thThe 17 Annual Conference of TIEMS(The International Emergency Management Society)
June 8-12, 2010, Beijing, China

CLARIFYING THE SITUATION OF THE VICTIMS WITH
SPECIAL NEEDS ON EVACUATION SITE USING THE 7
LIVELIHOOD DOMAIN MODEL
Keiko Tamura
Risk Management Office, Niigata University, Japan1

Reo Kimura
Graduate School of Environment and Disaster Research, Fuji Tokoha University, Japan2

Munenari Inoguchi
Research Center for Natural Hazard and Disaster Recovery, Niigata University, Japan3

Haruo Hayashi
Disaster Prevention Research Institute, Kyoto University, Japan4

Keywords
Victims with Special Needs, the Niigataken Chuetsu-oki Earthquake in 2007, 7 Livelihood
Domain JACCW Model, Social Welfare, Risk Management

Abstract
The rapid pace of aging in Japan implies that the number of elderly persons requiring special
care will also increase rapidly in the time of disasters. The sure sign of this state was seen in
the recent two disasters occurred in Japan, which were received public attention as a social
problem of suffering of the elderly. In the 2004 Niigata Flooding twelve of 15 fatalities wereover 65 years. The Mid-Niigata Prefecture Earthquake caused over 1000 elder refugees
staying in emergency shelters, who needed nursing care.
The Victims with special needs require the support for going through each phase; 1) move toevacuation site, 2) live in evacuation shelters, 3) live in temporary housings, 4) rebuild the life.
The final destination of those supports must be the self-reliance efforts to realize rebuild thelife after disaster; however, the process is never planned as the whole. At the time of the
Niigataken Chuetsu-oki Earthquake in 2007 the local governments properly applied theirexperiences of the past two disasters to realize the intensive care of the victims with special
needs through the whole process of rebuilding the life after disaster1

Address: 8050, Ikarashi Nino-cho, Nishi-ku, Niigata city, Niigata 950-2181, Japan
Tel: +81-25-262-6115, E-mail: tamura@gs.niigata-u.ac.jp
2
Address: 325, Obuchi, Fuji city, Shizuoka, 417-0801, Japan
Tel: +81-545-37-2030, E-mail: reo@fuji-tokoha-u.ac.jp
3
Address: 8050, Ikarashi Nino-cho, Nishi-ku, Niigata city, Niigata 950-2181, Japan
Tel: +81-25-262-6252, E-mail: inoguchi@gs.niigata-u.ac.jp
4Address: Gokasho, Uji city, Kyoto 611-0011, Japan
Tel: +81-774-38-4273, E-mail: hayashi@drs.dpri.kyoto-u.ac.jp

This study clarified the situation of the victims with special needs especially in the phase ofliving in the evacuation shelters through the activity of Japan Association of Certified Care
Workers, which sent the professional volunteers to the disaster-stricken area of the Niigataken
Chuetsu-oki Earthquake in 2007. We interviewed some of them to build the hypothesis andsurveyed 50 of them to clarify the situation on the evacuation site. We also found the 7
Livelihood Domain JACCW Model could be used as the framework to support the victims
with special needs after the disaster.

