Japanese Association of
Occupational Therapists

Road to Reconstruction

Contents
3

Message from JAOT

4

Support activities conducted by JAOT

9

Great East Japan Earthquake～Iwate Prefecture～

16

Great East Japan Earthquake～Miyagi Prefecture～

24

Great East Japan Earthquake～Fukushima Prefecture～31

2016 Kumamoto Earthquake

38

2016 Typhoon No.10 (Iwaizumi in Iwate Prefecture)

42

Support activities in four aﬀected prefectures

43

The role of occupational therapists in disaster relief activities*Japanese Association of Occupational Therapists: JAOT
*Japan Disaster Rehabilitation Assistance Team: JRAT

Phases of Disaster Rehabilitation
This report classifies the phases of disaster rehabilitation as follows, in reference to“Standard textbook in disaster rehabilitation” (planned and edited by Japan Disaster Rehabilitation Assistance Team and published by Ishiyaku Publishers, Inc).

Chaotic phase

Emergency
Restoration Phase

Recovery Phase

Reconstruction
Phase

・The first 72 hours after a disaster
・Lifesaving, first aid and evacuation are prioritized・Four days to one month after a disaster・Gradual recovery of transportation and information networks

・Two to six months after a disaster・Reopening social life and economic activity
・Over six months after a disaster・Improved infrastructure, transportation, and information
networks. Termination of external support for affected areas

Message from JAOT
Celebrating the issue of Road to Reconstruction
Upon publication of Road to Reconstruction, I would like to express my deepest condolences andsympathies to all those affected by the latest disasters, and our thoughts and prayers remain withthose who are striving to recover. This report contains the JAOT’s support activities during and after
the Great East Japan Earthquake, the 2016 Kumamoto Earthquake, and 2016 Typhoon No.10. Its
purpose is to inform the general public of the role of occupational therapy in disaster relief, and I
hope that this volume further promotes the recovery, health, and well-being of those affected.
When the Great Hanshin-Awaji Earthquake occurred on January 17, 1995, we received messages
and donations from many occupational therapy associations and individuals not only domestically,
but also internationally. Once again, I would like to express my sincere gratitude to everyone who
supported us at that time. I was able to experience firsthand that support in times of difficulty gave
us courage and pushed us toward recovery. In light of our own experience, JAOT sends messages
and provides necessary support when large scale disasters occur both in domestically and overseas.
The Disaster Relief Act provides an administrative framework to undertake disaster support
measures in Japan. However, this act does not specify occupational therapist as a profession. Under
the Act, disaster relief activities are conducted under the supervision of local governments. Whendisasters occur, corresponding prefectural associations of occupational therapists lead disaster relief
activities. Therefore, in order for occupational therapists, for example, to work in evacuation
shelters, good rapport with relevant organizations such as local governments and medical associations is essential. JAOT gathers information on damage of affected prefectures and their needs inorder to provide appropriate support pursuant to local circumstances. JAOT launched the volunteer
registration system, and we also hold a disaster relief seminar every year with the aim of training anddispatching staff during disasters. In response to rehabilitation support needs during the Great East
Japan Earthquake, the Japan Disaster Rehabilitation Assistance Team (JRAT), consisting of 13 rehabilitation organizations including JAOT, was established. During the 2016 Kumamoto Earthquake,
JRAT dispatched staff members and provided continuous support. JRAT was incorporated in April
2020 and has been taking actions to establish a local JRAT in each prefecture, develop humanresources, and build rapport with relevant organizations.
In conclusion, JAOT firmly supports people’s lives after disasters. However, we will never know
when disasters occur. Therefore, JAOT makes an effort to develop rapport with residents in communities and relevant organizations as a preparation for disasters. We greatly appreciate your warm andcontinuing support for the activities of prefectural associations of occupational therapists and JAOT.
Japanese Association of Occupational Therapists
President
Haruki Nakamura

3

Support activities conducted by JAOT
Great East Japan Earthquake

Kumamoto Earthquake

1. Great East Japan Earthquake (2011～)
1) Activities in FY 2011
Japanese Association of Occupational Therapists (JAOT) established the Disaster Headquarters on
March 12, 2011, the day following the Great East Japan Earthquake. The first Headquarters meeting
was held on the 13th to establish and promptly post the following policies on the website.
1. To set up a dedicated email address for communications with associations of the affected
prefectures, and to collect information about members’ safety and damage in the affectedareas
2. To open a bank account for a disaster support fund (raise donations widely from members)
3. To provide 300,000 yen to each of the four associations (Iwate, Miyagi, Fukushima, andIbaraki Prefectures) as an initial support fund
4. To accept membership fee waiver requests from affected members
5. To survey the impact on training facilities
6. To assist members with employment
7. To initiate volunteer activities
Below we report on disaster support activities conducted in FY 2011 in line with these policies.
(1) Information Gathering
As soon as the Disaster Headquarters were established within JAOT, associations of the affected
prefectures were contacted to confirm earthquake damage. The Disaster Headquarters were alsoestablished by each association of the affected prefectures, and confirmation of the safety of members
was already in place. On March 14, persons in charge of disaster response and their contact information were confirmed in every association of the affected prefectures, and a coordination framework
utilizing a constant liason was organized. After that, the liaison and coordination were maintained
through associations of the affected prefectures and JAOT; in doing so, JAOT staff members visitedthe affected areas as necessary, and JAOT held meetings to continue to coordinate with associationsof the affected prefectures. In addition, related organizations were contacted, and a framework toprovide disaster support activities in coordination with these organizations was established.
A dedicated page was provided on the JAOT website to report actions taken by the Disaster Headquarters, and to obtain information and opinions from members. A total of 26 announcements wereposted by the Disaster Headquarters by February 2, 2012.

4

(2) Fundraising
A dedicated bank account was opened on March 15 to raise funds aiming at support for associationsof the affected prefectures, resources for volunteer activities by JAOT, purchase of relief supplies,
etc. Contributions were made by many members, supporting members, prefectural associations ofoccupational therapists, hospitals and organizations to whom members belonged, as well as foreign
donors; the funds collected by June 2012 amounted to 13,531,328 yen.
The funds were transferred by request to associations of the affected prefectures to support theirdisaster relief activities, and used to cover expenses required to dispatch disaster support volunteers
from JAOT to the affected areas. In addition to the monetary funds, many members donated supplies
that were delivered to the affected areas.
(3) Initial Financial Support for Associations in Affected Prefectures
After establishing the Disaster Headquarters, 300,000 yen were transferred immediately to each of
the occupational therapy associations of Iwate, Miyagi, Fukushima, and Ibaraki Prefectures.
(4) Response to Affected Members
The following support was provided as a response to affected members. In so doing, a call for applications was published repeatedly via JAOT news, the JAOT website, and associations of the affected
prefectures.
1. FY 2011 membership fees waiver for those affected by the Great East Japan Earthquake: Acceptance of applications started from March 23, 2011 and 69 applications were
accepted by March 1, 2012; Sixty-five applications were approved.
2. Installment or deferred payments of FY 2011 membership fees for affected members not
eligible for waivers: One application for installment payment and two applications fordeferred payments were accepted during the application period from July 15 to December 15,
2011.
3. FY 2011 membership fees waiver for those evacuated because of the Fukushima-Daiichi
Nuclear Power Plant accident: Acceptance of applications started from July 22, 2011
targeting members evacuated from the restricted areas, deliberate evacuation areas, evacuation-prepared areas, and special evacuation recommendation spots. All of 19 received applications were approved.
(5) Response to Pre-Qualification Education and Training
An emergency email survey was conducted on March 17, 2011 to confirm earthquake damage toschools in the affected areas. A more detailed survey was carried out on April 21. In addition, opportunities for clinical training in institutions where members belonged to were urgently examined; 892
institutions nationwide confirmed such opportunities. After that, the Training and Education Division(former name) took charge of introducing available training facilities to schools.
(6) Provision of Information on Job Opportunities to Affected Members
Aiming to provide disaster-affected members with re-employment opportunities, we requested cooperation from occupational therapy facilities, occupational therapy schools, and prefectural associations ofoccupational therapists. Then, job opportunities information was posted on the JAOT website. The
number of job postings amounted to 166 by the end of March, 2011.

