A/HRC/23/41/Add.3

Advance Unedited Version

Distr.: General
2 May 2013
Original: English

Human Rights Council
Twenty-third session
Agenda item 3
Promotion and protection of all human rights, civil,
political, economic, social and cultural rights,
including the right to development

Report of the Special Rapporteur on the right of everyone tothe enjoyment of the highest attainable standard of physicaland mental health, Anand Grover
Addendum
Mission to Japan (15 - 26 November 2012)*,**
Summary
The Special Rapporteur on the right of everyone to the enjoyment of the highest
attainable standard of physical and mental health, Anand Grover, visited Japan from 15 to
26 November 2012. During the visit he ascertained, in a spirit of dialogue and cooperation,
the country‘s endeavour to implement the right to health, and in particular consideredissues related to realization of the right to health within the context of the nuclear accident
at the Fukushima Daiichi Nuclear Power Plant on 11 March 2011, the events leading to it
and emergency response, recovery and mitigation.
In this report, the Special Rapporteur commends Japan on steps taken to monitor thehealth of the affected population, designate evacuation zones, monitor radiation levels anddecontaminate the affected areas, as well as on its commitment to realizing the right tophysical and mental health. However, in order to fully realize the right, the Special
Rapporteur encourages the Government to address a number of serious challenges andconsider particular areas for improvements in the nuclear emergency response system; thescope and extent of the basic and detailed health management surveys; dose limits ofradiation; access to accurate information on radiation and its health effects; transparency
and accountability of the nuclear industry and regulatory authority; and participation of*

The summary of the present report is circulated in all official languages. The report itself, containedin the annex to the summary, is circulated in the language of submission only.
**
Late submission.

GE.13-

A/HRC/23/41/Add.3

affected communities in decision-making processes. With a view to facilitating thatendeavour, the Special Rapporteur provides a number of recommendations to theGovernment of Japan.

2

A/HRC/23/41/Add.3

Annex[English only]

Report of the Special Rapporteur on the right of everyone tothe enjoyment of the highest attainable standard of physicaland mental health, Anand Grover, Mission to Japan (15- 26
November 2012)
Contents
Paragraphs

I.

Introduction .............................................................................................................

1-3

II.

Legal framework .....................................................................................................

4-5

III.

The Fukushima Daiichi nuclear power plant accident ............................................

6-10

IV.

The right to health and nuclear disaster management .............................................

11-69

A.

Nuclear emergency response ..........................................................................

14-21

B.

Monitoring the health effects of the nuclear accident .....................................

22-44

C.

Policy decisions and information on dose limits ............................................

45-51

D.

Decontamination .............................................................................................

52-58

E.

Transparency and accountability ....................................................................

59-63

F.

Compensation and relief measures .................................................................

64-69

G.

Participation of vulnerable groups and affected communities ........................

70-75

Recommendations ...................................................................................................

76-82

V.

Page

3

A/HRC/23/41/Add.3

I.

Introduction
1.
The Special Rapporteur on the right of everyone to the enjoyment of the highest
attainable standard of physical and mental health undertook a visit to Japan, at the invitationof the Government, from 15 to 26 November 2012. The purpose of the mission was toascertain, in a spirit of dialogue and cooperation, measures taken by the Government ofJapan for successful realization of the right to health.
2.
During the mission, the Special Rapporteur considered issues related to therealization of the right to health within the context of the nuclear accident at the Fukushima
Daiichi nuclear power plant on 11 March 2011, the events leading to it and emergency
response, recovery and mitigation. The Special Rapporteur visited Tokyo, Sendai, as wellas numerous communities and cities in the Fukushima prefecture.
3.
The Special Rapporteur held meetings with senior Government officials from the
Ministries of Foreign Affairs; Health; Labour and Welfare; Education, Culture, Sports,
Science and Technology; Environment; as well as with senior officials from theReconstruction Agency and Nuclear Regulatory Authority. He also met with therepresentatives of United Nations agencies, health professionals, academics, representativesof civil society organisations and community members. He also met with senior
Government officials in Fukushima and Miyagi prefectures. The Special Rapporteur isgrateful to the Government of Japan for its invitation and full cooperation during his visit.
He also would like to thank all those who met with him, gave their time and extended
cooperation to him during the mission.

II. Legal framework
4.
Japan has ratified a number of international human rights treaties recognizing theright to health, including the International Covenant on Economic, Social and Cultural
Rights, Convention on the Elimination of All Forms of Racial Discrimination, Convention
on the Elimination of All Forms of Discrimination Against Women, Convention on the
Rights of the Child, including its two Optional Protocols, and International Convention for
the Protection of All Persons from Enforced Disappearance. Japan signed but has not yet
ratified the Convention on the Rights of Persons with Disabilities. The 1946 Constitution ofJapan does not explicitly guarantee the right to health. However, article 25 of theConstitution obligates the State to promote public health.
5.
The Act on Regulation of Nuclear Source Materials, Nuclear Fuel Materials andReactors, the Act on Basic Act on Disaster Control Measures, and the Act on Special
Measures Concerning Nuclear Emergency Preparedness provide the basic legal framework
for the nuclear disaster countermeasures and the emergency response of Japan after the
nuclear accident.

III. The Fukushima Daiichi nuclear power plant accident
6.
The nuclear accident occurred soon after the Great East Japan Earthquake andtsunami hit Japan on 11 March 2011. The earthquake of magnitude 9.0 occurred off the east
coast of Japan in the Pacific Ocean. It gave rise to a tsunami with waves up to 40 meters.

4

A/HRC/23/41/Add.3

The earthquake and tsunami resulted in 15,879 deaths and 6,126 injured people. 1 Nuclear
power reactors at Tokai Daini, Higashi-Dori, Onagawa, and the Fukushima Daini plant
were also affected. However no major harm was caused to any of these nuclear reactors.2
7.
At the time of the earthquake, reactors four to six of the Fukushima Daiichi nuclear
power plant, owned by the Tokyo Electric Power Company (TEPCO), were suspended due
to routine inspection. Though units one to three went into automatic shut-down mode assoon as the earthquake struck, electricity at the power plant was lost. Tsunami waves ashigh as 14 metres hit the plant approximately 50 minutes after the earthquake,overwhelming the walls of the plant. Designed to withstand waves of a maximum of 5.7
metres, the walls failed to contain the impact of the tsunami, causing a complete power
blackout in units one to five. Communication systems within and outside the plant site werealso severely compromised.3 Due to complete power outage, units one to three of theDaiichi Plant lost the ability to maintain proper reactor cooling and suffered a meltdown.
Consequently, fuels in the reactors were exposed and damaged and a series of explosions
occurred. Unit four suffered a hydrogen explosion on 15 March 2011.4 Since the nuclear
accident, reactors one to four have been decommissioned. 5
8.
The amount of radioactive caesium (137C) released due to the nuclear accident at theDaiichi Plant is estimated to be 168 times higher than that released by the atomic bomb in
Hiroshima.6 According to TEPCO, the accident released 900 petabecquerel of radioactive
iodine and caesium (iodine conversion).7 Other radioactive materials released due to the
nuclear accident include radioactive Tellurium (129mTe, 129Te), Silver (110mAg), Lanthanum(140La) and Barium (140Ba).89.
Owing to similarities between the nuclear accidents at Chernobyl, Three Mile Islandand Fukushima,9 it is understandable that lessons from Chernobyl and Three Mile Island
were drawn in devising strategies in Fukushima. The Special Rapporteur emphasises,