Sections
1. Support for victims with special needs during disasters in JapanThe fact that elderly persons accounted for more than half of the victims of storms and floods
in Japan in 2004, and that the nation officially entered the era of the so-called "super-agedsociety" (i.e., those aged 65 or above accounting for 21% or more of the total population) in
2007, have prompted Japan to work towards establishment of a system for providing
evacuation support and other assistance to the elderly and other victims with special needs attimes of disaster. Between 2005 and 2007, the Cabinet Office announced a series ofguidelines for local authorities to follow in terms of assisting victims with special needs
during disasters.
The Niigataken Chuetsu-oki Earthquake, which struck in 2007, saw implementation ofproactive and innovative measures to assist victims, particularly those who are vulnerable. A
Local Welfare and Health Headquarters was established in a health center in the disaster area
(Kashiwazaki City) where volunteers specializing in the fields of medicine, health, andwelfare assisted victims, focusing on vulnerable persons. The main measures were: 1)
establishment of nine welfare evacuation centers to assist the lives of vulnerable persons asevacuees, and 2) a health and welfare requirements survey conducted on all households inareas where damage was severe in order to ensure the safety of those afflicted by the disaster
who remain at home.
In the Chuetsu Earthquake of 2004, volunteers with specialist knowledge entered theafflicted area mostly autonomously, and staff from local municipal authorities independently
coordinated the activities of volunteers. While the support offered by the specialist volunteers
were extremely effective for the victims, the role of managing the volunteers fell on local
municipal authorities, and the disjointed nature of contact between the volunteers and theauthorities made it difficult to strategically coordinate the relief effort. With suchcircumstances in view, the Niigataken Chuetsu-oki Earthquake in 2007 saw the prefectural
authorities establish a Local Welfare and Health Headquarters and actively recruited specialist
volunteers through industry organizations with an aim to strategically provide support forvulnerable persons while coordinating the overall relief effort. As a result, the relief measures
were implemented with the participation of a total of 2,100 specialist volunteers in 19 days.

2. Assistance for victims who remained at home
The Local Health and Welfare Headquarters placed the confirmation of the safety of victims
who remained at home as its first priority, and conducted a health and welfare requirements
survey. All 24,424 households in the 15 particularly heavy-hit districts in Kashiwazaki City
were surveyed over 19 days from July 21 to August 8. The survey was conducted by total of
1496 researchers, comprising health nurses, social workers, care workers, and teaching staff
from nursing schools amongst others, divided into 720 teams (the majority of researchers
were health nurses). As a general rule, a team comprising a pair of researchers visited ahousehold with a pre-written questionnaire to obtain information such as previous medical
histories, current medical treatments, and presence of any subjective symptoms with regards
to the respondents and their families, and took separate details of any individuals who
required assistance so as to ensure that they receive the necessary service. The survey

contributed in particular to the discovery of 293 individuals who required assistance as amatter of priority.
The results of the survey conducted in Kashiwazaki City revealed that the main issues facing
those who required assistance were as follows:[Care] Difficulties caused by service usage restrictions, inability to contact care manager.
[Mental health care] Insomnia, depression[Medical Service] Interruption to medical treatment, worsening of chronic conditions[Parenting] Child regression, child anxiety[Disabilities] Uncertainties of being at home after leaving care facilities[Intractable Diseases] Care difficulties even for day service / day hospital users<Others> Problems with daily life (e.g. unable to bathe / tidy) etc.
Intractablediseases
1%
Disabilities
5%

Others
16%

Care
32%

Parenting5%
Medical service
17%
Mental health
care
24%

Figure1. The results of the survey conducted in Kashiwazaki City

3. Dealing with vulnerable persons at evacuation centers
Welfare evacuation spaces, which have a better environment in comparison to regular
evacuation spaces, are facilities that are set aside for use by those who require special
assistance at times of disaster. Specifically, welfare evacuation spaces are allocated one
specialist for approximately every ten vulnerable persons, and items required by vulnerable
persons are provided by the state. However, as of 2007, advance designations of welfare
evacuation centers had not been in progress. This was because local authorities lacked
understanding of the type of environment required due to lack of previous experience. In theaftermath of the Chuetsu-oki offshore earthquake, Niigata prefectural authorities and the local
municipalities in the afflicted area actively worked to secure welfare evacuation spaces,
resulting in the establishment and operation of nine welfare evacuation centers. These
welfare evacuation centers were used over a total of 46 days by 2335 people. The Chuetsu oki earthquake was the first full-scale establishment of welfare evacuation centers in Japan.