5

(7) Volunteer Activities
A disaster support volunteer center was established so that members could register as volunteers. 128
members registered during the 1st month, and eventually their number amounted to 248. At the earliest stage (April 3 to May 9, 2011), we coordinated with relevant rehabilitation organizations for
efficient support activities, and we, as healthcare professionals specializing in teamwork, weredispatched to Wakabayashi ward in Sendai City and implemented a pilot program. The program
involved 10 volunteers.
After that, upon requests of associations of the affected prefectures (Iwate, Miyagi, and Fukushima)and relevant organizations (“Advice and Help for Disaster-affected Disabled Children Project” by
Japan Developmental Disabilities Network, which is commissioned by Fukushima Prefecture),
JAOT dispatched appropriate personnel. The program started from April 15, 2011, and a total of 133
volunteers were dispatched by March 31, 2012 (Iwate Association Occupational Therapists: 37
persons, Miyagi Association of Occupational Therapists: 64 persons, Minamisoma City in Fukushima Prefecture: 23 persons, “Advice and Help for Disaster-affected Disabled Children Project” inFukushima Prefecture: 9 persons.
The disaster support volunteers deployed the following activities:
1. Arrangement and adjustment of living environments in evacuation shelters: As an initial
response, arrangements were made to provide evacuation shelters with social and private spaces,
handrails and other safety facilities for the elderly and disabled, etc., so as to make the living environment as comfortable as possible.
2. Formation of daily rhythms and participation in activities: Various measures were taken inorder to create daily rhythms in the monotonous environment of evacuation shelters, such as
preparation of daily schedules and implementation of small-group activities to boost motivation(exercise, handicraft, walking, etc.).
3. Individual support for seniors and people with disabilities who were experiencing a decline
in physical functioning in evacuation shelters, homes, and housing: Physical conditions andliving situations as well as the needs for rehabilitation were confirmed and evaluated, and thenguidance was provided regarding a decline in ADL (standing up, rolling over, eating, etc.). In
addition, assistive devices were fabricated and provided as necessary.
4. Individual support for people with mental disorders in evacuation shelters, homes, andprovisional housing: Living conditions of persons with schizophrenia, depression and otherdisorders were confirmed and evaluated, and support was provided including continued counseling to eliminate anxiety. In addition, somatic interventions and other therapies were provided topersons experiencing loss of motivation or depression.
5. Support for disaster-affected disabled children: Advice about evacuation shelters and procedures were provided to families with disabled children requiring special support; evacuation
shelters and new living conditions were assessed, and individual support plans were prepared foreach child, including assistance for special schools.

62) Activities in FY 2012
Activities of FY 2012 followed the same basic policies as in FY 2011. With regards to the response
to disaster-affected members, membership fee waivers were continued only for those evacuated dueto the Fukushima-Daiichi Nuclear Power Plant accident. Volunteers activities included dispatching 4
additional persons to “Advice and Help for Disaster-affected Disabled Children Project” in Fukushima Prefecture; another major project was “Creation of New Motivation in Life for the Elderly 2012”
commissioned by Iwaizumi Town in Iwate Prefecture. The project involved efforts of occupational
therapists to promote self-activities of the elderly aiming at a new motivation in life; 30 volunteers
were dispatched to support the project.
3) Activities in FY 2013
The articles of incorporation of the Association were amended with its restructuring into a generalincorporated association in April 2012. As a result, “Project Aiming at Support of the Disabled,
Elderly, Children etc. Affected nuclear Accidents and Natural Hazards’ were added to the scope ofactivities (Art. 4, Par. 6 of the articles). After a one-year preparation period, the Disaster Prevention
Office was established for realization of such projects. The major projects undertaken in FY 2013
include summarizing and publishing a full report in JAOT journal on “A questionnaire Survey Related to Disaster Support Volunteers,” holding a volunteer meeting during the 47th Japanese Occupational Therapy Congress and Expo (Osaka), compiling essential documents such as “Basic Guidelines on Large-scale Disaster Support Activities” (based on “Manual for Large-scale Disaster
Support Volunteer Activities” of 2007, completely revised with regard to experience of the Great
East Japan Earthquake), “Manual for Disaster Support Volunteer Activities”, or “Manual for Acceptance of Disaster Support Volunteers”, and issuing “Report on Disaster Support Activities in Great
East Japan Earthquake” to summarize disaster support activities through 3 years of FY 2011 – 2013.
In so doing, JAOT recognized the importance of disaster awareness, and deployed projects towardbuilding a framework for cooperation with regional associations of occupational therapists, relatedorganizations, and national and local governments, etc.
Furthermore, participation of specialists in “Advice and Help for Disaster-affected Disabled Children Project” in Fukushima Prefecture was continued in FY 2013, and members were dispatched asvolunteers.

2. 2016 Kumamoto Earthquake (2016～)(1) Initial Response
Two powerful earthquakes struck Kumamoto City of Kumamoto Prefecture on April 14, 2016 andApril 16th, 2016 with magnitudes of 7.0 and 6.2, respectively. On the day of the first earthquake, thepresident of JAOT contacted the president of Kumamoto Association of Occupational Therapists toexpress his sympathy for Kumamoto Prefecture and to confirm constant information sharing. A
Disaster Headquarters was established within JAOT on April 15, and it announced a message ofcondolence and sympathy to 7 prefectures in Kyushu region and began gathering information. Immediately after the predawn earthquake on April 16, the headquarters received an evacuation anddamage report from Kumamoto Association of Occupational Therapists and the Oita Association of
Occupational Therapy. The Headquarters held a meeting to discuss action plans.

7(2) Publication of reports on the JAOT website
An initial report was published on the JAOT website on April 18, and a total of six reports were
published by July 19.
◆Initial Report
Establishment of Disaster Headquarters, information gathering, and cooperation with JRATDisaster Headquarters◆Second Report
The following initial response policies in line with “Basic Guidelines on Large-scale Disaster
Support Activities” were determined.
1. Provision of 300,000 yen to Kumamoto Association of Occupational Therapists as an initialsupport fund
2. Acceptance of membership fees waiver requests for FY 2016 from affected members
3. Raising donations for disaster relief activities
4. Preparation for dispatch of disaster support volunteers
5. Cooperation with JRAT Disaster Headquarters (dispatching JAOT staff members)◆Third Report
Since it was decided that JRAT would lead support activities, JAOT expressed its intention to
conduct support activities cooperating fully with the activities of JRAT.
◆Fourth Report
Acceptance of membership fees waiver requests from affected members.
◆Fifth Report
Raising donations for disaster relief activities/◆Sixth ReportCompletion of JRAT’s relief support activities on July 16.
(3) Fundraising
JAOT raised funds between April 19 through June 30, 2016, and contributions were made by prefectural associations of occupational therapists (7), organizations/companies (3), individuals (15),others (3) which amounted to 933, 980 yen. The funds were used for “Project on Plowing Fortune”
conducted by Kumamoto Association of Occupational Therapists.
(4) Activities within JRATJRAT Kumamoto Disaster Headquarters (within the Kumamoto Kinoh Hospital) and JRAT Disaster
Headquarters (within Japanese Physical Therapy Association: Tamachi) were established on April
15. JAOT dispatched staff members to JRAT Disaster Headquarters from April 15 and a total of 68
members including members of JAOT Disaster Prevention Office were dispatched in order toprovide continuous support.
(5) Support Kumamoto Association of Occupational Therapists’ “Growing Fortune” ProjectAs a dispatch request for the “Growing Fortune” project, which was conducted by Kumamoto Association of Occupational Therapists between May 2017 through March 2018, was received, JAOT
called for participation of members who registered as disaster relief volunteers.

8Iwate prefecture
Great East Japan
Earthquake～Iwate Prefecture～

Great East Japan
Earthquake
March
11, 2011

2011/3/11

Outline of Earthquake in Iwate Prefecture
Outline of Earthquake in Iwate Prefecture◆Overview of the Earthquake Disaster
Date/Time：March 11, 2:46 pm
Size：Magnitude 9.0
Largest recorded seismic intensity：6（Ofunato City,
Kamaishi City, Takizawa VIllage, Hanamaki◆State of Damage
Deaths 4,671
Missing persons 1,173
Injured persons 206
Damage to housings：24,560 houses(12 cities, towns and villages in coastal areas）

City, etc.）
Tsunami：Ofunato City 8.0m or greater at 3:18pm,

No. of evacuees No. of shelters
Coastal Areas

39,489316

Inland2,032

47◆Number of Evacuees
Total
Maximum Number：51,491（12 cities, town and village in coastal area）

41,521363

Miyako City 8.5m or greater at 3:26

Number of Evacuees

60000 51491
50000
40000
30000
20000
10000
0

41521
25747
9339

4892

162

4

0

No. of houses

No. of residents

Provisional housings

12,73529,201Government rented
privately owned houses
as provisional housing

3,665

9,707

Total

16,40038,908

3/14 4/24 5/31 6/29 7/25 8/25 9/29 10/7
（Source: Great East Japan Earthquake Rehabilitation Support Activity Report）

9

Chaotic
Chaotic –– Recovery
Recovery Phases
PhasesMarch – August, 2011

March – August, 2011
♦Characteristics of the earthquake in Iwate
The main cause of death was drowning rather thanbuilding collapse. Among the victims whose ages wereidentified, those aged 60 or older accounted for 65%
percent (according to Mr. Satoshi Takahashi, director of
Iwate Disaster Medical Support Network). We tried tofind solutions to this unprecedented situation.
♦Report from Iwate Disaster Prevention Office
3 hospitals and 33 clinics were completely destroyed and 6
doctors died. 9 nursing homes got washed away and 14
others were rendered inhabitable by the tsunami. 6
Community General Support Centers on the coastline and
110 home-based services were affected by the earthquake
and tsunami. 18% of 9,150 home-based service users in caremanager offices died or were forced to move to other（Source:“Kiyofumi Oi: Disaster rehabilitation support in Iwate‐background story and future” ）regions.