1

National Police Agency of Japan, Emergency Disaster Countermeasures Headquarters, Damage
Situation and Police Countermeasures associated with 2011 Tohoku District – off the Pacific Ocean
Earthquake, (26 December 2012), http://www.npa.go.jp/archive/keibi/biki/higaijokyo_e.pdf.
2
International Atomic Energy Agency (IAEA), The Great East Japan Earthquake Expert Mission:
International Fact Finding Expert Mission on the Fukushima Dai-ichi NPP Accident Following theGreat East Japan Earthquake and Tsunami (16 June 2011), p.11.
3
Ibid., p.12.
4
The National Diet of Japan Fukushima Nuclear Accident Independent Investigation Commission(NAIIC), Full Report, Executive Summary (2012), p.13.
5
Ministry of Economy, Trade and Industry, Nuclear Emergency Response Headquarters, Government
and TEPCO’s Mid-to-Long Term Countermeasure Meeting (21 December 2011),
http://www.meti.go.jp/english/earthquake/nuclear/decommissioning/pdf/111221_02.pdf.
6
The Telegraph, Fukushima caesium leaks ‘equal 168 Hiroshimas’, (25 August2011),http://www.telegraph.co.uk/news/worldnews/asia/japan/8722400/Fukushima-caesium-leaksequal-168-Hiroshimas.html; http://www.enecho.meti.go.jp/radi_qa/45.pdf.
7
TEPCO, Estimation of the released amount of radioactive materials into the atmosphere as a result of
the accident in the Fukushima Daiichi Nuclear Power Station (24 May 2012),
http://www.tepco.co.jp/en/press/corp-com/release/betu12_e/images/120524e0201.pdf.
8
See PD McLaughlin et al, ―An update on radioactive release and exposures after the Fukushima
Daiichi Nuclear Disaster‖, The British Journal of Radiology (September 2012), vol.85, no.1017,
pp.1222–1225, p.1222; TEPCO also detected Strontium (90Sr) in the soil, Fukushima Daiichi Nuclear
Power Station: Strontium analysis result in the soil, http://www.tepco.co.jp/en/press/corpcom/release/betu11_e/images/110508e7.pdf.
9The nuclear accidents in Chernobyl and Fukushima are the only two accidents designated as level 7(major accident) on the International Nuclear and Radiological Event Scale (INES). The Three Mile
Incident was designated level 5 (accident with wider consequences) on the INES.

5A/HRC/23/41/Add.3

however, that crucial and complete information regarding the Chernobyl accident was notmade public until 1990.10 Thus, studies on Chernobyl may not fully cognize the effects ofcontamination and radiation exposure.11 In that context, it is of concern that only theincreased prevalence of thyroid cancer following the Chernobyl accident is acknowledged
and applied to the Fukushima accident. Reports on health effects of radiation exposure after
the Chernobyl accident have characterised evidence of other health anomalies asinconclusive.12 This regrettably neglects other health effects of radiation exposure such as
chromosomal aberrations13 increased childhood and adult morbidity, impairment 14 andleukaemia15, which may require monitoring.16
10.
The Government has relied on recommendations from the International Commission
on Radiological Protection (ICRP), which provide a reference level for radiation dose of
1mSv/year to 20 mSv/year for resettling people in contaminated areas.17 However, life span
epidemiological studies of survivors of Hiroshima and Nagasaki bombings point to causal
links between long-term exposure to low doses of radiation and the increased incidence ofcancer.18 The Special Rapporteur considers that disregarding these findings diminishes theunderstanding of and increases vulnerability to health effects of long-term exposure to lowdose ionising radiation.

10

International Physicians for the Prevention of Nuclear War, Health effects of Chernobyl: 25 years
after the reactor catastrophe (Berlin, April 2011), p.13; Letter dated 6 July 1990 from the Deputy
Minister for Foreign Affairs of the Union of Soviet Socialist Republic and the representatives of the
Byelorussian and Ukrainian Soviet Socialist Republics to the United Nations addressed to theSecretary General, Doc. A/45/342 E/1990/102 (9 July 1990),
http://chernobyl.undp.org/spanish/documentos/45-342.pdf.
11
Alexey V. Yablokov et al, Chernobyl: Consequences of the Catastrophe for People and theEnvironment (Boston, 2009), http://www.strahlentelex.de/Yablokov%20Chernobyl%20book.pdf.
12
United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), Sources andEffects of Ionizing Radiation, Volume II, Annex D: Health effects due to radiation from the Chernobyl
Accident (United Nations, 2011), pp.65-66, para.110; UNDP, WHO, The Human Consequences of theChernobyl Nuclear Accident: A strategy for recovery (2002),
http://www.who.int/ionizing_radiation/chernobyl/UN%20Report%20Strategy%20for%20Recovery%
20Jan%202002.pdf,p.7.
13
Nussbaum and Kohnlein, Inconsistencies and Open Questions Regarding Low-Dose Health Effects of
Ionizing Radiation, Environmental Health Perspectives (August 1994), vol.102, no.8, pp.656–667,
p.664.
14
Yablokov et al, op cit,pp.42-54.
15
Steven Wing et al, A Re-evaluation of Cancer Incidence Near the Three Mile Island Nuclear Plant:
The Collision of Evidence and Assumption, Environmental Health Perspectives (January 1997),
vol.105, no.1, pp.52-57,p.56.
16
E. Cardis et al, The Chernobyl accident — an epidemiological perspective, The Royal College ofRadiologists (May 2011), vol. 23, no.4, pp.251–260,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107017/pdf/nihms281413.pdf.
17
ICRP, Fukushima Nuclear Power Plant Accident,
http://www.icrp.org/docs/fukushima%20nuclear%20power%20plant%20accident.pdf (21 March
2011).
18
National Research Council, Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR
VII Phase 2 (Washington DC, The National Academies Press, 2006), p.30; Kotaro Ozasa et al,
Studies on the Mortality of Atomic Bomb Survivors, Report 14, 1950-2003: An Overview of Cancer
and Non-cancer Diseases, Radiation Research (March 2012), vol.177, no.3, pp.229-243,pp. 229,236.;
David J. Brenner et al, Cancer Risks Attributable to Low Doses of Ionizing Radiation: Assessing
what we really know, PNAS (November 2003), vol.100, no.24, pp.13761-13766; Pierce and Preston,Radiation-Related Cancer Risks at Low Doses among Atomic Bomb Survivors, Radiation Research(2000),vol.154,pp.178-186,p.185.

6

A/HRC/23/41/Add.3

IV. The right to health and nuclear disaster management
11.
The nuclear accident in Japan has affected the right to health of evacuees andresidents alike and has had an impact on physical and mental health, particularly of
pregnant women, older persons, and children. The precise health implications of radiation
exposure are still not clear, as long-term health effects of low-dose ionising radiation are
still being studied. The evacuation has caused the breakdown of families and communities,
giving rise to mental health concerns, especially among first responders, older persons,mothers and children.
12.
The enjoyment of the right to health is dependent on underlying determinants suchas safe and nutritious food, access to safe and potable water, a healthy environment andhousing.19 The accident caused widespread contamination of soil, water, food and theenvironment. Authorities in Tokyo, Fukushima, Ibaraki, Chiba and Tochigi therefore
imposed restrictions on the consumption of tap water when radioactive iodine and caesium
higher than the permissible limit were detected in tap water.20
13.
The right to health requires the State to ensure availability and accessibility ofquality health facilities, goods and services. 21 This includes information that enables
individuals to make informed decisions regarding their health. Further, monitoring thehealth of people for adverse effects of radiation and providing timely healthcare is an
important aspect of fulfilment of the right to health. The State is also required to have inplace evidence-based policies for the decontamination of affected areas to restore the lifeand health of people at the earliest. Finally, transparency and accountability ingovernance,22 access to remedies23 and participation of affected population24 in decisionmaking processes are necessary to the enjoyment of the right to health.

A.

Nuclear emergency response
14.
Soon after the earthquake and the tsunami hit the Daiichi plant, the Government ofJapan announced a ‗Nuclear Emergency Situation‘ pursuant to article 15 of the Act on
Special Measures Concerning Nuclear Emergency Preparedness.25 This was the first step in
initiating the emergency response system26 aimed at containing the nuclear accident andprotecting individuals from adverse health effects arising from radiological and nonradiological causes.27

19

Committee on Economic Social and Cultural Rights (CESCR), General Comment 14 (2000),
E/C.12/2000/4, para.11.
20
Ministry of Health, Labour and Welfare, Press Release: Detection of radioactive materials in tap
water (23 March 2011); Health Services Council, The Survey Results of Radioactive Materials in Tap
Water (19 April 2011).
21
CESCR, op cit, para.12.
22
Ibid., para.55.
23
Ibid., para.59.
24
Ibid., para. 11.
25
Tessa Morris-Suzuki et al, Lessons from Fukushima, Greenpeace International (February 2012), p.16.
26
IAEA, Preparedness and Response for a Nuclear or Radiological Emergency: Safety Requirements,
IAEA Safety Standards Series, No. GS-R-2, (Vienna, 2002), p.14.
27
Ibid, pp.4-5.

