Future of Healthcare
Healthcare Solutions Magazine
Offprint: Hospital Management & Healthcare Policy

The significant meaningof the medical care delivery system
in disaster medicine〜 Learning from the effortsof the Public Interest
Incorporated Association
Mobile Hospital International 〜

September 2022 · Vol. 8

Hospital Management & Healthcare Policy

The significant meaningof the medical care delivery system
in disaster medicine〜 Learning from the efforts of the Public Interest Incorporated
Association Mobile Hospital International 〜Japan, with its unique volcanic terrain and surrounded by trench plates, is constantly threatened by earthquakes. In
addition, there is an urgent need to further improve the medical care delivery system for disaster medical care in theface of concerns about the spread of new coronavirus infections and monkeypox, which continue to mutate
worldwide. Therefore, we invited Dr. Kouichi Sunada, President of the Public Interest Incorporated Association Mobile
Hospital International that promotes establishing rescue networks on hospital ships, to discuss MHIʼs philosophy,
activities, and challenges today and its future direction. Hideaki Mori, President and Representative Director of
Siemens Healthcare K.K., served as host.
Mori: Thank you very much for visiting us today,elevators. At the same time, the then-Japanesedespite your busy schedule. Since our foundation,

subsidiary of Siemens delivered Japanʼs first X-ray

we have been striving to create social value in Japanmachine to Tokyo Imperial University and the Armyunder our corporate mission, “We pioneer

Medical College in 1898. In the early 1900s, Siemens

breakthroughs in healthcare for everyone,

participated in various projects, including opening

everywhere.” We have also been sympathetic tothe current Enoshima Electric Railway and supplying

MHIʼs efforts to build a disaster relief network in thislow-frequency induction furnaces to the state-run

earthquake-prone country. Therefore, we have been

Yawata Steel Works.

cooperating with MHI as a supporting member,albeit in a small way. So today, I would like to talk to

Sunada: In 1923, this led to the establishment of

you about MHI.

the first joint venture with Japan, Fuji Electric
Manufacturing Co. I feel the companyʼs backbone isSunada: Thank you for inviting me. Siemensʼ

how to create social value.

relationship with Japan appears to date back to the
Edo period.

Mori: I believe this is the spirit of Siemens that has
been passed down from our founder, Werner.

Mori: In the 1860s, the founder, Werner von
Kouichi Sunada, Ph.D. (Human Environmental Studies)

Siemens, invented the electromagnetic pointerPresident of MHI, an incorporated public interest
association. Completed the doctoral course in Spatial
Systems, Graduate School of Human and Environmental
Studies, Kyushu University. Specialized in urban planning in
1999. Former coordinator for wide-area industry-academiagovernment collaboration at the Ministry of Education,
Culture, Sports, Science and Technology, former special
professor at the Graduate School of Art and Design, Kyushu
University, and member of the Committee to Study
Multi-purpose Vessels for Disaster Management (Cabinet
Office). He is also a member of the committee to study the
port call of the hospital ship Mercy (Cabinet Office). Special
advisor to the Diet Members Caucus for the Future ofDisaster Medicine in Japan, a Maritime Nation.

telegraph and presented it to the Edo shogunate of(Interviewer)
Hideaki Mori
President and Representative Director, Siemens Healthcare
K.K./Siemens Healthcare Diagnostics K.K.
After graduating from the Department of MechanicalEngineering, Faculty of Science and Engineering, Waseda
University, he joined Siemens-Asahi Medical Technologies
Ltd. (currently Siemens Healthcare K.K.), where he began
his career as an MRI development engineer. After that, he
was appointed as Business Manager of Molecular Imaging,
Angiography & X-ray Departments, the head of Sales
Division, as well as the head of Imaging & Therapy
Business Division. In 2015, he was appointed President
and Representative Director of the company, a position heholds today.