Coastline, Otsuchi

Evacuation shelter (gymnasium)】【Rehabilitation Support Activities in Iwate】
In Iwate, support centers covering a large area have been established since 2000 and a community
rehabilitation system is well established. Iwate Rehabilitation Center (hereinafter referred to as the Center),which acts as the Iwate Rehabilitation Support Center, dispatched a support team to affected areas in theearly stage of the disaster to provide care and prevention services and minimize the negative impact on
people’s health. In addition, the Center collaborated with the relevant organizations in order to re-develop acommunity support system.
In prior to providing support, collaboration and liaison with relevant organizations were required. Even
though the damage was huge and very widely spread, a lack of rehabilitation resources including doctors andtherapists in some coastal regions of Iwate and a risk of confusion to dispatch a support team to such regionswith limited resources were the priority issues to be addressed. Thus, rehabilitation support activities were
implemented after assuring that staff, including doctors, public health nurses (the government), and therapists
who were working as a hub in affected areas or each district were communicated and coordinated with. The
Center started providing support in Rikuzentakata City on April 1, 2011, followed by Kamaishi City, Noda
Village, and Yamada Town. On April 2, a disaster relief meeting was held with Iwate Physical Therapist
Association and Iwate Speech-Language-Hearing Therapists Association to decide the regions to which eachassociation would dispatch a support team. Even though wide area support centers themselves were affectedby the tsunami or were involved in accepting patients and clients from other hospitals and facilities, support10

activities at provisional housing area gradually commenced.
Figure 1 shows the municipalities and number of people evacuated as of May 2011. In May 2011, there wasalready a certain number of evacuees in facilities throughout Iwate, and the major difficulty was to provide
a rehabilitation support service not only to evacuees at shelters in affected areas but to evacuees in the inland
areas of Iwate. Therefore, support was first provided to Shizukuishi Town, followed by Hanamaki City. Widearea support centers in the inland areas of Iwate also began to carry out activities such as group exercises
targeting evacuees staying at hotels or Japanese inns in Hachimantai City and other cities. In addition, andnurses were dispatched to counsel at provisional housings.
Just after disaster
InlandCoastline

M ovement of evacuees
InlandKuji
Evacuation
Centers

M aximum of
54,429peopleevacuated

M iyakoKamaishi

Kesen

Coastline

Kuji

Hot spring
village, etc.

M iyakoKamaishi

Kesen

Figure 1

Provisional Housings(25/8/2011)

As of 10 M ay 2011
InlandCoastline

48 Hot spring village,
2,293 people

305places, 34,201people

Hachimantai 106

Noda 298

Shizukuishi 382

M iyako 2,470

M orioka 376

Ymada 2,787

Hanamaki 666

Otsuchi 5,263

Kitakami 195

Kamaishi 3,548

Oushu 140

Ofunato 5,049

Ichinoseki 150

Rikuzentakata 14,080

Coastline

Total 13,984 houses,
90.7% occupied. About
1,300 houses are vacant

Overview of evacuees（Source: Kiyofumi Oi “Disaster rehabilitation support in Iwate‐background story and future direction”）】【The situation of Iwate Association of Occupational Therapists when the earthquake hit】
Iwate Association of Occupational Therapists located in the inland of Iwate prefecture was hit by a huge
earthquake, followed by a blackout, water supply outage, and shortage of supplies. It was difficult to makecontact by phones but email was restored a few days after the disaster. Iwate Association of Occupational
Therapists established the Disaster Headquarters on March 13. Email was restored on March 14, and damage
assessment information and safety confirmation of Iwate Association of Occupational Therapists’ members
were carried out by Iwate Association of Occupational Therapists’ directors using a mailing list.
Confirmation of all members’ safety (476 members as of March 2011) was completed in the beginning ofApril; fortunately, no members died or were reported missing; after that, however, reports emerged about thedead and missing among members’ families. Furthermore, 7 members were living in evacuation shelters.
】【Iwate Association of Occupational Therapists’ support for people in evacuation shelters】
On April 1, we learned that a member of Iwate Association of Occupational Therapists who was working at
the visiting rehabilitation office in Kamaishi City and Otsuchi Town entered the health-care group of theKamishi Region Disaster Headquarters. Iwate Association of Occupational Therapists’ Disaster Headquarters
held discussions with Iwate Physical Therapist Association and Iwate Speech-Language-Hearing Therapists
Association, and on April 2, decided to give support to Kamaishi Region in coordination with these
prefectural associations. On April 3, Iwate Association of Occupational Therapists Main Office arrived in
Kamaishi and immediately began support activities.

11

At the beginning, support was mainly provided by the members of Iwate Association of Occupational
Therapists, but it was anticipated that an increase in demand for support could not be handled by only themembers. Thus, we asked JAOT to dispatch members to assist in support activities between Monday andFriday. Once a framework to dispatch 2 or 3 members a day was ready, we were able to begin support
activities on May 1.

Evacuation shelters (April, 2011)

Support provided in shelters】【Support activities conducted by Iwate Association of Occupational Therapists】
Participants: People living in evacuation shelters and their own homes
Support provided:
1. To support people who are at risk of disuse syndrome and people with physical disabilities who
were experiencing difficulties in the shelters
2. To conduct an environmental assessment of shelters and determine evacuees rehabilitation needs on
Sundays.
Processes:
Phase 1 (April – mid May)・ The aim was to assess living situations and clients’ needs.
・ Members of Disaster Headquarters and directors of Iwate Association of Occupational Therapists
acted as support staff
Phase 2 (Mid May – end of June)
・ To set up an appropriate organizational framework including a request of support staff andimplement activities
・ Support staff members consisted of members of Iwate Association of Occupational Therapists and
JAOT
Phase 3 (Mid June – end of July)
・

Participants moved to provisional housing. Support to achieve a smooth transition and education on
how to use local services were provided.

・

Local occupational therapists took over the role
◆Details of support in shelters
・ Number of supporters：357
・ Number of corresponded cases：842
・ Iwate Association of Occupational Therapists members：96
・ JAOT members：38

12

Reconstruction
Reconstruction Phase
Phase
September, 2011 – February, 2017
September,2011 – February, 2017
From September 2011 to February 2017, support was provided in provisional housing, within the frame of
Iwate’s existing community rehabilitation system, in collaboration with wide area support centers（Figure2）. Iwate Prefecture spans a wide area, as large as Shikoku island. Since cars were the main means oftransportation, it was impossible to provide rehabilitation support at a single facility. Thus, Iwate Associationof Occupational Therapists held discussions with Iwate Physical Therapist Association and Iwate SpeechLanguage-Hearing Therapists Association to decide the regions where each association could offer support.
Wide area support center
Kuji Hospital

Wide area support center
Miyako Hospital

Wide area support center
Higashihachimantai
Hospital

Rehabilitation Support
Center
Iwate Rehabilitation
Center

県士会

Wide area support center
Seitetsu Memorial
Hospital

Wide area support center
Geriatric Health Services
Facility Kesenen
Wide area support center
Nanshou Hospital

Figure 2 Wide area support centers’ rehabilitation support at provisional housing
Left: coastal area
Right: inland area
（Source : Kiyofumi Oi “Disaster rehabilitation support in Iwate‐background story and future direction”）】【Iwate Association of Occupational Therapists’ Support at Provisional Housings】
Iwate Association of Occupational Therapists held a meeting to report regional support activities andexchange opinions on whether or not to end its activities. During the meeting, participants complained ofloneliness and uneasiness, and Iwate Association of Occupational Therapists decided to stay close besideevacuees and continue providing support activities at provisional housing. In August 2011, Iwate Associationof Occupational Therapists worked out a plan for secondary support, namely, “Plan of Support Activities for
Living in Provisional Housing” which targeted at the residents of provisional housing, and submitted it to
the Social Welfare Council of Yamada Town and Kamaishi City.
“Plan of Support Activities for Living in Provisional Housing”
The plan demonstrated that evacuees living in provisional housing were at risk of social
withdrawal, loneliness, and disuse syndrome; scheduling and implementation of work activities
using temporary meeting places, and counselling on living in provisional housings are
implemented to mitigate such risks.
The plan’s goal was to help the residents lead work activity classes and events independently, thus
contributing to formation of communities in provisional housing（Figures 3, 4）.

13

1. Environmental modification
・Remove steps at the entrance, check the safety of its use,and check the client’s ability to move
・Choose, install, and check the use of assistive equipment

2. Creating an active life pattern

Provisional M eeting Space Activity

Provisional Housing Residents Counselling

Beginning Phase

Beginning Phase

Promote residents communication using an
occupational activity room at the provisional
meeting place for handcrafts, gardening,cooking and other activities.

Promotional activity for counselling throughflyers and posters

Activity Phase

Activity Phase

・Increase outing opportunities
・Increase occupational opportunities

Begin an occupational activity led by resident
teacher.

Information gathering from occupational
activity classes and individual home visits.
Information provided to municipalities.

3. Creating a space in provisional housing topromote communication between residents

Developmental Phase
Hold an event participated by provisional
housing residents and community residents.
Begin occupational activity classes forresidents on weekdays.

・Encourage residents to communicate with others
・Create a space to communicate

Figure 3

Living support at provisional housings

Transitional Phase
Occupational activity classes are led byresidents. Transition to an individual
occupational activity.

