One woman died Tuesday and at least 23 others are suspected of suffering so-called economy-class syndrome after evacuating from their homes in the wake of last week’s deadly earthquakes in Kumamoto Prefecture, authorities said.

The health consequences of the 2016 Kumamoto Earthquake, which refers to a series of quakes, could be far more severe than initially anticipated, as survivors struggle with an unusually large number of powerful quakes as well as prolonged evacuations.

The flurry of quakes includes a magnitude-6.5 “foreshock” that struck Kumamoto Prefecture on Thursday night and the powerful magnitude-7.3 jolt early Saturday morning.

On Monday at 8:41 p.m., a large temblor that registered a strong 5 on the Japanese intensity scale of 7 hit the city of Aso in Kumamoto and the western part of Oita Prefecture.

Meanwhile, a man and a woman were reported dead after a mudslide hit the village of Minamiaso, Kumamoto Prefecture, over the weekend, raising the death toll to at least 47 since Thursday.

The man was identified as Takanori Torii, 42, from Kagawa Prefecture. The female victim has not yet been identified.

As of Tuesday morning, at least 100,000 people in Kumamoto and Oita prefectures remained uprooted, with many staying in temporary evacuation centers or living in their cars.

The 51-year-old woman from the city of Kumamoto who died from economy-class syndrome had been sleeping in a car, according to the city’s fire department. She was taken to the Kumamoto Medical Center by ambulance on Monday morning.

Separately, at Saiseikai Kumamoto Hospital in the city of Kumamoto, 10 people were diagnosed with economy-class syndrome. Two were reported to be in a state of cardiopulmonary arrest.

Economy-class syndrome refers to the formation of blood clots in veins deep within the legs. In medical terms it is known as deep vein thrombosis.

The condition often affects people during or just after long flights, especially those traveling in economy class where leg room is limited. The syndrome is not limited to air travel as it is known to occur when people remain in the same position for a long period.

Experts say the elderly, people with obesity problems, pregnant women and those who have just given birth, as well as diabetes patients and those with high blood pressure, are particularly vulnerable.

Deep vein thrombosis can be fatal if blood clots travel through the bloodstream and block blood flow in the lungs.

Tatsue Yamazaki, an associate professor of disaster nursing at Tokyo Medical University, said the syndrome can afflict not only people sleeping in cars, but those staying in temporary shelters.

Yamazaki, who visited disaster areas in Kumamoto Prefecture over the weekend, said many people are staying inside cars or outdoors either because the shelters are overcrowded or because they have been traumatized by the huge tremors and are trying to minimize any chance of being crushed under structures.

Yamazaki advised people to drink lots of water, and to move and massage their legs whenever possible.

“It’s important to know that deaths from economy-class syndrome are preventable,” she said.

Meanwhile, local officials are calling for the continued emergency dispatch of doctors from around the nation.

Teams of emergency care specialists, including the Disaster Medical Assistance Team (DMAT) and Japan Medical Association Team (JMAT), have been deployed to the disaster zone.

On Monday, around 300 teams of medical professionals carried out relief activities across Kumamoto Prefecture.

DMAT, organized by the health ministry and consisting of doctors, nurses and other medical workers, specializes in emergency medicine immediately after disasters, while JMAT, organized by the Japan Medical Association (JMA), cares for patients over a longer period until local hospitals can start functioning again.

JMAT and DMAT are coordinating their responses to provide seamless care in the affected areas.

Another team of disaster specialists, the Disaster Psychiatric Assistance Team (DPAT), organized by the central government and tasked with providing psychiatric care, has also been called into action.

An official of the JMA said patients in serious condition and those with acute medical needs, such as dialysis patients, are given priority and many have already been transported to facilities in Fukuoka and Saga prefectures.

The official added that psychiatric care is in immediate high demand.

“As some psychiatric hospitals were damaged by the quake, many patients have been moved into evacuation centers and other places,” the official said. “We’ve heard from DPAT members they don’t have enough manpower to provide all the necessary care.”

Dr. Takashi Nagata, who has visited displaced people living in temporary shelters in the city of Kumamoto as a JMAT member, said sanitary conditions in some shelters are poor, noting that some children are suffering from asthma.

Information from Kyodo added.

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