11th March 2011: earthquake and tsunami: Japan one year after

Mdecins du monde Japan:

Doctors of the world first came to Japan for an intervention following the big Kobe earthquake in 1995. MdM Japan was created in 1995, shortly thereafter. Because an advance emergency relief plan is indispensible, MdM Japan drafted a Disaster Action Plan. The result of this work was that Japans official disaster prevention plan provided for a close network between administration, fire departments, transport systems and medical care, therefore eliminating the need for an NGO to provide additional relief activities. However, the seriousness of the disaster in March 2011 forced us to change our plan.

Earthquake, tsunami, nuclear danger

On 11 March 2011 the Pacific coast of Japan was hit by the most powerful earthquake in Japans history: a magnitude 9.0 (Mw) undersea mega thrust earthquake. From a global perspective it was one of the five greatest earthquakes ever since record keeping began in 1900. In the wake of the earthquake, tsunami waves up to 40.5 meters (133 ft) hit the coast in Iwate prefecture causing many deaths, casualties and other victims. The Japanese National Police Agency confirmed over 15,000 deaths with several thousand people injured or missing. The earthquake and tsunami also caused vast structural damage: 125,000 buildings damaged or destroyed, 4.4 million households affected by electricity blackouts and 1.5 million without water supply. The earthquake was felt as far away as Tokyo and many people were unable to return to their homes that day. Some of our team members lost their homes because the buildings they lived in had been damaged or partly collapsed. Pictures of streets, congested with people trying to get home by car at night were broadcast on TV. Pictures of the northern towns being attacked by the tsunami were shown over and over. You saw industrial complexes on fire; even after the tsunami a blazing fire in the darkness could now and then be seen. The number of dead or missing people steadily mounted. Immediately after the earthquake we received many, many emails, phone calls and letters of encouragement from all over the world. Friends whom we were working with at relief projects and partners who always supported our work sent words like Daijyoubu Are you ok? Anbare Dont give up! It was the first time we had ever experienced such heart-warming sympathy and encouragement and we were moved to tears. We now know how important it is to know that we were not alone. Thanks to the people who supported us, we found the strength to do our best to help the people who are now struggling in Northern Japan, as well as in the streets of Tokyo, and to create a new Japan, based on solidarity. The aftershock continued, and control of the reactor in the Fukushima I Nuclear Power Plant was lost; the stress level in Japan was at its peak. We felt strongly compelled to do something. Being Japanese, we had to act. We needed to make the most of our mobility capacities, expertise and experience (know-how). That's exactly how all of our team members and volunteers felt. So, we started to work in coordination with other stakeholders to find out for which projects and where our help was needed most. 1

MdM Japan in action

One of the towns severely damaged was Otsuchi in Iwate. With an estimated population of 16,727 in 2003, about 10% of the towns total population was wiped out in the disaster. The higher-lying areas of the town were also affected by the earthquake and the aftershocks but the harbour and lower areas were literally razed to the ground. Nearly 9,000 people lost their homes and were seeking shelter in the homes of family members and friends and 40 to 50 refuge centres. This is where we started working, on 3 April.

The O on the house means that corpses were found. When they were removed an X was written.

Looking at Otsuchis destroyed downtown

Temporary shelter

Working with the people in Otsuchi

Psychiatrist in action

Description of post-tsunami action

Tokyo Project, working with the homeless since 2010: after the earthquake, we immediately opened the doors of our Tokyo Project office to give the homeless someplace to go. As all shops were immediately cleared of all easy-to-prepare food, MdM welcomed the homeless who were able to cook and eat together. As usual, in such moments, the homeless are widely forgotten, even though they too had lost members of their families. One of the homeless people in the Tokyo Project came from a village near Otsuchi, where not a single house was left standing after the tsunami. The Tokyo Project team made a point of keeping all activities going with the homeless, trying to offer some comfort.

Shop in Tokyo a few days after the earthquake

3rd April to July 2011 The team of eight members of the Doctors of the World, made up of two psychiatrists, two nurses, a relaxation therapy expert specialising in emotional and psychological care, a project manager, a logistician, and a medical coordinator had been visiting temporary shelters and private homes beginning on 3rd April. An acupuncture team also added to handle a wide range of constantly changing medical needs. Furthermore, from May to the end of July, MdM teams worked in secondary schools with adolescents and the staff taking care of them. Three months after the disaster, all the rubble was totally removed and it was possible to see the sea from downtown again. Temporary prefab housing sprung up and some families left the evacuation centers to move into these new houses. The hospital moved to another makeshift site on the mountainside. Everyone, going from children to the elderly, those living in small and cramped shelters, as well as those in large and anonymous ones or in the new prefab houses, all of them had endured immense emotional strain and showed signs of instability as we could tell from their faltering voices.