7

A/HRC/23/41/Add.3

Information on the nuclear accident and evacuation
15.
Access to information is an essential component of the right to health, as it enables
individuals to make informed decisions regarding their health. Information about thenuclear accident, including contaminated and potentially contaminated areas should bemade public immediately and in a coordinated manner. In addition, an effective emergency
response system requires that the public be provided with useful, timely, truthful, consistentand appropriate information promptly throughout a nuclear or radiological emergency. 28
16.
According to the independent investigation committee, the System for Prediction ofEnvironment Emergency Dose Information (SPEEDI), a computer-based system forestimating potential radiation contamination based on real-time information, was not
utilized by the Government in a timely and efficient manner.29 Consequently and contrary
to IAEA requirements for a nuclear emergency response,30 on 11 March 2011, only 20 per
cent of Fukushima residents near the plant came to know of the accident. 31 Most people inthe 10km radius were informed of the accident simultaneously with evacuation orders on 12
March 2011.32
17.
Evacuation zones, designated by the Government, were based on proximity to the
nuclear plant, rather than on scientific data indicating areas likely to be contaminated due toradioactive plume. Mandatory evacuation zones were periodically altered from a radius of
three kilometres from the Daiichi plant to ten and later to 20km.33 Voluntary evacuation
was eventually endorsed within the 20-30km radius area.34 Evacuation orders for someareas with high radiation doses were not issued until one month later. On 22 April 2011, theGovernment issued evacuation orders for areas up to 50km north-west of the plant,
including Katsurao, Iitate, Namie, and parts of Minami-soma and Kawamata, due to highdose radiation detected in the area35 brought by winds carrying radioactive material fromthe plant. People in these areas thus remained exposed to high-dose radiation for asignificant period. Even after SPEEDI was used, the resulting data was not madeimmediately available to the public.36
18.
A coordinated and effective response at local and national levels is a key goal of
emergency preparedness.37 Japan‘s emergency response did not meet up to therequirements. Poor coordination between the authorities was evident when the Fukushimaauthorities initially ordered evacuation of the 2km area, after which the Government
ordered a 3km evacuation area.38 Due to insufficient training in the response system,
including inefficient use of SPEEDI, 573 deaths have been certified by the Government as‗nuclear disaster-related deaths‘.39

28

IAEA, Safety Standards, op cit, p.31.
Investigation Committee of the Accident at Fukushima Nuclear Power Stations of Tokyo ElectricPower Company (Investigation Committee), Executive Summary of the Final Report (23 July2012),p.11.
30
IAEA, Safety Standards, op cit, p.25.
31
NAIIC, op cit, Executive Summary, p.19.
32
Ibid.
33
Ibid, p.38.
34
Morris-Suzuki et al, op cit, p.16
35
Ibid.
36
Ibid, p. 18
37
IAEA, Safety Standards, op cit, p.6.
38
NAIIC, op cit, p.62.
39
Morris-Suzuki et al, op cit, p.19.
29

8

A/HRC/23/41/Add.3

Distribution of iodine prophylaxis
19.
The obligation to fulfil the right to health requires the State to take measures thatassist individuals in realizing their right to health when they are unable to do so.40 This isespecially significant in cases of nuclear emergency where the ill effects of radiologicalcontamination, such as thyroid cancer, on the health of people are immense and long-term.
In the aftermath of the nuclear accident in Chernobyl, more than 4000 cases of thyroid
cancer were documented in Belarus, Russian Federation and Ukraine from 1992 to 2002
among those who were children and adolescents at the time of the accident. 41 In suchcircumstances, the State should take all efforts to ensure that such health goods as stableiodine tablets are made available and accessible, in a timely manner, to mitigate the effectof radioactive iodine on the health of the exposed population.
20.
The Government, in its interim report to the IAEA, estimated that the quantity ofradioactive iodine (131I) released to the environment was about 1.6x10 17 Bq.42 Exposure toradioactive iodine increases the risk of thyroid cancer, especially in children, infants andnew-borns.43 To block or reduce the accumulation of radioactive iodine in the thyroid
gland, stable iodine is administered before, or soon after, the possible intake of radioactive
iodine.44 Although the optimal time for ingesting stable iodine is before a nuclear accident,
it can reduce the intake of radioactive iodine by 50 per cent if administered a few hours
after the accident.45
21.
Regrettably, the Government did not give prompt orders for administering stableiodine after the nuclear accident. Even though some municipal authorities had stocks ofstable iodine, they were not distributed. Some municipalities, such as Futaba and Tomioka,
distributed stable iodine without orders from the Government.46 During the meeting with
officials of the Fukushima Medical University, the Special Rapporteur learnt that thedecision to administer stable iodine had been delayed because of apprehension of potential
harmful side effects that iodine prophylaxis could cause. However, it is an accepted
position in radiological medicine that even where the absorbed dose is less than 100mGy,
stable iodine should be administered, as it does not entail any significant health hazards. 47

B.

Monitoring the health effects of the nuclear accident
22.
In the immediate and long-term aftermath of a nuclear accident, the right to healthnecessitates rigorous and prolonged monitoring of individual health, as the health effects ofradiation exposure are not always immediately known or treatable. Though experiencesfrom the Three Mile Island and Chernobyl accidents provide invaluable guidance, a narrowappreciation of the accidents would not provide proper guidance. The Special Rapporteur

40

CESCR, op cit, para.37.
IAEA, Chernobyl‘s Legacy: Health, Environmental and Socio-economic Impacts andRecommendations to the Governments of Belarus, the Russian Federation and Ukraine (Second
revised version), The Chernobyl Forum: 2003-2005 (Austria, April 2006), p.7.
42
Report of Japanese Government to IAEA Ministerial Conference on Nuclear Safety, Accident at
TEPCO's Fukushima Nuclear Power Stations, p.VII,
http://www.iaea.org/newscenter/focus/fukushima/japan-report/chapter-6.pdf
43WHO, Guidelines for Iodine Prophylaxis following Nuclear Accidents: Update 1999, p.8,
http://www.who.int/ionizing_radiation/pub_meet/Iodine_Prophylaxis_guide.pdf,
44Ibid, p.7.
45Ibid, p.19.
46
Morris-Suzuki et al, op cit, p.20.
47
WHO, Guidelines, op cit, p.14; IAEA, Safety Standards, op cit, p.52.
41

9

A/HRC/23/41/Add.3

encourages the Government to monitor any increased morbidity and leukaemia, since they
have been detected among the survivors of Chernobyl and Three Mile Island. 48 Due tolimited knowledge regarding the health effects of long-term exposure to low-dose ionizing
radiation, the Government‘s orders for resettlement of residents into areas withaccumulated dosage of 20 mSv/year and less should be followed by long-term healthmonitoring of affected people.
23.
The health management survey in Fukushima is implemented by the prefecture
authorities, which reportedly received 78.2 billion Yen from the Government, incoordination with the Fukushima Medical University. It comprises a basic survey and four
detailed surveys. The basic survey estimates levels of external irradiation among residents.
The detailed surveys include a thyroid ultrasound examination for all children in
Fukushima aged up to18 years, a comprehensive health check for all residents from theevacuation zones, an assessment of mental health and lifestyles of all residents from theevacuation zones, and recording of all pregnancies and births among all women in theprefecture who were pregnant on 11 March 2011.49
24.
Despite the funding reportedly given by the government mentioned above, during
the visit, the Special Rapporteur heard concerns about the slow progress of implementing
the survey due to the reported lack of capacity of the Fukushima authorities. He urges theGovernment to assume the central role in the implementation of the survey and make morefinancial and human resources available for its implementation.
Basic health management survey
25.
Three months after the nuclear accident, Fukushima authorities sent the healthmanagement survey to people who had resided in the prefecture on 11 March 2011.50 The
objective was to evaluate individual radiation exposure from March 2011 to July 2011. 51
Basic data collected will be used in health examinations of the target population and in their
future long-term health care.52
26.
The basic survey would gather information about the whereabouts of individuals
during various periods from 11 March to 11 July 2011, and the consumption of food, dairy
products and water between 11 March and 31 March 2011. 53 The survey did not inquire
into the health status of the individual at the time of the accident or in the time following
the accident. A standard medical question regarding injuries – conventional/radiationinduced/combined – around the time of the accident was absent from the survey.54 In
contrast to other surveys, it did not incorporate questions enquiring into the cancer historyof the respondents, including cancer diagnosis, thyroid disorders, radiation treatment, priorexposure to ionizing radiation at work and risk factors such as smoking.55

48

Nussbaum and Kohnlein, op cit; Wing et al, op cit.
Seiji Yasumura et al, Study Protocol for the Fukushima Health Management Survey, Journal of
Epidemiology (August 2012), vol.22, op cit, pp.375-383, p.376.
50
Ibid., p.377.
51
Fukushima Medical University, Information about the Fukushima Health Management Survey,
http://www.fmu.ac.jp/univ/chiiki/health_survey/pdf/en/en_zip.pdf.
52
Ibid.
53
Ibid.
54
See IAEA, Generic Procedures for Medical Response During a Nuclear or Radiological Emergency,
Emergency Preparedness and Response (Vienna 2005), p.138.
55
Marilyn Goldhaber et al, The Three Mile Island Population Registry, Public Health Reports(November-December 1983), vol.98, no.6, pp.603-609.
49

10

A/HRC/23/41/Add.3

27.
Early capture of information is crucial to an effective monitoring of the humanhealth impact from radiation exposure.56 However, the basic survey was sent out threemonths after the nuclear accident and relied solely on the memory of the respondent about
his/her activities around the time of the accident. Additionally, the cohort size has asignificant role to play in analysing and understanding the health effects of radiation
exposure. For instance, in a survey conducted following the Three Mile Island incident,
data from 92-93 per cent of the affected population was captured within six weeks. 57 The
Fukushima authorities informed the Special Rapporteur that the response rate to theirsurvey was as low as 23 per cent as of October 2012. The low response rate and theambiguous nature of replies due to a three-month time lag may not ensure an accurate
capture and evaluation of the health effects of the nuclear accident. The Special Rapporteur
therefore encourages the Government to put in additional measures to ensure adequate
health monitoring of affected residents. Moreover, given that the fallout from the accident
seems to have reached prefectures other than Fukushima,58 he also urges the Government toexpand the health monitoring to other affected prefectures. where radiation exposure ishigher than additional 1 mSv/year in effective dose.
Thyroid screening of children
28.
The right to health requires the State to pay special attention to vulnerable groups
such as children. As children are most vulnerable to thyroid cancer due to radioactive
iodine intake, the Fukushima authorities initiated thyroid check-ups of all children who
were up to 18 years old as of 11 March 2011. The Special Rapporteur commends theGovernment for this effort, and encourages it to explore other health effects of radiation on
children such as leukaemia, as epidemiological studies have not ruled out the possibility ofleukaemia in children who were exposed to radiation following the Chernobyl accident. 59
29.
The thyroid check-ups commenced in October 2011 and will continue to March
2014, after which they will continue every two years until the individual is 20 years old andthereafter will continue every 5 years. 60 The results of the thyroid check-up are divided into
four categories. An ‗A1‘ outcome reflects detection of no nodule or cyst. ‗A2‘ means thatthe size of the nodule present is less than 5.0 mm and/or the cyst is less than 20.0 mm.
Children with A1 and A2 result are not eligible for a secondary examination. Result ‗B‘indicates that the nodules and cysts are larger than 5.1 mm and/or 20.1mm respectively andqualifies the child for secondary examination. ‗C‘ indicates an urgent need for secondary
examination.61
30.
It is important to note that the size of the nodule may not always be indicative of its
malignancy, as the likelihood that a nodule is malignant is independent of the number of

56

IAEA, Generic Procedures, op cit.
Goldhaber et al, op cit, p.605.
58
Tomoka Ohta et al, Prediction of groundwater contamination with 137Cs and 131I from the
Fukushima nuclear accident in the Kanto district, Journal of Environmental Radioactivity (December2011), vol.111, pp.38-41; Hikaru Amano et al, Radiation measurements in the Chiba Metropolitan
Area and radiological aspects of fallout from the Fukushima Dai-ichi Nuclear Power Plants accident,
Journal of Environmental Radioactivity (December 2011), vol.111, pp.42-52.
59
Andrey G. Noshchenko, Patterns of acute leukaemia occurrence among children in the Chernobyl
region, International Journal of Epidemiology (February 2001), vol.30, no.1, pp.125-129; S. Davis etal, Childhood leukaemia in Belarus, Russia and Ukraine following the Chernobyl power station
accident: results from an international collaborative population-based case–control study,
International Journal of Epidemiology (April 2006), vol.35, no.2, pp.386-396.
60
Yasumura et al, op cit, p.378.
61
Data from the Fukushima prefecture, at: http://wwwcms.pref.fukushima.jp/
57

11A/HRC/23/41/Add.3

nodules and the size of the nodule. 62 Moreover, follow up treatment for children in A2
categories will take place after two years. This may be too long a period to check the rate of
growth of a tumour, which is an indicator of increased risk of malignancy. 63According to
the latest official information, 186 out of 38,114 children examined in 2011 fell into
category B (0.5 per cent) while, in 2012, 548 children out of 94,975 were in that category(0.6 per cent).64
31.
During the visit, the Special Rapporteur was informed that the Japan Thyroid
Association was instructed against providing secondary examinations to children in the A2
category. Parents and children will therefore have to wait for the second round of check-ups
after March 2014, before they are able to take any mitigating action against possible thyroid
cancer. The Special Rapporteur calls on the Government to remove such barriers which
prevent people from exercising their right to health and to ensure that children and parents
are able to access second opinions and secondary health examinations, as required under
the right to health.
32.
The Special Rapporteur was also informed that parents of children found it difficult
to access the results of their children‘s thyroid check-ups due to red tape and thecumbersome freedom of information act procedure that Fukushima authorities insist on
applying to parents‘ requests. Though confidentiality of information is an important aspectof the right to health, it should not become a barrier to obtain information regarding one‘s
own health. In accordance with the right to health, the State is required to ensure an
individuals‘ right to informed decisions regarding his/her health by enabling them to accessinformation relating to their health, which will have a bearing on their decision-making
ability.
Comprehensive health management survey
33.
The comprehensive survey seeks to review health information, assess the incidenceof various diseases and improve the health status of the respondents. The target populationis restricted to residents of the evacuation zone specified by the government and residents
of Yamakiya in Kawamata-machi, Namie-mach and Iitate-mura.65 Due to high levels ofcontamination in the soil, water and foodstuff, including marine life, there is a possibility ofinternal irradiation.66 Following the Chernobyl accident, increased morbidity due todiseases of the endocrine, haematopoietic, circulatory and digestive systems have beenfound among those affected.67 The comprehensive health management survey should
therefore include check-ups for internal radiation exposure. Radioactive caesium has
already been found in urine samples of people as young as 8 years old in Japan. 68 However,62

Dan Mihailescu and Arthur Schneider, Size, number and distribution of thyroid nodules and their riskof malignancy in radiation-exposed patients who underwent surgery, The Journal of Clinical
Endocrinology and Metabolism (June 2008), vol.93, no.6, pp.2188-2193; Mary Frates et al,Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus
conference statement, Radiology (December 2005), vol.237, no.3, pp.794-800.
63
Frates et al, ibid, p.799.
64
Thyroid Ultrasound Examination (Thyroid Screening) in 2012/2013, at
http://www.fmu.ac.jp/radiationhealth/results/media/10-2_ThyroidUE.pdf.
65
Yasumura et al, op cit, p.378.
66
Teppei J. Yasunari et al, Cesium-137 deposition and contamination of Japanese soils due to the
Fukushima nuclear accident, PNAS (December 2011), vol.108, no.49, pp.19530–19534.
67
WHO, Health Effects of the Chernobyl Accident and Special Health Care Programmes (Geneva,
2006), p.74.
68
Results of ACRO's monitoring in Japan (12 of July 2012), http://www.acro.eu.org/OCJ_en.html#33.

12

A/HRC/23/41/Add.3

the survey does not include urine tests for people under the age of 16 years. 69 Tests70 should
also be conducted to check for radioactive strontium71 as it presents a large risk for internalradiation exposure via ingestion of contaminated agricultural crops and can cause
leukaemia.72
34.
The Special Rapporteur was informed that whole-body counters, used for measuring
internal exposure to gamma radiation, are not available in healthcare facilities throughout
Fukushima prefecture, as required.
35.
The Special Rapporteur commends the Government for lowering the permissible
limit of radionuclides in food for consumption. 73 Careful scientific sampling is important tomeasure radioactivity in food. He however notes dissatisfaction among people about
government sampling and preferred community measurement centres. It is important that
the Government take steps in bridging the trust deficit with the people of Japan.
Mental health survey
36.
The right to health extends not only to provision of medical health facilities, goods
and services but also to facilitating an environment within which the affected population isenabled to enjoy the right. The State is therefore under an obligation to minimize the effectof the accident on the mental health of people by, among other things, reducing stress andanxiety related to radiation exposure and separation from families.
37.
The effect of nuclear disasters on mental health has been documented in the contextof Three Mile Island and Chernobyl. 74 A year after the Three Mile Island accident, mothers
had an excess risk of experiencing clinical episodes of anxiety and depression. 75 After the
Chernobyl accident, women with young children were found to be most vulnerable to themental health effects of the nuclear accident,76 and its continued impact on mental healthwas visible even after six years of the accident.77 In a study conducted by the IAEA, asignificant amount of stress and anxiety was found to be related to the Chernobyl

69

Yasumura et al, op cit, p.379.
Patrick C.D‘Haese et al, Measurement of strontium in serum, urine, bone, and soft tissues by Zeeman
atomic absorption spectrometry, Clinical Chemistry (1996), vol.43, no.1, pp.121-128.
71
IAEA, Fukushima Update Log, http://www.iaea.org/newscenter/news/2011/fukushima130411.html.
72
Norikazu Kinoshita et al, Assessment of individual radionuclide distributions from the Fukushima
nuclear accident covering central-east Japan, PNAS (December 2011), vol.108, no.49, pp.19526–
19529.
73
Ministry of Health, Labour and Welfare, New Standard limits for Radionuclides in Foods,
http://www.mhlw.go.jp/english/topics/2011eq/dl/new_standard.pdf.
74
Evelyn Bromet, Lessons learned from radiation disasters, World Psychiatry (June 2011), vol. 10,
no.2, pp.83-84; Evelyn Bromet & John Havenaar, Psychological and perceived health effects of theChernobyl disaster: a 20-year review, Health Physics (November 2007), vol.93, no.5, pp.516-521.
75
Evelyn Bromet et al, Mental health of residents near the Three Mile Island reactor: A comparative
study of selected groups, Journal of Preventive Psychiatry (October 1982), vol.1, no.3, pp.225-276.
76John Havenaar et al, Long-Term Mental Health Effects of the Chernobyl Disaster: An Epidemiologic
Survey in Two Former Soviet Regions, American Journal of Psychiatry (November1997), vol.154,
no.11, pp.1605-07, p.1606.
77
Ibid, p.1607.
70

13

A/HRC/23/41/Add.3

accident.78 Moreover, post-traumatic stress disorder reportedly have high prevalence rate
among survivors of man-made disasters.79
38.
The Fukushima nuclear accident resulted in breakdown of families and communities
and feelings of isolation. The Special Rapporteur personally observed the anxiety and stressamong evacuees, residents and their families, which were related to the effect of radiation
leakage on health, especially of children, cost of evacuation, loss of livelihoods as well as
uncertain future and delays in receiving compensation that hindered rebuilding of theirlives.
39.
The Special Rapporteur notes with concern that the mental and physical health ofchildren has been especially affected by the lack of outdoor activities, safe areas to play andrestrictions on activities in school. He calls on the Government to make quality mental
health facilities, goods and services available and accessible to residents of Fukushima,
evacuees and their families, with a focus on vulnerable groups such as first responders andchildren when they want it. The Government should also provide and support programmessuch as recuperation camps organised by NGOs to reduce stress and anxiety of the affected
communities.
40.
The Government developed a detailed mental health survey for residents of theevacuation zone. However, the target population does not include all people who have been
affected by the accident. As with the comprehensive health survey, the survey should atleast include residents of the voluntary evacuation zone. Further, the response rate was lessthan 50 per cent.80 The Special Rpporteur welcomes the Govenrment‘s effort to provide
direct care to those who require it per the survey. Efforts are still required to ascertain anddeliver services to the rest of the target population. Though the survey inquires about the
responder‘s experience during the earthquake, tsunami and nuclear accident, it is importantto record past experiences with radiation exposure as it may be an aggravating factor.
Pregnancy and birth survey
41.
The obligation to respect, protect and fulfil the right to health is a continuous
obligation and extends to progeny. The pregnancy and birth survey, however, is based on
the assumption that the Chernobyl accident did not significantly increase child anomalies or
foetal deaths.81 The survey includes antenatal health, delivery records and mental health ofwomen.82 It does not include a provision to either monitor the health of the foetus or thehealth of the child after birth. With a view to ensuring the highest standard of physical andmental health, the Special Rapporteur encourages the Government to revise the survey andtake into account studies, which have linked in utero radiation exposure with mental

78

Harold Ginzburg, The Psychological Consequences of the Chernobyl Accident – Findings from theInternational Atomic Energy Agency Study, Public Health Reports (March-April 1993), vol.108,
no.2, pp.184 - 191, p.188.
79
Y. Neria et al, Post-traumatic stress disorder following disasters: a systematic review, Psychological
Medicine (2008), vol.38, pp.467-480.
80
Yasumura et al, op cit, p.380.
81
Ibid. p. 379
82
Ibid.,p.380.

14

A/HRC/23/41/Add.3

disability.83 Further, the Government should explore the still unclear relation between inutero exposure and leukaemia.84
Health of the nuclear power plant workers
42.
In the aftermath of Chernobyl, workers involved in cleaning operations and first
responders were exposed to the highest doses of radiation. 85 During the Fukushima
accident, an estimated 167 workers were exposed to more than 100mSv of radiation, a doselevel unequivocally recognized to increase the risk of cancer. 86 Two operators received
doses above 600mSv.87 In addition, first responders face a high prevalence of posttraumatic stress disorder in man-made disasters.88
43.
The law requires medical check-up of all workers who have worked in controlledareas every six months89 and guidelines provide for additional medical check-ups ofworkers exposed to 50 mSv/year of radiation. 90 Despite this, the Special Rapporteur wasconcerned to learn that the results do not always get reported to the Government. In order toprotect the right to health of workers, it is important to give health check-ups regularly andreport their results. While acknowledging the Government‘s reiteration that healthmonitoring of nuclear workers is carried out under relevant laws and regulations, theSpecial Rapporteur notes concerns by nuclear power plant workers that such healthmonitoring is not conducted.
44.
The Special Rapporteur was informed that many workers employed in the nuclear
power industry are poor and some even homeless, increasing their vulnerability. Even
though the law91 requires compulsory medical check-ups for workers when they are hired, asignificant number of workers, employed through layers of sub-contractors for shortperiods of time, are not provided with proper and effective monitoring of their health.92 The
Government should take all measures to provide an environment that does not exacerbate
their vulnerability and provide access to affordable and quality health facilities, goods andservices at all times to all workers.

83

Otake and Schull, In utero exposure to A-bomb radiation and mental retardation: a reassessment, The
British Journal of Radiology (May 1984), vol.57, pp.409-414; European Commission, Effects of inutero exposure to ionizing radiation during the early phases of pregnancy (Luxembourg, 2002).
84
E.Cardis et al, Cancer consequences of the Chernobyl accident: 20 years on, Journal of RadiologicalProtection (2006),vol.26,pp.127-140,p.135;Richard Wakeford, Childhood leukaemia following
medical diagnostic exposure to ionizing radiation in utero or after birth, Radiation Protection
Dosimetry (October 2008), vol.32, no.2, pp.166-174.
85
UNSCEAR, op cit; WHO, Health effects, op cit.
86
NAIIC, op cit, Executive Summary, p.9.
87
Nature: News, Fukushima’s doses tallied (23 May 2012), http://www.nature.com/news/fukushima-sdoses-tallied-1.10686.
88
Y. Neria et al, op cit; Jun Shigemura et al, Psychological Distress in Workers at the Fukushima
Nuclear Power Plants, Journal of the American Medical Association (August 2012), vol.308, no.7.
89
Article 56, Ordinance on Prevention of Ionizing Radiation Hazard.
90
Guidelines on Health Promotion for Emergency Workers in TEPCO Fukushima Daiichi APP.
91
Article 56(1), Ordinance on Prevention of Ionizing Radiation Hazard.
92
Gabrielle Hecht, Nuclear nomads: A look at the subcontracted heroes
http://www.thebulletin.org/web-edition/features/nuclear-nomads-look-the-subcontracted-heroes; The
Asahi Shimbun, Nuclear power plants: A hidden world of untruths, unethical behavior,
http://ajw.asahi.com/article/0311disaster/fukushima/AJ201208060093.

15

A/HRC/23/41/Add.3

C.

Policy decisions and information on dose limits
Evacuation Zones
45.
In December 2011, the Government categorized evacuation zones in areas affectedby the nuclear accident. Areas with radiation dose exceeding 50mSv/year were designatedas restricted areas; entry in such areas is prohibited for five years. Entry has been restricted
to areas with radiation dose between 20mSv/year to 50mSv/year, and residents are allowed
to return for short periods, but staying overnight is prohibited. In areas where radiation
exposure is below 20mSv/year, people are returning.
46.
The Ordinance on Prevention of Ionizing Radiation Hazards in Japan (article 3),
which requires that areas where radiation dose exceeds 1.3mSv/quarterly be designated ascontrolled zones. The recommended limit of radiation exposure for the general public is
1mSv/year.93 In Ukraine, the 1991 law ‗On the status and social protection of the citizens
who suffered as a result of the Chernobyl catastrophe‘ limited radiation dose for living andworking without limitations to 1mSv/year.
47.
The dose limit of 20mSv/year is being applied by the Government due to the nuclear
emergency. In this behalf the Government seeks support from the letter issued to it by the
ICRP, recommending a reference level of 1mSv/year to 20mSv/year for determining an
area as inhabitable after the nuclear accident. 94 The ICRP recommendations are based on
the principle of optimisation and justification, according to which all actions of theGovernment should be based on maximizing good over harm. 95 Such a risk-benefit analysis
is not in consonance with the right to health framework, as it gives precedence to collective
interests over individual rights. Under the right to health, the right of every individual has tobe protected. Moreover, such decisions, which have a long-term impact on the physical andmental health of people, should be taken with their active, direct and effective participation.
48.
The Government assured the Special Rapporteur that it was safe to inhabit areas
with radiation dose of up to 20mSv/year, as there was no excessive risk of cancer below
100mSv. However, even the ICRP acknowledges the scientific possibility that the incidenceof cancer or hereditary disorders will increase in direct proportion to an increase inradiation dose below about 100mSv.96 Furthermore, epidemiological studies monitoring thehealth effects of long-term exposure to low-ionizing radiation conclude that there is no lowthreshold limit for excess radiation risk to non-solid cancers such as leukaemia.97 The
additive radiation risk for solid cancers continues to increase throughout life with a linear
dose-response relationship.98

93

See IAEA, Radiation protection and safety of radiation sources: International Basic Safety Standards– Interim Edition, General Safety Requirements, No.GSR Part 3(Interim)(Vienna 2011),p.90; ICRP,
1990 Recommendations of the International Commission on Radiological Protection, ICRP
Publication 60, Ann. ICRP 21 (1-3); and ICRP, 2007 Recommendations of the International
Commission on Radiological Protection, ICRP Publication 103, Ann. ICRP 37 (2-4).
94
ICRP op cit, n.17; ICRP, 2009b Application of the Commissions Recommendations to the Protectionof People Living in Long-Term Contaminated Areas after a Nuclear Accident or a Radiation
Emergency, ICRP Publication 111, Ann ICRP 39(3), (2009), para.48-50.
95
ICRP, 2009b Recommendations, op cit, p.26; ICRP, 2007 Recommendations, op cit.
96
ICRP, 2007 Recommendations, op cit, (Spanish) p.46; A.D., Wrixon, New ICRP Recommendations,
Journal of Radiological Protection (2008), vol.28, pp.161-168,p.162.
97
David Richardson et al, Ionizing Radiation and Leukaemia Mortality among Japanese Atomic Bomb
Survivors, 1950-2000, Radiation Research (September 2009), vol.172, no.3, pp.368-82.
98
National Research Council, op cit; Kotaro Ozasa et al, op cit; David J. Brenner et al, op cit; Pierce
and Preston, op cit.

16

A/HRC/23/41/Add.3

49.
Health policies put in place by the State should be grounded in scientific evidence.
Policies should be formulated so as to minimize the interference with the enjoyment of theright to health. In setting radiation dose limits, the right to health dictates limits that havethe least impact upon the right to health of people, taking into account the greater
vulnerability of such groups as pregnant women and children. As the possibility of adverse
health effects exists in low-dose radiation, evacuees should be recommended to return only
when the radiation dose has been reduced as far as possible and to levels below 1 mSv/year.
In the meantime, the Government should continue providing financial support and subsidies
to all evacuees so that they can make a voluntary decision to return to their homes orremain evacuated.
Government monitoring stations
50.
The State should facilitate access to information about radiation levels in theaffected areas, as this knowledge is crucial to decisions people make and have a bearing on
their health. The Special Rapporteur was pleased to observe that the Government has set up
monitoring stations to monitor the ambient air dose in Fukushima Prefecture. The
Government informed the Special Rapporteur that around 3,200 monitoring stations havebeen installed in the prefecture. stations. However, the air dose measured by these fixedstations only reflects the radiation dose in the immediate vicinity of the instrument.
Readings by fixed monitoring stations do not reflect the actual and varied dosage levels in
nearby areas, which may be higher than that at the monitoring station. Reliance on
unrepresentative information unwittingly exposes people, especially vulnerable groups suchas children, to higher radiation levels. During the visit, the Special Rapporteur observed
substantial variance, including in schools and public areas used by children, as well asradiation ‗hot-spots‘ close to the monitoring stations that were not reflected. Such incidents
have regrettably led many people to doubt the reliability of Government monitoring
stations.
Information in school textbooks
51.
The State should ensure accurate and scientifically sound information on radiation
and radioactivity is provided to children and, where appropriate, their parents to facilitate
informed decision making regarding their health. Additionally, respecting the right to healthrequires the State to refrain from misrepresenting information in health-related matters. The
Special Rapporteur was informed about the Fukushima official curriculum for compulsory
radiation education in public schools. The supplementary reading and presentationmaterials mention that there is no clear evidence of excess risk of diseases, including
cancer, when exposed for a short time to radiation levels of 100mSv and below. This gave
the impression that doses below 100mSv are safe. As noted above, this is not consistent
with the law in Japan, international standards or epidemiological research. Additionally, theSpecial Rapporteur notes that the textbooks do not mention the increased vulnerability ofchildren to the health effects of radiation. Such information may give children and parents a
false sense of security, which may result in children‘s exposure to high levels of radiation.
The Special Rapporteur urges the Government to ensure accurate representation of thehealth effects associated with nuclear accident and include methods of preventing andcontrolling health problems in a manner that is effective, age-appropriate and easy tounderstand.

17

A/HRC/23/41/Add.3

D.

Decontamination
Decontamination policy
52.
The Act on Special Measures Concerning the Handling of Radioactive Pollution waspromulgated in August 2011 to create a legal framework for decontamination activities.
However, the ‗Basic Principles‘ and fundamentally important regulations under the Act did
not come into force until January 2012. The Act covers the planning and implementation of
decontamination work, including collection, transfer, temporary storage, and final disposalof contaminated material.99 The Special Rapporteur notes with appreciation the
Government‘s efforts, and those of municipalities under the Basic policy for Emergency
Response on Decontamination Work, towards decontamination. However, decontamination
policies should have already formed part of the regulatory framework for the nuclear powerindustry.100 This would have enabled the Government to undertake decontamination
activities earlier than November 2011.
53.
Areas for decontamination extend beyond Fukushima prefecture and are prioritizedby radiation levels, with a focus on living environments for children. 101 By August 2013,
the aim is to reduce by 50 per cent the exposure in areas with radiation levels of less than
20mSv/year for the general public and by 60 per cent for children. Exposure dose is to be
reduced to less than 20mSv/year by March 2014 in areas with radiation between 2050mSv/year. Demonstration projects were established to secure the safety of workers inareas with radiation above 50mSv/year. The long-term goal is to reduce radiation levels
below 1mSv/year.102
54.
Although the right to health is subject to progressive realization, the obligation toformulate and implement deliberate, concrete and targeted steps is an immediate obligationof the State. It is regrettable that there are neither specific measures nor a timeline fordecontamination beyond 2013 and to levels less than 1mSv/year. The Special Rapporteur
urges the Government to urgently formulate a long-term decontamination policy with theaim of reducing radiation to less than 1mSv/year at the earliest.
55.
The Special Rapporteur notes the special attention paid by the Government tovulnerable groups such as children in conducting the decontamination by proritisingdecontamination of schools and playgrounds. However, isolated decontamination ofschools and playgrounds is not sufficient, as winds can deposit radiation from surrounding
areas on already decontaminated sites. Decontamination of schools and playgrounds should
therefore include surrounding areas, such as roads, ditches and fields, which can beradiation hot-spots. The decontamination policy should address radiation hot-spots, as apriority, because they can exist even within areas where radiation dose is less than 20
mSv/y.
56.
The Special Rapporteur notes that the Government is encouraging participation of
the community in undertaking decontamination. He, however, recalls that the State is
mandated to fulfil the right to health by giving necessary information and protective

99

Progress on Offsite Cleanup Efforts in Japan,
http://josen.env.go.jp/en/documents/pdf/documents_01.pdf,p.4.
100
See IAEA, Planning for Clean-up of Large Areas Contaminated as a Result of a Nuclear Accident,
Technical Report Series No. 347 (Vienna, 1991),p.8.
101
Priority-setting measures are also recommended by IAEA, International Basic Safety Standards forProtection Against Ionizing Radiation and for the Safety of Radiation Sources, Safety Series No. 115(Vienna 1996),p.24.
102
Progress on Offsite Cleanup Efforts in Japan, op cit,p.9.

18

A/HRC/23/41/Add.3

equipment to individuals engaged in hazardous activities.103 While the Act on Special
Measures requires provision of appropriate information or equipment for individuals
engaging in decontamination activities, the Special Rapporteur is concerned that in someareas these requirements were not strictly followed. He therefore calls on the Government
to provide information, safety equipment and appropriate protective gear to residents who
voluntarily undertake decontamination activities.
Storage of contaminated materials
57.
Decontamination activities involving the removal of 5-10cm of topsoil104 posechallenges for the Government regarding safe storage of the contaminated soil. Currently,
authorities are storing the radioactive debris in residential areas in sandbags covered withplastic or by burying it underground, including under playgrounds, in protective containers.
During the visit, the Special Rapporteur did not find any signs informing people of thepresence of radioactive materials in these areas, contrary to the right to health.
58.
The Special Rapporteur was informed that temporary and final storage and disposal
facilities would be prepared to deal with the contaminated waste, estimated to be 2.3
million tonnes.105 However, there were no concrete plans for the storage of the radioactive
debris. As the contaminated waste is stored in residential areas and under playgrounds,
thereby posing a health hazard to residents, establishing temporary storage facilities awayfrom residential areas is urgently required. The Government should formulate a timeline
and take urgent measures towards establishing temporary and final waste storage anddisposal facilities, with active participation of the community in the decision-making
process.

E.

Transparency and accountability
Transparency and independence in the regulatory framework
59.
The reports by the Nuclear Accident Independent Investigation Commission and theInvestigation Committee on the Accident at Fukushima Nuclear Power Stations of TEPCO
set up by the Parliament and the Government respectively, criticise the close association
between the nuclear regulatory bodies and the Federation of Electric Power Companies inJapan, which greatly reduced the independence of the regulatory bodies. 106 As a result, theregulatory bodies failed to hold TEPCO accountable for non-compliance with domestic andinternational safety standards, compromising the safety of the Daiichi plant.107
60.
Transparency in governance and in implementing national policies and regulatory
frameworks is key to the right to health. Effective transparency and independence of thegoverning and regulatory authorities also ensures accountability. The Special Rapporteurnotes that recognizing the need for independence and transparency, the Government createdthe Nuclear Regulation Authority (NRA).

103

See also IAEA, Planning for Clean-up of Large Areas, op cit, p.42.
This is one of the recommended methods for decontamination, see IAEA, Decontamination of
Settlements, http://www-ns.iaea.org/downloads/rw/projects/emras-urban-decontamination-ofsettlements-golikov.pdf.
105
IAEA, Final Report of the International Mission on Remediation of Large Contaminated Areas Offsite the Fukushima Dai-ichi NPP (October 2011),
http://www.iaea.org/newscenter/focus/fukushima/final_report151111.pdf, p.61.
106
NAIIC, op cit; Morris-Suzuki et al, op cit, pp.37-45.
107
NAIIC, Ibid; Investigation Committee, Executive Summary, op cit, p.22.
104

19

A/HRC/23/41/Add.3

61.
The Special Rapporteur stresses that information and data collected by the NRA
regarding domestic regulations and compliance of nuclear operators with domestic andinternational safety standards should be made publicly available to facilitate independent
monitoring and accountability within NRA and the nuclear power industry as a whole.
Accountability of TEPCO
62.
The Special Rapporteur is pleased to note that nuclear operators are strictly andabsolutely liable for injury resulting from nuclear operations in Japan.108 This renders
private non-State actors liable for violating the right to health of individuals and isconsistent with the State‘s obligation to protect the right to health.
63.
However, the Government‘s acquisition of TEPCO‘s majority stakes in June 2012
has arguably helped TEPCO to effectively avoid accountability and liability for damages.
Payment of compensation is made from government funds, funded by taxpayers. The
Special Rapporteur was informed that TEPCO would have to repay the Government
eventually. Nevertheless, under the current arrangement, the taxpayers may have tocontinue bearing the liability of the nuclear damage, for which TEPCO should solely beliable.

F.

Compensation and relief measures
64.
Where a violation of the right to health occurs, victims should have access toeffective remedies, including adequate reparation and compensation. The provision ofcompensation and other forms of relief are also essential to the recovery of individuals
affected by the nuclear accident.
65.
After the nuclear accident, TEPCO provided 120 billion Yen in financial security for
claims,109 even though compensation costs estimated by TEPCO were around 4,500 billion
Yen. The Government, therefore, established the public-private Nuclear Damage Liability
Facilitation Fund in September 2011.110
66.
The Dispute Reconciliation Committee for Nuclear Damage Compensation was
created to formulate guidelines for payment of compensation due to a lack of guidelines
within the existing Compensation Act. 111 The Special Rapporteur notes that the originalcompensation application forms comprised around 60 pages and 2,215 sections,accompanied with a 158-page instruction manual.112 He was also informed of the delays
caused at the Dispute Settlement Centre, which hinder the availability of compensation for
the affected population. While these application forms have since been streamlined, theGovernment should address concerns frequently raised by affected persons regarding
TEPCO‘s attempts to reduce compensation levels and delay settlement.
67.
The Special Rapporteur commends the passing of the Statute on Protection andSupport for the Children and other Victims of Tokyo Electric Power Company Nuclear
Power Plant Disaster (Victims Protection Law), which recognizes the right of victims tochoose whether to evacuate or not. It includes persons voluntarily evacuating or living inareas outside the Government-designated zones, whose relief needs were reportedly108

Act on Compensation for Nuclear Damage, 1961,§§3 and 4.
Eri Osaka, Corporate Liability, Government Liability, and the Fukushima Nuclear Disaster, Pacific
Rim Law & Policy Journal (June 2012), vol.21, no.3,pp.433-459, p.437.
110
Nuclear Damage Liability Facilitation Fund Act, Law No.94 of 2011, as cited in Osaka, op cit, p.443.
111
Morris-Suzuki et al, op cit, p.30.
112
Osaka, op cit., p.441; Morris-Suzuki et al, op cit, p.29.
109

20

A/HRC/23/41/Add.3

neglected. The Law also contains provisions relating to long-term health impacts of
exposure to radiation.
68.
The Special Rapporteur is concerned that despite the Law‘s adoption in June 2012,
implementing instruments have not yet been adopted. In implementing the Law,clarification is required with respect to ‗Covered Areas‘ under article 8. The Special
Rapporteur believes that ‗Covered Areas‘ should include those where radiation levels
exceed 1mSv/year. As the exact health effects of long-term exposure to low-dose ionizing
radiation cannot be accurately predicted, the implementing measures should also expressly
provide free, life-long health screening and medical treatment relating to radiation exposure
for all affected persons. The 20-year time limit contained in the Civil Code should not
apply to financial assistance for medical care related to the nuclear accident.
69.
The obligation to fulfil the right to health requires the State to ensure the provisionof the underlying determinants of health by, inter alia, providing positive measures thatfacilitate enjoyment of the right to health. The Special Rapporteur urges the Government toadopt implementing measures to the Victims Protection Law and provide funding forrelocation, housing, employment, education and other essential support needed by those
who chose to evacuate, stay or return to any area where radiation exceeds 1mSv/year.
These measures should include relief packages reflecting the cost of rebuilding lives.

G.

Participation of vulnerable groups and affected communities
70.
The right to health requires the State to pay special attention to the needs ofvulnerable groups. The State is also under an immediate obligation to prevent
discrimination, especially against vulnerable groups in its policies or practice, even during
times of resource constraint.
71.
By August 2011, 146,520 people evacuated from Fukushima Prefecture.113 Owing tofrequent changes in evacuation orders more than 10,000 people had to change evacuation
centres three or more times, with some people moving as many as ten times. 114 Even after
evacuation orders were given on 12 March 2011 for areas within a 20km radius of theDaiichi plant, approximately 840 hospital and nursing home patients remained until 13
March 2011.115 Additionally, 60 hospital patients died during evacuation. 116 The stress, illhealth, and deaths, could have been prevented had there been coordinated evacuation orders
and plans in place. In this context, mapping vulnerable groups and encouraging broad
community engagement may help in creating more appropriate emergency responses withrespect to vulnerable communities. 117
72.
Older persons, children, women and persons with disabilities are more susceptible toill effects of disasters.118 During the visit, such groups shared grievances with the Special
Rapporteur that they had no say in decisions that affected them. He was also pained to learn
that evacuation centres often did not have an accessible environment for persons with

113

NAIIC, Executive Summary, op cit, p.38.
Toshiaki Keicho, Evacuation Centre Management, Knowledge Note 3-5, Cluster 3: Emergency
Response, World Bank, http://wbi.worldbank.org/wbi/Data/wbi/wbicms/files/drupalacquia/wbi/drm_kn3-5.pdf, p.3.
115
Koichi Tanigawa et al, Loss of life after evacuation: lessons learned from the Fukushima accident
379, The Lancet (March 2012), vol.379, no.9819, pp.889–891, p.890.
116
NAIIC, Chapter 4, op cit, p.6.
117
Louise Lemyre et al, Emergency Preparedness for High Risk Populations: Psychological
Considerations, Radiation Protection Dosimetry (2009), vol.134, no. 3–4,pp.207-214, p.211.
118
Ibid.
114

21

A/HRC/23/41/Add.3

disabilities and women, including women with young children. Despite the existence ofJapan‘s Third Basic Plan for Gender Equality 2010, which promotes gender equality indisaster prevention and response, women faced greater disadvantage in evacuation centres,as the Plan‘s regulations were not fully implemented.119
73.
Participation of the population at all stages of decision-making processes at nationaland community levels is a critical feature of the right to health framework. Health-related
laws and policies should be instituted only with direct, active and effective involvement ofcommunities, since they are most impacted by these decisions. The Special Rapporteur
urges the Government to take this opportunity to ensure the effective involvement ofcommunities in the health management survey. Community participation would also help
the Government to address the concerns of the people more effectively, thereby creating amore efficient health system.
74.
The Special Rapporteur commends the Government for ensuring community
participation in the Victims Protection Law. The Government should continue facilitating
broad-based participation and effective engagement of affected communities with a view toaddressing their concerns. Participation of affected communities also encourages
community-led awareness raising and initiatives. Community participation should include
participation of vulnerable groups, as it is crucial for their empowerment and creating an
inclusive society.
75.
The Special Rapporteur urges the Government to involve individuals andcommunity organizations in current and future nuclear and health policies, including in datacollection and radiation monitoring, planning evacuation centres, designing healthmanagement surveys, decisions regarding radiation levels and evacuation zones and insetting compensation amounts.

V. Recommendations
76.
The Special Rapporteur urges the Government to implement the following
recommendations in the formulation and implementation of its nuclear emergency
response system:(a)
Establish regularly updated emergency response plans that clearly
demarcate the command structures and specify evacuation zones, evacuation centres,
and provide guidelines for assisting vulnerable groups;(b)Communicate disaster management plans, including response andevacuation measures, to residents of areas likely to be affected by a nuclear accident;(c)Release disaster-related information to the public as soon as a nuclear
accident occurs;(d)occurs;Distribute promptly iodine prophylaxis before or as soon as the accident(e)Provide for prompt and effective usage of such technology as SPEEDI ingathering and disseminating information on affected areas;
77.
With respect to health monitoring of the affected population, the Special
Rapporteur urges the Government to implement the following recommendations:

119

22

Fumie Saito, Women and the 2011 East Japan Disaster, Gender & Development (June 2012), vol.20,
no.2, pp.265-279, p.268.

A/HRC/23/41/Add.3(a)Continue monitoring the impact of radiation on the health of affected
persons through holistic and comprehensive screening for a considerable length oftime and make appropriate treatment available to those in need;(b)
The health management survey should be provided to persons residing
in all affected areas with radiation exposure higher than 1 mSv/year;(c)surveys;

Ensure greater participation and higher response rates in all health(d)Ensure that the basic health management survey includes informationon the specific health condition of individuals and other factors that may exacerbate
the effect of radiation exposure on their health;(e)
Avoid limiting the health check-up for children to thyroid checks andextend check-ups for all possible health effects, including urine and blood tests;(f)Make follow-up and secondary examination for children’s thyroid
check-up available to all requesting children and parents;(g)
Simplify children’s and their parents’ access to information regarding
their test results, while ensuring the protection of private information;(h)Refrain from restricting examination for internal exposure to wholebody counters and provide it to all affected population, including residents, evacuees,
and to persons outside Fukushima prefecture;(i)Ensure mental health facilities, goods and services are available to all
evacuees and residents, especially vulnerable groups such as older persons, children
and pregnant women;(k)Monitor the health effects of radiation on nuclear plant workers andprovide necessary treatment.
78.
The Special Rapporteur urges the Government to implement the following
recommendations regarding policies and information on radiation dose(a)Formulate a national plan on evacuation zones and dose limits ofradiation by using current scientific evidence, based on human rights rather than on arisk-benefit analysis, and reduce the radiation dose to less than 1mSv/year;(b)
Provide, in schoolbooks and materials, accurate information about therisk of radiation exposure and the increased vulnerability of children to radiation
exposure;(c)Incorporate validated independent data, including that from thecommunities, to monitor radiation levels.
79.
Regarding decontamination, the Special Rapporteur urges the Government toadopt the following recommendations:(a)Formulate urgently a clear, time-bound plan to reduce radiation levels toless than 1mSv/year;(b)

Clearly mark sites where radioactive debris is stored;(c)Provide, with the participation of the community, safe and appropriate
temporary and final storage facilities for radioactive debris;
80.
The Special Rapporteur urges the Government to implement the following
recommendations regarding transparency and accountability within the regulatory
framework:

23

A/HRC/23/41/Add.3(a)Require compliance of the regulatory authority and the nuclear power
plant operators with internationally agreed safety standards and guidelines;(b)
Ensure disclosure by members of the Nuclear Regulation Authority of
their association with the nuclear power industry;(c)
Make information collected by the Nuclear Regulation Authority,
including regulations and compliance of nuclear power plant operators with domestic
and international safety standards and guidelines, publicly available for independent
monitoring;(d)Ensure that TEPCO and other third parties are held accountable for the
nuclear accident and that their liability to pay compensation or reconstruction efforts
is not shifted to taxpayers.
81.
In relation to compensation and relief, the Special Rapporteur urges theGovernment to implement the following recommendations:(a)Formulate, with the participation of the affected communities, theimplementing framework under the Victims Protection Law;(b)
package;

Include cost of reconstruction and restoration of lives within the relief(c)Provide free health check-ups and treatment that may be required for
health effects from the nuclear accident and radiation exposure;(d)Ensure that compensation claims by affected persons against TEPCO
are settled without further delay;
82.
The Special Rapporteur urges the Government to ensure effective community
participation, especially participation of vulnerable groups, in all aspects of thedecision-making processes related to nuclear energy policy and the nuclear regulatory
framework, including decisions regarding nuclear power plant operations, evacuation
zones, radiation limits, health monitoring and compensation amounts.

24