What a cruel disaster that swept Japan on 22 March 2011. I have been watching it closely and have been in touch with friends and colleagues in the Japanese Red Cross and IFRC. It is pleasing to see some of my old friends such Dr Jeyathesan Kulasingam, the IFRC’s health and psychosocial support delegate, with experience of the Sichuan earthquake operation in China, joining the efforts of the JRCS. Jeya and I worked together during the tsunami operation in Indonesia. Patrick Fuller was the first in from the IFRC giving out crucial reports in those first 10 days and he has now been replaced by Kathy Mueller, who I worked alongside during the west Sumatra earthquake in late 2009. I post one of her recent articles later on. I have just heard that one of our best writers John Sparrow is currently en route to Japan to cover the tsunami and earthquake. The stories of rescue and immediate relief are dramatic, but now 16 days later the emphasis is shifting as needs and priorities change. Here is the latest:
Japan: Relief provided by Red Cross is more than just food and blankets
The article I post is by Sayaka Matsumoto, Japanese Red Cross Society and Francis Markus, IFRC
Even as a trained psychosocial nurse, Akemi Nitta is at a loss to try to capture in words the overwhelming impact of the emotions she faced, supporting grieving survivors as they identified the bodies of loved ones in the Japanese Red Cross Society’s hospital in Ishinomaki.
“I don’t know what words I can use to describe those people’s situation best. Whatever words we have used to talk about previous disasters, these descriptions seem totally inadequate to describe this situation,” she says.
For more than a week, Nitta worked as part of an eight-member team of dedicated psychosocial workers in the hospital following the disaster. One of their primary responsibilities was looking after the families, whose loved ones were assigned a black tag in the triage process, meaning that they were deceased.
“It’s not a matter of accepting or not accepting this person’s death; people don’t have a choice. They just have to face the situation,” says Nitta who has now returned to Yamanashi Red Cross hospital.
Amid the despair and numbness, there were shades of hope and comfort. In one family, a son brought the body of his 70-year-old mother to the hospital, not knowing whether his brothers were alive or dead. The next day, they appeared at the hospital, having heard that their mother was there. “She brought us here to meet up again,” one of the siblings said.
With nowhere else to lay bodies but in the car park of the hospital, some families want to take their loved ones back to a resting place at home. For many, however, nothing was left of their home after the tsunami.
The Japanese authorities, right across the disaster region, have to bury bodies rather than cremate them according to local tradition, simply because too many have lost their lives in this disaster. In such a situation, it’s all too easy for even trained psychosocial workers to feel inadequate.
“I could only do my best, that’s all I can say. I was beside the families and I felt affection for them and I cried. According to our psychosocial manual, the care giver can cry, but should try not to break down in tears,” Nitta says.
Many of the sources of comfort that help people come to terms with the death of a loved one are simply impossible to find in the aftermath of a tsunami, such as looking at a picture of a loved one or hearing their last words.
“The hurt of the people in this situation is so great, they can’t feel anything. So when things return to normality a bit, the emotions will burst out. People will feel anger, sadness and frustration that they can’t take anywhere. At that stage, there should be somebody or some system there to receive those emotions.”
Helping to plan the future roll-out of psychosocial support in the aftermath of this disaster is where psychology professors Kazuki Saito and Jun Maeda come in. They have just returned to Tokyo for consultations at the headquarters of the Japanese Red Cross after establishing a rotating system of psychosocial support teams at Ishinomaki.
“After most disasters Japan has experienced in the past, provision of basic relief is established within one to three days. This opens the way for survivors’ emotional reactions to be addressed through psychosocial support,” says Saito. The scale of devastation and the displacement experienced after the earthquake and tsunami in the north-east of Honshu Island made it impossible to wait until people’s physical situation stabilized, so relief and psychosocial support were delivered simultaneously.
Despite all of their experience, including the 2004 Indian Ocean tsunami and Hurricane Katrina in the United States, nothing could have prepared Saito and Maeda for what they saw on reaching Ishinomaki, in the heart of the tsunami-battered prefecture of Miyagi two days after the disaster.
“We saw 20 dead bodies on a concrete floor, we saw the civil defence forces lining up bodies by the roadside,” says Saito. Despite the calm and professional demeanour of both men, it is impossible not to be affected by such experiences.
Clearly, the psychosocial welfare of Japanese Red Cross Society’s own psychosocial support personnel is itself an issue needing careful attention. Mr Saito says that when staff finish their rotations, they will be asked to fill in a questionnaire to give a picture of their own emotional state.
Experts say that it’s important to recruit local people to carry out psychosocial support in order for them to be able to relate to survivors in their familiar dialect. There’s also a need to ensure that the techniques are adapted, as a high proportion of the survivor population are elderly.
“It’s important to introduce community activities such as exercises, as well as their normal habits such as chatting and drinking tea. Older people also need health advice because that is their worry. But they also need some peaceful time too,” says Dr Jeyathesan Kulasingam, the IFRC’s health and psychosocial support delegate, with experience of the Sichuan earthquake operation in China, where the welfare of the elderly was also a major concern.
It’s understandable that psychosocial support will be a vital part of the humanitarian operation as Japanese Red Cross Society gears up to meet the needs of the hundreds of thousands of survivors of this disaster, not just in the immediate aftermath, but in the coming months and even years.