In July most stakeholders who had come to support the people in Otsuchi after the tsunami, stopped their programmes. We at MdM Japan decided we could not simply stop our help and leave the people alone.

Team meeting

Outside the temporary shelter

Collective relaxation exercises in a shelter. Photo Eric Rechsteiner- July 2011

August to December 2011 Beginning of July, Doctors of the World set up a Stress consultation room for medical treatments. A psychiatrist, and a nurse kept regular consulting hours. Affected residents could visit the room when they needed to meet mental care experts. Most volunteers (including police and self defense forces) had left by the middle of August. The MdM team also aimed at reaching the affected people who were unable to come to the room, so they made home visits. Dr Suimei Morikawa, a volunteer psychiatrist at MdM, said that after moving from shelter to temporary housing, people experienced heightened loneliness and their faces became clouded with anxiety about their future since familiar surroundings, their relations and friends simply weren't there anymore. We met many people wanting to commit suicide, filled as they were with hopelessness about their future.

Acupressure

December 2011 to today In response to requests from residents who participated in an exercise programme during the first three months, Doctors of the World launched its regular exercise programme on 23rd December. Today, this programme takes place twice a month for three days, and is conducted by three relaxation experts. One psychiatrist and a one coordinator of MDM Japan said, We are not only aiming at the physical and mental health of the individual residents, but we are also aiming at recovering a community. KIZUNA means a bond of friendship between residents in the area. We will extend the programme jointly with local collaborators.

Talking with the psychiatrist (February 2012)

After the shelters, temporary housing (February 2012)

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Otsuchis centre in February 2012: wiped out, nothing left

IN FIGURES
Activities (03 April to 31 December 2011) Days of Activity: 192 days MdM Japan members involved: 188 people including 151 volunteers 959 consultations, including by phone; 253 prescriptions filled Funds collected: In 2011 (including pledged donations to be received in 2012) = 113 million yens (ca. 1 million euros) Expenditures: In 2011 = 26 million yens (ca. 244,000 euros) Funds already committed for 2012 = 78 million yens (ca. 732,000 euros)

Acting today for the future

MdM Japan faces several challenges: 11

The Iwate Prefecture Mental Health and Welfare Centre, and the Kamaishi Health Centre, which has been providing mental health care along with other prefectural and municipal bodies, began to scale back their on-site activities. Doctors of the World has become responsible for all the continuing outreach work. All the evacuation centres in Iwate Prefecture closed at the end of August. Even here in Otsuchi, everyone has moved into temporary accommodations. Because of this, the disastrous effects of the earthquake and tsunami are much less obvious, and as the victims move into their new homes it has become increasingly difficult to reach them. We have a new challenge in Tohoku: the reconstruction of the local mental care system based on the local community. We will continue to support activities in the affected areas. We want keep up our work in properly assessing residents needs in order to be more effective.

Collective training session to overcome insomnia (February 2012)

The hospital moved to another provisional site. Many medical professionals have left.

Doctors of the World opens two new programmes in January 2012.

The Fukushima So-So project: Doctors of the World is supporting the new clinic focusing on psychiatric outreach in the Soma and Minami-soma area (hence the So-So area) in Fukushima prefecture. Supporting a local NGO, we help organise psychological care support, providing medical equipment and helping the reconstruction of the local medical system. There hasn't been any psychiatric service and support after the effects of the earthquake and nuclear accident after 11 March in the So-So area. Most of the psychiatric clinics have been closed. The clinic will become a regional hub of psychiatric support. This 12

project has been developed in cooperation with the Non Profit Organisations Committee to create a totally new mental health care system. The anticipated annual number of beneficiaries of this program is 1,200. Medical system recovery project in Iwate By the request from the Medical Department of Iwate Prefecture, Doctors of the World is supporting the construction of a building for scanners rooms in the temporary hospital in Otsuchi and Yamada in Iwate Prefecture from February 2012. The anticipated annual number of beneficiaries of this program is 2,000.

Conclusion
We have decided to continue our support to Tohoku at least until the end of 2012 despite the fact that other non-profit organisations have reduced their support. We will not abandon this area as long as so many people need our support, We will go on providing mental healthcare, medical equipment, and we will keep on helping reconstruct the health system in the region. ----------------------------------------------------------------------------------------------------------------------------- ---------Tohoku Northeastern region of Honshu Nicocoro name of the MdM Japan program in Tohoku area Otsuchi a city in Iwate prefecture, in Tohoku region

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