4. Activities of specialist volunteers
In this paper, the situation surrounding persons requiring special assistance during disasters
in terms of evacuation life assistance is uncovered through activities of volunteer care
workers from the Japan Association of Certified Care Workers (JACCW) who worked in theareas afflicted by the Niigataken Chuetsu-oki Earthquake. The JACCW is a professional
body of nationally certified care workers who, as specialists in the care industry that supports

the aging society, engage in care services for the elderly and the disabled in care facilities andhospitals or through home care 5). The JACCW's activities in the areas struck by the Great
Hanshin Earthquake in 1995 prompted it to commence dispatchment of disaster relief
volunteers. A group interview was conducted on several care workers who worked as
specialist volunteers in disaster-afflicted areas in order to comprehensively uncover theconditions of evacuation lives of victims, particularly those of persons requiring special
assistance, as observed by the workers through their activities in the afflicted areas.
The seven livelihood domain model, proposed by the JACCW, are used to model concepts
that represent the target framework for supporting those requiring special assistance. In
addition to food, clothing, and housing, which represent the fundamentals of living, the model
further assesses physical health, mental health, family relationships, and social relationships
in order to establish the state surrounding the mind and body as well as the family and social
backgrounds of users. These are used to analyze the causes and backgrounds of difficulties
facing the users in order to deliver solutions. From the point of victims, disasters are events
that destroy or alter their lives. After saving the lives of the victims in the aftermath of thedisaster, there is a need to comprehensively and objectively determine, using the seven
livelihood domain model, aspects of their livelihoods that still have potential and areas where
they require assistance in order to recover.
Table1. Activity areas of Care workers
Assistance

Activity

Prevention Prevention of disuse syndrome
Assistance in bathing by undressing and dressing themBathing Assistance in bathing by guiding them
Direct assistance in bathing
Detect Communicating with the victims to establish their needs
Participating in the survey to establish the needs of those who remained at home
needs
Assistance in taking fluid after bathing
Bathing Assistance in setting table
Assistance in cleaning table
Environment Assistance in organizing environment in shelters
Toileting Assistance in toileting by guiding themBathing Keeping watch at the time of bathing
Disseminating food and materials
Eating Direct assistance in having food
Making observations about the health condition
Bathing Assistance in dry bathing
Prevention Assistance in exercising for care prevention
Direct assistance in toileting
Toileting Assistance in cleaning up portable toilets
Making observations about the health condition
Bathing Making observations about the health condition

#

24
20
19
16
15
13
12
12
10
9
8
8
7
6
6
6
6
5
5
4
2

%
48
40
38
32
30
26
24
24
20
18
16
16
14
12
12
12
12
10
10
8
4

5. Details of activities of specialist volunteers
Fifty individuals who participated as care work assistance volunteers were asked about thelocation and details of their activities. It was revealed that 37% of the respondents
participated in care work support in regular evacuation centers, 23% participated in care work
support in welfare evacuation centers, 21% participated in the safety confirmation survey
conducted on victims who remained at home, and 10% participated in care work support incare facilities and institutions.
The 50 individuals who participated as care work assistance volunteers were asked "Whatspecific activities did you participate in?" to obtain responses about the types of activities thatthey carried out in the afflicted areas. The responses were arranged in order of frequency anddivided into categories. The activity that the largest number of volunteers participated in wasprevention of disuse syndrome (24 respondents), followed by assisting patients in bathing byundressing and dressing them (20 respondents), guiding them (19 respondents) and throughdirect assistance (16 respondents). This was followed by communicating with the victims toestablish their needs (15 respondents) and participating in the survey to establish the needs ofthose who remained at home (13 respondents). The effective method of bathing assistance isfor the carer to provide comprehensive assistance from undressing and dressing, guidance,
direct bathing assistance, hydration, and keeping watch, to making observations about thehealth condition of the patient, with the same carer making continual observations over an
extended period of time; however, the questionnaire revealed that this type of assistance was
not necessarily made available in the disaster-afflicted area.

