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The severe conditions facing evacuees from the series of quakes in Kumamoto Prefecture are starting to take a heavy toll on the health of the residents who were forced to flee their homes. On Wednesday the prefecture reported that 11 people have died of health problems related to evacuation from the quakes. As protracted evacuation appears inevitable given the extensive damage caused by the temblors and the continuing aftershocks, the authorities should take steps to move the evacuees out of the disaster areas to ensure their safety and health.

The reported death of a 51-year-old woman in the city of Kumamoto due to “economy-class syndrome” — or deep-vein thrombosis — points to the potential health risks for the tens of thousands of people taking shelter outside their homes since their residences were either destroyed or damaged or they fear further damage from the aftershocks. The woman was among an unknown number of evacuees who are sleeping in their cars to avoid the overcrowded public shelters.

Nearly a week after the first of the chain of powerful quakes hit Kumamoto on April 14, over 100,000 people in that prefecture alone remain evacuated, though the number has fallen from the peak of roughly 180,000 after the biggest temblor hit early Saturday. The figure may not go down significantly anytime soon, since aftershocks continue with an unusual intensity and frequency. The total number of quakes to hit the area has topped 700 and rising, and the Meteorological Agency says it’s hard to forecast the trend of seismic activity in the days ahead.

Kumamoto Prefecture estimates that at least 3,500 houses and buildings have been destroyed or damaged. But the municipal office of Mashiki — located at the epicenter of the first quake — says it has confirmed 5,400 crushed or crippled structures in that town alone, or roughly half the municipality total. Damage from the quakes have not been adequately assessed in many of the areas that sustained extensive devastation from the temblors, which have also caused massive landslides, destroyed roads and bridges and crippled railways.

Public facilities such as gyms and halls serving as shelters for the evacuees are overcrowded, and hygiene concerns are reportedly growing at many such centers where water supplies remain insufficient. Many evacuees are choosing to stay out of such shelters due to privacy and other concerns, instead sleeping in their cars — which are parked everywhere from sports fields and store parking lots to roadsides.

The Kumamoto woman was reportedly sleeping in her car parked outside her house. She collapsed when she got out of the vehicle Monday morning and died of pulmonary embolism, also known as a lung infarction. There are reports than more than a dozen other people have been diagnosed with economy-class syndrome — so called because it often affects people during or after long flights who are sitting in economy-class seats with limited leg room — at several hospitals in Kumamoto. The syndrome, in which blood clots are formed in veins deep within the legs after people remain in the same position for a long period, can be fatal if the clots travel through the bloodstream and block blood flow in the lungs.

The problem was highlighted when it claimed the lives of some of the evacuees in the 2004 Niigata earthquake — which was similarly marked by large numbers of aftershocks that led many people to take shelter in their cars for days. While Kumamoto Prefecture says it has no idea how many of the evacuees are sleeping in cars, the town of Mashiki estimates the number at 10,000 in the town alone, or nearly one-third of its population. But experts say the syndrome can affect not just people sleeping in cars but those who stay for days in crowded evacuation shelters. And it is only one of the health hazards for the evacuees who are exhausted and stressed out after being forced out of their homes for days.

Efforts continue to restore lifelines like gas and electricity in the quake-ravaged areas. On Wednesday, Kyushu Shinkansen superexpress services were partially resumed, following the resumption of some flights to and from Kumamoto Airport on Tuesday. Help is arriving, including emergency supplies such as food as well as doctors. But there will be limits to such aid coming in from outside the disaster zone.

It is known from past experiences with large-scale disasters, such as the 2011 Great East Japan Earthquake and tsunami, that extended evacuation can take a heavy toll on peoples’ health, especially the elderly and those suffering from illnesses. Exacerbating the problem are the continuing strong aftershocks in Kumamoto, which are keeping evacuees in a state of constant fear.

It’s time to consider moving at least the most vulnerable evacuees out of the quake-hit areas. The government said it has secured roughly 5,000 rooms in hotels and inns, public apartments and commercial properties to accommodate elderly and disabled evacuees. It should also work together with municipalities and other public institutions that can potentially provide safe shelter for the Kumamoto evacuees.

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