Severe natural disasters take a heavy toll on the health of the survivors. At least nearly 5,000 people died of indirect causes linked to disasters during the Heisei Era, such as illnesses exacerbated by difficult conditions in evacuation shelters, the heavy stress from the radically changed living environment and suicides among evacuees, according to a recent tally by Kyodo News. These are lives that might have been saved if their problems had been properly addressed. It is incumbent on the government to gather data and analyze these deaths to find out what needs to be done to reduce them in future disasters.

The problem of people dying from indirect causes of natural disasters came under the spotlight following the 1995 Great Hanshin Earthquake, in which more than 900 people who survived the temblor that devastated Kobe and its vicinity died after being evacuated — partly due to an outbreak of influenza in the shelters. People who have died of indirect causes are officially recognized as disaster victims through the screening process by local authorities if relatives step forward and apply for condolence money. The number of such deaths is believed to be much larger than the officially recognized figure, however, because some victims who should have qualified were rejected by authorities and because some relatives simply fail to apply for the recognition because they are unaware of the system.

Even though the problem has been identified for some time now, no national government body keeps track of the number of indirect deaths or the reasons behind them. Kyodo compiled the tally — 4,958 — by contacting the local governments where the disasters took place. As a result, efforts to study the circumstances behind the indirect deaths with the aim of preventing health-damaging effects among disaster survivors, such as improving conditions in evacuation shelters, remain slow.

Following the March 2011 Great East Japan Earthquake, which left more than 18,000 dead or unaccounted for, roughly 3,700 people have been recognized as victims of indirect death, including 2,250 in Fukushima Prefecture, where large numbers of people were forced to move from one evacuation shelter to another due to the radioactive fallout from the meltdowns at Tokyo Electric Power Co.’s Fukushima No. 1 nuclear power plant.

When a major disaster strikes, gymnasiums in local schools and public halls are often turned into emergency shelters — in many cases evacuees sleep with little privacy on blankets laid out on a crowded floor.

Some steps have been taken in recent years to improve conditions for evacuees, such as providing makeshift beds and improving hygiene conditions in the shelters. When a series of big earthquakes hit Kumamoto Prefecture in 2016, however, many people whose homes were damaged chose to sleep in their cars — avoiding crowded public shelters — and suffered from so-called economy-class syndrome, or deep vein thrombosis.

In the Kumamoto quakes, the number of people who died of indirect causes topped 200 — four times more than those who were crushed to death under collapsed houses and other buildings or buried by landslides caused by the temblors.

The health of evacuees can deteriorate — particularly among elderly people who suffer from chronic illnesses — when they are confronted with sudden changes in environment or dietary habits. Some elderly evacuees reportedly won’t drink a sufficient amount of water because they don’t want to use dirty toilets in the shelters, and consequently suffer dehydration and conditions that make them susceptible to blood clots.

The heavy stress of experiencing the disasters following by rough conditions in a public shelter risk raising blood pressure, possibly causing stroke or a heart attack. Experts point out that deaths among disaster evacuees can be reduced significantly by providing them with better beds, making sure shelter toilets are sanitary and ensuring that emergency food is nutritious.

If the mega-earthquake that is predicted to take place in the Nankai trough off the Pacific coast should strike, a massive number of people will likely be forced into public evacuation shelters over an extended period of time. Improving conditions for the evacuees in those shelters, and thereby reducing the potential causes of secondary health damage, will be an urgent challenge. Toward that end, the government should start by reviewing past cases of survivors who died of indirect causes linked to the disasters to find out what could have been done to save their lives.

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