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Future of Healthcare

the time. During the Meiji period (1868-1912), whenelectric power was introduced to Japan, 60 Hz wasused in western Japan and 50 Hz in eastern Japanbecause western Japan adopted General Electricʼs
system and eastern Japan adopted Siemens' system.

Sunada: I was not aware of that. Your company has
been deeply involved in the modern history of Japan
up to the present. When I trace the history of yourcompany, I think there are many things we should
know more about.

Mori: It is as you say. Werner, who believed that “thevalue of an invention lies in its practical application,”
introduced the worldʼs electric locomotives andFounder of Siemens: Werner von Siemens

TrendWerner took an extraordinary interest in corporate

disaster medical care in Japan, a maritime country.

hospital ship to emphasize the need for a systemsocial policy with an eye to the future. For example,

In Japan, a disaster-prone country, rescue by medical

and contribute to that social change. Now, a yearin 1872, more than ten years before the German

ship using sea routes is a revolution in the social

after the bill was passed, the primary questions

national pension system was established, he set up asystem to have a sound medical care delivery system

concerning what is needed to implement the system

corporate pension plan and assigned a family doctor

in place. However, it took ten years and another year

for demonstration purposes. Is the existing system

to treat employees who became suddenly ill or

to pass a bill to promote it.

sufficient to handle the main body of operation andinjured. The various medical services offered bymanagement? Since volunteers are not part of theSiemens Healthineers today have their origins in thisMori: You have really devoted yourself to thissystem at the start, when and where should they bebusiness.

project for a long time. As you have just explained, I

included and managed? How can we incorporate

think the great thing about MHI is that it is not only

volunteers into the system?

■ Social change is urgently needed for the 2025

Osaka Expobuilding hospital ships but is also trying to build asystem that includes volunteers who can respond toMori: In promoting social change, we have almost

Mori: Could you tell us your thoughts on a medical

disasters. Infrastructure may not function just bydone the same as I mentioned initially, except thatcare delivery system that utilizes vessels?

building it, but how will it be used? Or around it,

we specialize in healthcare. To this end, we havebecause without a system that serves the entire

established several pillars. We have set a goal of

Sunada: As you know, Japan is a maritime nation

healthcare system, it will eventually only be able toimplementing strategies to realize these pillars bysurrounded by the sea on all four sides, with many

function in part.

2025. We have decided on what we will do this year,

active volcanoes, and has long suffered earthquakes.

Will the system in the promotion law be built toone by one, and are now moving forward with

It also lacks a medical system for infectious disease

include volunteers?

learning each goal and checking our progress every
month. One of the pillars is “Access to care” - how to

outbreaks. It is impossible to provide modern
medical care in a hospital surrounded by the sea andSunada: Yes, it is built-in. Since the law is adeliver care to those who have difficulty accessing

without power. Medical capabilities in the affected

promotion law that commands the government tomedical care, precisely what you are trying toareas could be maximized by effectively using ships“do what and how next,” it is now necessary toachieve in Japan through the Hospital Ship Project.

that operate independently from the electric power

create the systemʼs engine that will run the system;

grid. We know that it will be challenging to secure

this means that the engine also needs to be“medical facilities that can operate immediately after

maintained and related to the day-to-day matters ofa disaster” in the event of an anticipated Nankai or

when, where, and how it will be operated. We are

Tonankai Trough earthquake. Therefore, we believe

now entering the level of implementing the law,

it is imperative to establish a medical care delivery

which includes how to set up partners, where tosystem that utilizes ships to quickly resolve theobtain financial resources, and who will be in

We are currently asking the Cabinet Secretariat toissues of providing “well-equipped medical facilities”

charge. The law states that the date of enforcement

comply with the recently enacted law thatand “mass transportation.” We would also like towill be “a date specified by a Cabinet Order within aestablishes a headquarters for the promotion of thepromote the understanding that these vessels

period not exceeding three years from the date ofdevelopment of a medical care delivery system using

require many professionals other than medical

promulgation,” so even if nothing is done when thisships in the event of a disaster within a period not topersonnel and that they are also teaching grounds

date arrives, the law will have no choice but to go

exceed three years, as stipulated in Articles 7-15 offor simultaneously systematically training volunteers

into effect. If neither the private sector nor politics

the law. One of the benchmarks is the enactment ofwith specialized skills.

pretend to be ignorant at that time, it would not be

the implementation law for the timing of Osakaa system with a soul. We are speaking out to build a

Expo 2025.