Figure 4

Occupational therapy program（Iwate Association of Occupational Therapists : Report on Great East Japan Earthquake Disaster Relief Activities）

A provisional housing in Kamaishi City was selected as a target of support. Later, we received a report fromand evacuee who was a member of Iwate Association of Occupational Therapists that residents at theprovisional housing needed support, and it was decided that support activities to be provided at 3 provisional
housing areas in Yamada Town. In Yamada, a reconstruction support network of local volunteers “Odense
Yamada” requested support for residents in provisional housing, and activities were co-hosted with Odense
Yamada. Iwate Association of Occupational Therapists’ headquarters recruited volunteers from members of
the association to provide support.
The activities were announced one week in advance, and local members of Iwate Association of Occupational
Therapists, and supporters put up the posters and passed out the leaflets, while delegating members toparticipate and prepare materials. Activities that were reported in a newsletter distributed among the residents
the followings day.

Provisional housing

14

Making a basket

Bon Festival at provisional housing

Walking】【Support in Kamaishi City】

・ November 2011 – February 2017
・ Started providing monthly support activities (two sessions in daily) at the common room in provisional
housing. We gradually reduced the number of sessions to once a month (one session daily) from May
2012, and once-every-two-months from August 2016.
・ 2 or 3 members of Iwate Association of Occupational Therapists acted as supporters.
】【Support in Yamada Town】
・ October 2011 – March 2014
・ Once a month (two sessions daily) in provisional housing in three regions
・ About 6 members of Iwate Association of Occupational Therapists acted as supporters.
】【Co-host with Odense Yamada】
・ August 2011 – August 2013
・ Held at the community centers near provisional housing in each region・ Men’s cooking, housekeeping, gardening, and exercise classes which aimed at preventing the risk ofmen’s social isolation.
Support activities in provisional housings
Yamada Town

Co-host with OYamada

Kamaishi City

Period3.5 years

2 years

5 years 3months

Venue

3 venues

4 venues

1venueFrequency

55 times

16 times

53 times

Number of people supported

619

237

777

Number of OTs

287

84

144

※OYamada (Reconstruction support network by local volunteers “Odense Yamada”)

15Miyagi
Prefecture
Great East Japan
Earthquake～Miyagi Prefecture～

Great East Japan Earthquake

2011/3/11
March 11, 2011

Outline of Earthquake in Miyagi Prefecture
Outline of Earthquake in Miyagi Prefecture◆Damaged Infrastructure◆Overview of the Earthquake Disaster
Power outage: 1,545,494 units（at peak）
Date/Time：March 11 (Friday), 2:46pm※Recovered on June 18, 2011
Epicenter：Sanriku coast (N38.1, E142.5)
Water: 35 municipalities※130 km east of Ojika Peninsula
Gas: 13 municipalities
Depth：Approximately 24 km
Magnitude : 9.0
Largest recorded seismic intensity：7 (Kurihara)
Tsunami：Port of Sendai 7.2m (Reported by Japan
Meteorological Agency on April 5, 2011）
Ayukawa in Ishinomaki：8.6m（Reported by Japan
Meteorological Agency on June 3, 2011）※Reference：Highest tsunami recorded by tsunami tracing
method conducted）
Shizukawa, Minamisanriku Town：20.2m
Utatsu, Minamisanriku Town：26.1m
Onagawa Town：34.7m
Source: Miyagi Prefecture’s Restoration and Reconstruction

16Damagein Miyagi
Miyagi Prefecture
Prefecture
Damage in◆Extent of Damage（（as of February 28, 2019））
Human Casualties（（pending））
Deaths（including related death）：10,565
Missing：1,221
Severe injury：502
Minor injury：3,615◆Number of evacuees
No. of evacuees：320,885（at peak: March 14, 2011）
No. of shelters：1,183（at peak: March 14, 2011）※All shelters in Miyagi closed on December 30,2011.

※Above data includes damage from aftershocks on April 4, July 25
and 31, August 25, and October 10.

Damage to Residences（（pending））
Destroyed（incl. flooding above floor level）83,004
Heavily damaged（incl. flooding above floor level）155,130
Partially damaged 224,202
Flooding under floor level 7,796
Damage to non-residences 26,796

No. of evacuees outside Miyagi：
9,206 (April 2012) → 170 (February 2019)◆Emergency Provisional Housing and residents
April 2012

February（at peak）

2019

Prefabricated provisional

21,610 homes

196 homes

houses (No. of residents)（53,269）(388）

Privately rented houses

25,137units

138 units(No. of residents)（67,753）（314）

No of residents in Emergency Provisional Housings and other facilities
140000120000122852

126948113527106381122958

100000109956

80000

93260

85393

97154
89130

60000
40000

53247

20000
0

Source:Miyagi Prefecture’s Restoration and Reconstruction
Efforts17

Chaotic
Chaotic –– Recovery
Recovery Phases
PhasesMarch – August, 2011

March – August, 2011
【Initial Response】】
The probability of a subsequent earthquake off the coast of Miyagi was estimated at approximately 60%
within 10 years, 90% within 20 years, and 99% within 30 years. After the Iwate-Miyagi Nairiku Earthquake
in 2008, Miyagi Association of Occupational Therapists prepared the “Manual for Disaster Support Activities”(came into force as from February 12), and offered intra-prefectural cooperation in case of disasters. The
earthquake caused Miyagi extensive damage, including communication network disconnection,
infrastructure disruption, and fuel and information shortages due to the chaotic situation.
】【Support Activities in Evacuation Shelters】
On March 18, 2011, a meeting to discuss contingency plans was held and the Disaster Headquarters
according to “Manual for Disaster Support Activities” (revised on June 15) was established. The Disaster
Headquarters continued collecting information about Miyagi Association of Occupational Therapists
members’ safety, utilizing websites to gather and disseminate the latest information, working with relevantorganizations including Miyagi Prefectural Government, Japanese Association of Occupational Therapists(JAOT), and Miyagi Physical Therapy Association, and securing source of revenue to recruit disaster relief
volunteers and conduct support activities.
・ March 19: Received a disaster relief support request from the Health Promotion Division, Department of
Health and Welfare, Miyagi Prefecture Government (Health Promotion Division of Miyagi Prefectural
Government) to evacuation shelters in Kesennuma area, Ishinomaki area, and within the jurisdiction of
Iwanuma Public Health Center (Natori City, Iwanuma City, Watari Town, and Yamamoto Town) whichsuffered severe damage by the tsunami.
・ March 22: Health Promotion Division of Miyagi Prefecture Government, Miyagi Physical Therapy
Association, and Miyagi Association of Occupational Therapists held a collaborative consultation andreceived a dispatch request to conduct needs assessment in Ishinomaki area, Iwanuma City, and WatariTown. We began to collaborate with JAOT to provide disaster relief support in the affected areas
・ March 24 – April 2: Dispatched staff toconduct a needs assessment in Ishinomaki
area, Yamamoto Town, and Kesennuma area.

Flow of disaster relief volunteering
Dispatch request from Miyagi Prefectural Government(Health Promotion Division or Public Health and Welfare Office)・ April 3: Inspected Wakabayashi Gymnasiumin order to provide support and collaborate
with the use of JAOT model project(Wakabayashi in Sendai City)⇒A request was received, registered volunteer members wereasked to join
⇒Held an orientation about each dispatch area
⇒Began support activities※A report on disaster support activities should be submitted

・ April 8: Discussed the provision of assistive
devices with the Miyagi Prefecture Rehabilitation Support Center・ April 9: Received a dispatch request from Kesennuma Public Health and Welfare Office・ April 11: Briefed members of Miyagi Association of Occupational Therapists about disaster relief
volunteering, and requested a dispatch of JAOT disaster support volunteers.

18

1. Support Activities in Ishinomaki Area・ April 7: In response to a request for cooperation in research on evacuees’ daily performance and economy
class syndrome, we worked with the Health Promotion Division, Department of Health, Ishinomaki City
(Ishinomaki Health Promotion Division), the East Miyagi Public Health and Welfare Office, and Japanese
Red Cross Ishinomaki Hospital to begin support activities at evacuation shelters.
・ April 16: Conducted a research on evacuees’ daily performance and provided assistive devices (walking
sticks, silver cars, etc,.）for those who were living in their homes or shelters and had a substantial needfor assistive devices
・ April 23: Began providing support at social welfare institution evacuation shelters in response to a request
for assistance to transfer evacuees from general evacuation shelters to social welfare institution evacuation
shelters. Environmental modification, participation in activities, mini-days, and individual support wereconducted in collaboration with Ishinomaki City Hospital, Japan Primary Care Association, and physicaland occupational therapists from 10 relevant rehabilitation organizations. Support at social welfare
institution evacuation shelters continued until September with the help of JAOT’s disaster relief
volunteers.
・ May 1: Upon a request from a physical therapist in the east of Miyagi Public Health and Welfare Office,we made a round of health checkups of evacuees in designated shelters in Higashimatsushima City andMatsushima Town.

