations Sector) (5) Director General (General Affairs Department) (6) Director General (Compliance Management Office) (7) Director General (Disaster Management and Social Welfare Department) (8) Director General (International Department) (9) Director General (GEJET Recovery Task Force) Article 3 The President shall preside over the work of the Council. Article 4 The Council shall be called by the President. Article 5 The President, should it be deemed necessary, can invite a person other than the members to the Council for consultations. Article 6 The GEJET Recovery Task Force(under the Disaster Management and Social Welfare Department) shall handle the general affairs of the Council as the Secretariat. Article 7 The matters other than articulated herewith in relation to the management of the Council shall be separately defined by the President. Based on Article 6 of the above guidelines, JRCS established the GEJET Recovery Task Force in the Disaster Management and Social Welfare Department of the Operations Sector on May 1, 2011, with the aim of addressing the GEJET recovery assistance program in an intensive and comprehensive manner. (3) Organizational structure of the GEJET Recovery Task Force The GEJET Recovery Task Force is a self-contained organization with a certain amount of authority to implement the project. Regarding the responsible persons inside the Task Force, the experience and original posts Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 189

217 Great East Japan Earthquake and Tsunami Chapter 8 of each staff member were taken into consideration. In establishing the Task Force, the Guidelines for Establishing the GEJET Recovery Task Force, which described its aims and activities, was formulated. According to the guidelines, the Task Force should have the aim of addressing, in an intensive and comprehensive manner, the GEJET recovery assistance program financed by the donation from overseas collected through overseas Red Cross Societies and other organizations, etc. Guidelines for the Establishment of the GEJET Recovery Task Force (extracts) 1 Purpose To manage the GEJET operations funded by the overseas National Societies and other institutions in comprehensive and intensive manners, the GEJET Recovery Task Force shall be established under the Disaster Management and Social Welfare Department (hereafter Task Force ). This is a temporary arrangement based on the Article 3 of the JRCS Regulations on the Headquaters Organization. 2 Terms of Reference (1) Planning and overall management of the GEJET programmes (2) Coordination with relevant administrative organs (national and local governments emergency management headquarters, etc.) and with relevant institutions (3) Contracts and authorization of order and delivery of merchandise (4) Budget management (5) Audit, progress reporting and financial reporting (6) General affairs of the council for the GEJET Recovery Assistance Program (7) Other relevant matters 3 Staffing Those who are dispatched from the Headquarters to the Chapters shall work in close coordination with their counterparts in Chapters and shall provide supervision to the staff from the staffing agencies. 4 Date of Establishment 1 May 2011 The implementation regime of the recovery assistance program was as follows. The Recovery Task Force was composed of 51 members. There were 17 Headquarters staff (10 fulltime and 7 part-time position staff) and 34 consigned / outsourced staff (mainly for dealing electrical household appliances). 1 fixed-term staff member of the Headquarters was dispatched to each of the three Prefectures of IWATE, MIYAGI and FUKUSHIMA for conducting needs surveys. Consigned / outsourced staff was deployed as the persons in charge of dealing with the electrical household appliances in the above three affected area, in addition to the Headquarter staff members who were intermittently dispatched. A call center responding to inquiries related to Gienkin and the donation of electrical household appliances packages was established in CHIBA and 15 staff members were deployed at the center. Figure 8-1 Regime of the GEJET Recovery Assistance Program (as of June 30, 2011) 190

218 Figure 8-2 Changes in the personnel structure for recovery support Call コールセンター center Staff responsible for electrical 家電スタッフ household appliances 委託 派遣スタッフ JRCS 職員 staff Consigned/ Outsourced staff (4) Holding of the Partnership Meeting for GEJET In the middle of April 2011, the holding of the Partnership Meeting for GEJET on May 9 was decided. Following this decision, a dedicated team for responding to donation from overseas formulated the basic policy as an overall plan for recovery, the fields and actual projects to be supported, and the method of providing financial report. On May 9, 2011, the meeting was held at the Headquarters in TOKYO. The main purpose of the meeting was so that Red Cross and Red Crescent Societies throughout the world who had transferred donation to JRCS to support its activities for the disaster recovery could get together to discuss the use of the donation from overseas that were expected to reach a total amount of over 30 billion yen. A total of 43 representative members from the Participating National Society (PNS) (such as the United States, Australia, Austria, the United Kingdom, Canada and China, total 18 societies), IFRC, ICRC, Embassies and Ministries of Foreign Affairs (MOFA) participated in the meeting, in addition to the 19 executives from JRCS, including the President and Vice-President. <Purpose of the meeting> Consensus on the purpose, period and outline of the recovery assistance program Confirmation of the role that JRCS should play in the disaster recovery activities Report and confirmation of the emergency relief that JRCS conducts Discussion on the JRCS action plan from the early to middle stages of the recovery support Conclusion of an agreement on support from PNS for the future [Meeting of the PNS supporting the GEJET relief and recovery] Prior to the meeting, a minute of silence was offered for the victims of this great disaster. The President stated in the opening speech that the support from our PNS throughout the world has touched our hearts, and we have reaffirmed the spirit of togetherness at the core of Red Cross activities. In the meeting, JRCS presented to the PNS the planning for the projects that JRCS would develop with the use of donation from overseas in the future, and obtained unanimous agreement. In addition, it was agreed that the use of the funds was not basically specified. The basic policy of recovery support and the main projects agreed were as follows. (The total budget was approximately 30 billion yen at this stage.) Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 191

219 Great East Japan Earthquake and Tsunami Chapter 8 Main projects agreed 1Emergency reconstruction support for the medical infrastructure (approximately 5 billion yen) Emergency reconstruction support until complete rebuild of the medical infrastructure around the Ishinomaki City including Ishinomaki Red Cross Hospital (RCHP) 2Support for improving the livelihoods of affected people (approximately 19 billion yen) Project to improve the environment in the evacuation centers (installation of water supply facilities and air purification systems, etc.) Project to donate electrical household appliance packages to evacuees living in temporary housing (the temporary housings under construction were for 70,000 to 80,000 households) 3Social welfare and support for the elderly (approximately 3.5 billion yen) Project to donate social welfare vehicles (provision of the means of access to services for the physically challenged, for the elderly who require nursing care, etc.) Project to install nursing beds (for special care nursing homes, geriatric health services facilities, etc.) 4Others (2.5 billion yen) Purchasing and replenishment of relief goods (blankets, emergency relief kits and partitions, etc., installation of a storage warehouse, etc.) Enhancement of the activities of the medical relief teams (upgrading the equipment of temporary health clinics) Regarding the finance, the basic policy, reporting format and schedule were reported on. In the next day, the relevant parties of the Red Cross and Red Crescent Societies from throughout the world made inspection visits to Ishinomaki RCHP and evacuation centers (in Ishinomaki City) on May 10, and to an evacuation center (Takata Daiichi Junior High School in RIKUZEN-TAKATA) and temporary housings on May 11. The monitoring visit by the Red Cross and Red Crescent Societies supporting the GEJET relief and recovery was held over the three days from October 31 to November 2, JRCS explained the overall plan for recovery support and its progress to the PNS, and the IFRC evaluation team reported on the evaluation of the International Red Cross and Red Crescent Societies activities. Following the meeting, the members made inspection visits to the affected areas. On May 18, 2012, the Second Meeting of the Red Cross and Red Crescent Societies supporting the GEJET relief and recovery was held, in which the progress of the recovery assistance programs and the evaluation of IFRC activities were explained, and the response of JRCS to the results of evaluation was reported on. The participants acknowledged the prompt implementation of the assistance programs and the accountability of JRCS. 2. Implementation regime of the recovery assistance programs (1) Framework and basic policy of the basic plan This is the first experience for JRCS to develop recovery assistance programs in Japan based on such large-scale support from overseas. Therefore, each project has not always started with a clearly existing policy and strategy for recovery assistance programs from the beginning. Based on a rough policy, the purpose and meaning of the projects have become clear and detailed while each project has been promoted. a. Outline of the recovery support planning JRCS hosted the PNS Meeting on May 9, 2011, in order to report on the future approach to the disaster recovery to overseas Red Cross and Red Crescent Societies. In the meeting, the Outline of the GEJET Relief and Recovery Plan was presented and agreement was obtained from them. The Outline of the recovery support plan consists of the basic plan, purpose and the main projects. The constrained conditions (special considerations) of the recovery assistance programs were stated in the basic plan of the Outline of the GEJET Relief and Recovery Plan, and the fields to be addressed in the future recovery assistance programs were presented in its purpose. The planned and implemented projects of JRCS as of May 2011, 2 months after the disaster, were shown in major initiative of the outline. b. GEJET Relief and Recovery Plan funded by the donation from overseas While promoting each project based on this Outline of the GEJET Relief and Recovery Plan, JRCS developed an overall and field-specific vision, reviewed the basic plan, promoted planning and organization of the project implementation plan, and developed a GEJET Relief and Recovery Plan funded by the donation from overseas (vision and basic plan). The plan was decided on at the 7th the council for the GEJET Recovery Assistance Program in FY2011 held in March 2012, and was agreed to at the PNS Meeting held in May The basic plan for the GEJET recovery assistance program consists of an overall vision, Divided vision by field and basic policy. 192

220 Figure 8-3 Outline of the GEJET Relief and Recovery Plan Basic Approach 1. Utilizing the funds efficiently in implementing rapid response 2. Seeking fairness in delivering assistance to the widespread areas 3. Providing special attention to the vulnerable people including the elderly those who require care, children, etc. 4. Implementing assistance in conformity with national or prefectural, municipal support plan. 5. Ensuring accountability to the domestic donors, PNS, media etc. Objectives 1. Rebuilding lives of affected people Improving the living condition in evacuation centres which is expected to prolong. Facilitate smooth shift into temporally house and restart living with a sense of normalcy. Rehabilitating social welfare service in affected areas. Providing educational support for children. 2. Strengthening JRCS disaster response capacity Procurement of special vehicles for communication system, water provision, food supply, and temporary showers Major Initiatives 1. Improvement living conditions of evacuation centres and transitional shelters, including installation of sanitation facilities and electric appliances. 2. Provision of electric household appliances 3. Provision of vehicles for social welfare institutions 4. Provision of nursing beds 5. Children s education support 6. Capacity building of JRCS national disaster response Figure 8-4 GEJET Relief and Recovery Plan funded by the donation from overseas Overall vision We are committed to bridge the international community and the affected areas and contribute to safe and secure recovery through support to build the platform for livelihood, education, social welfare and medical service. Divided vision by field Improving the living conditions of affected people Children s education support Social Welfare Support Medical Services Support Assistance for Nuclear Power Plant Accident Victims We contribute to building the basis for the lives of the survivors towards recovery through support needed to revive communities and regain people s everyday lives. We contribute to building the basis for the future of the children through delivering items, places and comfort lost in the front line of education. We contribute to building the basis for the elderly and the physically challenged to live reassured through supporting the recovery of the welfare services. We contribute to building the basis to protect lives and health of the survivors through supporting the restoration of local medical coordination structure and the strengthening of capacity to respond to disasters. We contribute to alleviating anxiety over nuclear plant accident and radiation by setting the environment to accurately understand the ramification of nuclear radiation and its status. Basic Policy 1.Effective utilization of the network of International Red Cross and Red Crescent Movement 2. Implementation fairness and promptness in delivering assistance to the widespread areas. 3.Collaboration with central government, prefecture, municipalities and other organizations 4.Ensure the accountability domestically and internationally 5.Implementation of support in soft and hard, fully utilizing JRCS resources 6.Succession of the activities to be rooted locally Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 193

221 Great East Japan Earthquake and Tsunami Chapter 8 Figure 8-5 Outline chart of the basic plan for the GEJET Relief and Recovery Plan (Note) Definition of terms - Vision: Situation expected to be realized through the recovery assistance program (Model to be realized) - Basic policy: Direction of the recovery assistance program and the constrained conditions to achieve the vision (special considerations) - Divided vision by field: Fields of projects to be mainly addressed in order to achieve the vision - Basic plan for the recovery assistance program: General term for the vision, basic policy and focused specific-fields of the recovery assistance program, Plan to form the basis of the project implementation plan - Project implementation plan: Plan prepared for the individual project In the overall vision, the focused fields to be specifically addressed in the GEJET recovery assistance program were clearly stated and the situation expected to be realized through the overall projects was presented. The vision was developed in anticipation of the goals at the third year from the start of the recovery assistance program. The areas of improving the living conditions of affected people, children s education support, social welfare services, medical service and assistance for Nuclear Power Plant Accident Victims were set as the focused fields, and specific visions for each focused field were presented. The basic policy presented in the PNS Meeting (held in May 2011) was revised and the topic of succession of the activities rooted in the community was added. (2) Project implementation process Although the project on donating electrical household appliances packages had already started as of May 9, 2011, JRCS s implementation process for the GEJET recovery assistance program after May 9 was determined in parallel with the project as follows. Figure 8-6 Implementation process of the recovery assistance programs Conclusion of agreements Planning of projects Procurement / Operation Expenditures / Project reporting Conclusion of agreements Received fund control Planning of projects Procurement / Contracts Operation of projects Expenditures Project reporting - Negotiation and conclusion of agreements with overseas Red Cross and Red Crescent Societies - Received fund control - Planning of recovery assistance programs based on requests from the affected areas and the needs surveys - Prepare the specifications for procurement, determine the number of goods requested from the affected areas, and select the suppliers - Promotion of projects based on the plan, countermeasures to resolve problems, and response to the termination of projects - Payment processing after the determination of expenses for the recovery assistance programs - Preparation of financial report - Preparation of project reports and their disclosure, holding of the PNS Meeting a. Conclusion of agreements When overseas Red Cross and Red Crescent Societies expressed their support for the recovery assistance program of the GEJET, JRCS exchanged copies of an agreement on the relief activities and recovery plan for the GEJET with these PNS, as necessary. In the agreement, JRCS s emergency relief, early rehabilitation, recovery plan, funds transfer and its use, accounting and audits, reports and other matters are described. The JRCS International Department manages the 194

222 reception status of donation from overseas at the following three time points: at the expression of support, at the conclusion of an agreement, and at the reception of donated funds. The amount of donation from overseas received as of the end of March 2013 was approximately 59.6 billion yen. b. Planning of projects ; Procurement ; Operation JRCS draws up a plan for recovery assistance program funded by the donation from overseas based on the requests of the affected areas and needs surveys, and implements the projects after selecting the suppliers. The planning stage of projects generally consists of planning for projects based on specific requests from the affected areas (request-driven planning) and the planning of program based on ideas proposed by JRCS (project idea-driven planning). However, there were many cases in which a program was constructed through repeated discussions with the affected Prefecture and other communities from the beginning to satisfy their needs. Examples of request-driven planning include support for constructing temporary gymnasiums, support for a community bus and donation of food radiation detectors. Examples of project idea-driven planning include donation of electrical household appliances packages, organization of mobile indoor play areas and implementation of Nordic walking. In addition, a subsidy for pneumonia vaccines for the elderly is an example of the projects that JRCS has constructed based on repeated discussions with the affected prefectures and other communities. Figure 8-7 Flow of a planning of recovery assistance program (brief overview) The forms of support in these projects include the donation of materials, support with personnel, knowledge and experience, and subsidies, and each form has a specific means of procurement. In the process of the donation of materials and the support of personnel, knowledge and experience, JRCS prepares specification forms for the procurement, confirms the numbers of requests from the affected areas (the number of items to be procured), and selects the suppliers. In the form of subsidies, support is provided mainly for construction related projects by means of the delivery of subsidies. As it was the first experience for JRCS to provide subsidies, administrative procedures for the implementation of recovery support subside projects for the GEJET were prepared that describe the administrative procedures for delivering the subsidies. At the stage of operating the projects, promotion of the projects based on each plan, countermeasures to deal with problems and procedures for terminating the projects are focused on. The basic plan for the promotion of the projects is included in the details of the planning described in the written approval for implementing the projects. c. Accounting ; Project reporting With regards to the accounting ; project reporting, JRCS determines the expenditures for the recovery assistance program and submits regular program reports to the PNS. Regarding the expenditures for the recovery assistance program, the Recovery Task Force determines the amount of the payments, and the General Affairs Department of the Headquarter executes payment processing. As the information on the expenditures for the recovery assistance program, financial sources (which funds collected from overseas Red Cross and Red Crescent were used), program (for which recovery support, the funds were used) and the item of the expenses (what was the expense item) are managed using an existing accounting system. The accounting report is submitted once a year and the project reports are submitted every quarter. As the place for presenting the FY2011 report of the recovery assistance program for the GEJET to PNS, the PNS Meeting supporting the GEJET was held in May Actual achievements of the recovery assistance programs (1) Implementation summary of the recovery assistance programs and the list of major projects a. Geographical areas to be supported The projects started in March 2011 for the main supporting areas of IWATE, MIYAGI and Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 195

223 Great East Japan Earthquake and Tsunami Chapter 8 FUKUSHIMA where extensive and devastating damage was caused by the GEJET. In some of the projects, in addition to these three affected prefectures, the affected areas of AOMORI, IBARAKI, TOCHIGI, CHIBA and NAGANO, and the people who were evacuated mainly from FUKUSHIMA to places throughout Japan due to the effects of the nuclear power plant accident will be covered. b. Forms of support The forms of support for the recovery assistance programs can be classified into the following three categories: (1) Donation of materials: Support to provide materials that were lost in the disaster (2) Support of personnel, knowledge and experience: Support through which JRCS directly provides services to the disaster victims (3) Subsidies: Support subsidizing the expenses for constructing facilities and purchasing equipment (JRCS makes a decision on the support after discussions with the Prefecture and Municipalities) (2) Outline of the major projects a. Improving the living conditions (a) Donation of electrical household appliances packages (i) Background Providing electrical household appliances to residents living in temporary housing was beyond the scope of application of the Disaster Relief Act, but there was a great need on the part of the residents for electrical household appliances as a precondition for improving their living conditions. In past disasters, there have been cases where the assistance grant funding through the Act on Support for Reconstructing the Livelihoods of affected people was spent on purchasing electrical household appliances. In addition, JRCS had experience in providing electric hot water dispensers to the residents in temporary housing in past disasters, and thus the initiative for a project to donate electrical household appliances financed by donation from overseas was launched. (ii) Purpose To provide support to ensure that affected people forced to live in temporary housing due to the earthquake and Tsunami can make their lives as comfortable as possible in with a refrigerator and other electrical household appliances. (iii) Target areas/population The target areas are the eight affected prefectures of IWATE, MIYAGI, FUKUSHIMA, AOMORI, CHIBA, IBARAKI, TOCHIGI and NAGANO (those area to which the Disaster Relief Act applied due to the GEJET, and from which JRCS received assistance requests for electrical household appliances packages). The target population consists of those households that are permitted to live in temporary housing based on the Disaster Relief Act in these target areas. Temporary housing means prefabricated housing constructed on a temporary basis or public housing or private-sector housing that the affected prefectures lease for people (hereinafter referred to as deemed temporary housing ). At the start of the project, the target population was only the residents in the prefab temporary housing. However, along with the policy of the National and Prefectural Governments, the provision of temporary housing under the Disaster Relief Act is applicable to deemed temporary housing, and the scope of the target population of this project was thus also extended. With this policy of the National and Prefectural Governments, more evacuees living outside the affected prefectures came to live in deemed temporary housing and the range of recipients of donations of electrical household appliances packages was expanded to the whole of Japan. (iv) Implementation period The project started in April 2011 and terminated with the delivery of the packages in response to the applications received from each municipality by the end of December (v) Implementation details This project is a project to donate electrical household appliances packages to residents in temporary housing. Each package consists of six items of electrical household appliances: a washing machine, a refrigerator, a TV set, a rice cooker, a microwave oven and an electric hot water dispensers. The first package of electrical household appliances was brought into prefab temporary housing in Rikuzen-takata City on April 7, Initially, the number of donated electrical household appliances packages was calculated to be 70,000 based on the number of packages requested by the affected 196

224 prefectures, but the number of applications rapidly increased during June through September 2011 to reach to 100,000 packages, far exceeding the 70,000 packages originally estimated. The number of applications decreased significantly after October 2011, and the reception of applications for this project terminated at the end of December 2012 with an accumulated total number of applications from 135,000 households. By prefecture, the number of households that received the packages was approximately 19,000 households in IWATE, approximately 49,000 in MIYAGI, approximately 65,000 in FUKUSHIMA and approximately 2,000 in other prefectures. For the termination of this project, in response to requests from prefectures that it is necessary to have enough time to notify the affected people of the termination of this project, it was decided to set the deadline for the final reception of applications in the municipalities as the end of December autonomous operation by the residents of the prefab temporary housing, only the meeting room/lounge was constructed but was not furnished inside. (ii) Purpose By furnishing the meeting rooms ; lounges, the purpose was to promote their utilization in order to contribute the development of mutual assistance systems and the effective operation of community associations among the residents of prefab temporary housing. In addition, by installing an AED in the meeting room, create an environment where the residents in the prefab temporary housing could provide a life-saving measure with the use of the AED. (iii) Target areas / population The target meeting rooms/lounges were those constructed in the prefab temporary housing in IWATE, MIYAGI and FUKUSHIKA, and those for which JRCS received a request for assistance. (iv) Implementation period This project started in June 2011 and was terminated in FY2012. nobuyuki kobayashi [A family receiving an electrical household appliances package] (b) Furnishing public meeting rooms (i) Background This project was implemented after the period during which the emergency response activities just after the disaster had calmed down and mental care for the affected people was being focused on as another challenge. When the place of living for people moved from the shelters to temporary housing, as there was a fear that traditional local communities would break down and the residents in temporary housing would be isolated, a meeting room/lounge was constructed in areas of prefab temporary housing as a means of dealing with this concern. From the viewpoint of the formation and maintenance of the community, the active utilization of a meeting room; lounge was expected, but due to the principle of its (v) Implementation details In this project, JRCS provided a refrigerator, a TV set, an electric hot water dispensers, a vacuum cleaner, a radio-cassette recorder, a low table, floor cushions, a long desk, chairs, a filing cabinet, a whiteboard, an AED, etc., to the meeting room/lounge of the prefab temporary housing. The items of equipment for the meeting room/lounge of the prefab temporary housing were selected based on requests from the prefectures in the target areas. (c) Implementation of Nordic walking (i) Background After the emergency response activities just after the disaster had calmed down and the life of residents had been established in temporary housing, there was concern that the residents were facing a decline in their physical functions due to a lack of exercise, or mental instability due to a feeling of loss or solitude caused by the loss of family members or their way of life. The Hokkaido Chapter volunteers organized then an event of Nordic walking in the coastal area of IWATE. Nordic walking is a sport involving walking through the countryside using two walking poles, one in each Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 197

225 Great East Japan Earthquake and Tsunami Chapter 8 hand. In addition to the general confirmation of the maintenance and promotion of good health, another effect was the promotion of communication among the participants, and this led the Iwate Chapter to adopt this style of Nordic walking as its leading recovery assistance program and organize the Nordic walking events actively. (ii) Purpose Provide an opportunity for the residents in temporary housing to get exercise as well as to contribute to overcoming the lack of exercise and maintaining and promoting good health. In addition, as a secondary purpose, contribute to community formation among the residents in temporary housing through their participation in these events. The walking poles are loaned out free of charge to those who participated in the trial walking and wish to borrow them to create an environment where they can voluntarily enjoy Nordic walking when no events are organized. In FY2011, 25 Nordic walking events were conducted in Miyako city etc., and the number of participants reached 259 people. As of the end of December 2012, a total of 84 events were organized in 53 places, and 809 people participated. In FUKUSHIMA events which are similar to Nordic walking were held. During July to November 2012, a total of 7 events were held with 156 participants, and the event continues today. (iii) Target areas / population The target population of this project was the residents in prefab temporary housing in IWATE (iv) Implementation period It started in November as a recovery assistance program and has continued after FY2012. (v) Implementation details For the residents in prefab temporary housing in IWATE, trial walking and network walking are organized as events based on Nordic walking. In the trial walking, after some instruction on Nordic walking, participants take a walk around the prefab temporary housing. The JRCS staff members do the rounds of prefab temporary housing about once in two months and organize this trial walking. This is expected to have the effect of providing an opportunity for the participants to acquire regular fitness habits to maintain and promote good health as well as to facilitate communication in the community of residents in prefab temporary housing. In the network walking, Nordic walking is conducted in an appropriate place in each area so that the participants in the trial walking can expand their communication exchanges. These network walking events are organized around twice a year (in spring and autumn). It is expected that increased opportunities for exchanges through Nordic walking will lead to the activation of communication in the local community beyond the areas of prefab temporary housing. [Nordic walking] b. Social welfare services (a) Donation of nursing beds (i) Background In the GEJET, many social welfare facilities around the Tohoku coastal areas became unavailable due to the damage from the earthquake and tsunami. In response to special measures, the facilities that were spared its direct damage accepted patients requiring nursing care beyond their capacity, but as there were few facilities that had spare beds, the environment was such that nursing care was provided for the patients lying on mattresses placed directly on the floor and patients requiring nursing care could not receive appropriate care. Therefore, JRCS considered it necessary to improve the nursing environment for patients requiring nursing care as a socially vulnerable group and decided to implement support for providing nursing care beds. 198

226 (ii) Purpose The purpose of this project is to provide nursing care beds required for social welfare facilities that have accepted affected patients requiring nursing care and ensure that the affected people can receive appropriate care in an improved nursing care environment. (iii) Target areas / population The target areas are the three affected prefectures and the target facilities are the social welfare facilities that newly accepted patients requiring nursing care who were affected in the disaster. (iv) Implementation period Based on a request from MIYAGI in April 2011, the first donation started in June. Then donations started in IWATE and FUKUSHIMA, and a series of donations continued until November 2011 for the three affected prefectures. (v) Implementation details In this project, JRCS donates sets of nursing care beds (a nursing care bed, side rails, a mattress) to the social welfare facilities that newly accept affected patients requiring nursing care. A total of 959 nursing care beds were donated in the three affected prefectures. Of these, 205 nursing care beds were donated to IWATE, 658 to MIYAGI, and 96 to FUKUSHIMA. [Nursing care beds] (b) Donation of welfare vehicles for the physically challenged (i) Background In the areas that were devastated by the tsunami, many vehicles floated away or broke down. The social welfare facilities, where welfare services are provided to the physically challenged, people requiring nursing care and the elderly, had many welfare vehicles swept away or destroyed and had difficulty in providing appropriate welfare services. In these facilities, rental cars or used cars were temporarily used as substitutes for the lost or damaged vehicles, however, as there were many requests for brand-new welfare vehicles that can be used for a long time in the future and that are useful for improving the quality of welfare services, JRCS considered it necessary to give assistance and decided to provide support for welfare vehicles. (ii) Purpose The purpose of this project is to donate welfare vehicles needed for social welfare facilities in order to help recover lost welfare services in the devastated areas due to the GEJET. With these welfare vehicles, the facilities can provide appropriate welfare services to the physically challenged. In addition, another purpose of this project is, by donating welfare vehicles to each municipality in the affected areas other than the welfare facilities, to facilitate the enhancement of welfare-related activities by utilizing them in health and welfare projects. (iii) Target areas / population The target areas are the affected three prefectures, and the target facilities/organizations are the social welfare facilities and municipalities that had their welfare vehicles swept away or broken down in the disaster. (iv) Implementation period In response to a request from MIYAGI in April 2011, the planning of this project started. The delivery of welfare vehicles to each social welfare facility and each municipality started in December 2011 and was completed in April (v) Implementation details In this project, JRCS donated welfare vehicles to the social welfare facilities and local governments that had their welfare vehicles swept away or destroyed in the disaster. For each affected prefecture, a total of 338 welfare vehicles of 11 different types were selected in consideration of the situation of each facility and municipality. Of these, 40 vehicles were delivered to IWATE, 145 to MIYAGI and 153 to FUKUSHIMA. Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 199

227 Great East Japan Earthquake and Tsunami Chapter 8 <List of the types of vehicles donated> Minivan type (bus type) Minivan type (wheelchair-accessible with a lift) Light motor vehicle (wheelchair-accessible) Vehicles with electric elevating seat (front passenger seat) Vehicles with electric elevating seat (backseats) Compact car (hatchback) Light van (hatchback) Lightweight truck Light motor vehicle (jeep type) Minivan type Light van (hatchback with specification as a Red Cross rescue vehicle) be constructed in Kawamata town with government subsidies. However, as the construction of a school gymnasium was ineligible for the subsidies, there were no prospects of having a school gymnasium at that time. (ii) Purpose This program aims to restore the educational environment lost in this disaster, supporting the construction of temporary school gymnasiums with the use of subsidies, which enable the eligible schools to continue providing physical exercise (PE) lessons, and to provide pupils and students with a place where they can do appropriate exercise and promote good health. (iii) Target areas ; population The target areas and population of this project are the following schools in the cities of Ofunato and Otsuchi in IWATE and IITATE in FUKUSHIMA. [Vehicle with an electric elevating seat] c. Education (a) Subsidy for constructing temporary gymnasiums (i) Background Four elementary schools of Otsuchi, Otsuchi-kita, Akahama and Ando located in the coastal area of IWATE and Otsuchi Junior High School could not continue the school lessons in their original school buildings because they had been flooded or washed away, and they resumed their lessons in rented facilities in their own towns or towns nearby. In June 2011, the construction of temporary school buildings with government subsidies was decided on, but as the construction of a school gymnasium was ineligible for the subsidies at that time, there were no prospects of having a school gymnasium. Regarding Iitate Village in FUKUSHIMA, an entire area of the village was designated as a Planned Evacuation Area due to the accident at the Fukushima Daiichi Nuclear Power Plant, and the residents were forced to evacuate their homes. The three elementary schools of Kusano, Iitoi and Usuishi in Iitate Village resumed their lessons in the rented classrooms in a junior high school in Kawamata town, and received the decision that the temporary school buildings would Ofunato city in IWATE 133 students in Akasaki Junior High School Otsuchi town in IWATE 735 pupils and students of the elementary schools of Otsuchi, Otsuchi-kita, Akahama and Ando, and of Otsuchi Junior High School Iitate village in FUKUSHIMA (Gymnasium constructed in Kawamata town where the victims evacuated) Approximately 220 pupils of the elementary schools of Kusano, Iitoi and Usuishi in Iitate village (iv) Implementation period In response to a request from each municipality, the support was sequentially provided from September 2011 through July [Temporary gymnasium in Iitate village in FUKUSHIMA] 200

228 (v) Implementation details In this program, JRCS gave assistance for the construction of temporary gymnasiums for eligible schools with government subsidies. In FY2011, 5 schools in Otsuchi town in IWATE, 3 schools in Iitate village in FUKUSHIMA, and in FY2012, 1 school in Ofunato city in IWATE received the funds. Otsuchi town in IWATE had planned to rebuild the school gymnasium before the disaster, and the construction of a temporary gymnasium was proceeding. Therefore, as the construction materials for the temporary gymnasium were already procured, the construction was not affected by the lack of funds or rising costs of the construction materials due to the disaster. As such, the temporary gymnasium could be constructed at an early date as well as at a low price. the schools who asked for support. In the areas where early assistance was required (Yamada town and Otsuchi town in IWATE, Okuma town in FUKUSHIMA), the support started using rented bus or the contracted operation of buses as a means of transportation from and to school. However, with the on-the-spot requests asking for school buses to be available not only for transportation to and from school, but also for other purposes including travelling classes, club activities, field trips, etc., the form of support was changed to the donation of school buses. Regarding the donation of school buses, JRCS took a survey of assistance requests which each school made through each prefectural Board of Education and Department of Health and Welfare, and determined the schools to be supported. (b) Providing school buses (i) Background In the affected areas of the disaster, some pupils and students moved into prefab temporary housing, and it became difficult for them to go to school on foot. When school education resumed in the affected areas, it was necessary to secure the means of transportation to school such as school buses in consideration of the distance from the prefab temporary housing to the school as well as the importance of ensuring the safety of the route to and from school. (ii) Purpose This program aims to ensure the safety of pupils and students when commuting to and from school by allocating school buses and to create an environment where pupils and students can focus on their schoolwork. In addition, it also aims to reduce the anxiety of their parents as a secondary benefit. (iii) Target areas ; population The target population of this project is the pupils and students as well as the preschoolers living in the target areas shown in Figure 8-8. (iv) Implementation period In response to a request from each Prefectural Board of Education, the support was provided from August 2011 through March Figure 8-8 Target support areas and the details of support by providing school buses Target areas Implementation Form of Types of buses period support deployed Rental of 6 mini-coaches Aug. - Dec Yamada vehicles (29-passenger) town Donation of 6 mini-coaches Jan vehicles (29-passenger) IWATE FUKUSHIMA Otsuchi town Okuma town Iwaki city Iwaki city (Nursery) Katsurao village Naraha town Apr. - Jul Aug Oct Jul Aug Apr Mar Aug Aug Dec Rental of vehicles Donation of vehicles Contracted operations Donation of vehicles Contracted operations Donation of vehicles Donation of vehicles Donation of vehicles 5 mini-coaches (29-passenger) 5 mini-coaches (29-passenger) 2 motor-coaches (50-passenger) 2 motor-coaches (50-passenger) 1 motor-coach 1 mini-coach (29-passenger) 1 mini-coach (29-passenger) 1 mediumsized coach (42-passenger) 2 motor-coaches (48-passenger) Chapter 8 Recovery Assistance Program (v) Implementation details In this program, JRCS allocates school buses to [Pupils going to a swimming pool on a donated school bus] Great East Japan Earthquake and Tsunami 201