Sunada: That is precisely what we are aiming for.
■ Hospital ships with full amenities to help

those “unable to receive care” during
disasters

Mori: Thank you very much. June 2021 marks one
year since the House of Councilors passed the “Acton Promotion of Improvement of Medical Care
Delivery System Using Vessels in Times of Disaster.”
at a plenary session, and a symposium was recently
held to commemorate the first anniversary of thepassage of the bill.

Sunada: Thank you for your attendance. In the
United States, “hospital ships” rescue hurricane
victims. In the Great East Japan Earthquake of 2011,
many Japanese were saved by the U.S. militaryʼs“Operation Tomodachi,” which took advantage ofthe geographical location of Japan surrounded by
the sea. Based on this experience, MHI wasestablished in the same year with the goal ofbuilding a hospital ship in Japan for the future of

Future of Healthcare3

Hospital Management & Healthcare Policy

time of the Osaka Expo. The Nankai Trough will be
the biggest problem. In short, I believe it is important
to worry about things that have not yet happened,
or in other words, to be prepared for what may
happen before it happens.

Mori: It's too late once something happens.
Sunada: I think the same thing can be said for
diseases. In the terminal stage, itʼs too late.

Mori: You are right. The biggest problem withJapanese healthcare is that not much money is spenton prevention. Japanʼs medical insurance systemdoes not pay unless you get sick. Preventive
dentistry is self-paid, so we finally see a dentist when
we get a cavity. This is why so many people in Japan
have cavities, and why so few have teeth left when
they get old. The big issue for Japan is how to have“a walking stick” ready before people stumble. In

Mori: When we think about disaster medicine indeaths. However, few people in the JapaneseJapan, there are people who “cannot be cared for.”terms of the meaning of “look before you leap,” I

Association for Acute Medicine are considering thisthink the reason why volunteers have become so

as a hospital ship.

popular in Europe is because Europe as a whole is a

Sunada: You are right. Some people are notreceiving medical care. These are the people who
say very little in times of disaster. In other words,

country that has lost everything due to war, so in■ Look before you leap. They need to beprepared in advance.

the end, they could not rely on the government.
Without volunteers, there was nothing that could be

peopleʼs voices are not heard even if they speak out.

Mori: There is not much time before the Osaka Expodone. I think the difference between Europe andAs you can see in the actual evacuation centers,in 2025.

Japan is that Japan hasnʼt institutionalized the

They are laid directly on the floor of the gymnasium.
They sleep in small groups.

infrastructure for volunteers as a country.

Sunada: There is a threat of a Nankai Troughearthquake in the Osaka area. Even if we say we are■ German Federal Agency for Disaster Technical

Mori: So there are actually dead bodies lying on the

prepared, we must be ready. The bureaucrats arefloor, too, aren't there?

reluctant to do that. In other words, they donʼt have

Sunada: The key point of this Diet memberʼs bill is

Assistance (THW) specializing in volunteerism

the means to do it. So now we are in the process ofthat the basic plan clearly states that independent

Sunada: Thatʼs right. On 3.11 earthquake, many

checking to see if there are no moves. If we donʼtadministrative agencies and private citizens can also

people came to the evacuation center to look for the

manage to move forward this way, and if the rest ofoperate vessels if they can establish a medical carebodies of those who had been brought in, saying,

the political situation does not allow for a resolutedelivery system. First of all, the government urgently“My little boy is missing,” or “Is my mother there?”