Japan: Red Cross teams fuel hope for survivors
The tsunami caused by the earthquake that struck of the coast of Japan on 11 March devastated more than 70 kilometres of coastline in Iwate prefecture in northeastern Japan. This photo was taken in Yamada town. (Photo: Katherine Mueller, IFRC)
Kathy Mueller talking to earthquake affected children after West Sumatra earthquake in 2009. Photo: Bob McKerrow
“The lack of fuel is a major problem for us. It is hampering our ability to assess, and is thereby making it difficult for us to get the full picture.”
“It’s frustrating. A lot of people want to volunteer. They want to help, but there is no fuel to get them where help is needed most.”
“Some buses are operating again, but sporadically. Because of bad road conditions and limited access to fuel, they can’t run their usual routes.”
These are just some of the comments made by emergency personnel from the Japanese Red Cross Society, who are trying to assist the hundreds of thousands of people devastated by the 11 March earthquake and tsunami.
Iwate prefecture was one of the areas hardest hit. Located several hours’ drive north of the epicentre, 70 kilometres of its coastline was obliterated by the ten-metre-high wave. Electricity, for the most part, is still out. Water pipes were broken along the entire length of the affected area. There are 2,773 confirmed dead in this prefecture alone; another 5,000 are still missing; and about 370 evacuation centres have been set up to house the 45,000 survivors – many as young as two and others in their eighties.
“People are definitely relieved to see us,” says Hidenobu Yokomatsu, a Red Cross logistician. “But it’s a major challenge for us to try to meet their needs. Whether it’s medical care or clothing, we just don’t have access to the amount of fuel needed to carry out such a large relief operation,” he continued.
The situation should improve soon – one of Japan’s largest oil refineries, in Yokohama, has recently resumed operations and will provide 270,000 barrels of oil a day. Whilst this is expected to significantly ease the current fuel shortage, the benefit is not being seen at the petrol pumps just yet.
As we leave Tokyo and head closer to the disaster zone, the longer the queues at service centres, some stretching for up to 2 kilometres. Some petrol stations have closed completely, whilst others are giving priority to emergency vehicles, including the Red Cross, although we too are rationed and only allowed to fill up with 10 litres at a time.
Fuel isn’t the only road block for those trying to help. Bad weather has grounded the helicopters that were delivering supplies. It snows on a daily basis, with temperatures hovering above the freezing mark, and evacuation centres often have little or no heat. Children run and play to keep warm. The elderly wrap themselves in blankets; the Japanese Red Cross Society has distributed about 125,000 already.
Despite all these challenges, progress is being made. Many evacuees are now getting three meals a day. Thousands are returning home as electricity is restored, and the government has started building more than 33,000 temporary shelters. Optimism about the future, however, is also in short supply.
“It’s very hard to see the reality. It is overwhelming,” says Hidenobu Yokomatsu. “We feel for the people. You can’t get that from watching the images on television. A young man came up to me the other day and asked: ‘How do you see the situation? Is there hope?’ I had no answer for him.”
For an excellent update from CNN, CLICK HERE: LATEST EQ AND TSUNAMI
This week the President of the IFRC and Japanese Red Cross, wrote this very moving letter to all member countries of the IFRC.
This provides fascinating background information on the earthquake and Tsunami:
On 11 March at 2:46pm a huge earthquake of magnitude 9.0 on the Richter scale struck off the coast of Sanriku (lat. 38.0 N, long. 142.9 E). The quake reached level 7 on the Japanese seismic scale - the highest level possible for that 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, each one followed by a tsunami alert.
The north-eastern coast of Japan has long been prone to tsunamis and is known for the most advanced level of preparedness for such events in the world. Such preparedness includes solid and high banks, shelters for evacuation, warning systems and evacuation drills for the anticipated worst case scenario. But 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 systems. 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 the people, 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 areas 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 Defence Forces teams, medical teams, fire brigade units and ambulances. The Japanese Red Cross Society also dispatched its own 14 disaster relief teams to the three affected prefectures within first five hours. As of 21 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 these function as base-camps to receive 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 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 Ishinomaki 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” situation. Yet, paradoxically, not many were injured directly by the tsunami. Therefore, the well-organized 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 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 21 March, 8,649 people are dead, 13,262 people are still missing and 2,644 people are wounded, and 14,637 buildings have collapsed. There are 2,113 evacuation centres up-and running and accommodating 349,349 people. From the beginning of our operation, we have faced large operational challenges, such as limited information due to 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 conditions that 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 centres gradually by mobilizing the power of volunteers.
An international liaison/support team was sent to Japan, consisting of the secretariat, 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 four 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 since these nuclear power plants are not small producers of electricity for Tokyo and the 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 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 specialized hospitals in Hiroshima and Nagasaki in the area of medical services for the radiation-exposed. They are on stand-by 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 a real-time basis.
This disaster is without doubt unprecedented in terms of the scale of damage and its comprehensive nature. In such a situation, I can never feel that our relief effort is good enough. Rather, I strongly feel that we should do more in terms of 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 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 the global Red Cross Red Crescent family 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 a 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.