International symposium on disaster management
and recovery for children and communities 2016
Date

Saturday May 7 ‐ Sunday May 8 , 2016

Venue

Soma Civic Center ‐Large Hall
Kitamachi 51‐1 Nakamura, Soma City, Fukushima 976‐0042, Japan

Visitors

1,300 people （ May 7 700 people 、 May 8 600 people ）Organized bySoma Area Council of Local Governments

Collaborated by

WHO Centre for Health Development

Hosted by

Executive committee of International Symposium on Disaster
Management and Recovery for Children and Communities

Honorary
Supporter

Japan Medical Association

Honorary
Collaboration

Soma Central Hospital

Supporters

Fukushima PrefectureInternational Atomic Energy Agency(IAEA)
Foundation for Global Children Yomiuri Shimbun
Fukushima‐Minpo Fukushima Minyu Shimbun
Soma‐gun Medical Association

Sponsors

Kowa Yakuhin Co. LVMH Moët Hennessy‐Louis Vitton Japan S.A.
Toho Bank Ltd. IHI Co. Soma Kyodo Power Company Ltd.
Sun‐Ei Nori Co., Ltd. FRESCO Kikuchi Co.
FUJIMOLD Industry Co., Ltd. El Sistema Japan F‐COM. Co., Ltd.

Executive
Committee

Chief of the executive committee
Sae Ochi Director of Internal Medicine, Soma Central Hospital
Member of the executive committee
Kenji Shibuya Professor, Department of Global Health Policy,
Graduate School of Medicine, The University of Tokyo

Masahiro Kami Director of Medical Governance Research institute
Professor of Rikkyo University, Director of AAR Japan
Yukie Osa
Yasuo Miyazawa Chairperson of SEISA Group
Secretary general
Masaharu Tsubokura Attending physician, Soma Central Hospital

Staff

Symposium (May 7) 123 people
Soma Area Council of Local Governments 8 people
Soma city official 65 people Soma Central Hospital 18 people
SEISA Group 12 people Shibuya laboratory student 9 people
Kami laboratory student 11 people
Symposium (May 8) 123 people
Soma Area Council of Local Governments 8 people
Soma city official 65 people Soma Central Hospital 18 people
SEISA Group 12 people Shibuya laboratory student 9 people
Kami laboratory student 11 people

Lunch time lecture (May 8) 30 people
Soma city official 11 people Soma city woman fire brigade 11 people
Shinchi town official 1 people Iitate village official 2 people
Panel display cooperation co. 5 people

Total 276 people

Saturday May 7,2016

CONTENTS■Welcome speech
P1

Sae OchiChief of the executive committee■Opening remarks
P2

Shinjiro Nozaki
Senior consultant, WHO Centre for Health Development■Congratulatory speeches by guests of honor
P4

Satoshi Imamura
Japan Medical Association Vice President■Reports from local government mayors
P7

Norio Kanno

Mayor of Iitate Village

Singularity of nuclear disaster among disasters

Katsunobu Sakurai

Mayor of Minamisoma City

P9

From Minamisoma city to the world:
Our vigor for reconstruction

Norio Kato Mayor of Shinchi Town

P13

Shinchi Town : Disaster and recovery

Hidekiyo Tachiya

Mayor of Soma City

Human care in the period of disaster recovery

P16

■Session １：

Children and disaster recovery

Chair Yukie Osa
Professor of Rikkyo University,
Director of AAR Japan

Tomohiro Morita

Soma Central Hospital, Physician

P27
The 3.11 Triple Disaster:Health Effects on the Residents of Soso District,and Possibilities for Health Promotion

Masaaki Abe

Director, Seisa Nagoya Junior High School

P33
Activities of the Follower Team:
prevention of PTSD among children

Asako Sugioka

Lawyer, Japan Legal Support Center,
1st Operation division

P39

Recovery from the Great East Japan Earthquake and lawyers,
and the role of Japan Legal Support Center

Yutaka Kikugawa Executive Director, Friends of El Sistema
Japan

P43

Strengthen Lifeskills through Music：Recovery, Regional
Revitalization, international Exchange through Art andCultureYukio Shibuya

Professor of Tokyo University of Agriculture

P47

Recovery in agriculture in Soma area : Support by the Tokyo
University of Agriculture (TUA)

Yujiro Watanobe Soma Fisheries Cooperative
Fishing trial; The present situation

P53

Sunday May 8,2016■Opening remarks

P57

Masayasu Kitagawa
Emeritus professor of Waseda University■Session ２：
Health impact by radiation
Chair

Shinichi Suzuki
Professor and Chairman,
Fukushima Medical University Schoolof Medicine Department of Thyroid andEndocrinology

Hiroki Shimura

Department of Laboratory Medicine,
Fukushima Medical University

P59

A progress report of Thyroid Ultrasound Examination
program in Fukushima Health Management Survey

Gerry Thomas

Department of Surgery and Cancer,
Imperial College London

P66

Thyroid Screening – the Global Perspective

Sae OchiDirector of Internal Medicine, Soma Central Hospital

P73

Health impact of a disaster on physical performance ofschool children and elderly people

Masaharu Tsubokura
Attending physician, Soma Central HospitalPart time physician at Minamisoma Municipal General Hospital

Current situation of internal and externalradiation exposure in Soma region

P77

■Session ３：

Social impact by the earthquake
and the nuclear accident

Chair

Tomoyoshi Oikawa
Associate director of Minamisoma
Municipal General HospitalPeter Johnston

Director, Division of Radiation,
Transport and Waste Safety,
Department of Nuclear Safety and Security, IAEA

P85

International Radiation Protection System: ProtectingChildren in the Community

Shuhei Nomura PhD Candidate Department of Epidemiology andBiostatistics, School of Public Health, Imperial
College London

P91

Post‐nuclear evacuation and health risks
in Fukushima

Ryugo Hayano

Professor, Department of Physics,
University of Tokyo

P98

Empowering the young‐ radiation protection in Fukushima ‐■ Keynote Lecture
Chair

Kenji Shibuya
Professor, Department of Global Health
Policy, Graduate School of Medicine,
The University of Tokyo

Shinjiro Nozaki Senior consultant,
WHO Centre for Health Development

P105

Lessons for Disaster Management and Recovery

Claire Leppold

Minamisoma Municipal General Hospital,
Researcher

The Minamisoma Babies Study:
Health at Birth in the Four Years Following the 3.11 Triple
Disaster

P113

■Panel Discussion

P121

Moderator
Kenji Shibuya
Professor, Department of Global Health Policy,
Graduate School of Medicine,
The University of Tokyo

Panelists

Gerry Thomas

Department of Surgery andCancer, Imperial College
LondonShinichi Suzuki
Professor and Chairman, Fukushima
Medical University School of Medicine
Department of Thyroid andEndocrinology

Claire Leppold
Minamisoma Municipal
General Hospital,
ResearcherPeter Johnston
Director, Division of Radiation,
Transport and Waste Safety,
Department of Nuclear Safety andSecurity, IAEA

Shinjiro Nozaki

Senior consultant,
WHO Centre for Health
Development

Hidekiyo Tachiya

Katsunobu Sakurai

Kana Yamamoto

Chikako Hokotate

Mayor of Soma City

Minamisoma Municipal
General Hospital,
PhysicianMayor of Minamisoma City

Parent‐teacher associationof Soma■Closing remarks
Masaharu Tsubokura■Photograph digest

P143
Secretary general

P145

Welcome speech

Sae OchiChief of the executive committee

Good afternoon,
ladies and gentlemen.
On behalf of the executive
committee members,
I would like to welcome
you to this International
Symposium on Disaster
Management andRecovery for Children andCommunity hosted by theSoma Area Council of Local
Governments and incollaboration with WHO
Center for Health
Development and theJapan Medical Association.
First of all, I express mygratitude to the guest speakers, Dr. Shinjiro Nozaki from the WHO Kobe Center, Mr. Peter Johnston from
IAEA, Professor Gerry Thomas from Imperial College, London, and Ms. Claire Leppold from
Minamisoma Municipal General Hospital as well as all the speakers, chairs, and moderators forattending this symposium in busy schedule.
Last month, a huge earthquake struck Kumamoto and Oita Prefecture killing around 50 people. And
several days after the disaster, more than 600 people in Republic of Ecuador were killed by anearthquake. I’d like to express my sincere condolences to the families of the victims. Now, the worldis facing increasing intensity and frequency of disasters. With this, there is an increasing need insharing experience and knowledge about how to prepare for, mitigate, and recover from suchcatastrophic disasters.
Fortunately, during these 5 years, we, the residents and researchers in Fukushima Prefecture haveachieved a significant progress with regard to community recovery and we have accumulated many
important knowledge. All the speakers here today and tomorrow have made enormous contribution
to the recovery of this area. Learning from their activities will have an impact on all of our lives,
provide a legacy for the children, and ultimately will benefit the entire world.
So, I have no doubt that we are having really interesting 2 days. Before I hand over to Mr. Shinjiro
Nozaki, I’d like to thank Fukushima
Prefecture IAEA, Foundation for Global
Children, Yomiuri Shimbun, Fukushima
Minpo, Fukushima Minyu Shimbun, andSoma‐gun Medical Association for yoursupport. And all the staff of Soma Area
Council of Local Governments, Seisa Groupand University of Tokyo for setting up andorganizing the conference.
Finally, I’d like to thank all the participants
here today. Welcome, and please enjoy
this symposium along with us. Thank you.
1Opening remarks

Shinjiro Nozaki

Senior consultant, WHO Centre for Health Development
Good afternoon,
ladies and gentlemen.
I have to say very sorry for
our Director, Alex Ross
couldn’t come here
because of the family
emergency problem.
But I would like to read his
message on behalf ofWHO.

Honorable Mayor Hidekiyo
Tachiya, Mayor Norio
Kanno, Mayor Norio Kato,
Mayor Katsunobu Sakurai,
Dr. Sae Ochi, Executive
Director, organizing
committee of this symposium, Professor Masayasu Kitagawa, Waseda University, Professor Kenji
Shibuya, University of Tokyo, Professor Geraldine Thomas, Imperial College of London, Mr. Peter
Johnston, Director of IAEA, distinguished speakers and honorable guests, on behalf of the World HealthOrganization, WHO and the entire staff of the WHO Kobe Center, it is my great honor and pleasure towelcome you to this important international symposium.
My sincere congratulations to Mayor Tachiya and organizing committee for organizing this robust
conference that will explore many of the lessons and challenges that Soma City, the Tohoku region, andJapan have experienced during and after the Great East Japan earthquake, tsunami, and the nuclear
accident. The innovations that you have created over the past 5 years, particularly in supporting thecommunity to recover from these events, and mitigating the long term psychosocial impact of thedisaster provide inspiration to others in Japan and around the world.
As we recently have seen in Kumamoto, the risk of natural disasters and their significant impact on
people and economics are constant. Although tragic, the number of deaths from the Kumamoto
earthquake was far less than that experienced during the Great Hanshin Awaji earthquake or the Great
East Japan earthquake. This points to the benefits of constant learning from past experience andimplement improvement in preparedness. Across the world, we are seeing a significant increase in
the frequency and severity of natural disasters, many hazards, and communicable disease outbreaks.
We have been watching the emergence of new diseases such as Ebola, Zika as well as the spread ofexisting ones such as dengue and malaria.
WHO has a very important role to play to support countries and communities across the disaster healthemergency, risk management, continual preparedness, response, recovery, and ensuring resilient
health systems and communities. WHO and its many partners have various instruments andmechanisms to do this including the international health regulations and the providence of the Sendai
Framework for disaster risk reduction.
WHO is emphasizing supporting countries to build resilient health systems that can detect and respondto any health emergency and to better assess risks and vulnerable populations.

2Opening remarks
WHO Kobe Center is a global WHO research center that focuses on UHC, Universal Health Coverage,
innovation, and aging populations. Since its beginning, the center has also focused on supporting andsharing lessons and policy research for health emergency management.
Led by Japan, there is an increasing interest in learning about how to support long term survivors of
disasters, especially older populations. We look forward to learning from this symposium and to
working with you to disseminate the many important lessons globally. Thank you very much once
again for being with us today and for your kind attention. Arigatou gozaimasu.

3

Congratulatory speeches by guests of honor

Satoshi Imamura

Japan Medical Association Vice President
Good afternoon,
ladies and gentlemen.
May I add my warmest
congratulations for the
opening of theInternational Symposium
on Disaster Recovery forChildren and Community. I
am really honored to offersome words of welcome
on behalf of JMA, in frontof many VIPs who arepresent here.

On April 14th, there wasan earthquake inKumamoto Prefecture
where lots of people have perished, and I would like to offer my heartfelt condolences to all of them.
I think that many of you who are present today may be dedicating yourself to help the people there,
and I’d like to say my heart is always with those who were affected and who are still living in the
shelters. As for JMA, we have dispatched JMAT or Japan Medical Assistance Team to the affectedareas. We do hope that these medical assistances would help the residents there return to theirnormal life with security and peace of mind as quickly as possible.
Now, I’d like to offer my congratulations to the organizers including Dr. Ochi, the Executive Committee
Chair, and Dr. Tsubokura, the General Secretary for their dedication to recover from the triple disasterin the past 5 years. Ever since the accident occurred at the power plant, the JMA have dispatched the
JMAT comprising medical doctors and other health professionals from all over the nation to Soma City,
Minamisoma City, Koriyama City, and Iwaki City amongst others. And on September 2011, we havemade the proposal to the Governor of Fukushima, Mr. Sato, on recovery and construction from thedisaster. Particularly after the nuclear power plant accident, we were worried about the healthimpacts on the pregnant women and children. That was why we have declared the importance of
their assistance. Our other supports include development of the guidelines for intake of antidote
iodine, conducting research on the emergency exposure effect on health, and so on. I hope that these
efforts was of a help for your recovery activities.
Considering disaster and children, we will have to start with reconstruction of communities.
Particularly, it is true in the aging society in Japan, that medicine‐ and nursing care‐ centered economy
is essential to develop a community where people can live with mind of peace. Medicine and nursing
care also can create new job opportunities in the affected areas, so it may leverage recovery ofcommunities from the disasters. In other words, we need to create societies where children grow up,
find their jobs, and then have their own families within the same community.
Tomorrow, Dr. Shibuya, professor of the University of Tokyo, will chair a keynote lecture and panel
discussion. He was the Chair of a committee that issued ‘Japan Vision Health Care 2035’, which, byreversing our way of thinking, aims at taking adverse situations such as stagnation of economic growthand financial crisis as a big opportunities to add values to the healthcare of Japan so that it can lead theworld.
Disasters do not only happen in Japan and nuclear power plants exist throughout the world. I believe
4Congratulatory speeches by guests of honor
this symposium on children and disaster recovery will be beneficial to not only Japan but also to theworld. In closing, I do hope for the success of the 2 day symposium. And also, I’d like to wish for thehealth and prosperity for all the participants here. Congratulations on this symposium. Thank you.

5Congratulatory speeches by guests of honor

6

Reports from local government mayors
Singularity of nuclear disaster among disasters

Norio Kanno Mayor of Iitate Village
In spite of safety myth of
nuclear power plants, theaccident did happen.
Six thousand residents in myvillage was forced toevacuate from theirhometown and 5 years havepassed since then. We arenow entering in the 6th yearof evacuation.
In order to evacuate thevillagers I told myself that I
should maintain good senseof balance in looking atthings which was reallyunfolding in front of me.
At that time, I had little
knowledge about nuclear power plants or radiation. But according this philosophy of ‘afraid radiationin reasonable way’, we set out risk communication as a pillar of the village operation. Since July 2011,
we have set up a number of projects along with this idea of the risk communication.
As for evacuation, we had to balance risks of radiation exposure and those of displacement, which
resulted in a drastic change in life and lifestyles, at the same time. We could not just evacuate everyone
as far as possible. So with much thought, we decided to set an evacuation center within 1 hour drivefrom the village. Currently 90% of the residents are living within this area and now new communities arebeing created at the shelter houses there where the villagers are now having their lives.
There is an instruction from the national government that the annual radiation exposure dose should beless than 20 mSv. So we had made some kind of negotiation with the national government saying that
if the indoor levels of radiation exposure are less than 20 mSv, we can work within the evacuation zone.
Thanks for this negotiation, there are several special nursing homes for the elderly and major
enterprises companies that continue operation in the village. This, again could not be achieved without
the sense of balance. We have to leave the judgement of our choice up to our descendants. Later, ahistorian will find that.
As time goes by and people are gradually exhausted, fatigued, heartbroken, and down and out by thebusy days. It is not easy to manage the situation. What I learned in the very bitter way was that thenuclear power plant accident and the radiological disaster is somewhat totally different from othernatural disasters. Natural disasters include earthquake, typhoons, tsunami, and eruption of volcanic
mountains. Talking about severity, disasters that killed more and destroyed more houses are
considered as more severe. I agree with that, but the nuclear disaster has a singularity and specificity of
its own way.
Because in other natural disasters, people may lose their properties, but after a few years they canaccept the situation and decide to restart their lives from the scratch. But our combat to the nuclear
disaster is different. Nuclear victims should strive to get to the scratch, which means, eliminate thecontamination. This takes a long time, maybe we have to take generations. We have to struggle with ourlife with contaminated land, job losses and anxieties about the future. So we do not start from thescratch, but start to the scratch.

7

Reports from local government mayors
Another characteristic in a nuclear disaster is the people’s perception of risks related to radiation
exposure is quite different. Some people may say that this air dose rate is far from satisfactory.
Others may say that this is the level at which we can start living. As each decision is ‘right decision’ foreach person, it is quite difficult to unify diverse opinions or get to consensus.
The difficulties we are facing are the fact that our village was divided into three zones according to air
dose rate: less than 20 mSv; 20‐50mSv; and more than 50mSv. Each area differs in the time at which
evacuation order is lift, and the amount of compensation. So, the people in those three different zones
have different perceptions. And that kind of division of village may lead to the division of the minds
and heart in the people.
And the most serious problem we encountered in the village is that young people or young families andchildren are living away from the village. 90% of our villagers are now evacuated, living in the area 1
hour away from the village. Last year 57% of the school children were attending our village schools lastyear but this year, the number decreased to 36% this year. Allegedly, there are some villages where
only 2‐10% of school children are attending the village schools. Making villages to which no young
people or children would like to return is the responsibility of the national government.
But there are some kind of bracing we are able to get from that disastrous experience we had.
Because back then, when we were weary, the Mayor of the Soma city extended us the helping hand andgave us water and temporary housings, which we needed. Also the friendship extended to the various
parts of Japan and from the world is so heartwarming. This expanded ties among people. This gratitudeof us should be actually used as an engine for disaster recovery. So we can use this adversity against
itself and may create a community which we could not create without such disaster.
Swamped with daily chores, we often forget important things‐ What lessons we have learned? What wehave to hand down to the next generation?
Currently, 2.6 million vending machines are working in Japan. Fifty thousand convenience stores are
doing business for 24 hours a day. That is the convenience of modern days. But does thisconvenience actually lead to our happiness by lighting up everywhere and reducing places where we canenjoy starry sky? If you seek blindly for more happiness, more convenience, and richness, we need more
electricity and energy. When we use up all the energy resources, including regenerated energy, Japan will
end up with a nation with mindless debts, which became a heredity that we hand down to our future
generation.
There is a Spanish old saying that goes ‘the poor are not those who have less, but those who want more’.
In other words, ‘He is rich that has few wants’. In Denmark, it goes like: ‘the sin of elderly should be
repaid by young people’. This might be actually the situation we are facing now.
Now we need to look back on the past andre‐think whether growing economy is the
only way to happiness. We are in maturesociety, so we have to think what to be handover to our generation. This is what I havelearned from the nuclear disaster.
There is an article in the newspaper, weneed two earths if we continue living likethat. In 2030, we need resources worth
two planets. But the earth is only one
planet in the universe. You really have toadjust yourself to the earth. This is a learning
I had never thought before the disaster andthere is another learning I learned the bitter
way and I’d like to share this with you.
Thank you very much indeed.

LLaakkee H
Haayyaammaa
IIIiiitttaaattteee V
V
Viiillllllaaagggeee

8

Reports from local government mayors
From Minami‐Soma city to the world : our vigor for reconstruction

Katsunobu Sakurai

Mayor of Minamisoma
I’d like to share with you thecurrent state of Minamisoma
city by looking back at what
has happened in the past 5
years. Particularly, as this
symposium is on children anddisaster recovery, I’d like tofocus on children.
Minamisoma city was struckby the big tsunami of 21
meters high, which reachedabout 4 kilometers from theshore.

This disaster was followed bya nuclear power accident.
Minamisoma city was separated into three areas: no‐entry zone; in‐door evacuation zone; and otherareas. The gymnasium of Haramachi Daiichi Elementary school was due to be completed on March 31st
but instead of the completion ceremony, the venue had to be used as a shelter.
Although the Japanese national government gave no instructions to us, Izumida Hirohiko, the Mayor of
Niigata prefecture decided that the prefecture would accept the evacuees from Minamisoma city. Thus
we could evacuate our citizens to Niigata.
After decontamination works, the elementary schools within the in‐house evacuation zone werereopened in October and children went back to school. They are playing in the swimming pool and theplaying grounds. And in the following year the school held entrance ceremony.

9

Reports from local government mayors
Before the disaster, thenumber of birth per year inthis city was 582, and thenthere was a sharp drop after
the disaster. The number has
gradually recovered to about
400 now.
Looking at the age distribution,
there appears a decrease in
the number of children.
Just as the Mayor of Iitate saidin this session before, many
younger people are leaving
this area. The number of
elementary school children andjunior‐high school children
dropped to about 70% in 2016
compared to that before thedisaster. The number ofchildren entering kindergarten
and nursery school also sharply
dopped, but it is gradually
recovering. The numbers ofkindergarten children in 2014,2015, and 2016 are 960, 1126,
and 1188, respectively. This ispartly because Minamisoma
city made the fees for thekindergarten and nurseryschools free.
What about the radiation
exposure including both theexternal and internal
irradiation? Actually, 99.7%of the children are falling into
the category of ‘not detected’,
which means their internalradiation contamination levelis under a detectable level.
From this measuring using
individual dosimetry, it is clear
the radiation exposure levels
have massively decreased.
After the measurement,children started playing
outside.

10

Reports from local government mayors
Minamisoma city are creating
indoor playgrounds forchildren so that they can playwithout fear of radiation
exposure. The playground
donated by the ‘Everyone’s
playground project’ will becompleted soon. The
Cheerful kids!! Net. is aninternet website providing
information for those who areraising children. The‘Welcome baby project’ is a
project that presents diapers
and milk powder for
newly‐born babies.
But there are lots of things
that still remain to be done forchildren. Because of theevacuation, many families had
to be separated, which made itdifficult to raise children. Lossof young generation made theresidents pessimistic to their
future.
Now regeneration of thecommunity is an urgent issue
for us. One of the challenges
Minamisoma city is facing is tocreate the environment inwhich the parents feel at easein raising their children andgiving birth to babies. That is
the most important thing andthat is what we are exactly
doing here.
I’d like to offer my deepest condolences to the victims of the disaster in Kumamoto. As Minamisoma
received much help from that prefecture so we would like to return the favor, and five medical staffs
were dispatched to Kumamoto Prefecture. People there allegedly were surprised by the support from
Minamisoma. Nearly 50 people died in Kumamoto. However in Minamisoma, 636 people died by
Tsunami. And 485 people lost their lives due to the disaster‐related death after the nuclear power
plant accident. So, this number is unfortunately the number one in Japan. I’d like people outside ofJapan to know this fact, although the life is equal and it should not be boil down to the simple numbers.
As the Mayor of the Iitate village mentioned, the families are separated and communities are
disappearing. And this problem is getting to be worse every day. Because of the nuclear power
accident, recovery and reconstruction are very difficult and this fact is not well known by people outside.
Although I repeat the message, it seems that people outside of this area don’t seem to really
understand.
11

Reports from local government mayors
The mass media were amongst the first to flee after the nuclear power plant accident. I know there aremany journalists here today, but no one was in Minamisoma at the time of the disaster. There was not asingle reporter remaining and the national government didn’t come. TEPCO and the national
government promoted the nuclear power generation by saying that the nuclear power plants are safe.
However, they were the first to evacuate themselves. After the accident, I stayed in a tent for 50 days
without changing my underwear for 11 days. Nobody came to support us. By drewing the circle of 20
kilometers, 30 kilometers, people were prevented to visit us. Policemen built barriers to prevent people
to enter into the area. That was the reality in Japan.
That is why I speak up that nobody needs nuclear power plants. And I am saying that message to Japan,
to the world. However, the Japanese government decided to resume the nuclear power plant operation.
However, still there are earthquakes occurring throughout the country as if they are laughing at us. The
world is watching us, whether this return to the nuclear power plant policy is the right thing or not.
Just as the mayor Kanno mentioned, money do not compensate the losses of family members andseparations of communities. Money do not people rich in the real meaning. This is the most importantmessage that we ought to learn from the nuclear power plant accident.
I, as a citizen of Minamisoma City, and as a family member, have to send message of what we have to do
for the disappearing communities. It is not just only for us, but for the sake of the country as a whole.
That’s our mission, because we have the responsibilities for our children. Our children are feelinganxiety. So are their patients. No matter how many inspections we conduct and how many times wesay it’s okay, still 70% of the residence purchase PET bottle waters instead of tap water. Even though wehave been conducting a radiation inspection every other day, they do not trust the tap water and blindly
trust bottled water. Many people also refuse to eat the produce from Minamisoma City.
Why nuclear power plant accident destroyed the mental health of the residents? The nuclear power
plant policy make people lose their mind. Can we accept such policy? And my message, my answer is no,it’s not the right policy. We need to create the environment where people can feel at ease in raisingchildren. We need to protect the environment including clean air and water. The nuclear power
accidents, we made a sin once but we shouldn’t repeat the sins. It is my responsibility to send thismessage all over the world.
Therefore, I am continuously sending on‐site report to the leading party, regardless it is Democrats or the
Liberal Democratic Party. I make a local input whether mothers can live without anxiety, and if not, whatis needed. I contact every day to those bureaucrats in Kasumigaseki, because at the forefront thesituation is changing every day.
Currently the major challenge in Minamisoma city is how to make a ‘soft landing’ when evacuation order
the evacuation order is lifted in the area of 20km radius from the power plant. We have had meetings
and were scolded by the residents for hundreds of times. However, we keep toiling ourselves because
Minamisoma City is a city that has one of the brightest histories in the past.
So, we want to rejuvenate ourselves.
We want to deliver the forefront
messages from the Soma area, ahistoric city since the Edo period.
We want to maintain this prestigious
name of Soma. And for that we will
have to join forces so that we cantogether deliver our messages to theworld.
Let’s keep toiling ourselves for therecovery of the region and for thesake of our children. Thank you.
12

Reports from local government mayors
Shinchi town: Disaster and recovery

Norio Kato

Mayor of Shinchi town
First and foremost, I’d like toexpress my sincere
condolence to the people ofKumamoto, who arecontinually suffering from theaftershocks. Five years ago
at the time of the greatearthquake, we wererecipients of the great loveand care from the rest ofJapan and the world. So wewant to support other disasterareas to repay what we havereceived 5 years ago.

Last week, we handed ¥3
million of donation to Mayor
Araki, the chairperson of Kumamoto Council of Municipality. Mr. Araki said ‘we have gotten enoughgrubstake. What we need most now are human resources, especially officers who can assess damaged
houses and municipal staff who can issue disaster damage certificate.’
The Fukushima Council of Municipalities is going to provide whatever support we can offer while
appealing the needs of staff whom we are able to dispatch to assist the recovery work in Kumamoto.
Mr. Sakurai, the Mayor of Minamisoma mentioned that the city was separated by the 20 km or 30 km
radius from the nuclear power station. Shinchi town is 50 kilometers over away from the nuclear power
plant. Even so, more about a half of the children disappeared on March 2011, because their parents
decided to make voluntary evacuation away from the town. After much thought, as the Mayor of thetownship, I did make the daily measurement of the air dose rate of radiation. The dose was announced 7
am every day via community disaster management radio so that every household in the township would
know the dose amount. And
I continued thatannouncement every day for
4 months.
The second thing we did at
the township is to raise theknowledge of the radiation
because virtually we had noor little knowledge about
radiation. We invitedspecialists, experts, and theuniversity professors andprovided basic lectures onradiation and radio‐activities
targeting municipal staff
members, parents, PTAs andschool teachers.
13

Reports from local government mayors
I think these measures partly paid
off. School entrance ceremony,
usually held in early April, delayed
but was held on 14th April forelementary schools and 15th April
for junior high school. Until thattime, thankfully 80% of the school
children had returned to the town.
After summer holidays most of theschool children came back to theschools because the air dose rate
had been reduced enough. We
measured external and internal
exposure levels of the children
using glass badges and whole bodycounter, respectively. And theresult was no abnormal levels ofradiation contamination found. I
heaved a sigh of relief.
For a while, there were claims from
PTAs and parents that the local
vegetables, rice, and water
shouldn’t be used for school lunch.
However, after intensive inspectionof radiation, which proved our
products were safe enough, westarted to use the local products
since 2 years ago. And children
are really enjoying their lives andthey are so active.
Now I move on to the situation of
the disasters and recovery of
Shinchi town. Shinchi town is asmall coastal town facing the Pacific
Ocean with a population of about
8,000. At the time the Great East
Japan earthquake disaster with themagnitude of 9.0 on 11th March
2011, the tsunami with the heightof 15 meters struck our townshipand 119 residents lost their precious
lives. A train stopping at Shinchi JR
station was swept away and broken,
but luckily, passengers were able toevacuate from the train andeverybody was safe. Now themunicipal staff members, themembers of municipality assemblies,
and the residents are all engaged in
14

Reports from local government mayors
the recovery of the damages andlosses of disaster. Our motto is ‘team
Shinchi’.
Now, 5 years have passed since thedisaster struck us and the affected
residents have started their new
lives at houses and apartments
newly built in inland hills.
We are so grateful for your warm
supports during this recovery
process, from Japan as well as
overseas. 70% of the affected
agricultural fields have been
recovered and in this season farmers
are now busy planting rice in that
paddy field. The majority oflifelines and infrastructures also havebeen recovered. Highways havereopened and JR railway with a new
track will resume its operation in
upcoming December.
A plan is in progress to build a newtownscape centering around new
station. The stock base for LNG gas isunder construction at Suma port, on
which much hope is pinned for
future alternative energy resources.
The big tsunamis and disasters hit us
hard, but we have tried to turn the
difficulty into opportunities.
Together with all the residents,
assemblies and administration, weare heading to a new form ofcommunity.
I am going to close my presentation
with words of thanks to all thefriendship and supplies and supports
extended to us. Thank you verymuch indeed

15

Reports from local government mayors
Human care in the period of disaster recovery

Hidekiyo Tachiya

Mayor of Soma city
Good afternoon. The threemayors have spoken
representing theirmunicipalities. I am thechair of the region’s
municipal government
council. On behaf of thecouncil, I’d like to offer myheartfelt appreciation to allof you who are present here.

This symposium is looking
back the past five years’
efforts. I think it is our duty
to summarize what we havegained and learned and tosend a message for the
future. When we planned for this symposium, it was not expected the huge earthquake in Kumamoto,which occurred just 3 weeks ago. Because we were given the assistance from Kyushu 5 years ago, manymunicipalities in Soma area want to return the favors. The regions’ effort during past 5 years is very
precious because we experience the unprecedented events. But the more important thing is to makeuse of what we have learned for the generations in the future. That’s the most important thing for this
symposium.

First, I would like to look back at the Soma City’s efforts in the past 5 years. But there are many things I
won’t introduce because they are left to the speakers in the next session. But I will talk someexperiences in which what we learned could be applied for the Kumamoto earthquake.
We have a panel discussion
tomorrow, but this is not theideology or politicalstatements that we would
like to make. Our aim isonly to make thescience‐based
recommendations.
This (Picture 2) is Soma Cityand this is a picture
immediately after thetsunami in Haragama, Somacity. You may see thedamage was extensive.
This (Picture 6) is a picture of16the shelters. Amongst them, there were many

Reports from local government mayors

vulnerable people including
pregnant women or theelderly who had justrecovered from the diseaseor the newly born infants.
Our first priority was to
identify such vulnerable
people and rescue them fromthis foul living conditions at
shelters. Second priority
was to prevent indirect
deaths caused bydisaster‐related damages. In
disaster management, wehave to keep thinking
whether there is any
possibility of death in eachsetting.
This is Soma City Disaster
Management Office (Picture7) at 3 a.m. on 12 May. You
may think ‘the Mayor is
missing’, but it is because I
was taking this photo using
my cellular phone. We
categorized what we ought to
do into two: one was thethings to be done
immediately, and anotherwas the things that we will
have to embark on for the
restoration of the community
over a long‐term period.
First and at most priority was,as I mentioned, to preventthe unnecessary deaths after
the disaster. For example,
there were a number of isolated people in the tsunami‐struck areas. When the ground floor of a house
was washed away, people still saved their lives by staying on the second floor. But they could notevacuate in the middle of muddy rubbles. These people had to be rescued as soon as possible. And
when they arrived at shelters, there was a problem of securing water and food. For this purpose, what
we needed was to grasp the current situation. How many people are living in which shelters?
Without that number, we do not know the necessary volume of water for instance. These were theimmediate measures.
Next thing to think of was building temporary housings. The tsunami destroyed coastal areas not only inFukushima but also in Iwate and in Miyagi prefectures. And in each prefecture, hundreds of thousandsof people were in the shelters. We needed to construct temporary houses for this number of people.
So I thought that there would be a competition for the materials for the temporary housing. I am the
Mayor of Soma City, so I was not allowed to lose this competition. So, I ordered ‘let’s begin the work on
temporary housing construction now. Find land for the houses. Draw a blueprint. Then send in an
17

application to the prefectural government.’
Reports from local government mayors
And I also thought there would be a competition for coffins. So I ordered ‘when morning comes, ordercoffins.’ Another thing to be considered was to rescue vulnerable people from the shelters.
They needed to be housed in apartments, for instance, to secure their privacies. So I also made anorder ‘Get hold of all the vacant real estates in the next morning.’ These immediate measures did work.
Then the next morning came. Thankfully, on the following day, rescue supplies were sent in fromfriendship cities. That was not only Toyokoro‐cho, Taiki‐cho, and Nagareyama City that we had had thesister city affiliation, but also many other cities that we unofficially made friendship with offered help tous. We really appreciate the favor of these cities, and this made us realize the importance of keeping
good relationships in usual settings.
A basic registry of residents was really helpful in the disaster management. Because we were on thegovernment side, we count residents based on the residents’ registry. As the tsunami killed many
people, this residents’ registry changed drastically. So we had to confirm the change of the registry.
We decided to give ¥30,000 for each survivor immediately because they evacuated without any
possession. Due to the nuclear power plant accident and following disruption of infrastructure, we ran
short of cash. But fortunately, the Toho Bank kindly offered help. Actually, most of the staff at the bankevacuated, but Mr. Ando, the manager of the branch bank, collected cash and distributed the money
himself. Another important thing ‐ when we give the cash, we made sure to give the money on aface‐to‐face basis. For example, if a person came and said ‘I have 5 family members, so give me ¥150,000,
we gave s/he only ¥30,000. By doing so, we could confirm the number of survivors and updated the basic
residents’ registry at the same time.Soma is located at 40 to 50 kilometers from the nuclear power plant.
On March 12th, the first report was given to us. We had extensive damage already with the earthquake
and tsunami and this was the third disaster, the nuclear power plant exploding. And my initial reaction
was, no way, we do not want any more disaster. And the fear of radiation was coming to the people in
Soma City. As we needed some kind of standards, I decided that we follow the national government’s
instruction. If the government really instructs us to evacuate, we just follow it. If we have to evacuate,
it should be done systematically, because there are very vulnerable people who need help to evacuate.
The risk of the evacuation andrisk of the radiation exposure
needed to be compared. And
we had to do it on a long‐termbasis, several months ormaybe years. But at thatjuncture, I thought the risk of
the hasty evacuation would beriskier than that of radiation
exposure.
This (picture 13) is a picture ofme saying ‘you don’t need toevacuate now’. However, an
unexpected problem emerged:
supplies were totally disrupted.
Minamisōma City sufferedmost, but the situation issimilar in Soma City.
Especially medical supplies
were in shortage. A hospital claimed ‘water for dialysis will run out within 3 days.’ This was alife‐threatening situation for the patients, so we formed a truck team, which went to Tokyo and brought
water for dialysis. If supply doesn’t come in, we have to go out to get it. But of course it was apparent it
18

didn’t work longer, so we had to take other measures.
I askedfrom
Mr. Takita,
president of Kowa
Reports
localthegovernment
mayorsPharmaceuticals, to open up a temporary branch office of pharmaceutical companies or pharmacies in
Soma City. Mr. Takita, thank you very much for your help – with your help, we were able to really get
the supplies enough for the city of Soma as well as Minamisōma. And also, they actually gave us a lotof donations to make this symposium possible. Thank you very much at the same time.
There were many medical support teams coming to help us. But accepting these medical teams was a
bit challenging. I am a physician myself, so I know the situation. When you go to the evacuation
centers and if you hear some noise by auscultation, perhaps that person is suffering from pneumonia ormaybe bronchitis. If the person is suffering from severe pneumonia, he or she needs to be hospitalized.
But the judgment cannot be made just by auscultation. You need to have the X‐ray, a medical device tomake a thorough diagnosis. Therefore, medical support should also be conducted in a systematic way.
We saw the same kind of confusion in Kumamoto this year.
We had a number of
supporters dispatched fromthe Tokyo Medical University,
the Ishikawa Prefectural
Medical Association, theShizuoka Prefectural Medical
Association, and the Japan
Medical Association (Picture16) to give us systematic andconsistent team services. As
all these people are highly
specialized persons, so there
were a lot of debate among
the physicians. Also, thesituation of the evacuation
shelters was changing everyday. So we held a morning
meeting every day to make itsure that all the members of the support teams share the overall direction. For example, when there
was an influenza outbreak in a shelter, we had to isolate the person, but we did not have enough space
for these people. Therefore,
we made a special evacuation
center for influenza patients.
When the patients recovered,they went back to the original
shelter. In order to manage
such situation, we needed tohave meetings and made a
database of evacuees as wellas patients Mr. Okawada,
who was the director of the
Health and Welfare office,worked really hard to manage
such difficult contribution.
At the evacuation center,meals were supplied bysoup‐run. Rice balls were the19basic staple, and we also got
Reports from local government mayors
many food supplies from outside. But these meals were not supervised from a nutritional perspective.
So we decided to use the school kitchens to provide meals for the evacuees (Picture 18). The SHIDAX
Corp, one of the food companies, agreed to dispatch dieticians. In addition, we temporarily employed
female evacuees as cook. The school kitchens were for the school children in the day time. But in themorning and in the evening when the children are back, the school kitchen was vacant so we served foodfor evacuees in the mornings and in the evenings using the kitchens. Lunchtime meals were still
dependent on catering service, but we became able to get nutritious management for evacuees, though
not thoroughly. This enabled as
to systematically supervise thehealth of evacuees in alliancewith dieticians and doctors.
We would like to apply thismethod to the evacuation
centers in Kumamoto.
nother measure taken at theevacuation shelters wasbuilding partitions between
households. Veneer boards
were actually in short supply
but the Yoshino Gypsum, agypsum board company in
Soma city, kindly donated theboards. We made partitions
like that (Picture 19). By
doing this, we not only madeprivacy spaces for the evacuees
but also were able to give temporary addresses, like ‘3‐1 of Nakamura, the junior high school evacuationvillage, Soma city’. This idea of applying the temporary address to those partitions could be used at
Kumamoto.
And as Ms Sugioka will present later, the Japan Legal Center has constantly dispatched lawyers to Soma.
Judicial scriveners, administrative scriveners, and real‐estate surveyors also gave us precious support.
Soma city established a charge‐free law center. As of today, more than 3000 consultations were raised,
and thanks to these activities, there was no economic suicide in Soma city.
The temporary housings were under construction during this period. Then the time came for theevacuees to move to temporary housings. Now the shelter houses, everything can be supplied like
medical services and the food is prepared and delivered. But once they move away from theevacuation shelter to their temporary housings, they have to be self‐sustainable. So Soma city provided
100,000 yen per household to prepare for their life. Japan Red Cross kindly donated TVs, refrigerators,
and washing machines. And AAR, the Association for Aid and Relief also donated kitchen utensils andother daily necessities for each household. Those kitchen pans and cooking pans were reallyindispensable for life.. I would like to thank Ms. Osa, the president of AAR. She will chair the next session.
And 30 kilograms of rice are delivered to each one of the citizens.
In Soma city, all the evacuees moved to the temporary housings (Picture 21) until June. One of thechallenges is to prevent solitary deaths, in which a person dies alone and was found several days later.
Unnecessary deaths we tried to prevent was disaster‐related deaths in the acute phase, economic
suicides, and then solitary deaths. To prevent solitary deaths, we have to invent management system toorganize those people in such a way. One compartment comprised of 5 houses, and 20 compartment
share one assembly house, which could be seen as a unit. We nominated compartment leaders and unit
leaders.
20

Reports from local government mayors
We had 15 units in the city ofSoma, and those 15 unit
leaders regularly had ameeting, at which theyexchanged information, theirviews, and ideas. In thisway, we could make somekind of community network.
While making such network,
we delivered dinner to every
resident, which was a good
opportunity for us to checkthe health status of theresidents. The problem wasit cost ¥320 million per year.
Some members of parliament
who came over to visit us andencouraged us like ‘This is agood project, you should continue.’ However, nobody was assistive for us to give us a special budget.
Instead, Synapse Co. donated us a kitchen car. This kitchen car is now on lease to Kumamoto Prefecture.
And those people who are not able to go out shopping, we have the peddlers with carts. While
providing necessities, we could prevent solitary deaths.
Another problem was PTSD among children. We recruited clinical psychotherapist all over the world
and dispatched 5 of them to the schools. Later in the symposium, there will be a presentation on the
results. We owe Mr. Miyazawa, the president of the Seisa group for this management. We appreciate
all the staff members of Seisa Group.
In Soma, 5,400 were affected by tsunami and 458 were killed. This means 90% of the people survived.
It was thanks to the firefighters who went to the shoreline to call on people to run away to the higher
ground. Ever since Meiji Era, 150 years ago, nobody was killed by tsunamis in this area. So some ofthe people did not intend to evacuate saying ‘I don’t think tsunami will hit this area’. The firefighters
persuaded such people to evacuate. However, 10 firefighters lost their lives due to this action. These 10
firefighters had their families and they had their own children. We decided to give each child ¥30,000
every month until the children become the age of 18 years old from the donation we received. As
other children also lost their parents, so we counted the number of bereaved children, which turned out
to be 51. So we made a new low so that we can give these children ¥30,000 every month.
We further thought of what the firefighters wanted for their children the most ‐ probably, a goodeducation for their children. So, we decided that we will support all of these children to go touniversities. As there is no university in Soma, these children will have to go outside and they will needfees for the dormitory. Therefore, we decided to cover ¥76,000 per month for their life cost if they go touniversities. And that means ¥10 million per year for one university student and that would mean ¥510
million altogether. Fortunately, we were able to get all of the money in 2 years’ time.
On July 2011, I personally handed over the first supply to the children (Picture 35)
with the words ‘please study hard and go to university without any worry. All the finances would comefrom Soma City.’

21

Reports from local government mayors
Now that enough donation
were collected, but will thesechildren go to universities?
Well, they need goodeducation to pass theentrance exams. So we
introduced new types of
education e.g. drills using
iPads. In addition, the Tokyo
University, the bright students
began the Terakoya, the cramschool, the private school
scheme. They also helped
the children in Soma.
Another help came fromLouis Vuitton Co. Louis
Vuitton Co. agreed with what
we were doing and LVMH
Child Art Maison was built in
Soma City (Picture 39).
This is designed by theworld‐renowned architect, Mr.
Shigeru Ban. This is Ban andhe decided to design on a
volunteer basis for free.
This artistic building isdoughnut‐shaped and muchsunlight come through thewindow. Tomorrow, thestaff of Louis Vuitton will
come and join us. In theenvelope of the symposium,
you will find a memo pad.
This is specifically made anddonated by LVMH, so if you
see them tomorrow, please
thank them.
Mr. Abe, now the Prime Minister of Japan, visited Soma a year after the disaster. At that time he was
not yet a Prime Minister and he was a Member of Parliament. Be brought with him Members of the
Shinto Political League to pray for the victims. At that time Joban Line was interrupted due to thedamage by the tsunami, so children in Soma could not commune to Sendai. So I asked Mr. Abe, ‘please
make bus services from Soma to Sendai, at least 10 shuttles a day so that the children at Soma cancommune to Sendai.’ He fulfilled his promise although he was still not yet a Prime Minister at that time.
I really appreciate his effort.
We also held a meeting on prevention of solitary deaths after the evacuees at temporary housings have
moved to recovery housings. For the most vulnerable elderlies, we decided to make the row houses.
About 12 households live in the same building under the same roof with a private space for their own(Picture 43). The strength of this share house is that the elderly people can look after each other. In
22total 58 people are now living at the share houses.Reports
Dr. Morita,a physician
Soma Central Hospital,
fromlocal atgovernment
mayorsvisits the residents every
month for healthconsultations. He is still 28
years old, so he is about theage of their grandson of theresidents, and the‘grandmothers’ at the sharehouses love him so much.
Another thing that required
the most energy was building
recovery housings. Unlike
the disaster area struck by anearthquake, like that inHanshin‐Awaji earthquake,we cannot construct buildingsin the area struck by thetsunami, because there still isa hazard of tsunami. So, thereconstruction houses had to be built on the elevated ground. That was easier said than done. How
can we ensure the plot of lands there? The strength of the City Hall was not sufficient. And so, thelocal people mad an action group so that they can help us to obtain the land space.
Then we held study meetings together with the residents. They had a variety of opinions. Some people
said that I would like to live in a flat‐type housing, others said they would build houses by themselves sothey just need land spaces, andothers said they would liketwo‐story houses and wouldpurchase them later. We
discussed repeatedly at themeeting to reach an
agreement.
But finally, the reconstruction
houses were completed(Picture 46). In total, we
freed up about 290 hectares ofland and constructed 514
housings, including rent houses
and house for sales, wereconstructed in nine locations.
The construction started in
September 2011, and last year,
26th of March, all of theconstruction was completed.
However, another problem emerged: elderly people do not have cars, so they were not able to go out for
shopping. Therefore, with the subsidiary from the Ministry of Economy, we provided mobile catering
service. Mr. Kikuchi, the President of Kikuchi Super Store, took up this service without expectation of
profit. Mr. Kikuchi further gave us a donation to make this symposium possible. Thank you so much, Mr.
Kikukawa.

23

Reports from local government mayors
Then we built a storage warehouse for disasters. If the municipalities who assisted us in the time ofdifficulties got faced with disasters, we will quickly deliver stockpiles such as water from this warehouse,in recognition of the favor they gave us. So this warehouse is not only for the people in Soma city but
also for our friends.
Five football courts werebuilt: four by FIFA and JFA,
the Japan Football
Association; and one bySoma city (Picture 58). A clubhouse called ‘a special
recovery support center’
was also built in front of thecourts. And the Rakuten
Eagles, a professional
baseball team, constructed abaseball dome called ‘Soma
Children Dome’ for thechildren in Soma city. This
dome actually gave thechildren hope for future andnow the children are doing
exercise in the dome. We
really appreciate it.
The owner of Rakuten, Mr. Tachibana, asked us to be the fans of Eagles and kindly said he will offer free
shuttle bus to come to see the game of Rakuten. But I said ‘sorry, I cannot take the offer, because I ama great fan of Takahiro Suzuki of the Yomiuri Giants, who was bone and grew up in Soma city.’ Actually, I
am the associate of the fan club of this person.
The new civic hall was completed in October 2013, 2.5 years after the disaster. We wanted to build thiscivic hall as soon as possible in order to lighten up the feelings of the citizens. So to speak, the civic hall
as a symbol of recovery. Next to the hall, we have the special history museum with all the artifacts
related to the history of Soma.
If you are interested, please
visit the museum.
Another serious problem offlooding was groundsubsidence by 80 centimeters
or so in the coastal area.
With this subsidence, wehave a higher risk of flooding.
We equipped mechanicalpump to bail out water(Picture64). We need twounits of pump‐houses andone pump has been
completed. We designed thepump house with a beautiful
exterior like historical24

architecture.
Reports from local government mayors
And for the bereaved people,
people who lost their lives in thedisaster, we have the memorial
monument (Picture 66). There
are two monuments in different
zones, Isobe and Haragama. Next
to the monuments at Haragama, amemorial hall was also built sothat people will never forget thishuge disaster.
A new municipal government
office is due for completion in
upcoming September. It’s very
similar to the Civic Hall design.
Architecture is very Japanese taste
so that people feel nostalgia when
they visit the office. Whenever
you come over to City Hall, you
may feel that you are coming backto your old family home. Thatkind of familiarity should be
attached to the City Hall. The
City Hall can serve as a meeting
place or a place you can enjoy a
cup of coffee or tea. Now somepeople are still evacuating out
from the city and others arecoming back, but both of themneed to have a spiritual hometown.
So, I hope that the Soma City andthe city hall becomes the icon ofyour special hometown.Then I
move on to our experience at thetime of the Kumamoto earthquake.
Every time disaster comes over we
actually look at the record of who
helped us at the time of difficulty.
We got a support from Tamanashi
region, Yamato‐machi region of
Kumamoto. It was around 10
o’clock PM on 14th April when we
knew a huge earthquake struck
Kumamoto prefecture. The nextmorning I made an order to send
water to those two municipalities
based on the experience of what
we had needed the most soonafter the disaster. But 28 hours
later, there was another major
25

quake in the early morning of 16th
Reports from local government mayorsof April. In that morning I
made an order to send waterand blankets from ourstockpile warehouse to the
12 municipalities ofKumamoto.
Also, I remembered the
kitchen car I mentioned
before. Anticipating thatpeople in Kumamoto would
need a kitchen car, I talked
with the municipality head of
Takamori and so we sent the
kitchen car to Takamori City
(Picture 71). And the
kitchen car is now serving
food for the evacuees in an
evacuation center. As one
kitchen car is not sufficient, I
hope that other municipalities will copy our idea.
Yesterday morning, we found there are 150 sheets of gypsum board which you used as partition at the
shelters 5 years ago (Picture 72).
They were sent to Takamori municipality yesterday in joint consultation with the assembly member ofKumamoto. But the municipal staff at the disaster area do not understand why these partitions areimportant until we explain our situation. So it will be good to start from Takamori city and then spreadthe idea to the surrounding areas. But in Kumamoto, people evacuate at the time of aftershocks andthen come back to their home soon. So it is difficult to identify how many of those partition boards are
required. This management problem could be solved by making a database of the damage of eachhouse, but it is easier said than done.
That’s all from me, and we want to deepen our discussion further on various topics. When I saw thesituation in Kumamoto, I was so shocked. It’s something to do with what Mr. Sakurai mentioned. Fiveyears ago, we learned bitter lessons but that bitter lessons were not actually shared and applied in
Kumamoto. I sincerely hope this international symposium will be a good opportunity to achieve better
preparedness for disaster. Our
knowledge, especially thosedata about radiation
protection, will be of greatvalue for future use. Thankyou very much indeed for yourattention. I’d like to conclude
my presentation now.

26

Children and disaster recovery
The 3.11 Triple Disaster:Health Effects on the Residents of Soso District, and Possibilities for Health Promotion

Tomohiro Morita

Soma Central Hospital, Physician
Thank you for the
introduction. My name is
Tomohiro Morita from Soma
Central Hospital. I am aphysician. Now, I’d like to
begin my presentation.

“The 3.11 report disaster
health effects on residents ofso‐so district and possibilities
for health promotion”, this is
the title of my presentation.
First of all, the introduction.
The health impacts of adisaster can be distributed to
two types. The first is
direct health impacts, whichis caused by the injury fromthe disaster. The second is the indirect health impacts, which is due to the drastic environmental
change. For instance, in Kumamoto earthquake, some cases of “economy class syndrome” leading todeath during evacuation were reported by the media. Besides, at the time of the Hanshin earthquake,some studies reported the increased number of patients with myocardial infarction after the disaster.
These indirect health impacts can be caused by social impact of a disaster such as the loss of access to
medical care, environmental change, and physical and psychological stress.
In the East Japan earthquake, there were large direct and indirect health impacts. Psychological stressfrom losing their families and the long‐term evacuation life could have resulted in deterioration of
medical condition. All of these are the compounding factors leading to the impact on health which we
still do not know. That is why we have targeted Soma City and Minamisoma City to do the survey on
mortality and cancer mortality.
This is the method and we have used
the Vital Statistics managed by the
Ministry of Health, Labor, andWelfare, which is also used for thedeaths statistics. And also, we
adjusted mortality rate for age.
This is the result, that is the trend ofage adjusted mortality rate per
100,000 population before thedisaster and after the disaster. As
you can see, there was no majordifference. The size of the peak isasserted. That would mean thedeath from the disaster. Although
there was a big peak in 2011, age
adjusted mortality rate have notchanged significantly after thedisaster compared to before.

27

Session １
This is as of 2011, what was the direct
impact from the disaster. So, we dida detailed survey. In order to assess
the indirect health impacts, we
excluded the deaths from tsunami or
the earthquake from further analysis.
The result indicated only in the firstmonth from the disaster, mortality
risk was increased both among men
and women: relative risk were 1.52
for male, and 1.35 for female.
This is the cumulative mortality rateby age group by sex. Among both
sexes, mortality rate was increased in
the first month. Especially, among
women, mortality rate among thoseolder than 85 years old has increased
from the first to the third month fromthe disaster. The relative mortality riskin post‐disaster period in these threemonths were 1.45, 1.75, and 1.81.
his result indicates that indirect healthimpacts of the disaster can be more
severe and persistent among elderly
people than younger people.
In the Kumamoto earthquake case,only 1 month has passed but we will
have to focus on the healthpromotion, particularly for the elderly.
And so, we dig deeper the cause ofdeath for these people. This is 1
month after the disaster and thepneumonia for male. And also, thisis 1 month after pneumonia, usually
22 per month. However in 2011, 47
people died, about double thenumber died from pneumonia, so thecause of the 1 month period. This is
the elderly people’s deaths due topneumonia. Probably, these elderly
people can suffer aspiration
pneumonia. That’s the biggest causeof the disaster related deaths.
In order to prevent these secondary
death s, we have to prevent theelderly deaths due to pneumonia.
This is why when helping the medical
assistants in the affected areas, wewill have to cater them in cleaning
their oral cavity for instance for the
purpose of prevention especially inthe 1st month of the earthquake.

28

Children and disaster recovery
Then, how severe health effects of thenuclear accident itself was? Thoughradiation exposure among residents
have been proved low, fear for healthdamage due to radiation exposuresuch as cancer still remains.
Therefore, we compared cancer
mortality rate between pre‐disasterperiod and post‐disaster period. The
result indicated that there is no
increase in age adjusted cancer
mortality after the disaster. In thepast 5 years after the disaster you
could find no long term increase inall‐cause mortality or cancer mortality
rates after disasters.
But the disaster related deaths in thepast 5 years, most significant, thecritical period was 1st month of thedisaster. So, initial management or
the countermeasure is required.
Especially, focus should be on elderly
people to really relieve them from thatpneumonia aspiration, and pneumonia
scenarios.
In the latter half of my presentation, I’dlike to share you the medicals and thehealth measures we are taking. As
Mr. Sakurai, the Mayor of Minamisoma
mentioned that one of thecharacteristics of the disaster is that
there are many young people
evacuated from their hometown.
Mass evacuation has occurred in
mandatory evacuation within 20 km
from the nuclear plant and also involuntary evacuation zone from 20 to
30 km from the plant.
As a result, population in Minamisoma
City has been aging rapidly. The
aging rate has increased from 23%
before the disaster to more than 30%
after the disaster. The rapid
population ageing means that the
number of the people supporting
elderly people is proportionally smaller.
Here is the trend of the amount ofpublic long‐term care expenditure perelderly person in Minamisoma City.
And the long term care expenditure
spent by the municipality has
increased after the disaster comparedwith prior to the disaster by 30%.

29

Session １
Besides, those who lost their carersometimes lost houses because oftsunami, lost their families, andthen these elderly people are left
alone and solitary in the community.
Those isolated elderly people areprone to get many diseases
including stroke, fall, fracture,dementia, and others. Therefore,social support to save them fromthe health risks has been a public
issue in this district.
Like in the previous case in thetemporary housings of the victimsof Hanshin earthquakes in Kobe,
50% of residents are elderly people.
So, in Fukushima, the rate of theelderly in temporary housings were
estimated as high as that used to bein Kobe. Thus, the demand forsocial support to keep the health ofthe elderly is huge. Now, local
governments are struggling tomanage this situation. One
example is, the community housingsfor the elderly. It is a single story
and semidetached house andelderly people who have lost theirhouses are actually living together.
57 people are living in this terraced
house and half of them are 80 years
or above.
One of the characteristics of thisprogram is that like a kind of sharedhouse, they show some privacy
space. Everyone has their own
private room and everyone canactually sustain his or her own life.
They go out as they like and they
have their own activities to enjoy.
In contrast, as for lunch, lunchboxes
are distributed to all residents in the
public dining room so that residents
have an opportunity to meet witheach other at least once every day.
So, meet with them, talk with themto really refrain from getting alone
and solitude. To create the elderly
people’s community, this kind ofcooperative community can be
useful.

30

Children and disaster recovery
I visit the community housings once
every month and the public healthnurse also visits. With help of
volunteers, there is a number ofactivity programs or tea time eventsor other gathering events.
This community housings seems tohave a good effect to the healthstatus of elderly people to preventsocial isolation. If somebody is ill,
some other people will take notice ofthat. So, the early detection ofillness can be assured because thepeople can actually observe otherpeople, this person is not coming up
to the lunch or he does seem sick.
And also the better access to thehealthcare. Sometimes elderly
people refrain from going to hospital
clinic. I am sure that you
understand that the people think it’srather tedious to go out and go to
the clinic and the hospital. But if
your neighbor takes note of that andthen the neighbor could offer you
that I will take you to the hospital.
And then, the healthcare can beprovided. There are a number ofcases where the sick patient was
found and taken good care like
hypertension. And this person was
not quite aware of his own
symptoms but the neighbors actually
took him to the hospital.
There was the old lady with auditory
hallucination.
It was not actuallynoise that she noticed. It was
actually hallucination. And then it
was pointed out by her neighbors
and she took the professional
diagnosis. And it’s quite often thatneighbor to call the ambulatory
service to save the life. It is safe
and safe and securities and also
better healthcare be attained withthis kind of terraced house, theelderly people’s home.

31

Session １
Now in conclusion, during 5 years from the disaster, total mortality rate has increased only in the 1stmonth. It’s a very assuring result, but along with the greying population, we should have long term
healthcare support for the elderly. With all those issues in mind, we have to come up with the mosteffective community support to elderly people. With this, I’d like to conclude my presentation. Thankyou very much indeed.

32Children and disaster recovery
Activities of the Follower Team: prevention of PTSD among children

Masaaki Abe

Director, Seisa Nagoya Junior High School
Until March 2007, I was living
in Koriyama City and worked
as a center head of Seisa
International High School, acorrespondent high school.
My ex‐students are still livingin this area.
Soon after the disaster Mr.
Yasuo Miyazawa, the grouphead, and Mr. Tachiya, theMayor of Soma discussed
what support is needed, theyreached the conclusion that
we need some measures tohelp children, particularly thepsyche of children. Then I was
assigned as a team manager
because I have manyacquaintances here.
This is what we experienced at the Hanshin‐Awaji earthquake. Psychological problems became peakthree years after the disaster. So, I thought that a single year follow‐up is not enough. I thought
long‐term close relationship with children is required to prevent such problems. And that was mymotivation and that was why the ‘Follower Team’ was created.
The ‘Follower Team’ is a clinical psychologist’s team that was dispatched to this area. To my knowledge,
this was the first attempt of long‐term follow‐up of children’s psychological problem as a team.
Before us, many psychological aids were given, but they were provided for a short term without
appropriate handover, so children were asked the same sort of questions repeatedly. When we started
our activity, many people said that it would take much courage in order to consult with clinicalpsychologists. We thought of ways of overcoming these hurdles.
As for the short term goal, we aimed
at fulfilling the immediate life needs,
because we cannot go back to thepast. If we look back on the past, we
would just miss it. Instead, what was
important was to fulfill our current
life. That was our short term goal.
Then, we raised the midterm goal;
and that is to increase theself‐reliance of the children. To
achieve this goal, expanding
self‐confidence and self‐affirmation
was the key. To expand the spectrumof the possibility of the children
under the limited reality, we helped
them to gain profoundself‐understanding and to practice
positive behavior.
33

Session １
And the last one was a long term goal; that is to have the gold stars for everybody’s lives. To achieve thisgoal, we have to collaborate with school teachers to create healthy atmosphere so that the children canfeel that their lives were destroyed by 3.11, but they were able to successfully overcome these eventsand now they have a fulfilling life. These are the goals and the missions. And how to hand these realexperiences down to future generation is our mission from now on.
When the team was formed, the most important mission was to prevent PTSD. The word PTSD was
already popular among parents and children, which made them more anxious about the problem.
Indeed, there were emotionally unstable children or children who are easily upset, which clearlysuggests they got lots of mental stresses.
Under this situation, we had to devise measures to prevent or mitigate PTSD. Particularly, we tied up
with a school community and also we did the interaction and cooperation with specialists. Because our
focus was children, our main activity was in schools. And we wanted children to charge positive energy
in them and to enjoy their school life so that they can have fun. So the Soma Follower Team provided
both direct support and indirect support via parents and teachers for the children. All these efforts
provided at the schools are one if the features of our activity.
Two junior high schools and twoelementary schools, which wereseverely damaged by the tsunami
and thus were in urgent need ofsupport were chosen. The students
experienced different types ofhardships and needed a careful
hand. Some children saw theirfriends and relatives washed awayby the tsunami. Others lost theirparents or their grand parents or
siblings. In such a situation, our firstpriority was to build rapport withsuch children, facilitating them toget mental support at ease.
Particularly in the school where theteachers were also the victims, we
needed to be accepted without
becoming a burden on the teachers.
Mingle with children and teachers
during daily life were the key points.
Through these experiences, weliterally lived with them in thecommunity, which made us provide
consistent support. Because if
people come and go, they ask thesame question to the same persons,potentiating the anxiety of thestudents. That was not our stance.
The same person would be there,
would be persistent in helping them.
So, we established a system where
the single persons continued
support giving the local people
confidence.

34

Children and disaster recovery
This consistent support was achievable only when we have a confidential relationship based on trust.
One of the key measures that that gave peace of mind to the teachers was how we could respond to an
emergency.
Without delay. And also, we wanted the children to have stronger ties with teachers rather than to us.
So, we offered indirect support to children through their teachers.
You may think that counseling is conducted in a private room. But if that is the case, that would be a big
hurdle. So, it was not a private room but in the corridor of a school or in a classroom where we provide
support. Throughout the school life, we contacted children and teachers to create thecounseling‐friendly environment so that more teachers and children could come to us for help. We neverintended to grade these children. We just accepted their feelings. We simply listened, and we did notcoach them. Such ‘never‐rejected’ atmosphere, I think, gave them a sense of security.
These were some of the stresses thatchildren had to go through. This is
the data after the typhoon number
23rd of 2004, which caused a hugeflood damage. There were many
types of stresses. As you can see,as the age advanced, the level of thestresses become stronger.
Although this kind of data wascollected by several support teams, it
seemed that these study results
were not put into practice. What we
had to do is to use this data to
improve our support activity forchildren. So we utilized the findings
in devising method of
psychoeducational intervention forchildren. We provided psychoeducation such as trust working, stress management. We also createdmore opportunities for children to confide with each other or with teachers.
These are some of the important things in mental care. It is important, of course, to provide adequate
information to children who need help. But more important thing is to provide children practical ways toeliminate solve the problems. We may not be able to eliminate a problem, but we can think together
on how possibly we can solve these problems in the real world.
And also, we need to accept the reality so that we return to our daily life as soon as possible. Children
have their own distress and challenges, but we think that children already have the answers inthemselves. So we do not tell children what to do. We help children come to be aware of what they arethinking and the answers that they already have. And we get along with the children to take action forsolving the problem. If children try to solve the problem using measures beyond their capability, thatmeasure will become another burden for them. Therefore the most important thing for us is to detect
what kind of and how many resources each child have. Look deeper in themselves so that they can find away out is the shortest way to solve a problem.
I think vulnerabilities and risks had existed even before the disaster. Those who had had more factors
before the disaster were more vulnerable to mental instability and were more likely to show emotionalor physical expression after the disaster. This vulnerability existed because each child had a different
living environment before the disaster.

35

Session １
What was lucky about Soma area is that the school resumed soon after the disaster. And in some cases
where teachers visited shelters and provided lectures. And of course even after the schools were opened,
many children commuted from shelters while others commuted from their own homes.
I am also used to go to Minamisoma. There, some children have houses not damaged by the disaster but
they cannot go back (due to radiation contamination). Other children’s houses were literally “washedaway by the tsunami “ so they didn’t physically have their houses to go back. Others live in their own
houses. The situation was different and some children have the sense of guilt because they are living intheir own homes. However, although each child had a different background, all of them went to thesame school and saw see each other, which created a sense of stability.
The school I was involved in was a school that was washed away by the tsunami. After the school
reopened, children had to commute using the bus, which drove through the area where the tsunami
swept away everything. Some of the children told me that they cannot look outside of the bus and try
not to look outside by talking with each other or reading books. But even with these kinds of flashbacks,
they wanted to go back to schools and the local government responded to their wish. They had cultural
festivals, and the theme of the festival was ‘what the town would look like 10 years from now’. They
talked about how to create positive ways of thinking, and shared such image is help them to overcome
the current difficulty and build back better. In another activity, children made the charms for the prayer
using the natural stones that were donated. These tokens of prayer are to pray that these children canpass the entrance examinations for high schools. And these were some of the things that we did together
with children. Through such activities that strengthen connection with others, they could gain a sense of
self‐affirmation and charged positive energy within their mind.
When we came first, we interviewed all the school members including the teachers. And one interview
was not sufficient so throughout their daily lives, we chatted with them to establish the rapport. And
twice or three times a year we did do the interviews.
Through the interview, a student said that I want to ‘feel better’, though s/he did not know what is better.
I think the student experienced hardship. And the student said that s/he wanted to die. Then I asked
what actually s/he wanted to do, and then s/he answered ‘I want to be set free’. And then I asked, ‘how
can you be set free?’. And that was the trigger of the conversation. This student became my Facebook
friend and I know what s/he is doing now, and the goal we discussed at that time is what s/he is pursuingnow. S/he is now studying hard to get the job related to the goal.
Several students burst into tears when evacuation drills were conducted in May 2011. They are still
having unstable minds. They had already had some problems before the disaster, and the stresses causedby the disaster triggered their physical manifestation. While talking it was revealed that she had mental
stress from daily classes, extracurricular activities, friendships, and family problems. The stresses fromthe disaster were added to such stresses.
But one student, who easily lost temper before the disaster, regained himself because they had theopportunities of looking into them by having to live apart from their family. So, each environment isdifferent and each student’s coping capacity is different. So, we will have to look at individual students
one at a time.
I think understanding each student’s background and making the best of the information to support
children is important. So we shared such information with the teachers and working together withchildren to solve the problem. In other words, how to make interrelationship with the teachers was thekey.
After the disaster, there was a big change in environment and the interpersonal relationship. But somestudents converted these emergencies into opportunities. Through many support activities, theyexperienced what they would not have had if the disaster didn’t occur. Through such experiences, somechildren broadened their dream. Some make a plan to study abroad, and others try to send messages to36

Children and disaster recovery
all over the world. And that was a good aspect of what we did. We thought that it would be better if
we can do such support without giving extra burden on the teachers.
Extracurricular activities andsupport require teachers to arrange
things. If teachers feel they are
overwhelmed, the scheme will notadvance. So, we also can drive
how we can help students without
giving extra burden to teachers. And
this resulted in success. Somestudent expanded their experienceand their dream for the future
became greater. There are many
students who successfullyrecharged mentally and ready to
grow. The words in the slide aresome of the words that werementioned by students. I wantthem to praise themselves formaking such progress.
And also, teachers said that theyalso had the space of mind toobserve students’ behavior inclassrooms. And as such space ofmind among the teachers will bereflected to the students, we thinkthat what we did had a certain levelof success.
This is the result of a questionnairetargeting head teachers after the 2years’ activity. On the 3rd year, we
asked the school teachers ‘how
many days a week do you want thecounselors to be at schools?’. About
84% answered they want us to stayat least 2‐3 days a week. Of
course, the clinical counselors will
not be able to be there forever.
But probably, this would be thedesired number of days for us at schools.
And also, when we ask about the mental care necessity, 47% of the teachers say that they have thedisaster‐related stresses and they need help. And the majority of the teachers said that mental care to
the adolescent children, in fact, 79% of the teachers said that the children need that kind of help. Thatmay be the main reason why more than 80% of the teachers wanted school counselor to present at
school.
The second issue was the parent support. Most of the children have accepted their new daily life andhave recovered from the damage of the disaster, but many adults still compare their current lives withthose before the disaster. That’s why the parents are more likely to be stressed out from the disaster.
And the teachers also said that they want us to help the parents as well.

37

Session １
We want the children to continue
to smile. I want them to feel that‘there have been many ups anddowns, but I’m happy where I am
now.’ We want to create suchsociety as adults and that’s the
responsibility for us.
Five years have passed and during
the time I learned myself and I
believe that what we have learned
is applied to the operation of the
Seisa Nagoya Junior High School.
This junior high school is focusing
on school truant students andaccepting students who refuse to
go to school. And so, what wehave learned in Soma is very much
helping these truant students.
Finally, we want to continue to contrive so that we can keep the children smiling.

38

Thank you.

Children and disaster recovery
Recovery from the Great East Japan Earthquake and lawyers, and the role of Japan Legal Support
CenterAsako Sugioka

Lawyer, Japan Legal Support Center, 1st Operation division
I belong to the Japan Legal
Support Center. I would like toshare with you the experienceof Japan Legal Support Center,roles and responsibility inconjunction with the disaster.
When the Great East Japandisaster occured, I belonged
to the Bar Association ofJapan. The Association set up
the East Japan Disaster
Countermeasure
Headquarters and I was one of
the staff members at theheadquarters to be engaged in
the recovery activities of thatdisaster in Tohoku region.

I want to share with you about our efforts how the lawyers were engaged in the recovery of the disasterand how we made a relationship with the people in the community. During that period, I worked at theJapanese Bar Association, which is located in Tokyo. Many lawyers throughout Japan were actuallyjoined in the support activity for the residents not only in Fukushima but also all over the Tohoku region.
I was engaged in organizational work rather than legal consultation work, so let me start with theorganizational aspect of the activities we conducted.
We lawyers were engaged in the dispute mitigation consultation. What I was usued to do in normaldays was to delist various cases. We actually provided the legal consultation and made the procedure
for lawsuits and acted as the proxy or the legal attorney.
After the Great East Japan disaster occured, many things arose What the lawyers did first was toprovide legal consultation services. We went to the evacuation centers to have the consultation
services there. And many people evacuated to various parts of the region, so we provided telephoneservice to accept consultation from throughout Japan.
As far as we know, there are 40,000 cases within 1 year. So many consultations were asked for, and the
local office of the Japan Legal Support Center in Fukushima has accepted 43,000 cases so far. Especiallyduring the ‘golden week’ (Japanese holidays: 3‐5th May) of 2011, 300 lawyers attended 95 evacuation
centers in Sendai and got 1000 consultations.
After the legal consultation services, evacuees actually refered to the various cases and programs and we
get the direct involvement to resolve those cases legally. Compared to the ordinary days, there weresome differences after the disaster. We have a larger number of familial cases such as division of
inherited properties, guardianship, and devotion than normal days. And also there were many cases
inherent to the disaster: requesting compensation for damages related to nuclear plant incidents, which
includes direct requests to the Tokyo Electric Power Company, requests using ADR processes and throughjurisdiction procedures. And as for the disaster‐related death, the local governments set up the review
board for disaster‐related deaths, and if the death is certified to be related to the disaster, thecondolence money was provided to the bereaved family or special subsidy. Therefore, whether or not a
person is certified as disaster‐related death does matter for his/her family. We helped the procedure of
the request and if the death is not certified, we made a proposal for lawsuit requesting certification.
39

Session １
What specific activity we did
was to deal with ADR. ADR
stands for the Alternative
Dispute Resolution outside ofcourt settlement. For
ordinary people, going to thecourt and fight or thelitigation case is quite
stressful and also
cumbersome. However,even for those who wereactually suffering, they had totake an action as resort tosuch kind of litigation toresolve problems. However,such action and effort forthe court may be rather
difficult for the ordinary
people. To make the procedure easier and quicker, two ADR procedures were set up after the disaster.
One was the guidelines for voluntary liquidation. This system is for the debtors who had difficulty inrepaying their debts because of damage and losses by the disaster. Through some kind of consultations
with debtor and lessors, the debt amount could be reduced, and/or the due could be postponed. As
the registered expert, the lawyer supported those debtors.
Also, a center alled the dispute settlement center was establsihed for settlement of disputes incompensation for damage related to nuclear plant accident. They settled litigations not based on a direct
request but by using ADR measures. As lawyers, we often served as agents to make some request andthen to settle the case.
Another our activity was legislation proposal. Although there are various legislations laws to support
disaster victims, they are not always a perfect fit. Sometimes it ws too complicated or not sufficient, or
sometimes they were not supportive for the victims to put their lives back in practice. As disasters arediverse in many forms and patterns, so that any single law cannot cover to resolve the problems and thaton‐going law system is not always perfect. Therefore we listened to the victims and the evacuees, andtried to reflect what we have learned to formulate new laws and regulations.
One major proposal we made is to establish the right of claim for damage by the nuclear power plant.
Usually, the expiry period was only 3 years, but it seemed too short period for the victims of large
incidents as such. So, we proposed to extend the term to 10 years from the time the damage wasconfirmed. And the proposal was accepted.
There were other activities we did. Lawyers were sometimes assigned as a termed or the short period
public servants and made advice on paperwork or were directly engaged in city planning or community
redevelopment. But personally, I think our fundamental work msut be legal consultation.
Legal consultations in usual times are important to dispute resolution, to prevent conflicts by listening to
the complaint and making legal advice for the solution. But at the time of disasters, somewhat
different roles of lawyers is required. One is the provision of practical information. Only when you
yourself become the victim, you start to realize what kind of measures and relief support there arenecesaary. Through legal consutltations, we lawyers can provide those kinds of information, what kindof support system they are able to take.
And the counseling capability is another important role that lawyers can play. We listen attentively
many worries and concerns of those victims have. We share the sorrows and grief with them as muchas possible. That kind of attitude of lawyers I think is very important.
40

Children and disaster recovery
Also, other than the role of conflict prevention, we had a role of collecting legislated facts. By listening to
the victims and survivors of disaster we recognized what is needed in the current legal system. Feedback
based on the opinion of the victims can be deflected for the future improvement of the legal system.
However, for you and perhaps for other people too, the legal consultation, lawyers and court are in a
faraway existence. And the same is true when you are in the middle of a disaster.
The Japan Legal Support Center conducted a large‐scale survey in 2013 targeting the victims of thedisasters, and asked ‘what actually hindered you from making access to lawyers?’. We got a variety ofanswers. Sometimes they think it is just meaningless to make a legal consultation. It is a shame forlawyers because our roles and responsibilities are not well understood. The second point was thatpeople think – well actually, 1/4th of respondents say that it will be very costly. Or they answered they
don’t know any lawyers or the legal professional personally. And these are the bottlenecks for them tomake access to the legal specialists.
Now, let me move on to introduce theJapan Legal Support Center. Thiscenter is a publicly establishedcorporation that provides every
Japanese with necessary legal support.
The aim of the center is to eliminate
barriers against referral to lawyers,
such as cost and access.
But unfortunately, in reality, notanybody is entitled to the service ofLegal Support Center. We provide afree consultation or put up the cost for
the legal procedures only for thosewith economic difficulty.
At the time of the Great East Japan
Earthquake disaster, many people areconcerned about the cost and they
don’t know the acquaintances who area lawyer, as I mentioned before. On
the other hand, as Legal Support Center’s system provides service only for those with economic difficulty,
it requires clients to declare the income and assets and a number of family members. It is mandatory
to provide this kind of information. I am sorry to ask those suffering from the loss of income and asset
questions like how much money you have, how many assets do you have. We want to change suchsituaton. Another issue is the problem in reimbursement. Aided expense for lawyers is not for free, but
the object is to be reimbursed. Installment payment starts immediately after the consultation. But for
the victims of the disaster, who have to rebuild their life, I felt that paying the legal expenditure
immediately after is a bit challenging.
As for the process for ADR, its cost was not covered by our service, I meant at that time that to use theLegal Support Center is not practical.
In response to the needs of the victims, one year after the disaster, the Earthquake Special Provision Act
was enacted. After that, all the residents who lived or worked in the affected area before theearthquake became able to get a free consultation. In addition, reimbursement has begun after thecase was completely finished. The ADR procedures also became in the scope.
This Earthquake Special Provision Act is really effective for the Japan Legal Support Center to receive or
to provide so many consultation services to victims. The Houterasu Fukushima is the branch office ofLegal Support Center in this region. About 430,000 cases have been handled by the branch.

41

Children and disaster recovery
Let me introduce several
characteristic consultation cases inthis branch office: requesting
compensation for damages, which
had been only 118 cases in 2010,
increased to 2,497 cases in 2012.
And divorce cases significantly
increased in number. There had
been only 430 cases before thedisaster, but in 2013 it became
1,300, about triple the number.
Other than divorce, there are cases
for children whose parent died,such as guardianship andsuccession of property. There had
been 365 family cases in 2010, but
the number increased to 1,793 in2014, and 2,327 in 2013, about 6
times as much as that before thedisaster. As for the control of debt management, there’s not increase in the case.
These trends show that not only compensation for damage by the nuclear accident but also divorces andother familial cases caused by drastic changes in their daily lives that really affected their life. Therefore,
we have to follow up the area for a longer time.
Now, 5 years have passed and people’s worries and concerns are very much diversified. Compensation
appeal is one only thing. As health problem, environmental problem and how to secure houses to live inhave been arisen, we would like to actually help those people with those problems from a legal
perspective.

42

Children and disaster recovery
Strengthen Lifeskills through Music：
Recovery, Regional Revitalization, international Exchange through Art and Culture

Yutaka Kikugawa

Executive Director, Friends of El Sistema Japan
Today I will introduce ouractivities in Soma City,
Fukushima Prefecture. I
assume many of you do notknow “El Sistema” in the firstplace.

El Sistema was established
41 years ago in Venezuela.
It is a music education
program, which provides
children with an opportunity
to learn music in an
orchestra or chorus,
regardless of their family
background and disabilities
with an aim of develop
self‐confidence and life skills.
In Venezuela, with the annual budget of approximately ¥10 billion, 500,000 students participate in 250
orchestras. At the moment, El Sistema is operated not only in Venezuela but also in around 70
countries.
With the aim to “develop life skills based on intrinsic motivation among children”, the first El Sistema
inspired program in Japan started in Soma City. The Friends of El Sistema Japan was founded on March
23, 2012, signed the cooperation agreement with the City of Soma and initiated activities on May 7,
exactly 4 years ago from today. Since the time I was with UNICEF, I worked with the School Board
members to support the children affected by the Great East Japan Earthquake and tsunami.
Soma is a small town but has great human resources as well as a long history of appreciating music,
including classical music and folk songs. Therefore, we decided to make the most of the existing
framework and resources. It was one year after the earthquake and tsunami hit the local communities,
so the local government was then at the stage of planning recovery and rehabilitation activities. The
stakeholders might have had the ideaof bringing about drastic changes.
Our cooperation agreement was
based on the reconstruction plan.
As I mentioned earlier, what weregard as an important component inintroducing the El Sistema inspired
music education in Japan is to makeit available to any child who wishes
to participate at no charge. You cansing and play music alone, but wevalue the process of making music
together as it promotes teamwork.
By learning from each other(so‐called “peer learning” or “peerteaching”), children can develop
solidarity among themselves. As
the teacher from Seisa Junior High43

Session １
School touched upon, we envisage
developing a framework forlong‐term psychosocial care andsupport.
The children participating in our
activities include those who lost
homes and settled in Soma as well as
those who evacuated from the areas
contaminated by the nuclear
accident. By implementing a musicprogram, which can be participatedby any child, we plan to heal theirwounds on a long‐term basis. Ifchildren become resilient, then theirfamilies become also resilient, andso does the community they belong
to.
Since 2013, Professor Kariyado,
Aoyama Gakuin University, has been
conducting an external evaluation.
Recently, the latest report became
available. Comparing the data of
our weekend music class with thenational level data collected by
Benesse Educational Research andDevelopment Institute in 2009, we
found that our weekend music class
scored higher on the question of“How do you feel about yourcommunity?” Additionally, on thequestion of “How do you feel about
yourself”, the number of children
who responded ‘very satisfied’ is not
many, but “’fairly satisfied’ scoredhigh in comparison with the national
average. Observing the children’s
day‐to‐day behavior, I myself feel they have gained self‐confidence over time.
We have the cooperation agreement with the local government from the onset. Furthermore, theMinistry of Education, Culture, Sports, Science and Technology has commissioned us a school counselor
project, and the Agency for Cultural Affairs has decided to subsidize our program. Thanks to theframework that enables coordination with the local government, the implementation mechanism has
grown to be more sustainable. Since the end of last year, we have joined “Furusato Nouzei”, aninnovative tax collection system where taxpayers can earmark and decide how their money will be used.
Our partners are committed to holistically fostering the ownership of children, their families and the
School Board. Therefore, our program supports not only the Soma Children’s Orchestra and Chorus but
also the local public schools. Some of the small‐scale primary schools in Soma are not equipped withmusic teachers, so we dispatch trained music teachers to the schools, organize music appreciation
classes and engage local traditional music masters to enrich learning experiences for children in any ways
possible.

44

Children and disaster recovery
Those who can extend support doso and make a place for children –that is the joy of being together
with music. Thanks to the supportof the government, the private
sector and generous individuals,
our activities are made possible todeliver. What I feel and realize
recently is that music itself does nothave national borders. It is often
said music can connect the world,and El Sistema’s network is, in fact,extended around the globe. Last
year the Youth Orchestra Los
Angeles came from the US to playwith the Soma Children’s Orchestra
and Chorus at Suntory Hall inMarch, and around 200 membersof the Teresa Carreño Youth
Orchestra of Venezuela also visited
us and organized a joint concert inNovember. This year 37 children
from the Soma Children’s
Orchesstra, Soma High School andSoma Higashi High School travelled
to Germany and played with themembers of the Berlin
Philharmonic in March. Then, 36
children of the Kaposoka Orchestra
will visit us next and the following
weeks from Angola where the gap
between the rich and the poor still
persists.
How I started the Friends of El
Sistema Japan dates back to thetime I was serving UNICEF as
Emergency Relief Coordinator. A
member of the Berliner Philharmoniker, who was on a visit to Japan as UNICEF Goodwill Ambassador,
observed the situation of children in the disaster affected areas and proposed the idea of introducing an
El Sistema‐inspired program. He mobilized his own network in Germany to get the initiative rolling.
Then, the Beliner Philharmoniker organized a fund‐raising concert in fall of 2012 to establish an orchestra
for the children in Soma. We were very grateful for their generous support and dreamed of returning
thanks to the people of Germany by organizing a concert tour to Germany someday. The dream cametrue in March this year. Out of 37 children who joined the concert tour to Germany, 16 children started
learning the strings from the summer of 2013 onwards. The youngest cellist is a second grade girlstudent. At present, the members of the Soma Children’s Orchestra range from 5 year‐old to 17
year‐old children. The Soma Children’s Orchestra counts approximately 85 children while the Soma
Children’s Chorus is 70 children.
Lastly, I would like to share with you one more anecdote. Our weekend music class started in April
2013 with support from the Kumamoto Lions Club and the Youth Symphony Orchestra, which has along‐standing history of playing in Kumamoto. They made financial contributions to support ouractivities for the disaster‐affected children. Recently, a major earthquake hit and devastated
Kumamoto. I discussed the situation with the children and their families. The children said they45

Session １
want to return thanks to the peopleof Kumamoto, particularly to theYouth Symphony Orchestra, by
joining fund‐raising activities.
Everybody says they want to playmusic with the Youth SymphonyOrchestra in Kumamoto andnurture friendships.
In such a way, the children havedeveloped the sense of gratitude
and grown to find what they can dowith music. I am very pleased
with their growth, which is the outcome of ouractivities.

46

Children and disaster recovery
Recovery in agriculture in Soma area : Support by the Tokyo University of Agriculture(TUA)

Yukio Shibuya

Professor of Tokyo University of Agriculture

The Tokyo University
Agriculture（TUA） located at
Setagaya, Tokyo. We arecelebratin
g 125th anniversary this year.
I think we, TUA, were invited
to this International
Symposium on Disaster
Management and Recovery
for Children and Communities,
because recovery ofagriculture is essential in thiscommunity. Local industries
have to actually recover andstrive for young family to growand sustain the family
household and grow theirchildren. So agriculture, I am
sure is very important to actually navigate the future of their community in Soma City.
First I’d like to share with you how we started support for the Great East Japan earthquake disaster, thenoutline each support project we have conducted. Lastly, I’d like to talk about some of the researchachievements and how we have spread the achievement to the world.
Now, let me start with how the Great East Japan Earthquake Disaster and Support Project wasformulated. The mission of our university is to educate personnel that support local industry inagriculture, forestry, and fishery. During the past 125 years, we were actually nurturing those navigatorpersonnel for the primary industry. And our founder said, ‘send people back to farm’.
At the time of the disaster, 1500 students of our university were from the affected areas, and 250
students had their houses swept away or severely damaged by the tsunami. Therefore, although welocate ourselves in Tokyo, we are closely related to this disaster in Tohoku area. And recovery of local
industry, agriculture, forestry, and fishery in the affected area is an important mission for us, anominated university of primary industries.
As we have the practical learning as a philosophy of the university, on‐site problem‐solving is our basicstyle. It was the exact time when the earthquake took place that we use our wisdom and knowledge
accumulated at university to serve to the community. There are three prefectures in Tohoku area, or six
prefectures all over Japan, that were severely affected. It was difficult for us to cover all these
prefectures. We had to select a small number of places and concentrate our resources to make theeffective research. Solution of a local problem will be applicable to solving global problems. So, after
this disaster we focused on Soma City and adjacent municipalities in Fukushima as our research field.
We chose this area because this region is suffering from the triple difficulties of the earthquake, tsunami,
and the radiation problems. And Soma city really needed realization of our philosophy, practicallearning, because what they need was solution‐based approach to achieve both recovery of entire local
industries and recovery of people’s life at the same time. Soma City has a good network ready to teamup with local government, research organizations, and agricultural association agencies. And some of
our faculty members are from this region. So, we decided to choose Soma district as a center of ourresearch field.
We made the field survey from 1st to 4th of May, 2011. As is shown in this photograph, Dr. Osawa, thePresident of the University and 15 staff members with various specialty visited the region. And theyracked their brain as to how their knowledge and expertise can serve to the Soma City.
47

Session １
On May, 2 months after the disaster,
there were rubbles in paddy fields.
In some area, automobiles were
floating in the middle of the field.
On the surface of the paddle field
you see cracks in the shape of scales.
When sodium goes into clay soil andprecipitated, cracks like this is made.
This shows that the tsunami brought
the clay containing sodium into the
paddy fields.
Damage to the agriculturalequipment was also severe. Most of
the agricultural operation in the rice
field is carried out by machineries
nowadays. Retrieving the set of themachineries costs about ¥10 million
per agricultural household. One ofthe very serious damages to the
local agriculture is this loss of
personal possession.
On 2nd May 2011, we got a lectureon the local agriculture at a local
research center near the coastal
area. I and Professor Monma, theformer project officer, also visited
Mr. Tachiya in his office and took an
intensive lecture about the status ofdamage caused by the disaster.
And then, we visited Mr Matsumura
in Tachikiri district, who was living ina house in which the ground floor
was swept away by the tsunami.
So, the families are actually living on
the second floor. And we
discussed as what assistance Tokyo
University of Agriculture can provide
to the local citizens. In the beginningof May, temporary housings werestill under construction, and theaffected people were living in theevacuation shelters.
Based on the first survey, we set up
the Great East Japan Earthquake
Disaster Support Project. This is
the organization chart which
encompasses various topics like therebuilding communities, improving
the nutritional state of people,
forestry recovery, growing products,
recovery of soil and farm,48

Children and disaster recovery
managing bad rumors, and recoveryof agricultural industry. We
literally collected the wisdom of the
TUA.
At first we conducted an interview
to see whether those farmers areintending to continue their farmingin the future. The interview was
conducted by postgraduate
students targeting about 30 farmers
until the summer of 2011.
Before the disaster, 20% of farmers
wanted to expand their operation
and 70% to actually continue thescope, some percentage of farmers
wanted to shrink their scope. But
after the disaster, about a half ofthese farmers wanted to shrink thescope, quit farming, or have no
scope. This clearly shows that thedisasters demotivated the farmers
to continue agriculture.
We took a closer look at this resultand found two patterns. One isthat small scale farmers were more
likely to want to shrink or quit
farming. And farmers who lostthe agricultural equipment also
wanted to shrink their agriculturaloperation. As was mentioned
before, it takes as much as ¥10
million to invest. People who are
engaged in agriculture is aging andit was too hard for them to invest
on the recovery of agriculturalactivity. From these results, it was
revealed that some support isneeded to manage abandoned
farmlands of the small farmers.
Or for those farmers who lost theiragricultural equipment, there
should be some means to get theequipment for them to continue
agriculture.
The new agriculture corporation
was established a year after thedisaster that acquired land or rightof the farm of those who wanted toquit agriculture. Based on theinterview, it was revealed that thecorporation would have to manage
100 hectares of farmland within
49

Session １
several years. And actually, this year
they are managing 80 hectares offarmland. 80 hectares is quite
large in Japan. Usually, thoseexisting agricultural corporations
take as long as 20 years to expand
their farmland up to such size andaccumulate knowledge andpersonnel during this period. But
as it was estimated that thecorporation would need to manage
100 hectares of farmland within 3
years, the corporation could
prepare for the size from the startof its activity.
The second project is theSoma‐style desalination measures.
Salination and contamination werethe major barriers for the farmers toharvest their crops. The Ministryof Forest instructed to scrape thesurface of the soil.
However, Professor Goto, thespecialist of soil analyzed the surface
soil and found that the tsunami
brought good minerals into the soil,
so scraping was waste of money.
So we decided to mix the debris
together with the soil underneathinstead of scraping. To make the soil
alkaline we were advised to use
converter slag from ironworks andthis led to our success to retrieve
rice crop. We named this method
as the ‘Soma‐style desalination of
farmland’ and spread this method
to the farmers in Soma.
Not only salination but also
contamination with radioactive
cesium was a very serious problem.
And acquaintance of Professor Goto,
Sasaki‐san, and Kobayashi‐sangenerously offer their land for our
experiment on the effect of adding
zeolite or chloride potassium to thesoil; because people said that it’svery effective.
And we found out the larger theamount of zeolite mixed with soil,
the less radioactive cesium
absorbed to brown rice. Further
addition of potassium turned out tobe more effective.
50

Children and disaster recovery
In 2013, there was a slight increasein the cesium level. According toProfessor Goto, radioactive
substance might be dispersed atsome time of decontamination at
the nuclear power plant. But thistiter was rapidly decreased in 2014.
It was our achievement to provezeolite, which is abundant in Japan,
can prevent the brown rice andother crop to absorb radioactive
cesium.
Tamano district in the western partof Soma City, mountain side got
more fallouts of radioactive
substances than the flat land, andfarmers were nearly giving up
agriculture. Especially after young
parents with children left the area
and only elderly people were left,
which highly demotivated thefarmers to continue farming or
agriculture.
With help of our students, every
farming lot were measurement ofradiation dose before and after
decontamination work. And this is
the result. Prior todecontamination, red and yellow
lots are the ones with higher
dosage. The red to yellow andthen down to the blue,
decontamination is truly effective.
And then Tamano people were verymuch enlightened and also
motivated. And now the Tamano
district now in the middle of the rice
planting season and all those paddy
fields are filled with young green
rice plants. Our effort confirmed
the effect of decontamination led toencouragement of farmers tocontinue agriculture and to therecovery.
There is another interesting projectusing arthropods. Accumulation ofradioactive substances in the bodies
of arthropods are used to monitor
the dynamic state of radioactive
substances in the farmlands. We
captured butterflies, dragonflies,
crickets, locust, and spiders in
regular basis and monitored the51Session １
levels of the radiation
contamination. Using those
insects that are existing everywhere,
we actually detected the dynamic
state of radioactive substances.
This survey is conducted in Itate
village as well as Soma city.
The result is that the cesium
concentration in locusts andcrickets were rapidly decreased in
18, 30, 42 months after the disaster.
But the situation is quite different
among spiders. We speculate thatas spiders are carnivorous insects,
cesium is accumulated in the bodyof the spider. This study was praisedby the Ministry of Education and weare going to scale up this project.
And by joint collaboration with thecity and TUA, we have published abook titles ‘Agricultural andForestry Reconstruction After theGreat East Japan Earthquake’. This
was translated into English so that
we can share the knowledge withpeople overseas.
Using Soma desalination method,
we are able to harvest very goodrice with much mineral. So incollaboration of Soma City, TUA,
and the agricultural association, we
made a brand called ‘Disaster
Recovery Rice in Soma’. And the
package design was made by aschool child of Soma.
These are examples of our support
activity for agricultural recovery.
From now on, we are supporting
this area by wiping‐off bad rumors,
support for the livestock industry,and establishing sixth sector
companies. Through these
activities, we hope the agriculture
in Soma adapts to the newsituation and motivates younger
generation to engage in
agriculture so that cities andcommunity will prosper for ever.
That is our goal and the mission.
Thank you very much indeed foryour attention and giving me theopportunity to present to you oureffort at Tokyo University of Agriculture.
52

Children and disaster recovery
Fishing trial; The present situation

Yujiro Watanobe

Soma Fisheries Cooperative

Originally, Mr. Sato, theDirector ought to be taking
the podium. However due
to his illness, he is notavailable. So, I would
replace him to present toyou.
This is Soma Fisheries
Cooperative, consisted ofseven fisheries cooperatives.
Small boat coastal fishingarea we cover is northernhalf of the water area inFukushima, including thearea facing the power plant.
Today, I would like to talkabout Soma City fisheries
industry recovery and our
engagement in pilot fishing in this area.
This is Soma City. We had 3 fisheries cooperatives: Soma Haragama; Isobe; and Matsukawa Bay. The
number of boats before the disaster was 531. After the tsunami, 381 damaged and 150 remained. We
utilized a fund and have recovered more than 200 boats. So altogether we now have 354 boats. This issome of them and 700 altogether, but currently we have 420 this month.
In Soma City, the entire coastline
was destructed by the tsunami.
However, thanks to the leadershipof Mr. Tachiya, the Mayor, we wereable to reconstruct thefisheries‐related facilities quickly,
and we very much appreciate it.
In Soma Haragama region, we have
now the fishing processing plant aswell as the pickup and delivery areaand sea water purification center.
In Isobe region, we have seafood
processing center and also fishingequipment destroyed in Sefo City as
well as the water purification center.
And also we have laying out the
ground for the seaweed
production.
In Soma Haragama area, a new fish handling center was constructed immediately after the damage.
There is a large space for collect, pick‐up and delivery, where we can pass to the intermediaries andthey use the facility to box them for delivery.This center enables us to maintain the freshness of the
product and by using fresh seawater. This is the fishing equipment storage with a space to repair
broken fish‐net.

53

Session １
In Isobe area, reconstruction ofseaways, fish storage, and fishhandling facilities were completed
in March this year. These fish are
harvested from the sea and using
the equipment to lift them up to
the facility. We had 62 boats there
before the disaster, all of whichwere completely destroyed by thetsunami. Isobe was a center ofthe fishery of Hokkigai shellfish andKonago Shirasu. So we
reconstructed the fish handlingfacility as a symbol of recovery inthis area.
The fisheries cooperatives and the
local intermediaries joined theirforces in order to establish the joint
fishery facilities. Originally, theharvesting was the end of thefishery work. However, we haveestablished a new system to include
processing and distribution. Afterthe distributer sell the product, we
divide the surplus.
On this February the 18th, thefacility was completed and on
March the 16th, fishery was started.
Konago sea fish was the first
harvest we handled.
From April 29th to May 1st, thisfacility was used for commercialdelivery and enjoyed good
reputation.
Minamisōma City has only one port,
Manogawa. On March 21st, thefacility in Manogawa equipped witha handling, storage, icing andoil‐supply was started.
Many products were still underpilot fishing. Immediately after
the nuclear power plant disaster,
contaminated water wasdischarged to the sea. And in all
the Soma areas, we voluntarily
restricted the fishing. We thoughtthat if we did nothing, the fisheries
industries would go extinct. So,
on June 2012, we started pilot
fishing of octopus and seashell.

54Children and disaster recovery
At that point in time the Director,
Mr. Sato, who would be here but is
not available today due to illness,played a central role. Until lastmonth, 73 sea productswere thetarget of the pilot fishing, but thisnumber is less than half of the
products we had before thedisaster.
But in 2011, the our fishery yieldwas ¥ 3.6 billion. If Konago fishingin March was not disturbed by thedisaster, probably ¥ 7.0 billion
would have been the total sales in2011. The sales in 2014 was only
¥ 80 million, . Last year, this hasrecovered to ¥ 290, but this still is
only 4% of the pre‐disaster level.
Currently, 28 products are restricted
for fishing due to the contaminationof the seawater, including Konago,
shirasu and octopus as well as
Hirame (Japanese flounder) andKarei (flatfish), which were ourmajor source of income. So, itwould take time before we resume
full scale operation of fishing.
For pilot fishing, radioactive
cesium inspection is essential. In
Fukushima Prefecture, the upper
limit of radiation contamination for
seafood is 100 Becquerel(Bq)/kg.
However, we, the fisheries
cooperative settled our delivery
criteria as <50 Bq/kg. Even withthis effort, there still is a bad rumor
spreading. In the Isobe fishhandling facilities we haveadditional nondestructive
inspection tests as well theconventional ones. We announce
that weare testing all of our
products and then the consumers
were pleased to purchase from us.

55

Session １
We raise 5 goals for the recovery of
the fishery in Soma: wiping off badrumor, moving from pilot fishing tofull‐scale fishing, recovery of fishingground, reconstruction of
distribution channel, andre‐branding of the products inFukushima (Joban‐brand). We
want the consumers to eat fish from
Fukushima and that would be theonly way to achieve these goals.
We will take responsibility to supply
safe fish. And we need yoursupport and understanding for oureffort. Thank you.

56

Opening remarks

Masayasu Kitagawa

Emeritus professor of Waseda University
Good morning, ladies andgentlemen. I am here
because I and Mayor Tachiya
is a friend since more than 10
years ago. We have been
holding a study meeting todiscuss the ideal state of theregional municipalities.

When the disaster occurred, alot of activities were needed
to prevent any death fromhappening in future. With
such overload of activities,
there might be something
you overlook. So, we
needed an advisory council toexchange ideas candidly froma broader perspective, and I was invited to be a member. Since then, I have been associating with him.
The symposium yesterday and today is representative of the achievements. So I am deeply moved by
all the effort you have made.
The framework of modern society in Japan is now moving from centralization to regionalization or
decentralization, but just shifting power from central to local government is not enough – local
communities must revitalize themselves. Without such motivation and spirit, we cannot create futureof Japan. I think the 2011 disaster awakened us to recognize the need of this spirit once again. It goes
without saying that recovery is important, but we need more: we have to go for the next 5 years andnext 50 years to innovate Soma, Tohoku. Such information should be sent out not only to Japan but
also to the world.
Kumamoto may learn from the lessons learned in Soma after the Great East Japan Earthquake and createa safer and more resilient Kumamoto and Kyushu. You can also be a world‐class successful model ofappropriately address and manage radiation issues based on evidence and data. For us, members of
the advisory council, this is also a excellent case of regional revitalization and we can utilize these lessons
effectively for the future.
Today many experts from home and abroad are sharing knowledge and experience on radiation andchildren’s health, and this discussion will be spread all over the world. I hope all the attendances ofthis symposium make these 2 days a great opportunity to change future of Japan or world from a local
region. That’s something we may confirm in these 2 days.
I would like to thank you all for your hard work and I would like to wish a great success of this symposium.
Thank you.

57

Opening remarks

58

Health impact by radiation
A progress report of Thyroid Ultrasound Examination program in Fukushima Health Management
SurveyHiroki Shimura

Department of Laboratory Medicine, Fukushima Medical University
Good morning. My name is
Shimura. I am in charge ofthe thyroid ultrasoundexamination or TUE which is
the topic of my presentation
today.
This is the humankind andwe have been learning
lessons in the past. This isexternal exposure which was
experienced through the
A‐bombing of Hiroshima andNagasaki and internal
exposure through Chernobyl
Nuclear Power Plant
accidents. These are someof the representative
examples.

This is Hiroshima and Nagasaki. The A‐bomb, the victims’ data, the details will be eliminated.
However, this is the thyroid dose versus odds ratio and this is a linear relationship of the emergence ofsolid nodules, malignant tumors, benign nodules, and cysts.
What about in the case of Fukushima? So this is an estimated dose of external radiation. It wasprobably at most 0.03 Sv. And this is almost 0 Sv for the emergence of these conditions.
This is Chernobyl for internal exposure. There is also a linear relationship in the incidence of thyroid
cancer for children. 0.03 Gy or Sv is estimated to be the maximal dose in residents living in Fukushima.
Concerning all of them, the risk should not be high. However, the people living in Fukushima might
have a worry that there may be an increase in thyroid cancer. So in order to respond to these concerns,
Fukushima Health Management
Survey and part of that was TUE or
Thyroid Ultrasound Examination
was stated.
This is A‐bomb victims’ data. Less
than 20 years old or less than 18
years old, there is an increased risk
for thyroid cancer and that was thesame with Chernobyl nuclear
accident. So that was why weconducted these thyroid ultrasoundexaminations for children between
0 to 18 years old.
This is the flowchart of TUE program.
Primary examination we usedthyroid ultrasound examination and
we interpreted the ultrasound59

Session ２
images. This is the primary examination and how we did that. This is a notebook PC‐styled ultrasoundexamination apparatus. Because many of the subjects are children, we arrange these animation
characters so that the children can be relaxed.
This is the program of preliminary baseline screening that was done in the first week. Minamisoma is
our neighbor which is closer to the nuclear power plant. So we began with the areas with the highest
airborne radiation dose, and then proceeded to Fukushima, Koriyama, and Soma, Iwaki, and then Aizu.
That was the second round of testing that was the full‐scale screening. And 2‐1/2 years werecompressed into 2 years. All of these screenings have been completed. Time flies and the second
round of screening is complete and we will begin the third round of screening.
How are we doing the screening? These red marks indicate the clinics or hospitals where you canreceive the TUE or ultrasound examination, Fukushima Medical Association supported us with all theirefforts. So, these technicians and doctors pass the examination for the ultrasound testing to conduct
the testing. For example, there are 11 places in Fukushima city, 8 places in Iwaki city, 1 places in
Aizuwakamatsu city, and 2 places in Inawashiro. Soma city, none.
Soma city, the medical institution is coming soon to conduct the ultrasound testing. In fact there are 45
already, and 33 additional institutions will take part. Thirty three institutions are preparing for thetesting so there will be more clinics coming in your neighborhood. I believe that the situation is getting
to be closer to ideal situation.
This testing has been receiving all Japan support system. So this message was the gist of mypresentation. These seven are the medical societies who support us with all their efforts. This issomething that we are much grateful for.
This graph is outside Fukushima andFukushima Medical University iscanvassing throughout the country.
The doctors and medical
technologists are collaborating withus. In 2015, 700 people came fromthroughout the country for thetesting. The neighboring prefectures,
as well as Yamanashi and Nagasaki
Prefecture show high bars.
I believe that most of theprefectures send the ultrasonicexaminers inside Fukushima
prefecture. There are moreexaminers in Fukushima rather thanoutside of Fukushima. But people
graduate high‐schools in Fukushima
but then they leave Fukushima Prefecture to go to universities or to work. But these people can receive
ultrasound examination because the testing is conducting throughout the country which is also
unprecedented.
This is Tohoku area. And Miyagi, Tokyo, and that is Kanto, these are the majority of the participantsreceiving the testing. In all the prefectures, tests are available. This is so mething that is unique andthat is to be blessed.

60

Health impact by radiation
About the diagnostic criteria, this issomething that you all know. B is
nodule 5.1 or more, cysts 20.1 or
more, and these will be subjected toconfirmatory examination. This
examination of nodules and cysts.
Cysts are pouch with fluid, benign
only, and nodules are the solid
tumor. And partially there may be
fluid retention, but these can beeither benign or malignant.
The preliminary baseline screeningof the results, 360,000 people
participated or 360,000 residents
were subjected, out of which 81.7%
participated. About half had
known detection, and A1 more thanhalf, and A2 less than half; so themajority either A1 or A2. And
0.8% of B, subjects were nodules
and only 1 most of them had
subject was C, and these B and C
were subjected to confirmatory
examination.
This was the result by age at thetime of disaster. The green is A2,
most of them were cysts.
Elementary school children andjunior high school students, about
half experienced A2; and thesmaller children showed, lessincidents of A2 and B.
What about the breakdown by age
and sex? The left one is A2, mostof them were cysts. There was nodifference between male andfemale. And the right side is B,
most of them were nodules. And
more incidents with female thanmale. This is something that iscommon with thyroid disease, morein female rather than male.
Second round of examination andsimilar results were observed.
About half or less than half was
judged as A and the majority is
about A2 and only that few
percentage of the solid tumor was
found. Similar result is actual age
at examination is plotted. So theelementary, junior and senior
61

Session ２
high‐schools, the majority should I
say are the recipients have the cyst.
Then some solid tumor case wasfound.
Once again it’s about theconfirmatory
examination, secondary
examination following after the
primary examination. The
procedures are similar to theordinary consultation at clinic.
We actually diagnosed and someinterviews and made some kind of
medical test. And also we
conduct the thyroid ultrasonicexamination, TUE, with more
expensive and more accurate
machines and the result actually
determined whether or not do we
go on to define needle aspirations
cytology using very fine needle toproducing the ultrasonic image.
The decision of whether you
actually conduct Fine Needle
Aspiration Cytology, FNAC or not isdecided by this criteria. The
tumor sizes of less than 5
millimeters are the majority oflatent thyroid cancers. It has
been reported that the 10% of
ordinary people do have. Verysmall latent thyroid cancers. And
those small tumors or the solid
wouldn’t do any harm but if left
untreated, there could be somepossibility so that we have to makemeticulous procedures or testing.
So that criteria is divided into fourclasses. Simply put like this, if it
is below 5 millimeters, I mean we
don’t need to do extra or theconfirmatory examination. The
follow‐up procedure will start 2
years after. But if it is larger than
20 millimeters and then you haveto go through the FNAC, the fineneedle aspiration cytology.
The size around 10 to 20, if there isa suspected malignancy, and thenwe may be deciding not to conduct
FNAC. And 5 to 10 millimeters, if
there is any strong suspicion of62

Health impact by radiation
malignancy and then we will makedecision to conduct FNAC.
This has been the proceduredescribed in the guideline which
was established well before thedisaster. Whether or not we goby those criteria, we have to
meticulously look into theultrasound diagnostic criteria.
Malignant ultrasonic features are,for example, irregular boarder
heterogeneous matters or themultiple high echo spots.
So as a result in the first round of
test, the primary examination,
2294 people were judged as B andC findings and out of 2294, 2056
subject completed the test
because some of them judged as B
and C didn’t come up. One‐thirdof the confirmatory examination
recipient subject werere‐diagnosed as having A or A1 or
A2. Such kind of nodules wereshrinled cystic nodules or ectopic
thymus. It was actually judged or
diagnosed at the confirmatory
examination.
Two‐thirds of the subjects were
found somewhat larger tumor.
So we made the decision toactually go through the surgicalprocedures and/or the follow‐up.
Then we conducted like this thenecessary procedures and this is
the second round confirmatory
examination. And recipient of
FNAC were reduced only that 10%
or so, 1 in every 10 recipients; therest of them were for follow‐up.
That is the general image you may
take about the outcomes of the
thyroid ultrasonic examination
programs. And this has alreadybeen announced and publicized.
In the preliminary baseline
screening, the 113 cases were
found as having malignant orsuspect malignant cases in theirchildren with mean age of 17.2
years and age at exchange was
14.8 years.
63Session ２
In 99 surgical cases, one case was benign nodules and three cases with poorly‐differentiated thyroid
carcinoma , and 95 was papillary thyroid carcinoma. Then second round, 45 people were malignant or
suspicious for malignancy in FNAC and 16 cases surgical or the procedural operation was conducted andall 16 cases were diagnosed as papillary carcinomas.
The number was much larger than originally thought but further analysis using the thyroid ultrasonicexamination we were able to detect thyroid cancers symptom at very early stage. We are able torespond to those four major questions that we often were asked. Is there any place dependent
differences? What about age? In comparison with Chernobyl if that age distribution is similar or theradiation dose has something to do with the progress? Is the gene mutation in thyroid cancer same asthat observed in patients in Chernobyl?
That’s the place difference. We have four subdivisions in the prefecture. As indicated that we
conducted the preliminary baseline screening to all the respondents or recipients of the examination.
About 0.03% to 0.04% of the incidents were statistically found not significant differences.
As for the age, at the time of disaster in the upper half and at the time of examination, you will see thatthe gradual increase as time goes by but to smaller children and infant too as of today there is no infant
found worst carcinoma. In the situation of Chernobyl, I would like to attract your attention to this graph.
Time and age at the exposure from 0 to 1, the significant incidence was observed and that the age at thetime of that the examination took place. By the way, the control group is the result of the data takenfrom the districts which were not affected by radiation and this shape of graph shows similarity to that of
Fukushima.
As for the estimated external radiation dose, others departments of the Fukushima Medical University
conducted base research. As for the external radiation dose by Millisieverts, if it is above 5, there are
no incidents, 5 mSv. The first one was Sievert but the unit is different. Millisieverts is 0.005. For
those, the people who got the external radiation dose at that amount didn’t have any thyroid
abnormality. So that the radiation dose amount is generally low.
What about genetic alteration? Gene mutation wakes a cell in patients with cancers, such oncogenic
mutations are only found in cancer tissue, but not in other tissue or organs. Mutation in BRAF gene was
the most frequently observed motion in childhood thyroid carcinoma in Fukushima.
And chromosomal rearrangement
mutations were less observed. In thecase of Chernobyl, relatively
speaking, RET/PTC that two
chromosomes joined together wasoften observed and less incidence of
BRAF. And the situation in
Fukushima was quite reversed withmany BRAF and very small RET/PTC.
That is the kind of mutation often
found in adults, so more like
adult‐type cancer.
Now of course only 5 years has
passed and it is just too prematurefor us to draw some conclusion.
However, the radiation dosecompared to Chernobyl is very low
in the case of Fukushima. There is no significant difference in the prevalence rate of thyroid cancer
between places of residence. And we didn’t see any cancer in small children, maybe in the future, butpattern is quite different in the case of Chernobyl and in the case of Fukushima. Genetic pattern of highprevalence is different from those patterns found in Chernobyl.
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Health impact by radiation
So my presentation can be concluded as follows. There is long‐term large‐scale thyroid ultrasonicexamination program has just been started in Fukushima. In the first round we had 360,000 recipientsand that’s the second round, that is the full‐scale screening, we have 236,000 recipients. The FNAC wasconducted to those numbers of people in the preliminary baseline screening as well as full‐scale
screening.
In order to avoid the over‐diagnosis of thyroid cancer, this program has been performed with thestandardized criteria to decide indication of the FNAC. Only for those people we have very strong
suspicion of having carcinogen will go through the FNAC procedure. What is important is that we haveconducted this thorough screening program and that will be the standard for the future comparative
studies. You know, few years into the future if we conduct similar surveys and we are able to correctlyinterpret the data using the result of this program as a yardstick to see whether the prevalence isincreasing or not.
Without the cooperation of all the specialists in Japan and also cooperation from the residents ofFukushima, we would like to continue with this program.

65

Session ２
Thyroid Screening – the Global Perspective

Gerry Thomas

Department of Surgery and Cancer, Imperial College London
Thank you very much for
inviting me. It’s lovely to beback here in Japan again. I
come quite often and it’salways such a welcome that I
receive here. I think my job
today is to try and put this
into some context of what weknow about thyroid cancer inthe young from other cities
that we are currently doing.
It’s helpful to understand thatthyroid cancer is a bit
different from other cancers.
So here are some basic facts
about thyroid cancer.

Benign thyroid nodules arevery common. At about age 60, 50% of people in this room will have a thyroid nodule, but you won’t
know about it because it’s very small. It’s estimated that about 6% of the world’s population may havethyroid cancer but most people don’t know about it because it’s very small. That would mean that in
the US, about 16.5 million people could have a thyroid cancer and because it’s so small, they don’t know
about it.
Thyroid cancers are also associated with a 97% survival rate and it’s even higher in childhood thyroid
cancer. Most people when you say the word cancer think of death. They automatically think it is adeath sentence. That is just not the case with thyroid cancer because we have the best targeted
treatment to cure thyroid cancer. It’s better than anything else we have for any other cancer. So it’s
extremely easy to deal with thyroid cancer using a mixture of surgery and using radioiodine but highdoses of radioiodine.
Now there has been a large increase in places like the United States in the incidence of thyroid cancer
over the years and this graph just shows you that increase, so from 1975 up to the present day. And
you can see that again, as theprevious speaker said, it’s much
more common in females. Now
this doesn’t mean necessarily that
there are more thyroid cancers.
What it actually means is we candetect them much better. And weare starting to see similar things forrenal cancer for example in Europe.
We don’t do so much ultrasound of
the neck in Europe as they do in the
US. So that’s why they find thyroid
cancers in the US. But in the UK,
we often have patients who present
with abdominal discomfort andwhen we use a CT scan, we will findthey have lumps on their kidney.
So how you look really66

Health impact by radiation
matters and that can change the incidence of cancers over time as your technology gets better andbetter.
So how you look really matters. The old way of lo oking for a thyroid cancer was to stand behind thepatient and put your fingers on the neck and feel for a lump. And that was a very good way ofdetecting thyroid cancer but the incidence of nodules that were found that way was about 2% to 6%.
If you look with ultrasound, it’s much more sensitive. So you are going to find smaller tumors earlier inlife than you would otherwise do by feeling the neck and that can put the incidence up between 19% and
35% of the people that you examine will have some form of nodule in the neck. It depends on where
you do that screening, which country, because different countries have different incidence of thyroid
cancer and thyroid nodules. It also depends on the age group that you are screening as you will see
later.
Interestingly, if you look using a postmortem, so after a patient has died and you take the thyroid out andyou section it very carefully, you can find an awful lot more very tiny tumors and that frequency can be
between 8% and 65%. So this shows you how the method you use to investigate what is going on in the
thyroid can give you different percentages of incidents.
Now the other thing about thyroid isthat it has actually got a slightly
different curve to what we normallysee with other cancers. So, here
you can see the incidence for Japan,
so this is thyroid cancers in a
population that is not being
screened. So people go to thedoctor with a lump in their neck or
because they have difficulties
swallowing, they investigate theneck, and they find there is a thyroid
lesion there. So these tumors tend
to be much bigger than the ones
found at screening.
But you can see in young people it’svery rare but it rises very quickly assoon as you hit puberty. It rises
very quickly in women and thendecreases and there is a slow rise,
more normally what we see withother cancers in men. We don’tknow why there is a difference
between women and men but this is
the same the world over.
Now, when you screen a population,
what you do is you push thatincidence curve to the left. So if
you look at the age group at which
you are currently screening in Japan,
which is this age group here, andyou move that curve to the left, you
can quickly see that you will findmany more cancers than if you werelooking at an unscreened population.
67

Session ２
So this will rise rapidly as the population gets older beca use we know thyroid cancer increases. But
you can see what a difference that will make. And interestingly, that figure is a roundabout where weare seeing the numbers for the first screening of the Fukushima population here, about 30 per 100,000.
So that is just the effect of screening.
So what did we learn from Chernobyl? Normally we do not screen childhood populations but we didsome screening with a lot of support from the Japanese and the Sasakawa Foundation in the early years
after the Chernobyl accident. And the baseline frequency of thyroid cancer in Ukraine and Belarus wasaround about 9 to 18 per 10,000, so 90 to 180 per 100,000.
Now that they have a higher number of lesions found because they have less iodine in their diet andtheir thyroids are more lumpy because of that. We also know that the younger the child, the greater
the risk. The younger the child, the exposure to radiation, the greater the risk; and I will show you agraph about that in a moment. The increase was largely restricted to one particular type of thyroid
cancer called papillary thyroid cancer and I will show you what that looks like in a minute.
We also found much to our surprise that the subtype of PTC, so the type of cancer is a bit different inyoung people. And as they age
and we screen them and we pickthem up as they are older, thesubtype changes with age. So
there is a complex changes in the
biology that happens over our
lifetime.
So let’s go back to looking at the
number of cases that we see
relative to age. So here you havesome data that came from Ukraine
where they simply have plotted inblue the number of cases that theyfound in 1986 to 1989, so before 4
years after the accident. And you
can see the shape of that curve isvery similar to what you have inFukushima in the first round ofscreening.
Interestingly, that changed
dramatically after 4 years after theaccident and you are now in thesecond round of screening and we
don’t see that pattern at all in thesecond round of screening. So,
your pattern still looks like this,whichsuggests that as I showed you
before on the other curves, you
are just following the natural curveof spontaneous thyroid cancers
that occurs in the population. It’s
not radiation related.

68

Health impact by radiation
I said before about different
pathological subtypes and these are
pictures taken under microscope.
So here you have typical papillary
thyroid cancer. You have anothervariant that the cells form follicles.
So this round thing here is a follicle.
Then you have other variants thatare solid or trabecular.
Now these change over time so thatin children in Belarus, Ukraine, andin the UK – we did the same study in
the UK – this solid pattern is morecommon. And as you get older,
you change into this papillary
subtype. But it’s not quite as
simple as that. We actually foundthat it didn’t matter whether you
were an exposed child in the
Ukraine, so exposed to the radiation,or you were born after the accident
and not exposed to the radioiodine
and your cancer was therefore notcaused by radiation, the patterns
were the same.
However when we looked – this was
before Fukushima happened – when
we looked at children in Japan atsame age as the children we werelooking at in Ukraine, we found thatthe pattern was quite different.
We think this is probably due to thefact that the Japanese diet is very,
very rich in iodine, whereas in
Ukraine and in the UK as well wehave less iodine in our diet. We
don’t eat seaweed as much as you
do, although we are starting to eat
more Japanese food because it’svery nice.
This is also true for adult cancers.
So you have a different morphology
in Japan which is interesting because
it suggests that your diet is affecting
the molecular biology of your tumor.
So as you heard before, there are
two oncogenes that we look at
mainly in papillary thyroid cancer
and most cancers are driven throughthis pathway. So this is themolecular pathway that reallymatters. And in many cancers you will find that in thyroid cancer there69

Session ２
is either a rearrangement of the
RET PTC gene or the BRAF gene.
As you heard in the previous talk,this is a mutation so one of thebases changes in the DNA whereas
this is a rearrangement of a geneand there are many different formsof this rearrangement.
What we didn’t know before
Chernobyl because we had so few
pediatric thyroid cancers to look at,so few thyroid cancers in children,
was that actually the molecularbiology of adult cancers is very
different from childhood cancers.
It doesn’t matter whether it’scaused by radiation or not. The child and the adult require different drivers to make their thyroid
cancer grow. And in the adult, the frequency of RET rearrangement varies according to the study andaccording to the age of people in it but it’s very low usually.
The frequency of BRAF mutation is much, much higher as you heard with the previous speaker.
In pediatric thyroid cancer, so children under 15 who get thyroid cancer, the frequency of RET
rearrangement is about 50% to 70% in those who were radiated as part of the Chernobyl accident, but
the frequency is exactly the same in the US and the UK. So this RET rearrangement is not actuallycaused by the radiation. It is caused by the age of the child. So it’s the body selecting the mutationthat helps the cells grow into a tumor.
BRAF mutation is very rare. And it’s very rare is post‐Chernobyl thyroid cancer. In Japanese children
who had nothing to do Fukushima accident, this was all research done before the Fukushima accident,
and in a group of Portuguese children who had thyroid cancer.
So here you have the different subtypes that I showed you pictures of before and here you can see that
the RET rearrangement is quite common in that solid phenotype of PTC. It’s less common in thefollicular and papillary but it’s still quite a high percentage. The recent results from a whole genome
sequencing study done in the US suggest that in adults the frequency is about 7%. So the frequency of
RET changes depending on the age of the patient.
It’s the opposite way round for BRAF. So with the BRAF mutation we very rarely find – in fact we havenever found one in a solid phenotype tumor. We very rarely find it in follicular type PTCs. And thepapillary type PTCs we see it increase over time. So the older you are and the more papillary type yourcancer is, the likelihood is that you are going to have a BRAF mutation rather than anything else. So you
can see how complicated interpreting some of the data that is already coming out from many of thesestudies actually is. It’s not simple.
So let’s talk about the clinical prognosis of the childhood thyroid cancer. Well, the evidence that wehave from Chernobyl which is the largest amount of children who have got thyroid cancer that we canlook at suggests that some of them might get a recurrence usually in the neck. About 30% of them will
get a recurrence. However, their thyroid cancer remains really treatable with iodine 131. So it is not
bad news. For many other cancer types when you have a recurrence, it’s quite bad news but for thyroid
cancer we still have a really good treatment for those patients.
The mortality rates are about 1% and that’s how you know that the treatment in those who recur isgoing to work again because our mortality rates – the number of people who will die will be about 1%,
which is very low for any cancer type.
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Health impact by radiation
Despite early papers that suggested
that short‐latency tumors that arose
as a result of the Chernobyl accident
were aggressive, the actual clinicaloutcomes now we have suggest
that’s just not the case. Yes, they
did invade. They did go to thelungs but we were very good attreating them with iodine. So eventhough they may appear aggressive,
actually clinically they are not as
aggressive as we thought. And
now we understand the molecularbiology a lot more. We also
understand that actually themolecular phenotype that they havemeans that they will take up iodine
still which means we can use thebest weapon we have to treat thesepatients.
Many people are worried when they have a child who has thyroid cancer, should they have an operation
immediately? Well, we have a plenty of data now that suggests what we call watchful waiting which is
to keep watching the child, to keep examining the thyroid using ultrasound, to see if the tumor is growing,is actually better for the child and its clinical outcome rather than rushing into surgery immediately. I
have teenaged children myself. I know how difficult teenaged children can be. And sometimes
suggesting they have surgery might not be good for them at that particular age. But there is no reason
why you can’t wait.
We are starting to look at other tumor types like prostate and also think that sometimes we rush tosurgery too quickly and in many cancer types now that maybe just watching to see if the tumor isactually going to grow it better than rushing straight to surgery.
The key points that I think that I would like to emphasize is that thyroid screening that’s being carried out
at the moment as part of the TUE is going to lead to an increased frequency of thyroid cancer compared
to waiting for symptoms to develop. So you will see a larger number than you would expect based on
the operative statistics that you have.
We know that the molecularbiology and the morphology ofthyroid cancer is driven more by
the age at presentation and byiodine intake than by any exposure
to radiation. So, natural biology is
still driving that tumor. The
radiation doesn’t change that.
I would like to emphasize as well,
as you saw from the previous
speaker, the low doses of iodine
131 to the thyroid post Fukushimamean that an increase in thyroid
cancer due to radiation, not to thescreening, will not be discernible.
So although those figures that you
see in the press may look worrying,
71Session ２
in actual fact they are as a result of carrying out the screening and it is not induced by radiation.
Finally, if it wasn’t for other people in other countries, we wouldn’t have all the data we have now and
we wouldn’t be able to look at this with the help of our Japanese colleagues who were responsible fordoing most of the screening in the Ukraine and Belarus. So I would like to say a big thank you to thepeople in Belarus and Ukraine and Russia who have helped over many years, 30 years now, since theChernobyl accident, and many of the scientists that are involved in there and doing molecular studies
too.
Most importantly, if the patients in Ukraine, Belarus, and Russia had not agreed to donate their tissue,
we would not understand the molecular biology and we wouldn’t be able to help explain the thyroid
patterns that you see in Japan without the help. So without those patients being very generous in
donating their tissue, we wouldn’t know what we know today. Thank you very much.

72

Health impact by radiation
Health impact of a disaster on physical performance of school children and elderly people

Sae OchiDirector of Internal Medicine, Soma Central Hospital
Slightly different fromprevious speakers, I am
talking about indirect impact
caused by the nuclear
accident, especially on
physical performance of theresidents. As many speakers
yesterday have shown you,the Fukushima Daiichi
Nuclear Power Plant accident
was not a simple event of
explosion and contamination
but a complex series of
events which include massevacuation, bad rumor andclosure of the plant.

All of these factors, throughintermediate factors, may
deteriorate resident’s health. So what we have to do is to evaluate each health problem with regard toits size, cost, timing, duration, and risk factors. Only after that we can prioritize what intervention
needs to be made. However, so far more often than not discussions focus only on relatively in narrow
topic and many health problems are still overlooked.
So I am showing you one of the examples of these problems: muscle weakness among the residents.
Soon after the disaster, there were increasing concerns about deterioration of physical performance
because many people stayed indoors from fear of radiation. Not only that, but also many other factors
may affect physical activity, which includes long‐term displacement, deterioration of living conditions,loss of jobs, social isolation, and increasing mental health problems.
Especially, there were two vulnerable populations to such health impact. One was children who weremore likely at stay indoors, and another was the elderly who were more likely to be affected by lifestylechange.
In response to these concerns, we
conducted two types of research.
One was comparison of physicalperformance of elementary school
children before and after thedisaster. And another wascomparison of physicalperformance among the elderly
between temporary housing
residents and non‐temporary
housing residents.
First, let me show you the results
among children. Many
elementary schools in Japanannually provides physical fitness
test. So we collected this datafrom eight elementary schools in73

Session ２
Fukushima prefecture andcompared the data in 2010, before
the disaster, and 2012, after thedisaster.
Four physical tests were included.
First one was grip strength andsecond one was softball throwing.
These two tests represent
performance in upper body. A
side step test – many Japanesepeople may know
‘Hanpuku‐yokotobi’‐ is the test inwhich the subject jumps 1 meter tothe side, then jump back to thecenter and jump to the other side
and continue it for 20 seconds.
The number of lines crossed by the
subject was counted.
And the 20 meter shuttle run test
represents endurance tests. The
subject continuously runs between
two lines faster than the interval of
the beeps and as long as possible.
Here are the results of the tests.
This is among boys. Interestingly,
the performance in the upper body,
grip test and softball throwing,
there was no difference, or thedata score was slightly better after
the disaster in 2012. On thecontrary, the performance in thelower body ‐ side step test andshuttle run‐, the scores in 2012,
after the disaster, were slightly
lower among many grades.
And these are the results of thegirls, the same tendency wasobserved.
So in summary, physicalperformance of upper body seems
the same or better in 2012
compared with 2010. On thecontrary, agility and endurance test
appear to be worse in 2012 after
the disaster.

74

Health impact by radiation
So how about the elderly? One
year after the disaster, Soma city
local government, in collaboration
with University of Tokyo, conducted
physical performance tests targeting
elderly people in Soma city. The
residents of Soma city at 65 years
old or above were included andthey were categorized into twogroups. TH group means residents
in temporary housings and thecontrol group were the residents in
Tamano area who also got thisperformance test.
Two physical performance tests
were conducted: grip strength andopen eyed one‐leg standing test.
In open eyed one‐leg standing test,
the subject stands as long as
possible with one leg. And those
who could not stand more than 15
seconds were defined as declined
standing stability.
This is the result. For both maleand female, grip strength is stronger
among temporary housing residents.
On the contrary, about two‐thirds ofthe temporary housing residents
showed decreased standing stability.
Two‐thirds of them could not standlonger than 15 seconds. But, if therisk of decreasing standing stability
was calculated, the risk of declined
standing stability is more than fivetimes among temporary housing
residents.
Considering that many of thetemporary housing residents wereformer fishermen and farmers andthat muscle of leg is lost more easily
than grip, this result strongly
suggests that those foot muscles
were stronger before disaster, losttheir standing stability within 1 year
by living at temporary housings.
You may see the striking similarity
between children and the elderly.
Both lost their leg strengthcompared to arm strength.
Globally, physical inactivity has been
identified as the fourth leading risk
factor for global mortality with 6%
75

Session ２of the death globally. Not only that, but also for children, physical activity may affect physical andmental development. And even more, it may affect academic achievement. Among the elderly,
physical performance is closely related to life expectancy and healthy life expectancy. So you may seethat the indirect impact of the nuclear accident on physical performance caused much impact among theresidents in Fukushima prefecture.
In summary, the triple disaster in Fukushima appears to have caused negative impact on physicalperformance, especially for that of lower body. However, by focusing too much on radiation and cancer,
such preventable health deterioration might be overlooked and practical disaster risk reduction plan may
not be established.
We have to remember that the goal of disaster recovery is not reconstruction of buildings but recoveryof people’s health. So, broader view of health impact caused by the nuclear accident is required for us
to achieve full recovery of the society. Thank you.

76

Health impact by radiation
Current situation of internal and external radiation exposure in Soma region

Masaharu Tsubokura
Attending physician, Soma Central Hospital,
Part time physician at Minamisoma Municipal General Hospital
Dr. Suzuki, thank you for yourvery kind introduction. My
name is Tsubokura from Soma
Central Hospital and I am apart time physician at
Minamisoma Municipal
General Hospital.
I would like to make a
research report, especiallyabout internal and externalradiation exposure. How is it
examined and what are theresults? I would like tosummarize this in mypresentation. First of all,allow me to speak inJapanese.
We have an internal and external radiation exposure. External exposure is having radiation exposedfrom outside of our body. Internal exposure is to absorb radioactive material into the body throughinhalation or ingestion. The total radiation level from both internal and external radiation is an issue.
Some say internal radiation is more dangerous but the total dose level is going to be the issue at the end.
After Chernobyl, food control was poor so high levels of internal contamination were noted. Thus,
people tend to think about internal radiation but we have to consider the total exposure level.
You may know this already but let me look back upon the history of our 5‐year struggle. Initially thisbus came. This is Minamisoma Municipal General Hospital 4 months after the disaster. Radiologists andsonographers tried to use the equipment and created exam sheet and informed consent sheets to start
the screening for internal
exposure.
We have this kind of chair typewhole‐body counter first. We had
to go through trial and error
process. Although it didn’t work
initially, Dr. Hayano came toreanalyze the data. Thanks to his
help, we have been able toregenerate the data again.
There were school whole bodycounter screenings including
primary and junior high school
students twice a year in
Minamisoma area. Ninety‐nine
percent or more is the coveragefor 4 years by now. And also
there is almost no detection at all. We have been able to maintain this throughout this period.
77Session ２

We have these graphs in the initialstage of the nuclear incident.
From July 2011 we started
screening because we thought weshould start early. Radioactive
material, particular cesium, may
still remain in the body. From
which area we should start the test
that was the initial question. Many
municipalities wanted the test first.
During the screening people
sometimes became angry.
In the 5 years initially radioactive
cesium was detected but then very
low level has been maintained.
Over the past 5 years, internal
exposure level was controlled at avery low level in children according
to the results. It’s not something
we were able to achieve, but
farmer’s and fishermen’s hard
work resulted in this. This is
overwhelming differencecompared to Chernobyl, although
we had a similar level of soil
contamination in some areas
compared to Chernobyl.
Some people wondered whether
the situation is very similar to
Chernobyl. Clearly, we can saythat it’s very different. So please
do not say that it’s the same withChernobyl. We have been able tomaintain a very low level andinternal radioactive material
accumulation has been controlled
completely or suppressed.
In some cases some people may
like, particularly middle‐aged men
might like mushroom or mountainvegetables, maybe one in 10,000,
very rare. For them, even if they
continue to eat contaminatedmushroom every day, it doesn’tamount to 1 milisievert in 1 year.
So if you are going to talk about
radiation level, after 5 years wehaven’t detected anything
significant.

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Health impact by radiation
Initially, we did detect some level ofradiation, but in the autumn 2011
compared to the average 50 years
ago, the levels of internal
contamination among those in
Fukushima were comparable to theJapanese population in 1960’s since
there was a lot of nuclear testing 50
years ago. Japanese and people
around the world were exposed tointernal radiation then. Cesium
was detected from the urine.
So in terms of the internal radiation
in Soma and Minamisoma, it was
half or one‐fourth of the barium
testing right after the disaster. In
terms of the radiation in theautumn in 2011, it was lower than
the average 50 years ago and nodetection at all since for the past 5
years. So that’s the current statusof the value for the internalradiation exposure in this region.
Dr. Hayano is going to talk about thislater, but we developed equipment
for testing in babies. Manymothers wanted their small children
to be screened but we could not
because of lack of the equipment.
This was new equipment and staff
members studied a lot to enable
themselves to use this.
We have many student volunteers
here on this occasion this like this.
Students came from across Japanand bring the data to identify who
are the high‐risk groups. We hadlots of files, mountain of files.
There was a data entry. This is
Nomura‐san who did the
management. I was demanding to
him to finish everything bytomorrow morning and he did hisbest and we were able to generate
data. You may say that the risk ishigh in mushroom and mountainvegetables. You may think that’s
taken for granted but that’s thanks
to the data.
As for the external radiation
exposure, initially external radiation
exposure was the highest of all.
79

Session ２
These are the results from
Minamisoma city from theprefectural health management
survey just among children in
Minamisoma. In the initial 4months, what was the level of
exposure? This is the line for plus
1 millisievert. This is 2 millisievert
and this is 5 millisievert, up to plus 2
millimeter sievert. Up to 99% of
the children’s exposure levels arewithin this range. This is about theinitial 4 months; 0.1 was the level ofinternal exposure, so this is 10 times.
In the end there was more external
exposure.
According to the image, this 3
millisievert is one head CT. Chest
CT is 7 millisievert. If you had
appendicitis, it’s 15 millisieverts. It
doesn’t mean that it’s nice to havethis exposure but it doesn’t meanthat children are developing
diseases one after another. You
can tell based on this data. We
have to move on to that stage forthe future.
This is Soma city public healthcenter data. Public nurses in Soma
city worked very hard. Initial year
data was really in confusion. There
were mountains of data, you had tosummarize the data. This is doneby each municipality and the data
has been generated in that way.
You may think the data is high or low
but it’s not just that. In the
background a lot work has been
done to gather data to be able toshow this to you. In Soma in 2014,
as of 2014, there were almost 0 for
exceeding 1 millisievert. In 2015,
nobody exceeded 1 millisievert. In
Minamisoma, the curve is rather tothe right. The result can bedifferent in Iitate village but 98% to
99% of the children and theirexternal exposure level is below 1
millisievert. If you live in France,
1.5 times; if you live in Nordic
countries, 3 to 4 times higher
according to the data. So, no issue
at all about exposure.
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Health impact by radiation
It is true that we had a nuclear
accident and many people suffered.
That is also part of the reality.
Most of the exposure was external
exposure in the end. It was theexternal exposure right after the
nuclear accident in the initial stage,
90% or more actually 93.4%. The
initial value and the later value forinternal and external exposure issummarized here. In the end thevalue was not so high.
Then what should we do for the
future? Future, let me talk about
two points. First, we have beenable to maintain this low level but
still for food there is some tendency
for people to dislike certain food.
Whole‐body counter question survey
was done. Those who come to thewhole body counter were surveyed.
So they are more concerned.
Seventy percen t still try to avoid
food from Fukushima. There is a
declining trend but still this is notdeclining a lot.
Those who come to the whole‐bodycounter test are worried. Seventy
percent do not want food from
Fukushima. Those who don’t comefor whole body counter test do notreally care. So 30% to 40% of thegeneral survey respondents do notwant food from Fukushima. They
try to avoid it.
In this region, there is also a lot of
enquiry about water. Many mothers
tend to choose mineral waters. As
for the water, no differencecompared to the water in Tokyo.
It’s really safe. It’s tested andscientifically we can say that it’s safe.
When I see this data, there isbipolarization. Some say no andothers say this is fine and acceptable.
But we have to make efforts to movea step forward because 5 years havepassed. We have to make efforts tomove forward together. Onceagain, for example, what’s the levelof exposure, why you don’t like it,what about the data?
81

Session ２
People no longer touch thoseissues. That’s not mentioned in
the conversation. But there
should be more opportunities tohave a discussion on these topics.
We should talk about lessons
learned in 5 years’ and 10 years’time.
Children coming of age, reaching
20 years old drink mineral waterand do not eat vegetables from
Fukushima because their mom
didn’t like it. I don’t think that’s
the right thing. But still, it
doesn’t mean that we should tellthem to eat food from Fukushima.
And now, each one of us have torevisit these issues and discuss
together. We have organized seminars. Even 5 years after this, there can be a question about
low‐dose exposure and the disease in Chernobyl. There can be a lot of questions.
Most of the question topics do not really change overtime. In school lessons, that’s very important forchildren, but we do not have enough opportunity to talk about radiation. Adults do not really talk about
it. There is no more opportunity for children to discuss. It’s not raised as a topic.
I am invited to one of high schools. More than half of the students say they heard it for the first time.
When I went to school in Minamisoma, they said there was no such lesson for 3 years. Or at somejunior high school, they do this just once a year.
We can control the radiation level at a low level but in 5 or 10 years’ time when children go out into
society, what’s going to happen. Some children may try to withdraw themselves by taking a step behindor backward.
When we talk about radiation,some people say that’s noneof my business. How tomove the situation forward?
In my view if adults say they
don’t want to talk about
radiation, we have to takesome countermeasures toprevent the bully related toradiation problem fromhappening. In school
lessons at least basics should
be taught. I am notsuggesting we have a safety
lesson but we can talk about
radiation in chemistry andphysics classes. We cancontinue such efforts. I
think we are now at such a
stage. Five years after thedisaster, the size of radiation education is getting smaller. Continuity is also in question because of thelosing interest. We have to consider what we can continue.
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Health impact by radiation
We have to maintain the sustainable screening system. We have to create more opportunities toprovide information and discuss together
and we have to have education on radiation. This is my summary. I showed the results for internaland external exposure. There is some tendency to avoid food from Fukushima. What adults should
do, what children should do under these circumstances? I shared my ideas in my presentation.
I thank you for this precious opportunity today. I am doing these tests for past 5 years, thanks to yoursupport. We have a variety of data like this here and there. That’s the accumulation of all efforts by
local people. In order for you to move forward in your life, this is going to be a great asset.
Fishermen’s union face a lot of issues every day and people in Soma should know what fishermen are
doing every day as well. I think and hope that this can be such an opportunity to learn. Thank youvery much.

83

Session ２

84

Social impact by the earthquake and the nuclear accidentInternational Radiation Protection System: Protecting Children in the Community

Peter Johnston

Director, Division of Radiation, Transport and Waste Safety,
Department of Nuclear Safety and Security, IAEA
Thank you. Konnichiwa!
I am very happy to be here.
It’s a great privilege to behere in Soma city and I wasvery pleased yesterday to seesome of the very impressive
remediation work that has
been undertaken following
the disaster here in 2011.

I want to talk a little bit about
radiation protection ofchildren because that
seemed to be at the core ofwhat the symposium wasabout. So in this presentation
I will talk about the role ofthe International Atomic
Energy Agency, the development of safety standards, radiation protection framework and how it applies
to children, reference levels and dose limits because these dictate a lot of what we actually do, radiation
risks to children, how radiation risks are estimated, and finally the conclusion.
I start with the role of the International Atomic Energy Agency. The International Atomic Energy Agency iscelebrating its 60th anniversary this year. The IAEA is part of the UN family of organizations and it wasestablished with a number of roles. One of its roles is to promote the peaceful use of nuclear energy but
another of its roles is the establishment of standards, in particular standards for safety for the protectionof health and the minimization of danger to life and property. The Department of Nuclear Safety andSecurity is the department charged with the development of these standards.
The Division that I lead sits within the Department of Nuclear Safety and Security. It establishes safety
standards for use by member states. And really in many senses the most important role we have is toassist in the implementation of standards through interaction with regulators, that includes thedevelopment of regulatory
infrastructure and capacity building
across the member states.
The general framework of how
standards are developed begins
with the evaluations of science
conducted by the United Nations
Scientific Committee on the Effectsof Atomic Radiation, known as
UNSCEAR. In turn, that evaluation ofscience is considered by theInternational Committee on
Radiation Protection, ICRP, which
many of you will have heard of, andthat turns the science into
recommendations for protection.
And in turn, the IAEA’s job is to takethose recommendations and85

Session ３
essentially put them in a form which issuitable for use by regulators.
So, the framework for radiation
protection that we have really talks
about three types of exposure
situations, and it is somewhat useful
to look at these three types of
exposure situations. The first type iswhat we call planned exposure
situations and this is what applies if
you are proposing to build a power
plant or conduct any form of activity
which involves the use of ionizing
radiation.
When there is a planned exposure
situation, we have three principles that
we follow. The first principle isjustification, which I will explain a little
bit more later; the second one is
optimization; finally, the third one islimitation or the establishment of dose
limits.
The second type of exposure situation
is what we call an existing exposure
situation and that’s what happens
when the radiation exposure situation
wasn’t planned or had not previously
been regulated and I will come back tothat in a while. And finally, we have an
emergency exposure situation which iswhen something is out of control.
All three of the exposure situations
use the principles of justification andoptimization. In the case of planned
exposure situations, we have dose
limits and in the case of existing andemergency exposure situations, wehave things called reference levels.
The situation now in Fukushima
prefecture is an existing exposure
situation. We had an emergency.
There was something out of control. It
is now under control. So theemergency is over. But we had asituation which we didn’t plan to have
and we have to deal with the radiation
exposure from the situation we findourselves in.

86Social impact by the earthquake and the nuclear accident
So what does justification andoptimization really mean? Well,
justification is actually a very simple
concept. It simply says that a practice
is justified if it does more good thanharm. And in order to justify a practice,
we should look at all the hazards thatare involved and choose a path thatminimizes the total hazard to thecommunity.
Now this actually involves considering
not just radiation hazards but all theother hazards that might be present.
And it has been very constructive to
me to look at the deep understandingof disasters that Japan has and how it
understands the social impacts thatdisasters can have. These form an important part of the overall consideration of justifying what you do in
the future. In fact, I think there are many situations in Japan where radiation exposure is now a very
minor hazard in comparison to the other social problems that have arisen from the disasters.
In this context, I mentioned children because there is no separate framework for radiation protection forchildren. Radiation protection of children acknowledges that children have different sensitivities toradiation to adults. And certainly when one does assessments, one comes up with a different dose forchildren to what one might get for an adult. But in general children are considered in the same
framework as all other people.
Optimization is ultimately again a very simple concept as well. Optimization simply asks the question can
we do better with the resources that we have available. I can see already that in the social context someof Japan’s knowledge of disasters has recognized the fact that elderly people are particularly vulnerable
in the aftermath of a disaster. So there have been practical steps taken to improve the social situation ofelderly people. This is a form of optimization. Itis not applied to radiation of course; but nevertheless, it
is exactly what we would call, in radiation protection language, optimization.
So how do we apply optimization? First of all, we make the decision that is something justified, is it goingto do more good and harm, and is it the best option for the community. Then we often can do muchbetter by empowering the community to improve the situation itself.
An area which causes lots of problems and misunderstandings are the concepts of limits and reference
levels. Dose limits, as I have said before, apply only in planned exposure situations for workers andmembers of the public. So if I work in a hospital and I am doing radiography, then I am a worker and I
have to fall within a worker dose limit. If I am building a plant of any type, then I have to make aconsideration of whether I will expose members of the public to more than the public dose limit. And if I
am going to expose them to more than public dose limit, I have to find a better way of doing the job I
have to do.
Reference levels apply much more generally and these need to be developed by government at a levelthat is justified. In the case of reference levels for existing exposure situations, the ICRP recommends a
reference level in the range of 1 to 20mSv. It should be determined on the basis of minimizing all risks
from all hazards.
In Japan, the government has essentially chosen a reference level of 1mSv at the bottom of this range
because of the extreme concern about radiation issues. It’s worth reflecting on whether that is actually
the optimum reference level for the situation at hand.
87Session ３
We have talked a bit around 1mSv as
being an important number in the
symposium. I will try to put that intosome context. The natural backgroundworldwide averages 2.4mSv but it varies
enormously from less than 1mSv insome places to much more than 10mSv
in others. So this 1mSv which probably
has more prominence than it deserves isreally actually a very small dose which isused really prospectively for planning
new facilities. And we should not get
tied up too much about that. The
more important concepts are those ofjustification and optimization.
As was indicated this morning, if one
goes for a CT examination, one would get a lot more than 1mSv. In fact, depending on how big you are, it
is typically something of the order of 10mSv. For a child, it might be a in a range of 2‐5mSv. For me, it’s
probably considerable more. A chest X‐ray is something like 0.1mSv; mammography 0.7mSv, and if you
have to have radiation therapy, then the dose are really very, very large because they are designed to killlarge numbers of cells and leave very few cancer cells alone.
Our understanding of radiation risks to children comes from a wide range of sources. In fact there was avery excellent volume produced by UNSCEAR recently on exactly this topic. And children are not like little
adults. They actually have rather different presentations of cancers. Some cancers are much moreprevalent in children than they are with adults for a particular radiation dose. The other area where weactually know quite a lot about childhood cancer is from the aftermath of Chernobyl.
Now, Chernobyl was an accident which released a very large fraction of the core material from a verylarge reactor. It happened in an agricultural area where the economy was effectively a peasant economy
where a lot of people were eating produce from their own farms and there was very little restriction offood to many of the population in the immediate area.
One of the lessons that was learned from Chernobyl was that ingestion of milk, green vegetables, andother foods is a critical pathway in the radiation exposure of children. While one might criticize a numberof things that happened in Japan following the accident of Fukushima Daiichi Nuclear Power Plant,
certainly restriction of food was effective and that has saved Japanese children from being highly
exposed to radiation.
As a consequence of the accident,
UNSCEAR indicated that it is very unlikelythat there will be very discernible increasein cancers to the Japanese population.
They do say, however, that it was possiblethat one might see an increase inchildhood thyroid cancers. The UNSCEAR
report indicated doses which we now
recognize as being quite high compared tothe situation as we understand it now. So I
think it is reasonable to take those twopieces of information together andsuggest that it is very, very unlikely that
we will discern any increase in cancerfrom the Fukushima Daiichi Nuclear
Power Plant accident.
88Social impact by the earthquake and the nuclear accident
The UNSCEAR report of 2013 also indicates that data about cancers or radiogenic cancers in children are
really very limited. Children are more sensitive than adults with respect to radiation exposure but itvaries greatly with age. And the data is still really quite uncertain, and that there needs to be additional
research and the research should be focused around areas of high natural background after high‐dose
medical procedures and following radiation therapy.
We also have data that we apply fromthe US and National Academy of
Sciences who have examined theradiation‐sensitive children and theyalso indicate significantly higher
radiation‐sensitivity of children thanadults, significantly higher radiation
sensitivity of women than men. But
when it comes to the development ofsafety standards, because we are
dealing with a large population, we do
not differentiate between men, women,
and people of different ages because weare trying to come up with a standard
that is useful across the wholecommunity.
So to summarize our understanding ofradiation related to children, children are
considered to be more sensitive toradiation than adults. Cancers in children
are rare. Many studies are underway tolook at radiation‐induced cancers
following medical procedures, especiallycomputed tomography. And I think that
it is worth just digressing for a minute tothink about some of these studies
because these studies involve looking at
many hundreds of thousands of children
who have had CT scans with doses oftypically 5mSv.
These studies are some of the few
studies that have the power to actuallyshow effects of radiation at low doses ofthe sort that occurred in the Fukushima
prefecture. Those studies are going to belong and hard. The ones that we havepublished so far have been disputed
heavily in the scientific community andhave shown really very, very small
increases in cancer risk with the sorts ofdoses that come from CT which is of theorder of 5mSv.
So I conclude by again saying thatchildren are at greater risk due toradiation exposure than adults.
Radiation risks cannot be entirely
89Session ３
avoided. We are all radiated all of the time. Radiation is part of nature. The system of radiation
protection is designed to provide adequate protection to the entire community. And the greatest risk
following a nuclear accident is thyroid cancer in children from radioiodine; but fortunately, this can be
mitigated by effective controls on access of children to milk, green vegetables and other foods.
Finally, the risk of developing thyroid cancer is dependent on the dose. The thyroid doses in Fukushima
were low or very low. There will be health benefits for ongoing health monitoring and survey campaigns
as well as health assistance campaign to prevent radiological and non‐radiological health effects. But as
has been mentioned already, we have to be conscious of the fact that not everything that we find as anabnormality in those health surveillance programs is actually going to be a cancer that needs prompt
treatment.
Finally, the IAEA is heavily involved in working in Fukushima Prefecture. We have a range of projects
underway at the current time looking at remediation and decontamination, largely with Fukushima
Prefecture. Management of radioactive waste from remediation activities remains a matter of realinterest to us and you have a lot of soil to worry about, you have a lot of water and storage that has to be
dealt with. These are going to be ongoing problems.
We are working with the prefecture andthe Ministry of Environment in fact in theuse of radiation monitoring data todevelop maps that can be made available
to the public on our websites. So with
that, I conclude. Thank you.

90

Social impact by the earthquake and the nuclear accident
Post‐nuclear evacuation and health risks in Fukushima

Shuhei Nomura

PhD Candidate Department of Epidemiology and Biostatistics,
School of Public Health, Imperial College London
Yes, thank you very much for
introduction, Oikawa‐sensei.
Good morning, everyone. I
am Shuhei Nomura, a Ph.D.
candidate at Imperial College,
London. I do really, reallyappreciate all of you here andthose who organized this
symposium for having me
today. As this title suggests,
I am going to talk about
evacuation and health risks
after the Fukushima nuclear
incident.

But before getting into that,let me briefly introduce
myself. When the incident
happened 5 years ago, I wasjust a Master students at the University of Tokyo, Japan, and soon after the incident, my professor, whowill also speak this afternoon, gave me a chance to visit Fukushima as a volunteer for health checkup.
There I met a lot of people from this area including many of today’s speakers. In these 5 years, I havebeen working for the disaster recovery with the local government and with the local hospitals and local
health centers and many, many local staff. So in this session, I am going to introduce some of theresearch based at Minamisoma city and Soma city.
So this is the outline of my talk. The first topic is evacuation and mortality in elderly population andfollowed by chronic health risk. And finally, I will present other health challenges.
So the first topic, mortality associated with evacuation. You know, safe evacuation of elderly populationis very, very important aspect of disaster planning and preparations. For example, in the case of the
Hurricane Katrina in 2005 in America, some research suggested that evacuation can be associated withapproximately twice the mortality risk in elderly people. So, in elderly population whether or not toevacuate after major disaster and when evacuation is really necessary, how to reduce the potential
increase of mortality associated with evacuation are very, very well important issue at the local level andnational and global level.
Fukushima incident also required evacuation of elderly population and provided a lot of important
insight and lessons on this issue. So, to sum up the evacuation instruction by the central government
after the incident, soon after the incident, the central government issued mandatory evacuation orderfor those living in the 20‐kilometer radius of the nuclear power plant. A few days later the government
also issued a voluntary evacuation instruction to the 20 to 30 kilometer zone. So after that, a lot of
people evacuated from this area.
As of now there are some reports concerning the increased risk of mortality after the evacuation. Thisis from the National Diet of Japan Fukushima Investigation Commission where I worked as a research
assistant before. It says that in the 20‐kilometer zone, there were seven hospitals and from there after
the incident 850 patients evacuated and sixty people died within 1 month after the evacuation.

91

Session ３
Second one is from the Fukushima Medical University which said that in the 20‐kilometer zone there
were 32 nursing homes and from there about 2000 people evacuated and the mortality increased about
2.4 times in comparison with the previous year, 2010.
This is my paper using the data of Minamisoma city and we reported that after the evacuation, themortality increased about 2.68 in the nursing home resident. The final one is from the newspaper
article. As of the end of the 2013, 1‐1/2 years after the nuclear incident, the number of death due toevacuation exceeded the total number of tsunami victims in Fukushima prefecture. So, the mortality
due to evacuation was higher than the direct death of tsunami in Fukushima.
I am going to introduce my research work in more details. So, my study site, Minamisoma city andSoma city, and in total seven nursing homes participated in our study. Importantly, all the facilities in
Minamisoma city evacuated after the incident; on the other hand, facilities in Soma city did not. So,
this situation enabled us to conduct comparative analysis between evacuees versus non‐evacuees inorder to assess the mortality risk associated with evacuations.
It should be noted that after the nuclear incident in Fukushima, evacuation was not avoidable for thenursing home resident in Minamisoma city because of extreme anxiety about radiation exposure, lack ofreliable information on radiationlevel and also they lacked humanresource, medical supply, food stuff,
and lots of resources.
I would like to repeat that theobjective of this study was toevaluate the mortality associatedwith evacuation and the risk factorsthat affected the mortality increase.
What we have to learn from thisincident is how to reduce thepotential increase of mortality
associatedwithevacuation.
Lessons learned from this incident
can be applied to any type ofdisasters
which
will
requireevacuation of elderly population in
the future.
This is the first result showing therelative risk of mortality after theincident in Minamisoma city byfacilities that evacuated, so all of the
facilities in this table evacuatedafter the incident. The main pointis that the overall relative risk after
the evacuation was 2.68. Anotherpoint is that there are hugevariations of the increased mortality
after the evacuation between
facilities ranging from 0.98 to 3.93.
And two facilities, facility 3 and 5,
statistically did not increase themortality even after the evacuation.

92

Social impact by the earthquake and the nuclear accident
This result may indicate that themortality associ ated with
evacuation highly depends on
facility‐specific evacuation
procedures. This is the analysis
that evaluated the effect ofevacuation distance and evacuation
number on the mortality. After theincident, many people evacuatedseveral times like the first evacuationfrom the original facility to theevacuation site and second
evacuation from there to anotherevacuation site. And by doing so,they were moving away from thenuclear power plant and looking forthe facility best suited for them.
The point of this result is that initial
evacuation from the original facility
had about two times mortality riskof subsequent evacuations.
Another point is that evacuation
distance had no statisticallysignificant impact on mortality.
This result indicates that regardlessof evacuation distance, many people
died after the initial evacuation.
Those who survived the initial
evacuation could also survive thesubsequent evacuations.
Then this is the analysis thatincorporated the data of Soma citywhich did not conduct evacuation.
So this is a comparative analysis
between evacuees versus
non‐evacuees. The point is that incomparison with non‐evacuation,
initial evacuation from the original
facility had about 3.4 times mortality
risk, which is huge impact onmortality.
So this is the brief summary ofevacuation study. First of all, I
found a substantial increase of
mortality after the evacuation andthere are huge variations of theincreased risk between facilities,
which may indicate that themortality associated with evacuation
highly depends on each facility’s
specific evacuation procedures.

93Session ３
Also, we found that initial evacuation from the original facility had a huge impact on mortality while
subsequent evacuation has less impact, which may indicate the importance of well‐preparedness of
initial evacuation.
For example in Minamisoma city, as I mentioned, the facilities in Minamisoma evacuated because ofanxiety about exposure to radiation, lack of resources, human, food, and other resources. And also,
they could not prepare for proper transportation means like the vehicles for disabled persons. They
had to use general vehicle for their resident which might impose huge burden in the elderly. Then as aresult some facilities increased mortality after the evacuations.
On the other hand, the facilities in Soma did not conduct evacuations because they fortunately received
external support from like NGO or distant facilities and then they did not have to conduct theevacuations. Then they did not increase the mortality after the incident.
The lesson is that evacuation may not be the best life‐saving strategy for elderly people. But, you know,
when evacuation is necessary, which can be happening any type of disasters, in order to avoid
evacuation burden, especially the burden of the initial evacuation, arrangement of any evacuation
procedures such as well‐preparedness of evacuation site or proper transportation means are quite
important, which critically determines the survival of elderly population.
Finally, I think that relevant authorities need to help and support the affected facilities in emergency time.
In Japanese guidelines for emergency response, medical facilities are supposed to conduct evacuation
themselves. But in emergency time the facilities will not be capable to prepare for and to implement
evacuation themselves. They definitely need support.
If you are interested in our study or need more information about this topic, you can check this article
which is already published. I have some brief summary written in Japanese. So if you need Japaneseversion, please let me know so and another article related to the study.
Let’s move to the next topic, chronic
health risk. So the health impact ofevacuation is not limited to mortalityof course. Evacuation has powerful
influence on individual vulnerability
to psychological stress or changes insocioeconomic status and thus on
people’s health, and Fukushima
incident is no exception. Some
research suggested elevated value
for metabolic markers like BMI orblood pressure, particularly in
evacuees and in the acute phase of
the incident.
However, the long‐term healthconsequences of evacuations are notclear because of difficulty of datacollection or other reasons. So, the risks in the chronic health in long‐term perspective at this present
moment were unclear. However, the Soma city and Minamisoma city initiated evaluation of thischronic health risk in long‐term perspective. Data was collected from the annual health checkup from2008 to 2014 and we targeted diabetes and hyperlipidemia and hypertension.
First of all, in the analysis we classified the participants into evacuees and non‐evacuees based on theirhome address at the time of the incident. So in this figure, the area colored in blue, yellow, and green
were mandatory evacuation area after the incident. If the participants were living in these areas, they
were regarded as evacuees.
94Social impact by the earthquake and the nuclear accident
Then I compared the disease risk
between before and after theincident in order to see how muchdisease risk increased after theincident. And then that relativerisk before and after the incident
was compared between evacuees
versus non‐evacuees. This is theresult of the relative risk of thediseases before and after theincident by evacuation status. The
left is for evacuees and the right isfor the non‐evacuees. I apologize
for the very busy table.
So in summary, increased risk of
diseases was identified in diabetes
and hyperlipidemia after 2013, 2
years after the incident. On theother hand, the hypertension did
not increase the risk after theincident. This maybe indicatesthat hypertension was relatively
easy to control even in the disastersetting just using a medicine.
When comparing these relative
risks between evacuees versus
non‐evacuees, the significant
difference was identified in only
hyperlipidemia. So, this result
indicates that the increased risk ofhyperlipidemia after the incident
was greater among evacuees thanamong non‐evacuees.
A major disaster often social
disruption through massevacuation or changes insocioeconomic status which may
result in reduced physical exercise,decreased access to medical care,and thus they have a powerful
influence on human health.
In conclusion, my study also
demonstrated that disaster impact
may persist in long term withregard to particularly diabetes andhyperlipidemia. And also,
evacuation has powerful influenceon the risk in long‐term perspective.
So, all the disaster‐related
stakeholders including medical
community should pay more
95

Session ３
attention to the chronic health control in long‐term perspective and even at this present moment.
If you want more information, you can check this article which is already published. I also have aJapanese version. If you need that kind of version, you can ask me.
Finally, I will quickly introduce a new
study of Soma city which is aboutobesity in school children after the
Fukushima incident. This is not anevacuation study but there are someincreasing concerns about this topic.
So then I am going to speak a bit on
this topic today.
As many speakers alreadymentioned earlier, one of the major
public concerns after the Fukushima
nuclear incident is the radiation
exposure in the children. And
many people like many parents andmany schools teachers, they were
worried about particularly their
outdoor activities. And as a
response to the incident, many
schools in Fukushima prefecture
including Soma city andMinamisoma city imposed
restriction on the outdoor activities
by cutting or shortening physicalexercise classes. However, as aresult of these restrictions, anotherconcern has raised in Fukushima
which is that obesity level in school
children might increase in
Fukushima.
Then in order to answer this concern,
Soma City is going to evaluate theobesity level in the school children
in the city by comparing the obesity
level before and after the incident.
As you may know, in Japan – every
school in Japan measured the physical status of the school children almost every year and Soma city also
conducted the measurement in 2010, 2012, and 2015 and we are going to use this data.
We set three health outcomes as an indicator for obesity level: the BMI, the percentage of overweight,
and obesity rate. The definitions are a little bit too technical, so I want to skip this. But the BMI ispopular and maybe easy to understand.
The analysis will be undertaken soon. I think this is the old version. This is not what I sent. Briefly,
you can say that this is BMI. This is percentage of overweight and this is obesity rate. As you mightsee, the significant difference was not observed. There is only small shift in BMI, percentage
overweight, and obesity rate. Statistically, these are not significant. So based on this data, we might
be able to say that in Soma city the restrictions on the outdoor activities did no t much affect the obesity
level in school children. But at the next step, we are going to evaluate this data in more detail and will
release the result to the public as soon as possible.
96

Social impact by the earthquake and the nuclear accident
So this is the final slide. So
regarding evacuation and health risks,
I would like to repeat that after the
Fukushima nuclear incident,
evacuation was not avoidable for thenursing home resident and the local
people because of anxiety about
exposure to radiation. They also
lacked reliable information on
exposure level. They lacked humanresource, food, and medical supply.
What we have to learn from thisFukushima incident is how we canreduce the evacuation‐related healthrisks. The lesson learned from thisincident would be used for any typesof disaster, will inform the futuredisaster planning all over the world
beyond Fukushima, beyond Japan. Also, these lessons will be used for the health measurement for the
local people at this present moment.
Thank you very much all the people who made a huge contribution to our study and those whoorganized this super‐symposium. I really appreciate you. Thank you very much.

97

Session ３
Empowering the young ‐ radiation protection in Fukushima ‐Ryugo Hayano

Professor, Department of Physics, University of Tokyo
Thank you very much, Mr.
Chairman. Because this
symposium is about children,
I chose to speak with thistitle, How to Empower theYoung Generation of
Fukushima in Terms ofRadiation Protection?

I started to think about this 2years ago when I took three
students from Fukushima
High School to Geneva.
There is a laboratory called
CERN. That’s the world’s
largest particle accelerator
laboratory which hosted aradiation protection
workshop for high school
students. There were about 200 students including the three from Fukushima High School. These
three students gave very wonderful presentation about the status of Fukushima. One of these students
in fact is Mr. Oikawa, the son of our chairman.
Well, after the presentation they were surrounded by all the audience, the French and German students.
They all asked these Fukushima High School students ‘Are you really from Fukushima?’ ‘We thought after
the accident it is not possible anymore to live in Fukushima.’ That was quite a shock to me and also to
the students. So we thought we have to do something about it.
Well, in fact the CERN is where I work. I am a physicist. But the reason I am here today is because of
my Twitter account. I started to tweet about the Fukushima accident after March 11th and the numberof my Twitter followers increased from 3000 to more than 150,000 within a few days. That had manyside‐effects including the fact that I got connected to medical doctors in Fukushima including Dr.
Tsubokura.
So, our collaboration started andthe collaboration is about theassessment of the internal
exposure risks of Fukushima people,
which after some time resulted in
the paper.
This machine is called thewhole‐body counter. There
wasn’t any such device (inFukushima) immediately after theaccident. Now there are morethan 50 such devices around
Fukushima. Typically, you stand in
this box for 2 minutes. This isheavily shielded. From the end of
2011, we started to measure
Fukushima people using such
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Social impact by the earthquake and the nuclear accident
devices. And during 2012 wetogether measured more than
30,000 people.
Surprisingly, 100% of children were
below the detection limit; and evenfor adults, 99% were below thedetection limit as of 2012. For me
this was my first medical paper that
I authored.
Well, the detection limit of thewhole‐body counter that we used isabout 300 becquerel (Bq) per body.
This is the detection limit, andalmost everybody were below thislimit. In 1964, as Dr. Tsubokura
already explained, average
Japanese adult male had aboutnearly 600 Bq in the body as aresult of global fallout, that’s about
A‐bomb and H‐bomb test.
So already in 2012, the majority ofFukushima people were below thislevel. However, many people,
especially parents, were still
unconvinced and especially themost frequently asked question was‘How about our children?’.
Remember, the whole body counterthat I showed, you have to stand for
2 minutes and the geometry was
optimized for measuring theradiation workers at the nuclear
facilities of course. So it was
impossible to measure smallchildren who cannot stand.
So we stated a project to make ababy scan. It’s the special device
for measuring small children. But
this is not just a measurement tool ‐Well, it is a very good measurement
tool. The detection limit is now
below say 30 Bq per body instead of300. This is about 10 times moresensitive ‐ But this is acommunication tool. The parents
come to the hospitals to have theirchildren measured and it is awonderful timing for doctors like Dr.
Tsubokura to talk to or listen to
those parents. So this is why wemade this.
99

Session ３
It has a hyper‐adjustable belt andthe mother comes with the children
and the mother can watch the baby
and the baby can watch the mother.
The scan is done in about 4 minutes
or so. So, the first unit was
installed near Koriyama city at theend of 2013 and the second unit in
the spring of 2014 in Iwaki, then thethird unit in Minamisoma in thesummer of 2014.
So far we have measured about
more than 5,000 babies and wehaven’t found anybody who had
detectable level of cesium. Thisshows the distribution of where
those babies came from, so some ofthem actually came from around
Sendai. Well, this is good news but
this is not the end of the story.
I now compare the situation of
Minamisoma and a town of Miharu
which is about 40 to 50 km to thewest of Fukushima Daiichi Nuclear
Power Plant. As Dr. Tsubokura has
already explained, we asked theparents to fill out the questionnaire
before taking the test. We asked
about the evacuation situation,
situation of their food, water and soon. And this is what we found.
The area of the circle is drawn inproportion to the number of people.
So in Minamisoma, the majority ofpeople said that they avoid tap water.
This was already discussed by Mayor
Sakurai yesterday. A large fraction
also say they never eat local rice.
And again, a large fraction of people
said they avoid Fukushima
vegetables. And in fact, about 60%of them avoid all three. That’s thesituation in Minamisoma.
But the situation is quite different in
the town of Miharu. Only 4% avoid
water and rice and vegetables.
Well, if you understand why, pleasetell me. I don’t quite understand.
I have some theories but I cannot
prove this. But it is important tounderstand why there is such a large difference in risk perception among the parents at Minamisoma or
the Soso area and other places in Fukushima.
100

Social impact by the earthquake and the nuclear accident
Let me now switch to external exposures. Already in the fall of 2011, many municipalities started to
distribute this person dosimeters, usually called the glass badges, initially to children and to pregnant
women. This is the compilation of the first year measurement from Fukushima city, Minamisoma city,and Soma city. Already in the firstyear nobody exceeded 10 mSv peryear.
One mSv per year is the long‐termgoal set by the Japanese
government, and in 2011 about
50% of the children were alreadybelow 1 mSv per year, and that
number increased for instance inFukushima city to more than 96%
in 2014. So, external exposure islower than what most people thinkand have steadily decreased overtime. But in fact, it is higher than
the internal exposure level,
because internal exposure isalmost negligible.
Well, the glass badge is a common
method used by almost all themunicipalities. But you just get
one number printed on a piece of
paper after 3 months ofmeasurement, which is not so
informative. You cannot reallycorrelate this one number to yourbehavior. So, I started to use thedevice called D‐shuttle which is theelectronic dosimeter with which
you can measure and record theperson dose every hour with a timestamp.
Let me show you an example how
this device can be used. We sent
these units to France last summer
and French students came to
Fukushima with this D‐shuttle inthe summer of 2015. This is theresult. There are eight students
and four teachers, 12 people intotal came to Fukushima and this isan overlay of the 12 D‐shuttle
readouts. Then there is this tiny
peak while they were still in Paris.
They went to the airport and thedosimeter was X‐rayed. That’s
this tiny peak.
As you may all know, during flight,
due to the cosmic ray radiation, theradiation level is very high. It
101

Session ３overshoots. Then they came to Tokyo and then there was a peak while they were still in Tokyo. Why?
We all got invited by the French embassy downtown Tokyo and we have to go through the security gate.
The dosimeter was again X‐rayed.
And the next day we all got on thebus and drove to Iwaki. Then you
notice there is a peak. Why?
French students wanted to see theeffect of tsunami. So we
proposed to take them to Tomioka
station which was devastated by
the tsunami. And this is 10 km
south of Fukushima Daiichi andyou are still not allowed to live
there. This picture was taken in
front of the Tomioka station. And
as you may realize that each
student has a nametag and thedosimeter.
And during this time the students
stayed at Fukushima. They went
to Kunimi on the last day. Kunimi
is the northern part of the
Fukushima which is famous forpeaches. So we visited the peach
farmers and they told us about thehardships they have had, thedifficulty of selling the peaches andso on. And we picked andenjoyed eating the beautiful
peaches and then at the end we
picked the peaches and went backto Fukushima High School andmeasured the peach andconfirmed that the peach doesn’t
contain radioactive cesium.
Well, anyway, as you would all
agree, this is measured using thesame dosimeter worn by the same
people over about 1 week. Thereis not much difference between
Paris, Tokyo, and Fukushima. So
as you can see, this Deshuttle isvery powerful device andFukushima High School students
were motivated to use this device
to better understand theirenvironment by themselves.
So, we launched a project tomeasure the personal dose ofhigh‐school students and compare
the doses at different parts ofFukushima, other parts of Japan,
and other parts of the ward. Then102

Social impact by the earthquake and the nuclear accident
we recently managed to publish a research paper together. The project actually started in the summerof 2014. We invited ourcollaborators, the high‐school
students from other parts of Japan,
and then we had the first kickoff
meeting at Fukushima High School.
On that day, the last day of ourworkshop held at Fukushima HighSchool, this picture was taken insideof the classroom of Fukushima HighSchool. These students wereattending this workshop. This is
the cover of one of the best‐sellingbooks about the Fukushima
accident which I authored together
with Mr. Itoi and more than 100,000
copies have been sold so far.
Anyway, we then sent thedosimeters to France, to Poland,
and to Belarus and they came backto Fukushima High School end of2014 and then the data were again
analyzed by Fukushima High School
students. This is what wemanaged to publish end of
November last year. Most of these
233 coauthors are high school
students from Japan, from France,
Poland, and Belarus. In the 5months since we published thispaper, this paper has been
downloaded more than 60,000
times. Amazing!
We compared the high‐school
students attending six schools inFukushima, six schools outside of
Fukushima, three regions in France,
many regions in Poland, Brahin, andGomel. Brahin actually is very
close to Chernobyl Nuclear Power
Plant.
And This is the result. We
estimated annual exposure basedon our 2‐week measurement andthis is the comparison of individual
doses including the natural
background radiation. Thenactually the highest median was
found in France. Bastia, on Corsica
Island was higher than in
Fukushima.
103Session ３
Since our mission was to communicate this to the world, I took one of the coauthors, Ms. Onodera to theForeign Correspondence Club of Japan on February 2016 and we gave the press conference and that may
have contributed to some extent to this large number of downloads of our paper.
Here are conclusions. Well, internal exposure is negligibly low in Fukushima. I can repeat this andTsubokura‐sensei already repeated this. External exposure, at least in the region where we live,
external exposure is not higher than in other parts of the world.
It is very important to empower young people in Fukushima by having them actively involved inunderstanding and communicating the radiological situation of Fukushima. It is important for them toavoid unnecessary prejudice, discrimination, and so on. This is something that we have to continue
doing. Thank you very much.

104

Keynote Lecture
Lessons for Disaster Management and Recovery

Shinjiro Nozaki

Senior consultant, WHO Centre for Health Development

Thank you very much for thekind introduction, Professor
Shibuya. I was wondering
whether I should speak in
English or in Japanese. But
the original idea was Dr. Alex
Ross who was to deliver the
keynote lecture in English and
I was to augment as
supplementary information in
Japanese. However,
yesterday, due to the family
problem, he was not available
yesterday and there was no
keynote lecture. However,
he insisted that this material
to be delivered to theaudience. So first, I would like to use his materials and then I would like to use my slides to augment
what he had to say.
This is the WHO Center for Health Development where I belong to. That is WHO Kobe Center. That is
the nickname. It has a deep relationship with disasters. There was Hanshin Great Earthquake and it
was established as a symbol of the reconstruction from the earthquake together with Kobe and WHO
center was established. So, immediately after the foundation, it had devised various schemes against
disasters. So, these are some of the things that I would like to mention today.
First of all, this is WHO and what we consider the most important is global health security because thishas everybody’s business because it leads to health and security for all the people in the world. This isglobal health security. At the center is health security. When it comes to health, it has a politicalrelevance as well as economic relevance. And also, it is connected to food security and environmental
security. So it is very closely linked to all these aspects of security.

105Keynote Lecture
Why we need security? Because, that is required for our people living in happiness and in a healthy
state; I believe that that is the common value sense of human beings.
This is a map. This is an airplanethat is crisscrossing the world on areal‐time basis. This is thenumber of airplanes flying all over
the world. In the process ofglobalization, people are coming
and going and moving around.
That is the globalization in which
we have to consider healthsecurity.
So the risk related the health?
The most immediately one is the
Kumamoto earthquake. These
are the earthquakes and natural
disasters. What do we do? Thisis a safe hospital framework. I do not know your image about WHO but we go to the forefront together
with DMAT or firefighters or self‐defense forces and police. We rescue and help people. But rather
than going to the forefront, WHO works at the background; that is, to make the regulation studies to do
the monitoring and supervision and that’s what we do at the background.
For instance, in Kumamoto earthquake what did we do? There were reports about the Kumamoto
earthquake and MHLW Kumamoto prefecture, Kumamoto city makes the announcements. However, allof this information were in Japanese and also we have the WHO and CNN information in English. We
saw these English reports and these data all two times or three times difference. Also, it was true with
Great East Japan Earthquake.
Also in the Kumamoto earthquake, because this WHO is at Kobe Center and it is not Japan center but it iscoincidentally located in Kobe. So this center was and is responsible for research. But because it is inJapan, there were lots of people who can translate Japanese into English. So this all data can be
updated. That was why we translated the Japanese data into English and sent these data to WHO
headquarters. If the headquarters deemed this data necessary to be transmitted, then they were free
to do that. So, we devised the data and we monitored the data. That saved hospital framework and it
is to the regulation with which
hospitals become safe even in
emergencies.
It was GEJE or Great East Japan
Earthquake. In WHO it wasdeemed as a very complicateddisaster because it was a triple onecomprised of earthquake, tsunami,
nuclear accident. One after theother various things that have
happened and we were
overwhelmed by that. People
said because it is Japan, Japanesepeople can overcome them.
Most deaths were caused by106Keynote Lecture
tsunami and others are disaster‐related deaths that happen as secondary death. So direct, this is only
part of the total casualties.
Also it was a very vast area disasterand also it was a complicated one.
That was why it had long‐term
impacts. At the very beginning,
WHO was aware of that. We had
temporary houses which wererequired for many people. Thesehouses were needed over a vast
area and many people had to live
there for an extended time period.
That had big psychosocial impact.
And also, there was fear anduncertainty. We also had nuclear
power plant accidents.
At the time of Chernobyl, that was under the control of the Communist government of Soviet Union.
Data were not disclosed. And also, Nagasaki‐Hiroshima nuclear bomb, these data were not very much
made available because it was what happened during the war. So, this Fukushima Nuclear Power Plant
was virtually the first in human history in which we were able to have data and this data was disclosed tothe public. So there was a great level of uncertainty and fear associated with that and also PSND
management, elderly care, and continuity was tested.
Twenty years have passed since Great Hanshin‐Awaji Earthquake. This is the 21st year. We have stillreconstruction houses in Kobe. In the past 20 years, some people became independent obtaining jobs
and left the houses. However, there are still a handful of people who still remain there who do nothave many means to live. Even in Kobe city, it is a big problem.
Twenty years ago these people in their 50s and came to temporary houses. They lost everything.
Now they are 70 years ago; or 20 years ago, 60 years old and currently 80 years old. They were low
income people and they lost job and they still didn’t have job. Twenty years after that still they are
impoverished and they cannot leave the temporary houses. And that still exists in Kobe. So we canlearn something out of that.
This is statistics for Great East Japan Earthquake as you know. The death 175,000, missing 2848, injured
6109 as of 2012 August 8th. Sixty‐five percent of the dead were 60 years and older and also the sociallyvaluable, they had higher mortality and there were differences in regions. Also, this is PSND. This isabbreviation of persons with special needs at times of disaster. There were no shelters that wereadequate for them. And also, disaster related secondary deaths were a problem. So, this disaster wasof vast area and very complicated. That was why there were many mid‐
to‐long term impacts which came out of the disaster.
What can we learn from East Japan earthquake in terms of health? Mental health and psychosocial
support are needed. And also, we talked about vulnerable populations and we tend to think ofpregnant women and children. Of course these people are important but in addition to that the elderly
and persons with disabilities we shouldn’t forget the care for them.

107Keynote Lecture
Also medical institutions, how can
we maintain them? Just as thesafe hospital guide I mentioned, weneed to first reconsider. Also, thisis not just the WHO but Japanese
government is reviewing the
DEMAT system. And because wehave reviewed them, in Kumamoto
DEMAT is very much active.
And also, the logistics were a big
problem. Just as Mr. Tachiya,
Mayor of Soma city mentioned,
many things would stop at a timeof disaster. So, what things would
be stopped and how can we ensure
these necessities to be obtained. That’s what we will have to think about.
And in the case of Kumamoto, there are many things that can be considered. But in WHO, in the past
10 days to 2 weeks, in spite of the scale of the Kumamoto earthquake disaster, in the space of 10 days,
Shinkansen were reconnected and so were the national highways. We praise these efforts with an awe.
I believe that I think that that was a lesson learned from the great East Japan earthquake and also thegovernance, nationwide and local coordination and collaboration were deemed necessary.
Health security and healthemergencies, there are many
events and there are so many
events to list up. We have toactually consider out preparedness
for all hazards at WHO. We don’t
limit our responsibility only to thenatural hazard or natural disasterbut all the possible hazards andrisks should be actually captured
and also taken care of.
Our targets are always thevulnerable people. There arecommon people everywhere in theworld. And also that accidents
and events too take place so frequently now‐a‐days, we have to be aware of that. And casualties, death
tolls and others are increasing. But not only that, the economic and political impact had to be also be
considered. So, more than ever, a single disaster can cause so much damage and losses, and thosedamages and losses are really large in scale and also complex.
And also that the emerging diseases and disaster impact travel faster than ever before, like
communicable diseases and pandemics are travelling faster. Disaster itself and pandemics or thecommunicable diseases spread a fear, actually it is really fast because of the globalization and also
technology advancement and use of social media like SMS and others, so fears and worries actually
spread quicker than actual disease spread. Then social impacts have to be considered in long‐termbasis and these are the learnings from the past experiences of disasters.
108

Keynote Lecture
In 1980‐2016, if I am to pick up thehealth security incidents, have AIDS
and Chernobyl and past and NvCJD
and Nipah and Anthrax and SARS
and meningitis and cholera andAnimal Flu and Fukushima disaster,
the nuclear accident, MERS, polioor e‐coli, dengue, H71 andenvironmental contamination andpollution just to name a few, andrecently Ebola and Zika. Almost
every year, we have some kind ofoutbreak which really gives theimpact to the health security.
WHO is focusing on the global
health and security, we have the very important role to fight against the emerging viral diseases. And
as you can see from the world atlas, there are so many outbreaks of new diseases in the past few years.
Ebola in 2014, and last year and this year Zika, and I am sure that the new threat will emerge. In 1970s
and 2007, 1420 new pathogens made news, and 2007 onwards, we had 177 new pathogens, 70% of
which are derived from animals, animal origin.
This is Ebola virus. In 2014, the outbreak of Ebola fever, like Guinea, Sierra Leone, and Liberia, those
three nations, pandemic emerged, and actually epicenter is somewhere around here. But other than
three nations, no pandemic took place, or there effective containment was made. As for the damage,
more than 11,000 dead and 29,000 affected, 10 countries and three continents were affected including
capital cities. And some nations made a decision to close their borders. Liberia, Guinea, and Sierra
Leone, other than those three nations, containment was successfully conducted. So in a short period oftime, the problem was resolved.
Recently, the issue of Zika inconjunction with themicrocephalus reported fromSouth America, 2016 February,international declaration was madethat the PHEIC was actually issued.
PHEIC was the internationallyconcerned the public healthemergency situation. Thisdeclaration which I would like totouch up later to share with you
some detailed information.
Now, this one is the global cases of
MERS which took place recently,
MERS coming very strong in China
or Korea, Malaysia, Thailand, and Asian nations. And as been reported that the spread of this disease inanimal was in 2015 last year, the MERS cases was actually observed in Korea and we Japanese people
were so concerned perhaps that the epidemic will come to Japan.

109

Keynote Lecture
A new type of influenza, H1N1 data, they were reported to the WHO. We had so many cases in theworld. And death toll was also reported. Influenza had different strains and different type of flu
pandemics are introduced in the world.
Only in 2011, this one year only,
this is a natural disaster, natural
disaster that took place in the one
year of 2011.
From the year 2012, disasters had
so much serious impacts whichreally had a damage of $1.7 trillion
and 2.9 billion people wereaffected by the disasters and thosedisasters took 1.2 million lives.
Also the climate change relateddiseases, 3400, floods; 2689,
storms; 470, droughts; 395
extreme temperatures, just to
name a few. UNISDR the United
Nations agency with regard to climate change received those reports. And there are so many
challenges: the population explosion, drain of population, and urbanization and concentration
population to the urban cities.
The urbanization and health problem or in short urban health problem is becoming very predominant.
And also, along with advancement of technology or transportation means that people’s mobility isaccelerated and the communicable diseases to attack human beings.
All those challenges, the hazards
and disasters, the health risk isincreasing its magnitude. And
whether we are able to mitigate
those risks is our challenge and our
mission. Those disasters so much
impact the death of people,
psychosocial stress, possible
environmental pollution, exposure
to toxic substances, and all thosefactors are very much complex. As
for the outbreak of thecommunicable diseases caused somuch economic losses, as huge as
you can see from those numbers inthis atlas, so from which we have a
lot to learn from. Like 2014, the outbreak of Ebola, the fear actually spread faster than the actual
disease and caused so much economic losses or damages.
The new planning issues we have to actually deal with, be that the communicable diseases so the natural
disasters, we should build resilient health systems and maintain that system. And also to backup that,
healthcare financial system has to be made. In 2014, Ebola outbreak case which I mentioned, in threenations, contamination – spread because of the inability or the vulnerability of their healthcare system iscriticized.
110

Keynote Lecture
Physicians and medical institutions are not sufficient, or the healthcare professionals are very few innumber; that caused the spread out the pandemic. The situation is exactly the same with disaster.
Disasters, you have to actually make sure that preparedness and prevention to deal with disasters. And
then, there are chronic diseases in elderly people, people with disabilities, people who are socially weak
have to be taken care and consideration and also the continuation of care provided to the evacuees or
the people who are displaced, and also that long‐term psychosocial impact to people should also be
considered. Out of those bitter experiences in the past, we have so much learning.
As for the recovery as is written down in this slide, long‐term impact is very serious on survivors.
Sometimes it is overlooked and not enough research or implementation. As for the humanitarian
activities, in regard to the development activities and also the confrontation between national
government and local government, inability to have communication and sharing information, that kind ofissue has to be discussed and resolved.
But there are good points, thebright side to it. Because of theinformation revolution andbiotechnology revolution and also
communicable diseases actually to– we actually fought for that
communicable diseases and set up
the international health regulationin 2005. And Sendai Framework
for the disaster risk reduction was
adapted in the United Nation’s
Congress for the disaster risk
reduction took place in Sendai in
2015. The first and second andthird UN Congress was held inJapan, Yokohama, Kobe, and Sendai
last year. In Yokohama, the action plan was formulated, followed by the Hyogo action framework, andthen in Sendai, there’s another brush‐up in the development of the framework declared in Sendai for therealization of disaster risk deduction.
Now, WHO has a role to play. Aninternational health regulation was
issued and around thatinternational health regulation,
those collaborations and teamwork
with various other agencies outside
the health issues are agriculture
issues and transportation agencies.
In other safety security andtelecommunication, we should
actually have the holistic picture injoint collaboration with otherparties. And based on thatinternational health rules, weshould continue theimplementations and monitoring of
the health security.
111Keynote LectureInternational health regulation is a kind of agreement, a convention with 196 member countries to sign.
And effective in 2008, the revised IHR was issued. And the signers, the signatory countries follow the
stipulations and requirements in IHR to deal with the communicable disease possible for the outbreakand make the preparations and cooperation. And WHO is playing the role as a coordinator among
those member nations or the signatory nations.
I just mentioned Ebola fever, resilient health system should be established or built and also to be
maintained. That is emphasized in the international health rules, and that the continued discussion isunderway. In WHO, we have emergency refill agenda and universal health coverage agenda, so that weare able to fortify the health system. This is one of the very important projects that we are running at
WHO. This is a new schematic diagrams and concept of the project. This could be the outcome. To
create a resilient society, we should actually implement universal health coverage and otherfundamentals. You have to actually strengthen the medical system of each and every nation. That is akind of first step to move forward.
Based on that, we would actually have to strengthen the health system nations through the ideas ofuniversal health coverage so that we are able to actually establish and maintain a resilient health system
and resilient society.
Now into the future, however that
we are able to manage thedisasters and diseases and various
other emergencies, we have tostick to the IHR and also theevidences should be collected
through various researches andsurveys. In WHO, we have new
WHO health emergency program,
it is now being formulated and
OCHA has formulated thatinternational health emergency
processes.
Out of the experience of Ebola
fever, we have come up with theidea that we should come up with some kind of financial fund so that we are able to immediately
dispatch the specialist team at the time of disaster and emergency, so this is a contingency fund for
emergencies and World Bank also have the pandemic emergency Financing Facility.
As I just mentioned, there are many endeavors and activities going on. Please visit our website forfurther information. With this, I would like to conclude my presentation. Thank you very muchindeed for your attention.

112

Keynote Lecture
The Minamisoma Babies Study: Health at Birth in the Four Years Following the 3.11 Triple Disaster

Claire Leppold

Minamisoma Municipal General Hospital, Researcher
Hi everyone.
As Shibuya‐sensei said, myname is Claire Leppold and I
work in the research
department of Minamisōma
Municipal General Hospital.
Today, I would like to present
the results of my study on
health at birth in the 4 years
following the disaster. Thesefindings are from my paperthat is currently under review
at BMJ Open; because it is still
under review, it should beconsidered a work in progress.

I’m going to start with areminder that maternal and perinatal health are two very important parts of general public health. If themothers and babies in a population aren’t healthy and well, this can have devastating effects on
everyone. So to maintain and improve public health, these two groups are crucial.
Unfortunately, disasters can lead to negative health effects on everyone, and women may be particularly
vulnerable in these situations. Previous research suggests that women, especially during pregnancy orwhen they have young children, are at increased risk of negative health outcomes in the aftermath ofdisasters, and this of course can have implications for the health of their children as well.
One phenomenon that has been observed after previous disasters is that there have been significant
increases in the rates of low birth weight and pre‐term births. It is thought that the reason for this iseither through environmental exposures, as in exposure to a toxin, or psychological stress as a result of
the disaster. And while most previous studies have focused on women who were pregnant at the timeof a disaster, there is also evidence
that these changes in population ofbirth outcomes can continue foryears following the actual disaster.
You may look at this and wonder,
why would changed rates ofpreterm birth and low birth‐weightbirths be important? But theanswer is actually quite interesting.
There is a lot of previous researchthat suggests that weight at birthespecially, but also gestational age
at birth, can predict the long‐termand short‐term health of this child.
Of course, weight at birth andgestational age at birth reflect the113

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wellbeing of the mother as well, but they also hold key hints, like I just said, about the long‐term healthof newborns.
A wealth of interesting research has
been conducted on this subject andit’s been found that both of thesefactors (low birthweight andpreterm birth) can independently
predict mortality in the first year oflife but also disease in adulthood.
For example, low birthweight of lessthan 2500 grams is associated withincreased risk of diabetes, of
cardiovascular disease, of othernon‐communicable diseases inadulthood, which brings about thequestion, if disasters can change
rates of preterm birth and low
birthweight births in populations,does this have any long‐lasting
implications for the health risks of this population or the long‐term health of new generations?
As the entire theme of this conference suggests, we are standing in an area that was significantly
affected by three disasters. The 3/11 triple disaster immediately led to damage, mostly from theearthquake and tsunami, but the long‐term effects of the nuclear disaster have been particularly
profound. And we have seen continuing evacuation, changing lifestyles, changing health risks and ahost of mental health problems including radiation‐related anxiety. So when we look at the picture ofwhat has happened here and what is continuing to happen here after this disaster, we can wonder havethere been any impacts on the health of those born in affected areas, and this was the question that I
had.
I was able to find two previous studies that also asked this same question. These studies both looked atbirth outcomes in the first year after the disaster. One looked at Fukushima prefecture and compared
incidence rates of multiple birth outcomes to national averages at the same time, and they could find no
significant differences including pre‐term birth and low birthrate. Another study looked at earthquake
affected areas in Tohoku compared to non‐affected areas in the rest of Japan; and again, they foundsimilar rates of low birth rates and preterm births.
While these studies both have their limitations and they are only in the first year after the disaster, this isactually quite interesting in itself because this is so different than what has been observed after otherdisasters. After Hurricane Katrina or after the 2007 earthquake in China, there were immediately shifts
in population rates of low birth rate and preterm births that could be picked up in research. So, to see
these results is really interesting and surprising and I immediately wanted to know what the long‐term
trends looked like. In this way the Minamisoma baby study was born.
We decided to look at maternal and neonatal characteristics of all the births in our hospital from 2008 to
2015, and our objectives were to first see if there had been any long‐term changes in preterm birth andlow birthweight birth rates but also to see if there are any associations between evacuation and foodavoidance and birth outcomes.

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Keynote Lecture
I thought I would clarify the study
location for those who might not
know. Minamisoma Municipal
General Hospital is located 23
kilometers away from the nuclear
power plant and it borders multiple
evacuation areas. As
Hayano‐sensei explained really
nicely in his earlier presentation, the20‐kilometer radius of the power
plant was immediately designatedas a mandatory evacuation zone
after the disaster, and the 20‐30
kilometer radius was first an indoor
sheltering zone but it became avoluntary evacuation zone, and thisincludes our hospital.
Of course the zones have changed a
lot in recent years. The mandatory
zone has expanded to include somemountainous areas but it’s also
re‐opened for residency in someplaces the south. The main pointof this is to just show you that our
hospital borders multiple evacuation
areas and it serves places that havebeen significantly affected by all ofthese disasters.
For our methods, we looked at alllive singleton births from 2008‐2015
and we picked up this informationfrom patient records on maternal
characteristics and neonatalcharacteristics of every birth. We also classified all of the post‐disaster participants based on theirresidential address at the time of the disaster to try and estimate whether they had evacuated or not, or
whether they were forced to evacuate or not. For the pre‐disaster mothers, we also put them into thesame groups based on their residential address at the time of birth, just to make sure that there were nounderlying trends by area.
We also used data from the whole body counter screening program. As Hayano‐sensei said, wholebody counter screening is a screening for internal radiation contamination; but at the time of thescreening they also give a questionnaire which asks how you acquire your food products. We had ahypothesis that avoiding Fukushima food products could be indicative of radiation‐related anxiety.
Anxiety fits together with psychological stress, which is known to affect birth outcomes, and we thought
this could have been a factor contributing to any of the outcomes in our study. So, for all of thepost‐disaster mothers who did whole body counter screening – and this happens in our hospital for free
and all women are encouraged to undergo this screening during their pregnancies ‐‐ we picked up theirdata on food choices as well.

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Keynote Lecture
For our analyses, we first simply
looked at the prevalence of
pre‐term birth and low birthweightbirths in each post‐disaster year
compared to the pre‐disasterbaseline. We also calculated
weight ratios to see if there was any
increased risk of these outcomes
after the disaster, and we also justsimply looked if there were any
associations between evacuationand food choices and the twooutcomes.
So these are our results. Overall,there were 1101 live births in the
study years. We found that 93% of
the post disaster mothers went
through whole body counterscreenings, which is really great.
And most significantly, fromdemographic characteristics, weunderstood that there were no
significant changes in theprevalence of low birth rate andpreterm births in pre and postdisaster periods.
This table shows the demographics
of our study population and you can
see the prevalence of low birthrate
and preterm births, and the lack ofany significant differences by year.
You also might be able to noticethat there were some interestingchanges in maternal demographics.
We unexpectedly found that the
proportions of older mothers overage 35 and first‐time mothers
increased after the disaster. This
table is probably difficult to look at
and I apologize for that, the next
one is hopefully a bit easier.
This shows the distribution of birthrate in pre and post disaster periods.
And again, there were no significant
changes in the proportions of lowbirth rate. Of course, the numbersof birth themselves decreased after

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Keynote Lecture
the disaster probably due to evacuation or population changes; but again, the proportion of low births
itself did not significantly change.
On the other hand, this is the distribution of maternal age. You can see it got a lot flatter after thedisaster. Before the disaster, the majority of births
were to mothers between the ages of 25 and 35, but this age group really shrunk after the disaster.
Again, we think this is probably due to evacuation of young mothers especially. But you can see thatthe proportions of older mothers over age 35 therefore increased overall after the disaster. In our risk
rate ratios, we again could find no significantly increased risk of pre‐term birth or low birthweight birth
after the disaster.
Again, we coded people by their residential address at the time of the disaster to look for evacuation but
we still could find no significant associations between evacuation zones and birth outcomes. We also
ran this through a regression model and adjusted for factors such as sex of the neonate and age of themothers and still could find no significant associations. This suggests that evacuation was not
associated with preterm birth or low birthweight birth.
For food choices, we also could
find no associations between foodchoices and birth outcomes. Andagain, we ran this through aregression model and still could
find no significant associations.
This suggests that regardless ofwhether you were going to thestore and avoiding Fukushima
products or if you were directly
using a farm in Fukushima, there
were no significant associations
with the birth outcomes.
In summary, we could find no
significant increases in theprevalence of pre‐term birth or
low birthweight births after thedisaster, and no significant associations with evacuation or food avoidance. But we unexpectedly did
find an increase in the proportions of older mothers over age 35 and first time mothers after the disaster.
I think the natural response to hearing results like these is “why,” and of course we asked ourselves thissame question when we saw the results. These are again really different from what has been seen after
other disasters and it’s quite interesting to think, how did this happen and why are we not seeing
significant changes in Fukushima? I thought perhaps we could look at the reasons why it’s proposedthat there have been changes in other disaster settings, and to put those reasons in the context ofFukushima to try and think about why we might not have seen changes here.
As I said, in the beginning of this presentation, the two main hypothesized pathways from disasters tochanges in population birth outcomes are either psychological stress or environmental exposures. A
really good example of an environmental exposure is the love canal accident which happened in the US.
It was a toxic waste dumping and one neighborhood was reaffected by exposure to toxic waste, and it
was found that after this accident there were dramatic increases in low birthweight and birth defects inaffected populations.
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Keynote Lecture
After Chernobyl, it was similarly a concern whether radiation exposure would have had any effects on
pregnant mothers. There’s really mixed evidence for Chernobyl. While some studies do suggest
increases in birth defects, others generally don’t, and there have been no significant indications of any
changes in birthweight or preterm birth rates. Most reviews that I read of Chernobyl concluded that
there was little effect on most pregnancies. So in general, there’s mixed evidence for environmental
exposures, but it still remains a majorly hypothesized pathway from disasters to changes in population
birth outcomes and there have been countless studies on this topic.
The other main hypothesized pathway is psychological stress, and most earthquake studies have
hypothesized that this is the reason why they found changes in birth weight after earthquakes. Somestudies directly ask mothers “did you feel stressed after this earthquake?” or “how much stress did you
feel?” while others just classify people based on where they are living, but there are a significant numberof studies that find changes after earthquakes using this reasoning.
I think a really good example of this is the Swedish ferry accident. 500 people were killed in in an
accident when a ferry sank in Sweden. Subsequently, there was a 15% increase in very low birthweightbirths in the national population of Sweden. This is really interesting because it suggests that even if
you don’t directly experience a disaster, so even if you don’t feel the shaking of an earthquake or you are
not on the boat that’s sinking, you can still feel grief over these events which may in turn affect yourhealth or the health of your children.
We can try and put these two pathways in the context of Fukushima. If we start with environmental
exposures, a lot of people assume that because there is a nuclear disaster here, radiation exposure
would be the biggest pathway to population health changes. But we are finding that this perspective is
not so accurate. As I just mentioned about Chernobyl, there is overall really mixed results coming outof studies, but most reviews conclude there was little effect on most pregnancies. It is also importantto remember that the scale of disaster is different between Chernobyl and Fukushima. The United
Nations Scientific Committee on the effects of atomic radiation have actually predicted no significant
effects of radiation exposure on fetal outcomes in Fukushima.
It’s also worth noting that in the present study, out of all the post disaster mothers who underwent
whole body counter screening, none of them had detectable levels of internal radiation contamination(cesium).
So, all of this information suggests that in our study it would be very unlikely that radiation exposure
would have had any effects on the outcomes. However, psychological stress is still another big concern,and after Chernobyl, it was found that actually radiation‐related anxiety, not the radiation itself, wasassociated with earlier births.
We were also concerned about this in Fukushima. As I said earlier, there has really been continued
evacuation and changes in the lives of residents here, and we thought that this could have contributed to
psychological stress. We also know from previous studies that in disaster settings, women may be more
susceptible to feeling high levels of stress than men. There’s also growing research on stress and birthoutcomes in non‐disaster settings, so general settings, finding that stressful life events prior toconception are associated with low birthweight births later in life. This suggests that stress you feelbefore you are even pregnant may have effects on your later births.
To take account for all of these factors, we tried to capture any possible pathways from the disaster tostress to health effects by categorizing our participants based on evacuation and food avoidance. And
to look for any long‐term effects, we included all the births up until 2015. But again, we could still findno changes in the rates of preterm births or low birthweight births. This result is quite perplexing
because it’s difficult to say, really impossible to say, that mothers in Fukushima felt not stress after this118

Keynote Lecture
disaster. We can’t say that. Which leads us to wonder, in this situation with a huge potential for stress,
why did we see no apparent effects of stress on health outcomes? This point leads us into further
discussion.
The results of this research suggest that a disaster in and of itself may not lead to population levelchanges in birth outcomes. And this is really a call for further research. We really need to know what
the exact factors are that lead from disasters to changes in health outcomes. In particular, I am curious
if could there be any factors that may exacerbate or protect against the effects of disaster‐induced stress.
Some of my other questions are: are there any other factors that may make people who experiencestress less likely to experience or be hit by the negative health implications of it? Are there any
community or structural factors that could mediate effects of stress on health? And while our researchdoesn’t have the answer to all of these questions, I think it can rather be thought of as a springboard for
future studies on birth outcomes in disaster settings but also stress and birth outcomes even innon‐disaster settings.
To close, we’d like to leave you with the following messages. To mothers and families in Fukushima,
after this disaster we could find no significant increases in the prevalence of low birthweight or preterm
births, and no effects of evacuation or food avoidance. To scientists, our data suggests that disasters
did not necessarily result in changes in population level birth outcomes. This is a point that needs
further research. And to the general public, we have found that health at birth in our hospital located23‐kilometers from the power plant did not significantly change after the disaster. We are surprised bythis result but we find it to be something worth celebrating.
This study would have been impossible to do alone, and I am greatly thankful for the help and support ofthe people listed here. In particular, I would like to thank Dr. Hiroshi Anbe who has been the only
Ob‐Gyn in our hospital since the disaster. The health and safety of these babies is really thanks to him.

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Keynote Lecture120Panel Discussion

Moderator

Kenji Shibuya
Professor, Department of Global Health Policy,
Graduate School of Medicine,
The University of Tokyo

Panelists

Gerry Thomas
Department of Surgery and Cancer,
Imperial College London

Peter Johnston
Director, Division of Radiation,
Transport and Waste Safety, Department of
Nuclear Safety and Security, IAEA

Shinjiro Nozaki
Senior consultant,
WHO Centre for Health Development

Shinichi Suzuki
Professor and Chairman, Fukushima Medical
University School of Medicine Department ofThyroid and Endocrinology

Hidekiyo Tachiya
Mayor of Soma city

Katsunobu Sakurai
Mayor of Minamisoma city

Claire Leppold
Minamisoma Municipal General Hospital,
Researcher

Kana Yamamoto
Minamisoma Municipal General Hospital, Physician

Chikako Hokotate
Parent‐teacher association of Soma

Kenji Shibuya
Five years have passed since the disaster in Soma area. Regarding
the survey results of the health and health impact andcountermeasures, the data was also presented and we viewed a lot ofvoices from the field. We’d like to divide the panel discussion into
three areas: immediately after the disaster, up until now, and thefuture.
First, right after the disaster. As the head of the municipal
government, I’d like to have comments from Mr. Sakurai first.

Katsunobu Sakurai
Before I talk about that topic, I’d like to talk about the Chile Earthquakethat occurred in Februrary, 2010, when the entire eastern Japan
received a warning of tsunami. In Minamisoma city, 45 centimeters
tsunami was observed at that time. However, a year later, on March 11‐ I remember I had finished a speech at the graduation ceremony ofHarumachi 2 junior high school a 21 meter tsunami came in
Minamisoma city. This was the first huge tsunami in 400 years, andnobody was able to deal with it. As a result, 636 people were killed
121Panel Discussion
and 41 square kilometers were washed away, and 111 people are still missing.
At the time of the Chile Earthquake, we established evacuation centers, to which only 15 people per
center had evacuated. However on March 11, we had to accommodate close to 2,000 people at one
place. We didn’t imagine a nuclear accident would occur on the next year.
Let me explain how was the situation at the time of the nuclear accident. Shortly after 3 p.m., we got
an announcement from the police that there seems to have been an explosion at the nuclear power
plant. We instructed the firefighters to check, but thirty minutes later, they reported that they could notconfirm anything at all.
We had made an evacuation order in response to the tsunami on March 11. When we got a flash reportfrom the police, we had made an order of indoor‐evacuation to the people. When it was not confirmed,
we announced that ‘it was a mistaken report’. But after 5 p.m., what we saw on the TV screen was the
exploding reactor building. We again made an indoor‐evacuation order. Such was the confusion in thedisaster countermeasure taskforce.
The evacuation order within 20 kilometer zone was issued from the national government while we werestill searching for those who were missing after the tsunami; 2500 people were still missing at the time.
So we couldn’t even notice that order so it was only after watching TV, that started to instruct theresidents living within 20 kilometer radius. We had to move 14,000 people overnight. So there was ahuge confusion. Everybody did a great job but still 100 people in the Minamisoma city were left within
the 20 kilometer radius. Then March 14, when I contacted Mayor Tachiya, he offered former Soma
women’s high school as an evacuation center for those people.
On March 15, on my own decision, 1,500 people were sent to Soma, Date, and Marumori areas that day.
Public buses owned by Minamisoma city, buses of Showa company and school buses of Iitate village
were used to evacuate these people. The problem was that a huge number of the residents had alsostared to evacuate by themselves at that time. Because of the traffic jam, it took more than 3 hours toevacuate to Fukushima city‐ usually, it’s just 1‐1/2 hours. What was more difficult back then was that
supplies didn’t come at all into our area because of the evacuation order. We were isolated. Mayor
Tachiya talked about the pharmaceutical products and drugs, but such problem was not limited to drugs.
As banks were closed, we could not withdraw cash. Even if you had cash, there was no place to shop.
Finally, a week later, a store
in Soma decided to open. So
Minamisoma residents had
to come to Soma to get
commodities. So the major
confusion in our area wascaused by the total
disruption of supply of ournecessities such as water,
medical supply and food,because of the nuclear
accident. We were asked
to get oxygen and heavy oil
for the municipal hospitaland butane gas for gas
companies. We were in suchan emergency. In the
middle of this panic, we noticed that there is no more mass media people. I tried to contact thejournalist club but nobody was there. This means that the situation within Minamisoma city was notreported at that time. They reported the situation of the northern part of Miyagi prefecture (theprefecture adjacent to Fukushima), but it was not until I had sent a message through YouTube on 24th
March that the global media came to our area to understand the situation in Minamisoma.
122Panel Discussion
We were able to contact the national government on 13th March for the first time. It was about the
supply of gasoline. Then Mr Shogo Tsugawa, a government vice minister, visited Minamisoma on 17th
March. On 18th March, Mr. Ryu Matsumoto, the minister in charge of disasters came, which was thefirst direct access of the national government to me.
On 14th March the number 3 reactor exploded and then even self‐defense forces suddenly disappeared.
There was a rumor that evacuation order was expanded to 100 kilometers’ radius, there was a major
confusion. I contact with the Fukushima prefectural government and claimed ‘The self‐defense forces areleaving. What’s happening? I wanted to contact the governor, but he couldn’t answer the phone. At thattime, they were busy trying to settle down the government officials. Someone say the situation was‘beyond our assumption’, but actually, I rather say something we had never imagined did occur. In thefield, we tried to deal with the situation; in the middle of this havoc, we had to search and rescue thevictims of the tsunami. In Minamisoma city, 9 fire fighters and 2 city government officials and a police
officer were killed. One reporter was also killed. What was happening in Minamisoma city was notreported on the media at all, but we had to save and rescue the affected people. That was the situationback then.

Kenji Shibuya
I really felt that must be quite a confusion back then. Now in Japan, there is a lot of turmoil going on at
the time. And question to professor Thomas.
How did the countries outside Japan look the situation of right after the disaster?

Gerry Thomas
Immediately after the disaster or the Great East Japan disaster, what
everybody saw was the huge tsunami wave. We knew there had
been an earthquake in Japan but earthquakes happen in Japan quite alot. But I think as soon as we saw the pictures on television, and thiswas the first time that something like this had really unfolded with us
all watching. There had been the earthquake and the tsunami inIndonesia before but now we were actually seeing it in Japan andeverybody was completely shaken by the fact that such a natural
disaster like that could happen.
But the sad thing was that as soon as the accident in the Fukushima
power station happened, information about the tsunami was in the middle pages or the back pages of
the newspaper and the only thing the media wanted to talk about was the accident at the power station,and people tended to forget that there had been a huge earthquake and a massive tsunami and thedeath toll from the tsunami was just impossible for us to imagine. Those of us who lived in westerncountries cannot imagine losing that number of people in a matter of minutes. It just isn’t somethingthat happens in our countries.
And it was quite annoying to be asked all the time about an accident that was killing nobody but was
making people very frightened. And I think the western media in particular have a lot of answer for this.
The headlines that were coming out used incredible emotive language. They were based on very bad
science. They weren’t actually interested in the early phases of the accident, and in talking to thescientists; they were quite happy to listen to other people who did not really base their comments onscience but could made good headlines. And I think part of the problems with people understanding
what was happening was that while the Japanese press were reporting properly measured information,
the international press was sensationalizing everything. So, many people who spoke both languages
were in touch with me on email, saying ‘Who do I believe?’ The worst thing you can do to a human is
to give them two sources of information that tell complete opposites. That is destined to cause fearand panic. So I think the international media have to look at the way they reported this.
Eventually, they did start talking to scientists and I think some scientists were quite reticent about
coming forward. None of us like to talk unless we have facts. And because you’d had a huge disaster,
it was almost impossible to get those facts out. We are used to being able to use email and fax and123

Panel Discussion
things like that. When you
have no electricity, you
can’t use anything. So it
was difficult to get facts
and I think that was the
problem with the natural
disaster that would causesuch situation more thananything else. But people
liked to speculate it was forother reasons, but I think
actually it was due to thefact that there was very
limited communication.
Scientists don’t like to speak
until they have the facts and that gives other people a chance to step into that vacuum and to talk to thepress and that’s why you see the headlines that you saw. I think after a while the press began to realizethat actually it wasn’t the story they thought it was several years later. I now have journalists saying tome, “We got it all wrong, didn’t we? Why did we report this so badly? What can we do to make itright?” Well, 5 years later, that’s a bit too late. They should have realized that earlier. But I think weare now starting to have sensible conversations with journalists about the aftereffects and we should befocusing more on the earthquake and the tsunami. That’s what caused the death toll here.
Yes, we can learn lessons from the nuclear power plant accident, but it was an accident. I think weturned it into a disaster. It wasn’t the nuclear power plant itself that was the disaster, it was our actions
that made the disaster. So I think there are big lessons to learn in the scientific community. We
should be prepared to talk to the media. Most of us are very scared of the media. We must be
prepared to talk to people. We must be prepared to listen to what the population is telling us. But I
think the one abiding thing that most of us will remember is the dignity of the Japanese people. It wasincredibly dignified, the response that we saw on the television, to such a huge disaster. I doubt there
are many other countries that would have had the resilience to cope in the way that Japan has done.

Kenji Shibuya
I gather from both you and mayor about why we are – while he was focusing on power plant accident,
people tend to forget about the actual disaster. That’s one of the messages. But also you mentioned thebad science and headline stuff. And you said international media tend to focus on that. But to me that all
surprise to the Japanese media, they tend to focus more on the headlines not stuff like baseline evidence.
So can you just give us some examples of bad science, which you experienced during the early phase ofthis Tohoku disaster?

Gerry Thomas
I can remember one occasion I was actually on live television on BBC World, and we had just had a story
about a Belgian minister who used the word ‘apocalypse’ to describe the nuclear power plant accident.
And I think that tells its own story. It’s the very, very emotive use of language. And unfortunately, we
tend to respond as humans to the language that is being used. So, there were many people who were
saying thousands of Japanese were going to die because of the radiation. That’s just not true. And
unfortunately, I have to say that 30 years after Chernobyl, we are still hearing bad science reported on
our television screens.

Kenji Shibuya
Why is that?

Gerry Thomas
Because there is lots of papers out there, and there are lots of charismatic people who are not scientists
124Panel Discussion
but who can talk to the media and talk to them well. And journalists like somebody who looks good on
television; and sadly, most scientists don’t look good on television. So I think we have to be prepared toengage in an awful lot more.

Kenji Shibuya
So we need somebody like you.

Gerry Thomas
Yes, in Japan, you definitely need people who are prepared to talk out.

Kenji Shibuya
Somebody like Dr. Tsubokura and these kinds of people.

Gerry Thomas
There is a problem however and I think we need to be honest about this. If you are a scientist on the
media, you will become a target. You become a target for the anti‐nuclear lobby. And I have heardsome incredibly rude and nasty things said about Japanese colleagues that I know personally, which musthave hurt them an awful lot. And I think if the media want to talk to scientists, they have to respect themtoo, and they also have to support people with an opposite opinion, often with a different set of values
to the ones that we would hold. They want to come out and try and say something different. The
personal attacks are very painful. Scientists are not used to that. That’s why we stay in our labs and work.
We are not good on talking to people. So when the attacks come personally, and within 2 minutes ofleaving my first TV interview, I had hate mail on my phone. And I was quite taken aback. I was expecting
it because I’m used to that sort of thing but it still shocked me how fast it was because of social media
etc. And because academics particularly are very visible, it’s easy to find my email‐ you just have to
Google me, and it will come up. So it’s very easy for people to get at you personally. We need to makesure that there is support for scientists when they speak out otherwise they will win the argument, notus.

Kenji Shibuya
Well, we listened from the administrator. So let’s switch gear. And this is a question to you, Ms. Hokotate.
You are representing parents at schools, what were the reactions at the time of disaster?

Chikako Hokotate
This is according to my own experience and so these things are very
subjective. My house was not affected by neither tsunami nor theearthquake. The roofs were partially damaged, but the house was still
standing, and none of my family members was injured. However, thenuclear power accident that occurred afterwards gave us the toll. We
didn’t know what we should do at that time. Because of the fear wewere very much in chaos.
With regard to radiation, that was something that we had no thoughts
at peacetime. I just knew it doesn’t smell and is not visible. But wehadn’t thought about how to manage it in peacetime. When the accidents occurred the firefighters cameto us and urged us to go inside the house. So we thought, “Okay, we have to go inside the house andconfine ourselves into the house.” However, we still didn’t know whether tap water was drinkable ornot. Or we didn’t know what about using the water for bath, whether that would damage us through theskin or not. We knew nothing. So our family decided to evacuate ourselves temporarily. We went out ofSoma and we took refuge in Nihonmatsu. But afterwards, we have learnt that the radiation level in
Nihonmatsu was higher than that in Soma. If we knew that, our action would have been different,
although the absolute radiation level at that time was not something to be feared.
The schools were to be resumed some months later, and we came back to Soma. We thought that
because schools were open, there would be no problem with the radiation. But when the schools
reopened we had to use Geiger counters or dosimetry to measure the dose levels in the ambient125Panel Discussion
environment. I took part in dosimetry
measurement, and there was areference level; below this level itis safe, something like that. But thatwas the first experience for us so we
didn’t know whether we could trustthat level or not. We didn’t know
either that whether the dosimetry isreally accurately measuring the levelor not. Negative things are easily
accepted by the people but even if theauthorities say, “It’s okay”, it is difficult
to accept it; we needed courage tojudge ‘it’s OK’.
My children were elementary students
at that time, not kindergarten or nursery school or babies, but those with younger families must have
had greater fear because they thought that they had the responsibility to protect their babies. So theseyounger parents had to make decisions on the spot whether they stay in Soma or they go out of Soma,
without any accurate information.
Now I trust these figures and now I trust what the authorities said, so I came back to Soma. This is partly
because my friends brought me to Dr. Tsubokura’s lectures on radiation soon after the disaster. And I had
the opportunity to listen to Dr. Tsubokura. That was a very fortunate thing for me. But I thought
because he is a renowned doctor, I suspected that he might be paid off by the national government, andhe might be only saying what the national government wants him to say before I came to know his
personality. One day, he was on the move to somewhere, running in a sweat. Yes, he easily sweats, but
anyhow, when I saw him sweating and running, I was somehow convinced that this person will never lie.
So from that point on, I trusted him 100%.

Kenji Shibuya
Yes Dr. Tsubokura’s lectures on mothers, what were the things that impressed you the most?

Chikako Hokotate
The doctor himself took the dosimetry and he himself inspected the produces. And because theseproduces are safe, he’s eating them himself. He also told us that if there is no radiation at all in theatmosphere, worms do not reproduce, so radiation is sometime harmful to ourselves, but there ought tobe a certain low level of radiation. So I learned that we do not need to eliminate radiation but be carefulthat radiation level is lower than reference level.

Kenji Shibuya
Mayor Tachiya, the mayor, it’s your turn. Immediately after the accident, there was a big chaos and theinformation was crisscrossing, and as a mayor, what did you think was the priority issue?

Hidekiyo Tachiya
Well, I may be a little bit the sidetracking from what we have beentalking. Dr. Tsubokura is a physician and he was much fatter. Now heis slimmer now. But we have to talk about acute phase, subacute phase,and chronic phase separately.
In the acute phase, radiation is only a part of many problems. When
we have disasters, there is no written scenario. This is particularly true
with the triple disasters, and the most severe damage was tsunami.
Fortunately Ms. Hokotate’s home was away from the coastline but as amayor I looked at the city and the most affected areas were thoseaffected by the tsunami. So the first priority is to rescue the survivors and to prevent secondary deaths126Panel Discussion
among the evacuees in the theshelters. So radiation was not
the priority immediately after theaccident or disaster.
Administrators need to get an
overview and prioritize policies.
What is the most urgent issue?
That is what we have to think
about. The basic rule of decision
making is probably to consider
whether that is fatal or not andwhether that leads to the death ornot. The other thing isoverviewing the current state ofthe disaster effects. But then,
the next problems would emerge.
For example, while we are thinking of preventing secondary deaths among people surviving tsunami inthe shelters, next wave of damage, a radiation issue from the nuclear power plant accident, arrived.
As professor Thomas and Ms. Hokotate mentioned, before, the major problem was a severe lack of
information. Soma city had no radiation countermeasure headquarter, and there was no expert onradiation protection. So we needed to consult with the Fukushima prefectural government, but noinformation came from them. Ms. Hokotate mentioned that the mothers were very anxious because oflack of information, and that was because as a mayor I was not able to have the answer to lay downthese anxieties. To overcome the problem, Soma city began dosimetry measuring.
two days after the nuclear power plant accident. At that time accuracy of the measurement and validityof the formula that we used for calculation might not have been guaranteed, but we needed to decide
whether to evacuate the hospital inpatients. Hospital evacuation itself has a risk, so we needed tochoose the measures with less risk. That was why we collected information in order to execute thatmeasure. That was a continuous process of thinking what was the priority issue and what was the thingthat we needed to do urgently. This process was required not only in managing radiation issues but also
managing other newly emerging problems such as PTSD. As a mayor of Soma city, first I tried to have agrip on the overall picture then consider the priorities and implement these priority measures on myown responsibility.
And information is the key to these decision makings, just as professor Thomas mentioned. I waswatching TV news and felt that what the commentators are talking was not at all helpful. The
commentators on TV predict the worst case scenario and mention what to do to prevent the case. The
commentators on TV predict the worst case scenario and mention what to do to prevent the case
Making any plans is never free from risks. However, there are also risks of not having any plans at all. So
while agonizing ourselves, we make temporary decisions and implement these priority measures.
During such days, we have to give top priority to avoid risks of radiation exposure among children. We
were not so much confident about our knowhow, knowledge, and technologies we had; to what extent
we can address these issues. Especially we were not very confident in the mid‐to‐longer term. As Ms.
Hokotate said, we didn’t know what to believe. But I could feel the concern of the citizens in my bones. If
I can say something with confidence, that would be better, but I was not confident at that time. Then we
received support. Dr. Tsubokura he worked very hard to provide radiation education to the residents.
Judgment to avoid risks as much as possible for a mid‐to‐long term was needed and I had struggled tomake the best judgment and we were able to overcome the super acute and acute phases. I am not surewhether our judgment was correct. It must be proved in the future generations. But as Soma city office,
we struggled to think, and asking you to stay in Soma city.
Regarding children, I think it is important to investigate and study carefully to send out a good message
based on the evidence to take action. That is going to be the best approach. From across Japan, we had
127Panel Discussion
physicians. Thanks to their support I think we have been able to do this in both Minamisoma and Soma
city.

Kenji Shibuya
Thank you very much. We have to give top priority to life to make a judgment under these circumstances,according to Mayor Tachiya.
Then from the super acute to chronic phase, you decided to give higher priority to children’s health.
Going back to topics of countermeasures against health for children, municipalities took health measures.
We had cases presented in each lecture. Based on the contents of the lectures, Dr. Suzuki, could you
share the current status of thyroid screening and also back then how was it started? It’s impossible toeliminate the risk to zero so you have to consider tradeoffs, but initially what was your idea to proceedwith the thyroid screening? Could you look back upon the past to share with us?

Shinichi Suzuki
Right after the disaster, Dr. Yamashita and Dr. Takamura came from
Nagasaki University, and Dr. Kamiya from Hiroshima University as
advisors of the Fukushima Risks Communication Council. They also gave
lectures to the residents in Soma and Minamisoma city. I was attending
the lecture as a disaster medicine coordinator of Fukushima prefectural
government. I was able to learn how to make risk communication orwhat the residents were thinking through this process.
Then thyroid cancer became to cross the lips of the residents. But rightafter the disaster, during such a panic, it was impossible to talk about
conducting investigation and screening. We just tried to be close topeople because of the concern. Then we gathered experts from across Japan to hear their views on how
to conduct screening. People wanted to have the screening as soon as possible, but we cannot do thisovernight. If we do this all at once, the quality would be down and there can be variance in the results.
You have to use the same standards. Just doing a token ultrasound screening is meaningless. We needa certain level of precision and we have to continue it for the future. We consulted with many experts
at that time.
At first, I and a few other experts and non‐experts in my university as well as experts from all over Japan
worked together to educate others so that more physicians would become able to conduct standardized
form of screening three years later. As Dr. Shimura presented this morning, many physicians are now
joining in the screening, and support structure has also improved.
This project got started on 9th October. We did a lot of simulation before starting. For example, when we
simulated how to provide the information, the staff members brought their children and conducted drills
together with the mothers. After simulation, we received lots of feedback. Even with this preparation, we
got a lot of claims when we exerted the screening on thousands of the residents. We decided tochange where possible to make progress little by little. We couldn’t look back upon the past until now
but thanks to support from all across Japan and also from people in Fukushima prefecture we have cometo the third round of the screening.
The problem was that the frequency of A2, most of which were benign cysts, was higher than expected,
and it was a big topic in the world. Some experts suggested that even when we explained this is benign,some people would be worried and take the ultrasonography repeatedly. Then if cysts that they didn’t
have before were detected, they would become more worried. This concern was tern out to be correct.
Although we started based on various scenarios, not all the people fully satisfied with the screening. So
we struggled a lot, but we shouldn’t stop, because it was not us who decided to conduct the screening.
We started in response to the opinions from many people and with approval for many people.
Now a lot of data has been accumulated. Looking back at the beginning, we could not expect this result
when we had started. From across Japan, we invited experts. All of them are specialists. They had many128

Panel Discussion
patients because they are specialists. They had to leave their patients behind to come to Fukushima.
That means that there are colleagues across Japan at hospitals to support those specialists and theydecided to come to Fukushima to continue these efforts. Every day it was difficult to secure enoughhuman resources. Sometimes we have to go and leave our work to help the staff. Finally, it’s becoming
more stable.

Kenji Shibuya
Dr. Thomas, based on the experience in Chernobyl regarding thyroid cancer, regarding the recent thyroid
ultrasound screening was started, you talked about it. How do you perceive the screening in Fukushima
right now?

Gerry Thomas
I think the thyroid screening is going to give you an awful lot of data but you have to interpret that data
for the media and for the public. And I think one of the early problems that we had is that people havetaken the figures from an ultrasound and compared it with figures from operative cancer, and the two ofthem are not comparable at all. And as I showed in my talk, when you screen, it changes the curve, it
moves the curve to the left, and I think explaining that to the public and to the media has been very
challenging.
When you talk about human health, nothing is ever simple and so it becomes very difficult to explain topeople. But I think, you know, you have experts. You have the world experts in thyroid in Japan. You
have the world experts in using ultrasound to screen patients. Very often they will give the presentationsat international meetings because they know more about it than the rest of us. So, I think you can bevery confident in the people that you have doing the screening. I think the difficulty becomes in theinterpretation of the data. And you could say maybe you should have done mass screening elsewhere in
Japan to make it easier to explain that actually what you are seeing is a result of screening, not as a resultof radiation. But I spoke to a young mother once in Iitate, who said I do not want another mother to go
through what I went through. It was so stressful as a parent seeing that. And I think she had a very
good point. As scientists, we may see the world in one way but you need to speak to the people who are
actually going through the procedures to understand whether you have it right. And I think a lot of
discussion is now going on with the people who are in the screening program as to how they want tohave the results presented, how they want it discussed with them. And I think the world will learn anawful lot from this and we should be learning an awful lot.

Kenji Shibuya
You are exactly right that we didn’t have the exact choice to how to proceed, and we have really a broad
way but we have some mission to fulfill that kind of effort like a thyroid examination problem.
Now Claire‐san, fromstandpoint of healthmanagement, maybe you
can actually share your view
because you came fromoutside this region. I am
sure that we expect thatyou have fresh perspectives,
and that you engage in thatkind of health managementfrom the standpoint of
women as well.

129Panel Discussion

Claire Leppold
Lot of us have already discussed the importance of information
availability, especially right after the disaster. And one thing that I’ve
really learned since I came here is the importance of sharing science
with the public and sharing results of studies with the public andmaking science accessible for everyone, particularly in the case of
Fukushima with the result of the whole body counter screenings or
the baby scans. Really, people need to know the results of these andthe importance of the results and then the importance of theircontinued participation. So I think, thinking of important areas ofhealth from here on out, in Fukushima I would say there’s a really big
importance on continued work to track the health of affected
populations but to also make these results available for everyone. That’s my general impression.

Kenji Shibuya
As Dr. Thomas mentioned, the scientist should be at the forefront of the communication to the generalpublic and it has to be very effective. Now, what about the situation of the children in Soma?

Hidekiyo Tachiya
About 3 months after the disaster, the members of parliament from the Niigata prefecture visited us andshe insisted that all the children in Fukushima should be evacuated. She said it is the safest way tosafeguard the health of the children. But the children’s health has to be evaluated in a holistic way. If
the children are separated from their parents, or leave their own hometown, this doesn’t actually serve
right, like a psychological stress can easily be anticipated. The issue of radiation exposure, as Dr.
Tsubokura mentioned, is considered with regard to the total amount of exposure and incremental
probability of health problems.
As I have just mentioned, in disaster management, you have to compare risk and choose the option withsmaller risks. So, the decision of Ms. Hokotate was not wrong. You can evacuate and if you think Soma
is safe, then you can come back.
At that time, no one, including
administrators, was confident in
the decision they made. We hadsome information and data
available to make the finejudgment that the dose level was
not as serious to evacuate all thechildren from this district.
However, we cannot measurepeople’s anxiety. Therefore, if
someone were worried, we don’t
deny their decisions to evacuate,
because the situation was so
uncertain.
But the city government must make the accurate measurement of the dosage and share the results withthe community. We measured the external and internal exposure levels of the residents and air dose rate.
Meticulous efforts was needed to see whether the trend was aggravated or improved. We have beenmeasuring air dose rate since right after the disaster. When the dose aggravated, our decision would
have been different. But luckily the dose was going down as time went by. So we made a decision to stay.
From this experience, we learned that we should have scientific measurement and research so that wecan be afraid properly and reduce risks wisely. In the areas with little bit high air dose rate, there is atendency that the rate by windows is higher than by corridors. If that is the case, then the children’s
bedroom should be closer to corridor to reduce the amount of radiation exposure.
130Panel Discussion
Of course, people would say that if there is some amount of radiation, it is better to evacuate children
with all means. But considering that the exposure level is minimum, and that there is also the risk ofchildren to be separated from the family or from the home, we may make the wise decision and option.
We actually have made a decision based on that evidence. For example, we offered the option to thefamilies living in the areas with higher air dose rates to evacuate to the area within the city withrelatively low air dose rate.

Kenji Shibuya
Soma city was really proactive and participatory, and deal with that situation by conducting internal andexternal radiation exposure measurement. They also openly shared the results with public since the very
early stage after the disaster. So Ms. Hokotate, can you tell us what made up your mind that you andyour family came back to Soma city.

Chikako Hokotate
Well, not only the information from the municipal, but also the measurement conducted by the school
gave us assurance. The measurement was done at every school and on every corner on the street to theschool. The results of the measurement was disclosed and that really gave us the peace of mind and we
felt secured and that all information is shared with citizens. We were very thankful for the city
government, which made a great effort to create environment in such a way so that children can live
safely.
As for the food selection, there was a concern of food contamination. So soon after the disaster, I asked
my relative living away from this city to send us rice. I cooked the rice for my children, and the adults
ate the local rice. So we had two rice cookers. And at school lunch, the old ingredients were disclosed sothat some measurement data was actually shared with us and all those efforts by the city government
made us more secure of the situation, keep track of the situation.

Kenji Shibuya
Now, outside Japan, what was the situation? How the disaster in Fukushima was announced and also
reported? Question to first of all Mr. Johnston. How the Fukushima incident was communicated?

Peter Johnston
I think the first thing to say is that we were only interested in theradiation, particularly the nuclear safety side of the accident. We were
aware of course of the terrible tsunami and of the terrific loss of life.
But the normal orthodoxy was that if there was going to be a nuclear
accident, it would happen in a single nuclear power plant. It would
involve a release of radioactivity over a short period of time, and thenthere would be countermeasures put in place and it would becontrolled.
And that’s not what happened of course. We had a power plant
which was damaged by water where multiple units had failures. There was very little information
provided to the international community and so people really had little idea of the status of the plants.
Most of the people who knew what was going on worked for governments and so weren’t allowed totalk to the press. And so, people were thinking very bad things, and as a result of that, for example, theUnited States imposed a 50 mile exclusion zone for Fukushima Daiichi nuclear power plant. And theinstant that happened, the Australian government did exactly the same thing. And so there was really a
lot of concern. A lot of Australians lived in Japan and a lot of Australian companies had major offices inTokyo. And the questions were, should those people leave? Some of the foreign embassies in Tokyo
left, and so a lot of confusion.
The current situation from an IAEA perspective is we remain very concerned about the fact that there issomething like 100,000 people who are still displaced from their homes, that’s a very bad situation.
131

Panel Discussion
We don’t think about the situation in Soma city. We think about the situation in Fukushima prefecture.
We think on a much bigger scale I guess. And also, we are really aware that there is a very long way to go
to decontaminate areas so that all of the communities can be restored. And there are enormous
problems with respect to waste and soil collection and water. Water is obviously going to be a really big
issue in terms of the release of water that is being purified at the plant. And then there is the long‐term
decontamination. So, from the international perspective, we see significant progress but we also see anawfully long road ahead with many technical problems.

Kenji Shibuya
Dr. Nozaki, what is the world view on the situation in Fukushima?

Shinjiro Nozaki
Well, probably from the viewpoint of WHO I’d like to speak. I was in
Geneva at the time of accident. In the Fukushima Daiichi nuclear
power plant, the roof blew off with the explosion. That image spreadthrough the world. Rather than the word ‘the Great East Japan
Earthquake’, people all over the world said ‘Fukushima’, ‘Fukushima’,and they focused only on the nuclear power plant. In the case of
Sumatra earthquake in Indonesia, there was the earthquake andtsunami and all the people throughout the world came to rescue andthe WHO was also there to do the investigation.
But WHO does not have such office for advanced countries, such as
Japan office. And if it were earthquake and tsunami only, the role of WHO would be just to gather
information of damage and recovery. However, unfortunately, there was the nuclear power plant, andafter that all attention was paid on Fukushima. Since immediately after the disaster till 4 years later,
there were people with signage saying ‘Fukushima’ in front of WHO in Geneva office everyday. So every
day during the commute I saw the signage of Fukushima, so I thought that WHO will have to investigate
the situation in Fukushima.
Initially people thought that it is the same as Chernobyl, but there were many WHO reports and thanks
to that, the current understanding of the world about Fukushima is that the radiation level is low enoughnot to cause the health effect. So that is no more panic in the world.

Kenji Shibuya
Mr. Johnston mentioned about the 50 mile evacuation zone which was advised by the US government.
On which basis did they decide to set the 50 miles evacuation zone? We now understand the exposure,radiation level is very low, but we didn’t know that at that time.

Peter Johnston
That’s right, and it wasn’t based on the radiation dose level. It was based on the fact that the US NIC had
formed the view that one of the spent fuel ponds had cracked, and that there was a possibility that all of
the spent fuel in that pond would deflagration and burn. And we did modeling in Australia all the timeabout what was happening at Fukushima. And if that eventuality had happened, the plutonium
annihilation plume would have gone at least 100 kilometers, at a level which would have been dangerous.
So that was the Americans really adopting a worse case approach and putting the dose limit andAustralia followed because it could. There were only a few hundred people within that radius who wereAustralians, but of course for Japan it was impossible.

Kenji Shibuya
Professor Thomas, what about UK perspective, what about the UK views on Fukushima now?

Gerry Thomas…very different perspective on the accident which is why the British embassy didn’t evacuate from Tokyo.
We are lucky in the UK in that we have scientists, working scientists in each of our government132

Panel Discussion
departments. So, the first thing that happens when there is bad news somewhere, whether it’s a new
disease or whatever, is that the prime minister will call a meeting of the working party, which is really toadvise governments on what its action should be. And the advice of our chief scientist, and he’d spent
most of the night on the phone to experts about reactor safety. And in the UK, because we were early
adopters of nuclear technology, we have quite a lot of good experts. So he spent most of his time talking
to people about nuclear reactor safety and he was able to put a worst case scenario from the British
perspective, which was very different from the American perspective.
And said, what do we need to do to make British people safe, because that’s always the concern of aforeign government is their own people. And the decision was taken that Sir John Beddington who was
the chief scientist at the time would video link in to Tokyo, that that could be provided as a video link toanybody who wanted to listen to it, whether they were British or not. And the advice was stay where
you are, do not try to get on a flight home. You will have more of radiation dose on the flights.

Kenji Shibuya
So it was quite opposite to theother countries.

Gerry Thomas
Absolutely, yeah, very opposite,
and I don’t know why the
scenarios that played out were so
different. But there is a very
interesting video that I saw when I
was in Tokyo on the fifth
anniversary, that when the British
embassy team went to Sendai tolook for British people that we
knew were in this area, and there
were quite a lot of British people
in this area, they filmed what happened, and it is now used as a training video for disaster management.
And it was quite incredible to see it actually unfolding in real time and you can understand why people
were so worried.
But now, we know what the doses are. We have lots of very august reports that have told us what thedoses are. And I think most people in the UK now understand that those doses are very low, that there
will be no visible health effects from it. There are still some people who are nervous but I think we havebeen allowed a lot of media access after Fukushima to try and explain what is happening. And it’sinteresting now, when you see the anniversary, it’s not a story about the nuclear accident any longer. It’sa story about the earthquake and the tsunami and that’s really what we should be talking about, not thenuclear disaster as people like to call it. It’s an accident and it’s interesting how that has changed overtime. Frist year, first 2 years, it was all focused on the nuclear, now it’s focused on the tsunami and how
well Japan is recovering from that.

Kenji Shibuya
Thank you very much. As Dr. Thomas said, the dose was relatively low, but we were able to tell only after
measuring. Initially we didn’t really know. Thyroid screening and as Dr. Hayano showed the data, the air
dose rate was not so high. So with regard to communication with the general public what was the issue
and what should have been done better? Dr Suzuki, what could have been done better based on yourexperience in the field?

Shinichi Suzuki
That’s a difficult question. First of all, regarding radiation level, external and internal radiation exposurelevels were measured several months after the disaster. 131 iodine has very short half‐life time, someasurement of external exposure to 131iodine for each of the affected residents was impossible. But it
is Iodine 131 that affect the thyroid the most. We have several research with small sample size and we
133Panel Discussion
had some estimated data, but the variance was too big to apply the result to each individual. So that waspart of the difficulty.
Communication changes by time, and timing is very critical. We need to ‘read’ the atmosphere around us,which changes over time, and make an appropriate explanation and address this situation properly. Our
explanation may not have been sufficient, but we tried to be more meticulous in explaining.

Kenji Shibuya
I see. Dr. Thomas, sorry to ask you many times, but in crisis communication, in UK scientists find it
difficult to communicate about thyroid screening. Despite the low dose, crisis communication was alsodifficult in Japan. You came to Japan many times. You also have experience in UK about the study in
Chernobyl. So, what should we have done better in the crisis communication?

Gerry Thomas
As professor Suzuki has mentioned, it is very difficult to tell you what you should have done, but I will
share one thing with you. The year before Fukushima happened, there was an International Thyroid
Congress in Paris. I was there as were most of the thyroid community around the world, and we heardthat because the following year was the 25th anniversary of Chernobyl. We heard from the Japanese andwe heard from the French what they would do in the event of a nuclear accident. So I knew what theJapanese plans would be, which gave me great confidence to be – and I knew the people who would be
involved, so it gave be great confidence to be able to speak out on the media. And I think it’s a shamethat that plan had not been shared with the Japanese people beforehand.
So I didn’t understand at the time but I think I understand now, it’s difficult for us from a different culture
to know what is going on in another country. And I think the thing that was missing in Japan was theelements of risk communication. When we do anything in business, in academia, we have to draw plansthat assess all the risks and have what we call business continuity plans now. People don’t like using risk
assessment any longer. It’s business continuity is the term we use. And so that means for absolutely
anything that we do, we have to assess the risks and be able to say what we will do to reduce those risks,
and I don’t think that culture existed in Japan before 2011.

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Kenji Shibuya
You mean the contingency plans?

Gerry ThomasNo, risk assessment and then how you are going to alter that risk and how you are going to communicatethat risk. So that’s all part of what we do in everyday life virtually. So I think that’s partly it. I was shocked
when I heard from Japanese nuclear industry that they had told everybody that nuclear power wascompletely safe. There is nothing in life that is completely safe and we may as well accept that – goinghome on the plane in a couple of days, going home on the train is not completely safe. So I think that
was a myth that didn’t help. I think if the plans had be known, I think people would have been a little
more relaxed. They would still have been worried. And I think one of the things that we have tounderstand is a nuclear power plant is not a nuclear bomb, and the two things have been confused in
our minds. And we have to understand that the doses that we get from a nuclear power plant accident
are very, very small and it’s the individual dose that matters to the risk for health.
I am a pharmacologist originally so I understand dose response curves but that’s not something thateverybody else understands. But we have to get the concept over that a small dose equals a small risk
and a small effect. A big dose equals a big effect and a large risk. And I think we have a problem and it’s
not just Japan. It’s everywhere. We all share the same misconception that from a nuclear power plant
the individual dose is very large. That is not true.

Kenji Shibuya
We talked about the situation since the disaster till now, so those who have moved to Soma area, Ms.
Kana Yamamoto and Ms Claire living in Minamisoma city, what made you decided to live in the city, what
was your concern and what has changed on your mind after actually living in Minamisoma? First
Yamamoto‐san?

Kana Yamamoto
I began to live in Minamisoma city, 1 year and 1 month has passed. I
am in the second year as an intern at Minamisoma Municipal General
Hospital. When I was a university student, I had a chance to listen to Dr.
Tsubokura’s speech on radiation. So I was not worried when I camehere. But on my way here, my mom asked me ‘You are not willing to
get married? Are you okay?’ My university professor also asked me‘Do you know how near Minamisoma city is from the nuclear power
plant?’ And my friend also told me ‘It’s close to the nuclear power
plant. I wish you good luck.’
But personally I was not concerned. My concern is whether I can dowell in my first year of my career, whether I would be accepted by the hospital staff. And because of myignorance, I thought Tohoku is a snowy region, so I wonder whether I can endure winter.
It’s a kind of promotion, may I? On April 19th, I published a book about anemia from Kobunsha
publishing company. Right after the national exam I began to write this book. Dr. Kami gave us advice sothat I can write this book. There were deadlines. I was managed to send the draft by the deadline. And
there is a Facebook post by the doctor. I say sorry, the deadline is approaching. I wondered whether I
would be able to complete. So there is no regret after coming here at all.

Kenji Shibuya
Any difficulty?

What about your parents?

Kana Yamamoto
No further misunderstandings. Initially they were worried. Are you living okay? Do you have people
around you? They didn’t really understand, so I continued to send delicious sweets from this region formonths. And I sent photos with my colleagues at the hospital and photos taken by Dr. Oikawa, and thenmy parents came here so they understood my situation.
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Kenji Shibuya
Claire‐san may have a different perspective, coming from Edinburgh, what was the reaction of yourparents and friends there?

Claire Leppold
Many of my friends were really surprised when I came to Fukushima. I came here because I met Dr.
Tsubokura, so fortunately I was able to learn a lot from him before I came. And of course I readeverything that had already been written about this place and so I felt pretty well informed and I didn’t
have particular worries myself. But of course my parents were shocked, and my response to their shock
was to actually send them all of the papers I had found. And my mom is a nurse, so she has somemedical knowledge and she can read scientific papers and understand them. My dad was particularly
worried because he’s actually very anti‐nuclear and he’s the type of person who thinks everyone should
put a solar panel on their house and not use any other type of power. So he was really worried and it
took him a long time to kind of accept that I decided to come here.
But recently, he finally got used to the idea of me being here, and he read as much as possible himself as
well and it made himself informed of the reality.
My friends first lost their words – one of my friends joked that my future children would be born withbirth defects, and I saw the problems of stigma.

Kenji Shibuya
Now the next part of the panel discussion will focus on social impact of disaster and challenge and into
the future.
So I would like to ask once again the passionate, the Mayor of Minamisoma, Mr. Sakurai. After 5 years,
what social impacts remains? What is the current situation? What will be the future hld, your comment
is very much welcome.

Katsunobu Sakurai
As I said yesterday, 20 km or 30 km divisions were made within my city. All those zones were designatedby the national government. This also draw lines in the hearts and minds of our citizens, which caused
psychological impacts. For example, monetary compensation was not given to those who were living
more than 30 kilometers away from the nuclear power plant. Medical fee and fee for nursery is also
free for the people living within 30km zone. So to speak, these residents were not treated as citizens of
Minamisoma. the treatment is totally different from one zone to the other. Within 30 km distance,long‐term care, insurance fee were all free. There is a totally different treatment, no grants, no subsidies
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outside the 30km zone. This sense of discrimination prevented us from talking this issue openly. There isa division, division of relatives, division between parents and the children.
With regard to radiation, we started monitoring since July 2011, following instructions of experts.
Parents of small children in Minamisoma now understand that the health impact by radiation is small.
However, there still are psychological barriers, especially among those who are still evacuating. At
maximum 60,000 people evacuated from the city, though residents living in the mandatory evacuation
was only 14,000. These 14,000 people are not allowed to return to their homes yet.
In addition, 636 people lost their lives by the tsunami. Part of these victims’ houses exist in the 20 km or
30 km zones. This complexity is hardly understood by people outside. Among those who lost theirfamilies and houses, compensation is quite different whether or not they live within 20km zone or not.
Those within 20km zone get 100% compensation of the nuclear power plant accident, even when theirhouses were not damaged. But those families who lost everything by the tsunami were compensatedonly for the land. This situation is causing sense of inequality among the residents.
In such a situation, residents’ needs vary depending on age. For example, elderly people living in
temporary housings want to return to their home and end their lives at their own home. But parents
who want to avoid health risks of their children are more likely to decided to leave; 9500 people totallyleft from Minamisoma, which is 1.5 times larger than that of Iitate. Minamisoma actually evacuated,
9500 people left the city and 11,000 people are living outside of Minamisoma. In addition to this, 7,000
evacuees from 20 km zone are evacuating within Minamisoma. In total 27,000 evacuees‐ this is theworst number among the affected cities.
Particularly, 13,000 people of productive age are lost from Minamisoma.Therefore, how to compensate
the loss of human resources is a key to the recovery of Minamisoma. We need to invite people fromoutside. Sharing scientific data to actually assure people outside that living in Minamisoma is safe, andletting people like Yamamoto‐san and Claire‐san spread the message all over the world, is important.
This is why I need support from your cooperation, specialists, and then the industries, we have so manyindustries there in Minamisoma. Why don’t you come over and join us.
In order to fulfill our objectives, we decided to team up with the national government and theprefectural government and make test fields for innovative science. We are also planning to build
international research institute in Minamisoma. In agriculture, plants factories will be open. Before thedisaster, we focused on farming of the crops but now that we have new kinds of crops that we are
growing, that’s the rapeseed flowers to make the rapeseed oil and soap out of that. We have to create a
new job, new industry. So such series of new challenges and new innovation is needed for us to realize
our dream to recover and reconstruct Minamisoma.

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In Edo era, the Soma clan experienced a severer famine and so many population was lost. Then the
migration policy was taken and they invited migrants from outside. So that’s just like Yamamoto‐san and
Claire‐san, the great resources coming from outside really contribute to the great future of Minamisoma.
Also, in that city we have to provide better education to nurture and foster the future human resources.
That means that the population, 71,000, has actually shrunk to 57,000. But this number is not so bad.
There are some new entrants. I think this is partly because the city functionality was maintained andthanks to the Tohoku Electric Power, there was no blackout. That resulted in the resumption of thewater services or the recovery of the social infrastructure.
All those recovery, and reconstruction work was done by city staff members, but city staff members ,who
were often the target of criticism by citizens, have to actually retire due to stress. But it is due to theefforts of those public servants that we are able to really retain their population. They were the great
driver to keep us going with grand plan for the future.

Kenji Shibuya
Thank you very much indeed. The health effect is one and also that social discrimination, and that the
future, city development and perhaps introducing people from outside the city to Minamisoma.
Now I would like to ask a question to the people living outside this region. Question to Dr. Thomas.
Now that’s the 5 years after the disaster but we have to continue the effort for the total recovery of thisregion. From the world, what is the difference in the viewpoint between people inside and outside?

Gerry Thomas
First of all, I think you are really lucky to live in Japan, a beautiful country. I think you have fantastic
resources with the investment that is going in. There are still people who query whether it is safe to eat
Fukushima food and when they ask me, I say, “Not only is it safe to eat the food but you should come to
Fukushima to eat it. Food is always best where it’s grown so why don’t you come and visit the place foryourself.” There will be nervousness on behalf of some people and some people you will never persuade
to come back. But I think you need to carry on doing what you are doing. You need to really sell thisarea. You are putting in new infrastructure, new jobs. Why would you not want to bring your family
here? It’s much better than Tokyo or Sendai? To live in the country is what most people would want. So
why do people not want to come here? And I think you have to keep reinforcing that and I think
eventually you will find the population comes back. I certainly can’t think of a much better place to be.
It’s beautiful here.

Kenji Shibuya
Would you like to stay?

Gerry Thomas
I would like to stay and, even better, I might get my son to come here. Hopefully, if he gets the grades, heis going to do German and Japanese. I brought him to Japan when he was a young boy. He loves Japan.
I have to have a separate bag when I go home to take food for him because he loves Japanese food, andhe’s so in love with the country, he wants to come and live here.

Kenji Shibuya
What about Mr. Johnston?

Peter Johnston
I think I am seeing lots of good investment, and lots of good facilities here in Soma city. I can see,however, that for the areas where there has been evacuation, the redevelopment of those areas is going
to be quite different because I think the returning population is going to be small and I am sure theministry of environment is actually thinking about these issues going forward.
A horrible reality of a disaster is that things are never the same after the disaster. You build a newsituation. You build a new community, but it’s not the same as the old community. It’s changed.
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Kenji Shibuya
Okay. Just as Sakurai‐san mentioned, there are two immigrants, or two young aspiring persons haveimmigrated to this city, and so these younger people coming back and they work and they have families,
they raise children, and these two could be the role models, Yamamoto‐san and Claire‐san. So you areyounger people with lot of things in the future. What are the good things that the city will have to say tothe outside world in order to convince the people coming back or outside people immigrating in thisregion? First, shall we start with Claire and then Yamamoto‐san.

Claire Leppold
What’s important for people going anywhere or for people to live in any place is to have good jobs, goodplaces to live and accurate safety information or information about risks in a place. So I think for
Minamisoma, if we are going to increase the number of young people, we really need to create a goodenvironment; but also, like I said earlier, the spread of accurate risk information. And I think those are
truly the most important things and all of those things are what helped to bring me here as well. And I
think it’s going to be true for young people from other places in Japan to come here, or for people
originally from here to come back are those three points.

Kana Yamamoto
I am still a fresh person in second year, so I do not have strong opinion like other panelists. What I haveto do is to fulfill my mission in the hospital. I want to become the Ob‐Gyn and I worked as a resident in
Minamisoma Hospital. There is only one Ob‐Gyn doctor and he is really busy. And some patients asked
me until when I will work in the hospital. I was very much wanted, that’s what I felt. Also I had theovernight duty under supports not only by the doctor but nurses and the patients themselves, and that’s
what I feel every day. It was quite a good luck that I was able to come here and also I got acquaintanceswith the city hall people and the civil servants in the Soma city.
So that was good luck that I had and that sort of destiny I should meet you in this wonderful place and I
feel very lucky myself about that.

Kenji Shibuya
Ms. Hokotate, as a mother, I believe that one of the main topics is to send out the message to the world.
So you live in Soma region and you are a mother. What is your message to the world? If not to the world,
to other people. So what about your personal view? Your message to the world.

Chikako Hokotate
First of all, ever since the disaster, we have received a great deal of assistance from throughout thecountry and throughout the world. And as an ordinary citizen, I didn’t speak up much, I would like to takethis opportunity to thank them all.
During this 2‐day symposium I was able to listen to what the people with different background thought
and acted. My children are participating in El Sistema, and SEISA group also invited my children to theplace where they can play outside with no concern.
I personally feel that Soma is safe enough for me to raise children, but to prove this, I have to remain
healthy and lead a happy life. I believe that that would be the best return that I could give back to those
who have helped us.
And of course, still many people are working to stabilize the Fukushima Daiichi nuclear power plant.
But of course, there is a long way to resolve the situation completely. So what we can do is we will keep
receiving the test screening using the whole body counter and the glass badges to monitor our radiation
exposure levels.
If people say it’s safe after an accident happens, we may not be able to accept these words. As there are
nuclear power plants throughout the country, throughout the world, all the people will have to educate
themselves before accidents happen and these sorts of learning processes can be part of everyday life.
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I heard companies are still building new nuclear power plants, so I want them to develop more robust
disaster plans in case an accident happens. As long as there are nuclear power plants, there is apossibility of accidents anywhere at any time. So we will have to prepare before accidents happen.

Kenji Shibuya
Before we close, we would like to have a message from each panelist. First, Dr. Thomas.

Gerry Thomas
I think I’d like to see this place to return to how it was. I came here in September 2011, and (in today’s
short sightseeing tour) I didn’t recognize where I had been until we suddenly realized that we’d been to
the same place and it looks totally different. We remember the (abandoned) bus. We remember theship, but now it looks a lovely seaside town. So I hope in the future that with all of the efforts you are
putting in, that you will invite people back, that they will come back and that you will have a thriving
young population here. I could see no reason why that should not happen, and it should be happening
now already. There will be jobs in this area. There will be jobs associated with the power station
because it has to be decommissioned. Those will be good jobs, highly paid jobs, skilled jobs and there
should be no reason why you shouldn’t be able to bring an awful lot more people back to live in thislovely area.

Peter Johnston
Thank you. I just wanted to reassure everyone here that in fact many lessons have been learned in the
nuclear safety area from what actually happened at the power plant, and the safety standards have beenreviewed and updated. And with this accident we have learned things and we will put the lessons into
practice.

Shinjiro Nozaki
Keyword is that Soma is the only area in the world with unprecedented disaster and we have a mid‐ tolong‐term initiative. We need to continue for the future as well. To the world, this experience must
be shared. You have to send a message. You are working on this aggressively. This is great. WHO
Kobe center would like to cooperate with you as we proceed for the future. So, we appreciate yourcontinuous collaboration.

Shinichi Suzuki
We have to continue screening as was mentioned this morning. I heard that Soma Central Hospital will
start screening from next week. This means you can get screening from the nearby doctors who you
know well. So we can do this more locally. That is going to happen from now on. Next issue is aboutcollecting data. We have to gather data to report so that you can evaluate. We would like to continue
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these efforts. All the more, we shouldn’t allow the quality to go down. We have to continue in the same
way so that we can do the same assessment.

Claire Leppold
First, I hope that this place can continue recovering and that young people will come back here and that
we can continue learning lessons and sharing lessons from the situation and to not forget what has
happened, but what also can be recovered and what can be done from here on.

Kana Yamamoto
I came from outside. I would like to communicate the real situation of Minamisoma area with the rest ofJapan.

Chikako Hokotate
I thought I didn’t have to talk anymore. I thought that was my last turn. Some people may still have someworry to live a healthy life. So I’d like to send a message to them. And also, we received a lot of support
but still I’d like to ask for continued further support.

Katsunobu Sakurai
Within 20 kilometer radius, animals and plants were sacrificed. Cows were sacrificed and they wereforced into famine. Plants were in ruins. Can we live in a society where we just value the human life? As
Mayor Tachiya said, we have to value the life. But human beings are supported by all other living
creatures, and we should not have a society that thinks about only human beings. Like the lesson fromthe nuclear accident, we must educate all people how human beings should live. At the same time, wehave to make efforts to give a future to young people, who should have future. For elderly people, time
is running out. So how to ensure sense of safety for them is important. So we have to make every effort
to achieve these goals. We have to work with people around the world and also people across Japan tosend out the message that here is a great region. This is what I’d like to do.

Hidekiyo Tachiya
This symposium has the capability to disperse so much information and data message, and that will beproceedings later so that we really invite you to actually go and see the result of this symposium. Many
people died and lost their lives because of starvation. Elderly people who were bedridden and thoseabandoned people died because they were not able to get food. That is why we have to make decisionon which risk should we choose. That’s the ultimate question. During these 2 days, we have had so141

Panel Discussion
many discussions, and as wecame to the conclusion thatradiation should be faredwith properly and be avoided
in a reasonable way. I’d like torepeat this message.
Yesterday, at the onset of thesymposium, I touched upon
the story of the relief surprise
to Kumamoto. We sent
gypsum panels but they
didn’t know the panels is touse as the partition to secure
privacy at evacuation centers.
On 5th of May, I convinced amayor in Kumamoto
prefecture to convince themthat the gypsum panels
should be used and used wisely. All efforts we have paid in the past 5 years were not effectively
communicated and shared in the disaster management, the disaster preparedness. That is really
unfortunate.
So, I think the result and the outcomes of this symposium and also the lessons learned have to beevaluated by whole the society. I am so grateful for Ms. Hokotate for her contribution to the symposium.
She emphasized the importance of the radiation education and also disaster education training.
We are grateful to take many presentations and recommendations from the floor during these two days.
We’d like to send these messages from Soma area to the rest of the world.

Kenji Shibuya
Thank you very much. Very rightly and a very powerful concluding comment by the Mayors.
Ladies in gentlemen, please join me for the appreciation of the contribution given by the panelists.

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Closing remarks

Masaharu Tsubokura Secretary general
Now that this international
symposium on disastermanagement and recovery
for children and communities
2016 has now successfully
been concluded, I thank youvery much indeed for yourattendance to the 2‐day
symposium, to squeeze timeout of your busy schedules.
It is a truly international
conference with English andJapanese and interpretation,translation. It was a
dizzying experience for me
but I hope that this
symposium has served the
purpose to provide you the information and message.
The moderators, panelists, and speakers, keynote speakers, I’d like to sincerely express my heartfelt
gratitude. We have the session 1, 2, 3, and presentations from four mayors of the municipalities, panel
discussions, and keynote speeches. Personally, I had two learnings out of this symposium: one is that
there are so many issues remaining but 5 years have passed since the disasters and slowly but steadily
we are moving a step forward. Of course, it is unlikely that the radiation will be reduced to zero, but
the dosage is coming down and the industries have revived and the people are doing their utmost effort
to really continue their lives.
Second point is that people cannot live alone. They can live with the support of others, neighbors, andfriends to move ahead, inspection, monitoring, screening and all the industries and every one person
cannot live alone. He has to be supported and he has to support other people around him.
Now this symposium was made possible with the cooperation of so many people. Two beautiful
moderators, students working as volunteers. Transportation was actually provided by Seisa‐group. And
you actually enjoyed the lunch curry. The cooks were working very hard early in the morning to prepare
the tasty seafood curry for you.
And then there are interpreters. Interpreting work is quite consuming work because the interpreters
have to keep up the pace of translating from my very quick Japanese into English. And also the city staff
member and also the staff members from the municipality, governments and those guides and escorts,
all those people really contributed their power and their enthusiasm to make this symposium a truly
successful one. I sincerely hope this information and data, a message will be a foundation for us to reallymake the great future.
Thank you very much indeed.

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Closing remarks

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Photograph digest

Executive committee

Press release

Venue -Soma Civic Center-

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Photograph digest
Symposium (May 7)

146

Photograph digest
Symposium (May 8)

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Photograph digest
Excursion to the disaster/recovery area

Reception Party

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Lunch time lecture149

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Display panel- Lunch time lecture -Toho Bank Ltd.

IHI Co.

Soma Kyodo Power Company Ltd.

FRESCO Kikuchi Co.

El Sistema JapanFoundation for Global Children

Correspondence and lesson to an
earthquake disaster

Action for the revival

The damage situation at the time of theearthquake disaster of Shinchi power stationand the revival situation

Messages from a visitor

Support activity or radiation briefing
sessionState of the activity

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Tokyo University of Agriculture

Soma (TUA) method of salt removal fromflooded land, The radioactivity measurement
every rice field

Soma Fisheries Cooperative
Fishing trial; The present situation

Soma City

Minamisoma City

Shinchi Town

Iitate Village

The damage situation and the revival
situation

Earthquake disaster-related document,
introduction of the revival allied enterprise

The damaged situation,
reconstruction contracts

Record magazine after the disaster,Trend of the village after the disaster

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International symposium on disaster management and recovery
for children and communities 2016
-History of the five years of the Soma Area-

Record magazine

Publication: Executive committee of International Symposium on Disaster
Management and Recovery for Children and Communities
Address

Kitamachi 63-3 Nakamura, Soma City,
Fukushima 976-8602, Japan（Soma Area Council of Local Governments）

TEL 0244-35-4021
FAX

0244-36-8932

E-mailsymposium.soma.area@gmail.com

HP http://www.soma-area4.jp/symposium.html