Cardboard bed

Making cardboard beds

Social welfare institution evacuation shelter
outside Ishinomaki City

Mini-Day at thesocial welfare institution evacuation shelter

19

Environmental modifications
at a social welfare institution evacuation shelter

Assessing risk of disuse syndrome

2. Support Activities in Kesennuma Area
“Recovery from Disaster Kesennuma Community Rehabilitation Support Team” was established at
Kesennuma Public Health and Welfare Office.
Upon a request from Kesennuma public health nurses, care managers, nurses from visiting nursing homes
and staff from medical teams, Kesennuma area rehabilitation specialists (PT, OT and ST), Miyagi Physical
Therapy Association, and Miyagi Association of Occupational Therapists started working together to provide
support services on April 16. The purpose of support was to sustain ADLs, advise on assistive devices andcare, minimize care burden, host a rehabilitation consultancy for each evacuation shelter and living
community, and conduct exercise sessions to minimize the risk of disuse syndrome. As evacuation shelters
closed when people moved to emergency provisional housings and social resources resumed, the support
ended.

＜Considerations when Providing Support＞＞
Kesennuma Public Health and Welfare Office in Miyagi
1. “Support” is different from training or rehabilitation services provided at hospitals.
2. Main purpose is to conduct rehabilitation and make recommendations to improve
activities of daily performance and reduce burden of clients, families, and careers.
3. Without a request, do not prepare a rehabilitation plan or force clients and families tocarry it out.
4. Be aware that environmental modifications to individuals in shelters can be undesirable
and become a cause of trouble with other evacuees.
5. For security, be punctual and return to office as scheduled.

March 30, 2011: Health Promotion Division, Miyagi Prefectural Government
Flowchart:
Dispatching rehabilitation specialists to evacuation shelters

20

Public health and welfare office,Rehabilitation Staff
Collection anddissemination of assistiveequipment, and information

Rehabilitation
Support Center

Disseminating information on
evacuation shelters which
require support

Collaboration

Please dispatch ateam to B shelterin ○○City and C
shelter in ○○City.

Public Health Nurses dispatched from Prefectures
and Municipalities, Disaster Headquarters

Health Promotion Division

RequestRequestあJPTA

Dispatch
Volunteers

Accommodation(delegating tasks
between OT and PT
associations)

Miyagi Physical
Therapy Association

Miyagi Association of
Occupational
Therapists

・ Accepting volunteers
from other prefectures
・ Dispatching staff toaccommodate a support
request・ Accepting volunteers
from other prefectures
・ Dispatching staff toaccommodate a support
requestDispatch

Dispatch

OTs

OTs

Please dispatch ateam to B shelterin ○○City and C
shelter in ○○City.

Dispatch
Volunteers

JAOT

Evacuation Shelters

When a rehabilitation doctor finds a need in clients, doctor reports it to public health nurses,
public health and welfare office, or Health Promotion Division. Once reported, a dispatch
request for rehabilitation specialists is sent.
◎ Please contact Rehabilitation Promotion Team if you need support from PT, OT or rehabilitation
doctors. A support team will be dispatched.
◎ A team of Niigata University and Tohoku University is working on the test for economy classsyndrome, exercise education, and provision of compression stockings. Contact Shokuiku Promotion
Team for any requests or questions. A support team will be dispatched.

21

Reconstruction
Phase
Reconstruction Phase
September, 2011 – February, 2017

September, 2011 – February, 2017

coshel＝making things】【Welcome to “Coshel Group”】
A working team from Miyagi Association of Occupational Therapists provided a monthly disaster relief
group activity, the “Coshel Group” at the emergency provisional housings (47 units) in Higashimatsushima
City Neko area between September 2011 and March 2014. A limited number of volunteers working at the
emergency provisional housings and people gathering from other areas were the reasons to form the “CoshelGroup”.
With the support from Higashimatsushima public health nurses and the president of a residents' association,
the team of volunteers from Miyagi Association of Occupational Therapists was able to use a community
hall close to emergency provisional housings to open a salon for the residents. The salon received a requestfrom Higashimatsushima City to provide activities that 1) become a hobby, 2) activate brain, 3) target men,4) have a name that makes people feel energetic. “Coshel” means making things in Miyagi dialect. The teamplanned and conducted three activities, a cat exercise (pole exercise), tea time, and making things under theconcept of “Coshel Healthy Body, Coshel Things, and Coshel Peers” every month.

Coshel peers

Having a cup of tea

22

Coshel healthy body

Hand massage to relax

Miyagi Association「Coshel group」core members

Cat exercise to improve flexibility“Cat exercise” is an exercise using a pole made of newspaper. Some people continued this exercise at theirhomes and we were able to see an improvement in their flexibility. Making things activity began with anameplate, and something that is seasonal, simple but fancy, and can be made from materials that could
be easily obtained. Some of the participants were male, and some participated with their children andgrandchildren. During a tea time, people not only talked about the disaster or their lives but enjoyedconcentrating on making and sharing their work with peers. Through the support activity “Coshel Group”,
occupational therapists recognized their responsibility to promote people’s connections, occupational
connections, and opportunities, and think together for their participation.

23

Fukushima Prefecture
Great East Japan
Earthquake～Fukushima Prefecture～
Great East Japan Earthquake

2011/3/11

March 11, 2011

Outline of Earthquake in Fukushima Prefecture
Outline of Earthquake in Fukushima Prefecture◆Overview of the Earthquake Disaster
Date/Time：March 11(Friday), 2:46pm
Epicenter：Sanriku coast (N38.1, E142.5)※130 km east of Ojika Peninsula
Depth：Approximately 24km
Magnitude : 9.0
Hama Street after the earthquake◆Fukushima Nuclear Power Station Accident
After an hour of earthquake, Fukushima Daiichi Nuclear
Power Station of Tokyo Electric Power Company Holdings
was hit by 14-15m height of tsunami. Station blackout
occurred in units 1-5. A core meltdown accident occurred
which was caused by the loss of sufficient cooling. It
resulted in the radiation leakage and lead to a serious nuclear
accident.

24

Source: Nuclear Regulation Authority

36 days after the disaster【To Start Support Activities】】
Each branch to begin support activity was agreed at the board meeting ofFukushima Association of Occupational Therapy (April 16, 2011)

Many members of Soso branch, where the power station
was situated at, evacuated and it was extremely difficult
to begin support activity.

To get back a normal life
Providing support activity for evacuees is important but we, members of Fukushima Association of
Occupational Therapy are too evacuees. It was also necessary for us to get our life back, return to a normal
work routine, take a good rest, and relax.
The support activity was started by people who had enoughenergy and ability to support others rather than Fukushima
Association of Occupational Therapy or each branch giving thedirection.

The situation of each evacuation shelter is different andsupport activities were provided in many different ways.
The next section will introduce Aizu & Minamiaizu
branch’s support activities.

Evacuation shelters

25

Emergency
Emergency Restoration
Restoration Phase
Phase
April – May, 2011

April – May, 2011
【The Early Days of Support Activities】】
On the weekends in April, we asked people who evacuated in shelters (gymnasiums etc.) if there wasanything that they were having trouble with at shelters.

We heard the voices “Every morning and night, we do radio gymnastics with public health nurses”, “A danceteacher comes to give us a lesson”, and “I can walk and do not have any issues”, and there seemed to benothing was bothering them.

Activities at shelters】【Changes in Support Activities】
Purpose：Delivering occupations to shelters just for a change
We restarted support activities at shelters in May 1. People began to open up to therapists throughparticipation in occupations and confided their issues, “To tell you the truth, I had a light stroke 5 years ago
and my hands do not move like it used to be”, “It is not easy to walk around the shelter and I often stumble.
I fell in the bathroom”, and “I find it difficult getting up from the mat on the floor”.

We conducted a simple hand and balance assessment, and it was apparent that most residents had some kindof issues and were experiencing a difficulty in living. Through occupations, people felt unwind and relaxedand opened up to therapists. To provide life support at shelters, social environment needs to be approachable
for people to talk and share their stories since some people felt anxious after the disaster and were unfamiliar
to live in an environment like shelters.

26

Recovery Phase
Phase
RecoveryMay – August, 2011

May – August, 2011
Transition from Fukushima Association of Occupational Therapy
to Consultation Support Team
【Establishment of Fukushima Consultation Support Specialist Team】
Fukushima Consultation Support Specialist Team, a part of Fukushima prefecture commissioned project, wasestablished on May 19, 2011. The team consisted of 6 organizations; Fukushima Care Manager Association(the organization in charge), Fukushima Certified Social Workers, Fukushima Association of
Psychiatric Social Workers, Fukushima Association of Psychiatric Social Workers, Fukushima Physical
Therapy Association, and Fukushima Association of Occupational Therapy.

