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

1. YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT (JAPAN EARTHQUAKE AND TSUNAMI) KEY LINKS BACKGROUND • GOVERNMENT OF JAPAN • http://www.kantei.go.jp • INTERNATIONAL ORGANIZATIONS • RELIEFWEB • UNICEF • International Nuclear Safety Center • International Atomic Energy Agency • Global Disaster Alert and Coordination System • WHO • US GOVERNMENT ORGANIZATIONS • The Department of State • U.S Embassy in Japan • State Dept.'s DipNote on Twitter • State Dept. Background Note • U.S. Agency for International Development • OFDA • Library of Congress Country Study - Japan • CIA World Fact Book • The Department of Defense • Pacific Command • 7th Fleet • Yokota Air Base, Japan • The Department of Homeland Security • The Department of Health and Human Services • Centers for Disease Control and Prevention • CDC- Tsunami • CDC-Earthquake • CDC-Radiation Emergencies • EPA • FEMA Blog • 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 • LIBRARY • National Medical Library – Japan Earthquake • Disaster Information Management Research Center • Radiation Emergency Medical Management CURRENT SITUATION GOVERNMENT OF JAPAN JAPANESE RED CROSS US RESPONSE UN RESPONSE OTHER ORGANIZATIONS HEALTH PSYCHOLOGICAL IMPACT ELDERLY POPULATION SHELTER LOGISTICS & TRANSPORTATION CULTURAL CONSIDERATIONS FUKUSHIMA NUCLEAR ACCIDENT AS OF 1300 HRS EDT 28 MARCH 2011

2. EARTHQUAKE AND TSUNAMI • 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 waves were as high as 15 meters in the worst affected areas, destroyed everything in their path, and went six kilometers inland. • Because the earthquake’s hypocenter was 24.4 kilometers deep, it is considered a shallow earthquake, the most dangerous type of quake. The 9.0 magnitude places the earthquake as the fourth largest in the world since 1900 and the largest in Japan since modern instrumental recordings began 130 years ago. • Worst-affected areas are the prefectures (states) of Miyagi, Fukushima, Iwate, Yamagata, Ibaraki, Chiba, Akita and Aomori in Japan’s northeast. The tsunami caused severe damage along some 600 km of coastal region and went in as far as 7 km inland along Japan’s northeast • . • The population in these areas before the disaster was estimated at over 14.8 million people, of which 1.6 million lived within 5 kilometers of the coast. Particularly hit hard are areas near the coastal city of Sendai in Miyagi prefecture, with a population of some 1 million people. • The initial tsunami that swept over Japan’s northeastern coast was reportedly as high as 33 feet at the port of Sendai. The prefecture capital is located some 180 miles (300 km) from Tokyo and 128 km from the epicenter. The JMA reported that the highest tsunami wave on the day of the quake was more than 49 feet high in Mekawa, Miyagi. • According to the Geospatial Information Authority and the UN, the tsunami inundated 400 square kilometers in four prefectures (an area equivalent to 20 percent of the area of Tokyo) About 190 out of 300 kilometers of embankments on the seafront in Iwate, Miyagi and Fukushima have been destroyed either entirely or partially. • DEATH AND DESTRUCTION • Japan's police have confirmed 28,550 dead or missing with 10,901 confirmed deaths and 17,649 reported as missing.The bodies of about 7,270 people have been identified, and 6,860 of them have been returned to their families. • Police say the number of deaths is likely to rise further as there appear to be many cases in which entire families went missing with no one able to file reports with the police. JAPAN EARTHQUAKE AND TSUNAMIBACKGROUND OCHA Sit Rep 13: 25 March 2011 WHO-WPRO SitRep No. 17: 26 March 2011 USAID Fact Sheet #13: 24 March 2011 IAEA Update: 26 March 2011 US Geological Survey NOAA Center for Tsunami Research • NOTES: • The tsunami following the 9.0 magnitude earthquake was the primary cause of major damage to the region. • Cold weather is exacerbating the emergency due to shortages of blankets and fuel, and lack of electricity. Aftershock distribution since after the main shock on 11th March. Aftershocks with magnitude larger than 4 are plotted on the map. The information is according to the JMA unified catalogue.

3. CATDAT and Earthquake Reports

4. SITUATION • EMERGENCY RESPONSE, • Harsh weather is still continuing in the affected areas with snow storms. The temperature is dropping to minus 6 degrees Celsius overnight and authorities in Miyagi Prefecture say the lack of fuel means they cannot use heaters. 210,000 households (516,600 people) do not have electricity and one million people are without gas. Freezing temperatures, snow, and rain are expected to continue thru 29 March. • The Japan Meteorological Agency forecasts from now until Tuesday (29 March) that minimum and maximum temperatures will be lower than normal and may drop below freezing in the morning and evening in the Tohoku region. • The JMA is urging people to be on the alert for continuing aftershocks. The JMA has said there is a 20 percent likelihood through Sunday (27 March) of an aftershock 7.0 or greater. The agency continues to caution that although aftershocks are less frequent, the possibility of aftershocks of 7.0 magnitude or higher could still occur and trigger more tsunami. • A lack of fuel, coordination and logistical issues are still the biggest challenges facing Japan’s emergency relief operations as it enters its third week in providing assistance to hundreds of thousands of people left homeless from the March 11 earthquake and tsunami. The sheer scale of the destruction means that about • There are now 28,550 dead or missing with 10,901 confirmed deaths and 17,649 reported as missing. In the 3 hardest-hit prefectures, Miyagi, Iwate and Fukushima, it is estimated that more than 230 school children (7-18 years old) have died and 885 are missing, while 13 teachers are dead and 56 are missing. A survey has found that 19 percent of the casualties were people over the age of 60, 22 percent were over 70 and 23 percent were over 80. The survey shows that the elderly were most affected by this disaster, probably as a result of not being physically able to evacuate quickly enough. • 250,000 people are living in more than 2,000 evacuation centers. Some of the centers are in large government buildings such as schools and sports stadiums but hundreds more are in small groups of about thirty people living in unofficial shelters such as houses. Others are living in their cars. (NOTE: Different agencies are reporting different numbers in the evacuation centers. Will continue to monitor this) • Because of the amount of debris, the lack of fuel and restricted access on the roads up until recently, emergency workers have been unable to move people to centers where they could receive assistance. As a result relief workers are desperately trying to provide a regular supply of food, water, warm clothing, and medicine to 2,000 evacuation centers, as well as provide critical medical, mental health and sanitation services. • For the thousands of people who are living in their homes without electricity and water, there is no access to basic supplies unless they are able to receive it from one of the bigger evacuation centers. • MESSAGES FROM US EMBASSY - JAPAN • (Posted March 26, 11 a.m. JST) As a precautionary measure, the U.S. Embassy is continuing to make potassium iodide (KI) tablets available to private U.S. citizens who have not been able to obtain it from their physician, employer, or other sources. We do not a recommend that anyone should take KI at this time. There are risks associated with taking KI. It should only be taken on the advice of emergency management officials, public health officials or your doctor. For more information about KI, see this fact sheet from the Centers for Disease Control, or contact your doctor. • (Posted March 25, 9 a.m. JST) The United States Government advises American citizens that, in accordance with guidelines that apply to water in the United States and based on analysis of tap water samples for radioactive iodine on March 24, 2011, the water in Tokyo is safe for drinking. • On 22 March, he U.S. Department of State advised U.S. citizens who live within 50 miles (80 km) of the Fukushima Daiichi Nuclear Power Plant to evacuate the area or take shelter indoors if safe evacuation is not practical. OCHA Sit Rep 13: 25 March 2011OCHA SitRep No. 12: 23 March 2011OCHA SitRep No. 14 : 28 March 2011 WHO-WPRO SitRep No. 17: 26 March 2011USAID Fact Sheet #13: 24 March 2011

5. SITUATION • FOOD - The Emergency Disaster Response Headquarters reports that an estimated 10.7 million meals have been delivered to evacuation centers and hospitals in the affected areas to date. Approximately 890,000 meals were delivered on 26 March. The figure does not include distribution of food items by municipalities, NGOs, private sector, and Japan’s Self Defense Force. • WATER - MHLW reported on 27 March that 652 254 households were without water. • The Ministry of Health, Labor and Welfare (MHLW) reported on 26 March that 874,944 households were without water • The Emergency Disaster Response Headquarters says approximately 3.4 million bottles of water have been delivered to evacuation centers in the affected areas so far. Another 1 million is in transit. • The Ministry of Health, Labor and Welfare MHLW is coordinating 440 water companies for emergency water supply. It has arranged to send 485 water supply vehicles to the affected areas in Miyagi (211 vehicles), Fukushima (25 vehicles), and Iwate (39 vehicles). • ELECTRICITY - As of 26 March, approximately 200,000 households remain without • power, mostly in the Tohoku region. • COMMUNICATIONSSome 126,541 telephone lines remain out of service. A reported 2 291 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. • SEWAGE– Sewage treatment plants were damaged in the quake area. Many of the sewage lines were damaged or destroyed. It is still unclear how much damaged has occurred throughout the region or how long it will take to repair the systems. According to the Ministry of Land, Infrastructure, Transport and Tourism 15 sewage systems are not functioning or damaged in Iwate, 59 in Miyagi, and 14 in Fukushima. This is a slight improvement in Iwate and Fukushima. • DEBRIS - The cleanup operation is proving to be challenging. In Miyagi alone, the debris amounts to roughly 15 to 18 million tons, which is equivalent to 23 years worth of waste for the prefecture. It only has capacity to dispose of 0.8 million tons per year. Authorities say it will take three years to remove all the debris and this does not include cars and boats. The Government says it plans to cover most of the removal costs. GAS - Slow improvement: Some 379,292 households remain without gas supply. PETROL - Petrol is being provided to evacuation centers by freight train and tankers from areas both north and south of the affected Tohoku region. Some purification plants remain out of operation. BUILDINGS - So far, some 137,000 buildings are estimated to be damaged either completely or partially, of which 18,778 were completely destroyed, and 118,137 • RADIATION CONTAMINATION • Radioactive iodine higher than the acceptable limit for infants has been found in tap water in Saitama, Ibaraki, Tochigi and Chiba Prefectures. Authorities of Tochigi Prefecture as well as the cities of Hitachi and Kasama in Ibaraki Prefecture have advised not to give tap water to babies. • The authorities in Saitama have not issued this advice as the measured values have decreased. However, they are carefully monitoring the situation. • Radiation has also been detected in sea water collected 30km from the coast, near the nuclear plant. The Ministry expressed the need to study the long-term impact it may have on marine life. • Surveillance of seawater near the NPP sites indicates 1250 times above safety level (iodine 131) for seawater at 330m from Daiichi plant. This is much higher than the 147 times safety level detected on 23 March. • Radioactive materials exceeding Japan’s legal limits have now been found in 11 types of vegetables grown in Fukushima Prefecture as well as the water there. The Government of Japan (GoJ) has ordered residents not to consume the vegetables and has banned their sale, or drink tap water or milk there. OCHA SitgRep No. 14:28 March 2011 OCHA SITREP No.13: 25 March 2011 OCHA SitRep No. 12: 23 March 2011 OCHA SitRep No. 11: 22 March 2011 WHOI-WPRO SitRep No 11: 26 March WHO-WPRO SitRep No. 10: 25 March 2011 WHO-WPRO SitRep No. 13: 22 March 2011 USAID Fact Sheet #10: 20 March 2011

6. SITUATION CURRENT ASSESSMENT • HEALTH • Local media reports that 53 percent of hospitals with 100 beds or more are either closed or only partially operational in the three worst affected prefectures.Out of 255 hospitals, 17 are closed and 117 are operating on a limited scale. The majority of hospitals explained this was due to a shortage of staff and medicine, due to damaged buildings and equipment, and a delay in restoration of water, electricity or gas. 46 hospitals said they didn’t have the capacity to meet the number of demands. • The local medical associations have reported limited capacity of the health facilities (as of 25 March). Out of 231 hospitals and clinics in Iwate, Fukushima and Miyagi prefecture, 121 (52%) are unable to accept new patients, while 33 (14%) are unable to accept any patients due to lack of resources including staff. • An Internet-based ad-hoc surveillance system was set up by the Infectious Disease Surveillance Center, National Institute of Infectious Diseases. http://www.syndromic-surveillance.net/hinanjo/index.html • Influenza viruses were detected in Sendai and surrounding areas. Based on a report, 21 out of 59 specimens were tested positive for influenza A (21 were positive for H3N2 and 2 were positive for pandemic influenza A (H1N1). Influenza rapid test kits were used at an emergency center in Sendai for the period 12-21 March. Rapid test was conducted for 335 out of 1 180 patients（28.3%). It was found that influenza A positive: 107(31.9%), influenza B positive: 5(1.5%). • Reported on 24 March that three workers at Unit 3 had exposure of higher levels of radiation and they are currently being treated at a hospital under the National Institute on Radiation Science and no serious health consequence reported. • People continue to face cold temperatures with insufficient heating. Hypothermia reported particularly among the elderly population in the evacuation centers. • Around 60% of the evacuation centers have patients who need immediate psychosocial support. NOTE: Assessment estimates are for the impacted areas. The overall infrastructure outside of the affected areas remains strong. 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 R R A A R A R R R R JAPAN PUBLIC HEALTH COMMUNICABLE DISEASES SANITATION WATER MENTAL HEALTH RADIATION SURVEILLANCE FOOD WASTE\DEBRIS SEWAGE • NOTE: • Improvements in living conditions of displaced persons will be necessary to prevent further spread of infectious disease. • The elderly and medically fragile are particularly vulnerable to hypothermia and other medical issues present. R R A R R A A R R R B JAPAN OVERALL PH/MEDICAL ASSESSMENT OCHA Sit Rep 13: 25 March 2011WHO-WPRO SitRep No. 17: 26 March 2011

7. GOVERNMENT OF JAPAN RESPONSE • HEALTH & MEDICAL CARE • The Ministry of Health, Labour and Welfare has coordinated the deployment of approximately 135 teams of doctors, pharmacists, social workers, child welfare and psychological care specialists to the affected areas from medical institutions across the country. In order to assist the establishment of disaster volunteer centers which will coordinate volunteers and their activities, the Japan National Council of Social Welfare has deployed 27 staff to Iwate, 63 staff to Miyagi and 22 staff to Fukushima. • The National Centre for Child Health and Development and Japanese Society of Emergency Pediatrics deployed a team to Miyagi Prefectural Pediatric Hospital for assessing the pediatric medical needs. • Some 101 teams, consisting of 542 members are responding to Iwate, Miyagi and Fukushima from the National Hospital Institution, Japan Red Cross Society, Japan Medical Association, etc. • Some 234 pharmacists are deployed to Miyagi (165), Fukushima (53), Iwate (14), Ibaragi (2) by the Japan Pharmaceutical Association and Japanese Society of Hospital Pharmacists. • On 25 March, the Japanese Nursing Association dispatched 76 nurses to Iwate and Miyagi. • Some 97 public health nurse teams have been deployed to evacuation centers and public health centers in a number of the affected areas including Fukushima, Iwate, Sendai and Miyagi. Additional 9 teams have been mobilized or on standby for health-related services. • As of 25 March, a total of 25 mental health care teams have been deployed to provide psychosocial support to the affected areas, including Iwate, Miyagi, Sendai City and Fukushima. Additional 7 teams have been mobilized or on standby for mental health support. • TRANSPORTATION & INFRASTRUCTURE • As of 26 March, 2,035 damaged road have been reported from 11 prefectures (Aomori, Miyagi, Yamagata, Akita, Tokyo, Ibaragi, Tochigi, Saitama, Gunma, Chiba and Iwate). There were reports of 56 damaged bridges in four prefectures. Many roads and highways have remained closed. Assessments from Fukushima were not yet completed. • As of 26 March, 36 damaged rail lines in three prefectures were reported. About 30 local trains in the affected area remain out of service. • Sendai airport is open for 24-hour operations for rescue activities and all 15 ports in the affected area are available for “disaster measures”. • SHELTER - Approximately 19,500 public housing units across 47 prefectures are now available for displaced families. About 10,000 hotel rooms are also available in Yamagata, Akita and Gunma prefectures, as reported earlier. Public housing is much needed as there are an estimated 99,000 evacuee families living in evacuation centers with minimal access to basic services. They would need to move into public housing while temporary shelters are being constructed. In Iwate Prefecture, the construction of temporary housing has begun in the coastal city of Kamaishi, while the municipal governments of Ofunato and Miyako announced they would begin construction on 25 March. At least 8,800 temporary housing units will be built in the prefecture. • DEBRIS REMOVAL - The Government has set guidelines for debris removal in relation to private property rights. Temporary entry to private land for debris removal is allowed, housing debris can be removed without the permission of the owner, vehicles and vessels can be relocated to different locations and disposed of when the owners do not reclaim them. Personal mementos will be temporarily stored. • LIVELIHOODS - The Ministry of Health, Labour and Welfare has implemented an employment adjustment subsidy and the provision of a special unemployment allowance for the affected businesses. For the fishery unions, the Ministry of Agriculture, Forestry and Fisheries is planning to provide a subsidy for the removal of debris in the ocean, which will help the affected populations to rebuild their livelihoods. • AGRICULTURE - The Ministry of Agriculture, Forestry and Fisheries says a total of 20,000 hectares of agricultural land in Iwate, Miyagi and Fukushima prefectures has been damaged by the tsunami. This is about 100 times greater than the area damaged by the 1995 Kobe Earthquake. Experts estimate that desalination would take more than a year. OCHA Sit Rep 13: 25 March 2011 WHO-WPRO SitRep No. 17: 26 March 2011

8. The Japanese Red Cross Society (JRCS) is scaling up its relief operations to help meet the needs of hundreds of thousands of survivors housed in evacuation centers. • JRCS has delivered 125,000 blankets and reported that many evacuees are now getting three meals a day. They are providing support to thousands still living in evacuation shelters. • As of 23 March, 43 emergency relief teams composed of doctors, nurses, supported by non-medical professionals are on the ground providing first aid, medical care, and psychological care to the affected populations, continuing to assess the further needs. Since the disaster, a total of 230 emergency relief teams have been deployed to the affected prefectures with more than 1,600 staff members of JRCS. • The Medical teams and Red Cross hospitals in affected areas are treating patients who have survived the disaster. Establishment of field clinics is being planned, as well as mobile clinic services for remote locations. • JRCS is deeply concerned about the psychological well-being of the affected populations. It is one of the urgent needs to alleviate the suffering and the stress of victims, particularly those who are living in the temporary evacuation centers can accumulate the further fatigue and psychological stress under the current difficult living conditions. Psychologists have arrived in Tokyo for consultations at the headquarters of the Japanese Red Cross after establishing a rotating system of psychosocial support teams at Ishinomaki. • The JRCS has received over US$249 million in financial support • JRCS in-country capacity: 47 branches, each with relief item stocks, 92 Red Cross hospitals, 66 Blood centers; 26 nursing colleges, 60,000 permanent staff (50,000 working for Red Cross hospitals), 495 deployable medical teams; 2 million registered volunteers. • A Family Links web site has been opened in cooperation with ICRC (in Japanese, English, Chinese, Korean, Portuguese, and Spanish). As of 19 March, 5,103 people have been registered.:http://www.familylinks.icrc.org/eng/familylinks-japan JAPANESE RED CROSS SOCIETY Photo : Japanese Red Cross Society • A total of 122,530 blankets and 20,760 emergency kits (composed of portable radio, flashlight, wrapping cloth, booklet on emergency health care, etc) have already been distributed. • In order to reinforce and mobilize the network of volunteers, volunteer centers have been established at the head quarter of JRCS, and 4 branches in the affected prefectures. NOTE:The psychosocial welfare of Japanese Red Cross Society's (JRCS) own support personnel is itself an issue that is being actively monitored by the JRCS.. IFRC Info Bulletin 4: 22 March 2011JRCS SITREP 23 March 2011 COE-DMHA Update: 25 March 2011IFRC Update: 25 March 2011

9. On March 11, US Ambassador to Japan John V Roos declared a disaster due to the effects of the earthquake and tsunami, which allowed US Agency for International Development/Office of Foreign Disaster Assistance (USAID/OFDA) to provide an initial US$100,000 through the US Embassy in Tokyo to assist with local relief efforts. • The USAID team is working to manage the overall USG response effort in Japan in coordination with the U.S. Embassy in Tokyo. • At the request of the GoJ, USAID deployed a Disaster Assistance Response Team (DART), including two urban search and rescue (USAR) teams from Fairfax County, Virginia and Los Angeles County, California, to help in the rescue effort in Japan. The US USAR teams worked with the UK and China USAR teams to establish a sub-OSOCC at their base of operations in Ofunato, facilitating coordination with the OSOCC to ensure a systematic international USAR effort. USAR teams completed search assignments, but were unable to find any live victims. All sub-OSOCCs are closed down and teams are advised to remain in close connection with OSOCC and VOSOCC. • The DART continues to engage at three levels to determine any possible humanitarian needs in Japan: nationally through Japan’s Ministry of Foreign Affairs, locally at the prefecture level and in coordination with U.S. Forces-Japan, and through Japanese civil society organizations. • The DART team nuclear experts are monitoring technical aspects of the nuclear power plants, engaging with Japanese officials on the status of the health impacts of radiation, and providing guidance through the U.S. Embassy in Tokyo on efforts to cool reactors. • U.S. experts from the NRC, Department of Energy, Department of Health and Human Services and the U.S. military are in place in Japan, cooperating directly with Japanese authorities to help contain the damage at the Fukushima Daiichi reactors. They are monitoring technical aspects and engaging with Japanese officials on efforts to cool the reactors at Fukushima, as well as regarding the health impacts of radiation. • Approximately 10,000 USAID/OFDA-funded personal protective equipment sets—including suits, masks, gloves, decontamination bags, and other supplies—have arrived in Koriyama city, near the contaminated zone in Fukushima Prefecture, for distribution to individuals working near the nuclear exclusion zone around Fukushima Daiichi nuclear power plant. • USG Funding Announced and Committed To Date: • USAID/OFDA Assistance =$7,291,550 • Department of Defense (DoD) Humanitarian Assistance = $24,960,294 • Total USAID and DoD Assistance for the Earthquake and Tsunami = $32,251,844 UNITED STATES RESPONSE • NOTES: • US Department of Energy, DART, U.S. Nuclear Regulatory Commission, and U.S. Embassy staff continue to monitor and triangulate information on radiation levels in Tokyo. To date, U.S. agencies continue to report that there have not been any increases in radiation levels in Tokyo. DART nuclear specialists also note no significant changes in the situation at the Fukushima Daiichi power plant in recent days. • US Department of State has made Potassium Iodide (KI) available to US government personnel in Japan as a precautionary measure. The DOS advises that it should only be consumed after specific instruction. USAID Fact Sheet #13: 24 March 2011 U.S. Embassy Tokyo News Update: 25 March 2011 DOS Note on Potassium Iodide 21 March 2011 DOS Travel Warning – Japan: Update 21 March 2011 COE Japan Update 21 March 2011

10. Dubbed Operation Tomodachi -- Japanese for "friendship" -- U.S. military assets mobilizing in the area include a wide range of equipment, air, sea, and ground capability and expertise. • U.S. Air Force • As of 24 March, Airmen have transported more than 4.7 million pounds of cargo, more than 3300 passengers and completed more than 245 missions in support of Operation Tomodachi. • PACAF has generated 265 sorties moving 3,315 passengers and more than 2,512 short tons (5,025,600 million lbs) of cargo in support of Japan Relief Efforts. • USAF C-17 delivered 5 generators, 4 reverse osmosis water purification systems and 4 individual storage units from Andersen to Yokota • Two USAF C-130s delivered fuel bladders to Misawa AF and Sendai airport. • USAF C-130 delivered 4 passengers and 5 pallets of waters from Kadena to Sendai • USAF C-17 delivered H2O purification equipment from Andersen AFB to Misawa AB • USAF HH-60 flew GoJ/USAID/UN/DART to survey Sendai and Ishinomaki areas • USAF crews flew seven C-17 missions, delivering 184 passengers and 273 tons of cargo, as well as 4 KC-10 missions, delivering 409,300 pounds of fuel to Japan • More than 300 Airmen and USAF civilians have deployed to assist the 13,000 USAF personnel stationed in Japan helping with recovery operations • Number of AF Personnel deployed in support of relief operations:  698 • Number of PACAF aircraft deployed in support of relief operations:  18 • U.S. Army • 458 U.S. Army Japan personnel are supporting Operation Tomodachi as well as 1,000 national labor contractors. • 10 water trailers have been released from APS for emergency use at Camp Zama. Bottled water was distributed for a second day.  Commissary rations bottled water to three cases per person. • LTF 35 is conducting bilateral and joint convoys to deliver kerosene to Internally Displaced Persons' camps and are continuing to clear debris at Sendai Airport. • Over the last three days, Logistics Task Force 35, U.S. Army Japan, assisted U.S. Marine units in clearing debris from the runway and taxiways at Sendai Airport. Over 1,000 destroyed vehicles that littered the area. • U.S. Marine Corps • Supporting GoJ-led HA/DR efforts, more than 1,000 III MEF and Marine Corps Bases Japan Marines and sailors are deployed on mainland Japan. As of Thursday (Mar 24), III MEF has completed more than 450 helicopter missions, providing assistance in survivor recovery, personnel transport and relief supply distribution. In total, over 129,000 pounds of water, 4,100 pounds of food, have been distributed. • Marines Are Located At McasIwakuni, Yokota Air Base, Naval Air Facility Atsugi, Camp Sendai, and Yamagata Air Field. • Marines from Combat Logistic Battalion 31, pushed to Oshima Island, located near Camp Sendai in Northern Japan, by LCU to begin Operation Field Day.  A 7-day exercise consisting of field day/cleanup of the tsunami-ravaged island.  One of the main focuses of Marines efforts will be getting the school running again for the kids who are scheduled return there in mid-April. UNITED STATES RESPONSE(DOD-OPERATION TOMODACHI ) Soldiers and Marines unload hardware to install hot showers at a makeshift shelter for displaced residents on Saturday in Higashi Matsushima, Japan (26 Mach 2011) Aircrews from the 36th Airlift Squadron fly from Yokota Air Base to Misawa Air Base to deliver four pallets of mission essential equipment (25 March 2011) NOTES: The assistance from the DOD had been key in the survival of many victims as they were able to reach the most hard hit areas due to strong logistical capacity. Japan Earthquake and Tsunami Update 27 March 2001 Japan Earthquake and Tsunami Update 26 March 2001 Japan Earthquake and Tsunami Update_25 March 2011 Operation Tomodachi- 24 March 2011PACOM Relief Updates - 26 March 2011 PACOM Relief Updates - 25 March 2010

11. U.S. military assets mobilizing in the area Seventh Fleet forces continued sustainment of life efforts in support of Operation Tomodachi.  Currently, 19 ships, 140 aircraft and 18,282 personnel are in the area of operation. Since Operation Tomodachi started, U.S. 7th Fleet forces have delivered more than 230 tons of humanitarian aid/disaster relief supplies to survivors of the tsunami and earthquake, in support of Japan Self Defense Force (JSDF) efforts. • The 31st Marine Expeditionary Unit (MEU) continues relief efforts off the northeast coast of Honshu in support of Operation Tomodachi, They have delivered more than 50,000 pounds of supplies via helicopter to affected areas including; Myako, Hamanaki, Yamada and Oshima Island. Heavy and medium lift helicopters of the 31st MEU, operating from USS Essex (LHD 2), are also transferring needed materials from primary distribution points at undamaged facilities to smaller hubs in the disaster area in order to get relief aid closer to those in need.  • A medical team from Essex flew to JS Hyuga (DDH 181) to meet up with Japanese medical personnel, and then moved ashore to determine potential medical needs and areas where the 31st MEU medical staff could provide assistance.  • The USS Essex ARG will conduct an amphibious resupply of Oshima Island, off the coast of Kessennuma, early in the morning on 28 March 2011.  The ship will launch two Landing Craft Units (LCUs) carrying Japan Ground Self Defense Force personnel and vehicles, as well as a commercial electrical utility truck and a fuel truck to the island that has been largely cut off since the earthquake and tsunami March 11. • Commander Task Force 76 (CTF 76) continued harbor clearance operations in Hachinohe today. USNS Safeguard (ARS 50) with the embarked divers of Mobile Diving and Salvage Unit 1, Explosive Ordnance Disposal Mobile Unit 5 and Underwater Construction Team 2, worked with Japanese Maritime Self Defense Force (JMSDF) and commercial divers to open additional areas of the harbor for operations. Teams cleared the Liquid Natural Gas (LNG) pier in preparation for the arrival of an LNG tanker which will bring much needed fuel to the crisis stricken area. With many displaced personnel still living in shelters without electricity or heat, requests for fuel have been a consistent theme from survivors to Navy personnel delivering aid packages. Navy teams are working with the Japan Self Defense Force (JSDF) and local authorities to plan for similar efforts in the ports of Miyako, Kamaishi, Ofunato, and Sendai. • USS Ronald Reagan (CVN 76) sent hygienic HADR supplies to Matsushima airport in support of 2,000 tsunami and earthquake victims there. The hygiene supplies were requested by the JSDF liaison personnel.   • Commander, Fleet Activities Yokosuka (CFAY) handed over the second of two water barges on March 26 to the Japan Maritime Self Defense Force. Together with the first barge sent yesterday, a total of 500,000 gallons of fresh water is en route the area off the coast of the Fukushima Daiichi nuclear power plant to support cooling efforts for the damaged reactors. The JMSDF ship JS Hiuchi is escorting with the first barge arrival scheduled for tomorrow. The fresh water may be used in replacement of salt water in the cooling operations to lessen the corrosive impact of salt from the sea water which is currently being used for emergency cooling. UNITED STATES RESPONSE7th FLEET PACIFIC OCEAN (March 25, 2011) – A Marine with the 31st Marine Expeditionary Unit pulls a pallet of humanitarian aid supplies to an CH-46E Sea Knight helicopter with Marine Medium Helicopter Squadron 262 (Reinforced), 31st MEU. The supplies will be delivered during relief efforts in support of Operation Tomodachi. YOKOSUKA, Japan (March 25, 2011) – Barge YOGN-115, carrying 1.04 million litres (275,000 gallons) of fresh water, departs Commander, Fleet Activities Yokosuka (CFAY) to support cooling efforts at the Fukushima Daiichi nuclear power plant PACOM Relief Updates - 27 March 2001 PACOM Relief Updates - 26 March 2010 U.S. 7th Fleet Update: 26 March 2011 PACOM Relief Updates - 25 March 2010

12. 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. • WPRO has been providing regular situation reports, including situation updates that have been posted on the WHO websites. • "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) • Working with local government, the Japan Committee for UNICEF has conducted a rapid needs assessment on the ground to better support children. • In addition to the delivery of supplies, UNICEF relief workers have been working to ensure the support needs of children are met. A needs assessment has been conducted in collaboration with Japan local government. UNICEF workers are beginning to increase efforts on education and psychological support for women and children affected by the disaster. • Eight Japanese experts have been deployed from their posts around the world to work with the Japan Committee. UN OFFICE FOR THE COORDINATION OF HUMANITARIAN AFFAIRS (OCHA) - On 24 March, OCHA staff accompanied by colleagues from the World Food Program (WFP), USAID’s Disaster Assistance Response Team (DART) and officials from the Ministry of Foreign Affairs and Cabinet Office travelled by helicopter to Miyagi Prefecture. The aim was to determine the need for further international assistance to the affected areas of the prefecture. The team met Prefectural officials from the Social Welfare Department, the local branch of the Red Cross Society and Non Profit Organization (NPO) and NGO representatives in Sendai as well as the local Social Welfare Council, Red Cross and NPO/NGO staff in Ishinomaki for comprehensive briefings and discussion. OCHA is now working in close coordination with government counterparts to determine what if any international assistance may be required. UN HIGH COMMISSIONER FOR REFUGEES (UNHCR) - At the request of the Government, UNHCR is providing 1,794 solar lanterns for Miyagi Prefecture. The GoJhas received 131 offers of assistance from countries as well as 33 offers from international organizations. It has accepted relief items from 17 countries. UNITED NATIONS RESPONSE In the above picture, UNICEF delivers supplies to a shelter in Miyagi Prefecture. Picture provided by UNICEF. WHO-WPRO SitRep No. 17: 26 March 2011 OCHA Sit Rep 13: 25 March 2011 UNICEF Press Rel: 23 March 2011 UNICEF Press Rel: 24 March 2011

13. OTHER ORGANIZATIONS OF INTEREST • INTERNATIONAL MEDICAL CORPS International Medical Corps has completed another assessment of the affected areas and reports that health care for the vulnerable and the elderly in evacuation centers, and possibly also for those who have stayed in their homes in the affected areas, and mental health care for those affected by the disaster remains the biggest priority. • International Medical Corps’ emergency response team is assessing the post-disaster needs of isolated coastal villages north of Sendai that have yet to receive humanitarian assistance. Information acquired from assessments of evacuation centers has been communicated to the Japan regional office of International Medical Corps in order to properly facilitate coordination efforts. • Shortages of food, water, fuel and some medicines, and survivors in need of mental health support have been found. While conditions related to shortages of food and water have improved, there is still a need for proper coordination of mental health services to ensure that individuals in need of support are receiving proper attention. • International Medical Corps’ assessments include: Minami-Sanriku, Kesennuma, Riken-Takata, East Matsushima, and areas north of Ishinomaki. • Based on assessments at evacuation centers and a regional hospital where critical patients have been referred, International Medical Corps will work to fill essential gaps - including addressing the need for food, water and chronic medicines at shelters, providing psychological support, and if needed deploying four medical teams currently on standby. • WORLD VISION - has delivered blankets, bottled water, sanitary and hygiene supplies for more than 6,000 people in urgent need in Minami Sanriku and Tome. • AMERICARES - has concentrated relief efforts in Sendai, providing basic hygiene supplies for dissemination to shelters in the area. Twenty tons of hygiene items are expected to be delivered to Japan this weekend. Additionally, AmeriCares is collaborating with other medical professionals in the area to determine the medical supply needs of individuals in the area, particularly with chronic conditions such as diabetes and asthma. In order to facilitate efforts of the organization in future weeks, AmeriCares is setting up a center in Tokyo. • MÉDICINS SANS FRONTIÉRSES (MSF) plans to support a teams of six psychologists in addition to the 12-person MSF team that has mainly been treating elderly patients with chronic diseases. On 23 March, MSF distributed 10,000 hygiene kits containing soap, tooth brushes, and towels to evacuees in Minami Sanriku. On 25 March, non-food-item kits containing batteries, candles, matches, and towels were distributed to 4,000 people. • OPERATION BLESSING INTERNATIONAL (OBI) - has delivered food, clothing, and other essential supplies in the town of Ishinomaki, where there are currently over 200 shelters. OB was also able to secure 1.5 tons of rice from a rice farmer who had an excess supply of rice available. In the above picture, Operation Blessing International relief worker is assisted by Japanese military personnel in unloading relief supplies. Picture provided by Operation Blessing. AmeriCares OCHA SitRep No. 12: 23 March 2011World Vision News: 21 March 2011 IMC: 23 March 2011 Operation Blessing: 24 March 2011 NOTE: All offers of assistance should be directed to the GoJ.

14. While aftershocks still continue in Iwate and Miyagi Prefectures, current cold weather (snowing in some areas) poses an extra burden on those who are withstanding the aftermath. However, a good news came from Kamaishi city (Iwate) that despite the lack of merchandise some of the convenience stores have started to resume services. Overall, the distribution of goods has been improving gradually. • Association of Medical Doctors of Asia (AMDA) has 62 relief personnel working in the impacted area 23 doctors, 10 nurses, 2 midwives, 1 assistant nurse, 2 pharmacists, 24 coordinators • . Ohtsuchicho: • The medical infrastructure in the town of Ohtsuchicho was totally devastated due to the torrential tsunami. The clinics and hospitals in the coastal area were all washed away. • Operations at Ohtsuchi Hospital have been suspended until April 15, leaving coordination of operations at evacuation shelters a challenge. Coordination at Ohtsuchi High School has been a challenge, exacerbated by the various relief organizations that come through the area in a brief amount of time. Ohtsuchi High School is primarily comprised of individuals with chronic diseases. Road access and communication lines have not been recovered in Ohtsuchi, making communication a challenge for disaster headquarters. • Majority of patients at Ohtsuchi High School are those with chronic diseases. • One of AMDA doctors accompanied a local volunteer to deliver mobile clinical services to a remote community in a mountainous area where assistance hadn't reached. In the community contained fifty households (most of them elderly) and the patients with chronic diseases had been left untreated. Among the patients were diabetes patients with abnormally high blood sugar level or those with excessive high blood pressure. In response to this, the team delivered mobile clinic services on a regular basis. • KamaishiCity: Medical volunteers are regularly allocated to the disaster headquarters in Kamaishi City. People are counting on AMDA and its doctors. Large amount of medicine donated from all around the country have exceeded the capacity of the initial storage. • Miyagi Prefecture (Minamisanriku-cho): • All of AMDA personnel were relocated to Minamisanriku-cho and have been working at Shizukawa Elementary School since Mar. 23rd. AMDA is mainly supporting a local doctor who had already been active in the area. In order to fulfill the needs at the smaller evacuation shelters where medical aid has been scarce, AMDA team is planning to deliver mobile clinic services. • On-site needs assessments have been conducted at several evacuation centers yielding overall findings that collection of medication at evacuation centers by individuals has been a challenge, there has been an increase in depressive symptoms as well as a number of suspected influenza cases, close communication between mobile clinic medical professionals and health care workers conducting home visits is necessary to avoid duplication of effort. • Now that the road access to Minamisanriku-cho has recovered, the transportation of relief goods has been relatively stable. Food supplies have been somewhat well-off and medicines can be delivered within a few days of ordering. OTHER ORGANIZATIONS OF INTEREST AMDA International SITREPS

15. HEALTH – MEDICAL TEAMS • Through the coordination by the Ministry of Health, Labor and Welfare (MHLW), various medical institutions have dispatched or in the process of dispatching medical assistance teams to the affected areas. • The Ministry has assessed the capacity of social welfare facilities in the non- affected Prefectures to receive patients. The ministry found space for 31,294 in elderly facilities, 8,756 in handicapped facilities, 6,752 in child welfare facilities and 734 in other protection facilities. • Some 132 teams, consisting of 651 members are responding to Iwate, Miyagi and Fukushima from the National Hospital Institution, Japan Red Cross Society, Japan Medical Association, etc. • Some 236 pharmacists are deployed to Miyagi (166), Fukushima (54), Iwate (14), Ibaragi (2) by the Japan Pharmaceutical Association and Japanese Society of Hospital Pharmacists. • On 25 March, the Japanese Nursing Association dispatched 76 nurses to Iwate and Miyagi. • MSF medical teams continue to work in evacuation centers in Minami Sanriku in Miyagi, and have started to support a Japanese doctor in the town of Taro in Iwate prefecture. MSF reports the main activity continues to be consultations with elderly patients suffering from chronic diseases. • There was a survey on mental health issues in Iwate prefecture. Some 73 evacuation centers were investigated. Around 60% of the centers have patients who need immediate psychosocial support. • The National Centre for Child Health and Development and the Japanese Society of Emergency Pediatrics deployed a team to Miyagi prefectural Pediatric Hospital for assessing the pediatric medical needs. • Some 109 public health teams have been deployed to evacuation centers and public health centers in a number of the affected areas including in Fukushima, Iwate, Sendai and Miyagi. An additional 4 teams have been mobilized or on standby for health-related services. • As of 27 March, a total of 24 mental health care teams have been deployed to provide psychosocial support to the affected areas, including Iwate, Miyagi, Sendai City and Fukushima. An additional team has been mobilized or on standby for mental health support. OCHA Sit Rep 13: 25 March 2011COE-DMHA: 26 March 2011 AMDA Emergency Bulletin #7WHO-WPRO SitRep No. 17: 26 March 2011 AMDA Emergency Bulletin #8WHO-WPRO SitRep No. 19: 28 March 2011

16. HEALTH – HOSPITALS • As of 25 March local media reports that 53 percent of hospitals with 100 beds or more are either closed or only partially operational in the three worst affected prefectures. Out of 255 hospitals, 17 are closed and 117 are operating on a limited scale. The majority of hospitals explained this was due to a shortage of staff and medicine, due to damaged buildings and equipment, and a delay in restoration of water, electricity or gas. 46 hospitals said they didn’t have the capacity to meet the number of demands. • The local medical associations have reported limited capacity of the health facilities (as of 25 March). Out of 231 hospitals and clinics in Iwate, Fukushima and Miyagi prefecture, 121 (52%) are unable to accept new patients, while 33 (14%) are unable to accept any patients due to lack of resources including staff. • The National Centre for Child Health and Development and Japanese Society of Emergency Pediatrics deployed a team to Miyagi Prefectural Pediatric Hospital for assessing the pediatric medical needs. • It is difficult to supply dialysis treatment in the affected area. MLWH, cooperating with the Japanese Association of Dialysis Physicians, requires prefectural and city governments to set up a system for accommodating patients. • In the town of Tagajo on the coast of Miyagi Prefecture, the Sen-en Hospital has been without electricity, gas or running water for nearly two weeks. There are shortages of basic medicines. Several elderly patients have died because of the freezing temperatures in the wards. About 200 patients were transferred to nearby hospitals. Those who remain are the most serious cases. (NOTE: It was reported that there were 15 out of 170 elderly who died within one week after evacuation) • Most of the patients here have had strokes or cerebral infections, so they can't move by themselves • Most needed is the special milk, which is fed through tubes. They don't have any of that so they aren't getting enough nutrition • The army has installed a generator, which operates for two hours in the evening and is a vital window for the doctors to perform the most important tasks. • As of March 20, the WHO reports that medical doctors with non Japanese medical licenses will be allowed to conduct basic medical treatment. . • The UN reports that deaths are being reported in hospitals due to the lack of medicines, fuel and other basic items. • A physician from Niigata University reported on an investigation in a high-risk population for deep vein thrombosis and pulmonary embolism (from staying in a vehicle at night). He reported 11 among 39 subjects who had embolism in the legs. Advice was given to increase water intake among the evacuees. • Hospital in Miyagi Prefecture. Red Cross doctors are seeing an increase in influenza and diarrheal diseases among the displaced communities and cases of hypothermia and pneumonia among people who have survived long periods in water. • The Japan Medical Association started to ship insulin to affected sites but there has been difficulty in reaching the affected areas because of bad road conditions and lack of petrol Ishinomaki Japanese Red Cross hospital. The hospitals corridors are lined with beds. Most of the seriously ill are the elderly with hypothermia and respiratory infections. Photo: IFRC OCHA Sit Rep 13: 25 March 2011WHO-WPRO SitRep No. 17: 26 March 2011WHO-WPRO SitRep No 18 27 March 2011 WHO-SitRep No. 19 28 March 2011 Voice of America (VOA): 22 March 2011COE-DMHA: 26 March 2011

17. HEALTH – PSYCHOLOGICAL IMPACTS . • MHLW is coordinating the needs by location and deployments of mental health workers to the sites. • There was a survey on mental health issues in Iwate prefecture. Some 73 evacuation centers were investigated. Around 60% of the centers have patients who need immediate psychosocial support. Many people are experiencing irritations, anxieties and sleeping disorders as well as sleep-walking. One of the doctors reported that the larger evacuation centers seem to be worse in terms of mental health overcrowded. • Any natural disaster of this scale involving sudden loss of life, traumatic destruction, relocation and homelessness, and deep uncertainty about the future carries serious risk of short- and long-term psychological impacts. • Nuclear accidents and other man-made disasters also produce profound anxiety and mental health complications. • Studies on the psychological consequences of Chernobyl and Three Mile Island show increased depression and post-traumatic stress disorder even years after the event, especially among mothers of young children. • Children themselves are psychologically vulnerable but also can be quite resilient, if a sense of normalcy returns as quickly as possible. MSF is working to provide psychological support and continue to provide elderly patients with care for chronic conditions. Photo: MSF • Physical • Fatigue • Insomnia • Hyper-arousal • Eating disturbances • Decreased immunity • Emotional • Shock • Anger • Guilt • Confusion • Grief • Nightmares • Withdrawal • Reliving the event Some common symptoms resulting from trauma are:

18. HEALTH – PSYCHOLOGICAL IMPACTS Psychosocial support to disaster victims is crucial. Those delivering psychosocial support services need to be well versed with the culture and way of life of disaster affected victims. People should have access to social and mental health services to reduce mental health morbidity, disability and social problems. • MHLW has also received requests from the social welfare facilities in the affected areas for dispatching social workers. • MHLW is currently mobilizing nearly 6,000 social workers from other non-affected Prefectures. • The Ministry has also prepared a mental care guidebook that is being distributed to affected municipalities and website has been set up to provide information for counselors and teachers. • Many evacuees are suffering from acute stress disorder, which can develop over time into post traumatic stress disorder. • There is a need for the simultaneous distribution of physical and mental health care, and the establishment of a rotating system of psychosocial support teams • Psychosocial support and mental health needs have been identified as increasingly vital health concerns, especially the needs of children and elderly. • Survey on mental health issues in Iwate prefecture (73 shelters were investigated): Around 60% of the shelters have patients who need immediate psychosocial support. • The Ministry of Health, Labor and Welfare (MHLW) is coordinating mental health needs by location and deployments of mental health workers to the sites • As of 26 March, a total of 25 mental health care teams, consisting of 124 members have been deployed to provide psychosocial support to the affected areas, including Iwate, Miyagi, Sendai City and Fukushima. • An additional 7 teams have been mobilized or on standby for mental health support. • MHLW is mobilizing 389 child welfare specialists from 52 municipalities to be dispatched to evacuation centers and child welfare centers, pending the request from the affected areas. • The Ministry of Education, Culture, Sports, Science and Technology has decided to dispatch 144 clinical psychotherapists for affected school children in Miyagi and Fukushima, 22 of these have been deployed. • NOTE: • As response and recovery operations continue, the need for long term medical and psychological support will increase for pre-existing conditions as well as those caused by the disaster • A long-term strategy will be required to support these conditions as well as to transition response assets into the recovering infrastructure as appropriate IFRC News: 25 March 2011COE-DMHA update: 26 March 2001MSF NEWS: 25 March 2011WHO-WPRO SitRep No. 18: 27 March 2011 WHO-WPRO SitRep No 19: 28 March 2011

19. ELDERLY POPULATION • • Japan has a large elderly population that is nearly double the proportion of people aged 65 and over in the United States. • CASUALTIES • A survey has found that 19% of the casualties were people over the age of 60, 22% were over 70 and 23% were over 80. The survey shows that the elderly were most affected by this disaster, probably as a result of not being physically able to evacuate quickly enough. • As of 26 March, 52 deaths in shelters have been reported, particularly among the elderly. • The tsunami killed nearly half the 113 residents at a retirement home in Kesennuma. Eleven of those who lived there died of exposure, and the other 53 are in a shelter with only kerosene heaters to keep them warm in near-freezing conditions. • VULNERABILITIES • • Influenza viruses H3N2 and H1N1 were detected in Sendai and surrounding areas. Particular vulnerable populations are young children and the elderly. • There are also concerns for people with disabilities in the centers, especially the hearing impaired who rely on emails via their mobile phones to communicate but are currently unable to do so until the mobile phone network is fully restored. • CHRONIC DISEASE • While local officials are gradually taking over responsibility for medical care, MSF says its main activity continues to be consultations with elderly patients suffering from chronic diseases such as diabetes or hypertension. • IFRC reports that most of their patients are elderly and many have lost their regular medication in the disaster, many with chronic conditions who are also affected by the cold • Some elderly have dementia or do not remember what or how much medication they were taking, which complicates the medical situation. • HYPOTHERMIA • Hypothermia has been reported, particularly among the elderly in evacuation centers, increasing their vulnerability • The temperature is dropping to minus 6 degrees Celsius overnight and authorities in Miyagi Prefecture say the lack of fuel means they cannot use heaters. 210,000 households (516,600 people) do not have electricity and one million people are without gas. • NOTE: • One of the most urgent needs right now is to provide blankets and heat-generating mechanisms to keep bodies clean, prevent bed sores, and in general protect the most vulnerable sections of the population. • Recommended treatment of hypothermia in the field is core rewarming to prevent post-rescue collapse. • Many rescuers and first-aid providers do not have equipment to institute rewarming with warm, humidified oxygen, and warm IV-fluids, although these methods should be initiated to help prevent (core) temperature afterdrop. Elderly victims of the tsunami wait covered in blankets in freezing temperatures at an emergency shelter in Kensumma. There is in heating to most of the shelters across Japan and supplies of food, water and medicine are running low. IFRC News: 25 March 2011COE-DMHA update: 26 March 2001MSF NEWS: 25 March 20117 NEWS-MEDICAL CRISIS IN JAPAN”S EVACUATION SHELTERS WHO-WPRO SitRep No. 18: 27 March 2011OCHA SitRep No. 13: 25 March 2011RESQ Products Inc- TREATING HYPOTHERMIA

20. SHELTER • SHELTER • 193,213 people were staying in temporary shelters across the country. That's 3,932 fewer than the previous day. Miyagi Prefecture is sheltering the largest number, 83,537. Iwate Prefecture has 42,923 evacuees, followed by Fukushima Prefecture with 30,630 evacuees. • The number of people staying outside their prefectures following the nuclear power plant accident in Fukushima Prefecture fell by 70 from Saturday to 33,748 by Sunday. • Harsh weather is still continuing in the affected areas with snow storms. The temperature has dropped to as low as minus 6 degrees Celsius overnight and authorities in Miyagi Prefecture say the lack of fuel means they cannot use heaters. Hypothermia has been reported particularly among the elderly population in the evacuation centers. • As of 26 March, 52 deaths in shelters were reported, particularly among the elderly. • The evacuees have also established managing committees in the evacuation centers. The committees are trying to establish order in the centers in regards to 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 Ministry of Land, Infrastructure and Transportation says that only 8 percent of the land needed for the construction of temporary shelters has been secured. The Ministry has requested the Federation of Housing Production to construct 30,000 temporary shelters in two months. The number of shelters so far requested by the prefectures is over 33,000, and is likely to increase. So far land has been allocated for only 2,645 shelters. • Local authorities are facing difficulties in finding suitable land, as the coastal area in Tohoku is not flat, and a large part has been damaged by the tsunami. 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. • In Iwate Prefecture, authorities are taking applications for the first 200 temporary shelters it is constructing. • