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YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT (JAPAN EARTHQUAKE AND TSUNAMI)

YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT (JAPAN EARTHQUAKE AND TSUNAMI). KEY LINKS. GOVERNMENT OF JAPAN http :// www.kantei.go.jp Prime Minister of Japan and His Cabinet Japan Meteorological Agency Japan Fire and Disaster Management Agency

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YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT (JAPAN EARTHQUAKE AND TSUNAMI)

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  1. YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT (JAPAN EARTHQUAKE AND TSUNAMI) KEY LINKS • GOVERNMENT OF JAPAN • http://www.kantei.go.jp • Prime Minister of Japan and His Cabinet • Japan Meteorological Agency • Japan Fire and Disaster Management Agency • Ministry of Foreign Affairs of Japan • Ministry of Health, Labor and Welfare • Japan Coast Guard Data Collection via Google Translate • Nuclear and Industrial Safety Agency - All updates are in PDF Only • Minister of Economy, Trade and Industry • Japan National Tourist Organization • Ministry of Land , Infrastructure, Transport and Tourisms • Ministry of Agriculture, Forestry and Fisheries • INTERNATIONAL ORGANIZATIONS • RELIEFWEB • UNICEF • International Nuclear Safety Center • International Atomic Energy Agency • Global Disaster Alert and Coordination System • WHO • WHO Western Pacific Regional Office • US GOVERNMENT ORGANIZATIONS • The Department of State • U.S. Agency for International Development • OFDA • The Department of Defense • Pacific Command • 7th Fleet • Yokota Air Base, Japan • The Department of Health and Human Services • Centers for Disease Control and Prevention • CDC- Tsunami • CDC-Earthquake • CDC-Radiation Emergencies • EPA • US Geological Survey • NOAA Center for Tsunami Research • NOAA Pacific Tsunami Warning Center • PORTALS AND RESOURCES • All Partners Access Network (APAN) • Japan Disaster Wiki • CATDAT and Earthquake Reports • GDACS • Center of Excellence – Disaster Management Humanitarian Assistance • Earthquake Research Institute, University of TokyoNational Center for Disaster Medicine and Public Health • Google Crisis Resources • LIBRARY • National Medical Library – Japan Earthquake • Disaster Information Management Research Center • Radiation Emergency Medical Management BACKGROUND CURRENT SITUATION GOVERNMENT OF JAPAN JAPANESE RED CROSS US RESPONSE UN RESPONSE OTHER ORGANIZATIONS A 9.0 magnitude earthquake hit Japan, unleashing a tsunami. HOSPITALS AND MED TEAMS HEALTH RISK SHELTER TRANSPORTATION AS OF 1200 HRS EDT 16 APRIL 2011 Note: The Yale/Tulane Japan Earthquake and Tsunami brief will be produced weekly.

  2. EARTHQUAKE AND TSUNAMI • On 11 Mar 2011 05:46 UTC, a 9.0 magnitude earthquake struck 400km north-east of Tokyo off the coast of Japan, triggering a tsunami that flattened parts of the northeast coastline. • The earthquake’s hypocenter was 24.4 kilometers deep (shallow; most dangerous).The 9.0 magnitude makes it the fourth largest in the world since 1900 and the largest in Japan since modern instrumental recordings began 130 years ago. • Researchers at the Yokohama National University and University of Tokyo say that the tsunami reached as high as 29.6 meters in Ofunato City, Iwate. This figure exceeds the previously reported record of 20 meters. • There were seven tsunamis waves over a six hour period after the earthquake. The first and the largest tsunami was recorded 26 minutes after the earthquake. • Japan’s Geospatial Information Authority estimates that at least 443 square kilometers (equivalent of 53,000 football fields or five times the size of Manhattan Island) of coastline was inundated by seawater. • In Fukushima and Miyagi, about 110 kilometers of coastline was submerged and the water reached as far inland as five kilometers. Seawater still hasn’t receded in about 70 per cent of the flooded areas. In Minami-soma, Fukushima, water pumping is ongoing to remove seawater covering about 350 hectares. • DEATH AND DESTRUCTION • Worst-affected areas are the prefectures (states) of Miyagi, Fukushima, Iwate, Yamagata, Ibaraki, Chiba, Akita and Aomori. The tsunami caused severe damage along 600 km of northeast coastal regions. • The population in these areas before the disaster was estimated at over 14.8 million people, of which 1.6 million lived within 5 km of the coast. Areas near the coastal city of Sendai in Miyagi prefecture were the hardest hit, and had a population of some 1 million people. • KEY FACTS • 4th strongest earthquake worldwide since 1900 • Tsunami up to 30 meters high inundated 433,000 square kilometers of land • 492,000 people were evacuated • 20 International Search & Rescue teams from 15 countries responded • 58,610 homes and buildings destroyed, 177,729 damaged • More than 119,000 emergency service personnel responded within 8 days • Estimated damages of $US 309 billion • More than $951 million has been donated bilaterally • 13,540 dead and 16,963 missing JAPAN EARTHQUAKE AND TSUNAMIBACKGROUND Government of Japan, 4 Apr 2011CATDAT Report: 12 April 2011 US Geological SurveyNOAA Center for Tsunami Research

  3. FATALITIES AND MISSING • RECOVERY OF REMAINS • From 1 - 4 April the Japan Self Defense Force and the US military launched a three-day joint operation to recover the bodies of people still unaccounted for in the coastal areas of Miyagi, Iwate and Fukushima. Approximately 18,000 Self Defense Force personnel and 7,000 US military personnel will participate in this search on land, sea and from the air using 120 aircraft and 65 naval vessels. • On 7 April around 300 police searched for missing bodies inside the 20-km deserted evacuation zone around the Fukushima Daiichi Nuclear Power Plant that has been largely off limits because of a radiation leak from a nuclear power station. Around 3,900 people are missing in Fukushima and many are thought to have died within the evacuation zone, according to NHK. (NHK, AP, April 7) • On 14 April Japanese police searched for the missing moved to within 10 kilometers of the crippled Fukushima nuclear plant for the first time wearing white, protective suits to shield them from radiation that has leaked from the facility since the disaster. The team of recovered 10 bodies in the debris of a tsunami-devastated town near the plant. The concern is that there may be up to 1,000 bodies may be in the area. • CASUALTIES AS OF 15 APRIL 2011 • Hokkaido - 1 dead • Aomori - 3 dead, 1 missing • Iwate - 3900 dead, 4098 missing • Miyagi - 8275 dead, 10317 missing • Yamagata - 2 dead • Fukushima - 1302 dead, 2544 missing • Ibaraki - 23 dead, 1 missing • Tochigi - 4 dead • Gumma - 1 dead • Chiba - 18 dead, 2 missing • Kanagawa - 4 dead • As of 15 April 2011: • 13,540 dead and 16,963 missing = Total of 30,503 dead or missing • NOTES: • Some of the missing may never be found because the tsunami likely pulled bodies out to sea. • Recovering the bodies of the missing is seen as an important step in helping the country to move on but according to officials time is running out to find and identify the remains because of decomposition Japan's Ground Self-Defense Force members take a moment of silence exactly a month after a massive earthquake struck the area in Otsuchi, Iwate Prefecture, Monday, 11 April. (AP / Yomiuri Shimbun, Yasuhiro Takami) Voice of America 14 April 2011 CATDAT 15 April 2011

  4. AFTERSHOCKS • On April 11 at 1716 hours Japan Standard Time (JST), or 0416 hours Eastern Daylight Time (EDT), a magnitude 6.6 aftershock occurred in eastern Honshu—approximately 22 miles west of Iwaki, Fukushima Prefecture, and 161 miles northeast of Tokyo—at a depth of approximately 6 miles, according to the U.S. Geological Survey (USGS). The earthquake killed one person, disrupted power for approximately 220,000 households, and temporarily interrupted power and pumps used for cooling reactors 1, 2, and 3 at the Fukushima Daiichi site. • · On April 12 at 0808 hours JST, or 1908 hours EDT on April 11, a magnitude 6.2 aftershock occurred just off the east coast of Honshu—47 miles southeast of Tokyo—at a depth of approximately 8 miles. Minimal damage occurred due to the aftershock. • USGS and the Japan Meteorological Agency noted that aftershocks of magnitudes above 6.0 will likely continue to occur regularly throughout the coming months. JMA Tsunami Warning: 11 April 2011 USGS Magnitude 6.6 Earthquake: 11 April 2011USAID Japan – Earthquake and Tsunami Fact Sheet #16, Fiscal Year (FY) 2011