229 Great East Japan Earthquake and Tsunami Chapter 8 (c) Organizing mobile indoor play areas called Smile Parks (i) Background In FUKUSHIMA, a nuclear disaster occurred with the spread of radioactive materials following to the accident at the Fukushima Daiichi Nuclear Power Plant in addition to the disaster caused by the tsunami. Amid concerns that the air and soil had been contaminated, outdoor activities at the schools were restricted. Since the accident, the national and local governments have been engaged in decontamination of the soil in school playgrounds for the schools where the atmospheric radiation level was high. However, as the plan for decontamination is a longterm challenge and the parents still have anxiety even in the advanced stages of decontamination, outdoor activities have continued to remain restricted. As a result, mental stress and a decline in the physical strength of the children due to their lack of exercise came to be considered a problem. In elementary and junior high schools, certain countermeasures were taken, but the response for preschoolers was not necessarily sufficient. Consequently this project was proposed by the Fukushima Chapter to provide preschoolers with opportunities to get physical exercise. (iv) Implementation period The events in the Smile Parks that were organized from February 2012 are shown in Figure 8-9, and have continued to be organized in FY2013. (v) Implementation details In this program, JRCS organizes and runs events intended to provide a place for the preschoolers living in FUKUSHIMA to get physical exercise using a gymnasium or other facility. The events were organized during the hours from 10 a.m. through 4 p.m., and staged events were organized with a playland available at all times in the gymnasium. In the playland, a set of play equipment, including large inflatable play equipment, a ball pool and cyber wheels was installed, and special programs including an exercise class, reading picture books, singing songs with finger plays as well as an invitation to meet special guests on Saturdays and Sundays, were provided as staged events. An event called Furusato Art, in which children put a message sticker on the petals of origami cherry blossoms to complete an artwork for thinking go to their home, was also conducted. (ii) Purpose The purpose of this program is to provide a place to enable preschoolers who cannot play outdoors to get physical exercise due to the anxiety over radiation exposure and suffer from a lack of exercise and mental stress, and to help them relieve their mental stress as well as maintain and promote their ability to exercise. (iii) Target areas / population In FY2011, as the event was implemented in a gymnasium located in Fukushima city and the invited kindergartens and nursery schools were located in the City, the main target population was the preschoolers living in Fukushima city. However, from FY2012, the number of places for conducting these events was expanded to four areas in the Prefecture and the target population was also broadly expanded to preschoolers living in FUKUSHIMA. [Children energetically playing in a ball pool] 202

230 Fiscal Year Figure 8-9 Implementation of the organization of Smile Parks in FUKUSHIMA Implementation period Venue of the events Total number of visitors (preschoolers, parents/ guardians) Name of the facility Target area FY2011 Feb. 8-17, 2012 (10 days) FUKUSHIMA 5,340 Fukushima Prefecture Youth Center Fukushima City Jul. 3-13, 2012 (11 days) FUKUSHIMA 6,487 Fukushima City Minami Gymnasium Fukushima City, Kawamata Town, Nihonmatsu City Jul Aug. 3, 2012 (13 days) SOMA 5,297 Soma City General Welfare Center, Soma City, Shinchi Town, Minami-soma City Hamanasu-kan Iwaki City Nanbu Arena of Sep Oct. 10, 2012 (11 days) IWAKI 7,607 FY2012 Minami-no-mori Sports Park Iwaki City Oct , 2012 (10 days) SHIRAKAWA 4,775 Shirakawa City Commemorative Gymnasium Shirakawa City, Nishigo Village, Izumizaki Village of National Sports Festival Nov , 2012 (13 days) SOMA 5,618 Sports Arena Soma Soma City, Shinchi Town, Minami-soma City Dec , 2012 (10 days) FUKUSHIMA 5,766 Paruse Iizaka Fukushima City, Date City (e) Summer Camp (i) Background Following the GEJET, children, as a vulnerable group in a disaster, live a psychologically stressful life with environmental changes in their education and daily life caused by the destruction of the educational facilities as well as human suffering. in order to protect children s health and safety and promote their psychological stability and healthy growth. (iii) Target areas / population (participants) Pupils in 5th and 6th Grade of elementary schools and Students in 1st to 3rd Grade of junior high schools living in the three affected prefectures. (ii) Purpose In such a situation, this project aims to have children regain their zest for life and to foster human resources that can take a leadership role in the community in the future through interactive learning in various youth programs that JRCS provides in its Junior Red Cross activities as well as through experiences and exchanges, (iv) Implementation period From Saturday, July 21, 2012 to Thursday, August 23, 2012 Total 11 camps (3 nights / 4 days per camp, 320 children 11 camps) The project to organize summer camps continues to be implemented in FY2013. Figure 8-10 Summary of the implementation of summer camps Number of participants Boys Girls Total Composition IWATE % MIYAGI , % FUKUSHIMA , % Total 1,651 1,800 3, % Number of staff Type of staff Number of staff Number of staff per camp Chief of the camp village (Headquarter staff) 11 1 Red Cross Youth Group support staff Japanese Red Cross College of Nursing / School of Nursing Headquarter staff (including 20 prospective employees) 88 8 Adult volunteers 86 8 First aid instructors (volunteers) Headquarter staff 60 5 Instructor staff (JRC Teacher Sponsor) 43 4 Organizing secretariat staff Clinical psychotherapist 11 1 Nurse 33 3 Staff of Kinki Nippon Tourist Co., Ltd Total (during the camps) Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 203

231 Great East Japan Earthquake and Tsunami Chapter 8 Schedule Time Day 1 Day 2 Day 3 Day 4 8:00 Morning assembly Breakfast Moving to the work site Closing ceremony Study program: First aid, etc. Departure Group work: Making sausages, jam, etc. 12:00 Lunch 16:00 Arrival Opening ceremony Group meeting Activity program 1: Orienteering Group meeting Activity program 2: Experience of harvesting crops, dairy operations, fishing in a mountain stream, etc. Farewell party Dinner / Taking a bath 21:00 Lights-out Cooperating companies Name of the company Details of the cooperation Cooperation provided Jaguar Land Rover Japan Limited Vehicles 1 vehicle NTT docomo Inc. Satellite phones 2 satellite phones Hokkaido Coca-Cola Bottling Co., Ltd. Drinking water 28,000 bottles Portable insect repellent 4,000 repellents Earth Chemical Co., Ltd. Insect spray 120 sprays Insect repellent for rooms 80 repellents Sapporo Tourist Association Entrance fee for Sapporo Hitsujigaoka Observation Hill 3,451 tickets Casio Computer Co., Ltd. Watches 50 watches JCB Co., Ltd. Mizuho Financial Group, Inc. House Foods Corp. Dispatch of volunteer staff (v) Implementation details In this camp, groups were organized by dividing approximately 320 participants per camp into groups of 14 to 15 children. The basic unit of camp activities was a group consisting of children with a diversity of ages, gender and home prefecture, attended by 1 to 3 volunteers per group. The volunteers participated in the camp after receiving training in advance concerning operational rules and mental attitude. In addition to the corporate volunteers, teachers from Junior Red Cross member schools, clinical psychotherapists, nurses and office staff of JRCS, and staff of a contracted travel agency participated in the camp as staff members and operated the camp, giving first priority to the safety and security of the participants. The program was developed in committee consisting of teachers of elementary and junior high schools who were instructors for the Junior Red Cross in the three affected prefectures, clinical psychotherapists and JRCS staff. In addition to the refreshment of the bodies and spirits of the participants, this camp focused on the recognition of various things through experience of the fundamental rules of living based on the know-how of the Junior Red Cross, interaction among the participants, field work (orienteering), horse riding, harvesting crops and various other experiential programs (options), and aimed to promote the growth of children. (vi) Sum Up Participants learned a lot of things including the rules necessary for group living, consideration for others, the importance of mutual cooperation, the existence of volunteers who were taking care of them, and a cooperative society, etc. In particular, they achieved an experience of becoming strongly connected by living together with children and volunteers who were complete strangers to each other. It is expected that this experience will nurture children in their growth in the course of recovery when they go back to their own community. 204

232 [Children freely enjoying the great outdoors] In addition, the personal growth of the volunteers who attended to the children for four days was a secondary benefit. d. Medical care (a) Rebuilding the Ishinomaki and Kesennuma Medical Regions (i) Background In the affected areas, medical institutions were badly damaged by the GEJET. In particular, the coastal areas of MIYAGI suffered extensive damage from the tsunami after the earthquake and a large proportion of their medical functions were destroyed. Particularly in the Ishinomaki Medical Region, Ishinomaki RCHP faced a situation in which it was required to take on the great majority of primary emergency care, and its original function as an advanced emergency medical care facility was reduced. Therefore in FY2011, it was considered to be important to preferentially give assistance to medical institutions that had assumed primary emergency care. In the Kesennuma Medical Region, Shizugawa Public Hospital, which was the only hospital in MINAMI-SANRIKU, was completely destroyed and it was especially required to secure alternatives to reestablish its functions. In MIYAGI, a Review meeting to discuss the recovery of community healthcare consisting of healthcare organizations, universities and local governments in MIYAGI was set up in May 2011 in order to facilitate the early recovery of the lost medical functions and healthcare provision system as well as to promote the recovery of a farsighted medical infrastructure. Thereafter, in September 2011, six short-term challenges and three medium- to long-term challenges were compiled and the direction for recovering community healthcare was presented (see Figure 8-11). Based on the fact that JRCS had Ishinomaki RCHP as a core hospital for the community in Ishinomaki city in MIYAGI and that Ishinomaki city and its surrounding areas were devastated particularly by the tsunami with badly damaged medical institutions and a great number of casualties, JRCS decided to give assistance for the recovery and rehabilitation of the medical infrastructure in Ishinomaki, Kesennuma medical region in line with the planning developed by Miyagi prefecture goverment. Through repeated consultations with the goverment just after the disaster, JRCS decided to focus on support corresponding to (2) Setting up temporary clinics and (3) Securing hospital beds (temporary) of the shortterm challenges towards the recovery of community healthcare in order to take on the role of facilitating the early recovery of medical functions and the healthcare provision system. (ii) Purpose The purpose of this project is to develop the infrastructure that can provide secured healthcare services for the local residents in the affected areas by rapidly recovering and rebuilding the lost medical functions and healthcare provision system in the Ishinomaki and Kesennuma Medical Regions. To this end, as it was necessary to facilitate the recovery and rebuilding of each medical institution located in the community as well as to recover the medical cooperation system in the community, the support plan covers the entire area according to the planning by Miyagi Prefecture. Figure 8-11 Direction for recovering community healthcare (prepared in September 2011) Short-term challenges Medium- to long-term challenges (1) Securing medical relief teams (2) Setting up temporary clinics, etc. (3) Securing hospital beds (temporary) (4) Improvement of the systems for psychosocial care, public health activities, nursing care support, etc. (5) Employment measures for healthcare professionals and to prevent the outflow of them (6) Countermeasures for the early resumption of the operation of medical institutions (1) Redeployment of medical resources through the integration and reorganization of municipal hospitals, etc. (Reconstruction, intensification and functional sharing of hospitals in the affected areas from MIYAGI) (2) Construction and enhancement of medical cooperation systems in the community (Medical cooperation systems in the community utilizing ICT) (3) Countermeasures for securing human resources for healthcare (in cooperation with the universities and other bodies concerned) Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 205

233 Great East Japan Earthquake and Tsunami Chapter 8 (iii) Target areas / population The target areas of this project are the Ishinomaki Medical Region centered around Ishinomaki City in MIYAGI and the Kesennuma Medical Region centered around Kesennuma city in MIYAGI. The Ishinomaki Medical Region covers Ishinomaki City, Higashi-matsushima City and Onagawa Town, and the Kesennuma Medical Region covers Kesennuma City and Minami-sanriku Town. The population of each Medical Region is 200,867 people for Ishinomaki and 84,785 for Kesennuma. (iv) Implementation period Regarding support for the reconstruction of the Medical Region by JRCS, the overall plan will be prepared by the end of FY2013 and the support will be completed by the end of FY2015. (v) Implementation details The direct support implemented for rebuilding medical regions was the subsidization of construction, extension or reconstruction, and renovation of the facilities of medical institutions. The main reason to select subsidization as a form of support was that it was considered to be important that the determination of the specifications of the medical devices needed and the selection of suppliers should be determined by the parties involved on the spot. In preparation for subsidization, JRCS carried out adjustments and examination of the planning in advance with the relevant parties. The target medical institutions supported within the framework of the rebuilding of the Ishinomaki and Kesennuma Medical Regions are the following 4 facilities: (1) Temporary Ishinomaki City Nighttime Emergency Center, (2) Temporary hospital ward of Ishinomaki RCHP, (3) Onagawa Community Medical Center in the Ishinomaki Medical Region, and (4) Minami-sanriku Public Clinic (Sizugawa Public Hospital) in the Kesennuma Medical Region. The support for these medical institutions was implemented in response to the request of Miyagi Prefecture after repeated consultations and adjustments with the prefecture governors. JRCS is planning to provide continuous support for constructing the Shizugawa Public Hospital. [Reconstructed Onagawa Community Medical Center] (b) Supplying whole body counters (i) Background In FUKUSHIMA, the level of concern about the impact of radiation on health was extremely high and resulted in increased anxiety among the residents after the accident at the Fukushima Daiichi Nuclear Power Plant of Tokyo Electric Power Company. In order to assess the health impacts of radiation and remove the fears felt by the residents, Fukushima Prefecture Governor developed a plan for a Fukushima Health Management Survey for all the residents of FUKUSHIMA and began to implement the plan in some parts of the Prefecture. With the need to measure the status of internal radiation exposure in order to assess the health impact of the radiation, the Governor decided to prepare radiation measuring instruments including whole body counters that could measure the level of radioactive substances accumulated in the human body as well as thyroid test monitors that could measure the level of radioactive iodine deposited in the thyroid gland. However, as whole body counters and thyroid test monitors were extremely expensive and it was difficult for Fukushima Prefecture to independently provide sufficient equipment for all the residents, the Prefecture asked JRCS for assistance. Having operated the Fukushima RCHP in Fukushima City, JRCS decided to provide the equipment at this hospital. Simultaneously, JRCS decided to provide certain test equipment for Fukushima Medical University in order to facilitate the implementation of the Fukushima Health Management Survey. (ii) Purpose The purpose of this project is to facilitate the conduct of the Fukushima Health Management Survey for the residents of FUKUSHIMA who have fears regarding radiation contamination problems associated with the 206

234 accident at the Fukushima Daiichi Nuclear Power Plant caused by the GEJET. (iii) Target areas / population The target area of this project is Fukushima Prefecture and the residents of Fukushima Prefecture are the target population. (iv) Implementation period The discussions on the assistance for acquiring whole body counters and other test equipment with Fukushima Prefecture governor started in September 2011, and JRCS provided whole body counters in March 2012 and a set of test equipment in August Since April 2012, a sequence of examinations using the equipment has started. (v) Implementation details In this program, JRCS provided a whole body counter and 2 thyroid test monitors for Fukushima RCHP, and a set of the test equipment necessary for the Health Management Survey for Fukushima Medical University in Fukushima City. Regarding the selection and procurement of the equipment, including whole body counters, JRCS procured the same equipment as that prepared by FUKUSHIMA from the viewpoint of ensuring the consistency of tests throughout the Prefecture. [Whole body counter to measure internal radiation exposure] (c) Donation of food radiation measuring equipment (i) Background FUKUSHIMA had started to conduct measurements on the air dose rate and internal radioactivity substances level in order to relieve the concerns of residents in the prefecture regarding the health impact of the radiation. Under these conditions, radioactive substances exceeding the safety standards were detected in food harvested in Fukushima Prefecture, which led widespread concerns about food safety. In response to this situation, in November 2011, Fukushima City tried its best to relieve the concerns of the citizens by establishing radiation monitoring centers in the City as well as conducting radioactivity measurements of the materials used for meals in schools and nurseries, agricultural crops and processed foods produced and manufactured in the City. However, with this system, Fukushima City could respond only to some of the enormous number of requests for radioactivity measurement made by the residents. To develop a system to fully respond to the requests for radiation measurement that are expected to increase in the future, Fukushima City governor planned to deploy food radiation measuring equipment in the City Hall and its branches and asked JRCS for assistance. In addition, JRCS received requests for assistance for food radiation measuring equipment from Fukushima Prefecture to compensate for the deficiencies in the equipment in Nihonmatsu City and Kawauchi Village, which was not covered by rented equipment from the Consumer Affairs Agency and the available equipment provided by using the supplementary budget of the Prefecture. JRCS also received requests to provide food radiation measuring equipment from the Miyagi Prefectural Board of Education. (ii) Purpose The purpose of this project is to relieve people s concerns about food safety and provide reassurance about both the physical and mental health aspects to the residents in FUKUSHIMA and MIYAGI who have concerns associated with radiation problems. To this end, JRCS implemented the donation of food radiation measuring equipment, complementing the support provided by the national and prefectural governments. (iii) Target areas / population The targets of this project are Fukushima City, Nihonmatsu City and Kawauchi Village in FUKUSHIMA, and Miyagi Prefectural Board of Education. (iv) Implementation period For the requests received in November 2011, all of the equipment was provided from February to May The examination of radioactive substances in food using this equipment is being continuously conducted. Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 207

235 Great East Japan Earthquake and Tsunami Chapter 8 (v) Implementation details In this program, JRCS procured and provided a total of 109 items of food radiation measuring equipment to 3 municipalities in FUKUSHIMA and the Miyagi Prefectural Board of Education. The breakdown was 77 items of equipment for Fukushima City, 23 for Nihonmatsu City, 6 for Kawauchi Village, and 3 for the Miyagi Prefectural Board of Education. (iii) Target areas / population The target areas are the entire area of the three affected prefectures of IWATE, MIYAGI and FUKUSHIMA, and the target population is the elderly aged 70 and older who registered residents in each of these area. (iv) Implementation period In this program, the ceiling for the amount of subsidy in each prefecture was set up and the project should be terminated when the actual amount was expected to exceed the limit. Therefore, the termination was expected to be on March 30, 2012, but in FUKUSHIMA, the program was terminated on February 29, 2012, one month earlier than the date originally expected. The implementation period of this project in each prefecture was as follows. [Food radiation measuring equipment] IWATE: November 8, March 30, 2012 MIYAGI: October 15, March 30, 2012 FUKUSHIMA: November 18, February 29, 2012 (d) Subsidizing vaccination against pneumococcus for the elderly (i) Background The elderly who were affected in the GEJET were forced to spend their life in unfamiliar places throughout FUKUSHIMA including shelters, prefab temporary housing and private sector housing taken over by the Prefecture. In these environments, there was concern about a decline in the body s resistance and an increase in respiratory diseases such as pneumonia among the elderly as the winter season approached. Pneumonia is the third leading cause of death among Japanese and more than 95% of the deaths from pneumonia are among the elderly aged 65 and older. Furthermore, the commonest infectious organism in communityacquired pneumonia in the elderly aged 65 and older is pneumococcus. The Japan Medical Association also submitted a written statement promoting vaccination against pneumococcus to the Ministry of Health, Labour and Welfare in the early stages after the disaster, and called for the need for vaccination. (v) Implementation details In this program, JRCS was responsible for all the costs of vaccination against pneumococcus on behalf of those who were actually vaccinated. The vaccine used for the vaccination in this project was said to have an immune effect on 23 out of approximately 90 types of pneumococcal organism in total, which was effective for approximately 80% of pneumonia caused by pneumococcus. The number of people who received the vaccination against pneumococcus at the end of this project reached approximately 440,000. The breakdown of the number of vaccinees in each Prefecture was approximately 130,000 in IWATE, approximately 130,000 in MIYAGI and approximately 180,000 in FUKUSHIMA. (ii) Purpose The purpose of this program is to prevent pneumonia caused by the pneumococcal organism and its aggravation in the elderly by subsidizing vaccination against pneumococcus for the elderly. [Vaccination against pneumococcus] 208

236 Figure 8-12 Performance of the relief and recovery assistance programs for the GEJET Field of support Improving the living conditions of affected people Social welfare services Children's education support Name of the project Details of the project Target (those who received the support) Donation of electrical household appliance packages Distribution of winter amenity item for those living in temporary housing Improvement of the equipment in the meeting rooms Psychosocial care activities Nordic walking Community bus Health class Support measures for problems in summer Donation of a package including a refrigerator, a washing machine, a TV set, a microwave, a rice cooker and an electric hot water distributer Donation of a Kotatsu table heater, an insulation sheet, heating pads Donation of long tables, a set of Zabuton (floor cushions), a whiteboard and an AED Installation of flower planters outside temporary housing Households living in temporary housing Households living in temporary housing and the meeting rooms for those living in temporary housing Meeting rooms and lounges in temporary housing Temporary housing Implementation of psychosocial care activities including attentive listening and Shelters / temporary housing individual consultations Walking led by instructors (JRCS volunteers) Operational support for free community buses connecting temporary housing, hospitals and the municipal offices, etc. Organization of health classes, training sessions in first aid / AED Donation of refrigerant sprays, cool towels, and insect sprays, etc. 6 Municipalities to the south of Miyako City in IWATE, Nihonmatsu and Aizuwakamatsu Cities in FUKUSHIMA Residents living in temporary housing Temporary housing in FUKUSHIMA Shelters Performance / Number of beneficiaries 135,166 households 729 temporary housing 137,438 items 806 meeting rooms 34,597 items 34 times 2,130 planters 15 shelters and temporary housing / 120 times 4,335 people 116 times 1,224 people 2 buses 9 services / day 11 temporary housing / 30 times 1,025 people 145 shelters 239,575 items Construction of a temporary meeting room Construction of a temporary meeting room Kawauchi Village in FUKUSHIMA 1 meeting room Donation of apparatus for measuring blood pressure and physical check-ups Security kit Implementation of various exchange meetings 100 Japanese character essay contest Health survey project for the residents of Namie Town Medical devices needed for each municipality Exclusive cylindrical container for information including medical information and patient registration cards (copies) Relaxation, exchange meetings for the residents of evacuated areas Poem and 100 (Japanese) character essay contests on the experience of the GEJET as well as the nuclear power plant accident Implementation of health examinations for the residents of Namie Town now taking refuge and living in Iwaki City away from its temporary town office established in Nihonmatsu City Meeting rooms and lounges in temporary housing Municipalities in MIYAGI Each relevant area in the three affected area Member schools of the Junior Red Cross in FUKUSHIMA Residents of Namie Town taking refuge and living in Iwaki City Distribution of nursing beds Donation of nursing beds Social welfare facilities Support for group homes for the elderly Donation of electrical household appliances and living room furniture Temporary group homes Provision of welfare vehicles Donation of welfare vehicles Social welfare facilities Construction of public housing for the elderly Construction of public housing for the elderly Shinchi Town and Soma City in FUKUSHIMA Dispatch of caregivers Provision of equipment for school clinics Prefabricated school gymnasiums Construction of nursery schools Construction of school gymnasiums and provision of goods for gymnasiums Donation of training autfits for football teams Support for dispatching caregivers Donation of scales for body height and weight measurement, vision analyzers, audiometers, stretchers, and beds Construction of temporary school gymnasiums Construction of nursery schools Donation of tools and equipment for school gymnasiums Donation of practice jerseys for soccer Donation of AEDs Special elderly nursing homes in Rikuzen-takata City in IWATE Elementary, junior high and high schools in IWATE and MIYAGI Otsuchi Town, Ofunato City in IWATE, Iitate Village in FUKUSHIMA Yamada Town in IWATE, Naraha Town in FUKUSHIMA Elementary and junior high schools in Otsuchi Town in IWATE, Sendai City and Higashi-matsushima City in MIYAGI Soccer teams in the affected areas Soccer teams in the affected areas 2 spaces / rooms 118 items 57,720 kits 313 times 12,053 people 76 schools 4,739 poems and essays 275 households 389 people 161 facilities 959 beds 62 group homes 2,239 items 207 facilities 338 vehicles 5 areas 2 homes 67 caregivers 160 schools 1,799 items 3 gymnasiums 3 nursery schools 11 schools 899 items 121 teams 3,655 uniforms 92 teams 102 AEDs Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 209

237 Great East Japan Earthquake and Tsunami Chapter 8 Field of support Children's education support Medical services Assistance for Nuclear Power Plant Accident Victims Name of the project Details of the project Target (those who received the support) Support for school kitchens centers Provision of materials and equipment for schools Donation of school buses Organization of Safety Classes Indoor playground Summer camp Assistance for the disaster victims by Junior Red Cross and Red Cross Volunteers Corps Wanpaku Genki (Mischievous Activity) School International exchange program Medical support Development of the Minamisanriku Public Clinic Renovation of Kesennuma Municipal Motoyoshi Hospital Renovation of Onagawa Community Medical Center Development of Ishinomaki City Nighttime Emergency Center Development of the temporary ward of Ishinomaki RCHP Vaccination against pneumococcus Provision of instruments for measuring radiation exposure Donation of food radiation measuring equipment Donation of large refrigerators, kitchen utensils, eating utensils and vehicles Donation of lights, reflective safety sashes for satchels, AEDs and personal computers Operational support for school buses Health Safety Classes, support for field trips, mobile movie theater Implementation of Smile Parks Organization of a summer camp Implementation of training sessions and exchange meetings Implementation of nature experience classes in groups International exchange program with junior high and high school students from Thailand Construction of the clinic of Shizugawa Public Hospital Renovation of Kesennnuma Municipal Motoyoshi Hospital Renovation of Onagawa Community Medical Center Construction of Ishinomaki City Nighttime Emergency Center Construction of the temporary ward of Ishinomaki RCHP Support for free vaccination against pneumococcus Donation of whole body counter and thyroid test monitors, etc Food radiation measuring equipment Kamaishi City school lunch center in IWATE, Ishinomaki City school lunch center in MIYAGI, Otsuchi Town and Minami-soma City in FUKUSHIMA Rikuzen-takata City Board of Education in IWATE, high schools in coastal areas, elementary and junior high schools in Nihonmatsu City in FUKUSHIMA Yamada Town and Otsuchi Town in IWATE, Okuma Town and Katsurao Village in FUKUSHIMA Yamada Town Municipal Kindergarten in IWATE, Okuma Town Municipal Kindergarten in FUKUSHIMA Preschoolers in Fukushima City and Soma City in FUKUSHIMA Pupils and Students of elementary and junior high schools in the three affected prefectures JRCS Open-air Class in IWATE, JRCS training centers in MIYAGI and FUKUSHIMA Elementary school pupils living in temporary housing in MIYAGI Junior high and high school students in MIYAGI Minami-sanriku Town in MIYAGI Kesennuma City in MIYAGI Onagawa Town in MIYAGI Ishinomaki City in MIYAGI Ishinomaki RCHP The elderly aged 70 and older living in the three affected prefectures Fukushima Medical University Fukushima RCHP Miyagi Prefecture Board of Education Fukushima City and Nihonmatsu City in FUKUSHIMA Performance / Number of beneficiaries 16 centers 8,933 items 58 schools 13 schools / 32 buses (18 donated, 11 rented, 3 contracted operations) 8 times 740 kindergarteners 7 times 40,890 participants (total number of visitors) 1 time 3,451 pupils and students 5 times 206 people 1 time 41 pupils 1 time 14 students 1 clinic 25,070 people (total number of patients) 1 hospital 23,724 people (total number of patients) 1 medical center 48,549 people (total number of patients) 1 center 7,480 people (total number of patients) 1 hospital ward 12,127 people (total number of patients) 437,856 people A set of testing equipment 2 million people (Number of persons subject to the survey) 1 WBC 7,990 people (Number of persons tested) 2 thyroid test monitors 5,311 people (total number of persons tested) 68 points 109 equipment items Government of Kuwait Funds for the recovery projects for the affected areas Recovery of community infrastructure, medical support, educational support, support for agriculture, forestry and fisheries, support for small and mediumsized companies IWATE, MIYAGI, FUKUSHIMA 210

238 4. Assistance from Kuwait (1) Background to the request and the overall flow of the assistance On April 18, 2011, through the Minister of Economy, Trade and Industry (METI), Japan received an offer from the Minister of Oil, Kuwait that Kuwait to provide 5 million barrels of oil (equivalent to approximately 80 thousand kilo liters, approximately 40 billion yen) as free as assistance for the affected people of the GEJET. This donation was the maximum amount received from a single country. METI decided that is would be appropriate for the JRCS, who had a good track record in the support of the affected people of disasters both in Japan and abroad, to utilize the money equivalent to the oil donated in order to implement effective projects and asked JRCS to implement the assistance programs for the affected people of this disaster. The Director-General, Trade Policy Bureau of METI asked the President of JRCS for the implementation of recovery assistance programs for the affected areas, and JRCS replied, under the name of the President, to the Director-General, Trade Policy Bureau that JRCS would willingly implement the projects requested. Subsequently, JRCS had repeated consultations with METI and other relevant organizations and decided that the targets of support should be the three Prefectures of IWATE, MIYAGI and FUKUSHIMA that had an extremely large amount of damage among the affected 15 Prefectures in this disaster. The flow of the assistance from Kuwait was as follows. 1. Kuwait Government provided for free 5 million barrels of crude oil through the Japanese Government. 2. Oil wholesale companies in Japan received this crude oil and transferred the amount equivalent to the price to JRCS. 3. JRCS gained agreement with METI and implemented assistance programs for the disaster affected people in the Prefectures of IWATE, MIYAGI and FUKUSHIMA (transfer of donation from overseas to each affected prefecture). 4. Each of these prefectures received the donation from JRCS as funds that can be spent down and allocated them to the assistance programs for the affected people implemented according to the priority, emergency level and actual situation of each affected area. The President of JRCS notified the Governors of the three Prefectures to be supported of the implementation of recovery assistance programs, and received answers of acceptance from all of the three Prefectures. Framework of the support from Kuwait (Free provision of crude oil) Kuwait Petroleum Corporation (KPC) Japanese Red Cross Society Provision of crude oil as a raw material Support for the recovery projects implemented by the local governments for the affected people (transfer of recovery support funds) Prefectures of IWATE, MIYAGI and FUKUSHIMA Establishment of funds that can be draw down Advice Implementation report Implementation of recovery projects on the projects 1. Project for recovering the community infrastructure 2. Project for medical support 3. Project for welfare and nursing support 4. Project for educational support 5. Project for support for agriculture, forestry and fisheries 6. Project for support for small and medium-sized business 7. Project for employment support 8. Project for support for the victims of the nuclear power plant accident Oil companies (JX and three other companies) Payment of the amount equivalent to the price for the crude oil provided for free Establishment of a committee (2) Project team On August 1, 2011, a project team for responding to this matter was assembled (a total of 4 members) inside the JRCS Headquarter (3) Holding a presentation ceremony On October 12, 2011, the first delivery of crude oil sent from Kuwait arrived in Japan and a presentation ceremony hosted by METI was held. JRCS President Konoe, METI Minister Edano, JX Nippon Mining and Metals President Kimura (Vice-President of the Petroleum Association of Japan), representatives of each of the affected three prefectures, Kuwait Petroleum Corporation CEO al-zanki, and the Ambassador Extraordinary and Plenipotentiary of the State of Kuwait to Japan al-otaibi attended the ceremony. [Scene at the presentation ceremony] Japanese Red Cross Society Chapters of Iwate, Miyagi and Fukushima Third party committee on the management of the funds After the ceremony, a reception was held with the participation of the former Prime Minister Hatoyama, Diet members and other relevant parties in addition to those who attended the ceremony. JRCS President made a speech stating that JRCS would try hard to give assistance for rebuilding the lives of the affected people in cooperation with the three prefectures. Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 211