response, we may find ourselves with nothing at theneeds to establish a system to protect the lives andOverseas, for example, the Rohingya refugee camps
in Myanmar are also in poor condition. Bothevacuation centers used during the Great East Japan
Earthquake and the Rohingya refugee camps wereof low quality internationally. The government

What is a medical care delivery system that utilizes ships?

probably takes this kind of environment for granted.
People donʼt speak up and donʼt complain, which is
why they are forced to sleep in such places for days
at a time. There is nowhere else to go, and there areno cafeterias. So we thought, why not house theevacuees on a ship equipped with comfortableamenities that prioritize their health? The ship would
provide hot meals, hot showers, and a safe place tosleep. Using vessels with such amenities andresident medical personnel to provide health care,
we can transport large numbers of evacuees from

(1) Surrounded by the sea on all four sides, it is impossible toprovide modern medical care in a hospital where electricity
has been cut off. An effective use of power-independent
ships is the best way to maximize medical capabilities in thedisaster area.
(2) It is challenging to secure “medical facilities that can operate
immediately after a disaster” in the event of a possible
Nankai Trough or Tonankai Trough earthquake.
(3) To urgently solve the two problems of providing “wellequipped medical facilities” and “mass transportation,” theestablishment of a medical care delivery system that utilizes
vessels is imperative.
(4) Vessels require numerous professionals other than medical
personnel. Promoting a better understanding that a hospital
ship is a teaching facility that simultaneously provides
organized training of volunteers with expertise.

poor shelters and help prevent earthquake-related
Presentation material for Symposium Program II commemorating the first anniversary of the enactment of the “Law for
the Promotion of Medical Service Utilizing Vessels in Times of Disaster” by lawmakers.

4

Future of Healthcare

Trendlivelihood of the people by securing a command post

world. Thus, when German THWs are sentmechanism to utilize so-called professionals andfunction that can centrally operate the national,

representing the UN or the EU, the German

volunteers functionally and flexibly because we needprefectural, and municipal governments, as well as

government receives funding. Therefore, it is an

our country to have a system that can withstand amanage crisis management organizations such asexport of the system.

declining birthrate. We have people who voluntarily

fire departments, police departments, and Self-

THW has an outstanding reputation in Germany,

serve when a major disaster comes. Still, they are

Defense Forces in any situation. To this end, wewith people from all walks of civil society and all

not proactive because they serve after the disaster

formed the Bipartisan Diet Members Caucus for the

professions teaming up to form units. So, foroccurs. Their work is also limited to cleaning up mud

Promotion of Medical Vessel Utilization in Disasters

example, there is a unit just for women who canand related activities. Crime abounds. Therefore, I(hereafter, the Bipartisan Diet Members Caucus). We

bring their children to training. There is also a unit

think it would be advantageous to have apassed the “Disaster Medical Vessel Utilization Bill”

just for veterinarians who save the animals sinceregistration system so that professionals can beto establish a lifesaving and rescue system that

there are large animals on the farm.

identified by function and provide a system toutilizes medical vessels during a disaster.
The proposal was submitted to Chief Cabinet
Secretary Hirokazu Matsuno by Fukushiro Nukaga, amember of the House of Representatives andchairman of the Bipartisan Diet Members Caucus. He

Pet Rescue Veterinary Unit for dogs,
cats and other pets

Technical Support Unit for Flood Control Bridges

has stated that it is essential to establish a system
for relevant organizations to share disaster
information, such as weather phenomena andearthquake warnings, at all times. At the same time,
it is also essential to establish a human resource
development and technical support system so thatdisaster response specialists and volunteer workers
can perform functional activities based on an
appropriate division of roles. Until now, it has only
been said that the Self-Defense Forces should own
the vessels for disaster response. However, I believe

Womenʼs unit with children participating in training

the role of the Self-Defense Forces is to go to thebattlefield and other specialists are needed. Disastersecurity requires the addition of medical care toresearch specialists who integrate diverse areas such