6. Status of disaster victims in terms of the seven livelihood domains.
The Japan Association of Certified Care Workers (JACCW) established the concept of thelivelihood domain model for defining its sphere of activities. The Model is called “The 7
Livelihood Domain Model”, which consisted of 7 elements should be focused on; Clothing,
Food, Housing, Physical Health, Mental Health, Family Relationship, Social Relationship.
We also found the 7 Livelihood Domain JACCW Model could be used as the framework to
support the victims with special needs after the disaster.

In a time ofDisasterSocialRelationship

FamilyRelationshipTHE 7 LIVELIHOODDOMAIN MODEL

Clothing

災害
要素

Food

Victims
MentalHealth

Housing
Physical
HealthFigure 2. The conceptual scheme of Care Workers

6.1. Clothing
Lack of access to clean clothes was the issue that was most commonly cited by care work
support volunteers as a problem that faced disaster victims, with 46% of the total considering
it to be a problem. While laundry facilities were available in some evacuation centers, they
were not in others, and this was the only response which almost 50% of all respondents
regarded as an issue that required addressing.
Table2. Victims’ condition (Clothing)Victims' Condition （Clothing）

Lack of access to clean clothes
Lack of any change of clothes
Unable to purchase any clothes

%
46
24
20

6.2. Food
There were no aspects which more than 50% of all respondents thought to be a problem forthe disaster victims. The most commonly cited problem was that the food was not
nutritionally balanced (38%), followed by the supplied food not catering for restrictive diets(34%).
Table3. Victims’ condition (Food)
Victims' Condition （Food）%

Food was not nutritionally balanced
Supplied food not catering for restrictive diets
Unable to purchase any foodNot to drink enough fluid
Pattern of meals is not suitable for victims
Way of conserving food was not appropriate
No opportunity of setting/clearing table by oneself

38
34
24
18
18
14
10

6.3. Shelter
The issue that was most commonly cited by care work support volunteers to be a problem
facing disaster victims was the lack of privacy, with 64% of all respondents considering it to
be a problem. This was the only response that more than 50% of the respondents regarded as
an issue that required addressing.
Table4. Victims’ condition (Housing)Victims' Condition （Housing）

Lack of privacy
No enough bedding to maintain good health
Not well-establised living space for each victim
Temperature or humidity was not appropriate
Not good enough condition for Moving around
Living space in the condition of poor hygiene
There was the difference in level on the floor

%

64
28
26
18
16
12
10

6.4. Physical healthWith regards to physical health, the issue that was most commonly cited by care work
support volunteers to be a problem facing disaster victims was the lack of opportunity tomove the body. This was considered to be a problem by 52% of all respondents. This was
the only response which almost 50% of all respondents regarded as an issue that required
addressing.
Table5. Victims’ condition (Physical Health)Victims' Condition （Physical Health）

Lack of opportunity to move the bodySuffering poor health
Lack of access to primary care docto
Lack of enough opportunity of bathing
Having problem in excreting
Having diseases
Having pain

%

26
20
17
17
12
11
10

6.5. Mental health
Insomnia caused by anxiety was the issue that was most commonly cited by care work
support volunteers to be an issue facing disaster victims, with 56% of all respondents
considering this to be a problem. This was followed by build-up of stress due to unfamiliarity
with communal living arrangements. Insomnia caused by anxiety was not particularly
discussed in detail during the group interview, but many respondents raised this issue.
Table6. Victims’ condition (Mental Health)Victims' Condition （Mental Health）%

Insomnia caused by anxiety
Getting stressed out to living togher in shelters
Feel unmotivated because of protracted life as evacuees
Remain deep in the shock by the earthquake
Feel conflict because of expecting return to the condition before theearthquake but it was impposible
Be left bihind out of the movement toward rebuilding their lives
Want to discuss about their problems but cannot
Tolerating lower living situation

56
52
44
40
34
30
30
30

6.6. Relationship with family
There were no issues which were cited by more than 50% of respondents to be a problem
facing the disaster victims. The issue that was most commonly cited to be a problem waschanges to relationships within family (36%), followed by victims not wishing to burden theirchildren (34%).
Table7. Victims’ condition (Family Relationship)
Victims' Condition （Family Relationship）

Aggravating relations with family retionship
Hesitating to cause children into any trouble
strengthen the bonds between family members
Adding to his caretakers' burden
Become clinically evident everyday problems about family relations

%

36
34
32
30
22

6.7. Relationship with societyWith regards to relationship with society, there were no issues which were cited by morethan 50% of respondents to be a problem facing the disaster victims. The most commonly
cited issue was the unavailability of services that are normally available (38%), followed byfamily members losing their jobs as a result of the workplace suffering damage from theearthquake (34%).
Table8. Victims’ condition (Social Relationship)
Victims' Condition （Social Relationship）

Not Receive everyday services in welfare program
Losing jobs
No opportunity of going out
Any friends not visit shelters
Feel lonely

%

38
32
28
28
26

7. Summary
The most crucial problem that was revealed was that frameworks for providing assistancethat aims towards rebuilding of independent lives in the next stage after the evacuation stage
were not shared among relief workers nor had there been such a system in place. Specifically,
although Local Welfare and Health Headquarters and administration departments (i.e.,
prefectural and municipal authority staff) played a role of co-ordinating the allocation of tasks
to care work volunteers, the staff lacked sufficient knowledge in the field of welfare; thisresulted in undermining of the effectiveness of task allocation. A further factor that
undermined the effectiveness of the relief effort was the fact that while other professional
bodies (such as nurses) were also active, there was a lack of opportunity for such groups tocommunicate effectively between each other so as to co-ordinate their efforts.
In the future, it is necessary for specialist volunteers in the fields of medicine, health, andwelfare, to 1) refine their respective skills in providing assistance to disaster-afflicted areas
and organize them in a way that can be shared, and 2) develop specific means through which
specialists in each field can remotely share information in the field about disaster victims (i.e.,
those receiving assistance), and through which users without specialized knowledge cantransmit information.

References[1] Hayashi, H., ed. (2004) Socio-economic Recovery from the 1995 Hanshin Awaji
Earthquake Disaster-Report of Panel Survey 2003-, Technical Report DRS-200301, Research Center for Disaster Reduction System, Disaster Prevention ResearchInstitute, Kyoto University. (Japanese)[2] Hayashi, H. and Tamura, K. (2005) Profiling Causes of Deaths at the Niigata
Flooding Disaster on July 13, 2005, Journal of Social Safety Science, 7, pp.101111. (Japanese)[3] The Japan Association of Certified Care Workers (JACCW) HP (2005), Available
from: http://www.jaccw.or.jp/ [Accessed 05/01/2010].
Acknowledgements
This research was supported by “Niigata Chuetsu Earthquake Recovery Fund.
Author Biography
Name:
Keiko Tamura, Ph.D.
Affiliation:
Professor, Risk Management Office / Research Center for Natural Hazard & Disaster
Recovery, Niigata University, Japan
Address:
8050 Ikarashi 2-no-cho, Nishi-ku,Niigata, 950-2181,Japan
Brief Career:2004-2006 Researcher, Research Center for Disaster Reduction Systems, Disaster
Prevention Research Institute, KYOTO UNIVERSITY
2006-2009 Associate Professor, Research Center for Natural Hazard & Disaster Recovery,
Niigata University, Japan
2009-now Professor, Risk Management Office / Research Center for Natural Hazard &Disaster Recovery, Niigata University, Japan
Selected Publications:
TAMURA, K., “Defining Recovery: 7-Element Model”, Journal of Disaster Research,
Vol.2, No.6, pp.475-483, 2007.
Academic Societies & Scientific Organizations:
Institute of Social Safety Science (ISSS)
Japan Society for Natural Disaster Science (JSNDS)
Japan Society for Civil Engineers (JSCE)