239 Great East Japan Earthquake and Tsunami Chapter 8 Regarding the details of the recovery projects, the summary of the master plan was sent to each Prefecture from JRCS. [JRCS President Konoe who made a speech at the reception] (4) Framework of the support JRCS gave assistance for the recovery projects implemented by the local governments for the affected people, utilizing as capital funds the amount equivalent to the crude oil provided for free by Kuwait. The intention of Kuwait was that the Kuwait Government thinks it the first priority to give assistance to the people who are still forced to live a hard life in the affected areas, and asks JRCS to implement effective projects, and the specification of the form of the projects was left to the discretion of JRCS. In September 2011, JRCS visited the three prefectures. JRCS also consulted in advance with METI and the Kuwait Government, and after having determined the framework of its recovery assistance programs, judged it appropriate to leave the implementation of specific projects to the discretion of each local government who understood well about the actual situation of the affected areas, and decided to allocate the funds received by JRCS to each of the three prefectures. As the range of these projects was set up to be broad, the projects could be available for a variety of support programs for the affected people. 1. Project for recovering the community infrastructure 2. Project for medical support 3. Project for welfare and nursing support 4. Project for educational support 5. Project for support for agriculture, forestry and fisheries 6. Project for support for small and medium-sized business 7. Project for employment support 8. Project for support for the victims of the nuclear power plant accident (5) Total amount of recovery support funds and amounts allocated to the three affected prefectures The amount equivalent to the price of the crude oil donated was transferred to JRCS from oil wholesale companies 1 in 7 installments, and the last transfer was completed on November 22, The amount of recovery support funds was approximately 524 million dollars in total, which was equivalent of approximately 40 billion yen. Total amount of funds for recovery support: 40,066,027,141 yen (equivalent to 524,008,400 dollars) The allocation of the funds to the target three prefectures was determined in consideration of the specificity of the nuclear disaster in addition to the scale of the damage and the fairness of distribution. The amounts allocated to each of the three prefecture were approximately 8.4 billion yen to IWATE, 16.2 billion yen to MIYAGI, and 15.4 billion yen to FUKUSHIMA. Figure 8-13 Amounts allocated to the three Prefectures IWATE MIYAGI FUKUSHIMA Total Allocation for the response to the nuclear power plant accident Uniform allocation Prorated allocation (index 2,223,961,629 10,007,827,328 6,301,224,614 for the secondary (12%) (54%) (34%) allocation of Gienkin ) ,000,000,000 3,000,000,000 6,177,671,190 6,177,671,190 6,177,671,190 18,533,013,570 18,533,013,571 (100%) Total 8,401,632,819 16,185,498,518 15,478,895,804 40,066,027,141 The details of the major projects in the three Prefectures were as follows. IWATE (approximately 8.4 billion yen) Recovering the community infrastructure Educational support Development of railway vehicles and station buildings of the Sanriku Railway, etc. Restoration of private schools, renaissance of local performing arts, etc. (1) A total of four companies including JX Nippon Oil & Energy Corporation, Idemitsu Kosan Co., Ltd., Cosmo Oil Co., Ltd., and Showa Shell Oil K.K. 212

240 Support for fisheries Support for small and medium-sized business Recovering the community infrastructure Support for fisheries Subsidy for recovering salmon and trout resources, etc. Support for the early recovery of small and medium-sized companies, etc. MIYAGI (approximately 16.2 billion yen) Support for small and medium-sized business Recovering the community infrastructure Recovering the community infrastructure Subsidy for the maintenance and management of temporary housing, etc. Subsidy for recovering aquaculture facilities, securing fishery seeds, etc. Subsidy for recovering the equipment and facilities of small and medium-sized manufacturers and traders, etc. FUKUSHIMA (approximately 15.4 billion yen) Support for small and medium-sized companies Employment support Subsidy for the maintenance and management of temporary housing, etc. Subsidy for the repair and protection of cultural properties, etc. Subsidy for recovering the equipment and facilities of small and mediumsized companies, etc. Support for encouraging the temporary engagement in agriculture of farmers at their places of evacuation, etc. For implementing these projects, JRCS discussed and approved the supplementary budget for the fiscal year 2011 in December Supplementary budget for the budget of revenues and expenditures of the general account in FY2011 Amount of the supplementary budget: 40,066,028,000 yen (both revenues and expenditures) Recovery assistance programs for the GEJET (6) Establishment of a Third Party Committee (coordination with the Chapters of the three prefectures) In the three affected prefectures of IWATE, MIYAGI and FUKUSHIMA, a fund that could be spent down was established to ensure the transparency of fund management, and the money for recovery support transferred from JRCS was received through this fund to be allocated to the projects for supporting the affected people. JRCS had determined that the implementation of specific projects was to be left to the discretion of each local government who understood well about the actual situation of the affected areas, but judged it necessary to have a system where the opinions of a third party could be reflected in the planning and performance of the projects in order to facilitate more appropriate and effective implementation of the recovery assistance programs, and established a committee consisting of a third party from each Chapter in the Prefectures. With the start of the committee in the Fukushima Chapter in February 2012, the three affected prefectures launched the recovery projects in light of the advice of the committee. (7) Transfer of the funds to the three affected prefectures On January 6, 2012, JRCS transferred all the recovery support funds on the establishment of a fund in each prefecture for receiving the recovery support funds as well as the completion of the procedures for submitting the supplementary budget. (8) Implementation status of the recovery support funds Based on reports from the three prefectures as of March 31, 2012, the implementation status of the recovery support funds in FY2011 is shown in Figure Figure 8-14 Implementation status of the recovery support funds in FY2011 (Unit: yen) Allocation of funds for recovery support Amount of implementation in FY2011 Accumulated total amount of implementation Balance payable IWATE MIYAGI FUKUSHIMA Total 8,401,632,819 16,185,498,518 15,478,895,804 40,066,027,141 29,632, ,825, ,457,516 29,632, ,825, ,457,516 8,372,000,819 16,185,498,518 14,866,070,288 39,423,569,625 Amount of the initial budget in FY2012 (NOTE) As of April 1, ,701,383,000 7,341,392,000 7,180,044,000 19,222,819,000 Each prefecture should submit a report on the implementation status of the project to JRCS every half year, and JRCS should sum up these reports and submit to METI. In light of the characteristics of the funds that should be used for recovery support, it is desirable to implement Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 213

241 Great East Japan Earthquake and Tsunami Chapter 8 the measures for support for the affected people as soon as possible, but some projects may take a certain amount of time from the start to the end. JRCS assumes that the time required for a project would be generally 3 years at longest, but it might be allowed even if the project takes more than 3 years because of its nature. 5. Accounting and audit (1)GEJET Operation Expenditure Report Period covering from 11 March 2011 to 31 March 2013 As of the end of March 2013 Budget: Cumulative Spending: Mar Mar S p e n d i n g : Jan. - Mar All figures are in thousand Japanese Yen (JPY) Accounts Supplies Land,vehicles Transport &equipment &Storage Personnel General Expenditure Others Program Project 1. Distribution of Emergency Relief Supplies 1-(1) Purchase and Replenishment of Emergency Relief Supplies 464, , Emergency medical services and PSP 2-(1) Medical and PSP assistance (*) 2,987 2, Regional Healthcare Support 3-(1) Pneumonia vaccination for the elderly (*) 3,619,420 3,619, (2) Provision of Air Purifiers Assistance for nuclear power plant disaster victims 4-(1) Whole Body Counter and thyroid gland monitoring 1,105, , (2) Nuclear Disaster Preparedness Project 1,000,032 55,128 33,916 11,078 22,839 4-(3) Provision of food radiation measuring equipment (*) 222, , Rehabilitation of health infrastructure 5-(1) Construction of a temporary night-time emergency medical centre (Ishinomaki) 108,894 95,888 6,048 6,048 5-(2) Construction of a temporary hospital for secondary medical care (Ishinomaki) (*) 715, , (3) Construction of a temporary hospitals as a secondary medical care (Minamisanriku) (*) 600, , (4) Strengthening the disaster/emergency medical capacity of Ishinomaki RC Hospital and reconstruction of RC nursing school and emergency health training centre (Ishinomaki) 4,300,167 12,246 12,079 12,079 5-(5) Construction of a hospital (Motoyoshi) 153, , , ,060 5-(6) Rehabilitation of Community Medical Center (Onagawa) (*) 1,887,506 1,888, (7) Shizugawa permanent public hospital (Minamisanriku) 1,600, (8) Social Welfare Care centre (Minamisanriku, Miyagi) 620, Improving the living conditions of affected people in evacuation centres and temporary housing 6-(1) Installation of electric appliances and other items at large-scale evacuation centres and temporary housing 333, ,707 7,966 7, (2) Distribution of summer amenity items, drinking water, temporary showers, water taps, etc. (*) 119, , (3) Distribution of winter amenity items (*) 97,762 97, (4) Community bus operations support (*) 50,270 39,379 8,073 8,073 6-(5) Psychosocial support 26,517 15,972 2, ,756 6-(6) Distribution of six electric household appliances sets(*) 26,852,306 26,968, , ,304 20,105 23, (7) Public housing and community centres (Otsuchi, Iwate) 1,448,655 12,774 12,094 12, (8) Construction of community centre (Kawauchi, Fukushima) 39,852 39,851 1,711 1,711 6-(9) Nordic style walking as physical exercise 21,167 5,750 1, ,785 6-(10) Health and Social Class 46,947 6,976 2, ,075 6-(11) Home visits for evacuee's health care (Iwaki, Fukushima) 31,000 11,077 6,818 2,484 4,334 6-(12) Psychosocial support centre for children and youth in Iwate Medical University Hospital 137, (13) Mobile dental care services for elderly and physically challenged persons 60,000 56,350 56,350 56, (14) Miscellaneous 78,565 30,539 4,622 1, , Social welfare support 7-(1) Distribution of medical/nursing beds (*) 163, , (2) Distribution of items for group homes for the elderly (*) 101, , (3) Provision of vehicles for social welfare institutions(*) 687, , (4) Services of caregiver for the elderly (*) 1,855 1, (5) Support for social welfare centres 600, (6) Public housing for the elderly (Soma, Fukushima) 300,017 20,990 20,973 20,973 7-(7) Public housing for the elderly (Shinchi, Fukushima) 100,749 75,953 75,000 75,000 7-(8) Social welfare centre (Kesennuma, Miyagi) 6,000 5,458 5,312 5, Children's education support 8-(1) Provision of items for school kitchen centres (*) 292, , (2) Provision of goods for gymnasiums (*) 107,799 9, (3) Nursery school and after-class centres (Yamada, Iwate) 422, , , , (4) Construction of after-class centre (Ofunato, Iwate) 24, (5) Health and safety support (*) 3,333 3, (6) School bus operations support(*) 203, ,170 35,781 32,309 3, (7) Provision of school items (*) 48,792 48, (8) Training outfits for football teams (*) 39,578 39, (9) Provision of items for school clinics (*) 23,496 23, (10) Organization of indoor playground (Smile Park) 348, ,736 94,673 94, (11) Summer Camp 1,130, , (12) Prefabricated school gymnasiums 289, ,202 44,206 44, (13) Red Cross Youth Project 81,486 23,680 9,684 9, (14) Establishment of "Children's World" 78,121 58,103 58,103 58, (15) "Dream Blossom" Project (*) 3,000 2, (16) Miscellaneous 10, Community Based Disaster Preparedness 9-(1) Provision of DP material and storage facilities 1,501, Capacity building ofjrc in the area of disaster management 10-(1) "Development of disaster response capacity, tools and facilities " 2,000,022 1,712,777 1,695,316 1,677,796 17, Other Projects 11-(1) AED and other necessities for volunteer centres 15,916 16, Project under formulation 12-(1) Future potential programmes. 3,669, Project management and support 13-(1) HR, consultancy, audit, evaluation, support by IFRC 1,788, , ,154 54,694 96, Total Expenses 59,788,266 41,749,641 2,733, ,356 1,678,265 31,744 91, ,828 22,470 Report Prepared by: Tatsuya Sugiyama Notes: #1 General expenditures include costs related to travel, communication, utilties, etc. #2 Others includes services support from the IFRC (*) Projects completed per financial records. 214

242 (2) Audit a. Audit based on the International Standards on Auditing (a) Background to the implementation of accounting audits for donation from overseas based on the International Standards on Auditing In response to the fact that a letter of agreement to call for the implementation of an accounting audit was signed for the donation through overseas Red Cross and Red Crescent Societies and that it was necessary to fulfill accountability both in Japan and abroad concerning the implementation of recovery assistance program donation from overseas JRCS decided to receive an audit based on the International Standards on Auditing and entered into a contract with Ernst & Young SHINNIHON LCC. (b) Summary of the audit work An audit based on the International Standards on Auditing 800 (Audits of financial statements prepared in accordance with special purpose frameworks) (the Audit) was implemented for the statement of income and expenditures of the donation from overseas for the GEJET prepared by JRCS. This statement was prepared to disclose the status of revenues and expenses of the donation among the accounting transactions of JRCS, and the Audit was different from a financial statement audit on the overall performance of JRCS. It was an unprecedented experiment for an organization in Japan to receive an audit based on the International Standards on Auditing 800. The period subject to the audit of FY2011 for the statement of income and expenditures of the donation from overseas for the GEJET was from March 16, 2011 through March 31, The statement of income and expenditures of the donation from overseas for the GEJET was prepared according to the guidelines for preparing the statement of income and expenditures of the donation from overseas for the GEJET, and the audit opinion stated whether the statement was prepared in accordance with the guidelines for preparing the statement of income and expenditures of the donation from overseas for the GEJET. Figure 8-15 Summary of the operations of the Audit Items subject to audit Statement of Income and Expenditures of the donation from overseas for the GEJET Standards for preparing the statement of income and expenditures Practice standards for the audit Format of the audit report Guidelines for preparing the statement of income and expenditures of the donation from overseas for the GEJET International Standards on Auditing 800 (Audits of financial statements prepared in accordance with special purpose frameworks) Stating an opinion about whether the statement of income and expenditures of the JRCS donation from overseas for the GEJET was prepared in accordance with the special purpose frameworks (guidelines) Figure 8-16 Flow of the procedures of the Audit Chapter 8 Recovery Assistance Program Great East Japan Earthquake and Tsunami 215

243 Great East Japan Earthquake and Tsunami Chapter 8 (c) Audit results The Audit was implemented for the statement of income and expenditures of the donation from overseas (for the period from March 16, 2011 through March 31, 2012) prepared by JRCS. As a result of the Audit, an opinion was stated in the Auditor s opinion report that the statement of income and expenditures of the donation from overseas for the GEJET was prepared, in all material respects, in accordance with the guidelines for preparing the statement of income and expenditures of the donation from overseas for the GEJET. For FY2012, JRCS continued to receive the Audit. 216

244 b. Implementation of internal audits (Recovery Task Force) In the JRCS Recovery Task Force for the GEJET, self-evaluations for the recovery assistance programs were implemented in order to find out and correct any facts that might pose an obstacle to the improvement of operational procedures and the appropriate implementation of operations related to the recovery assistance program. Based on these evaluations, the Compliance Management Office, the internal audit division of JRCS, implemented an internal audit to confirm that the decision-making processes and the administrative procedures were appropriately conducted in accordance with the predefined rules for the implementation of the recovery assistance program for the GEJET. Date: Tuesday, August 2, 2011 Period subject to the audit: Friday, March 11, Thursday, June 30, 2011 Operations subject to the audit: Operations implemented by the Recovery Task Force for the GEJET Operations implemented by the relevant departments (Recovery Task Force, General Affairs Department, Human Resources Department, International Department, and Medical Services Department) in relation to the operations mentioned above Auditor: 3 staff of the Compliance Management Office (including Deputy Director General for the audit) Items to be audited: Progress of discussions about the recovery assistance programs in the council for the program Appropriate implementation of the recovery assistance programs based on the discussions and agreements with the affected prefectures Preparation of the necessary documents on resolutions and books of accounts related to the recovery assistance programs Project reports to the overseas Red Cross and Red Crescent Societies based on the agreements Results of the audit: The finding of the internal audit was that there was a flaw in an article on personal information protection in the outsourcing agreement. In the on-site offices of the Recovery Task Force established in each Chapter of the three affected prefectures, internal audits were implemented for the labor, management status of cash, and delivery procedures and usage status of electrical household appliances packages and welfare vehicles in the destination areas, related to the recovery assistance programs for the GEJET. Date: Monday, December 19 - Tuesday, December 20, 2011 Auditee: On-site offices of the Recovery Task Force for the GEJET established in MIYAGI and FUKUSHIMA, Organizations who received the electrical household appliances Auditor: 1 staff of the Compliance Management Office (Director for the audit) Items to be audited: Appropriate labor management of the on-site stationed staff Periodic report to / discussion with the Recovery Task Force about the implementation of operations Appropriate handling of personal information Results of the audit: Each item audited was generally appropriately implemented and there were no written findings. (3) Implementation of a third party evaluation a. Background and purpose JRCS decided to implement an evaluation of the recovery assistance programs for the GEJET and to sum up the performance of the projects with the aims of (1) Appropriate implementation of the projects and the verification of their effects, (2) Utilization for the external disclosure of information and reporting as well as the proposals, and (3) Internal sharing and preparations for the future. In addition to the self-evaluations conducted on the performance of the projects, JRCS implemented an external evaluation by a third party in order to ensure the objectivity of the results of the self-evaluations and verify their neutrality and validity. As the recovery assistance programs by JRCS may continue for a long time, JRCS is planning to conduct the evaluation every fiscal year. For this third party evaluation, JRCS entrusted the evaluation to the Japan Research Institute, Limited. For the projects implemented in FY2011, JRCS received a report 2 on October 31, For the projects implemented in FY2012, the evaluation is being continued. Chapter 8 Recovery Assistance Program (2) A report of A third party evaluation of the recovery assistance programs for the GEJET (projects implemented in FY2011) prepared by the Japan Research Institute, Limited (October 31, 2012) Great East Japan Earthquake and Tsunami 217

245 Great East Japan Earthquake and Tsunami Chapter 8 b. Evaluation targets In the evaluation for the projects implemented in FY2011, the following recovery assistance programs implemented by JRCS were evaluated as the targets. (c) Actions implemented and the methods of examination / analysis In this evaluation, the following actions were implemented and summed up in the report. I. Individual project evaluations (i) Detailed evaluation (ii) Brief evaluation II. Overall evaluation (i) Evaluation by support sector (ii) Evaluation by form of support (iii) Evaluation by region (iv) Evaluation based on studies in the affected areas (v) Evaluation based on recognition of the recovery assistance programs outside the affected areas (vi) Evaluation of policies / strategies, and organizations / operational frameworks c. Evaluation methods (a) Approach and evaluation criteria for the individual projects evaluations In the individual projects evaluations, output (project outcome) and process (the course of a project carried out) were focused on, and a total of 7 items including 2 items of outputs and 5 items of process were evaluated. Review of the JRCS internal evaluation for the recovery assistance programs Recognition survey of the beneficiaries (affected people) on the recovery assistance programs Recognition survey of the relevant organizations including municipalities on the recovery assistance programs Recognition survey of the general public on the recovery assistance programs Survey on the operations of the recovery assistance programs Analysis of the details of the above surveys Evaluation based on the results of the analysis Output Process Items evaluated Quantitative aspects Qualitative aspects Promptness / Smoothness Efficiency Effectiveness Transparency / Validity Fairness (b) Approach to the overall evaluation An overall evaluation for the recovery assistance programs was implemented based on the following perspectives. (i) Policies/strategies and operational frameworks of the projects (ii) Rationality of the selection of the projects implemented (iii) Allocation of resources (aspects of both finance and human resources) (iv) Promotion Management of the projects 218

246 Chapter 9 Gienkin (Cash grant scheme)

247 Great East Japan Earthquake and Tsunami Chapter 9 Chapter 9 Gienkin (Cash grant scheme) 1. Gienkin ; Cash grant scheme (1) Collection of Gienkin through the Japanese Red Cross Society (JRCS) JRCS started Gienkin (Cash grant scheme) on March 14, 2011, together with the Central Community Chest of Japan and NHK (Japan Broadcasting Corporation, including the NHK Public Welfare Organization). The collection of Gienkin was implemented in accordance with the JRCS Regulations for Handling Gienkin for Disasters, and generally the chapters in the affected prefectures play the main role in collecting the Gienkin, but as the damage was extremely extensive in the Great East Japan Earthquake and Tsunami (GEJET), it was determined that the Headquarters should coordinate the nationwide collection of Gienkin. The collection of Gienkin was implemented in the several ways including: 1. Normal transfer (Japan Post Bank/Japan Post), 2. Bank transfer, 3. Use of a credit card, convenience store or Pay-easy, 4. Use of the Family Mart Fami Port Donation system, 5. Contribution by Ecopoint, 6. Collection at the reception counters of the JRCS offices. The collection period was first set until September 30, 2011, but it was extended in a step-by-step manner due to the continuous contribution of huge sums the Gienkin funds and it was decided on March 31, 2013, that the collection period for Gienkin collection would be extended until March 31, (2) Initial response to the collection of Gienkin The JRCS decided to start collecting Gienkin on March 12, 2011, the day following the disaster, and actually started collecting Gienkin on March 14 after some coordination work with the relevant organizations, including financial institutions. For the collection of Gienkin, the JRCS Organizational Development Department had initially responded to all telephone inquiries, and this resulted in a situation in which the staff was tied up on the telephone to answer questions. A call center was set up in the Headquarters on March 16 to respond to the inquiries and staff members were deployed, exclusively in handling the inquiry calls. In addition, a toll-free hotline call center was opened outside the JRCS on April 27, On Figure 9-1 Main actions related to the collection of Gienkin and the responses by the JRCS Date Actions and responses A massive earthquake of magnitude 9.0 March 11, 2011 occurred off the SANRIKU Coast. Decided on the collection of Gienkin at the Headquarters and informed the chapters of this. March 12 Informed the relevant financial institutions concerning the collection of Gienkin. Informed the relevant news media including NHK of the collection of Gienkin. March 14 Started the collection of Gienkin. Deployed full-time staff to respond to March 16 telephone inquiries about the Gienkin. (Establishment of a call center) March 22 Started to sort the postal transfer forms. (Establishment of a sorting center) Establishment of a full-time system for the March 24 operation of cash receipts. (Establishment of a cash receipt center) Deployed staff members to respond to March 30 inquiries by about the Gienkin. (Establishment of an center) April 6 Started to input the postal transfer forms. (Establishment of an input center) Through press releases and a website, April 7 apologized for and corrected an error in the summary values announced on April 5. Participated in the first meeting of the distribution committee to decide on April 8 the fair proportional distribution of the Gienkin and determined the rate of distribution. Started the transfer of the first April 13 distribution of Gienkin to each affected prefecture. April 14 Started to dispatch the receipts for the Gienkin. Established a hotline call center outside April 27 the JRCS to respond to inquiry calls about the Gienkin. May 13 Started to issue receipts for the Gienkin in irregular cases. Participated in the second meeting of June 6 the committee to decide on the fair proportional distribution of the Gienkin. Started the transfer of the second June 17 distribution of the Gienkin to each affected prefecture. Increased the number of staff to issue August 29 receipts for the Gienkin in irregular cases. (Establishment of a receipt handling center) Participated in the third meeting of December 8 the committee to decide on the fair proportional distribution of the Gienkin. 220

248 March 30, a mail center was also opened to respond to inquiries by and full-time staff members were deployed to respond to these s. From April 14, issuance of the receipts for the Gienkin was started. On August 29, a receipt handling center was established to smoothly issue the receipts for the Gienkin received not only via postal and bank transfers, but also by registered mail. In a situation where the Distribution Committee had hardly been established in the affected local governments, the rate of distribution was determined in the first meeting of the Gienkin Collection and Distribution committee to decide on the ratio for the fair distribution of Gienkin, held on April 8 and the first transfer of Gienkin to each affected prefecture was started on April 13. In the initial response period where huge sums of Gienkin were contributed over such a short period, some errors occurred in the summary values of the Gienkin collected. A total value of approximately 30 billion yen more than the actual amount received had been announced on the JRCS website, and the error was apologized for and corrected through a press release dated April 7 as well as on the website. 2. Handling of Gienkin (1) Role of the JRCS The role of the JRCS is to collect the raised Gienkin together with the Central Community Chest of Japan as a Gienkin collecting organization and to deliver the full amount of Gienkin to each affected prefecture. Regarding the collection of Gienkin and its distribution to the affected people, it is stipulated in the Basic Disaster Management Plans prepared by the Central Disaster Management Council that regarding the use of Gienkin, affected local governments with Gienkin collecting organizations and a Distribution committee and should determine its use after sufficient discussions. It is also stipulated in the Operational Plan for Disaster Prevention 1 of the Ministry of Health, Labour and Welfare (MHLW) that affected prefectural and municipal governments should organize a Gienkin Collection (Distribution) Committee consisted of relevant support organizations, determine its distribution criteria in view of the total amount of Gienkin and the situation of the affected areas, and quickly and appropriately distribute it with the help of news media. According to the above stipulations, Gienkin should be generally collected and distributed under the Gienkin Collection and Distribution Committee established by the affected areas governments, Gienkin collecting organizations, news media and other relevant parties. (2) Handling of Gienkin in the GEJET As the GEJET had inflicted widespread damage over multiple prefectures, and some governments suffered such devastating damage to their administrative functions that their response to Gienkin was delayed, JRCS began to collect Gienkin without waiting for the establishment of Gienkin Collection and Distribution Committees by the affected local governments. Delayed establishment of Gienkin Collection and Distribution Committee in each affected local government caused a situation in which the distribution method of Gienkin was not determined and JRCS and other Gienkin collecting organizations continued to hold the collected Gienkin. In addition, it was required to discuss the same distribution criteria in the affected areas so as not to develop distribution criteria that were different for each affected prefecture. Thus, as a result, the JRCS asked the Cabinet Office to make an adjustment at the national government level and the MHLW requested the Cabinet Office to become the Secretariat to establish a Committee to decide on the ratio for the fair distribution of Gienkin consisting of intellectuals, the affected prefectures, Gienkin collecting organizations (JRCS, Central Community Chest of Japan, NHK and NHK Public Welfare Organization) in preparation for the distribution of Gienkin to each affected prefecture and coordinated by MHLW. On April 8, the first meeting of the Committee was held. Collected Gienkin was transferred to each affected prefecture based on the distribution ratio for the fair distribution determined by the Committee. Each affected prefecture established a Gienkin Collection and Distribution Committee and discussed the allocation of Gienkin, and transferred it to each targeted municipality in each prefecture. In the prefectures most affected, such as FUKUSHIMA, MIYAGI and IWATE, the Gienkin Collection and Distribution Committee was established in FUKUSHIMA on April 1, in MIYAGI on April 13, and in IWATE on April 18. Chapter 9 Gienkin (Cash grant scheme) (1) Operational Plan for Disaster Prevention of the MHLW, Title 2 Disaster Emergency Response Measures, Chapter 4 Welfare-related Measures, Section 7 Collection of Relief Supplies and Gienkin, Item 3. Great East Japan Earthquake and Tsunami 221

249 Great East Japan Earthquake and Tsunami Chapter 9 Figure 9-2 Members of the Committee to decide on the ratio for the fair distribution of Gienkin Intellectuals Mr. Tsutomu Hotta, Director of the Sawayaka Welfare Promotion Center Ms. Fumiko Nishizaki, Professor of the Faculty of Law, Seikei University Mr. Hiroshi Takahashi, Executive Director and Secretary General of the Furusato Kaiki Support Center (Support Center for Return to the Home Land) Local governments HOKKAIDO, AOMORI, IWATE, MIYAGI, YAMAGATA, FUKUSHIMA, IBARAKI, TOCHIGI, GUNMA, SAITAMA, CHIBA, TOKYO, KANAGAWA, NIIIGATA, NAGANO Gienkin collecting organizations JRCS, Central Community Chest of Japan, NHK and NHK Public Welfare Organization Figure 9-3 Name of prefecture Status of holding the first meeting of the Gienkin Distribution Committees in 15 affected prefectures Date of the meeting Name of prefecture Date of the meeting HOKKAIDO No meeting held GUNMA Apr. 15 * AOMORI Apr. 14 SAITAMA Jul. 21 * IWATE Apr. 18 TOKYO May 13 MIYAGI Apr. 13 CHIBA Apr. 19 YAMAGATA Apr. 22 KANAGAWA No meeting held FUKUSHIMA Apr. 1 NIIGATA Apr. 19 IBARAKI Apr. 25 NAGANO Apr. 13 TOCHIGI Apr. 21 * Document-based discussions in GUNMA. The first meeting was only held from the second distribution in SAITAMA. 3. Collection status of Gienkin JRCS received huge sums of Gienkin at the reception desks at the Headquarter and each chapter. The status of Gienkin collection was disclosed on the website of the Headquarters and has been updated as needed. The collection status of Gienkin received at JRCS by March 31, 2013, is shown in Figure 9-4. Exceptionally huge sums of Gienkin were collected immediately after the disaster. (In March 2011, nearly 100 billion yen was collected as Gienkin in 20 days from the occurrence of the disaster until the end of the month.) Since then, Gienkin has been collected continuously and the sum reached approximately billion of yen by the end of March 31, Gienkin received from overseas through many foreign embassies in Japan is included in this sum, and some senior officials or ambassadors to Japan came directly to the Headquarter to hand over the Gienkin. Figure 9-4 Sum of Gienkin received (Amount received each month and the cumulative amount) (Amount received each month: million yen) Amount received in the month Cumulative amount March 2011 April 2011 May 2011 June July August September October November December January 2012 February March April May June July August September October November December January 2013 February March (Note 1) The total amount was added up at the end of each month. (Note 2) The amount of Gienkin received through the Central Community Chest of Japan and NHK (including NHK Public Welfare Organization) is not included in the amounts shown in the above figure. 222

250 Figure 9-5 Distribution flow of the Gienkin Committee to decide on the ratio for the fair distribution of Gienkin (Secretariat: MHLW) Determination of the distribution method Contributors JRCS Central Community Chest of Japan NHK NHK Public Welfare Organization Affected Prefectures Affected Municipalities affected people * Gienkin Collection and - Confirmation of the Distribution Committee (Established in the affected status of the damage prefecture) - Issuance of affected Consisting of the affected prefectures, Gienkin people Certificates collecting organizations and news media, etc. 4. Transfer and distribution status of Gienkin (1) Holding the first meeting of the committee to decide on the ratio for the fair distribution of Gienkin As mentioned above, the MHLW became the Secretariat to establish the committee to decide on the ratio for the fair distribution of Gienkin consisting of intellectuals, the affected prefectures, Gienkin collecting organizations (JRCS, Central Community Chest of Japan, NHK and NHK Public Welfare Organization), and the ratio of the distribution of Gienkin to each affected prefecture was determined. The first meeting of the committee was held on April 8, The policy for the initial distribution to the affected prefectures (primary distribution) was determined based on the damage situation in each prefecture estimated as of April 8 and the total amount of Gienkin collected. Specifically, it was determined that, in accordance with the base amount of 350,000 yen for a household with their house completely destroyed, burned or washed away, or with lost or missing family members, 180,000 yen for a household with their house half destroyed or burned and 350,000 yen for a household located in the evacuation order zone or indoor confinement order zone affected by the nuclear plant accident, the total amount multiplied by the number of applicable households and residents should be transferred to each affected prefecture. It was also determined that JRCS and other Gienkin collecting organizations should transfer the Gienkin to each affected prefecture based on the distribution ratio determined in the Committee at the request of the affected prefectures. (2) Holding the second meeting of the Committee to decide on the ratio of Gienkin As a result of the primary distribution method where the amount obtained by multiplying the base distribution amount by the number of applicable households and residents was transferred to each affected prefecture upon request, only a part of the Gienkin was distributed and a large amount of Gienkin was retained by the Gienkin collecting organizations. As of June 3, 2011, the total amount of collected donation at JRCS, Central Community Chest of Japan, NHK and NHK Public Welfare Organization was approximately billion yen, but the amount that had already been transferred to the affected prefectures was only approximately 82.3 billion yen (of which, the amount that had been transferred to the Municipalities was approximately 72.4 billion yen). Consequently, on June 6, 2011, the second meeting of the Committee of Gienkin was held with the aim of the prompt distribution of Gienkin. In the committee, it was confirmed that the full amount of collected Gienkin should be transferred to the affected prefectures (a certain amount of Gienkin should be retained due to the unclear state of the damage, and the remaining amount should all be transferred), and that the means of distributing it to the affected people should be independently determined by each local government. It was concluded that the allocation of the Gienkin to each affected prefecture should be determined according to the degree of damage, with the indication of 1 for a household with lost or missing family members, or houses completely destroyed or burned, or an evacuated household due to the nuclear power plant accident, and 0.5 for a household with the Chapter 9 Gienkin (Cash grant scheme) Great East Japan Earthquake and Tsunami 223

251 Great East Japan Earthquake and Tsunami Chapter 9 house half destroyed or burned, and that the amount to be transferred should be calculated by dividing the total amount of Gienkin proportionally based on the damage reported by each prefecture. (3) Holding of the third meeting of the Committee of Gienkin On December 8, 2011, the third meeting of the Committee to decide on the ratio for the fair distribution of Gienkin was held. In the Committee, the distribution of Gienkin retained by the Gienkin collecting organizations, the affected prefectures and the municipalities was discussed to allow it to be available when new damage was revealed. Consequently, it was determined that the full amount of the Gienkin should be distributed based on the rules of its second distribution. The decision made in the committee was as follows: Gienkin collected by the end of September Full amount of the Gienkin should be distributed based on the rules of its second distribution. Gienkin collected in and after October Distribution of the Gienkin should be made based on the rules of its second distribution. However, it can be effectively utilized such as for distribution to the reserve funds for affected people including orphans of the GEJET. (4) Distribution amount of the Gienkin The amount of approximately billion yen of the Gienkin was sent to the affected prefectures from JRCS and Central Community Chest of Japan by March 31, As mentioned above, based on the distribution ratio determined in the first meeting of the Committee of Gienkin, the primary distribution of Gienkin to each affected prefecture was initiated on April 13, In addition, on June 17, 2011, the transfer for the second distribution began based on the distribution ratio determined in the second meeting. Since then, a total of seven transfers of Gienkin based on the ratio of the second distribution were made on July 15 and August 12 in 2011, January 15, March 9, June 1 and November 9 in 2012 and by March 31, Figure 9-6 Status of the distributed amount to each prefecture (As of March 31, 2013) Name of the Prefecture Total amount transferred (Unit: yen) HOKKAIDO 10,289,072 AOMORI 753,592,840 IWATE 33,495,173,344 MIYAGI 175,769,337,248 YAMAGATA 9,714,568 FUKUSHIMA 123,054,025,024 IBARAKI 15,552,669,904 TOCHIGI 1,938,705,920 GUNMA 5,169,536 SAITAMA 157,277,096 CHIBA 7,694,386,080 TOKYO 224,902,864 KANAGAWA 96,419,168 NIIGATA 195,826,864 NAGANO 141,203,984 Total 359,098,693,512 (Note) The amount above is the total amount sent from both JRCS and the Central Community Chest of Japan. (Note) As of March 31, 2013, JRCS collected 326,471,943,265 yen, and the Central Community Chest of Japan collected 40,868,904,923 yen. (5) Conduct of an audit based on the International Standards on Auditing JRCS had an audit conducted according to the same International Standards on Auditing as for the donation from overseas to ensure the transparency of the handling of the Gienkin. As a result of the audit, the opinion was stated in the report that the income and expenditure statement for the Gienkin for the GEJET prepared by JRCS (from March 14, 2011 through March 31, 2013) was duly developed in accordance with the preparation guidelines of the income and expenditure statement of the Gienkin for the GEJET in every important point. 224

252 Figure 9-7 Changes in the status of the Gienkin transferred / distributed 5. Response system for the Gienkin (1) Response to inquiries about Gienkin a. Establishment of an incoming call center Just after the occurrence of the disaster, the JRCS Organizational Development Department was inundated with various inquiries including those about Gienkin, and the operational burden on the staff became extremely heavy. Therefore, from March 16, a dedicated team was established to respond to these telephone inquiries. A total of 14 staff (10 staff received the calls) worked in two shifts - early shift (09:00-18:00) and late shift (12:00-21:00) - to establish a seven-daysa-week response system, and prepared a manual for responding to phone calls to provide a standardized operation. In addition, from April 11, an English speaking staff was also added to enhance the system to be able to respond the inquiries from abroad. b. Establishment of an center Just after the occurrence of the disaster, inquiries on Gienkin, overseas inquiries and other s addressed to the JRCS main address had increased and reached more than 14,000 s for a while. At first, these s were handled with the cooperation of volunteers, but as they became unable to provide a sufficient response, an response center was established on March 30. The center had a total of six staff (initially three staff), of which one staff member could respond in English. As with the incoming call center, a manual and some templates for an response were prepared to provide a standardized operation. c. Response to inquiries outside the call center Furthermore, because it was too much to respond to so many telephone inquiries with the internal incoming call center mentioned above, an external toll-free hotline call center was established on April 27 to enhance the response for incoming calls. In the external call center, a total of 15 staff (five staff to respond the incoming calls) worked on a combination of four patterns of shifts on weekdays, 09:00-13:00, 09:00-18:00, 13:00-19:00 and 09:00-19:00, and a shift of 09:00-17:30 on holidays to provide a sevendays-a-week response service. This external call center received a total of 42,729 inquiries about Gienkin and other disaster relief and recovery operations provided by JRCS. Regarding the contents of inquiries about Gienkin, a Chapter 9 Gienkin (Cash grant scheme) Great East Japan Earthquake and Tsunami 225

253 Great East Japan Earthquake and Tsunami Chapter 9 request for a receipt was the most frequent inquiry. In addition, during the period of tax returns from February through March, 2012, as there were many inquiries about tax deductions, the number of inquiries about Gienkin temporarily increased. Among the calls received at the incoming call center, there were not only inquiries or complaints, but also many messages of encouragement to the affected people and for the activities of JRCS. The number of telephone responses above includes such messages of encouragement. Figure 9-8 Number of telephone responses at the external call center 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1, ,158 7,587 6,760 Number of calls received 5,676 Cumulative number of calls received 3,299 2,456 2,211 1,869 1,992 4,465 2,929 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 (Note) Regarding the contents of the inquiries, those about Gienkin and the household appliance packages donated to the affected people as a part of the recovery operation accounted for more than 40%, and particularly in July and August, inquiries about household appliance packages accounted for over half of the inquiries. checked it against the record of deposits received, and issued a receipt. As the record of deposits received through bank transfers or payment by credit card was compiled in a database, the request could be promptly checked against the record of deposits received based on the money transfer record (date, name and amount of the transfer) to enable the smooth issuance of receipts. On the other hand, regarding donations through postal transfer, registered mail or direct carrying-in to the office, the request was able to be checked against the record of deposits only after the organization of postal transfer forms, the preparation of a document necessary for money receiving operations (receipt record), and data entry of the necessary information or other clerical work, and it took much time and effort to check and prepare a receipt, resulting in delays in issuing the receipts. To streamline the organization of postal transfer forms and the preparation of the receipt record, a sorting center for postal transfer forms was established on March 22. Figure 9-9 Breakdown of the contents of the inquiries about Gienkin 4,000 Request for a receipt Inquiry about tax deductions Request for splitting a receipt Others 3,000 2,000 1,000 0 (2) Issuance of a receipt for Gienkin JRCS issued a receipt for Gienkin for those who wish it, and issued a total number of approximately 400,000 receipts by March 31, Regarding the issuance of a receipt, receiving a request for issuing a receipt from the donor through a phone call or the request form for issuing a receipt on the website, JRCS confirmed the money transfer record (date, name and amount of the transfer), [ View of the sorting center for postal transfer forms (meeting room 302 of the Headquarters) ] In addition, a data input center was established on April 6 to begin data entry for the sorted postal transfer forms. With these improvements in the operational system, the dispatch of receipts could start on April 14. Figure 9-10 Cumulative total of receipt issuances Figure omitted The improvements in the operational system mentioned above made it possible to prepare most receipts issued as a routine operation, but there were quite a few cases requiring irregular responses. 226

254 For example, when the issuance of split receipts or a receipt in English was requested, appropriate individual attention was required. From May 13, the response to such requests for irregular receipt issuance started. However, as the work was initially divided among the staff involved in the operation of issuing receipts and no systematic response was established, the operational burden increased. Then on August 29, a receipt center was established and personnel dedicated to responding to irregular cases were deployed in order to systematically handle such cases. (3) Receiving and totaling of the Gienkin a. Confirmation of deposits Just after the occurrence of the disaster on March 14, 2011, a dedicated account for receipt of Gienkin was opened and the collection of Gienkin was initiated. During a half year from the occurrence of the disaster until the end of September, huge sums of Gienkin were donated not only in Japan, but also from overseas, reaching approximately billion yen, equivalent to some 90% of the approximately billion that was collected by March 31, In such situations, the number of deposits received in a day was extremely large (approximately 12,000 deposits per day on average), and as it exceeded the upper limit of using internet banking, the deposits could not be confirmed. In addition, after updating the account book, the book immediately became full again, and it was not appropriate as a means for the confirmation of deposits. Furthermore, with the system down in some banks, situations in which the collected amount of Gienkin could not be confirmed continued for approximately 2 weeks after the occurrence of the disaster. To resolve these problems and ensure confirmation of the deposits, JRCS asked banks that could not confirm the deposit in the ordinary way to send a regular report in the form of data every day. Moreover, regarding the money received from overseas through bank accounts, it was not automatically credited to the bank account like a domestic transfer, but it was necessary to confirm whether the money could be credited in the JRCS bank account through internet banking. Therefore, only after JRCS staff had confirmed the contents of the deposit one by one, determined that the contents were appropriate as a deposit addressed to JRCS, and followed the procedures to allow the deposit to be entered in a due account through internet banking, was the money credited to the JRCS account. Due to the extremely large amount of Gienkin donated from overseas immediately after the disaster and if the details of the deposits had to be confirmed one by one for the account with a large number of deposits, the depositing procedures would be delayed, thus an exceptional measure was taken whereby the procedures to allow it to be entered in a due account through internet banking. Among the transfer money actually received, there were cases where a bank account other than for Gienkin was designated as the beneficiary, although it has a clear notification of use for Gienkin, or only the bank name was designated as the beneficiary. As there were many cases in which the banks could not make a clear decision on going through the depositing procedure, JRCS continued to receive inquiries almost every day from the banks for about 3 months after the disaster. In such cases, JRCS went through the procedure in tandem with the banks. Regarding deposits by credit card, as it was difficult to specify the category between Gienkin and a donation, or requests for the cancellation/correction of a transfer or a refund were made by the donors, deposits by credit card were the greatest cause of delays in specifying the collected amount of Gienkin. b. Collection of Gienkin in cash (including in foreign currency and cash sent by registered mail) There were many donors who directly brought cash to the Headquarters or sent cash by registered mail. To immediately deposit the collected cash in the bank account, a Cash Center, where the confirmation operation of the amount and denomination of the cash was outsourced, was established from March 24 through the end of September In addition, a system that allowed for the immediate delivery of the confirmed cash to the banks was established by asking the persons from the banks to come to the Headquarters every day until mid-august, five months after the occurrence of the disaster. However, it took a long time to handle cash since some foreign currencies were not accepted by the banks or some coins were so dirty that the banks refused to receive them and the JRCS staff consequently cleaned them and brought them again to be deposited in the bank account. Chapter 9 Gienkin (Cash grant scheme) Great East Japan Earthquake and Tsunami 227

255 Great East Japan Earthquake and Tsunami Chapter 9 d. Operation of adding up the collected Gienkin As JRCS received a huge amount of Gienkin from home and abroad, considering it needed to immediately announce the received amount even as an approximate calculation, JRCS announced the total sum of the received amount of Gienkin in the form of a daily report by adding up the amount deposited in the major accounts dedicated to receiving Gienkin. [Cash Center established on 7F of the Headquarters] c. Reception of foreign checks Regarding foreign checks, it sometimes takes at least one month from its reception to check encashment, or some received checks are dishonored. Therefore, because the amount received cannot be finalized until its actual encashment, and moreover, a handling fee is charged even if a check is dishonored, JRCS generally makes it a rule not to accept foreign checks. However, actually foreign checks were continually mailed to JRCS, and a total of 1,085 foreign checks, which was approximately 90% of the total of the 1,161 checks received as of March 31, 2013, were received during a half year from the occurrence of the disaster through to the end of September. These contributed to the delay in the finalization of the amount received. For this reason, until the end of October, seven months after the occurrence of the disaster, one temporary staff member dedicated to the operations related to the encashment procedures for foreign checks was deployed. 6. Public relations activities and public opinion related to Gienkin (1) Public relations activities a. Public relations activities via the website JRCS disseminated information on its website to make the public aware of the status of Gienkin collection as well as the JRCS collecting activities. Regarding the status of the Gienkin collection, the number of donors and the total amount were announced on the website and updated every day. In addition, JRCS explained that the total sum of Gienkin would be distributed to the affected people and tried to make information clearly with a newly prepared website page showing the specific flows of Gienkin. Furthermore, after the establishment of the Committee to decide on the ratio for the fair distribution of Gienkin, a press release was issued and posted on the website whenever Gienkin was sent to each prefecture. At the same time, to report the activity status of JRCS and to smoothly respond to various questions, banners for Activity report, Gienkin and Activity funds were set up on the home page of the JRCS Figure 9-11 Difference between Gienkin, overseas donations and membership fees Flow of Gienkin and Overseas donations in the GEJET Donation from overseas Gienkin Overseas relief funds Activity funds Individuals and corporations at home and overseas Red Cross and Red Crescent societies throughout the world Donations, etc. Membership fee Donation From the employees (members) in Japan JRCS Central Community Chest ofjapan and other Gienkin collecting organizations. Gienkin distribution committee affected people Established in each affected Prefecture The Gienkin will be transferred in full in cash to the affected people of the disaster via the Gienkin distribution committee. Support projects provided by the Red Cross Society Flow of the Red Cross Society activity funds Disaster relief activities, etc. Humanitarian activities of JRCS Affected Municipalities The funds will be used for livelihood support for the affected people including the distribution of electrical household appliances. * When a disaster occurs abroad, overseas donations collected in Japan are transferred to the Red Cross and Red Crescent Societies in the affected country via JRCS. In the case of the 2010 Haiti Earthquake, approximately 2.1 billion yen of overseas donations were used for emergency relief and recovery operations in Haiti. The funds will be used for medical support, psychosocial support and the distribution of relief goods including blankets at the time of a disaster, for the promotion of emergency aid seminars and for the nurturing of volunteers and Red Cross Youth in times when there are no disasters to deal with. 228

256 website and the toll-free number for inquiries was also clearly shown. Figure 9-12 Screen of the Status of Gienkin collection and distribution on the website of the JRCS headquarters Figure omitted b. Newspaper advertisements JRCS ran newspaper advertisements to show its appreciation for cooperation on the Gienkin and to ask for continuous support for the affected areas. Regarding the campaign of newspaper advertisements in May 2011 as a part of an activity month for JRCS, the contents of the Appeal for activity funds that had been scheduled was changed to an Appeal for Gienkin i n order to ask for cooperation on Gienkin collection. A newspaper advertisement with Ms. Norika Fujiwara, an actress, the Red Cross public-relations ambassador, in a JRCS rescue uniform at the center surrounded not by entertainers but by JRCS staff was placed in the morning edition of the Nikkei shimbun (newspaper) dated May 1, In addition, on May 2 and 3, acknowledgement of Gienkin was also placed in the Nikkei shimbun along with articles including an interview with the President of JRCS and an introduction to JRCS activities. In addition, other newspaper advertisements about Gienkin were placed in four national newspapers. Furthermore, certain other newspaper advertisements were placed in national newspapers, block newspapers, and the most widely-circulated local newspapers in each prefecture dated September 11, 2011, March 11 and September 11, 2012 in order to fulfill accountability about the Gienkin by explaining to the public about its status of money transfer to the affected prefectures and the status of the activities of JRCS in the affected areas. (Regarding the newspaper advertisements, details were described in Chapter 11 Public Relations Activities.) c. Television coverage With regard to Gienkin, JRCS was interviewed directly or by telephone for various TV channels. At first, as there were many critical TV reports about the situation of the delayed distribution of Gienkin to the affected people the JRCS Call Center received a number of complaints each time such reports were broadcast on television. Then, as the system of Gienkin became widely known to the public, there was an increase in TV coverage explaining that the reason for the delayed distribution of Gienkin was the loss of administrative functions of the governments of affected area. (2) Misunderstandings about JRCS s activities a. Misunderstandings about JRCS s activities The JRCS activities in relation to Gienkin collection were generally not well understood and there were many cases of criticism based on such misunderstandings. Specifically, in the June 2 issue of the weekly magazine Shukan Shincho (released on May 26), an article with the title The affected people are crying! Negligence of JRCS who have not distributed 130 billion yen of Gienkin appeared, and a misleading report was made that the delayed distribution of Gienkin to the affected areas was due to the negligence of JRCS. Regarding this matter, JRCS sent a letter of protest dated May 27 to SHINCHOSHA Publishing Co., Ltd., which expressed sincere regrets, stating that the article was written without verifying the actual situation of JRCS activity from the occurrence of the disaster until today nor considering the situation of the affected local governments, and its contents were based on misinterpretation of the facts, resulting in slander and abuse against JRCS and damage to confidence in the JRCS. This letter of protest was also posted on the website. Figure 9-13 Letter of protest posted on the website of the JRCS headquarters Figure omitted As the situation in which Gienkin had hardly reach the affected people continued, false information that JRCS charges 20-30% of the amount of Gienkin as a handling fee was disseminated through TV coverage or SNSs which caused a further dissemination of the false information by means of communications media even by the intellectuals who had received such information. In the September 1, 2012, edition of JRCS News issued every month by JRCS, an opinion survey 2 was (2) People who were surveyed: affected people who received Gienkin from the local government Attributes of the targeted respondents: Men and women in their 20s to 50s who live in the three affected prefectures Number of people surveyed: 309 (232 in MIYAGI, 61 in FUKUSHIMA, 15 in IWATE) Period of the survey: February 17-18, 2012 Survey organization: Dents Public Relations Inc. Method of the survey: Internet survey Great East Japan Earthquake and Tsunami Chapter 9 Gienkin (Cash grant scheme) 229

257 Great East Japan Earthquake and Tsunami Chapter 9 conducted of the affected people who had received Gienkin, and the following results were obtained. According to the survey, more than 70% of the respondents answered that they had not known that JRCS and other Gienkin collecting organizations had sent the money without taking any handling fees, and it was revealed that the activities of JRCS were not fully known. b. Response to the misunderstandings related to JRCS activities As it is considered that such misunderstandings were partly due to the various kinds of donations collected by JRCS, including Gienkin, Overseas donations and Activity funds, JRCS tried its best to simply explain about each type of donation. On April 28, 2011, an article entitled [Differences between Gienkin, Overseas donations and Activity funds ] was posted on the website to make information on the differences in the use of three type of contribution known. On June 14, an article entitled To transfer Gienkin to the affected people as soon as possible, with the contents of the reason why the distribution of Gienkin was delayed and of the situation of how JRCS handled the Gienkin, was posted on the website in order to give a better understanding of JRCS activities. In addition, on July 13, JRCS prepared a leaflet entitled 100% of Gienkin will be sent to the affected areas and distributed it to the chapters, facilities and collaborators, and on the same day, it was also posted on the JRCS website. For the individuals who sent out false information, JRCS sent a letter stating that the information was wrong, however, it was a fact that no effective action was taken with regard to the SNSs. 7. Discussion about the future methods of handling Gienkin (1) Review of the Basic Disaster Management Plan Following the GEJET, the Basic Disaster Management Plan was partially amended in the meetings of the Central Disaster Management Council held in December 2011 and September Regarding the reception of Gienkin, it had only been described that the local government together with the Gienkin collecting organizations should organize Gienkin Distribution Committee and determine the use of Gienkin after thorough discussions in the Basic Disaster Management Plan at the time of the disaster, but after reviewing in the Central Disaster Management Council twice, it was amended and it is now stipulated that the local government together with the Gienkin collecting organizations should organize and Gienkin Distribution Committee, and determine the use of Gienkin after thorough discussions. In this regard, the local government should try to ensure the prompt distribution of Gienkin by determining in advance the basic distribution method. In addition, in the case of a widespread disaster with damage occurring in multiple prefectures, JRCS Figure 9-14 Results of the opinion survey of the affected people regarding Gienkin Approximately half immediately used the funds for daily living expenses and the repair of their houses Did you immediately use the Gienkin received? (only one answer) Don t know 2.3% Others 6.8% Used only a little 44.7% Use of Gienkin Immediately used most of the Gienkin 22.7% Immediately used about half of the Gienkin 23.6% The proportion of households who immediately used and those used only little was almost equal, and this was almost the same even if there was the presence or absence of damage, or where there was a difference in its degree. The immediately used amount was mostly to contribute to daily living expense and repair costs for housing. Three out of four people surveyed did not know that JRCS distributes the full amount of the Gienkin to the affected people JRCS and other Gienkin collecting organizations distribute the full amount of the Gienkin to the local governments without taking any handling fee, but when this question was asked in the survey, more than 70% of respondents answered that they didn t know. In particular, more than 80% of the affected people in their 20s answered that they didn t know JRCS and other Gienkin collecting organizations distribute the full amount of the Gienkin to the local governments without taking any handling fee. Did you know this? I didn t know it. 74.1% I knew it. 25.9% Free opinions from the respondents Please continue your activities for those who are in constrained circumstances. I was really grateful to be able to provide household appliance packages to the people in temporary housing. As there are many people who don t understand the activities of JRCS, it would be important to frequently provide correct information. Source: JRCS News, September 1, 2012 edition 230

258 and other Gienkin collecting organizations should determine in advance the basic concept of the Gienkin collection method and its distribution criteria as they are required to promptly distribute the donated Gienkin to the local governments. (2) Submission of a request paper to MHLW from JRCS As mentioned above, JRCS received various opinions and criticisms regarding the handling of Gienkin for the GEJET. It is considered that there are various reasons contributing to the delayed distribution of Gienkin including: (1) the existing system of handling Gienkin could not always fully respond to a large-scale widespread disaster, (2) many local governments were affected and lost their administrative functions, (3) there was a lack of common understanding regarding the handling of Gienkin not only among the citizens, but also among the national and local governments as well as the Gienkin collecting organizations. As JRCS could not solve these problems by itself, JRCS discussed with the Central Community Chest of Japan and NHK, who worked together collecting Gienkin, and summarized the results and submitted them to the MHLW as a document on Discussion about the handling of Gienkin (request) dated March 22, The outline of the request paper is shown in Figure Figure 9-15 Outline of the request paper submitted to the MHLW 1. Executive summary Behind the background to the delayed distribution of Gienkin to the affected people, there is a question as to whether a common understanding regarding the Gienkin existed among the relevant parties. Applying the lessons of this time, in case that a similar large-scale disaster occurs, it is necessary to establish a system for the distribution of Gienkin as soon as possible. To this end, it is also necessary for governments and the relevant parties to get together to hold discussions to prepare for the future. To achieve the purpose, the relevant parties should share a common understanding about Gienkin and discuss the following: a. Effective innovative ways for the fair and prompt distribution of Gienkin. b. Specific criteria for the distribution of Gienkin. c. Public relations methods and the disclosure of information. d. Issue of costs related to the administration of Gienkin collection. 2. Specific items to be studied Problems recognized as a result of the handling of Gienkin this time and the direction to be taken for improvement (1) Necessity to have a common understanding for Gienkin among the relevant parties It is necessary to hold appropriate meetings to discuss the fundamental items including the characteristics and positioning of Gienkin, to form a common understanding of Gienkin among the relevant parties. (2) Importance of establishing a certain legal status for Gienkin, and to ensure that the government and the private sector smoothly play their own roles When a large area of the country becomes damaged due to a disaster, it is necessary for the government agencies to organize a meeting to coordinate the overall handling of Gienkin for the targeted victims and the distribution criteria. It is desirable to clearly stipulate in the Basic Disaster Management Plan and the Disaster Relief Act the procedures concerning the handling of Gienkin, and the roles that the relevant ministries and agencies, local governments and private Gienkin collecting organizations should play. (3) Determination in advance to a certain degree the basic rules for Gienkin distribution It is desirable to roughly determine in advance the basic rules for Gienkin distribution (eligible persons, criteria for distribution ratio) (4) Need for innovative ideas on how to promptly distribute the Gienkin It is desirable to discuss facilitation of administrative work related to Gienkin distribution as well as to improve the operational procedures for its allocation. (5) Public relations and the disclosure of information concerning Gienkin (ensuring transparency) Further efforts and innovative ideas are required regarding public relations related to the system of Gienkin. In particular, it is necessary for the future to decide on how to disclose required information, including the amount of collection and the status of the transfer of Gienkin to the recipients based on a certain degree of common understanding among the relevant parties, considering the possibility of the need for close cooperation with financial institutions. (6) Other aspects In a situation in which various groups or organizations collected Gienkin other than JRCS, the Central Community Chest of Japan and NHK (including NHK Public Welfare Organization), it is necessary to discuss their eligibility as those organizations. In addition, as there is a significant administrative costs related to the handling of Gienkin, there should be a discussion on how to manage the administrative costs. Chapter 9 Gienkin (Cash grant scheme) Great East Japan Earthquake and Tsunami 231

259 Great East Japan Earthquake and Tsunami Chapter 9 (3) Discussions of Gienkin with the MHLW a. Report of the Office of After-care Service Promotion in the MHLW The MHLW verified its response to the GEJET and summarized the future countermeasures mainly by the Office of After-care Service Promotion in the MHLW (consisting of four research specialists from the private sector). For the preparation of the above report, a hearing with JRCS was conducted on April 4, In this hearing, the feedback on the results of hearings on Gienkin collection and other activities with municipalities conducted by the Office of After-care Service Promotion was provided. In addition, JRCS explained the details of the above document entitled Discussion on the handling of Gienkin (requests) and asked the MHLW what was wanted from the JRCS. The Office of After-care Service Promotion prepared a document entitled Response of the MHLW to the GEJET (report) in July 2012, based on the hearings with JRCS and other parties concerned. In the report, the following six topics were selected from the responses of the MHLW to the GEJET, and the major responses provided and problems, reflections and future countermeasures were summarized: (I) Response systems in the MHLW (cooperation system among the central ministries, their local agencies and local governments, response to the Nuclear Emergency Response Headquarters and local nuclear emergency response Headquarters, the state of public relations, etc.); (II) Securing medical doctors, nurses and other human resources requested by the affected areas; (III) Transfer of the aged, sick and disabled to shelters (including the large-scale transfer over the border of the evacuation zone and the area under an evacuation order due to the Fukushima Daiichi Nuclear Power Plant Accident), distribution of the necessary medical drugs and medical devices to the shelters; (IV) early distribution of Gienkin ; (V) Recovery of children and child-rearing including psychological care; (VI) Recovery of employment (verification of the results of the job creation funds project, etc.). Regarding Gienkin, the following were described as future countermeasures: When a similar largescale disaster occurs in the future, the MHLW will actively become involved in the distribution of Gienkin and support the Gienkin collecting organizations in order to ensure the earliest distribution of Gienkin to the affected people ; The MHLW asked that the Gienkin collecting organizations make clear and specify their responsibilities related to the collection and distribution of Gienkin, consult with the MHLW about ways to receive support from the Government of Japan (GoJ), and then to clearly define the results as regulations that they will establish for the handling of Gienkin ; The MHLW requested the Gienkin collecting organizations to determine in advance the collection methods and distribution rules for Gienkin ; The MHLW will actively support the Gienkin collecting organizations when they determine the collection methods and the distribution rules for the affected prefectures. b. Request from the MHLW to JRCS Based on the report summarized by the Office of Aftercare Service Promotion, the Chief of the Social Welfare and War Victims Relief Bureau of the MHLW sent notification of an appeal for the efforts to address the challenges related to Gienkin (request) to JRCS. The contents of the appeal requested by the MHLW are shown in the Figure Figure 9-16 Appeal for the efforts to address the challenges related to Gienkin (request) Thank you for your disaster recovery assistance at the time of the earthquake disasters. Regarding the distribution of Gienkin in GEJET, we understand that we have received various opinions from people in many fields and recognize the many challenges. The MHLW has summarized the responses to the GEJET and future countermeasures in the Office of After-care Service Promotion Consisting of experts from the private sector (July 20). In this report, we have verified the challenges related to Gienkin through the opinions of JRCS and other Gienkin collecting organizations and the prefectures as well as through the hearings, and have proposed the countermeasures shown in the attached document. In addition, a similar proposal was submitted as a final report of the committee for policy planning on disaster management of the Central Disaster Management Council (July 31). In this regard, based on the above discussions, we would like to ask you to take the following countermeasures. We are willing to support your discussions on these matters. (Responses of the MHLW to the GEJET (extract)) 1 Make clear and specify the JRCS s responsibilities related to the collection and distribution of Gienkin, 232

260 consult with the MHLW about ways to support the GoJ, and then clearly define the results in regulations for handling Gienkin that you will establish. 2 Determine in advance the collection methods and distribution rules for Gienkin in order to ensure the early distribution of it to local governments in the case of a broader disaster. In this regard, pay attention to the following points: (i) For the Gienkin collection, discuss the methods to ensure that the intentions of the donors are well reflected in the result; (ii) Discuss a highly transparent system for Gienkin collection including the certification that you are entrusted with Gienkin and the provision of information about the status of Gienkin distribution; (iii) Determine in advance some rules around Gienkin with the prefectures; and (iv) Discuss the administrative costs that you and the local governments should bear. c. Response of JRCS to the reguest As a reply to the request of the MHLW, JRCS submitted to the Social Welfare and War Victims Relief Bureau of the MHLW a document entitled Basic policy on the handling of Gienkin. JRCS s basic policy on Gienkin handling is shown in Figure Figure 9-17 Basic policy on handling Gienkin (1) Regarding the basic framework for the flow from Gienkin collection and reception to its distribution it would be appropriate to be based on a system that has been employed before. (2) Therefore, particularly when a disaster affects large areas with widespread damage, it would be desirable that JRCS, the Central Community Chest of Japan and other Gienkin collecting organizations should determine in advance the rules concerning the criteria for Gienkin distribution to the prefectures and arrive at an agreement among these organizations in order to ensure that the relevant parties can promptly initiate the operations of Gienkin distribution. (3) However, considering the public nature and role of Gienkin, its distribution cannot be determined by the Gienkin collecting organizations alone, but it is necessary for the national and local governments, the Gienkin collecting organizations and other parties concerned to have discussions and arrive at an agreement based on a common understanding. Based on the fundamental policy mentioned above, JRCS organized an Opinion exchange meeting on the handling of Gienkin at the time of a large-scale widespread disaster with the cooperation of the National Governors Association. The first meeting was held on November 21, 2012, and the second meeting on December 26, The local governments (Iwate, Tokyo, Niigata, Shizuoka, Hyogo and the Secretariat of the National Governors Association), the MHLW, and the Gienkin collecting organizations (JRCS, Central Community Chest of Japan, and NHK) participated in these meetings and exchanged opinions on the handling of Gienkin. Based on the opinions expressed in these meetings, JRCS verified and analyzed the handling of Gienkin in the GEJET, and then, based on the lessons obtained from the results, prepared a report entitled Challenges and future directions in Gienkin collection for disasters (report) - based on the verification and general overview of the GEJET - which summarized the future challenges and directions. This report was posted on the website of the Headquarter and submitted to the MHLW, Cabinet Office, National Governors Association, Japan Association of City Mayors, and National Association of Towns & Villages. It was also distributed to each prefecture through the Secretariat of the National Governors Association. JRCS will try to disseminate the contents of it and encourage continuous discussions on this matter among the relevant parties, including the national and local governments as well as the Gienkin collecting organizations. Challenges and future directions for Gienkin collection in the event of disasters (report) - Based on the verification and general overview of the GEJET Executive summary Introduction JRCS, the Central Community Chest of Japan and NHK initiated the reception of Gienkin on March 14, 2011, and the number of it rose to more than 3.2 million and the amount reached billion yen by the end of December Of these, JRCS received Gienkin from 2.88 million donors and the total amounted to more than three times the amount collected in the Great Hanshin-Awaji Earthquake. Regarding the handling of Gienkin, various discussions were held and opinions offered, while many words of appreciation were sent from the affected people. Because it is a natural obligation for JRCS as an organization entrusted with the handling of Gienkin to Chapter 9 Gienkin (Cash grant scheme) Great East Japan Earthquake and Tsunami 233

261 Great East Japan Earthquake and Tsunami Chapter 9 make efforts to ensure the prompt and effective use of Gienkin, JRCS verified and analyzed its handling of Gienkin in the GEJET, and then summarized the future challenges and directions based on the results. With the assistance of the MHLW and the National Governors Association, JRCS listened to the opinions of the prefectural governments of Iwate, Tokyo, Niigata, Shizuoka, and Hyogo as well as the Gienkin collecting organizations (Central Community Chest of Japan, NHK), and prepared this report. JRCS wishes to continue further discussions among a broader range of parties concerned with the future of this issue. I. Handling of Gienkin in the GEJET In the GEJET, because the disaster affected a very wide area and coincided with the Nuclear Power Plant Accident, coordination of the handling of Gienkin was essential. JRCS asked the GoJ to coordinate through a central meeting with the relevant parties, and it was decided that the MHLW would play the coordination role as the secretariat. On April 8, the first meeting of the Committee to decide on the ratio for the fair distribution of Gienkin was held and the criteria for primary distribution was determined. Following this decision, JRCS and other Gienkin collecting organizations transferred Gienkin to the affected prefectures on April 13, but this had already taken about a month after the occurrence of the disaster. Subsequently, it took a considerable number of days for the transfer of it from the affected prefectures to the municipalities, then to the affected people via the municipalities, resulting in a situation in which various opinions and criticisms were directed at the JRCS and other Gienkin collecting organizations. JRCS had conducted reviews of its handling of Gienkin based on the experience of the Great Hanshin-Awaji Earthquake, but the GEJET was on a much larger scale and was a more widespread disaster than the Great Hanshin-Awaji Earthquake, and the system of Gienkin distribution at that time had not imagined such a devastating disaster. The fact that many of the local governments were seriously affected, there were a huge number of affected people and the activities of rescue and relief operations immediately after the disaster took the top priority and made it very difficult to follow the established procedures for Gienkin distribution. Various ideas and opinions about essential questions such as what is Gienkin and how to consider the nature and position of Gienkin among the citizens, who are the donors to Gienkin, as well as the personnel of the GoJ, local government and Gienkin collecting organizations became an obstacle to responding adequately to the requests for prompt processing of the procedures in an emergency. II. JRCS s fundamental policy for handling Gienkin The basic characteristic of Gienkin itself is that it is not a public fund, however as the overall system of Gienkin from the collection to transfer and distribution has a strong public nature and role, it is understood that Gienkin should primarily be distributed to the affected people in the form of cash benefits. Regarding Gienkin, there are few specific legal regulations due to its nature as a goodwill donation and only a partial description is indicated in the Basic Disaster Management Plan. However, the GoJ, local government and Gienkin collecting organizations are required to share a common understanding and recognition, work in close coordination, and each play their appropriate role, regardless of the existence of any regulations. It is desirable to respect as far as possible the intentions of the donors, but it is impossible to individually confirm the intensions of each donor at the stage of receiving Gienkin. Thus, methods and procedures for receiving donations should be established separately for relief activities and recovery operations apart from those for Gienkin. In addition, requests for money transfers to specific local governments should be handled through the procedures mentioned above. JRCS considers that it is most important for each organization and group operating as part of the system of Gienkin collection to share a basic recognition and prepare in advance the necessary system and policy for responses during times when no disasters are expected. Regarding the handling of Gienkin, the three principles of promptness, transparency and fairness are the most important and should be respected to the extent possible. The basic framework on Gienkin handling should be the same as the conventional one, in which the Gienkin collecting organizations collect Gienkin and transfer it to the affected prefectures (Gienkin Distribution Committees), the Committees determine the criteria for its distribution and then the Municipalities 234

262 distribute it to the affected people. The target areas of Gienkin transfer (distribution) should in principle be the prefectures in which the municipalities subject to the Disaster Relief Act are located, but when the damage affects larger areas and is more widespread, the prefectures in which municipalities affected by the same disaster are located should be included regardless of the application of the Disaster Relief Act. It is necessary to establish a Gienkin Distribution Committee in the affected prefectures, but if it is difficult to establish such a committee at the early stages due to the large and broad scale of the disaster, it could be considered that the Gienkin collecting organizations should promptly collect Gienkin and transfer it to the affected prefectures based on their independent judgment. The Gienkin collecting organizations should determine the criteria for the prompt transfer of Gienkin to the Gienkin Distribution Committees in the affected prefectures, divide it proportionally based on these criteria, and transfer it to the distribution committees or the affected prefectures. It is the role of Gienkin Distribution Committees in the affected prefectures to determine the specific criteria for Gienkin distribution to the affected people, but it is desirable to establish a certain policy for Gienkin and share it as a form of guidance or guidelines. As various kinds of coordination are required in a larger and broader disaster, it is desirable to establish in advance a system whereby a meeting consisting of intellectuals, local government officials and representatives of the Gienkin collecting organizations is organized to assess the issues related to Gienkin, to make any necessary adjustments and promptly coordinate the response at the request of the relevant parties. Across-the-board distribution of Gienkin, the utilization of the Livelihood Welfare Fund Loan System, the necessity of coordination with the relief fund system under the Act on Support for Reconstructing the Livelihood of affected people, relationships between the disaster condolence grant system and other systems should be discussed. Since Gienkin collecting organizations bear the responsibility for reflecting as many opinions of the donors of Gienkin and other citizens as possible in its distribution and to appropriately report on the status and results of Gienkin distribution, it is important for the representatives of the Gienkin collecting organizations to participate in the Gienkin Distribution Committees as members of such committees. It is also necessary to discuss a backup for the Basic Resident Registration and other basic data, streamlining of the issuance procedures for issuing the Disaster Victim Certificate, improvement of the Gienkin processing system, as well as gaining the cooperation of general and life insurance companies, and the possibility and availability of the support and cooperation of volunteers from the viewpoint of support for Gienkin processing in the municipalities. As the Gienkin collecting organizations bear a significant amount of the administration and other miscellaneous costs related to Gienkin handling, this should be a future issue to be considered in the overall discussions. The Gienkin collecting organizations also bear the responsibility for appropriately reporting on the status of Gienkin collection and its distribution to the Gienkin donors and other citizens and should obtain their understanding. JRCS tried to appropriately manage operations related to the handling of Gienkin by establishing a call center, improving the system for Gienkin collection and management, establishing a sorting center for postal transfer forms, improving the deposit operation system for cash donations, improving the responses to s and donations through overseas credit cards, and establishing a cash receipt center. JRCS also made efforts to post information on its website, disseminate information to domestic and overseas media, and provide periodic announcements through newspapers and other media. These operations were conducted by temporary staff numbering more than 100 people at the peak time, volunteers, and support staff from the International Red Cross in addition to regular JRCS staff. Regarding the system of Gienkin, the role of collecting organization and the Gienkin distribution committees established by the affected prefectures and municipalities, the status of Gienkin collection, the criteria for Gienkin distribution, and provision of information regarding the status of Gienkin distribution, it is necessary for the GoJ, local government and Gienkin collecting organizations to work together to determine in advance the details and terms when there is no expected disaster or at the onset of a disaster. It is essential for the Gienkin collecting organizations to be subject to a rigorous audit by a third party Chapter 9 Gienkin (Cash grant scheme) Great East Japan Earthquake and Tsunami 235

263 Great East Japan Earthquake and Tsunami Chapter 9 concerning the provision of the necessary information related to the appropriate management and transfer of Gienkin as well its collection and distribution, and to disclose information on the results in order to ensure accountability. JRCS was subject to an audit on its handling of Gienkin based on the International Standards on Auditing and has made the results available to the public on its website and through the newspapers. JRCS has tried to response promptly to request for the inquiries from donors and the issuance of receipts by proceeding with data entry for the Gienkin received (approximately 2.88 million cases), while JRCS has promoted the improvement of the system to manage information related to Gienkin and developed a system of uniform management through adoption of functions by which donors can confirm the actual performance of their donations by themselves. In addition, to facilitate Gienkin donations, JRCS will work on constructing a cooperative framework with financial institutions for the establishment of a Gienkin collection system with its reception points nationally unified as well as the provision of its transfer data. Furthermore, in cooperation with GoJ and local government, JRCS intends to enhance the system of public relations concerning Gienkin handled by JRCS. 236

264 Chapter 10 Relationship with the International Red Cross and Red Crescent Movement

265 Great East Japan Earthquake and Tsunami Chapter 10 Chapter10 Relationship with the International Red Cross and Red Crescent Movement 1. Liaison/coordination with the International Federation of Red Cross and Red Crescent Societies (IFRC), the International Committee of the Red Cross (ICRC) and the National Red Cross and Red Crescent Society (NS) etc., in the initial response (1) Relationship between the Japanese Red Cross Society (JRCS) and the IFRC before the disaster In order to comply with its international obligations as a member of the International Red Cross and Red Crescent Movement (RCRC), the JRCS has actively conducted the international relief activities overseas, putting its medical activities at the center. The JRCS has expanded its active areas around the world including India, Iran, Indonesia, Zimbabwe, and Haiti since On the other hand, the JRCS has been preparing for various earthquakes that may be expected to occur in many areas in Japan. For example, the contingency plan for earthquake in Tokai area (prepared in 2010) demonstrates the response policy regarding the relationship with the IFRC and the NS as follows. Figure 10-1 Contingency Plan earthquake in Tokai area (2010) (Excerpt) Possibly necessary supports The JRCS shall accept donations from overseas, but not be specific about the way the money is spent in principle. The JRCS shall accept IFRC representatives where necessary to ensure close coordination with the RCRC The JRCS shall accept reporting staff from the IFRC where necessary to inform the RCRC of the information on the general situation of the disaster, the JRCS relief activities, and other matters. The JRCS shall accept media relations staff from the IFRC where necessary to respond to requests for interviews by major media around the world. The JRCS shall accept tracing request from the ICRC where necessary to identify the needs for tracing services of foreign nationals in the affected areas, as well as facilitate the development and practice of a safety confirmation plan. As for dispatch of staff other than from the IFRC, the JRCS shall accept only those that are coordinated by the IFRC in principle. Unnecessary support, etc. The JRCS shall not require Field Assessment Coordination Teams (FACT). The JRCS shall not require goods support in principle. JRCS shall not issue/launch the emergency appeal. Relationship with the IFRC The JRCS shall indicate necessary support and unnecessary support to IFRC as soon as possible after the natural disaster. In addition, the JRCS shall post its own role in the disaster response and the situation of disaster response conducted by the JRCS and administrations, and others on the Disaster Management Information System (DMIS) website, contributing to the Information Bulletins that the IFRC announces. The JRCS disaster response plan was shared with the IFRC many years ago. The JRCS just held a drill by the JRCS Headquarters in 2009 and confirm its effectiveness and asked staff who is of public relations sector of IFRC to participate in it. And the JRCS International Department was preparing for a conference held in Tokyo in April 2011, in response to the IFRC s request to discuss the possible role of the IFRC for a large-scale disaster in Japan. Eventually, the Great East Japan Earthquake and Tsunami (GEJET) occurred immediately before the planned conference, so it could not be carried out. Although the scale of the GEJET was far more than the disaster that was simulated in the contingency plan for earthquake in Tokai area, multiple evidences and records from the related persons or the IFRC reveal that the JRCS acted in accordance with the plan just immediately after the disaster. (2) Liaison/coordination with the IFRC, ICRC and NS after the disaster a. Action from immediately after the disaster of March 11 to the morning of March 12 At 14:46 on March 11 the disaster occurred. Immediately after the disaster, the International Department at the JRCS Headquarters started activities for liaison, coordination, and information sharing, positioning the International Relief Division as a key player. <March 11> At 15:00, the Director of the International Relief Division called the manager of the IFRC Asia Pacific Zone Office (AP Zone) in Kuala Lumpur, Malaysia. At the same time, the JRCS posted the first information on the DMIS website of the IFRC. (This website provided information access for the Red Cross officials throughout the world.) 238

266 At this stage, the JRCS responded negative to the IFRC s question asking, whether or not it would conduct Appeal Requests for relief activities. At 16:00, the JRCS requested the AP Zone to dispatch staff members to handle the overseas media relations. At 17:00, the JRCS posted on the DMIS for the second time. It noted again that it was not requesting international supports (donations, relief goods, and manpower) at this stage. At 19:15, the JRCS posted on the DMIS for the third time. At 20:56, the AP Zone informed the JRCS of the dispatch of Mr. Patrick Fuller, Communication Manager, Asia Pacific, to Japan in a day. At 23:39, the JRCS posted on the DMIS for the fourth time. <March 12> At 02:02, the Director of the International Relief Division contacted the AP Zone. The content was as follows. The JRCS was ready to accept the support by a liaison team as an IFRC team consisting of representatives of the Participating in National Red Cross and Red Crescent Societies (PNS). The JRCS requested that the team would be consisted of around six staff members including representatives of the IFRC and PNS. The JRCS asked the IFRC to determine the members by liaison/coordination with the PNS. At 4:00, the JRCS posted on the DMIS for the fifth time. At this stage, it noted that the JRCS do not require international supports, but will accept donations from the NS. (At 23:33, March 11, there was an internal notice to announce the opening of a donation account for overseas; Sumitomo Mitsui Banking Corporation, Ginza Branch, no , savings account.) Although the full picture of the disaster situation was uncertain immediately after disaster, the JRCS tried to share the information by closely contacting with the IFRC and convey its position clearly at the time. In the meantime, the JRCS International Department was inundated with telephone calls from the NS around the world. Most of them were inquiries asking whether the JRCS could accept the dispatched staff or relief goods. The staff of the International Department corresponded to one by one, conveyed the policy of the JRCS at the time, and asked for understanding of those countries. b. Acceptance of a High Level Mission Team (Investigation Team) from the IFRC Immediately after the disaster, an ever-increasing number of offers of assistance from the NS around the world came one after another. Behind this, people in various countries, who were shock by the terrible pictures of the disaster through media and YouTube, placed their confidence and expectations on NS as the channel to support the affected people. To respond these expectations and carry out the mission as RCRC, the NS around the world had to support Japan in visible ways. In light of the position of the NS around the world, at 2:00, March 12, the day following the disaster, the JRCS announced to the AP Zone that it was ready to accept an Investigation Team aiming at only identifying the site situation, not conducting relief or medical activities on the site. As a result, the Investigation Team was developed; which was consisted of eight staff members. The members and schedule in detail were as follows. <Members of the Investigation Team> Mr. Martin Faller (Head of East Asia Regional Delegation, IFRC) Ms. Donna McSkimming (Head of International Programs, Australian Red Cross) Mr. Pat Laberge (Senior Manager, Asia Program, Canadian Red Cross Society) Mr. Ren Hao (Deputy Director-General, Department of External Liaison, Red Cross Society of China) Ms. Eunhee Cho (Deputy Head of International Relations Office, Republic of Korea National Red Cross) Mr. Torris Jaeger (Director of Internaitonal Disaster Management, Norwegian Red Cross) Mr. Hakki Ersoy (Head of Disaster Response Unit, Turkish Red Crescent Society) Ms. Nan Buzard (Senior Director of International Response & Programs, American Red Cross) *From the JRCS, three staff members of the International Department accompanied the Team. <Schedule> March 14 (Mon)-15 (Tue), 2011: Arrived in Japan March 15 (Tue): Had a briefing at the JRCS Headquarters March 16 (Wed): Left TOKYO Visited the Miyagi Chapter s Headquarters for Disaster Control (HDC) March 17 (Thu): Inspected affected areas and evacuation centers in KAMAISHI, OTSUCHI Left the affected areas, Arrived in TOKYO Relationship with the International Red Cross and Red Crescent Movement Chapter 10 Great East Japan Earthquake and Tsunami 239

267 Great East Japan Earthquake and Tsunami Chapter 10 March 18 (Fri): Had a briefing March 19 (Sat): Departed for their home countries [Mr. Bjorn Eder, an IFRC Representative in Japan] [The investigation team visited the Miyagi Chapter HDC in the Miyagi Prefectural Government Office] The investigation team compiled the results of their inspection findings and recommendations for future support activities and submitted it to HDC at the Headquarters. This report listed the support required for relief and early recovery that were specified through this investigation. The contents are described as follows. <Relief and Support> The distribution of relief goods, logistic support, support for the sanitation sector, tracing services, cash benefits, volunteers, expansion of the scale of the medical Domestic Emergency Response Unit (deru), psychosocial support, link between international support and domestic support, and support for families who accept evacuees. <Early recovery/medium-and long-term support > Temporary housings, medical care, education section, and support for vulnerable groups c. Acceptance of the IFRC representatives Immediately after the disaster, it was revealed that RCRC would provide a large amount of donations through a telephone conference or individual contact. When accepting international assistance, based on the Principles and Rules for Red Cross and Red Crescent Disaster Relief the IFRC representatives should monitor the donation. Therefore, the JRCS were to accept the IFRC representatives as representatives of donors. Mr. Martin Faller (March 13-24) Mr. Michael Annear (March 21-April 1) Mr. Bjorn Eder (the first week of April 2011-May 18, 2012, and October 1, Scheduled to be end of May 2013) d. Acceptance of other related officials of the IFRC and ICRC The ICRC dispatched many experts who specialized in tracing services and radiation hazards to Japan at the very early stage after the disaster. They provided advice to the JRCS and conducted activities coordinated by the JRCS. In addition, two staff members of the media relations visited Japan from March 26 to 31 from the Norwegian Red Cross and two also visited from April 5 to 10 from the Netherlands Red Cross to report the current situation of the affected areas. The Red Cross officials such as the IFRC and the ICRC who visited Japan within a month, from March 11 to April 8, are shown on Figure e. Providing information at the initial stage Since the day of the disaster occurred, the JRCS has provided the NS with a large amount of information on the disaster situations and the response the government and the JRCS conducted. As a first step, the JRCS shared the information with the NS by posting 21 times on the IFRC DMIS in English, based on prompt reports on disaster relief activities that were prepared by the JRCS Disaster Management and Social Welfare Department. Furthermore, it provided Information Bulletins five times in total (March, 11, 12, 15, 22 and 28) via the IFRC. The basic information was provided by the JRCS, prepared by the IFRC, and then uploaded on the IFRC website. Moreover, the JRCS conducted telephone conferences with the PNS in the supporting countries through the coordination of the IFRC. The conferences were held four times in total: the first conference was held at19:00, March 14 (Japan Standard Time) and in March 21, 29 and April 8. The first telephone conference was 240

268 Figure 10-2 The Red Cross officials such as the IFRC and the ICRC who visited Japan (March 11-April 8, 2011) ICRC IFRC/PNS Organization Name Official position/mission Length of stay IFRC Representatives in Japan PMER (Reporting) Persons in Charge of Media Persons in Charge of Logistics service Mr. Tobias Epprecht Head of Regional Delegation in Kuala Lumpur, ICRC Mar Mr. Craig Strathern Diplomatic Adviser, ICRC Mar Ms. Beatriz Meunier Protection Pool Manager, ICRC Head of Nuclear Radiation Mr. Gregor Malich Biochemistry Operational Response Project, ICRC Mr. Steve Donnelly Mr. Steffen Birrer Mr. Jaime Briz de Felipe Mr. Arthur Milimo Tumwa Mr. Jean-Marc Zbinden Technical Advisor of Nuclear Radiation Biochemistry Operational Response Project, ICRC Information and Communication Staff, ICRC Administrator staff, ICRC Date Processing Staff in Protection Division, ICRC Project Manager of Architect, ICRC Mar Mar Mar Mar Mar Mar Mar Ms. Mariko Harada Delegate, ICRC Mar Mr. Martin Faller Mr. Bjorn Eder Mr. Michael Annear Mr. Andy McElroy Mr. Tom Alcedo Mr. John Manley Mr. Patrick Fuller Head of East Asia Regional Delegation (Beijing), IFRC Representative in Japan, IFRC Head of Disaster Management Unit in Asia Pacific Zone, IFRC Head of South East Asia Regional Program Coordinator (Bangkok), IFRC American Red Cross American Red Cross Media Staff in Asia Pacific Regional Delegation, IFRC Mar The first week of April The first week of April 2011-May 18, 2012 Oct. 1, 2012-the scheduled end of May, 2013 Mar.21-Apr.1 Mar.23-Apr.4 Apr.4-the end of June Mar Mr. John Sparrow Media Relations Staff, IFRC Mar.27-Apr.23 Media Staff of East Asia Regional Mr. Francis Markus Mar Delegation (Beijing), IFRC Ms. Katherine Mueller Media Relations Staff, IFRC Mar.21-the first week of April Mr. David Horrobin Logistics Service Staff, IFRC Mar.20-Apr.3 Mr. Lines Hughes Logistics Service Staff, IFRC Mar.20-Apr.3 Relationship with the International Red Cross and Red Crescent Movement Chapter 10 Great East Japan Earthquake and Tsunami 241

269 Great East Japan Earthquake and Tsunami Chapter 10 conducted for 20 minutes. The JRCS explained the issues including the disaster situation, the response status of the government, Self Defense Forces (SDF) and local municipalities, etc., the response status of the JRCS, the policy on the acceptance of overseas support, the cooperation status with the IFRC and the ICRC, etc., several issues of current needs, and logistic service. And then a question and answer session was held with the PNS. Since March 29, in addition to this, the JRCS International Relief Division provided an Information Update. with NS by four times in total (March 29, April 4, 12, 22). On April 13, the first issue of the Operation Update (status reports of the activities by the JRCS) was posted on the JRCS website English version. Since then, it has been issued every three months in addition to Annual Reports, both comprised of narrative and financial reports f. Letter from the president to NS around the world On March 22, the JRCS president sent a letter as the President of the IFRC to NS around the world. This letter, entitled After Ten Days, described an outline of the disaster, the response conducted by the government and the JRCS, the international response activities including the acceptance of the High Level Mission Team. And at the end, it made a commitment that we feel a strong the spirit of Togetherness due to the sympathy, encouragement and offers of support to Japan from National Societies around the world and will make an all-out effort by maintaining this spirit. After Ten Days Tadateru Konoé On 11 March at 2:46PM a huge earthquake of magnitude 9.0 on the Richter scale struck off the coast of Sanriku (lat N, long E). The quake reached level 7 on the Japanese seismic scale, which is the highest level on the scale, in the most affected area. A Tsunami alert was immediately issued for the Pacific side of the whole Japanese archipelago. The first wave of the tsunami reached the Japanese coast within 30 minutes and swept its north-eastern coastline over an area extending for 500km. The height of the waves exceeded 15 meters in some areas. Tsunami waves repeatedly reached the Japanese coast several times afterwards. Large aftershocks are still continuing now, ten days later from the first hit, followed by a Tsunami alert in each time. The Northeastern coast of Japan has long been prone to Tsunamis and known for the most advanced preparedness for it in the world. Such preparedness includes solid and high banks, shelters for evacuation, warning systems and evacuation drills for the anticipated worst case scenario. What happened this time was far beyond the most extreme predictions. The first strike caused heavy and widespread damage to all kinds of infrastructure and basic services, including communication lines, transportation, electricity, water supply and sewage system. This damage is still impeding the relief activities from being fully operational even after ten days. Before we had grasped the overall consequences of the earthquake, the tsunami quickly swept many coastal cities and left them in ruins. It was so cruel that by the time the tsunami reached them, they had already lost contact with others because of the earthquake. Fire broke out in many areas, which added another burden for the affected people to cope with for another few days. Many of these affected cities are located in the deep recesses of an indented coastline with sheer cliffs, known as a Rias coastline. This terrain made the access to the affected area difficult either by land or sea. None of the administrative functions could work properly, therefore no relief could be extended to the areas for a few days and no information on these communities fate reached the outside world. Mobile phones and even the radio network system designed for disasters could not function, because of the blackout and the damage to the relay stations of the radio network. The Government of Japan immediately set up an Emergency Task Force and started collecting information and dispatching Self Defense Forces teams, medical teams, fire brigade units and ambulances. Japanese Red Cross also dispatched its own 14 disaster relief teams to the three affected prefectures within first five hours. As of 21st March, 122,530 blankets and 20,760 boxes of relief goods have been distributed. On the day of the earthquake, even in Tokyo, the train service was affected by the quake and authorities had to suspend the whole service until next day. Consequently, many people suddenly lost their usual means of commuting in Tokyo and had to spend all night stranded at stations and other places. Heavy traffic jams inevitably followed and forced us to wait patiently, spending long hours to cover a distance taking ten minutes in normal times. Highways to the affected areas are now open to emergency vehicles for relief, but the shortage of fuel is still affecting the situation. The Japanese Red Cross Society is running several large scale Red Cross Hospitals in north-eastern Japan and naturally those are being used to function as base-camps to receive the evacuees and to launch mobile health activities. The city of Ishinomaki, which is located in the coastal area of Miyagi Prefecture, still counts 10 thousand people missing. The Red Cross Hospital in Ishinomaki is the only hospital in the city which was able to survive 242

270 in the earthquake and tsunami and stay operational. Naturally, it was filled with the injured and the evacuees, on top of many existing in-patients. The hospital had to adopt strict triage in order to maintain an appropriate level of medical service, but of course, such decisions entail a huge dilemma for the people, particularly the aged, who have nowhere to return to and nobody to depend on. In order to sustain the critical function of this Ishimomaki Red Cross Hospital which has been operating around the clock, many doctors and nurses have been sent from other Red Cross Hospitals nationwide to back up Ishinomaki. The tsunami put the local population in a life or death struggle situation. Yet paradoxically, not many were injured directly by the Tsunami. Therefore, the wellorganised Disaster Medical Assistance Team (DMAT) could work efficiently as it was originally designed for the earthquake. Many challenges remain such as caring for many in-patients who had to evacuate their original hospitals, the patients who were soaked in water by the tsunami and endangered by the harsh wintery situation afterwards, those who lost the means to get necessary medicines for chronic diseases and those who need psychological care. One week later, according to the police authority as of 21st March, 8,649 people are dead, 13,262 people are still missing and 2,644 people are wounded. 14,637 buildings are collapsed. There are 2,113 evacuation centres upand running and accommodating 349,349 people. From the beginning of our operation, there are big operational challenges, such as limited information due to the paralyzed communications, transportation and administration lines, the lack of fuel which has impeded the smooth distribution of relief goods, the limited sites suitable for evacuation centres, and the wintery weather condition which have prevented the evacuees from getting back on their feet. The involvement of volunteers has also had to be limited since the access to the affected area was not safe. These challenges have been gradually overcome day by day, following the recovery of essential services, the provision of more fuel and the establishment of more evacuee centres. Japanese Red Cross will continue to make maximum effort, primarily in its medical relief by mobilizing the resources of nationwide Red Cross hospitals collectively. We are also going to extend our relief work to the evacuation centers gradually by mobilising the power of volunteers. An International liaison/support team was sent to Japan, consisting of the International Federation, American Red Cross, Australian Red Cross, Canadian Red Cross, Red Cross Society of China, Korean Red Cross and Turkish Red Crescent. The team made a field visit to the affected area, accompanied by Japanese Red Cross staff. Its findings confirmed the wide variety of potential needs such as relief items, cash disbursement, tracing/psychological support, logistics support for relief, medical service for evacuation centres and volunteer intervention. We understand that a rough draft of our master plan for upcoming relief and recovery activity should be shared with you sooner than later. ICRC has been also helping us in establishing the special website for Restoring Family Links for this particular disaster. However, the critical situation at 4 nuclear power reactors in Fukushima prefecture have been casting a shadow over the aforementioned positive developments in relief activities. Despite various professional efforts, the situation is still unstable. The people living in the vicinity of 30 km around the nuclear power reactors were forced to evacuate the area in case of further deterioration in the situation. And indirectly, since these nuclear power plants are not small producers of electricity for the Tokyo and surrounding area, their troubles have been causing a shortage of electricity there. In order to overcome this shortage, so-called rolling blackouts of electricity have been implemented in the targeted area in Tokyo and the surrounding area. Due to this scheduled suspension and the effort to save energy, public transportation has been partly suspended. Because of the concentration on needs for fuel and foods in the affected areas of north-east Japan, certain goods are temporarily in shortage in Tokyo and the surrounding area. In addition to the standard Red Cross Hospitals, Japanese Red Cross has specialised hospitals in Hiroshima and Nagasaki in the area of medical services for the radiation-exposed. They are on standby to contribute whenever required. The pressing need right now is obviously relief for the evacuees. Japanese Red Cross has been deploying relief teams in shifts, and at the same time, we are also trying to attend to other needs on real time basis. Relationship with the International Red Cross and Red Crescent Movement Chapter 10 This disaster is without doubt unprecedented in terms of the scale of damage and its comprehensive nature. In such situation, I can never feel that our relief effort is good enough. Rather, I strongly feel that we should do more in terms of the scale, timeliness and efficiency. Such frustration must be felt by all, not only by our beneficiaries, but also by those engaging in relief day and night including ourselves. From this perspective, it is unfortunate that not all offers of support from overseas could be utilized earlier, but I hope you can profoundly understand the uniqueness and complexity of this disaster, which combines the elements of earthquake, tsunami and problems at the nuclear power plants. I hereby would like to state sincerely that all the condolences, encouragements and the offers of support from all over the Movement worldwide move us deeply and remind us of the Spirit of Togetherness that is at the heart of our Movement. On this firm basis of solidarity, we in the Japanese Red Cross Society will resolutely continue our efforts for the sake of the affected population in Japan. Our challenge will be prolonged for years and large amount of financial resources will be needed for the relief and recovery of the affected population. I sincerely appreciate all of your support in the past, the present and the generous help offered for the future. Mar. 22th, 2011 Tadateru Konoe Great East Japan Earthquake and Tsunami 243

271 Great East Japan Earthquake and Tsunami Chapter Acceptance response to the declaration of relief (1) The Policy of support acceptance In response to the declaration of offers of relief, the JRCS did not launch the emergency appeal, but accepted donations from overseas, but which were not be specified as to the way the money is spent in principle and not accept goods support, based on the contingency plan for earthquake in Tokai area as above. Besides this, the JRCS also did not accept medical teams through ERU, which is a medical relief tool of the IFRC. However, the JRCS later accepted some of the relief goods for various reasons and coordinated their distribution with the affected Chapters. (2) Acceptance of international donations The JRCS initially expected a large amount of international donation from the NS throughout the world, and concerned that it could not fully implement various projects worth of such a large amount of donation. Then it explored another direction to use the donation as Gienkin (cash grant sheme). However, the donation was all used for projects of the JRCS because of the reasons below. Considered the relief phase at the time, the NS strongly requested to use the donations for relief goods support. The NS strongly requested the JRCS to take responsibility for the use the donations and report on their use. The NS expressed concern that it could not report on their use in the name of the JRCS, when all the NS donations were send to the Contributions Distribution Committee, a third party as Gienkin. Thus, the JRCS accepted them by opening an account for the donations from overseas in the following way. This account was to be used by only NS in principle. The Japanese Ministry of Foreign Affairs (MOFA) also received an avalanche of support offers of money, goods and staff. Therefore the MOFA called for foreign governments, though overseas Japanese embassies, to send money not goods or staff members to the JRCS via the Red Cross Society of their own country, if they considered providing support. Individuals and companies abroad who offered support to the JRCS were introduced to the National Society in their own country as well as a dedicated account for receipt of Gienkin The contributions from overseas governments (via embassies in Japan) were accepted not as international donations, but as Gienkin in principle. This approach, however, was not fully enforced in the midst of the turmoil in the JRCS Headquarters and it created some confusion for a while. a. Confusion around the remittances from overseas The record of an in-house notification on the opening of an account for international donations at 23:33 on March 11 remains, but the contents of the responses to inquiries which were announced to the NS and the public were not consistent until March 16. This created great confusion when confirming their remitters, because the remittances from the NS and the public were mixed in one account and there were many cases in which different languages were used to make remittances in different countries. <The contents of the notification up to March 15> Both donations from the NS and from individuals/ companies abroad could select the type of donation (Gienkin or the donation from overseas). <The contents of the notification since March 16> A special account was opened only for remittances from the NS. These donations were dealt with as international donations; the information on this account was not to be announced to the public. On the other hand, the donations from overseas governments, Japanese embassies, individuals, and companies were to be accepted through another account as Gienkin. As above, the information on the donation account informed by the JRCS has been consistent since March 16. However, it was very difficult to correct the wrong information once it was posted on the internet and spread across the world. The confusion remained due to the mixing of some remittances from the NS, national governments, and overseas Japanese embassies. Furthermore, without note of caution when filling in overseas remittance requests, some NS put their names on the remittance information in their own language. So in some cases the receipt could not be confirmed. These problems caused a significant delay in receipt confirmation for some societies. To avoid these problems, the JRCS requested the NS to put the name of remitter on the bank remittance advice as well as on the information of the remittance account in English, and to notify JRCS by after following the procedures for the money transfer, if possible. 244

272 b. Agreement with the NS on the acceptance of the donations from overseas When international donations were sent using their own agreement forms, various narrative reports and financial reports were additionally requested, which From March-April, the JRCS accepted international donations by concluding a simplified agreement. the JRCS concluded agreements on the formal acceptance of donations after gaining approval in the first PNS Meeting for GEJET in May required a need to develop a common agreement. Figure 10-3 Acceptance Status of Donation from Overseas (prompt reporting) 1. Amount accepted As of Mar. 29, 2013 (Unit: JPY) Name of the country Amount 1 Afghan Red Crescent Society 4,879,150 2 Albanian Red Cross 1,682,400 3 American Red Cross 23,050,962,179 4 Andorran Red Cross 29,058 5 Argentine Red Cross 4,382,045 6 Armenian Red Cross Society 102,874 7 Australian Red Cross 2,175,995,664 8 Austrian Red Cross 486,967,819 9 Red Crescent Society of Azerbaijan 13, Bahamas Red Cross Society 405, Bangladesh Red Crescent Society 8,681, Belarus Red Cross 3,481, Belgian Red Cross 129,623, Belize Red Cross Society 779, Bolivian Red Cross 104, The Red Cross Society of Bosnia and Herzegovina 11,597, Brazilian Red Cross 13,234, British Red Cross 1,828,504, Bulgarian Red Cross 14,926, Burkinabe Red Cross Society 1,464, Cambodian Red Cross Society 1,584, The Canadian Red Cross Society 4,017,332, Chilean Red Cross 14,779,794 Red Cross Society of China 904,038, Hong Kong Branches 1,669,068,154 Macau Branches 44,305, Colombian Red Cross Society 1,277, Cook Islands Red Cross 175, Costa Rican Red Cross 11,889, Croatian Red Cross 85,775, Cyprus Red Cross Society 5,618, Czech Red Cross 47,342,500 Danish Red Cross 53,362, Danish Red Cross(Faeroe Islands Red Cross) 681, Dominica Red Cross Society 335, Ecuadorian Red Cross 2,590, Estonia Red Cross 3,302, Finnish Red Cross 119,570, French Red Cross 1,850,669,146 Relationship with the International Red Cross and Red Crescent Movement Chapter 10 Great East Japan Earthquake and Tsunami 245

273 Great East Japan Earthquake and Tsunami Chapter 10 Name of the country Amount 37 Red Cross Society of Georgia 4,031, German Red Cross 3,329,505, Honduran Red Cross 367, Hungarian Red Cross 6,688, Icelandic Red Cross 19,113, Indonesian Red Cross Society 79,118, Red Crescent Society of the Islamic Republic of Iran 7,653, Irish Red Cross Society 65,045, Italian Red Cross 389,027, Jamaica Red Cross 45,034 Red Cross Society of the Democratic People's 47 Republic of Korea 8,090, The Republic of Korea National Red Cross 2,977,101, Lao Red Cross 636, Latvian Red Cross 18,391, Lithuanian Red Cross Society 12,205, Luxembourg Red Cross 23,705,000 The Red Cross of The Former Yugoslav 53 Republic of Macedonia 1,529, Malaysian Red Crescent Society 171,120, Maldivian Red Crescent 2,718, Mexican Red Cross 72,535, Micronesia Red Cross 8,223, Red Cross of Monaco 5,156, Mongolian Red Cross Society 12,301, Red Cross of Montenegro 956, Myanmar Red Cross Society 4,309, Nepal Red Cross Society 3,580, The Netherlands Red Cross 752,925, New Zealand Red Cross 51,257, Nicaraguan Red Cross 200, Norwegian Red Cross 161,780, Pakistan Red Crescent Society 8,340, Palau Red Cross Society 2,428, The Palestine Red Crescent Society 840, Red Cross Society of Panama 1,092, Peruvian Red Cross 2,519, Philippine Red Cross 167,000, Polish Red Cross 12, Portuguese Red Cross 6,169, Qatar Red Crescent Society 67,526, Romanian Red Cross 11,443, The Russian Red Cross Society 163,836, Rwandan Red Cross 8,183, Salvadorean Red Cross Society 3,258, Samoa Red Cross Society 1,752, Red Cross of the Republic of San Marino 1,017, The Red Cross of Serbia 191,253,

274 Name of the country Amount 83 Singapore Red Cross Society 652,648, Slovak Red Cross 2,872, Slovenian Red Cross 19,304, South African Red Cross Society 10,829, Spanish Red Cross 404,746, The Sri Lanka Red Cross Society 395, Swedish Red Cross 51,600, Swiss Red Cross 1,999,210, Taiwan Red Cross Organization 6,774,484, The Thai Red Cross Society 748,362, Tonga Red Cross Society 11,534, Trinidad and Tobago Red Cross Society 5,999, Uganda Red Cross Society 108, Ukrainian Red Cross Society 7,100, Red Crescent Society of the United Arab Emirates 15,968, Uruguayan Red Cross 1,872, Vanuatu Red Cross Society 297, Vietnam Red Cross Society 608,584, Al-Waleed bin Talal Foundation 8,376, Belgian Embassy representatives 9,107, European Commission Humanitarian. Aid Office 943,464, Irish government 121,450, Japan-America Society of Hawaii 237,317, New Zealand government 60,730, Kuwait government 157,420, Stavros Niarchos Foundation 20,212,500 International Federation of Red Cross and 109 Red Crescent Societies 4,902,319 International Federation of Red Cross and 110 Red Crescent Societies Office to the UN 232,932, Indivisuals, corporations, other organizations 854,302,995 Subtotal (A) 59,363,649,285 2.Amount of the concluded agreement Name of the country Amount 1 Australian Red Cross * 4,403,700 2 Taiwan Red Cross Organization 189,418,167 Subtotal (B) 193,821,867 Total (A+B) 59,557,471,152 * The agreement was concluded in foreign currency. Converted to Japanese Yen (JPY) from TTM of March 29, 2013 Relationship with the International Red Cross and Red Crescent Movement Chapter 10 Great East Japan Earthquake and Tsunami 247

275 Great East Japan Earthquake and Tsunami Chapter 10 (3) Report to the donor NS As for international donations, the JRCS was not to deal with them as the donation from overseas as mentioned before, but to use them for its own relief projects and recovery support projects, as well as to report on their use to the PNS based on the international standards. Therefore, the JRCS employed temporary staff to prepare activity reports to overseas NS in late April and improved the system. Since then, various reports have been issued up to the present and sent to each PNS via . They were also posted on the JRCS website English version available for inspection by everyone. (4) Usage plan for the donations from overseas in the emergency phase As it was revealed that a large amount of donations would be sent from the Red Cross and Red Crescent Societies in other countries, thus the JRCS developed a provisional relief plan with a budget of 30 billion JPY to allot the donations to the emergency response for the 100,000 of affected people during three months of the period. This provisional relief plan was announced to the PNS in the international telephone conference of March 21. Figure 10-4 List of Reports on the GEJET 1. Information Bulletin prepared and distributed by the IFRC immediately after disaster Title Date of issue Notes Information Bulletin No. 1 Japan: Earthquake and tsunami Mar. 11, 2011 Information Bulletin No. 2 Japan: Earthquake and tsunami Mar. 12, 2011 Information Bulletin No. 3 Japan: Earthquake and tsunami Mar. 15, 2011 Information Bulletin No. 4 Japan: Earthquake and tsunami Mar. 22, 2011 Information Bulletin No. 5 Japan: Earthquake and tsunami Mar. 28, 2011 Prepared and issued by the AP Zone, and made publicly accessible on IFRC website. The JRCS website did not provide a link to the Information Bulletin. 2. Reports prepared and distributed by the JRCS (1) Informal Updates Title Date of issue Notes Informal Update No.1 Mar. 29, 2011 Distributed to NS and IFRC via . Described Informal Update No.2 Apr. 4, 2011 about the current situation and the JRCS response and Informal Update No.3 Apr. 12, 2011 posted on in the main text of the s. Informal Update No.4 Apr. 22, 2011 (2) Operation Updates Title Date of issue Notes Operations Update No.1 Japan: Earthquake and Tsunami Apr. 13, 2011 Operations Update No.2 Japan: Earthquake and Tsunami May 6, 2011 Operations Update No.3 Japan: Earthquake and Tsunami May 20, 2011 Operations Update No.4 Japan: Earthquake and Tsunami Jun. 29, 2011 Operations Update No.5 Japan: Earthquake and Tsunami Aug. 10, 2011 Operations Update No.6 Japan: Earthquake and Tsunami Nov. 18, 2011 Operations Update No.7 Japan: Earthquake and Tsunami Feb. 1, 2012 Operations Update No.8 Japan: Earthquake and Tsunami Aug. 10, 2012 Distributed to NS and IFRC, posted on the JRCS website (English version), and made publicly accessible. (3) 6-Month Report, 12-Month Report Title Date of issue Notes 6 Month Report Japan:Earthquake and Tsunami Aug. 31, 2011 Narrative Reports and Financial Reports. Distributed to NS and IFRC via , posted on the JRCS website 12 Month Report Japan:Earthquake and Tsunami Apr 27, 2012 (English version), and made publicly accessible. 248

276 (4) Others Title Date of issue Notes Conclusion of the Partnership Meeting for the Great Japan Earthquake, 09 May 2011, Tokyo Summary Report on the Partnership Meeting for the Great Japan Earthquake, 09 May 2011, Tokyo Summary Report on the 2nd Partnership Meeting for the Great East Japan Earthquake and Tsunami, 18 May 2012, Tokyo Great East Japan Earthquake and Tsunami (GEJET): FY 2011 Independent Auditor's Report and the Income and Expenditure Statement May 24, 2011 Jun. 9, 2011 Jul. 18, 2012 Jun. 29, 2012 Agreement concluded at the first pertnership meeting for the GEJET Japan Recovery Assistance Program (May 9, 2011), sent to conference participants via . Meeting summary report at the first pertnership meeting for the GEJET Japan Recovery Assistance Program (May 9, 2011), sent to NS and IFRC via . Meeting summary report at the second pertnership meeting for the GEJET Japan Recovery Assistance Program (May 18, 2011). Sent to NS and IFRC, posted on the JRCS website (English version), and made publicly accessible. The English audit report and the income and expenditures account statement, sent as s to PNS and IFRC, etc. and made publicly accessible on the JRCS website (English version). 3. Report prepared and by the IFRC and posted on the JRCS website. Title Date of issue Notes Evaluation Report: Preparing for and Responding to Large Scale Disasters in High Income Countries: Findings and Lessons Learned from the Japanese Red Cross Society s Feb. 13, 2012 * posted on the IFRC website on IFRC activity evaluation report. Posted the report on IFRC website and made publicly accessible on the JRCS website. The date of the post on the JRCS was June 1, 2012 Response to the Great East Japan Earthquake and Tsunami September 3, Tracing service activity (1) About Restoring Family Links (RFL) project As for tracing services by RCRC, the ICRC plays a leading role in establishment of systems at times of armed conflict and ordinary times with the NS, as a part of RFL. RFL is one of the RCRC s humanitarian activities defined by the Geneva Conventions. The RFL system of the ICRC produces results when the safety of family members cannot be confirmed for a long time due to their status as refugees and evacuees, or the disruption of the national communication infrastructure due to conflicts. The JRCS response to the GEJET raised a question of how the system could adapt to the disaster management system in Japan where its own systems have already established such as disaster prevention system and a safety information system that are improved by municipalities, mass media, IT-related public companies. Japan also has backup and recovery capacities that enable communications by telephone and internet services restart just within a week after a disaster. Moreover, in the case of this disaster, the Tokyo Electric Power Company Fukushima Daiichi Nuclear Power Plant Accident occurred at the same time. Each embassy took measures for many foreign nationals who managed to escape to evacuate to outside FUKUSHIMA by March 20, (2) Contents of the activities Activities conducted by the RCRC regarding the GEJET were as follows a. Establishment of the JRCS tracing service website by the ICRC On March 11, the day of the disaster, the JRCS received an inquiry from ICRC as to whether it needed a website for Red Cross tracing service. Thus, the JRCS requested ICRC to establish a multilingual website in the name of the JRCS Director General of the International Department within that day. The website was available in an English version within March 11 and in a Japanese version on the next day. As of May 20, 2011, 5,996 people registered, of which 1,786 were Japanese. b. Acceptance of the RFL staff from the ICRC (March 13-31, 2011) The JRCS accepted three RFL staff members, one from ICRC, one from the Geneva Headquarters, and one from the Bangkok regional office. c. Implementation of the RFL on-site needs survey (March 20-25, 2011) For a needs survey on RFL activities on-site, two staff from the JRCS Headquarters and one volunteer were dispatched to MIYAGI, and conducted interview surveys at the sites such as the Miyagi Chapter, the prefectural Relationship with the International Red Cross and Red Crescent Movement Chapter 10 Great East Japan Earthquake and Tsunami 249

277 Great East Japan Earthquake and Tsunami Chapter 10 HDC, the Miyagi International Association, the Sendai Disaster Multilingual Support Center, and evacuation centers, etc. As a result of this needs survey, JRCS recognized that there was still scope to go into the field and conduct tracing service at this stage. d. Development and donation of RFL kits in the field With advice and provision from the ICRC, the JRCS developed equipment kits to start on-site safety confirmation activities, and used them. e. Implementation of volunteer leader training as preparation for starting tracing service activities on site (March 27, 2011) A one-day volunteer training was conducted by three staff from ICRC acting as a facilitator and interpreter for six volunteers and three staff members of International Department at the JRCS Headquarters. f. Implementation of the safety confirmation pilot project using internet search functions (April 6-15, 2011) Based on the previous needs survey, the JRCS decided to implement the project in ISHINOMAKI, MINAMISANRIKU, HIGASHIMATSUSHIMA and ONAGAWA. One member from the International Department at the Headquarters and two volunteers were dispatched to MIYAGI. The cooperation of four local volunteers could be gained for 10 days for the project. g. Handing over the project to the volunteer center in the Miyagi Chapter (April 20, 2011) Since the team of the tracing service pilot project composed of the staff dispatched from the Headquarters returned to Tokyo on April 15, 2011, the project was handed over to the volunteer center in the Miyagi Chapter. When one and a half months had passed since the disaster, the project ended on April 27, 2011 after judging that emergency needs on-site had become much fewer. h. Response to inquiries of tracing service from NS and others conducted since the beginning of the disaster Since the beginning of the disaster, the JRCS had responded to enquiries on safety confirmation from organizations such as the NS, foreign embassies in Japan, MOFA, relevant agencies, affected prefectures, and individuals. Based on the contingency plan for earthquake in Tokai area, the JRCS did not receive requests for tracing service in the aftermath of the disaster, but directed people to the website for the JRCS safety confirmation, which was immediately established by the ICRC. Eventually, the number of people registered on the JRCS tracing service website reached nearly 6,000. In addition to this website, the JRCS dealt with tracing service with the help of safety information made by prefectures, Metropolitan Police Departments, NHK (Japan Broadcasting Corporation), and the Person Finder of Google which had 600,000 registered within two weeks after the disaster. In the JRCS Headquarters and affected areas, information was shared with international organizations and non-governmental organizations such as the United Nations International Children's Emergency Fund (UNICEF), International Organization for Migration (IOM), and the Japan Association for Refugees. (3) Actions of other organizations related to safety confirmation The Person Finder, in which affected people post news or safety information in times of a large scale disaster, was opened by Google after the Haiti earthquake of January 2010 and New Zealand earthquake of February The Person Finder Japanese version started to operate within two hours after the disaster. In Japan, at first 30 Google s company staff including engineers involved in maintenance and improvement, and later the nearly 100 company staff and several thousand volunteers joined to the operation such as posting names and information on the Person Finder. Because of this, 600,000 cases of information were posted on the site over about two weeks. Immediately after the disaster, even though the JRCS explored the possibility of sharing its own safety information on the investigation site with the Person Finder of Google, it was not realized. Afterward, the ICRC tracing service staff explored the possibility of cooperation with Google in future. But it concluded that it was impossible to share with the Google at this time, because there was a difference between the Red Cross's approach to handling personal information and Google's approach in light of the information platform on Person Finder. 250

278 4. Response and accountability to donors (1) Acceptance of inspections and visitors At the stage of the recovery support activities after the emergency relief period, many people such as the NS and government officials visited Japan and listened to explanations on the JRCS activities and traveled to inspect the affected areas. Moreover, some of them also participated in the ceremony hold accompanied with the completion of recovery support projects. Furthermore, since around autumn of 2011, the JRCS was invited to join meetings including symposiums that were held by United Nations, embassies, NGOs and NS, and was required to share the lessons learned through the experience of this disaster as a Red Cross. a. Acceptance of inspections and visitors (excerpt) The major events were shown as follows. (In 2011) The Danish Crown Prince (Patron of the Danish Red Cross), the Chairman of the Taiwan Red Cross Organization, and the Chairman of the Singapore Red Cross Society, as well as many executive officers of the Red Cross and the Red Crescent Societies from Pakistan, Canada, France, the Netherlands and others visited the JRCS Headquarters. The Commissioner of the European Union for International Cooperation and Humanitarian Aid visited the Headquarters and announced over nine million euros of aid. Foreign dignitaries such as the Belgian Crown Prince and Princess, and the Irish Deputy Prime Minister visited the JRCS Headquarters. The German President attended a ceremony given by the JRCS. In October, the JRCS dispatched staff to Belgium, the Netherlands and Canada aiming at conveying the responses. From September to October, the IFRC evaluation team visited Japan and researched in the Headquarters and the affected areas. In November at the IFRC General Assembly in Geneva, the JRCS created an opportunity for sharing the lessons from the evaluation of the IFRC with the NS, and the JRCS President presented a letter of appreciation of support from the NS. (In 2012) In February, children from a Taiwan elementary school traveled to the affected areas and performed their local arts. In July, at the ministerial-level international conference, the JRCS President attended and gave a lecture as the President of the IFRC. In July, the United Nation Office for the Coordination of Humanitarian Affairs (OCHA), the Japan International Cooperation Agency (JICA), and the JRCS held a meeting to learn from this large scale disaster and JRCS staff took the rostrum as panelists. In July, the JRCS announced the Audit Report for Fiscal Year In September, the JRCS staff gave a presentation at the Red Cross Red Crescent Asia-Pacific Forum held in Beijing and the Red Cross meetings for sharing the lessons from the large scale disaster in advanced countries including Australia and Canada. [A letter of appreciation that was handed to each supporting NS from the JRCS in November 2011] b. Response to the inspections of the affected areas by NS, etc. Over the years after the disaster, the JRCS have received more requests for inspection of the affected areas from the NS that collected international donations, etc. In response to these requests, the International Department arranged inspections in close corporation with the GEJET Recovery Task Force in consideration of the sentiments of the affected people and the transport conditions. Relationship with the International Red Cross and Red Crescent Movement Chapter 10 Great East Japan Earthquake and Tsunami 251

279 Great East Japan Earthquake and Tsunami Chapter 10 Figure 10-5 List of Acceptance of Visitors from Overseas in 2011 Date of arrival Name of the society Name Official position Destination to visit Mr. Gail J. McGovern President MIYAGI Mr. David Meltzer Vice President American Red Cross RIKUZENTAKATA Head of Country Representative, Mr. Tom Alcedo KAMAISHI Apr Indonesia Mr. Yoo Chong-Ha President MIYAGI The Red Cross Society of the RIKUZENTAKATA Democratic People s Republic of Korea Mr. Kim Juja Head of International Relations KAMAISHI May 9-11 Partner National Red Cross and Red Crescent Societies (PNS Meeting) See Figure 10-7 Mr.ChenCharng Ven Chairman Ms.Lin Hsiu Fen (Rebecca) Deputy Secretary General May Taiwan Red Cross Organization Ms. Hsu Hsiao Tzu (Lisa) Deputy Director of the Disaster Relief Department Ms.Chang Yu Chu (Gloria) Public Relations, Development Department, Desk Officer IFRC Mr.Jagannath Chapagain Head of the AP Zone Jun Jul European Commission, Directorate General for Humanitarian Aid and Civil Protection Red Cross Society of China, Hong Kong Branches Jul Singapore Red Cross Society Mr.David B. Verboom Lady Wu European Commission, Directorate General for Humanitarian Aid and Civil Protection, Head of the East and South East Asian Regional Office Director cum Chairman of the International and Relief Service Management Committee MIYAGI Ishinomaki RCHP RIKUZENTAKATA OFUNATO IWATE TONO, KAMAISHI, OTSUCHI MIYAGI SHICHIGAHAMA MIYAGI HIGASIMATUSHIMA, ISHINOMAKI Ms. Bonnie So Deputy Director of Office *Visited Japan in order to the study about Ms. Eva Lam Senior Health Coordinator, the activities of JRCS such as ERU, etc., International Relief Service and visited the affected areas. Mr TEE Tua Ba Chairman The Headquarters Briefing Col. Theampoh LIM Secretary General *Affected areas inspection given by the embassy Jul. 19 Indonesian Red Cross Society Mr. Jusuf Kalla Chairman Indonesia Embassy Mr.Muhammad Lutfi Ambassador The Headquarters Briefing Aug Qatar Red Crescent Society Mr. Saleh Ali M Al-Muhanadi Head of the Department MIYAGI Coordinator of Disaster Dr. Amer Rayad Melhem SENDAI, ISHINOMAKI Management, and others Mr.James Wu Secretary General IWATE Ms.Lin Hsiu Fen Deputy Secretary General YAMADA, OTSUCHI Deputy Director General of the FUKUSHIMA Ms.Hsu Hsiao Tzu Sep Taiwan Red Cross Organization Disaster Relief Department Prefectural government Ms.Cindy Wang Secretary MIYAGI Ms.Eri Ando Interpreter Prefectural government, MINAMISANNRIKU, KESENNUMA Sep.8 Ty Inc. Mr. Ty Warner President Ishinomaki RCHP Home for Infants, Japanese Red Cross Medical Center Ms. Bakhtiar Nilofar President MIYAGI Sep Pakistan Red Crescent Society Sep Swiss Red Cross Oct. 13 Irish Government Mr. Amjad Pervaiz Mr. Martin Fuhrer Mr. Felix Bollmann Mr. Peter Zihlmann Mr. Eamon Gilmore Mr.Colm O floinn Ms. Cathy Madden Ms. Mary Connery Mr. John Neary Mr. Donal Kenneally Oct. 17 The Canadian Red Cross Society Mr.Edward Tanaka President Oct German Red Cross Dr. Rudolf Seiters Dr. Johannes Richert Head of the Resources Development Department Head of the International Department at the Swiss Red Cross Head of the Swiss Foundation Head of the Caritas Swiss Relief and Recovery Department Deputy Prime Minister/Minister for Foreign Affairs and Trade Secretary General of Foreign Affairs Department Deputy Government Press Secretary Private Secretary of the Deputy Prime Minister Ambassador of Ireland in Japan Counselor of the Ireland Embassy President Head of the International Services, Domestic Relief Department SENDAI, Ishinomaki RCHP Temporary housing around ISHINOMAKI MIYAGI Ishinomaki RCHP, Onagawa Town HP The Headquarters Briefing MIYAGI Ishinomaki RCHP, MINAMISANRIKU HANAMAKI, RIKUZENTAKATA The Headquarters Briefing 252

280 Date of arrival Name of the society Name Official position Destination to visit Oct.31-Nov.2 PNS (Monitoring Visit) See Figure 10-8 Nov.8-11 IFRC Guidelines for Urban Earthquake Disasters preparation and investigation team Dec.5-7 Taiwan Red Cross Organization Mr. Nitin Verma Ms. Meghna Chawla IFRC Outside Consultant, Disaster Management Sector Specialist IFRC Outside Consultant, Media- Related Specialist IWATE MIYAKO, OTSUCHI MIYAGI Ishinomaki RCHP The Miyagi Chapter Ms.Lin Hsiu Fen (Rebecca) Deputy Secretary General IWATE Ms.Hsu Hsiao Tzu (Lisa) Deputy Director General of the Disaster Relief Department YAMADA, OTSUCHI MIYAGI KESENNUMA Figure 10-6 List of Acceptance of Visitors from Overseas, 2012 Date of arrival Name of the society Name Official position Destination to visit Jan Feb Swiss Red Cross Mr. Lorenz Indermühle Desk Officer Caritas Switzerland Ms. Yvonne Affolter Program Coordinator Taiwan Red Cross Organization Feb French Red Cross Feb.26-Mar.3 Taiwan Red Cross Organization Taipei Economic and Cultural Representative Office in Japan Tai Wu Elementary School Folk Singers Ms.Lin Hsiu Fen Ms.Hsu Hsiao Tzu Mr. Olivier Brault Mr. Jean-François Riffaud Mr.Chen Charng Ven Mr.Lee Hung Chun Ms.Lin Hsiu Fen (Rebecca) Mr.Chen Shih Jen Mr.Sun Wei Li(Paul) Ms.Hsu Hsiao Tzu(Lisa) Ms.Rung Yu Jiun Ms.Chang Yu Chu(Gloria) Ms.Yang Ting Ting Ms.Chen Shih Yi(Christine) Ms.Lin Yu Hui Ms.Shen Laiyi Mr.Wang Hong Ming Deputy Secretary General Deputy Director General of Disaster Relief Department Secretary General Head of the Communication and Fundraising Department Chairman Taiwan Red Cross Organization Consultant Deputy Secretary General Secretary General Public Relations and Development Department Deputy Director General of the Disaster Relief Department Public Relations and Development Department Public Relations and Development Department Relief Department Relief Department Assistant Director (Third-Class Secretary)] Choir of Elementary School and Junior High School Students, Head Coach, Documentarian (22 persons in total) Swiss Foundation Mr. Tony Burgener Managing Director Swiss Red Cross Mr Martin Furer Head of the International Department Caritas Switzerland Ms. Yvonne Affolter Program Coordinator Apr Mr.Urs Bucher Swiss Ambassador in Japan Minister of Embassy of Mr. Edger Dörig Embassy of Switzerland Switzerland Mr.Alexander Renggli Head of the Culture and Public Relations Department May PNS, IFRC, ICRC PNS, IFRC, ICRC, Head, Disaster Officer, etc. MIYAGI ONAGAWA IWATE YAMADA/OTSUCHI MIYAGI MINAMISANRIKU FUKUSHIMA SOMA MIYAGI Ishinomaki RCHP FUKUSHIMA AIZUWAKAMATSU, Smile Parks, Temporary housing IWATE YAMADA/OTSUCHI MIYAGI, MINAMISANRIKU FUKUSHIMA, SOMA MIYAGI Onagawa Regional Medical Center Fukushima Decontamination Information Plaza Fukushima RCHP FUKUSHIMA Watarai Kindergarten FUKUSHIMA Nankodai Regional Decontamination Site IINO District Office of IIDATE Fukushima Radiation Monitoring Center Relationship with the International Red Cross and Red Crescent Movement Chapter 10 Great East Japan Earthquake and Tsunami 253

281 Great East Japan Earthquake and Tsunami Chapter 10 Date of arrival Name of the society Name Official position Destination to visit MIYAGI MINAMISANRIKU Temporary Clinic May PNS Meeting See Figure 10-9 ISHINOMAKI Social Welfare Office named Laborare Ishinomaki RCHP Swiss Red Cross Mr. Hannes Heinimann Head of the Disaster Relief Division Jun.4-5 JTI Foundation Mr Stefan Rissi Mr Nenad Ljubicic Managing Director Program Manager MIYAGI ONAGAWA Regional Medical Center Japan Tobacco Headquarters Mr. Daisuke Fujimaki CSR staff Jun.6 PNS, IFRC Jul.2-5 Taiwan Red Cross Organization Ms. Hsu Hsiao Tzu (Lisa) PNS, IFRC, ICRC, Head, Disaster Response staff, etc. IWATE Within RIKUZENTAKATA RIKUZENTAKATA temporary government building Takinosato temporary housing complex Ms. Ching-Feng, Wang Chairman MIYAGI Ms. Ando Rie Deputy Director of the Disaster Relief Department Interpreter Jul The Netherlands Red Cross Ms. Pauline Krikke Arnhem City, Netherlands, Mayor Ms. Ching-Feng, Wang Ms. Wang Kuan Chen The Netherlands Red Cross Board Member Chairman MINAMISANRIKU town office Minamisanriku temporary clinic Tagajo temporary housing Arahama regions MIYAGI MINAMISANRIKU town office FUKUSHIMA Fukushima Decontamination Information Plaza Temporary housing and others FUKUSHIMA SOMA BABANO disaster municipal housing Ms. Chen Yi L Secretary General Aug.8 Taiwan Red Cross Organization Ms. Chen Shih Yi (Christine) Social Welfare Department Ms. Hsieh Yu Hsuan Relief Department Public (Florence) Relations Department Ms. Ando Rie Interpreter Government of Alberta, Canada Ms. Michelle Tetreault Prime Minister Strategy Division MIYAGI Aug.21 Mr. Norihiko Saito Commercial Officer Alberta Japan Office Ms. Mary Beth Takao Commercial Officer Assistant Sep.4 Commonwealth Bank of Australia Mr. Martin Spann Ms. Kumiko Sands Mr. Martin Gerdin Tokyo Branch, Branch Manager Personnel Department/General Affair Department, Manager Karolinska Institutet Doctoral course The Miyagi Chapter Ishinomaki RCHP Tagajo temporary housing The Miyagi Chapter Ishinomaki RCHP Temporary Minamizakai the 7th (Dainana) housing complex Ms. Åsa Ljungquist Senior Adviser Sep Swedish government officials Dr. Susannah Sigurdsson Dr. Magnus Simonsson Dr. Leif Stenke Dr. Johan von Schreeb Senior Adviser Doctor, Consultant Doctor, Doctor of Philosophy, Assistant professor Doctor, Doctor of Philosophy FUKUSHIMA Fukushima RCHP MIYAGI Ishinomaki RCHP Dr. Niklas Kviselius Science technology Attach Sep Taiwan Red Cross Organization Dr. Setsuko Hashimoto Ms. Ching-Feng Wang Ms. Helen Huang Program Manager Chairman Communication Development Department Nov.6-8IFRC Mr. Bjorn Elder Representative IFRC in Japan Middle of Jan.-middle IFRC Evaluation Team of Feb 2012 OSAKA SAKAI SAKAI Peace Contribution Award Ceremony IWATE MORIOKA, MIYAKO, YAMADA 254

282 5 Holding of various meetings and conferences (1) The first pertnership Meeting for GEJET (PNS Meeting) In May 9, 2011, the JRCS held the first Partnership Meeting for GEJET, inviting 43 people from 20 PNS, representatives of embassies, and foreign ministry departments. From JRCS, the President, the Vice President, and 19 major executive staff attended. The Vice President of the IFRC, Dr. Mohammed Al Maadheed and the Secretary General Mr. Bekele Geleta also participated in the meeting. This meeting was intended to meet all NS together that sent international donations and discuss how to use the international donations expected to amount to approximately 30 billion JPY in total. In the meetings, the medical activities and volunteer activities of the JRCS after the disaster were reported on, and the fact that the total of 30 billion JPY was relied on for the recovery activities plan was explained, and the agreement of the participants was gained. Moreover, the written agreement on the formal acceptance of funds was approved, presenting a common form to be used. Furthermore, they also discussed responses to possible large scale disasters in future around the world. In connection with the problem of the serious nuclear power plant accident caused by the earthquake and tsunami, the participants asked about the relief activities in FUKUSHIMA and the response to possible nuclear power plant accidents in future. There are over 400 nuclear plants in about 30 countries around the world. In the light of this accident, the strict measures are needed, said the JRCS President, and raised the question that RCRC also needs to bring up the issue of nuclear power plant accidents in international conferences. The agreement contents in the meeting was compiled as the Conclusions and shared among the participants with a summary report at a later date. After the meeting, from May 10 to 11, a two days inspection tour of the affected areas was conducted. Since traveling by train was still limited at that time, they chartered a bus from Tokyo. The total of 33 people from the NS, IFRC, and embassy officials participated in the tour. Eight staff of the JRCS International Department accompanied them. They inspected in ISHINOMAKI, MIYAGI (Red Cross Hospital and others), RIKUZENTAKATA, IWATE (e.g. a brief explanation was provided by the mayor, and inspection of temporary housing was conducted). [The Partnership Meeting for GEJET] (2) Monitoring visit From October 31 to November 2, 2011 the JRCS invited 25 representatives of NS, reported the progress of recovery support projects, and explained that the 30 billion-scale of recovery overall plan was changed to 53 billion-scale. In addition, they inspected the activities of relief projects in IWATE. In October 31, at the meeting at the JRCS Headquarters, Mr. Jerry Talbot, a leader of GEJET Evaluation Team, evaluated that the medical activities and the psychosocial support of the JRCS were effective and met the needs of the affected areas. On the other hand, he pointed out the problems, such as the efficient use of ERU of the IFRC and the strengthening of disaster-response volunteers. As the matters that NS around the world should think of, he said, the preparation of measures in advance is important and the support acceptance agreements between the IFRC headquarters or NS is also necessary. NS should consider the role of RCRC at the time of a nuclear power plant accident. In November 1, the inspection group visited MIYAKO and OTSUCHI, IWATE and saw inside temporary housing and assembly halls as well as Nordic Style Walking projected by the JRCS Volunteer Corps. as an occasion for communication among and fitness for the residents. After the inspection tour, the comments from the participant members were; we saw that the JRCS staff was operating close to affected people and we realized that the JRCS activities spread among the residents and so on. Relationship with the International Red Cross and Red Crescent Movement Chapter 10 Great East Japan Earthquake and Tsunami 255

283 Great East Japan Earthquake and Tsunami Chapter 10 Summary Report On the Partnership Meeting 09 May 2011, Tokyo Great East Japan Earthquake The meeting took place on the 9th May 2011, at the Japanese Red Cross HQs in Tokyo with the participation of 43 representatives from 18 National Societies, IFRC, ICRC, Embassies and MoFA as well as 19 persons from the senior management of JRCS, including the President and Vice-President. The IFRC was represented at the Governance level by Dr. Mohammed Al-Maadheed, Vice President and at the management level by Mr. Bekele Geleta, Secretary General. A two day field trip followed the meeting. The objectives of the meeting were; To have a common understanding of the context of disaster response in Japan and the role of JRCS To share the activities undertaken by JRCS during the emergency phase with the participants To share and discuss JRCS priority action plans for the early and mid-term recovery phases To consolidate assistance to be provided by partner National Societies and external supporters The conclusions of the meeting have been shared with all participants by . Proceedings 1. The meeting was convened at 9:30 by the Chairperson, Dr. Yamada, Executive Director General of JRCS, followed by a minute of silent prayer. 2. Mr. Tadateru Konoe, President of JRCS, made the opening remarks. He stated that the support from the Movement worldwide has moved us all deeply and reminds us of the Spirit of Solidarity that is at the heart of our Movement. On this firm basis of solidarity, the JRCS will resolutely continue its efforts for the sake of the affected population. 3. A 15 minute video depicting the emergency response activities of the JRCS was shown. 4. The focus of the first session was on the JRCS emergency response. Mr. Kimura, Director General of the Disaster Management and Social Welfare Department, explained the mandate of JRCS and gave the participants an update of the achievements in emergency health (mobilization of over 700 medical teams from 92 JRCS hospitals, the medical activities of Ishinomaki Red Cross Hospital), PSP, mobilization of volunteers and relief goods and response to the nuclear power plant accident, as well as constraints in the early days, including the difficulties in communication and the shortage of gasoline. 5. The second session was on the JRCS fundraising and unique cash distribution system that has been developed historically. JRCS alone has raised over 160 billion yen (or USD 2 billion). 6. Mr. Hattori, Director General of the Organization Development Department, explained the criteria for eligible beneficiaries and the amounts of cash to be distributed in the first round as decided at the central Grant Distribution Committee held on the April 8. As of May 1, JRCS had transferred 65 billion yen (or USD 790 million) to 12 prefectures for the first round of cash distributions. 7. The third session went through the Relief and Recovery plans of JRCS. This session was divided into two: a. Dr. Ando, Senior Technical Advisor on Health, explained JRCS intended activities for the rebuilding and strengthening of Medical infrastructure and services in the Ishinomaki region, Miyagi prefecture. The major projects are: 1) Restoring a night-time emergency medical center 2) Rehabilitating a 150 bed secondary hospital run by Ishinomaki city municipality 3) Strengthening disaster response capacity, including reconstruction of the damaged RC nursing school. b. The latter part of the third session was on the measures to be taken to improve living conditions for those who stay at evacuation centers and in transitional houses. Mr. Misawa, Director General of General Compliance Office, explained JRCS major initiatives: 4) Provision of evacuation center packages (water tanks, washing machines, TVs, air cleaners) 5) Provision of a home appliance package to transitional houses (refrigerator, washing machine, TV, rice cooker, microwave oven, water heater) 6) Provision of vehicles and nursing care beds to improve social welfare services 7) Educational support to children 8. The fourth session was devoted to discussing cooperation matters with partner Societies. Mr. Nishijima, Deputy Director General of General Affairs Department, presented issues relating to reporting, ear-marking and audit, followed by the presentation of Mr.Tasaka, Director General of the International Department, on MoU, monitoring and evaluation. 9. Each session was accompanied by a session for questions and answers, facilitated by Mr.Martin Faller, Head of Federation Regional Delegation for East Asia. 10. The final session was a group discussion leading up to the conclusion of the meeting. Participants expressed appreciation for the opportunity to meet and supported the presented JRCS framework for early and midterm recovery action plans and its mode of operation. 11. Dr. Yamada, Chairperson, closed the meeting at 18:30. (Conclusion of the meeting attached herewith) 256

284 CONCLUSIONS The participants to the Partnership meeting for the Great East Japan Earthquake held on 9 May 2011 in Tokyo: Expressed their gratitude to JRCS for hosting the conference and inviting its partners to deliberate, Recognised the challenges presented by the disaster and appreciated the tremendous work accomplished by JRCS, Developed a common understanding of disaster response in Japan and JRCS unique relationship with the Government of Japan, which defines the role of the National Society and the actions which it is expected to take in response to disasters Concluded the following: ACTION PLANS: JRCS framework action plans for early and mid tem recovery were discussed and supported by the participants and their comments and concerns addressed. ALLOCATION OF SUPPORT FROM SISTER NATIONAL SOCIETIES: The JRCS prefers non-earmarked funding, but is open to find solutions together with National Societies to meet their specific requirements. A standard format for a MoU was given by the JRCS in the official hand-out folder to the participants. MONITORING: The JRCS fully recognises the need for monitoring and invites sister Societies to participate in joint monitoring missions on a regular basis. REPORTING: Reporting on the progress of operations in response to the Great East Japan Disaster will be provided as per agreements with the partners and in Operations Updates, and will include assistance provided by partner NS and external supporters. EVALUATION: The JRCS with support of IFRC will conduct mid-term and final evaluations and invites the partners to participate in this process and the evaluation reports will be shared with parties concerned. LESSONS LEARNED: JRCS and its partners will review the course of action it chose to take in this operation, identify lessons learned and integrate them into global planning for future disaster response. Fundraising experience and innovative communications activity would be focused. DISASTERS IN HIGH INCOME COUNTRIES: The Federation should develop a cooperation model and tools for increasing the collective capacity of its components to respond to disasters in high income countries. THE NUCLEAR CHALLENGE: The situation at Fukushima Daiichi nuclear power plant reinforces the need for the Movement to develop a knowledge base and a model for responding to nuclear incidents. INTERNATIONAL DISASTER RESPONSE LAW: Within the global context, agreement should be reached on improving legal preconditions for international cooperation in disasters, and IDRL should be promoted wherever it needs to be strengthened. RESTORING FAMILY LINKS: The participants recognized the need to address RFL when planning for and responding to disasters. Relationship with the International Red Cross and Red Crescent Movement Chapter 10 COMMITMENT: The participants appreciated the outcome of the meeting and committed to continuous support for implementation of the JRCS framework response plan. Great East Japan Earthquake and Tsunami 257

285 Great East Japan Earthquake and Tsunami Chapter 10 (3) The second PNS Meeting After one year from the first Meeting, the second PNS Meeting was held in May On May 18, over 40 people from 13 PNS and the IFRC participated in the meeting at JRCS Headquarters in TOKYO. Before the meeting, they had an inspection tour of FUKUSHIMA and MINAMISANRIKU and ISHINOMAKI, MIYAGI, and saw how the recovery support projects have helped the affected people. The JRCS President delivered an address of thanks to the PNS by saying I express my thanks for your warmest support and encouragement, and your solidarity and continued let the Red Cross as a whole review the measures for large scale disasters by sharing the experience of the GEJET. When explaining the comments from the IFRC Evaluation Team, Mr. Bjorn Eder, the IFRC country representative in Japan, pointed out that even an advanced country like Japan has vulnerability to natural disasters causing the disruption of communications and transportation, and the breakdown of electricity and fuel supplies. He appealed that the NS may not have prepared for the nuclear power plant accident, but we have to imagine the things that are beyond imagination, and NS should conduct relief activities for victims even in a nuclear power plant accident. He also mentioned about the large amount of international donations offered to the JRCS, and said just RCRC in the affected country alone should not respond to the large scale disaster even though it occurred in an advanced country, which is recognized among NS. He added that needs to develop response rules of the IFRS are required. In response to these evaluations and suggestions, the JRCS Director General of Disaster Management and Social Welfare Department said that it would immediately consider the matters such as the roles and contents of disaster-response volunteer and psychosocial support activities, the acceptance system for overseas support, and the response policy, equipment, and training structure for nuclear disasters, and other issues. He said JRCS would create a system to flexibly respond to future large scale disasters, reinforce the disaster management capacity, and develop response plans using the advantages of the Red Cross networks. Some of the comments from representatives of the NS are as follows; we were impressed that the JRCS had achieved 63 percent of the recovery support project plan (Germany); the high reputation of the JRCS's ordinary activities might have been able to collect such a large amount of Gienkin and donations from overseas (Iran); and It was great that RCRC operated as a family. RCRC will also share this experience of the GEJET (Malaysia). artnership eetin r the Great East Japan Earthquake and Tsunami a 1 th 01 T k Japan [All the participants of the second PNS Meeting in May 2012] (4) Holding a Red Cross meeting regarding nuclear disaster measures a. GEJET drove RCRC to focus again on nuclear disasters In November 2010, before the GEJET, the JRCS President, who is also the President of IFRC, made a speech at the World Summit of Nobel Peace Laureates in HIROSHIMA as a representative of the Nobel Peace Laureates Group. He stressed that once a nuclear power plant accident occurs, the humanitarian impact can be as serious as that of a nuclear weapon or even greater than that and people working on humanitarian support will be forced to deal with nuclear accidents. What is more, such accidents can affect people all over the world. He also raised the question that RCRC should review its role regarding nuclear disasters as a humanitarian aid organization as well. Whereas the ICRC has led the issue of nuclear weapons in the past, and has to be going to do in future, making a new trend such as; the IFRC should lead the response to the issue of nuclear disasters as one of disaster management and measures in peace time. Thus the IFRC Secretariat hastily became a key player in adopting resolutions on nuclear disasters within half a year by the time of since the IFRC Assembly Conference of November b. Resolutions of the IFRC General Assembly and their Follow up For the adoption of these resolutions, the JRCS called for an international conference as the first meeting on this issue and proposed to host the meeting. In response to the proposal, the Red Cross Meeting on Nuclear Hazard 258

286 Measures was held at the JRCS Headquarters in TOKYO in May 2012, involving over 50 people from the NS of 16 countries and regions that have nuclear power plants or are highly concerned about this issue. After the three days of discussions, participants reaffirmed that the proposition to support the victims of nuclear disasters was one of the challenges to be addressed by not only some of the specialized agencies, but also RCRC that is not a government or business operator but a neutral and grassroots organization in that country. And they agreed as follows: this effort shall be on an extension of disaster management, a core activity operation of RCRC; it would be practical on a cost-benefit basis if it can apply to any measures including the explosion of a bio-chemical factory, not for only measures peculiar to nuclear disasters; it shall promote the sharing and accumulation of information and knowledge among NS by taking advantage of RCRC networks; and it shall strengthen collaboration with governments and related international organizations. The challenges that RCRC focuses on in particular are described below. American Red Cross Australian Red Cross Figure 10-7 (1)Improvement of the knowledge, skills, and equipment of the RCRC staff and volunteers. Because people who involved in activities have to take care of themselves in order to surely provide continuous supports. (2)Awareness-raising activities for local residents. (3)Recovery: psychosocial support, health monitoring, support for victims focusing on the vulnerable, such as elderly people and children. Centering on the new person in charge deployed at the IFRC Secretariat and an advisory group composed of societies who are highly interested in this issue, these challenges will be prepared to address. There was another comment indicating that determination of the Red Cross s policy for nuclear disaster response could become a base when providing information to national governments or other international organizations. And from this perspective, it is important for RCRC to disseminate some kind of international guidelines for support of affected victims. List of Participants at the First PNS Meeting Name Name of the society Official position Mr. Mark Preslan Mr. John R. Manley Ms. Donna McSkimming Mr. Maximilan Santner Director for Asia and the Middle East Senior Advisor, International Services Head International Program Head of International Aid British Red Cross Mr. Paul Jenkins Head of Partnership Development The Canadian Red Cross Society Red Cross Society of China Ms. Pat Laberge Ms. Zhang Ming Ms. Qiu Hailing Senior Manager, Asia Programme Director of External Liaison Department Head of International Management Division, External Liaison Department Relationship with the International Red Cross and Red Crescent Movement Chapter 10 Finnish Red Cross Ms. Kristiina Kumpula Secretary General French Red Cross Mr. Jean-Francois Riffaud Head of Communication and Fundraising German Red Cross Mr. Dr. Johannes Richert Director Internatl. Services/ Natl. Relief Division Hong Kong Red Cross Red Crescent Society of the Islamic Republic of Iran The Republic of Korea National Red Cross Ms. Ping Betty Lau Ms. Pui Wah Alice Ho Mr. Shahabeddin Mohammadi Ms. Eunhee Cho Mr. Wonyong Choi Head of International & Relief Service (Acting) International & Relief Service officer Director General, International Affairs Department Deputy Head of International Relations Director of Resource Mobilisation and Development Bureau he Netherlands Red Cross Ms. Suzanne Serrarens Director of Operations New Zealand Red Cross Mr. Andrew Mckie Manager International Operations and Emergencies Great East Japan Earthquake and Tsunami 259

287 Great East Japan Earthquake and Tsunami Chapter 10 Name Name of the society Official position Qatar Red Crescent Society Singapore Red Cross Society Dr. Mohammed Mr. Al-Maadheed Dr. Fawzi Oussedik Mr. Benjamin William Mr. Theam Poh Lim Vice President Vice President of IFRC Head of International Relations Dept. and IHL Dept. Director, Special Duties Director, Operations Spanish Red Cross Ms. Mercedes Babe Director, Inetnational Cooperation Department Swedish Red Cross Taiwan Red Cross Organization IFRC ICRC Mr. Bo Hermansson Mr. Martin Fuhrer Mr. Jams Wu Ms. Rebecca Lin Ms. Lisa Hsu Ms. Christine Chen Mr. Bekele Geleta Dr. Simon Missiri Mr. Pierre Kremer Mr. Alfred John Panico Mr. Martin Faller Mr. Bjorn Eder Mr. Michael Gillies Smith Mr. Tobias Epprecht Mr. Yoshinobu Nagamine Mr. Hitomi Makabe Board Member Head, International Department Secretary General Deputy Secretary General Deputy Director Disaster Relief Department Desk Officer Disaster Relief Department Secretary General Senior Advisor/Head, Resource Mobilisation and Government Relations Dept. Head of Communications Department Acting Head of Operations Head of Regional Delegation for East Asia Representative in Japan Communication Delegate Head of Regional Delegation, Kuala Lumpur Head of Office ICRC Tokyo Communication Officer, ICRC Tokyo Embassy of Ireland Mr. Donal Kenneally Deputy Head of Mission and Counsellor Embassy of Greece Mr. Nikolaos Tsamados Ambassador Delegation of European Union (EU) to Japan Mr. Gijs Berends First Secretary Ministry of Foreign Affairs of Japan Ms. Setsuko Kawahara Ms. Sayuri Muraki Director, Humanitarian Assistance and Emergency Relief Division International Cooperation Bureau Officer, Humanitarian Assistance and Emergency Relief Division International Cooperation Bureau * Did not participate in the Meeting, but attended the inspections in the affected areas. 260

288 Figure 10-8 List of Participants in the Monitoring Visits Name Name of the society Official position Mr. Thomas James Alcedo American Red Cross Country Representative, Indonesia Ms. Donna McSkimming Australian Red Cross Head of International Programme Ms. Katy Attfield British Red Cross Head of Disaster Management, International Division Mr. Hossam Elsharkawi The Canadian Red Cross Society Director, Emergency & Recovery, International Division Ms. Marina Hovannesjan German Red Cross Head of Aisa Unit Mr. T C Chan Hong Kong Red Cross Ms. Bonnie So Hong Kong Red Cross Deputy Secretary General Mr. Young Hyun Kim Ms. Yun-Kyeong Han Mr. Datuk Wira Dr Hj Bahari Bin Datuk Abu Mansor Mr. Datuk Hj Bahari Bin Hj Taib Mr. Rozalla Iskandar Bin Mohamad Rosni Korean Red Cross Malaysian Red Crescent Society Member of the Hong Kong Red Cross Council and International & Relief Service Management Committee Secretary General Officer, International Relations Department National Vice Chairman of Malaysian Rec Crescent / Chairman of Malaysian Red Crescrent Natioanl Disaster Management and Ambulance Service Committee Deputy Chairman of Malaysian Red Crescent National Disaster Management and Amblance Service Committee Disaster Management Preparedness Officer Mr. Andrew Mckie New Zealand Red Cross Manager, International Operations and Emergencies Mr. Robert Hsieh Ms. Lisa Hsu Ms. Christine Chen Mr. Dr.Ivan Usichenko Taiwan Red Cross Organization Deputy Sercretary General Deputy Director of Disaster Relief Department Desk Officer of Disaster Relief Department President of Ukrainian Red Cross Society Relationship with the International Red Cross and Red Crescent Movement Ms. Valentyna Pryshko Ms. Serhiy Glukhenkyy Mr. Gijs Berends Ukrainian Red Cross Society Head of Volyn Regional Organization Delegation of European Union (EU) to Japan Head of Vinnitsa regional organization First Secretary Chapter 10 Mr. Alain Aeschliman Head of Operations for Asia Pacific Mr. Yoshinobu Nagamine ICRC Head of Offie, Tokyo Ms. Hitomi Makabe Communication Officer Mr. Martin Faller IFRC Head of East Asia Reginal Delegation Mr. Enkas Chau IFRC Operations Coordinator, Disaster Management Unit, AP Zone Great East Japan Earthquake and Tsunami 261

289 Great East Japan Earthquake and Tsunami Chapter 10 Figure 10-9 List of Participants at the Second PNS Meeting Name Name of the society Official position Mr. Maximilan Santner Austrian Red Cross Head of International Aid Ms. Breanne England Mr. Nathan Huculak Mr. Wang Repeng Ms. Qui Hailing Ms. Qinghua Li Mr. Oliver M. Brault Mr. Jean-Francois Riffaud Ms. Natia Loladze Ms. Nana Keinivili Ms. Nino Drasalia Ms. Tatia Loladze Dr. Johannes Richert Mr. Christian Hoerl The Canadian Red Cross Society Red Cross Society of China French Red Cross Red Cross Society of Georgia German Red Cross Manager, International Emergency Response Funds Communication Advisor Secretary General Head of International Cooperation Division Head of Disaster Management Division Geneal Director Director Communination and Fundraising President Partron Member of bord in GRCS Tbilisi branch GRCS Volunteer Director Communination and Fundraising Deputy Head of International Cooperation Dept. Ms. Alice Lai Hong Kong Red Cross Deputy Head of International & Relief Service Department Ms. Yoon Jung Chang Mr. Datuk Wira Dr Hj Bahari Bin Datuk Abu Mansur Mr. Hi Tahir Bin Ahmand Ms. Hajjah Shamsiah Binti Abdul Kadir Mr. Ahamad Abd Talib Ms. Suhana Mohamed Salleh Mr. Daniel Goni Diaz Ms. Maria Isabel Rojo De Goni Mr. Francisco Javier Briseno Ramirez Ms. Maria Lusia Sanchez de Briseno The Republic of Korea National Red Cross Officer of President's Office Malaysian Red Crescent Society Mexican Red Cross National Vice Chairman of Malaysia Red Crescent / National Disaster Management and Ambulance Services Committee Chairman Johor Branch Director HR/Admin Manager National Excective Board Fund Raising Manager President President Volunteer Ladies Coordination Vice- President Vice Presodent Volunteer Ladies Coordiantion Ms. Wilma ter Heege The Netherlands Red Cross Disaster Response Coordinator, Disaster Response Unit Mr. Chun Yew Wong Singapore Red Cross Society Head International Services Ms. Yu Jiun Rung Taiwan Red Cross Organization Senior Desk Officer of Disaster Relief Dept. Mr. Martin Faller IFRC Head of Regional Delegation, IFRC East Asia Ms. Karen Poon IFRC Opetation Coordinator, Disaster Management Unit, AP Zone Mr. Bjorn Eder IFRC Representive in Japan Mr. Michael Annear IFRC Head of Disaster Management Unit, AP Zone Ms. Elizabeth Konstantinova Delegation of European Union (EU) to Japan Second Secretary, Political and Economic Section The following were observers Mr. Magendran Rajagopal Mr. Mohamed Azan Bin Mohamed Mr. Wong Sang Choon Malaysian Red Crescent Society Mr. Yusri Abdul Malek Mr. Lee Keng Fatt Mr. Rodrigo Emilio De Villasante Herbert Mrs. Jessica Consuelo Moncada de Herrera Mr. Antonio LópezBato Giral Mexican Red Cross Mrs. Martha Patricia Reza Rodriguez MRC Kuala Lumpur Branch Volunteer Counselor, Board of Directors Counselor, Board of Directors Mr. Marcelino eliseo Alvarez Gonzálz Mr. Masaki Watabe United Nations Office for the Coordination of Humanitarian Affairs Counselor, Board of Directors Head of Kobe Office / Humanitarian Affairs 262

290 6. Implementation of the evaluation by the IFRC evaluation team (1) Background to the evaluation research Given that in the GEJET an unprecedentedly large scale of relief and recovery activities have been conducted, and a large number of people made donations via many Red Cross and Red Crescent Societies, as well as that an increasing number of advanced countries are being affected by large scale disasters, the JRCS and the IFRC conducted evaluation research to clarify the lessons from this large scale disaster and to promote the preparation for and response to large scale disasters in advanced countries. Besides the GEJET, this research included other National Societies in advanced countries that had recently experienced and responded to large scale disasters in their own countries. (2) Outline of the evaluation research The research period was set for six months from March 11 to September 11, The evaluation team included the following. Evaluation Research Team Mr. Jerry Talbot (Team Leader) (Former Secretary General of the New Zealand Red Cross) Mr. Chris Staines (Senior officer, Quality and Accountability Tsunami Unit, IFRC) Ms. Mika Wada (Coordinator and interpreter of the Japan International Cooperation Center) In accordance with the operation guidelines, staff members that were necessary for the evaluation research were added. The JRCS International Department staff coordinated the operation and accompanied the team for on-site research where necessary. In October 2011, since the framework of the evaluation was presented by the evaluators, a research plan and setup were established. The evaluation team launched interviews with the staff in October and conducted on-site research in IWATE (chapter, prefectural government, YAMADA and OTSUCHI), and the MIYAGI (chapter, prefectural government, and Ishinomaki RCHP). The JRCS provided various kinds of related documents to the evaluation team, which helped to deepen the understanding about the situation of the JRCS and the surrounding institution, structure, and social status. Furthermore, the evaluation team collected feedback regarding the disaster response of the Red Cross and Red Crescent Societies in other countries using the internet. The report includes responses from 18 societies. Since then, the Evaluation Research Team conducted interview surveys with the AP Zone and the East Asia Regional Delegation. Then, exchanging comments with NS, and discussing and monitoring on the findings between the IFRC and the evaluation team were conducted. Based on this, on November 22, 2011, the first draft report was submitted to the IFRC and the JRCS. On November 30, the Evaluation Team leader and the IFRC representative in Japan announced the research summary at a workshop on large scale disasters in advanced countries held in Geneva. The JRCS translated this into Japanese in order to deepen the understanding of the evaluation research and gain feedback within its own society. On December 30, the JRCS submitted its opinions to the Evaluation Research Team and completed the final report by them reflecting this feedback on January 11, recommendations were presented to the JRCS, NS across the nation, the IFRC. In addition, in Japan, interview surveys were conducted covering 28 people involved in the JRCS, 11 people involved in municipalities, NGO and others in the affected areas, six government officials, etc. The interview survey was also conducted abroad involving 17 people of the IFRC and the ICRC, and 5 of the NS. The number of subjects interviewed reached 67 people in total. The JRCS investigated the recommendations from the IFRC along the lines of items such as the departments, the response measures, and the period of implementation. The JRCS International Department submitted them to the IFRC, with explaining the summary of the outlines at the second PNS Meeting in May Relationship with the International Red Cross and Red Crescent Movement Chapter 10 Great East Japan Earthquake and Tsunami 263

291 Great East Japan Earthquake and Tsunami Chapter 10 Items Figure10-10 Recommendations made by the IFRC Evaluation Team Summary Relationship in Government and the other organization 1. That JRCS take a lead to develop a framework for cooperation with the appropriate government authorities at central and local levels, NGOs and other relevant organizations to better share information, understand each others plans and foster coordination of activities in the future. 2. That national societies continuously nurture a close working relationship with the disaster management authorities at all levels to enable effective and efficient liaison when large scale disasters strike and decision-making bodies come under heavy pressure. Disaster response 3. That JRCS develop a contingency plan for large scale disasters after considering the following issues: the relationship with GoJ in implementing the disaster management plan (see recommendation 1) a strategy to scale up and meet abnormally large needs in the case of mega disasters and/or when two or more chapters are seriously affected. the possible role of JRCS health institutions, such as hospitals, in providing a forward disaster management coordination center in large scale disasters the need for capacity in making assessments, including in situations where municipalities are rendered dysfunctional (see recommendation 5) JRCS role and responsibility in case of large scale industrial accidents (see recommendation 8) the need for a JRCS recovery policy (see recommendation 14) a strategy for the most effective deployment of human resources within the Society, including those with practical experience and expertise in overseas large scale disasters and those familiar with Movement policies and standards (see recommendation 18) the need to strengthen the corps of JRCS trained volunteers to give added outreach to the communities and provide surge capacity to deliver emergency relief services (see recommendation 13) the basis on which additional resources (e.g. funds, international tools, supplies and personnel) may be mobilized from within the Movement (see section 5), and stronger coordination with the government, NGOs, the private sector and other organizations (see recommendation1). 4. That national societies undertake adequate contingency planning for large scale disasters, including arrangements to access resources and assistance from within the Movement, to respond to events which, while highly unlikely, may have catastrophic effects in their country. Assessment 5. That JRCS build capacity within its domestic disaster response personnel to conduct assessments on the basis of IFRC developed methodologies in order to better target assistance and reach the most vulnerable. Trained assessment teams should be available to be deployed at short notice to help municipality authorities assess the needs of their communities, especially in areas where JRCS can deliver services. JRCS should also review its volunteer base at municipal level and consider more systematic training and organisation for disaster intervention. 6. That IFRC develop tools for post disaster needs assessment in high income countries and systematically share best practice. IFRC disaster response tool 7. That IFRC assure the flexibility of the ERU model and make national societies aware of this so that ERUs can be more expeditiously made available and integrated into existing national society structures and systems in high income countries. 264

292 Items Summary Nuclear Accident Registration and Inquiry Psychosocial Support Programme Volunteers Recovery Programming Managing offers of assistance without an appeal Making best use of personnel with experience of large scale disasters Building Good Partnerships IFRC Coordination and Support 8. That the RCRC Movement continue to partner JRCS both in giving assistance to the affected population after the Fukushima Daiichi Nuclear Power Plant accident and in contributing to the development of a strategy (ideally expanded to an approach that includes all NRBC industrial accidents) to address the humanitarian consequences of such disaster events. 9. That a strategy for the Movement be developed to elaborate domestic and international roles in dealing with the humanitarian consequences of nuclear accidents, drawing on the extensive experiences of humanitarian interventions after the Chernobyl and Fukushima Daiichi nuclear accidents. 10. That the Movement continuously reviews and updates its restoring family links and tracing services to take advantage of evolving technology and the social media. 11. That JRCS undertake investigations to establish needs and the feasibility of providing long-term, volunteer delivered psychosocial support programming in support of individuals and communities affected by the GEJET as part of the recovery programme. 12. That national societies both plan to send and to receive trained psychosocial support personnel to support their expatriate communities when large scale disasters strike, given the presence of many different nationalities in most high income countries. The deployment of such personnel must depend upon usual travel protocols being respected including the agreement of the host national society. 13. That JRCS strengthen and diversify its trained volunteer base and have effective systems in place for their efficient mobilization and deployment. As well, effective systems should be developed to manage a surge in the recruitment of new volunteers in times of disaster. 14. That JRCS develops a national recovery policy and a plan to build relevant capacity as part of its disaster management strategy. 15. That national societies in high income countries adopt disaster recovery policies, taking account of their unique national context, the disaster risks present and drawing on the work being undertaken by IFRC in developing an IFRC recovery policy. 16. That IFRC consult with partners to consider and develop a coherent operational framework for national societies in high income countries to use when accepting spontaneous donations from partner national societies. This should regulate ways in which assistance can be efficiently and effectively channelled via the Red Cross Red Crescent to reach the beneficiaries and specify the responsibilities of the operating national society in accounting for the use of these resources. The development of this operational framework must take account of existing policies and procedures and may result in the need for amendments to and/or new policies. 17. That IFRC undertake a study on the adequacy of the secretariat s direct and indirect cost recovery during GEJET and determine a new formula for such no appeal situations, if needed. 18. That national societies in high income countries consider how best to organise access to relevant experience and knowledge about international disaster management best practice available within their national societies and plan to deploy their human resources accordingly in the emergency phase of domestic large scale disasters. 19. That national societies, including JRCS, prioritise the importance of having and building capacity and competence in communicating critical post disaster information via the internet and social media 20. That national societies and IFRC plan for the placement of an IFRC representative and technical delegates, as needed, in times of large scale disasters in high income countries when there is widespread Movement support. The placement of an IFRC representative is for coordination and experienced technical delegates with substantive consultative skills should be made available as needed and integrated into the host national society structure. The delegates assigned need to respect and work with colleagues according to the host national society s established standard operating procedures. Relationship with the International Red Cross and Red Crescent Movement Chapter 10 Great East Japan Earthquake and Tsunami 265

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294 Chapter 11 Public-Relations Activities

295 Great East Japan Earthquake and Tsunami Chapter 11 Chapter 11 Public-Relations Activities When a disaster occurs, the Planning and Public Relations Office (PPRO) of the Japanese Red Cross Society (JRCS) has three major roles to play as follows: Promptly communicate information on the activities of JRCS domestically and overseas Respond to news gathering by Japanese and overseas media Keep records of JRCS s activities PPRO was required to respond to a wide range of inquiries from various circles in Japan and abroad, including not only the activities of the Society, but also the disaster and the damage caused. In particular, partly because news of the earthquake and images of tsunami were quickly distributed throughout the world via the Internet, inquiries from overseas media came pouring in. 1. Early response (From the day of the disaster to the end of March) (1) Response to news gathering by phone and visits to JRCS During the two weeks after the disaster, PPRO was busy responding to inquiries from Japanese and overseas media as it constantly received them almost around the clock with three shifts a day. but due to the lack of personnel, the International Department at the Headquarters and the International Commnittee of the Red Cross (ICRC) Mission in Japan (ICRC-Tokyo) and volunteers capable of responding to such inquiries in English support the responding activity. News gathering by overseas media over the telephone continued during the nighttime due to the time differences. (2) Dispatch of Public-Relations (PR) officers to the affected areas On the day when the earthquake occurred, two PR officers visited MIYAGI as part of the Headquarters initial deployment. On the following day, March 12, a news-gathering team consisting of one PR officer, a video cameraman, and a still cameraman left for TOHOKU in their own car and joined the Headquarters initial deployment. The team headed for the Ishinomaki Red Cross Hospital (RCHP) earlier than any other to collect news materials on relief operations. The two officers who were part of the initial deployment also worked as members of the Headquarters Disaster of Control (HDC) in affected area, and since it was difficult to locally obtain a vehicle and fuel for PR purposes independently, they could not move around on their own and therefore could not fulfill the mission required of PR officers. On the other hand, together with the JRCS President, the news-gathering team headed northward from ISHINOMAKI along the coastal areas such as RIKUZEN-TAKATA, KAMAISHI and OTSUCHI that had suffered the severest damage from March 13 to 14. It brought the images and photographs taken immediately after the areas were hit by the earthquake and tsunami directly to NHK s Morioka Broadcasting Sation, and in addition, it provided news materials to the mass media in TOKYO. [On March 14, this photograph, taken in OTSUCHI, IWATE, was distributed to Japan and overseas media earlier than any other.] On March 20, together with the Iwate Chapter, two PR officers at the Headquarters organized a media tour because the relief work by JRCS was not widely reported as all Japanese media focused on covering the affected areas. This led to the wide coverage of JRCS s relief operations by local media. (3) Response to news gathering by overseas media Immediately after the earthquake occurred, oversea media started to constantly make inquiries to JRCS by dialing the PPRO s direct phone numbers at the 268

296 Headquarters or calling International PR officers on their mobile phones. On the afternoon of March 12, an International Federation of Red Cross and Red Crescent Societies (IFRC) PR officer in Kuala Lumpur arrived in TOKYO, followed by one from Beijing on March 13. Subsequently, IFRC dispatched two PR officers alternately. These two IFRC officers took turns to respond to news gathering at the Headquarters and in the affected areas and distributed the news materials they had obtained. In March, the IFRC-dispatched officers went to the affected areas for news gathering twice. In accompaniment of them, International PR officers from PPRO made arrangements for news-gathering locations and served as interpreters. They also gathered news materials together with the IFRC officers. (4) Website (including the updating of its English pages) Immediately after the occurrence of the earthquake, many people who wished to donate as Gienkin or their blood started to access JRCS s website. The huge number of accesses exceeded the processing capacity of the server on the second day after the disaster, making the Society s website inaccessible (The number of accesses to the website from March 12 to 21 reached 2,907,861, 40 times that for the pre-earthquake ten-day period from March 1 to 10, 2011, when it was 73,894 1.). An emergency measure was taken by installing more servers, preventing the website from becoming inaccessible. Later, Amazon offered to lend cloud servers free of charge using its Web services, and JRCS prepared for further waves of access by accepting this offer. the amount of Gienkin received was updated and disaster relief work were reported on its website every day with many materials such as photographs sent from the affected areas as possible. On the day of the disaster, JRCS also launched a page at its special English-language site to explain how to make a donation, and the number of accesses to the page from March 11 to 31 reached 317,442. In the acute phase, International Department staff supported to translate quick disaster reports into English from Japanese instead of the staff at the PPRO who usually update the website. (5) Issuance of press releases PPRO issued press releases on the work of medical teams, psychosocial care teams, and nursing care teams as well as activities such as the distribution of household appliances packages whenever new developments emerged. A total of eleven press releases were issued by the Headquarters from March 12 to the end of the month. Each chapter and facility also issued press releases to the local media when, for example, medical teams left for the affected areas or held a meeting to give briefings on their activities after their mission was completed. These efforts led to the publication of many newspaper and magazine articles and the broadcasting of many TV and radio programs on the earthquake and tsunami. 2. Domestic PR activities Even two mouth later of the disaster day, PPRO was extremely busy with earthquake-related work, and in addition, it needed to perform for the Red Cross Movement Campaign in May (JRCS has special event around the country Red Cross and Red Crescent day on 8 May every year). At the end of the month, PR officer were added one domestic and one international to PPRO personnel. At first, infomation was communicated mainly through JRCS s website and news releases, but after a certain period of time passed, PPRO began to put all relevant information onto DVDs and distributed them to the mass media. In May 2011, the Great East Japan Earthquake and Tsunami (GEJET) Recovery Assistance Task Force was established, and PPRO worked with PR officer allocated to the Task Force. (1) Response to news gathering by phone and visits to the Headquarters In May 2011, when requests from mass media for news gathering by phone and visits to the Headquarters Settled down gradually, PPRO began to record the number of such requests. until the end of April 2012, it accepted over 110 such requests in one year. Many of the inquiries concerned Gienkin, and while briefings were given chiefly by a PR officer, the Deputy Directors General in charge of PR responded to requests for recording and filming for radio and TV programs. PPRO often asked professionals such as doctors and nurses to answer technical questions about the medical needs in the affected areas. Chapter 11 Public-Relations ActivitiesGreat East Japan Earthquake and Tsunami (1) This is based on Google Analytics. 269

297 Great East Japan Earthquake and Tsunami Chapter 11 (2) Dispatch of PR support teams The number of PR officers at the Chapters in the three affected prefectures was so small that it was extremely difficult to meet all requests from the media within and outside the affected areas for news gathering. Therefore, from April 18 to May 16, Chapters in the unaffected areas took turns to send two PR support personnel each to the Iwate, Miyagi, and Fukushima Chapters weekly in order to enhance their ability to gather and provide news materials. The dispatch of such personnel from the Chapters in unaffected areas was not specifically provided for in the Headquarters guidelines for disaster relief system but after consultations with the Secretaries Generals of the Block Representative Chapters, the dispatch officially began with a notice from the Headquarters to all Chapters. The Headquarters asked the 1st to 6th Blocks to adjust the number of personnel to be dispatched among them, and eventually, a total of 24 personnel were dispatched with the cooperation of these blocks. Figure 11-1 Dispatch of PR Support Personnel from Each Block (Unit:persons) Blood Block Subtotal Chapters RCHP Centers The 1st Block The 2nd Block The 3rd Block The 4th Block The 5th Block The 6th Block Total 24 (3) Website In addition to updating quick reports on the activities of JRCS daily, PPRO offered three dedicated banners for the top page of JRCS s website--activity reports, Gienkin and activity funds-- in June 2011 so that visitors could have easy access to the information they wanted. In July, in order to provide easy-to-understand information on JRCS s activities in the affected areas, it launched a special page in which icons were displayed to enable visitors to understand the content of the activities through illustrations. (4) Identification of the JRCS supporters (Use of JRCS Logos) Many of the corporations and associations collecting Gienkin requested permission to use JRCS s logos for their campaigns, and there had already been many cases in which Red Cross emblems and logos were used without permission. Since it was highly likely that the needs of assistance would be larger and longer-lasting than ever, and in due recognition of the importance of their cooperation, JRCS officially introduced as of April 2011 the JRCS Supporter Logo. This new Logo, designed by a combination of the JRCS Logo and the brief introduction of Gienkin, was then widely used for packaging of commodities, publications and advertisement via media such as homepage, etc. [Example of the JRCS Supporter Logo] (Note)100percent of your donation will go to the affected people of the GEJET through JRCS (5) Mail addressed to the Headquarters Prior to the occurrence of the earthquake, the Headquarters of JRCS received around 100 mailed items a week, but during the post-earthquake two weeks, huge numbers of mail items from Japan and abroad were delivered to the Headquarters, exceeding 5,000 a week. Most of these mail items concerned offers to work as volunteers in the affected areas, provide relief supplies, etc., or contribute Gienkin as well as providing information on the current condition in the affected areas. Since it became difficult for the Organizational Development Department, which was responsible for responding to these mails, to answer each of the huge number of phone calls and mail items due to the limited number of personnel, it was decided that responding to these mail items concerning Gienkin should be outsourced to external organizations. The number of mail items received by the Headquarters decreased gradually after April, averaging about 300 mail items a week in August. 270

298 (6) Activities of the JRCS PR Ambassador On March 30, 2011, the Red Cross PR ambassador, Ms. Norika Fujiwara, an actress, visited the Headquarters to make a donation and attended the meeting of the HDC held on the day to declare her determination to provide support as JRCS s PR ambassador. Later she encouraged the Headquarters personnel. After participating in the distribution of preparing hot meals cooked food at evacuation centers in ISHINOMAKI in April 2011, she visited the affected areas six times during the period up to November Thus she joined JRCS s various relief and recovery support programs and engaged in activities such as encouraging the earthquake victims. years after it opened its account. In addition, JRCS PR officers sometimes appeared on live online programs using Ustream, a video sharing service. After the earthquake, in an effort to make JRCS s policy for its response to the earthquake and specific activities widely known to, PPRO continued to issue the JRCS News monthly and its in-house magazine once every two months. Figure 11-2 Overview of the Activities of the Red Cross PR Ambassador, Ms. Norika Fujiwara, in the Affected Areas (as of November 21, 2012) Detailed list omitted (8) Bulletins for members and the in-house magazine a. JRCS News Designed for Red Cross members, Bulletins, JRCS News, has a monthly circulation of about 120,000. In its pages, it reported on JRCS s activities related to the GEJET to those who supported JRCS s operations. Detailed list omitted (C)Ichigo Sugawara [Ms. Fujiwara helped preparation hot meals at an evacuation center in ISHINOMAKI, MIYAGI on April 13] (7) Communication through social media Sending messages via media such as Facebook and YouTube had been considered as a means of communication since before the earthquake, but the specific methods for doing so had not been determined. Following the earthquake, JRCS opened its official YouTube channel on June 23, The Society presented a video entitled Great East Japan Earthquake and Tsunami: 40 days in the affected areas, which was played 4,308 times during the period up to December 2012, and later it showed earthquake-related videos such as Records of the initial deployment at the Ishinomaki RCHP, which was played 64,024 times during the same period, as well as materials other than earthquake-related ones, including TV commercials and videos to promote First Aid. As of November 2012, 27 videos were available on the channel. JRCS launched its Facebook account on September 7, 2011, and has since updated it each day. It has presented not only its earthquake-related activities, but also its personnel and a wide range of other activities, and the number of people who clicked the Like button on the JRCS Facebook page exceeded 10,000 times two b. In-house magazine JRCS s activities In order to introduce JRCS s initiatives for various projects, 60,000 copies of the in-house magazine JRCS s activities are issued bimonthly to over 64,000 people who work for JRCS chapters and facilities nationwide. In its pages, the in-house magazine took up and reported on activities related to the GEJET. Detailed list omitted Chapter 11 Public-Relations ActivitiesGreat East Japan Earthquake and Tsunami 271

299 Great East Japan Earthquake and Tsunami Chapter 11 (9) Visual records and productions a. DVDs In addition to the video entitled JRCS Activity over the past year, which is produced in March of each year, PPRO produced DVDs recording the GEJET (see Figure 11-3). Copies of these DVD were distributed not only to all JRCS chapters and facilities, but also to JRCS Representatives, donors, foreign embassies in Japan, Japanese embassies abroad (through the Ministry of Foreign Affairs (MOFA)), and other stakeholders, and the videos were also shown via the YouTube channel. Construction of Community Centre Community Centre opened in the prefabricated housing compound. (Koriyama, Fukushima) b. Photo panels In April 2011, PPRO started to produce photo panels to introduce JRCS s business activities as required. A total of 64 photo panels had been produced by the end of December In addition to meetings of the Board of Representatives and the Board of Governors, PPRO exhibited them at the entrance hall on the first floor of the Headquarters and lent them to the organizers of various events and for other opportunities. Nursery service is also provided at the community centre. (Koriyama, Fukushima [An example of photo panels] Figure 11-3 DVDs Recording the GEJET Date of publication Title Outline Language Recording time March 2011 JRCs is close to the earthquake The DVD contains images recorded by the filming team who visited victims (Great East Japan the affected areas immediately after the earthquake occurred. It Earthquake and Tsunami) contains video recordings of medical relief work, the distribution of Japanese supplies, the HDC at the Headquarters, and so forth. 14 minutes May 2011 October 2011 February 2012 May 2012 September 2012 Great East Japan Earthquake and Tsunami: 40 days in the affected areas Great East Japan Earthquake and Tsunami: Path for reconstruction One year after the GEJET: Walking with the earthquake survivors with hope What is the Red Cross?: Looking at the starting point of its education Second summer in FUKUSHIMA: Advancing with children who lead the future generation In addition to the footage mentioned above, the DVD contains images provided by the Norwegian Red Cross whose officers visited the affected areas in March, those of an official ceremony held in April to present household appliance packages as well as other events. It also shows video records of medical services, relief supplies, psychosocial care, nursing care teams, volunteers, the installation of water stations, etc. The images contained in the DVD look back upon the half-year following the earthquake. In addition to the footage mentioned above, this DVD covers the response to the nuclear accident, the construction of temporary medical wards, the presentation of nursing care beds, Nordic walking, educational support, and so forth. The images contained in the DVD look back upon the past year and present the current condition of the affected areas through comments by the victims. Other events recorded include the distrubution of household appliance packages, psychosocial care, the construction of temporary medical wards, and Smile Parks. This DVD records the efforts of students from the Japanese Red Cross Ishinomaki School of Nursing, who were affected by the earthquake yet were filled with a sense of mission as students studying at the school, to treat injured persons even though neither water nor supplies were available. It also presents the JRCS disaster nursing education. This DVD contains images of the current condition of FUKUSHIMA, including food radiation measuring equipment, whole body counters, the reconstruction of public housing, and summer camping. Japanese and English Japanese and English Japanese and English Japanese Japanese and English 14 minutes 13 minutes 7 minutes 22 minutes 7 minutes 272

300 3. Effective use of the mass media (1) Press releases from the Headquarters Whenever there were new developments such as the presentation of household appliance packages, the withdrawal of medical teams, and the start of new projects, the Headquarters issued press releases to invite mass media to cover these developments. These releases were usually distributed through the correspondents club at the Ministry of Health, Labour and Welfare (MHLW), and if the subject was financed by international donations, they were also distributed to the correspondents club at MOFA as well as to the correspondents clubs at the government offices of the three affected prefectures through the chapters. The number of press releases issued after April 2011 is as shown in Figure 11-4 (only those related to the GEJET). Figure 11-4 Number of Press Releases Issued in 2011 (88 in Total) Apr May June July Aug Sep Oct Nov Dec 9 (2) Press conferences On March 13, 2011, the President, who was visiting the affected areas, gave a press conference at the Miyagi prefectural government office, but this was not widely covered by the mass media. Later, as it received inquiries from many news organizations, PPRO considered holding press conferences early to convey JRCS s opinions and receive questions, but the Headquarters was watching trends in public opinion concerning the distribution of Gienkin, and under these circumstances, by the President we decided to postpone the planned press conferences. At the Partnership Meeting for GEJET (PNS meeting), which took place in TOKYO on May 9, the first press conference was called to explain to the mass media about reconstruction support projects using international donations. Since there was strong criticism about the delay in the distribution of Gienkin, many questions about Gienkin were at the press conference although it was originally intended to be an opportunity to talk about donation from overseas. On May 11, at the Foreign Correspondents Club of Japan, the President explained to foreign news reporters about JRCS s activities in the affected areas and the utilization of donation from overseas. On September 9, the President, the Director General of the GEJET Recovery Task Force, and the Director General of the Organizational Development Department jointly gave a press conference to explain about JRCS s Figure 11-5 Overview of Press Conferences Given after March 11, 2011 Date Venue Purpose Briefer Articles published JRCS announced that it would strive with all Correspondents club at the its resources to provide medical relief as areas Several companies covered the Miyagi Prefectural Government centered on ISHINOMAKI had suffered enormous President press conference in their Web damage. news. March 13, 2011 May 9, 2011 May 11, 2011 September 9, 2011 March 7, 2012 July 10, 2012 PNS meeting for the GEJET (Held at the JRCS Headquarters) Foreign Correspondents Club of Japan (FCCJ) JRCS Headquarters Foreign Press Center/Japan (FPCJ) JRCS Headquarters Explanations were given concerning reconstruction support projects financed by donation from overseas. The President emphasized his hope that other countries in the world will be able to learn from Japan about measures to cope with disasters, including preparations for nuclear accidents, and at the same time presented JRCS s initiatives from emergency relief to support for recovery and reconstruction. The President and other executives explained about the extension of the deadline for the acceptance of Gienkin and their distribution while details of the reconstruction support projects financed by donation from overseas. The President looked back upon the year since the earthquake, presented JRCS s activities, and stressed the need to prepare for nuclear accidents. PR officers announced JRCS s plan to host summer camping and invited news reporters to cover it. Deputy Director General in charge of PR and Director General of the GEJET Recovery Task Force President President, the Director General of the PPRO, the Director General of the Organizational Development Department, and the Director General of the GEJET Recovery Task Force General President Director General of the PPRO, the Deputy Director General in charge of PR, and Director General of the GEJET Recovery Task Force Mainichi Shimbun (a newspaper) reported the donation of house appliances package, and Kyodo News (a newspaper) reported on the flow of Gienkin. Reuters distributed news of Gienkin and donation from overseas. Six newspaper publishers covered the extended deadline for Gienkin (Asahi, Yomiuri, Mainichi, Jiji Press, Kyodo News and Japan Times). Reuters quoted the President as saying that One year has been wasted, a comment its news reporter drew from him in a separate interview with him. The press conference was covered by news media such as the Hokkaido Shimbun (a newspaper) and Wing Travel Daily. 273 Chapter 11 Public-Relations ActivitiesGreat East Japan Earthquake and Tsunami

301 Great East Japan Earthquake and Tsunami Chapter 11 activities while looking back upon the half year since the earthquake. On March 7, 2012, the President was invited to speak about the past year at the Foreign Press Center/Japan. On July 10, the Headquarters held a press conference to brief the media on summer camping and invite news reporters to cover this event. (3) Newspaper advertising As usual, in conjunction with the Red Cross Movement Campaign in May, PPRO ran an advertisement in the national edition of the Nihon Keizai Shimbun (a newspaper) twice, one on May 1, 2011 and the other on May 12 of the same year, using the design for the annual PR poster. On May 11, it placed in the newspaper an advocacy advertisement, which also aimed at explaining about Gienkin and activity funds. But in all these advertisements, taking into consideration the possible responses from society at that time, the Headquarters thanked contributors for their Gienkin and emphasized, while restraining its appeal for cooperation in raising activity funds, that all their money would be delivered to the victims. Furthermore, on May 2 and 3, it published through the national edition of the Nihon Keizai Shimbun an article that included an interview with the President and an introduction of JRCS s activities as well as its appreciation for Gienkin. As the situation continued in which the Gienkin funds did not quickly reach the victims, however, the wrong information spread through TV, social media or other media that JRCS took part in the Gienkin as a handling commission. In order to settle this situation and explain to the nation about the distribution of Gienkin and JRCS s activities in the affected areas in an effort to fulfill its accountability, the Headquarters placed a PR article in national and regional newspapers as well as local ones with the largest circulation in each prefecture on September 11, 2011 and March 11 and September 11, This was based on a comment by a Board of Governors from a prefecture, who said, Since national papers do not have such a large circulation in provincial areas, it is necessary to place items ads in local papers to make JRCS well known to the entire nation. In addition, the International Herald Tribune, which is widely read throughout the world, offered to insert JRCS s advertisements in its issues free of charge, and JRCS accepted the offer. (4) TV and radio commercials By March 11, 2011, PPRO had completed the production of TV and radio commercials for the Red Cross Movement Campaign in May and prepared to send the chapters the number of copies they required. Since the contents of the commercials, which asked the audience how many M6.0 or larger earthquakes occurred in one year, was likely to infringe on the TV stations standards, PPRO decided to produce new acceptable commercials to replace the current ones. But since it was difficult to produce new ones using TV personalities (AKB48) again, PPRO revised the current ones using difference scenes and narrations so that the revised ones emphasized JRCS s attitude towards disasters. East Japan Marketing & Communications, Inc., an ad agency, kindly covered part (5 million) of the reproduction costs for the commercials. (5) Poster advertising The results of nationwide questionnaire surveys conducted annually indicated that JRCS s annual PR posters made its disaster relief activities well recognized among the public, and the PPRO placed its greatest expectations on them as a means of communication. The new poster was therefore designed to emphasize JRCS s mission to alleviate the suffering of people by placing the personnel chosen from RCHP nationwide in JRCS red relief uniforms. The new posters had already been printed, and their distribution to all chapters completed by February so that they were ready for Red Cross Movement Campaign in May, and therefore, they could not be replaced by new ones. However, the GEJET occurred, and to the eyes of people who watched JRCS s red uniforms via television and newspaper, they would have looked as if they had been produced after the earthquake, and this made these posters seem like a welltimed advertisement that further helped spread the image of the JRCS as a provider of disaster relief. PPRO adjusted the colors of the lettering It is human beings that save human beings and distributed the adjusted poster images so that they could effectively be used for subsequent leaflets, newspaper advertisements, and other marketing tools. 274

302 (6) Free use of other advertising media As all TV commercials started to be replaced by the Advertising Council (AC) Japan s ones immediately after the earthquake occurred, several companies offered to place JRCS s advertisements in various advertising media other than television free of charge, and having accepted such offers, PPRO provided PR materials such as posters and Web images. Among these companies, East Japan Marketing & Communications, Inc., an ad agency to which the Headquarters outsourced its PR operations, put up JRCS s posters in all trains on the JR Yamanote Line and at all JR stations in the Greater Tokyo area for three weeks from March 24. At that time, JRCS informally asked the AC Japan to air its TV commercials as AC s, but this did not materialize because AC Japan deals with small organizations. [A widely displayed in-train advertisement put up in all trains on JR Yamanote Line] (7) Free placement of advertisements in magazines and other media Several organizations such as Airport Transport Service Co., Ltd., foreign embassies, and the American Club offered to place in their magazines free-of-charge advertisements informing that JRCS was collecting Gienkin and JRCS accepted their offers and published its advertisements in these magazines. 275 Chapter 11 Public-Relations ActivitiesGreat East Japan Earthquake and Tsunami

303 Great East Japan Earthquake and Tsunami Chapter 11 A poster put up at three concourses of Tokyo Metro Co., Ltd. from April 4 to 11, 2011 following Montblanc Japan s offer to place JRCS s poster advertisements free of charge An advertisement inserted in the national edition of the Nihon Keizai Shimbun on May 1,

304 A PR advertisement placed in the national edition of the Nihon Keizai Shimbun on May 2, 2011 A PR advertisement placed in the national edition of the Nihon Keizai Shimbun on May 3, Chapter 11 Public-Relations ActivitiesGreat East Japan Earthquake and Tsunami

305 Great East Japan Earthquake and Tsunami Chapter 11 An advertisement run in the national edition of the Nihon Keizai Shimbun on May 12, 2011 An advertisement put in four national newspapers on May 16,

306 A leaflet aimed at promoting a correct understanding of Gienkin, which was issued on July 13, Chapter 11 Public-Relations ActivitiesGreat East Japan Earthquake and Tsunami

307 Great East Japan Earthquake and Tsunami Chapter 11 An advertisement placed in national and regional newspapers as well as local ones on September 10, 2011 An advertisement placed in national and regional newspapers as well as TOHOKU s local ones on September 15,

308 An advertisement inserted in the Mainichi Shimbun on March 10, Chapter 11 Public-Relations ActivitiesGreat East Japan Earthquake and Tsunami

309 Great East Japan Earthquake and Tsunami Chapter 11 An advertisement placed in the Asahi Shimbun and the Nihon Keizai Shimbun, both national papers, on March 11,

310 An advertisement placed in regional and local newspapers on March 11, Chapter 11 Public-Relations ActivitiesGreat East Japan Earthquake and Tsunami

311 Great East Japan Earthquake and Tsunami Chapter 11 An advertisement placed in the national edition of the Nihon Keizai Shimbun on May 1,

312 285 Chapter 11 Public-Relations ActivitiesGreat East Japan Earthquake and Tsunami A PR advertisement inserted in the national edition of the Nihon Keizai Shimbun on May 4, 2012 A PR advertisement inserted in the national edition of the Nihon Keizai Shimbun on May 5, 2012

313 Great East Japan Earthquake and Tsunami Chapter 11 An advertisement placed in national, regional, and local newspapers on September 11, 2012 An advertisement placed in the International Herald Tribune on May 19,

314 4. International public relations In December 2010, JRCS invited an IFRC PR officer to train its personnel in how to respond to a flood of inquiries from overseas media, and this training took effect when the March 11, 2011, earthquake occurred. From the day after the earthquake, two IFRC PR officers were stationed at the Headquarters until mid-may and one until the end of the month. Subsequently, PPRO obtained support from IFRC PR officers as required. This worked for international by establishing the following three priority goals: Ensuring exposure through the mass media Providing sufficient information to PNS Stepping up efforts to communicate information via the English-language website (1) Use of the mass media a. Press releases At major points in time such as one month, three months, and one year after the earthquake, JRCS issued press releases to foreign media in Japan through the Foreign Press Center and the Foreign Correspondents Club of Japan and the world s media through the Secretariat of the IFRC in Geneva and Red Cross and Red Crescent Societies worldwide. Figure 11-7 shows when press releases were issued and what their main subject was. Figure 11-7 Contents of Press Releases Date Apr. 8, 2011 May 11 Jun. 10 Sep. 9 Oct. 28 Feb. 3, 2012 Mar. 2 Mar. 2 Mar. 7 May 17 Jul. 3 Aug. 3 Sep. 3 Content Announcement on the start of the distribution of house appliances package Announcement on the restructuring of the medical infrastructure Announcement on the whole picture of the 30 billion for international donation-financed projects Briefing on the situation in the affected areas that was still severe even after half a year had passed and details of JRCS s continuous support programs Invitation of representatives from overseas Red Cross and Red Crescent Societies to visit the affected areas for news gathering Information on subjects on which news materials could be obtained as the first anniversary of the earthquake drew near Introduction of JRCS personnel who would answer questions in interviews on the day that marked the first anniversary of the earthquake Announcement on the extension of the deadline for the acceptance of Gienkin Emphasizing the importance of being better prepared for nuclear accidents as the first anniversary of the earthquake drew near Report on details of the conference of Red Cross Societies related to Nuclear disaster preparedness Invitation to summer camping for news gathering Information on subjects on which news materials could be obtained one and a half years after the earthquake Announcement on the extension of the deadline for the acceptance of Gienkin Figure 11-6 List of PR Officers from Overseas Name Official position Period of stay in Japan Mr. Patrick Fuller Communications Manager, IFRC Asia Pacific Zone Office Mar. 12 to 24, 2011 Jun. 19 to 24 Mar. 6 to 13, 2012 Mr. John Sparrow Communications Officer for GEJET, IFRC Mar. 27 to May 12, 2011 Mr. Francis Markus Communications Officer, IFRC East Asia Mar. 14 to 24, 2011 Jun. 19 to 24 Aug. 17 to 26 Jan. 10 to 13, 2012 Feb. 3 to 16 Mar. 6 to 12 May 10 to 17 Aug. 5 to 16 Ms. Katherine Mueller Communications Officer for Pakistan Floods Operation, IFRC Mar. 21 to Apr. 12, 2011 Mr. Olav Andreas Saltbones Communications Officer and Cameraman, the Mr. Truels Seiner Henriksen Norwegian Red Cross Mar. 26 to 31, 2011 Mr. Arjan Blanken Apr. 5 to 10, 2011 Ms. Eva Smith Communications Officers, the Netherlands Red Cross Apr. 5 to 10, 2011 May 20, 2012 Mr. Giovanni Zambello Communications Delegate, IFRC Europe Zone Apr. 9 to 22, 2011 Mr. Michael Jill Smith Media Advisor, Australian Red Cross (seconded to IFRC only during this period) May 6 to 28, 2011 Mr. Mark South Media Officer, British Red Cross Feb. 4 to 9, 2012 * In addition, PR officers from the Taiwan Red Cross Organization visited Japan several times. Chapter 11 Public-Relations ActivitiesGreat East Japan Earthquake and Tsunami 287

315 Great East Japan Earthquake and Tsunami Chapter 11 b. Interviews Immediately after the earthquake, PPRO received innumerable requests from the mass media for news gathering and those for appearances on TV and radio programs via phone and Skype. The number of such inquiries from May 25, 2011, when data on it started to be taken, to the end of March 2012 was about 80. PR officers received many questions that were not necessarily related to JRCS s activities, including the latest death toll and the damage caused, the current conditions in the affected areas, what was most needed at the time, and the perceived delay in the government s response. They tried to relate these questions to JRCS s activities as much as possible so that they could introduce those activities. [The Ishinomaki RCHP accepted many requests from overseas media for news gathering.] c. News gathering in the affected areas In March 2011, PPRO s personnel accompanied newsgathering teams from the Norwegian Red Cross and Euronews. In April, they accompanied a news-gathering team from the Netherlands Red Cross. In addition, PPRO received requests from several media such as CNN, BBC, ABC News, National Geographic, and documentary producers from Hong Kong for news gathering, and local Chapter staff and medical teams met such requests. Some of the media even requested JRCS staff to serve as interpreters and guide them in the affected areas, but in principle, except for teams of PR officers from sister societies, ordinary media were encouraged to make arrangements for interpreters, transport, and other requirements on their own and gather news materials independently. Based on this principle, PPRO coordinated news gathering in the areas where JRCS was working. As JRCS s recovery operations progressed, ceremonies for the completion of buildings or similar and other events took place. In such cases, many representatives from not only the Japanese media, but also those from the countries involved participated in these events, and JRCS international PR officers made arrangements for news gathering, guided these representatives, served as interpreters, and provided other services. d. Number of articles on JRCS published in overseas media From March to May 2011, PPRO monitored major newspapers, websites, blogs, and other sites on the Internet, and as a result, the number of articles that covered JRCS was as follows: March 38,639 April 10,874 May 5,268 Total 54,781 (Based on a Meltwater News survey of 8,603 media) Figure 11-8 Number of Articles in Major Newspapers, Websites, and Other Media That Covered JRCS Major newspapers Total for March, April, and May The New York Times 60 The Japan Times 74 International Herald Tribune (Global Edition) 35 The Wall Street Journal -Europe 15 Daily Yomiuri Online 20 Asahi. com 12 The Guardian 3 The Times 1 BBC News UK 9 CNN 14 (2) Communication of information to IFRC and National Red Cross and Red Crescent Societies across the nation a. Website In July 2011, PPRO set up a special English-language website focusing on GEJET, which arranged information on the earthquake in an easy-to-understand manner so that it attracted considerable attention from overseas visitors. This special website carried 40 stories from May 25, 2011 to November These stories not only covered the operations of JRCS, but also included accounts that described the true feelings of victims, including their experiences, thoughts, and concerns. These were also posted on the IFRC s website and sent to PR officers at 288

316 Sister Societies worldwide. The website also carried ten progress reports on JRCS s operations, entitled Operations Update, which were compiled by the International Department for donors and Sister Societies, as well as accounting reports, interim assessment reports, and so forth. In addition, all news releases were put up on the website. images and information using their own tweets, enabling as many as 2.2 million people worldwide to receive information on the disaster in real time. b. Flickr 2 PPRO officers immediately forwarded the photographs sent to the Headquarters from the affected areas to IFRC communications officers in Kuala Lumpur, who added captions to the photographs and made other adjustments and transmitted the adjusted ones to IFRC communications offices in Geneva, where they were uploaded onto the Flickr community site. Thus PPRO officers worked with IFRC communications officers to make the damage caused by the earthquake known to the world. There were one million views of JRCS s photographs during the two weeks after the disaster. [Top page of the special earthquake website in English] b. DVDs From May 2011 to September 2012, PPRO produced four DVDs including Japanese/English narration and presented them via IFRC s YouTube channel. Materials used for these disks were also provided to overseas media through IFRC s website. These DVDs were distributed at PNS meetings and to Japanese embassies in overseas countries through the MOFA. (3) Communication through social media a. Twitter When the earthquake occurred, JRCS did not have its own official Twitter account. The reason it started to use Twitter was, however, that International PR officer had strongly recommended having a Twitter account when a conference of IFRC Asia Pacific communications officers took place in 2010, and that the officer had opened own accounts on an individual basis. This officer sent 1,000 tweets from the accounts in the first four days after the earthquake to show photographs of patients brought to the Ishinomaki RCHP and provide updated information on the damage caused by the earthquake and tsunami, which was supplied by NHK. Furthermore, IFRC communications officers spread these c.youtube PPRO provided images from the above-mentioned DVDs to the public via IFRC s YouTube account, and the images thus shown in May 2011 were replayed more than 8,500 times. In addition, through this account, PPRO presented the President s message in English in September and a 30-second, short thank you message from beneficiaries in February A record of the initial deployment at the Ishinomaki RCHP with subtitles in English was also shown via the IFRC YouTube account. (4) Information for foreign embassies in Japan Support from overseas came in various ways such as donations contributed through a Red Cross and Red Crescent Society in each country as well as donations given through the Japanese embassy in each country, sent by foreign companies directly to JRCS, or received from foreign embassies in Tokyo. In July 2011, in addition to the President s letter of appreciation for contribution, PPRO issued Operations Update through the Foreign Press Center and sent copies of the DVDs to foreign embassies in Japan (from about 130 countries) together with the receipt for Gienkin. Chapter 11 Public-Relations ActivitiesGreat East Japan Earthquake and Tsunami (2) Flickr is a free community site where one can freely upload or download photographs and videos. 289

317 Great East Japan Earthquake and Tsunami Chapter Other PR activities (1) Offers of cooperation Businesses, distinguished people, and others made various offers of cooperation. Those related to supplies were taken over by the Supplies and Property Division of the General Affairs Department. All inquiries were forwarded to PPRO if definite decisions could not be made on how to respond to such offers, and there were cases in which even PPRO officers could not give an immediate answer. Due to the lack of personnel, PPRO officers were unable to respond fully to such offers and felt that it was necessary to strengthen JRCS system to work with the social contribution programs (CSR) of businesses, associations, and so forth. a. MTV Japan The name of JRCS was exposed to the public mainly through a concert held in CHIBA on June 25, 2011, as well as an MTV (Music program) Japan-hosted website, karaoke boxes, local concerts, and other media. JRCS logo was also printed on the panel at the back of the site where a popular singer gave a press conference when she visited Japan, and this led to wide publicity for JRCS. [A scene from the press conference given by Lady Gaga during her visit to Japan] b. Music industry s cooperation in collecting Gienkin across the boundaries of individual companies On March 25, 2011, four major record companies, Sony Music, Universal, Warner, and EMI, simultaneously started the digital distribution of charity CDs through itunes stores worldwide. These CDs continued to top the itunes stores album charts in 18 of the 22 countries where they were announced. In addition, in April saw the worldwide release by Sony Music of a set of two CDs with JRCS s logo printed on them. Furthermore, Universal distributed and sold Ai no Uta (song of love) via the Internet for a limited period of time, from April 2 to September 30. The record companies, music publishers, and artists involved in these productions did not claim compensation for royalties and other income from the sale of these products, and all revenues, including commissions for itunes stores, were donated to JRCS as Gienkin for the GEJET. These donations amounted to a little over 700 million yen. (2) Motto Cross! Prize The Motto Cross! Prize, which has been hosted by JRCS since 2008, officially commends those of chapters and facilities at 250 locations nationwide that produce remarkable results in PR activities. The Ishinomaki RCHP attracted the attention of many media and other organizations as the only medial institution that worked in the Ishinomaki area. Under these circumstances, the hospital continued to actively communicate information to the entire world on the damage caused by the earthquake, the lack of food at the hospital, and the medical relief work performed there. In February 2012, in recognition of the unprecedented PR activities the [Front of the CD jacket] [Back of the CD jacket] 290

318 hospital carried out at the time of disaster, JRCS added a special honor to the Motto Cross! Prize and presented a Platinum Prize to the hospital. (3) Survey of PR effects in FY2011 Each year, after the Red Cross Movement Campaign in May, JRCS conducts an online questionnaire survey of 2,000 persons on the effects of its PR. This survey is designed to assess the image of JRCS, the reach of its newspaper advertisements and TV commercials among readers and viewers, and their support ratings. The FY2011 survey items included how much cooperation the respondents extended in terms of Gienkin and whether those who cooperated in Gienkin also provided activity funds. Due to the effects of the GEJET disaster relief was the best known among JRCS s activities, and 77% of respondents (up 14% compared to the previous year) said that they knew about it. The number of those who replied that they had seen an article on JRCS through media such as newspapers, TV, and the Internet rose sharply, from 37% in the previous year to 57%. However, the percentage of those Red Cross members who cooperated in Gienkin was less than 20% with 80% of donors not being a Red Cross member yet. Asked whether they wished to become a Red Cross member, they donate for activity funds, and support JRCS in the future, 60% of those who cooperated in Gienkin replied that they wished to support JRCS or that they might wish to do so. Just because it attracted greater public attention and gained greater public trust through the earthquake, JRCS realized that it needed further PR activities for its activity funds and approach to the general public to obtain more Red Cross members. crisis management. PPRO also asked them to carry out a survey of awareness among Gienkin recipients so that the survey results could be used for briefing materials for donors, and this led to effective external communications in the subsequent months. (5) Events to collect Gienkin donations As part of its five-year campaign to commemorate the 150th anniversary of the foundation of the ICRC, JRCS had planned an event to make Red Cross activities known to the public, and since 2009 it had held it in Harajuku Omotesando area of TOKYO in May of each year. In 2011, out of recognition that it should actively support earthquake victims, the JRCS carried out an event to appeal for recovery support in cooperation with the store owners in this area from May 1 to 13. During the event, boxes for the collection of Gienkin were installed at the shops with the logo and campaign flags hoisted in the area, and on May 7 and 8 the campaigners called for Gienkin in the street and collected messages of encouragement for those in the affected areas (All messages thus collected were posted on the panels). These message panels were put up at evacuation centers in FUKUSHIMA (Azuma gymnasium) and at the Ishinomaki RCHP in early June. (4) More effective PR consultations Since the launch of the Motto Cross! Campaign, PPRO had continued to seek advice from PR consultants, and prior to the earthquake it considered engaging them to come to our office once every two weeks in FY2011. Following the spread of unfavorable reports and wrong rumors after the disaster such as misunderstandings concerning Gienkin, however, PPRO asked PR consultants to come to our office three times a week (once a week after November 2011) and requested them to conduct surveys of trends in media coverage and sought advice on how to respond to the mass media, call press conferences, and maintain public relations at the time of [Messages of encouragement for the earthquake-stricken areas from people walking along the street between HARAJUKU and OMOTESANDO in TOKYO] 291 Chapter 11 Public-Relations ActivitiesGreat East Japan Earthquake and Tsunami