  5. SITUATION • LIVELIHOODS • The Special Task force for Livelihood Support for Affected Populations was established to coordinate relief activities and rehabilitation in the affected areas, and the Disaster Volunteer Coordination Division for assisting volunteer activities by Japanese civil society. • The GoJ plans to allocate 1 trillion yen (US$11.9 billion) to curb job losses and help the unemployed • Japan has now firmly moved into the Recovery Phase despite strong aftershocks continuing to rock the county and the on going crisis at the Fukushima Daiichi Nuclear Power Plant. The cost of Recovery will likely be in the hundreds of billions and reconstruction will take years. • SHELTERS & EVACUATION • There are currently 141,528 displaced people living in 2,230 evacuation centers in 17 prefectures. The number of evacuees had peaked on March 15 at 440,000 people. • 85% of evacuees are concentrated in the worst affected prefectures of Iwate, Miyagi and Fukushima. Those who evacuated outside the abovementioned prefectures reached to more than 22,000 persons, mostly from the 20 km evacuation zone around the Fukushima Daiichi Nuclear Power Plant. Another 136,000 people who live within 20-30 km of the plant were encouraged by the authorities to evacuate or stay indoors. There are elderly and/or disabled people remaining in the 20-30 km zone who lack of means for daily food and medical services that they require due to the slow/stopped economic activities in the area. • Construction of temporary houses is slow at the moment despite the large needs. A total of 62,000 temporary houses have been requested by municipalities in Iwate, Miyagi and Fukushima. There are 4,321 houses in the process of construction in three prefectures. The government is planning to construct 30,000 temporary housing within 2 months, but the project is facing challenges, such as the delays in land acquisition and removal of debris in the affected areas, and the shortage of construction materials since nearly 50% of plywood production came from the affected areas in the Tohoku region. The current temporary housing plan does not include the provision of furniture, daily commodities and electric appliances. • At the same time, the number of those who returned to their residences and remained in the affected areas since the day of the earthquake tsunami is not clear. Municipal governments, in cooperation with NGOs and other civil society organizations, are now trying to reach out those people outside the official evacuation centers and assessing the needs of vulnerable populations. • POPULATION NEEDS OUTSIDE THE SHELTER • The number of those who have returned to their residences or remained in the affected areas since the day of the earthquake tsunami is not clear although it is estimated to be quite large. Many people who were originally living in evacuation centers have returned to their homes despite damage and no utilities. • Municipal governments, in cooperation with NGOs and other civil society organizations, are now trying to reach out those people outside the official evacuation centers and assessing the needs of vulnerable populations Japanese search for family albums and belongings among a pile of items recovered from the area devastated by the March 11 earthquake and tsunami and displayed at a school gymnasium in Natori, Miyagi Prefecture, Japan, Wednesday, April 13, 2011. Volunteers have been cleaning photos and personal possessions retrieved from damaged homes in the hope that they can be returned to survivors of the tsunami. (AP Photo/Sergey Ponomarev) COE-DMHA Update: 13 April 2011 WHO-WPRO SitRep No. 25: 06 April 2011 CATDAT- 12 April Report USAID Fact Sheet #15: 08 April 2011

  6. SITUATION • NUCLEAR SITUATION & RADIATION CONTAMINATION • On 12 April, Japan’s Nuclear and Industrial Safety Agency (NISA) revised upward its evaluation of the severity of the situation at Fukushima Daiichi nuclear power station to level 7, which is the maximum rating on the International Nuclear and Radiological Event Scale (INES). A Level 7 rating is characterized as a “Major Accident,” involving major release of radioactive material with widespread health and environmental effects requiring implementation of planned and extended countermeasures. • Japan’s Chief Cabinet Secretary Yukio Edano said that the evacuation of residents within 20 km (12 miles) of the Fukushima Daiichi nuclear plant (FDNPP) would be “long-term” as the crisis continues with no definite end in sight. Around 78,000 people live in the mostly rural area. • The GoJ said on 11 April that because of accumulated radiation contamination, it would encourage people to leave certain areas beyond its 20 km zone and that children, pregnant women and hospitalized patients should stay out of some areas 20-30 km from the nuclear plant. (Reuters, 13 April) • A ban imposed March 23 on shipments of raw milk from Ibaraki prefecture was lifted after tests showed it is no longer contaminated with radioactive materials above the designated limit for consumption. (Japan Times, 11 April) • Excessive levels of radioactive cesium were found in young sand lance fish caught some 22 miles (35 kilometer) from the troubled Fukushima Daiichi plant and some 550 yards (500 meters) off the city of Iwaki in Fukushima Prefecture. One of the sample fish had a level of cesium at 12,500 Bq/kg, some 25 times higher than the legal limit of 500 Bq/kg. (Kyodo News, 13 April) • Japan’s science ministry says radiation levels in seawater off the coast of Fukushima Prefecture are highest since it began monitoring some three weeks ago. It said the level of iodine-131 was 88.5 Bq/l or some 2.2 times higher than the legal limit in samples taken some 18 miles east of the plant on 11 April. • FOOD • According to the GoJ, nearly 19 million meals have been delivered to the affected area while additional 4.6 million meals are under delivery. Sufficient drinking water has also been delivered together with non-food Items such as blankets, fuels and sanitary items, especially to evacuation centers. • Nutritionists have warned that the current carbohydrate concentrated food supplies to survivors, such as rice balls and breads, could upset the evacuees’ health, and recommended to increase variety of food supplies with sufficient vitamins and minerals. • On 13 April, litate Village in Fukushima decided not to plant vegetables and rice this year. • WATER • MLIT reports that around 300,000 households in 8 prefectures are still without running water as of April 13. The ministry has sent water trucks to the affected areas. (NHK, April 13) More than 400 water supply companies deliver water to those without access to tap water for drinking. Hygiene is continually affected by shortage of daily use of water, especially in evacuation centers. • SEWER • MLIT reports that as of 15 April, 63 treatment facilities and 71 pump facilities in 11 prefectures are damaged. Sewers are also damaged. • EDUCATION • Over 6,600 schools in 24 prefectures have structural damage due to the disaster. Around 1,700 public schools (70%) have been damaged by the disaster in Iwate, Miyagi and Fukushima. As of 1 April, 291 primary and junior high schools have so far no prospect of resuming their classes. Another 345 schools are being used as evacuation centers. Each prefecture is considering using unused public facilities in other locations to minimize the delay to school opening. 155 primary and junior high schools and 27,600 students have so far no prospect of resuming their classes. MLIT Update: 15 April 2011 JANIC Situation Report 8 April 2011 COE-DMHA Update: 13 April 2011 WHO-WPRO Report No. 28: 13 April 2011 USAID Fact Sheet #15: 8 April 2011

  7. SITUATION • GAS AND FUEL • Gas supplies have been restored to roughly 32 per cent of households and 228,509 households remain without, as of 5 April, compared to 330,000 households on 1 April. • As of April 12, 2,888 out of 3070 service stations (94%) located in the Tohoku regions were in operation. • METI reports that temporary fueling sites were established and provided fuel to a total of 8,800 vehicles over 19 days (from March 27 to April 14), in 9 municipalities. • METI reports that 303 additional tanker trucks have already arrived in the Tohoku region. By using portable or second-hand fuel tanks, 7 service stations in 5 municipalities resumed temporary operation as of 14 April. • TRANSPORTATION - As of 15 April, MLIT reports that: • ROADS: 1 expressway, 15 national highways (under MLIT’s management), 29 national roads (under management of local government), and 224 local roads are closed. Of these, 2 national roads and 9 local roads are closed due to the earthquake on April 7 and 1 national road and 4 local roads are closed due to the earthquake on April 11. • RAILWAYS: Service stopped on 20 lines of 7 operators (including Tohoku Shinkansen). Of these, service stopped on 4 lines of one operator due to the earthquake on April 7 (including Tohoku Shinkansen). • BUSES: 24 operators are partially out of service. Of them, express buses of 1 operator are partially out of service due to the earthquake on April 11. • AIRPORTS: all 13 airports around the afflicted area are usable, Including Sendai Airport. BUILDINGS So far, some 160,000 buildings are estimated to be damaged either completely or partially. Of these, at least 72,554 buildings were destroyed, washed away or burnt down, as of 13 April, according to the NPA. (Reuters, 13 April) DEBRIS The Ministry of the Environment says that the amount of debris to be removed from 3 prefectures, Iwate, Miyagi and Fukushima, is estimated to be 24.9 million tons. However, the figure does not include debris from damaged roads and ports as well as stranded vehicles and ships. Although there is already 2.8 million square meters of temporary junkyard, more space for removed debris will be required. NGOs and volunteers are also assisting individual household to remove debris and mud. ELECTRICITY The supply of electricity continues to slowly improve. As of 11 April, an estimated 157,596 households remain without electricity, according to Tohoku Electric Power Co. (Reuters, 13 April) Electricity has been restored by 96.3 percent in Tohoku, according to the UN. (OCHA, April 1) The GoJ announced temporary power cuts across the nation and warned that rolling blackouts would begin March 14 and are expected to last until at least the end of April. COMMUNICATIONS As of 5 April: Some 88,988 telephone lines remain out of service. (Some companies provide free "pay phone" and specially laid out "payphone" in 16 prefectures). 1.88 million lines in total, were damaged by the disaster. A reported 1,644 base stations of mobile companies are not working. Some mobile companies provide free satellite phone, cell phone and charger as well as disaster messaging services. JANIC Situation Report 8 April 2011 MLIT Update: 15 April 2011 METI Update: 15 April 2011 COE-DMHA Update: 13 April 2011 WHO-WPRO Report No. 28: 13 April 2011 USAID Fact Sheet #15: 8 April 2011

  8. SITUATION CURRENT ASSESSMENT NOTE: Assessment estimates are for the impacted areas. The overall infrastructure outside of the affected areas remains strong. • HEALTH • Medical assistance for emergency phase is slowly moving towards to long-term commitment for chronic diseases and psychosocial care. Assessments will need to be continuously done. According to the WHO, one important issue is the coordination of health response and the need for strengthening information collection and dissemination. • The Ministry of Health, Labor and Welfare has coordinated the deployment of doctors (146teams including the Japan Red Cross Society), pharmacists (85 personnel), nurses (96 personnel), medical workers (132 teams), dentists (17 personnel), care managers (103personnel), child welfare and psychological care specialists (28 teams) from various medical institutions, evacuation centers and public health centers across the country to Iwate, Miyagi and Fukushima. • Nutritionists have warned that the current carbohydrate concentrated food supplies to survivors, such as rice balls and breads, could upset the evacuees’ health, and recommended to increase variety of food supplies with sufficient vitamins and minerals. The Japan Dietetic Association has published a food and nutrition guidelines for the evacuation centers, including for elderly, pregnant women, mother and baby. • The spread of influenza and stomach flu has been the concern in the evacuation centers. Evacuees are living in the condition where hygienic status is not good due to the shortage of daily use of water and breakdown of latrines. As for health situation, there are increasing trend that elderly survivors worsen their health conditions as the evacuation becomes longer and mental and physical stress increase • These public health concerns have been exacerbated by fears of health ramifications from exposure to nuclear radiation as a result of the ongoing crisis at he Fukushima Daiichi Nuclear Power Plant. Although radiation health risks have been described as low, certain experts have warned that radioactive releases of steam from the plant could last for months. This has prompted widening fears of long-term public health, food and environmental ramifications not only for the Japanese, but also for neighboring countries and across the Pacific. G R B A Not a Major Concern Currently Working But Inadequate Generally Ineffective Non-Functional Or Destroyed Unknown MEDICAL OPERATIONS AND PUBLIC HEALTH PRIMARY CARE COMMUNICATIONS MORTUARY AFFAIRS FUEL/GAS HOSPITALS VETERINARY MED SUPPLY ELECTRICITY EVACUATION SHELTER JAPAN A A A A A A A A A A PUBLIC HEALTH COMMUNICABLE DISEASES SANITATION WATER MENTAL HEALTH RADIATION SURVEILLANCE FOOD WASTE\DEBRIS SEWAGE A A R R A A R A A R B JAPAN NOTE: As the emergency phase of the operation has past and recovery and reconstruction begins there remains health risks to the population in the impacted zone. These include but are not limited to: hypothermia, dehydration, carbon monoxide poisoning, tetanus, water and foodborne illnesses due to contamination and poor sanitation conditions, and infectious diseases such as influenza, Norovirus, URI, gastrointestinal infections , infectious gastroenteritis, and measles. OVERALL PH/MEDICAL ASSESSMENT

  9. GOVERNMENT OF JAPAN RESPONSE • AGRICULTURE • Chief Cabinet Secretary Yukio Edano said that the GoJ plans to prohibit rice planting in fields where the concentration of radioactive cesium exceeds 5,000 Bq/kg of soil. Edano said that the new ban would apply to areas beyond the 30km zone around the Fukushima power plant where rice production is already banned. An analysis by the Ministry of Agriculture, Forests and Fisheries (MAFF) found that 10 percent of cesium in soil is absorbed by rice by the time it is harvested and the safety standard for cesium in rice is at a maximum of 500 Bq/kg of rice, so the MAFF decided that the standard for soil should be 5,000 Bq/kg of soil. Farmers will be compensated. • According to the Daily Yomiuri, the GoJ has decided to set consumption limits for radioactive iodine in fishery products at 2,000 Bq/kg which is the same limit set for vegetables. • DEBRIS & DESTRUCTION • The Ministry of the Environment says that the amount of debris to be removed from 3 prefectures, Iwate, Miyagi and Fukushima, is estimated to be 24.9 million tons. This figure does not include debris from damaged roads and ports as well as stranded vehicles and ships. Although there is already 2.8 million square meters of temporary junkyard, more space for removed debris will be required. NGOs and volunteers are also assisting individual household to remove debris and mud. • At least 72,554 buildings were destroyed, washed away or burnt down, as of 13 April, according to the NPA. • The destruction of housing, social infrastructure such as roads and ports, and production facilities could cost between approximately $US 198 and 309 billion. The figure far exceeds the approximately $US 123 billion cost of the 1995 Kobe Earthquake. The Government is currently preparing the firstsupplementary budget for debris removal, rehabilitation of infrastructures and construction of temporary housings which could be as large as $US 47 billion. NOTE: While there are enough food items in the affected areas, there is a lack of variety to meet appropriate nutrition balance, according to NGOs. Nutritionists have warned that the current carbohydrate concentrated food supplies to survivors, such as rice balls and breads, could upset the evacuees’ health, and recommended to increase variety of food supplies with sufficient vitamins and minerals. The Japan Dietetic Association has published a food and nutrition guidelines for the evacuation centers, including for elderly, pregnant women, mothers and babies. Emperor Akihito and Empress Michiko speak to evacuees in Asahi city during his first visit to the affected area. Photograph: Kyodo News/AP JANIC Situation Report 8 April 2011 COE-DMHA Update: 13 April 2011

  10. JAPANESE RED CROSS SOCIETY • The Japanese Red Cross Society (JRCS) continues to conduct relief operations in its mandated role as auxiliary to the GoJ during disasters. They are providing medical relief, psychosocial support (PSP), ongoing provision of full blood services, distributing relief supplies, and are collecting voluntary donations. • Some 579 teams have been mobilized from the JRC nationwide network of 92 hospitals, while an additional 163 are preparing for further deployment. In total, some 3,000 staff will be involved, with a psychosocial support provider assigned to almost all deployed medical teams. • The National Society, with the assistance of the International Federation of Red Cross and Red Cross Crescent Societies (IFRC), has distributed over 125,000 blankets, 183,000 pieces of clothing, 26,000 emergency relief packs and 11,000 sleeping kits to evacuees. • In the coming weeks, the JRCS said they will place greater emphasis on early recovery. As part of the recovery effort, they are to equip 70,000 temporary homes with a package of electrical appliances, worth an estimated US$160 million and aimed to benefit over 280,000 people. The appliance package includes refrigerator, washing machine, microwave, rice cooker, hot water dispenser, and a television. • The JRCS has almost US$1.3 billion in donations from the public. However, they are struggling to get the cash to those most in need. The JRCS plans to transfer about US$800 million to Japanese officials this week to start distributing cash grants to survivors • Following the devastating earthquake in Japan, JRCS has requested first aid advice for the survivors from DK books, the publishers of the UK’s new first aid manual. Guidance on conditions such as hypothermia, dehydration, abdominal pain, vomiting and diarrhea will be translated into Japanese and made available for free via the JRCS website. • JRCS has sent 609 medical teams in total to the areas affected by the earthquake and tsunami, and mobile medical teams are operating in the evacuation centers. Ishinomaki- Japanese Red Cross hospital. The elderly and the young are particularly vulnerable to contracting pneumonia – without electricity the nights are bitterly cold. Photo: American Red Cross NOTE: Evacuees have been enduring bitterly cold weather with several sleet and snow storms. These conditions have also hampered emergency relief efforts. Priority needs are fuel, prefabricated houses, sanitation materials, clothing, medicines and household appliances. COE-DMHA Update: 13 April 2011 IFRC Japan Report: 13 April 2011 BRITISH RED CROSS Japan Update 13 April 2011

  11. UNITED STATES RESPONSE • The USAID team is working to manage the overall USG response effort in Japan in coordination with the U.S. Embassy in Tokyo. • Staff from the U.S. Department of Energy, the U.S. Nuclear Regulatory Commission (NRC), the U.S. Embassy in Tokyo, and DART continue to actively monitor and analyze information on radiation levels in Tokyo. The NRC also continues to provide technical assistance to the U.S. Embassy in Tokyo and GoJ officials in support of assessment and mitigation efforts at the Fukushima Daiichi site. • FY 2011 Humanitarian Funding Provided to Japan as of 8 April 2011 • USAID/OFDA Assistance = $6,914,369 • DoD Humanitarian Assistance = $70,754,829 • Total USAID and DoD Assistance = $77,669,198 • MESSAGES FROM US EMBASSY – JAPAN • 14 April: In an integrated response that includes numerous U.S. Government agencies, the United States is working closely with Japan to support its efforts to respond to the ongoing nuclear emergency at the Fukushima Daiichi nuclear power plant. Reflecting on this, Ambassador John Roos said "the tireless efforts of all those involved, both Japanese and American, are yet another prime example of the enduring strength of our bilateral alliance.“ • The United States is providing technical assistance and equipment as requested by the Government of Japan. This assistance includes: DOE ground and aerial radiation monitoring teams, high pressure water pumping system, testing of agricultural soil samples by DOE laboratories, experts from DOE labs to assist in technical and analytical support, and 5 large stainless steel tanks to store radiated water. USAID Fact Sheet #15: 8 April U.S. Embassy Tokyo News Update: 14 April 2011 MAP: USG Humanitarian Assistance

  12. UNITED STATES RESPONSE (DOD-OPERATION TOMODACHI) • Dubbed Operation Tomodachi -- Japanese for "friendship" -- U.S. military assets mobilized in the area include a wide range of equipment, air, sea, and ground capability and expertise. Up to 6 April, the DOD has contributed the following items: 246 tons food, 2,147,909 gallons water and 31,615 gallons fuel. Since 1 April, the U.S. Military has begun repositioning assets but remains committed to sustained support in Japan. • The JSDF and US military forces launched a three-day joint operation 1 April in a final search for more than 16,000 people unaccounted for in the coastal areas of Miyagi, Iwate and Fukushima. This last big sweep before officials in Tokyo shift their focus to the national reconstruction effort resulted in the recovery of 79 bodies. The mission consisted of 18,000 SDF personnel and 7,000 US military personnel participating in the search on land, 120 helicopters and reconnaissance aircraft and 65 ships to cover the coastal areas from the northern tip of Iwate to the southern end of Fukushima Prefecture. • 12 April, the US Army Aviation Detachment Unit is assisting Japanese forcing in recovering remains of missing persons by doing passive searches during scheduled operations. • OPERATION FIELD DAY • US Forces continue efforts in conjunction with the JSDF in Operation Field Day, to remove debris and clean schools have been severely damaged. • 12 April, US Army Japan’s Joint Logistics Task Force continues efforts at Okaido Elementary School. This is the ninth of twelve schools selected as part of Operation Field Day. • 10 April, Japan Prime Minister Naoto Kan visited servicemen participating in Operation Field Day and to thank them for their joint efforts since Operation Tomodachi was launched on 11 March. • U.S. AIR FORCE • PACAF has generated 389 sorties moving 1,755 passengers and more than 3,597 short tons of cargo in support of Japan Relief Efforts. • Number of AF Personnel deployed in support of relief operations:  519 • Number of PACAF aircraft deployed in support of relief operations:  2 A worker cleared out a tsunami-damaged building at Sendai Airport. Photo: Ko Sasaki for The New York Times NOTE: A key project of the U.S. Air Force and U.S. Marines was the reopening of the Sendai airport, which has allowed extensive amounts of supplies to be distributed to hard hit areas. • U.S. MARINES • The 31st Marine Expeditionary Unit (MEU) wrapped up relief operations with the Japan Maritime and Ground Self-Defense Forces in support of Operation Tomodachi on April 7. • As of 3 April, 1st Marine Aircraft Wing units have flown 582 sorties, totaling 904 hours of flight time while delivering more than 511,400 pounds of cargo in support of Operation Tomodachi. • Task Force Fuji and LTF 35 conducted bilateral training convoys to Manato Elementary School for debris removal/clean up at Watanoha Elementary as part of Operation Field Day. • U.S. Marines delivered 205 backpacks from the Camp Zama community backpack project. COE-DMHA Update: 13 April 2011DoD News: 11 April 2011

  13. UNITED STATES RESPONSE7th FLEET • Since the March 11 earthquake and tsunami in Japan, U.S. military forces have been providing humanitarian assistance under Operation Tomodachi. • With Sendai Airport reopened , 7th Fleet’s focus has shifted to harbor clearance, consolidating relief supplies at airfields ashore, and assisting with debris clean-up. • 8 April, USNS Safeguard, and USS Tortuga, Mobile Diving and Salvage Unit 1, Explosive Ordnance Disposal Mobile Unit 5 and Underwater Construction Team 2 continue efforts for Operation Field Day in Oshima to assist in port clearance operations.  The island, which is dependent upon ferry service from the mainland, has been largely isolated since 11 March when the tsunami washed its ferries ashore. • 7 April, USS Harpers Ferry and USS Germantown, arrived in Okinawa. • On 1-3 April , Seventh Fleet ships, helicopters and aircraft searched over 2,000 square miles of ocean in a concerted effort to find victims of the 11 March tsunami.   USS Cowpens, USS Preble, USS Shiloh and USS Curtis D. Wilbur searched for remains in specific zones off the north east coast of Honshu, with their helicopters and additional support helicopters from the USS Ronald Reagan and one P-3 Orion aircraft providing aerial reconnaissance support. • 187 Sailors and Marines from the USS Essex Amphibious Ready Group and the 31st Marine Expeditionary Unit departed Oshima Island, on 7 April. The Marines and Sailors spent about six days moving cars, destroyed houses, and other debris out of public areas and restoring functionality to the port. • The Essex Amphibious Ready Group (ARG) concluded its participation in Operation Tomodachi on 7 April after conducting nearly three weeks of humanitarian assistance/disaster relief (HADR) operations with the Japan Self-Defense Force (JSDF). • 5 April, the San Diego-based Ronald Reagan Carrier Strike Group, which includes the Chancellorsville, Preble, Shiloh and Curtis Wilbur, completed their mission in Operation Tomodachi. • Dubbed Operation Tomodachi -- Japanese for "friendship" -- U.S. military assets mobilizing in the area Seventh Fleet forces continued sustainment of life efforts in support of Operation Tomodachi.  Currently, 14 ships, 130 aircraft and 13,893 personnel are in the area of operation. • Since the March 11 earthquake and tsunami in Japan, U.S. military forces have been providing humanitarian assistance under Operation Tomodachi, or Operation Friends. • U.S. 7th Fleet forces delivered more than 260 tons of relief supplies and flew more than 160 aerial reconnaissance and search sorties. Prime Minister Naoto Kan speaks to U.S. service members during a visit to express his appreciation to the U.S. military, Japan Ground Self-Defense Force and Joint Task Force Tohoku for such quick response to the natural disaster. Photo: US Army, Spc. April de Armas. COE-DMHA Update: 13 April 2011 Joint Support Force Relief Update: 3 April 2011 DoD News: 5 April 2011

  14. UNITED NATIONS RESPONSE • WORLD HEALTH ORGANIZATION-REGIONAL OFFICE FOR THE WESTERN PACIFIC (WHO-WPRO) IN MANILA • WPRO Situation room is on 24/7 operation to collect information and to monitor the evolving events, in communication and coordination with MHLW (Ministry of Health, Labor and Welfare of Japan), WHO Kobe Center, the WHO Headquarters and partners. • WPRO has been closely working with the National IHR Focal Point in Japan and the WHO Headquarter to facilitate sharing of information through the IHR Event Information Site (EIS) that is open to all the Member States. • "Forward" planning is ongoing to identify direct and indirect health and other impacts, expectations/concerns from the public/media, Member States, international communications and partners, and to prepare for possible WHO actions in responding to different scenarios. • UN CHILDREN’S FUND (UNICEF) • The Japan Committee for UNICEF received early childhood development recreation kits from UNICEF’s warehouse in Copenhagen in order to set up and maintain child-friendly spaces at shelters, nurseries and kindergartens. UNICEF has set up child-friendly spaces in quake-affected areas, where these kits are utilized. • UNICEF, the Japan Committee and other partners are ready to deliver more aid to children and women affected by the disaster – including health services for mothers and infants and mother-child friendly environments. Advocacy efforts for orphans’ best interests are also under way. • UNICEF and the Japan Committee for UNICEF are working hand-in-hand with local governments in the quake- and tsunami-affected areas to support back-to-school initiatives. The students who returned to school in Miyagi Prefecture all received UNICEF school bags filled with stationery and supplies. • The Japan Committee for UNICEF has launched a training program for teachers and volunteers participating in psychological care activities on 3 April with the cooperation of the Japan Association for Play Therapy. The training was held at Ogawa Kindergarten in Kamaishi City and about 15 teachers from local kindergartens and preschools participated. The training provided on this day was entitled “Play Therapy Interaction” and entailed learning about psychological assistance for children based on play therapy expertise. Adults are able to convey their fears using words or other forms of expression. Children, however, have not developed that linguistic competency, and they thus tend to shut away these fears internally. By having children convey their feelings externally through playing, they are able to return the lost sense of normality to their lives while also reducing their mental stress levels. • WORLD FOOD PROGRAMME (WFP) • World Food Program (WFP) is on the ground setting up logistics hubs to support relief efforts led by the Japanese Government, local institutions, and aid and welfare organizations. In early April WFP started the construction of five mobile warehouses and four prefabricated offices in Ishinomaki City in Miyagi Prefecture, which is estimated to have the highest death toll among all affected municipalities, with 20,000 people in evacuation centers. The warehouses and offices are for use by the city and various Japanese relief organizations that are delivering supplies to people who have been adversely affected by the disaster. • WFP is also working in Sendai in Miyagi Prefecture, where the agency will support Japan Platform, a consortium of NGOs working closely together with the Japanese Government and business community. Since the earthquake struck, WFP has airlifted in 50 metric tons of high energy biscuits - from its humanitarian hub in Malaysia, following a request from Miyagi Prefecture. These biscuits are being distributed by the Japanese authorities to people in evacuation centers. • WFP is supporting the Japanese Government's disaster response by the delivery of in-kind donations received from overseas, and assessing the need for logistics hubs in some of the other areas affected by the disaster across the stricken Tohoku region. . • INTERNATIONAL ATOMIC ENERGY AGENCY (IAEA) • IAEA has made available the agency’s direct support and coordination of international assistance. On March 15, the GoJ asked the IAEA to provide expert missions to the country. The IAEA is coordinating assistance from Member States through the Response and Assistance Network (RANET), which consists of nations able to offer specialized assistance after a radiation incident or emergency. Due to the confirmed presence of radioactive iodine contamination in food products measured in various prefectures by the Japanese MHLW, the IAEA has passed information to the UN’s FAO and WHO and will continue to report on this development. • The 141st Session of the FAO Council was briefed by representatives of the Joint FAO/IAEA Division on the nuclear emergency in Japan on Friday, 15 April. The briefing included a general background summary of the emergency, the current situation in Japan, FAO/IAEA/WHO responses and actions taken to date, and future challenges. Japan Committee to UNICEF COE-DMHA Update: 13 April 2011 WHO-WPRO SitRep No. 25: 6 April 2011 UNICEF At a Glance: 5 April 2011 WFP News 1 April WFP News Rel: 4 April

  15. OTHER ORGANIZATIONS OF INTEREST • A network of NGO/volunteer organizations Japan Civil Network for Disaster Relief in East Japan has been established in order to facilitate the communication among the organizations working in Tohoku area to support the survivors. A website has been created where readers have access in Japanese to information on the activities each organization is carrying out. The aim of the network is to coordinate the assistance provided in Tohoku area by the NGO/volunteer organizations.(www.jpn-civil.net) • The International NGOs which are requested to wait for the time being are strongly advised to inform and consult with a Pref. Disaster Volunteer Center prior to the commencement of their activities (communication to be made in Japanese language). The Pref. DVC may advice the NGOs about needs, local DVCs, etc. • The GoJ is identifying the needs and trying to match the offers with the identified needs for efficient and effective delivery. As the transportation and storage capacity is still limited, it is strongly recommended not to send any relief goods without coordination with the GoJ or the local authorities. • Due to the shortage of fuel and damage to infrastructure, international NGOs are recommended to wait until the situation improves before commencing services (that must be completely self-sustainable and coordinated with a local partner.) • INTERNATIONAL MEDICAL CORPS reports health care priorities are the vulnerable in evacuation centers, those living at home, and mental health services for disaster victims. • IMC’s emergency response team has assessed the post-disaster needs of isolated coastal villages in north Sendai. Information from assessments of evacuation centers has been communicated to the Japan regional office of International Medical Corps to facilitate coordination efforts. • Fatigue, stress and insomnia are being reported among many evacuees, while mental health and psychosocial support is recognized as a major priority in the response. • IIMC’s assessments include: Minami-Sanriku, Kesennuma, Riken-Takata, East Matsushima and areas north of Ishinomaki. • IMC has partnered with Peace Boat to support affected communities and those who chose to stay in their homes; providing hot meals, non-food items, cleaning services, and other community support activities. • IMC has also partnered with Tokyo English Life Line (TELL) to support telephone counseling services with trainings in Psychological First Aid, computer equipment, and tech support. • SAVE THE CHILDREN estimates that about 100,000 children have been affected and 74,000 children remain displaced. As part of the relief efforts, they have opened 12 Child Friendly Play Spaces. Save the Children is also procuring 5500 back-to-school kits for primary students. 500 hygiene kits are ready for distribution at the Sendai warehouse. • ASSOCIATION FOR AID AND RELIEF (AAR) delivered food, washing machines, and other home appliances to Minami-Soma City in Fukushima Prefecture. AAR also assisted a soup kitchen in Miyagi. • AMERICARES has airlifted an emergency shipment containing more than $525,000 worth of medical aid to evacuation centers and medical teams in hard-hit areas. • Two more convoys, containing more than 750 cases of hygiene items and over 5,000 bottles of water and soap are scheduled for delivery this week and will be distributed by their partners to shelters in the Fukushima prefecture and to soup kitchens in Ishinomaki in the Miyagi prefecture. People wait in line to receive food distribution. Reuters/Carlos Barria IMC Report: 5 April 2011 Americares Report: 13 April 2011 AAR Japan Report: 12 April 2011

  16. OTHER ORGANIZATIONS OF INTEREST • ASSOCIATION OF MEDICAL DOCTORS OF JAPAN (AMDA) ) has 131 relief personnel working in the impacted area: 48 doctors, 27 nurses, 3 midwives, 2 assistant nurse, 3 pharmacists, 2 psychotherapists, 43 coordinators, 2 caseworkers, 1 acupuncture therapist • Iwate Prefecture (the town of Ohtsuchicho): • The “Anpanman Program” is providing toys and stuffed animals of a popular Japanese cartoon character to uplift children’s moods in response to the call for help from AMDA's pediatrician. Mobile clinic services continue to provide recreation time for children besides medical treatments. While a number of stressed-related ailments are seen among patients, the program aims to take care of children's mental health and put them at ease. • Complaints about eye troubles from dust exposure have been common. • A nutritional program has also been implemented to improve the unbalanced diet of the evacuees and plans are underway to provide vitamin supplements as well. • Miyagi Prefecture (the town of Minamisanriku-cho): • While mobile clinic services were delivered to Omori district in Minamisanriku-cho, the local Shizugawa Hospital has taken over the temporary medical tents from the Israeli medical team. The hospital has put its hands on resuming their regular operations and is expected to be normalized gradually. • Norovirus is still prevalent in Minamisanriku-cho, however, the preventive/hygiene measures implemented by AMDA have been effective in controlling the outbreak. From now on, hygiene awareness will be very important due to the arrival of a warmer season. There are five norovirus patients out of 360 evacuees at Shizugawa Elementary School. (Map) Seeds Sit Rep 13 : 10 April 2011 NOTE: All offers of assistance should continue to be directed to the GoJ. AMDA International Emergency Bulletin 18: 14 April 2011 Photo: AMDA International

  17. OTHER ORGANIZATIONS OF INTEREST RELIEF OPERATIONS BY JAPANESE HUMANITARIAN ORGANIZATIONS IN MAJOR AFFECTED CITIES Seeds SitRep 13 : 10 April 2011

  18. OTHER ORGANIZATIONS OF INTEREST RELIEF OPERATIONS BY JAPANESE HUMANITARIAN ORGANIZATIONS IN MAJOR AFFECTED CITIES Seeds SitRep 13 : 10 April 2011

  19. HOSPITALS & MEDICAL TEAMS • HOSPITALS • f • According to WHO/Western Pacific Region as of 5 April, 27 of 33 (82%) designated hospital in Miyagi, Fukushima and Iwate are capable of accepting in-patients and 26 (79%) are accepting out-patients. Some medical, Kesennuma health centre areas started facilities in Shiogama, Ishinomaki ordinary arrangement of accepting patients. • From Miyagi Pref. website updated on 5 April, almost all medical facilities in Sendai City and health centre areas of Sennan, Osaki, Kurihara, Tome have ordinary arrangement of accepting patients. • In Miyagi Pref, mobile clinic services were delivered to Omori district in Minamisanriku-cho, the local Shizugawa Hospital has taken over the temporary medical tents from the Israeli medical team. • The hospital has put its hands on resuming their regular operations and is expected to be normalized gradually. • In Fukushima prefecture, emergency rooms in some hospitals are not fully functioning (according to prefecture website). • The situation of Mental Health and Psychosocial (MHPSS) hospitals is being monitored (with a map of operating hospitals in the Tohoku region) at: http://assertivecommunitytreatment.jp/ph/. • MEDICAL TEAMS • The MHLW has coordinated the deployment of doctors, pharmacists, social workers, dentists, care managers, child welfare and psychological care specialists to Iwate, Miyagi, and Fukushima. Japan Red Cross Society teams, Japan Medical Association teams, and teams from All Japan Hospital Association are also operational in the affected areas. • 141 teams, consisting of 663 members from the National Hospital Institution, Japanese Red Cross Society, and Japan Medical Association plus other organizations are responding to Iwate, Miyagi and Fukushima Prefectures. • 113 public health teams have been deployed to evacuation centers and public health centers to deliver health-related services in a number of the affected areas including in Fukushima, Iwate, Sendai and Miyagi. An additional three teams are currently mobilizing and seven teams are on standby. • As of 5 April, 22 "Kokoro no kea" (Care of mental health) teams (110 workers) are working on the ground (9 in Iwate, 10 in Miyagi and 1 in Fukushima). In addition, 17 pediatric mental health care providers have been dispatched by MHLW to Iwate, and 396 pediatric psychological care providers are on standby (as of 31 March). • Deployed MHPSS teams are planning to provide their services for three months (e.g., provision of drugs, transfer, and psychiatric emergency treatment and psychotherapy); prefectures will take over to provide normal care thereafter. • Israel said it will donate the makeshift clinic to Minamisanriku town when its medical team ends its mission there as all the hospitals and clinics in the town have been damaged by the disaster. • Some 579 teams have been mobilized from the JRC nationwide network of 92 hospitals, while an additional 163 are preparing for further deployment. PUBLIC HEALTH CARE TEAMS DEPLOYED TO EVACUATION CENTERS AND PUBLIC HEALTH CENTERS AS OF 6 APRIL WHO-WPRO SitRep No. 25: 6 April 2011 AMDA Emergency Bulletin #17: 14 Apr 2011COE-DMHA Update: 13 April 2011

  20. INITIAL RISK ASSESSMENT OF INFECTIOUS DISEASE Conducted by the National Institute of Infectious Diseases (NIID) WHO – WPRO SitRep No. 21: 30 March 2011

  21. MEASLES, MUMPS, AND RUBELLA (MMR) • MMR in Japan Overview • Measles, mumps, and rubella are highly contagious upper respiratory infections. • MMR is spread through contact with fluids from an infected person's nose and mouth, either directly or through aerosol transmission. • Japan stopped mandatory MMR vaccinations in 1994. • People living in crowded conditions such as shelters are at high risk of measles outbreaks if they are not immunized. • Follow guidelines for MMR prevention if a measles case is suspected • Who should not receive the MMR vaccine: pregnant women, women planning to become pregnant within the next 1 to 3 months, people allergic to gelatin and antibiotic neomycin, immunosuppressed individuals. • MEASLES • Measles virus causes rash, cough, runny nose, eye irritation, and fever. • It can lead to ear infection, pneumonia, seizures (jerking and staring), brain damage, and death.’ • Mumps virus causes fever, headache, and swollen glands. • It can lead to deafness, meningitis (infection of the brain and spinal cord covering), painful swelling o the testicles or ovaries, and, rarely, death. • WEEKLY MEASLES CASES (JAPAN) WEEKS 1 – 12 • (AS OF 30 MARCH 2011) • MUMPS • RUBELLA (GERMAN MEASLES) • Rubella virus causes rash, mild fever, and arthritis (mostly in women). • Rubella can cause miscarriages in pregnant women or cause serious birth defects in the baby. Measles skin rash NIH MMR Vaccine 28 Mar 2011 CDC Q & A about Vaccination Options for Preventing MMR Measles: Symptoms-MayoClinic.com Measles- Notified cases in Japan week 13, 2011

  22. MEASLES, MUMPS, AND RUBELLA (MMR) • CURRENT SITUATION (MEASLES) • 2011 reported 93 cases of measles during the first 13 weeks, 28% of which were either imported or imported related. • Since the earthquake occurred on March 11, 2011, Japan has had a huge displacement of their population and an influx of foreign aid and relief workers. The potential exist for an outbreak of measles. In the event of this Japan’s Infectious Disease Surveillance centers urges: • Those who have not received an immunization vaccine over the age of 1 years do so. • If there is a case of measles it be s reported to the local government immediately so that epidemiological studies are conducted to prevent spread of infection. • PREVENTION AND CONTROL • IMPORTANT: measles, mumps, and rubella are extremely contagious and the virus is spread through contact with fluids from an infected person's nose and mouth, either directly or through aerosol transmission. • Isolate patients if measles, mumps, or rubella is suspected • Use of droplet precautions (standard surgical mask within three feet of the patient) for patients with suspected or confirmed MMR. • Vaccination of those without evidence of immunity. • Non-immune workers should avoid contact with MMR patients • MMR VACCINE CONTROVERSY (JAPAN) • A number of cases of post-vaccination aseptic meningitis have been reported and attributed to the use of Urabe Am9 mumps vaccine. • As of 1994, an amendment to the Immunization Law made MMR vaccination voluntary and not mandatory. • A single dose of measles is recommended for children over 1 year old, which is different from the two-dose treatment recommended in the U.S. • Although Japan has implemented a nationwide measles elimination campaign in 2001, the country still experiences periodic measles outbreaks and is considered the top exporter of measles to the U.S. • A survey in 2000 showed that measles vaccine coverage in Japan was 81.4%, which is not enough to prevent outbreaks through herd immunity. • HERD IMMUNITY AND MEASLES • DEFINITION: the resistance of a population to a certain disease due to the high ratio of immune individuals to susceptible individuals. • Since measles is highly contagious, heard immunity is difficult to achieve and outbreaks of the disease can be common. • Herd immunity for measles is estimated to be achieved if 95% of the population is immune. CDC Progress Towards Measles Elimination –Japan, 1999-2008. MMWR Weekly 26 Sep 2008 CDC: Mumps-Prevention in Healthcare Setting CDC Measles, Mumps, and Rubella (MMR) Vaccines Measles vaccine coverage and factors related to uncompleted vaccination among 18-month-old and 36-month-old children in Kyoto, Japan The role of herd immunity in control of measles

  23. NOTES: Japan currently has very high tetanus immunization coverage in children, the largest populations of concern are infants and the elder who may have missed out on tetanus immunizations and those who have not kept up with boosters could be at risk. TETANUS, PERTUSSIS & DIPHTHERIA ABOUT THE DISEASES SYMPTOMS • Tetanus (lockjaw) : • Serious painful spasms of the muscles • Can lead to the “locking” of the jaw effecting the opening and closing of the mouth or swallowing • Pertussis (Whooping Cough): • Severe cough spells that can last for weeks making it hard to eat, drink and breath. • Can lead to pneumonia, seizures, brain damage and death • Especially life threating in infants • Diphtheria: • Thick coating in nose, throat or airways • Causing breathing problems, heart failure, paralysis, or death Tetanus, diphtheria and pertussis are serious diseases. Tetanus is caused by a germ that enters the body through a cut or wound. Tetanus is classically associated with rust especially rusty nails. Pertussis and Diphtheria spreads when germs pass from an infected person to the nose or throat of others. CURRENT SITUATION • Directly associated with the events, there have been 6 cases of tetanus (4 from Miyagi and 2 from Iwate prefectures) reported by the Infectious Disease Surveillance Center, National Institute of Infectious Diseases. The diagnosis of these cases occurred between March 17 - 31. • Diagnosis of the first 2 cases of tetanus (one each from Miyagi and Iwate prefectures) occurred between March 17 – 21. • 100 tetanus toxoid vaccines have been delivered to Miyagi March 25. • The Infectious Disease Surveillance Center, National Institute of Infectious Diseases released risk assessment result for communicable disease in the affected sites on March 14. According to this, acute diarrhea, influenza and other respiratory infections (e.g., RSV), measles and other vaccine-preventable diseases (e.g., pertussis and tetanus) are considered to have high public health importance. • March (Reuters) - Japan's health ministry halted the use of vaccines made by Pfizer Inc (PFE.N) and Sanofi-Aventis SA (SASY.PA) that prevent meningitis and pneumonia following the deaths of four children. Three of the children that died in Japan were administered Prevenar together with ActHIB. In addition, three of the children also received a mixed vaccine against diphtheria, whooping cough and tetanus on the same day they received the other vaccines. • March 8 (Reuters) - A panel of experts at Japan's health ministry found no direct link between vaccines made by Pfizer Inc and Sanofi-Aventis SA and the deaths of children, but said further checks were needed, Kyodo news agency reported on Tuesday. PREVENTION • Vaccination is the only way to protect against tetanus. Tetanus can be prevented through immunization with tetanus-toxoid (TT) -containing vaccines • To be protected throughout life, an individual should receive 3 doses of the vaccine(DTP, DtaP or DT) in infancy, followed by a TT-containing booster at school-entry age (4-7 years), in adolescence (12-15 years), and in early adulthood. In Japan, a booster immunization against tetanus is recommended every 10 years.  • The WHO 2010 Global Summary reported Japan in 2009 had 99% of the target population vaccinated by DTP1 and DTP3 antigens, greatly decreasing the risk of tetanus post-tsunami, however the report has no estimates for TT2plus antigen. WHO-WPRO SitRep No. 18: 27 March 2011 WHO-WPRO SitRep No. 21: 30 March 2011 WHO-WPRO SitRep No. 23: 1 April 2011 WHO-WPRO SitRep No. 25: 6 April 2011 Reuters - Japan panel finds no link to vaccines, deaths: report 8 March 2011 WHO vaccine-preventable diseases: monitoring system - 2010 Global Summary

  24. SHELTER AND EVACUATION • TRENDS IN SHELTER AND EVACUATION • Chief Cabinet Secretary Yukio Edano said Monday 11 April that the GoJ will expand the evacuation zone around the Fukushima power plant because of rising concerns over the long-term risk of radiation exposure. Residents in certain municipalities outside the 20-km evacuation zone will be “instructed” to leave in about a month. Areas include Katsurao, Namie, Iitate, and part of Kawamata and Minamisoma in Fukushima prefecture. Edano said the 20-30km area where residents have been told to stay indoors would be newly designated as an “emergency evacuation preparation zone” where residents might be asked to get out. According to the Yomiuri Shimbun, the population in the five localities is around 115,000. • There are currently 141,528 displaced people living in 2,230 evacuation centers in 17 prefectures. 85% of evacuees (approximately 135,000) are concentrated in the worst affected prefectures of Iwate (48,736), Miyagi (56,386) and Fukushima (25,886).The number of evacuees had peaked on March 15 at 440,000 people. • Starting in May, the GoJ will provide US$10,000 (1 million JPY) to each family who lost their homes. • According to the National Police Agency, around 140,000 people were in evacuation centers as of Wednesday 13 April mostly in Miyagi, Iwate and Fukushima. • ISSUES IN MASS EVACUATION SHELTERS • NGOs have been warning that prolonged lives in evacuation centers can affect the physical and psycho-social livings of affected populations, especially elderly persons and persons with chronic disease. • Lack of privacy, cold weather and hygienic conditions are the main challenges. • WHO reports that no major acute public health events and communicable disease outbreaks were reported from affected prefectures, including evacuation centers. • Cases of communicable diseases in emergency shelters are reported. • Around 113 public health teams have been deployed to evacuation centers and public health centers in a number of affected areas in Fukushima, Iwate, Sendai and Miyagi. • The Japan Red Cross Society (JRCS) has assigned a trained psychosocial support provider (PSP) in almost all their deployed medical teams, which are working in government-established evacuation centers. • Authorities are trying to consolidate the number of evacuation centers and move people into bigger shelters in order to provide a more efficient and sustainable way of providing assistance. They also need to empty the 345 schools currently serving as evacuation centers in time for the academic year, which begins in April. • Many of those schools will make arrangement for temporary classrooms in neighboring schools by May. JPF-JANIC SitRep: 8 April 2011 SEEDS SitRep No. 13: 10 April 2011 IFRC Update: 7 April 2011 An evacuee walks outside temporary homes in Rikuzentakata, in northeastern Japan. Public and private groups worked together to build and furnish them in less than a month. (Dennis M. Sabangan, EPA / April 9, 2011)

  25. SHELTER AND EVACUATION • NEEDS OF PEOPLE OUTSIDE MASS SHELTERS • 40,000 in Iwate, 72,000 households in Miyagi and 15,000 households in Fukushima do not have working water system. • Around 300,000 households in 8 prefectures are still without running water as of 13 April. • As of 11 April, an estimated 157,596 households remain without electricity. • Thousands are living in their cars and have returned to their homes even though there is no electricity or water. These people do not receive basic supplies from the municipal authorities but are becoming the focus of attention by local NGOs and volunteers. • Japan’s Chief Cabinet Secretary Yukio Edano said evacuation of residents within 20 km of Fukushima nuclear plant would be “long-term.” Around 78,000 people lived in the mostly rural area, while another 62,000 lie within the 20-30 km radius. • At least 100 residents are reportedly staying at their homes within the 20-km evacuation zone. Local officials and the SDF have been asking residents to evacuate, but have been unable to convince these residents. • Ministries such as the Ministry of Defense have provided bathing services to 1.2 million people so far. For evacuees, not being able to wash regularly or change their clothes is a particular hardship. • Iwate Prefecture announced that they are increasing the number of temporary shelters from 8,800 to 18,000, to cover 40,000 to 50,000 people. • The evacuees have established managing committees in the evacuation centers to assist with distribution of food and relief items, cleaning, water supply, and allocation of individual living spaces. A municipal official acts as the liaison between the committees and the municipality. This practice of self-management will continue when the evacuees are relocated to planned housing. The GoJ wants to keep people from the same evacuation centers together so bonds formed since the earthquake can be maintained. • The local municipality for Minamisanriku-town in Miyagi Prefecture has plans to relocate some of its evacuees to other prefectures due to poor sanitation conditions in the evacuation centers and to allow children and the elderly to have better access to basic services. But a recent survey indicated that around 2/3 are not willing to move. The municipality planned to relocate evacuees to seven towns but a large number of evacuees prefer to remain where they are as many of them are still looking for family members. Many evacuees have been moved several times. This is taking a toll on the evacuees, especially the elderly. • NGOs are providing “child friendly spaces” in the evacuation centers in Rikuzentakata, Kamaishi, Yamada in Iwate prefecture, Ishinomaki, Natori, Tome, Higashimatsushima and Minamisanriku in Miyagi prefecture. • Hypothermia has been reported particularly among the elderly population in the evacuation centers. • There are needs for washing machines in in evacuation centers, especially for female populations. Separate washing and drying space are also requested from female groups in evacuation centers. • The shortage of daily use of water is affecting the hygiene situation, especially in evacuation centers. A man walks a path made between allotted space for evacuees at the evacuation center set up at the Big Palette Fukushima sports arena in Koriyama, Tuesday, April 12, 2011. Photo: AP/Hiro Komae) JPF-JANIC SitRep: 8 April 2011 COE-DMHA Update: 13 April 2011 SEEDS SitRep No. 13: 10 April 2011

  26. SHELTER AND EVACUATION • The land ministry says that municipalities in Miyagi, Iwate, Fukushima and other prefectures have requested a total of 62,000 houses to be built. The ministry says construction is underway on 7,800 houses. NHK says one major obstacle is a shortage of land, especially in areas still submerged by tsunami waters. An association of landlords, the Zenjyu Association, has established a system to help landlords across the country offer vacant apartments at a discounted rent to the people affected by the disaster. 418,000 vacant apartments have been offered so far. • The Ministry of Agriculture, Forestry and Fisheries is looking at available accommodation in Japan’s fishing and farming villages as the population in these villages has been steadily decreasing over the years. The Ministry is collecting detailed information from local municipalities in order to make an allocation plan. • The Ministry is also considering purchasing material for the construction of temporary shelters from abroad, if they have the same cost, size and design specifications as Japan. After the 1995 Kobe earthquake, 3,300 temporary shelters were imported, as they could not all be procured in-country. • The JRCS said they will place greater emphasis on early recovery. As part of the recovery effort, they are to equip 70,000 temporary homes with a package of electrical appliances, worth an estimated US$160 million and aimed to benefit over 280,000 people. • PLANNED LONG-TERM AND PUBLIC HOUSING • A total of 62,000 temporary houses have been requested by Iwate (18,000), Miyagi (30,000) and Fukushima (14,000). As of 8 April, 36 houses were completed in Rikuzentakata, Iwate. • The construction of 8,550 emergency temporary houses has been started (completed 36). 2,266 houses are to be started. (the Minister requested Japan Federation of Housing Organization to provide about 30,000 houses in about two months, and about another 30,000 houses in about next three months.) 3,500 out of 22,000 public houses (as of April 11) as well as 650 out of 5,100 UR (Urban Renaissance Agency) rental houses (as of April 11) available for afflicted people were assigned. • The government is planning to construct 30,000 temporary housing within 2 months, but the project is facing challenges, such as the delays in land acquisition and removal of debris in the affected areas, and the shortage of construction materials. • The first lottery for temporary housing units was held Tuesday 5 April in Rikuzentakata, Iwate with 1,160 applications filed for 36 dwellings built on the grounds of a junior high school. The local government aims to build enough temporary housing units by the end of August to accommodate all applicants. • In Tokyo prefecture, 600 families have been allocated vacant public housing units on 31 March free of charge, for a period of 6 months. • The Special Task Force for Livelihood Support of the Affected Population says 40,500 government apartments and 19,500 public housing units are available for displaced families, making a total of approximately 60,000 apartments. Among them, 42,145 are immediately available. 70,409 evacuee families are currently living in evacuation centers. • The first move to newly built temporary shelters started over the weekend (36 units in Rikuzen Takata, Iwate). Prime Minister Kan indicated plans to build total of 70,000 units in the affected area. Ministry of Land, Infrastructure, Transport and Tourism plans to build 30,000 units by mid May and other The 2011 off the Pacific coast of 30,000 units by mid August. Lack of land and building material is delaying the process. • NOTE: • The transition of evacuees from shelters into planned housing will support the improvement of the health concerns associated with mass sheltering, including some psychological concerns. • The number of evacuees is reportedly growing with new pressures mounting on the government to expand the 20km evacuation zone surrounding the Fukushima power plants. COE-DMHA Update: 13 April 2011 JPF-JANIC SitRep: 8 April 2011 SEEDS SitRep No. 13: 10 April 2011

  27. TRANSPORTATION: STATUS OF ROADS As of 5 April, 2 126 roads damaged have been reported from 11 prefectures. There were reports of 56 damaged bridges in four prefectures. Many roads and highways have remained closed. Some 26 damaged rail lines in three prefectures were reported. Sendai air port is closed; open only for rescue operations. Sendai airport in Miyagi prefecture has partially resumed domestic passenger flight services, according to NHK. The Yamagata Shinkansen bullet train has resumed full service between Tokyo and Shinjo in Yamagata prefecture, according to NHK. East Japan Railways opened the route up for the first time since the disaster. The Tohoku Shinkansen resumed operating between Tokyo and Fukushima on Tuesday 12 April. STATUS OF ROAD RECOVERY Full map of the road status available at: http://resultmap.neis-one.org/japan.html This map is updated every 30 minutes and is powered by open street mapping. COE-DMHA Update: 13 April 2011 WPRO-WHO SitRep 25: 6 April 2011

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