Coordination meeting

Purpose of Activities
 To appropriately grasp the need of people living in evacuation shelters within Fukushima andfunction as one-stop center of general consultation.
 To provide consultation support including advice on the use of long-term care insurance andwelfare services and mental health care in order to minimize the impact of living in evacuation
shelters for a long period of time.
 To provide support services for evacuees is a main task of the team, but the team always cooperates
and collaborates with other relevant stakeholders to avoid being a burden on municipalities.
 To work as a specialist team with respect to each other in order to provide necessary support forpeople and lead them to appropriate services.
Source: Fukushima Consultation Support Specialist Team Activity Report (as of April 2015)27

Flowchart: Consultation Support Specialist Team
※Needs are identified based on information provided by municipalities or patrol screening by support teams①Significant decline in physical functioning②Decrease in mental activity and motication④Appropriate consultation and treatment⑤ Use of supporting the independence of

required

persons with disabilities③Suspected with dementia⑥Support for various procedures required⑦It is ok for now but will require continuous supervision and support for life reconstruction

Ⅰ. The person him/herself is not conscious or uncertain of needs⇒A team in the community conducts an initial intake (it is desirable that some consultants conduct it)
・A team coordinator in the community decides the main member who conducts an intake⇒In case a chief complaint is clear, a specialist team is dispatched.
・A request is sent to the organization in charge of specialist teams(1). Screening by PT, public health nurses etc., (2). Consultation support by mental health care team, (3).
Consultation support by a long-term care support specialist, (4). Needs identification by public health nurses
and MSW, (5). Consultation support by Association of Certified Social Workers, (6). Referral toadministrative agencies, (7). Continuous monitoring support By Fukushima Consultation Support
Specialist TeamⅡ．
．Intention to use medical, nursing care or welfare services is clear

Covered by long-term care insurance (over 65 yr old, orSecondary Insured Person）

Covered by disability support or other welfare services

New
application/
Change ofcategory

Use of services for
those who are
certified for
nursing care

Facility
admission

Disability
SupportMentalHealth Care

Advocacy forhuman rights

Provisionof support
undertemporarycare plan

Request In-homecare manager
association orCommunity
Comprehensive
Care Center tonominate a main
person in charge

Referral to
Fukushima
Nursing Care
Insurance
Office andmunicipalities
forarrangement

Referral to
Disability
SupportConsultant
incommunity

Mentalhealthcare
team

Referral tocertifiedsocialworker

The role of Consultation Support Specialist Team is to manage medical, welfare and nursing care of communities.
The team identifies the needs of evacuees and leads them to appropriate services without any delay.
Source: About Activity of Fukushima Consultation Support Specialist Team28

Reconstruction Phase
Reconstruction Phase
September, 2011 – March, 2013

September, 2011 – March, 2013
【Activity as Fukushima Consultation Support Specialist Team】】
Many evacuees at shelters moved to provisional housings. To
start with, advice on living environment including installationof handrails and removal of steps was the main support activity
and the support was provided in collaboration with Fukushima
Physical Therapy Association. Exercises, recreation andoccupational activities were provided with the aim ofpreventing care and social withdrawal.
Introducing occupations to lead a regular life and improve thelevel of activity was required since people in an unfamiliar
environment tended to isolate themselves.

Removal of steps at provisional housings

Occupational activities at provisional housings29【Publication on “How To live in Winter”（2 years after the earthquake））】
Many evacuees had to accommodate themselves to a
new living environment with a big gap in climate(homes are in the area with a warm climate andshelters are in the area of heavy snowfall). There wasa request from Okuma Town and Naraha Town andthe team conducted a seminar to tell the tips to live in
winter and how to walk in the snow and use a shovel.
Also, a brochure “How to Live in Winter” wasdistributed. It contributed to minimizing the risk offalls of residents and supporters.

Demonstration on how to use a shovel

How To live in WinterSeminar targeting local government staff
to inform the points to be careful in winter】【Publication of OT’s pearls of wisdom (since 2 years after the earthquake)】With the grant from JAOT, the team published a guidebook “OT’s pearls of wisdom”, which contains
information on recreation, handcraft and gymnastics activities. The guidebook was published to help
evacuees participate in activities in their own time since occupational therapists were not able to come andsupport evacuees in evacuation shelters all the time. The guidebook contains how to conduct recreation,
handcraft and gymnastics activities, things to care when participating, and ideas for activity grading.

OT’s pearls of wisdom30

Simple, easy to understandKumamoto prefecture
2016
Kumamoto Earthquake2016 Kumamoto Earthquake

2016/4/14・16
April 14&16, 2016

Outline of Kumamoto Earthquake 2016
Outline of Kumamoto Earthquake 2016
◆Overview of the Earthquake Disaster
Date/Time: April 14, 9:26pm（foreshock）
Epicenter: Kumamoto Chiho
of Kumamoto Prefecture（N32°44.5′, E130°48.5′）
Depth: 11km
Magnitude: 6.5
Date/Time: April 16, 1:25am（main shock）
Epicenter: Kumamoto Chiho of
Kumamoto Prefecture（N32°45.2′, E130°4.7′）
Depth: 12km
Magnitude: 7.3◆Seismic activities
Earthquakes with seismic intensity level of 6 upper
after April 14, 9:26pm
Date
April 14
April 15

April 16

Time

Seismic intensity

21:26

7

22:07

under 6

0:03

over 6

1:25

7

1:45

under 6

3:55

over 6

9:48

under 6Aftershocks(Number of earthquakes with seismic intensity over1)

4,140 aftershocks by midnight, November 13
Source: Cabinet Office, the Extreme Disaster Management
Headquarters, Japan Meteorological Agency’ report31Damage in Kumamoto Prefecture
Damage in Kumamoto Prefecture◆Number of Evacuees
No. of Evacuees：183,882（Total population of Kumamoto prefecture: 1,774,538）
Number of Evacuees
200,000

183,882

180,000
160,000
140,000
120,000
100,000

68,91180,0005,769 3,229

705

364

106

4

0

31 Aug27 Sep28 Oct

1 Nov

18 Nov

11,990 8,178

31 Jul30 Apr17 Apr16 Apr0

15 Apr

20,00031 May25,89440,00030 Jun44,4499 May

60,000◆Human Casualties
Deaths: 50

Related deaths: 220（as of February 13, 2019）※Source: Kumamoto Prefecture Disaster and Crisis Management Administration◆Damage to Residences
Destroyed: 8,339
Heavily damaged: 31,847
Partially damaged: 137,295※Source: Kumamoto Prefecture Disaster Headquarters◆Damaged Infracture
Power outage: Up to 470,000 houses (April 16)※Source: Ministry of Economy, Trade and Industry
Interruption of gas supply: Up to 105,000 houses (April 16) ※Source: Ministry of Economy, Trade and Industry※Source: Ministry of Economy, Trade and Industry
Water outage: Up to 445,857 houses (April 16)32

Chaotic
RestorationPhases
PhasesChaotic- -Emergency
Emergency Restoration
April – July, 2016

April – July, 2016
【Initial Response】】
On April 15 (the day after the foreshock), the Disaster Headquarters was established and safety confirmationof members and investigation of actual damage in the affected areas were in place. Since the situation was
chaotic immediately after the earthquake, and the emergency contact network was not well arranged, it took
considerable time to gather necessary information. Also, a list of members who could respond to the Japan
Disaster Rehabilitation Assistance Team (JRAT)’s dispatch request was prepared.

Kumamoto Association of
Occupational Therapists

JAOT・Established the Headquarters, confirmed
members’ safety, and instructed JRAT
operation
・Was notified of establishment of JRAT

April 14
(foreshock)

April15

Headquarters

April 16
(main shock)・Investigated the disaster situation withdirectors and e-mail to JRAT and otherorganizations to prepare for operation
・Established the Disaster Headquarters
・Directors to instruct each department
and area branch to confirm members’safety・Reported current situations toPrefectural Liaison Council and the
director responsible for JRAT
・Received a sympathy email from
JAOT’s Disaster Prevention Office
・Received information on meeting for
Kumamoto JRAT facilitators
・Received a report from departments andarea branches that there were no direct
human casualties among members

・Reported to JAOT’s Disaster Prevention
Office・Reported the initial response of disaster
relief activities

April 17・Received a dispatch request email from
Kumamoto JRAT・Identified members who could
participate in JRAT activities

33

Japan Disaster Rehabilitation Assistance Team: JRAT
JRAT, a disaster rehabilitation relief team, endeavors to promote collaboration between affiliatedorganizations on daily basis in order to confront adverse circumstances with people in affected areas. In theevent of disasters, the team protects frail evacuees, people with disabilities, and the elderly from the risk of
disuse syndrome, and offers support in difficult situations, and facilitates their independence and recovery.
The team promotes the development of well-structured policies and systems for people to receive secure,safe, and quality rehabilitation. (Source: JRAT website)【Main activities as JRAT】】
Coordination
Department

Operation
Department

Team on site

Became a part of Medical Care and Rescue Coordination Headquarters of Kumamoto
Prefecture and the command was executed in collaboration with other relevantorganizations
Team matching, development of manuals and assessment tools, information sharing,and data administration
Shared information with public health nurses, conducted environmental assessments on
evacuation shelters and implemented preventative measures to reduce the risk of disuse
syndrome

The extent of damage caused by the foreshock was less severe, and it was possible for Kumamoto-JRAT todeal with the situation without support from other prefectures. However, the main shock hit Kumamoto andthe damage spread much wider than previously thought, leading to a dramatic increase in the number of
evacuees and evacuation shelters. Many medical institutions and facilities were damaged, and the situation
exceeded the capacity of Kumamoto-JRAT to deal with. Therefore, support teams were dispatched from otherprefectures, and support activities were conducted in the damaged areas.

Although the team had to start the activities without a34

manual, it was supported by the Headquarters in Tokyo andTeams on site: total 554 teams

people with experience in logistics management from other⇒total number of people participated: 1,774 people

prefectures. The team gradually became organized.

Headquarters operation: 756 people

Recovery –– Reconstruction
Reconstruction Phases
PhasesRecovery
July, 2016 – March, 2018

July, 2016 – March, 2018
【Activities of Kumamoto Disaster Rehabilitation Team】】
The evacuees began to move into emergency provisional housings from evacuation shelters. As JRAT’s
support was completed in mid-July, Kumamoto Disaster Rehabilitation Team was established.

Flowchart:
Dispatching rehabilitation specialists to provisional housing

Kumamoto Community Rehabilitation Support Council

Activities byprofessionalorganizations

Prefecture

Designate

Kumamoto Disaster Rehabilitation Team
(Office: Kumamoto Medical Association)

1. Register dispatch
personnel/team

Alliance

Alliance(Liaison with
Disaster
Rehabilitation
Team and reportissues and requests)(Submission of adispatch request
paper anddiscussion on
dispatch of
specialists)

2.
Dispatchspecialists

Damaged【Affected Areas】】

Community Rehabilitation
Wide Area Support Center

Alliancemunicipalities(Consultation,
policy change)

PrivateComprehensive

companies

Support Center

Community Rehabilitation Wide Area Support Center(excluding affected areas)
Feedback

Community Based Rehabilitation Center・ Medical institutions, Geriatric Health Services Facility, etc
・ Organizations consisting Kumamoto Community Rehabilitation
Support Council (21 organizations) (Medical Association,
Kumamoto Area Rehabilitation Research Group, Kumamoto
University Hospital, Dental Association, Pharmaceutical
Association, Nursing Association, Physical Therapy Association,
Association of Occupational Therapists, Association of SpeechLanguage-Hearing Therapists, Dietetic Association, etc.）★Providing support activities at
emergency provisional housings, etc.
★Lecturing at community care
conference and seminars

35

Framework for Kumamoto Disaster Rehabilitation Activities
~May

June

Provisional Housings

Evacuation Shelters

PatrolApril 2017~March 2018

July~March

Education and guidance fromrehabilitation point of view

Prevention of disuse syndrome andcooperation for Long-Term Care Services◆JRAT(Japan Disaster Rehabilitation Assistance Team)*Kumamoto Community Rehabilitation Support Council,
Kumamoto Rehabilitation Research Group, Medical
Association, etc.

Support to run residents-driven care prevention activities
 Exercise instruction for care prevention
 Home-visits and environmental modifications of temporary houses
 Physical functional assessment
 Provision of activity programs
 Development of self-led group Advice at community care meetings and activity support through seminars etc◆Kumamoto Disaster Rehabilitation Team
◆Community Rehabilitation Wide Area Support Center◆ Affiliated organizations of Kumamoto Community Rehabilitation Support Council

Stationed

Community Based Rehabilitation CenterOther support organizations
Support to promote the activity level of evacuees

Exercise for care prevention
Development of self-led group
Activity program based on interest
checklist

Source: Kumamoto Disaster Rehabilitation Team

【Purpose】
・ Preventing disuse syndrome and reducing the percentage and level oflong-term care needs
・ Introducing free time activities other than care and social welfare services
・ Introducing activities people can participate in at evacuation shelters andemergency provisional housing
・ Supporting people to re-build their lives
・ Providing psychological support
・ A comprehensive approach to meeting evacuees needs
・ Reducing the stress of supporters in affected areas

36

Reconstruction Phase
Reconstruction Phase
2April, 2017 -April, 2017 【Kumamoto Association of Occupational Therapists’ “Fuko (Growing Fortune) Project”】】

Fuko (Reconstruction)

Fuko (Growing Fortune)

・Healthcare monitoring and environmental modifications of residents who are suffering from suddenchanges in their lives are the most important support activities, and these will eventually reduce the riskof disuse syndrome.
・As we move to the next phase of disaster support, people’s needs will change too. In addition to healthcare
monitoring and environmental modifications, we need to discuss the importance of teaching people how
to live a new life and create new hobbies.
・Many residents lost their homes and were forced to live in provisional housing. Environmental factors in
addition to personal factors need to be carefully considered when providing support for such people.
・The project “Fuko (Growing Fortune)”, led by residents, was launched as a tool to form a community.

Support by Kumamoto Association of Occupational Therapists①Recommendation

KAOT④Dispatch request⑤Dispatch

Kumamoto Prefectural Councilof Social Welfare③Application for
dispatch order②Notification and
Recruitment

Municipal Council ofSocial Welfare

In May 2017, therapists begansocial farming activities atthree evacuation housing
centers in Misato Town andparticipated in residents led
activities. A harvest festival
was held on March 25, 2018.

37

Iwate prefecture2016 Typhoon No.10

Typhoon
No.10～Iwaizumi2016
in Iwate
Prefecture～
Iwaizumi in Iwate Prefecture

2016/8/30

30 August,2016
OutlineOutline ofof 20162016 Typhoon
Typhoon No.10
No.10◆Outline of Iwaizumi
Iwaizumi is located in the Kitakami mountain range

of northeast Iwate prefecture, and is the largest town
in Honshu at 992.9 square kilometers (51 km eastwest, 41 km north-south) (Figure 1).
The town is surrounded by the Kitakami mountain
range which reaches an altitude of over 1,000 meters;
94% of the total area is forest. Three rivers empty
into the Pacific Ocean, and houses along the valley
form various small communities.
As of 2015, the estimated population is 9,842 (4,174
households). The rate of aging is over 40%.
◆State of Damage
On August 30, Typhoon No.10 hit the town and the river had
overflowed its banks. It caused extensive damage to housing
and facilities. A group-home with an extended care facility
for the aged, the only outpatient rehabilitation facility intown, was destroyed.

Figure 1 Iwaizumi in Iwate

September 2: 873 people (428 households) in isolation
September 4: 7 evacuation shelters(As of November 2016: death 19 people, missing 2 people)(Source: Satoru Okubo et al, (2016) Report on rehabilitation support
activity in Iwaizumi Town, Iwate after 2016 typhoon No10)

OTs heading to affected areas
38

Emergency Restoration – Recovery Phases
September –– October,
October, 2016
September
2016【Support system and support for evacuees in shelters (September 6 - 15)】】On September 16, 2016, Iwate JRAT began support activities in collaboration with Typhoon 10 Iwate
Disaster Medical Support Network Medical Rescue Support Team. Iwate JRAT also cooperated with the
Iwate Association of Occupational Therapists, Iwate Physical Therapist Association, and the Association of
Speech-Language-Hearing Therapists. Iwate JRAT attended the healthcare and public welfare liaison
meetings held by Iwaizumi Town for information sharing. At the beginning, there were seven evacuation
shelters. Because of widespread road collapse, the team split into two factions to provide separate support in
the eastern and western areas of town.
Disaster Medical
Care Coordinator

Medical Association

Dental Association

Pharmaceutical
Association

Iwate JRAT

Dietetic Association
Figure 2

Iwate Medical
University

Japanese Red Cross
Society Iwate Branch

Iwate Prefectural
Central Hospital

Nursing Association Morioka JRC Hospital

National Hospital
Organization

Iwate Prefecture
Japan Psychiatric
Disaster Welfare Wide Kitakami Saiseikai
Hospitals Association
Area Support
Hospital
Iwate Branch
Promotion Agency
Disaster Prevention
Iwate Prefecture
Iwate Prefecture
Volunteer Support
Bureau of Medicine
Bureau of Welfare
Network

Society of Certified
Clinical Psychologists

Typhoon 10 Iwate Disaster Medical Support Network Medical Rescue Support Team (19 organizations)（Source: Satoru Okubo et al, (2016) Report on rehabilitation support activity in Iwaizumi Town, Iwate after 2016 typhoon No10）】【Preparation to support people who remained at home (September16 - October 2)】
The basic data of 106 clients (name, home address,etc) of outpatient rehabilitation was lost in the flood.
The facility staff members gathered information andprepared to provide support for people who remained
at home. After the safety confirmation, and upon arequest from the clients themselves and public healthnurses, it was decided to provide support for 80 clients
who remained at home.

Support activities at evacuation shelters

39】【Support for people who remained at home (October 2 - 31)】
To reach people who remained at home, it took almost 90 minutes each way because of widespread roadcollapse. Since communities along the valley could not be detected by GPS, Iwate JRAT teamed up withoccupational therapists in the affected areas to conduct home-visit support.
SupportSupporters on site：Total 315 people（over 52 days）
Evacuees targeted：Total 600 people（evacuation shelters 279, homes 321）

OTs working on site

30 AugSupport activities for people who remained at home～week 3～week 1

Typhoonoccured～week 831 OctSupport for evacuees in shelters
Iwate
JRAT
activity
completion

Preparation to go home

Support for people who remained at home

Establisheda liaison
meeting

OTs inaffectedareas began
to work
togetherPT, OT, ST
Associations
began towork
togetherPrepared for
visiting
rehabilitation

OTs in affectedareas took overvisiting
rehabilitation

Figure 3 The Process of Support Activities(Source: Satoru Okubo et al, (2016) Report on rehabilitation support activity in Iwaizumi Town, Iwate after 2016 typhoon No10)40

Iwate JRAT Support System
Teams on site

Headquarters
Headquarters was set up in
Iwate Rehabilitation Center(Shizukuishi Town).
Main tasks were providing
direction to teams on site andaccommodating

teams

to

dispatch.

【Operational Headquarters】】【Units on site】】

Operational headquarters was set up in

Units consisted of 2 -4 members

Saiseikai Iwaizumi Hospital. Main tasksofwere information sharing with publichealth nurses upon receiving direction
from headquarters, matching with teams
on site, preparation of assessment
papers, and data management.
Affected Residents

Iwate

AssociationofOccupational

Therapists

andoccupational therapists in affectedareas. Units visited evacuation
shelters and homes to conduct
assessments and individual andgroup sessions to reduce the riskof disuse syndrome.

Public health, Medical, Welfare, and Care Liaison Meetings(Iwaizumi Town)

Iwate JRATTeam on site

Affected extended carefacility for the aged

Disaster
MedicalSupport
Network
Medical Rescue
Support Team

Saiseikai Iwaizumi
HospitalNursing
Association,
Care
Manager
Association

Iwate JRAT Headquarters（Iwate Rehabilitation Center）

Iwate Prefecture,
Medical
Association

Iwate Medical
University

PT, OT, ST
Associations

Figure 4 Disaster Rehabilitation Support Structure in Iwaizumi Town
(Source: Satoru Okubo et al, (2016) Report on rehabilitation support activity in Iwaizumi Town,
Iwate after 2016 typhoon No10)

Iwate JRAT activities were completed at the same time as the local visiting rehabilitation services began.
Throughout the activities, Iwate JRAT tried to provide rehabilitation support without a delay by grasping
the situations of evacuation shelters accurately and identifying and supporting people with longterm care needs who remained at home.

41

Support activities in affected four prefectures
Support activities- Howintheyaffected
worked together - four prefectures- How they worked together -The following reports on when occupational therapists were dispatched to the four affected prefectures, andwhere they were assigned provide disaster support activities.

1．Great East Japan Earthquake
1）IwateDuring the reconstruction phase, Iwate Association of Occupational Therapists began support activities
upon a request from Iwate Prefecture and Council of Social Welfare of affected municipalities.
2）Miyagi
Upon a request from Miyagi Prefecture and affected municipalities, rehabilitation specialists in publichealth centers took a role of coordinator and Miyagi Association of Occupational Therapists conductedsupport activities.
3）Fukushima
Upon a request from Fukushima Prefecture and affected municipalities during the recovery phase,
Fukushima Association of Occupational Therapy conducted support activities as part of the specialist team.

2．2016 Kumamoto Earthquake
・Kumamoto
JRAT began its activities soon after the earthquake occurred and worked with Kumamoto Disaster
Rehabilitation Team during the recovery phase. Kumamoto Prefecture and Councils of Social Welfare inaffected municipalities took a role of coordinator and Kumamoto Association of Occupational Therapists
provided support activities during the reconstruction phase.
3．2016 Typhoon No.10 (Iwaizumi Town in Iwate Prefecture)・IwateIwate Association of Occupational Therapists conducted support activities as part of Iwate JRAT.

42

The rolerole ofof occupational
occupational therapists
therapists ininThe
disaster relief
relief activities
activities
disaster- Lessons learned from the Great East Japan Earthquake, 2016 Kumamoto Earthquake and 2016 Typhoon No.10 -- Lessons learned from the Great East Japan Earthquake, 2016 Kumamoto Earthquake and 2016 Typhoon No.10 -Many occupational therapists in affected areas and disaster support volunteers contributed their time tosupport people affected by the Great East Japan Earthquake, 2016 Kumamoto Earthquake, and 2016 Typhoon
No.10. Below is a report on the role of occupational therapists in disaster relief activities.
1．Chaotic Phase (Onset of Disaster - 72 hours)
Since the top priority during the first 72 hours is search-and-rescue and lifesaving medical triage,
occupational therapists as one of medical professionals got involved in transporting injured people andadministration. Another role during the chaotic phase was gathering information on damage caused by thedisaster and modifying the environments of Disaster Headquarters, evacuation shelters, and other relevant
facilities to meet the needs of users.
2．Emergency Restoration phase: Living support in emergency shelters (Day 4 – 1 month)
Support at evacuation shelters is required during this phase. Firstly, the support activities were begun byprefectural associations of occupational therapists in the Great East Japan Earthquake and JRAT in the 2016
Kumamoto Earthquake and 2016 Typhoon No.10.
1) Functional assessment of evacuees in shelters
A good understanding of the environmental situation and health conditions of evacuees in evacuation
shelters is required. Therapists conduct health checkups and gather information on how people live inevacuation shelters.
2) Environmental modifications in shelters
There is not enough personal space for individuals in evacuation shelters. Since the elderly and people
with disabilities, in particular, will find difficulties living in such situations, therapists need to addressthese issues and create a comfortable environment for people. It can be done by securing personal
space, removing steps, and improving accessibility within a shelter, etc.
3) Selection of assistive equipment
Since the elderly and people with disabilities are more likely to face barriers and obstacles to thephysical environment in evacuation shelters, therapists prescribe shoes and walking sticks and secure
safe access within a shelter. Therapists address living difficulties, for example, by creating a table forpeople experiencing difficulty when eating and selecting and prescribing assistive equipment to meetthe demands of individuals.
4) Building a stable daily rhythm
Living in shelters may lead to people’s loss of purpose in their lives, inactivity, and monotonous life.
Therapists provide opportunities to participate in group activities such as exercise and occupationaltasks (handcraft, gardening, etc) to help people achieve and maintain a stable daily rhythm.

435) Maintaining physical functioning and preventing the risk of disuse syndrome
The reduction in daily activity level and physical functioning eventually leads to physical inactivity
and disuse syndrome. Living in a shelter over a long period of time has a greater risk of physicalinactivity among elderly and people with disabilities. Early detection of disuse syndrome,
implementation of preventative measures such as group exercise, and provision of ADLs support
including standing up and waking up tasks are essential.
3．Recovery Phase: Living support in shelters and provisional and reconstruction housings (2 – 6 months)
This is the phase in which evacuees move to provisional and reconstruction housing from evacuation shelters.
Since more personal spaces are available in provisional housing, therapists can provide more individualized
support. As there is still a risk of social isolation or withdrawl, measures to minimize its risk should be
introduced.
1) Environmental modifications at provisional and reconstruction housings
Therapists conduct necessary modifications and make recommendations in order to meet individual
needs. Such modifications include removing steps to reduce the risk of falls and installing handrails.
2) Increasing the level of activity with the aim of reducing a risk of social isolation/withdrawal
Although more personal spaces are available, there is still a risk of social isolation or withdrawal as aresult of reduced opportunities to communicate with others. Therapists help people form a community
by introducing opportunities to participate in group exercise and occupational tasks (handcrafts,
gardening, etc.).
3) Maintaining physical functioning to ward off disuse syndrome
The reduction in daily activity levels and physical functioning eventually leads to physical inactivity
and disuse syndrome. In particular, the elderly and people with disabilities experience a decreased
level of activity caused by changes in their environment. Therapists implement preventative measures
such as group exercise and provide ADL support, for including standing up and waking up tasks.
4．Reconstruction Phase: living support in provisional and reconstruction housings (6 months - )Since living in shelters over a long period of time causes a sense of disturbance and instability in physicaland mental functioning, continuous support for evacuees are required.
1) Living support to prevent social withdrawal and disuse syndrome
Therapists implement group exercise and occupational activities (handcrafts, gardening etc,.) in
community spaces. Continuous support such as exercise and occupational activities are essential inorder to achieve a stable daily rhythm.
2) Supporting formation of a community
A new community is formed as people begin to settle into a new life. Forming a group or community
through occupations which draw out people’s individuality is an important step during this phase.
Therapists open a salon where people can participate in occupational activities and exercise, and thesalon should be eventually led by residents.

44】【Lessons Learned】
Looking back upon our experiences over those disasters, the community JRAT has been established in eachprefecture in recent years, and occupational therapists are taking an important role in disaster relief activities
during the chaotic and emergency restoration phases. Although occupational therapists will continue to workas part of JRAT, community JRAT in each prefecture will be required to strengthen their level of collaboration
with other specialists in order to prepare for future disasters.
During the recovery and reconstruction phases, JRAT activities gradually come to an end and activities willbe led by prefectural associations and municipalities. During natural disasters, nothing seems to be more
important than the mutual assistance within the community. Communication with other therapists in nearby
prefectures and organizing a support system will be essential.
In addition, a smooth transition to Comprehensive Community Care System is necessary for evacuees as
they eventually become residents in those areas. Therapists not only complete their support in medical carefor people affected, but have an important role in establishing a good rapport within the community andgovernment. It is hoped that the spirit of local networking is nurtured even when there are no disasters
to make sure that evacuees have access to continuous support.

JRAT supporting people who remained at home
after 2016 Kumamoto Earthquake※Figures and pictures in this report were kindly provided by Prefectural
Associations of Occupational Therapists and Prefectural JRATJapanese Association of Occupational Therapists (JAOT)

45

復興の歩み2020 年 12 ⽉
発⾏：⼀般社団法⼈

⽇本作業療法⼠協会

住所：〒 111-0042

東京都台東区寿 1-5-9

TEL：03-5826-7871

災害対策室
盛光伸光ビル 7F

FAX：03-5826-7872

Japanese Association of
Occupational Therapists