Presentation material for Symposium Program II commemorating the first anniversary of the enactment of the“Law for the Promotion of Medical Service Utilizing Vessels in Times of Disaster” by lawmakers.

as meteorology, climate change, volcanoes,
earthquakes, land transportation, aviation, ports,

The reason we have prioritized the creation of laws

educate them. Also, creating a world map showing

maritime affairs, urban planning, architecture, rivers,

regarding hospital ships is that the government,

where the people are from and who governs themand Exclusive Economic Zone handling. A one-which tries to move the system, cannot move

would be helpful. For example, Some might say “Ipackage command function can be fulfilled onboard

without laws. When a major disaster strikes, theam good at handling phone lines,”, “I am good ata ship when the work is aligned. Combining thesegovernment alone cannot respond, so we are notusing the Internet,” or a maternity nurse might say, “Ielements onboard the vessel will enable the ship tobuilding a hospital ship alone, but a system to move

can help with births in emergencies. There will be

fulfill a one-package command function.

society as a whole. If the people who provide

many discoveries. The urgent task for Japan, asupport do not just go voluntarily but, as you said,

disaster-prone country, is to transform volunteersʼ

Mori: You visited the THW, which organizes

can functionally participate in the system. Thus,

expertise into digital information.

volunteers in Germany.

both the people who volunteer and the companies
that send them will feel secure. And if there is

Mori: It would be the creation of a public-private

permanence, it can continue for a long time.

partnership organization similar to THW in Germany.

founded in 1950 after the warʼs end and trained

Mori: In Japan, there were grassroots movements,

Sunada: Thatʼs right, although THW is a federal

81,000 volunteers under its umbrella. Recently, they

but there was no systematization of volunteer

agency, 98% of its members are volunteers. The

have responded to a wide range of requests from EU

activities by the government.

THW comprises 668 local organizations providing

Sunada: Yes, THW is an organization that hasgenuinely professionalized volunteerism. It was

headquarters and the United Nations.

electricity and water and building temporary roads.

Sunada: The fire brigade is the only organization

They establish and maintain evacuation centers andMori: They are famous as a competent organizationthat had done this. Many people died in the 3.11

set up and operate communication systems andthat can seamlessly execute everything fromearthquake. When I see that devastation, I cannot

logistics centers. We must install such a system andresearch on specialized disaster equipment tofeel the sense of science. In the last sentence of ourrealize a “hospital ship” that can serve as an offshore

human resource development.

request to Chief Cabinet Secretary Hirokazubase in the event of a disaster. Surrounded by the

Sunada: Thatʼs right. They are sent all over the

Matsuno, we included the need to organize asea, we cannot evacuate on foot as in Ukraine. Even

Future of Healthcare5Hospital Management & Healthcare Policy

if one or two cars carrying a single bed were to rushpharmacy, optometry lab, and CT scanner. In

to a hospital where the electricity has been cut off, it

addition, plant facilities produce purified water at

Sunada: Yes, until the national government

would not be enough.

70,000 tons per day and generate oxygen, making it

establishes a centralized disaster management

Nevertheless, with hospital ships, for example, wepossible to assist the affected areas while ensuringsystem like FEMA, our primary focus will continue tocan set up a logistics center that can carry various

their self-sufficiency and not burdening them. It also

prepare for the next disaster. First of all, I would likegoods to the other side of the Seto Inland Sea

has a helicopter deck that can land large military

to go to Germany sometime this fall to exchangearound Hiroshima, Okayama, or Hyogo prefectures,

helicopters and a side port to bring in patients from

opinions with people from the EU. After returning toeven if a Nankai Trough earthquake strikes. Suppose

the sea. In addition, Mercy makes regular port calls

Japan, we would be happy if we could hold aa law is passed and orders are given. In that case,in disaster-prone India and Asia-Pacific countries todebriefing session and an international symposium

self-defense officers could come out and share thedeepen exchanges and strengthen cooperation forin both EU countries and Japan. If all European

center as a heliport by order of the competentdisaster relief.

companies could participate in the symposium

authorities. If a causeway is built with a floating pier,Some criticize that hospital ships cost too much, but

together, it would create unprecedented potentialcargo could be delivered between ships. For daily

we believe this is a matter of how they are done. So,

and be an engaging event. Therefore, we have set

training, there would be a ship with a platform on

for example, in Mercy, the Navy has prepared a ship.

our sights on this next year and are considering awhich helicopters could drop in and land as part of

The manufacturer goes in and equips it withroadmap up to 2025.

civilian activities.

equipment. It functions like a kind of trade show,

We believe it would be most desirable to use suchwith various people observing the equipment at theMori: As a private sector organization such as thevessels for daily training; they do not need to beanchorage. We are considering that JapaneseEuropean Business Council, we would like to assist

hospital vessels. For example, suppose a domestic

hospital ships should also be equipped with robotic

you in any way we can. Thank you very much fortanker carrying fuel would accompany the ship. In

surgical equipment because of the rocking on board.

sharing your wide-ranging views with us today.

that case, it could take the tanker to the disaster

The manufacturers will install their equipment forarea where there is no gasoline or kerosene, andthis as well. And the fact that many professionals are

since it is a ferry, trucks could also be placed inside.

on board other than doctors means that the hospital

We would like to see such a tanker running in theship can also be a school or educational institution

disaster area. Bulldozers can also be used to clear

for organizing volunteers.

away the debris so that such work would be

What I think about the actual procurement of relief

possible. So, as President Mori just said, this is not

supplies, there are no financial instruments toabout a single ship but building a whole system. We

handle these in Japanʼs institutional design.

do not need to construct a new ship; instead, we canHowever, the procurement of disaster relief supplies

retrofit vessels used for other purposes, a carbon-

can be a derivative. For example, in the U.S., thesaving method. We believe that this could be done

system is based on derivatives, with contractors

in various ways through international collaboration.

automatically providing all supplies at pre-Another approach would be to have hospital ships

negotiated prices when emergencies arise.

defined as vessels that sail on the high seas, witheveryone participating in the construction of theirMori: So you have no choice but to do everything

own share of the ship. To have a proper

under a voluntary contract because the cost would

understanding, the government will take necessary

end up being several times higher after a disastermeasures to promote the development of a medical

occurs, and there is an urgency to do so.

care delivery system that utilizes ships in times ofdisaster, according to the Basic Policy.

Sunada: Thatʼs right. In the U.S., citizens are given a
card that displays a diagram of the emergency

Mori: Itʼs the development of the system. So, thesystem when inserted into a computer. The systemʼsdevelopment of infrastructure is only one part of it.

structure is straightforward, consisting of an
information center, its operations, logistics, andSunada: Exactly. Thatʼs right.

finance. For example, in an emergency, money isneeded. Society is in chaos with no electricity; thus,■ Learning from the American hospital ship
“Mercy”

ATMs are not functioning. When large quantities ofgoods are needed under these circumstances, theSunada: As a specific example of a hospital ship, webanks are the ones who arrange the derivatives; they

were invited to visit the United States Naval Shipare responsible for getting companies moving toMercy in 2018. With an inpatient capacity

deliver the goods. The United States Emergency

comparable to a large medical facility on land, theManagement Agency (FEMA)* applies this system inMercy has 12 well-equipped, state-of-the-art

its entirety.

operating rooms, a 1,000-bed inpatient hospital
facility, radiation services, a medical laboratory,6

Future of Healthcare

Mori: That is very American.

*

A government agency of the United States that
responds to major disasters. It is part of the U.S.
Department of Homeland Security, under the Under
Secretary for Emergency Preparedness and Readiness,and responds to natural and man-made disasters.

(Interviewed June 14, 2022)

TrendThe Act on the Promotion of Medical Service Utilizing Vessels in
Times of Disaster
Symposium Commemorating the First Anniversary of the Passageof the Legislation
On June 2, 2022, the Bipartisan Diet Members Caucus for the Promotion of Vessel-

Members Caucus, and Mr. Satoshi Umemura, a member of the House of Councilors

Based Medical Services in Times of Disaster (from now on referred to as “Bipartisan

and the same vice president, discussed the proposal to establish the headquarters andDiet Members Caucus”) and MHI co-hosted a symposium commemorating the first

the future goals. Although the image of a hospital ship probably varies from person toanniversary of the enactment of the “Act on the Promotion of the Development of

person, they also confirmed the importance of organizing volunteers for the hospital

Medical Care Provision Systems Using Vessels in Times of Disaster (Act No. 79 ofship, as they will be needed to provide specialized expertise as the technology2021).”

improves.

Following the opening address and activity report by Mr. Jun Tsushima, Secretary

Finally, Mr. Seiji Osaka, a member of the House of Representatives and vice president

General of the Bipartisan Diet Members Caucus, a member of the House ofof the Bipartisan Diet Members Caucus, reviewed the symposium. Mr. Osaka

Representatives, Mr. Fukushiro Nukaga, Chairman of the Bipartisan Diet Memberscommented, “Considering the issue of hospital ships leads to considering the structure

Caucus, gave a keynote speech titled “The Passage of the Promotion Law and theof society as a whole. For example, I feel that this is an issue that holds the root of how

Future of a Disaster-Ravaged Country” in Program I, in which he explained theto think about the structure of society as a whole, such as the issue of human“Proposal for the Development of a Medical Care Delivery System Utilizing Vessels inresources, volunteers, and supplies.” He also mentioned the word “beforehand” as aTimes of Disaster,” submitted to Chief Cabinet Secretary Hirokazu Matsuno. Mr.

keyword for the conference. In his closing remarks, he said, “The issue of hospital ships

Nukaga stated [1] that in preparation for the unpredictable occurrence of major

is a key initiative in considering how to create a society that is prepared in advance. I

disasters, the government should think about accelerating the development of abelieve that we have again confirmed today that hospital ships are not only medical

medical care delivery system that utilizes ships, establish a Headquarters for the

institutions operating on the high seas but are an important part of building a

Promotion of Vessel-Based Medical Care in the Cabinet, and quickly establish awell-prepared society.”complete disaster medical care system. [2] In the development and promotion plan,
the government should coordinate with the national, prefectural, and municipal

Proposed Act on Promotion of Medical Care Provision System
Utilizing Vessels in Times of Disaster.
summary

governments to establish a central command post for crisis management systems . [3]Furthermore, the government should establish a system for relevant organizations toshare disaster information such as weather phenomena and earthquake warnings at
the time of a disaster, and at the same time, develop human resources, technicalsupport, and technical assistance to enable disaster response specialists and volunteers
to functionally carry out their activities based on an appropriate division of roles.:“Medical care on vessels in times of disaster, in other words, emergency response,

could not be achieved without daily training. This applies to all organizations, including
the fire department, police, coast guard, and Self-Defense Forces. It is necessary tocooperate with medical institutions to protect the lives and health of the people ofJapan,” he said.
In Program II, Mr. Kensuke Onishi, President of Peace Winds Japan (a Japan-based
NGO that supports people affected by humanitarian and livelihood crises caused bynatural disasters, conflicts, poverty, and other man-made factors in Japan and abroad),reported on his volunteer activities in Ukraine. Mr. Tohru Aruga, President of Japan
Organization of Occupational Health and Safety, and Dr. Yoshihiro Yamaguchi,
Professor of Kyorin University School of Medicine, moderated the discussion.
A hospital ship is the best way to achieve both (1) “moving” and “transporting”
functions and (2) getting a well-equipped medical institution up and running
immediately after the disaster. It was discussed that hospital ships such as Mercy,
currently in operation, play a role in mobilizing and enhancing the abilities ofvolunteers who operate the ship, receive and treat patients, and send patients to theback-up facilities of the ship. Also discussed was the importance of providing
volunteers with equipment and training to use it on a regular basis, not only in timesof disaster, but also to enhance their expertise. The discussion was lively.
In the following Program III, as a summary of the symposium, Mr. Shinichi Yokoyama,Purpose (Article 1)
In Japan, which is surrounded by the sea, the provision of medical care by vessel effectively ensures medical care in times ofdisaster or when infectious diseases are spread or are feared to occur (from now on, referred to as "times of disaster").
Therefore, the development of a system to provide medical care by vessel in times of disaster, etc., should be promoted.

Basic Philosophy (Article 2)
The promotion of the development of the Medical Care Provision System Utilizing
Vessels in Times of Disaster, etc. shall be carried out to supplement the functions of
medical facilities in such areas and contribute to the protection of the lives and bodies ofcitizens from disasters or infectious diseases by providing necessary medical care in areas
where disasters have occurred, or infectious diseases have occurred or are spread or are
likely to occur, in a suitable and timely manner.

Responsibilities of the State (Article 3)
The national government must
promote the development of
the Medical Care Delivery
System Utilizing Vessels in
Times of Disaster by the Basic
Principles.

Basic Policy (Article 4)(1) Ensure an appropriate division of roles and mutual coordination and cooperation
between medical care provided by ships and medical care provided at land-based
medical facilities in times of disaster.
(2) Ownership of vessels to be used mainly for medical care in times of disaster(including ownership by independent administrative agencies or entities other than
the national government) to enable the accurate and prompt provision of medicalcare needed in areas where disasters have occurred.
(3) Securing medical personnel from the public and private sectors, vessel's personnel,
and other personnel necessary for providing medical care by vessel in times ofdisaster.
(4) Develop human resources by conducting education and training to provide medicalcare using vessels in times of disaster.
(5) Securing medical supplies such as medicines, medical equipment, and other goods
necessary for providing medical care by vessel in times of disaster.

Necessary measures (Article 5)
Based on the Basic Policy, theGovernment of Japan shall takenecessary measures to promote
the development of the Medical
Care Delivery System Utilizing
Vessels in Times of Disaster.
Any necessary legislative
measures shall be taken within
one year after the enforcementof this Act.

(6) Effective use of vessels in (2) above for traveling medical services on remote islands
and international emergency relief activities, other than in times of disaster.
(7) Utilization of private sector funds, management, and technical capabilities.
(8) Others.

Development and Promotion Plan (Article 6)
The Government shall formulate a necessary development and promotion plan for measures that the government should takeconcerning the development of the Medical Care Delivery System Utilizing Vessels in Times of Disaster.
The Prime Minister shall seek a Cabinet decision on the draft of the development and promotion plan.
When the Government formulates the development and promotion plan, it shall report it to the Diet without delay and make itpublic through the Internet or other appropriate means.

Headquarters (Articles 7-15)
Establishment of the Headquarters for the Promotion of Medical Services by Vessel, consisting of all Ministers of State and its
secretariat in the Cabinet (headed by the Prime Minister) for comprehensively and intensively promoting the development of
the Medical Care Delivery System Utilizing Vessels in Times of Disaster.

Effective date (Supplementary Provisions, Paragraph 1)

Consideration (Supplementary Provisions, Paragraph 2)

Date specified by a Cabinet Order within a period not exceeding
three years from the day of promulgation.

A headquarter shall be reviewed approximately five
years after the Actʼs enforcement, and necessary
measures shall be taken based on the results.

a member of the House of Councilors and the first vice president of the Bipartisan Diet
Adapted from the 49th Future Research Conference of the Japan Health Foundation“Initiatives of Mobile Hospital International”

Future of Healthcare

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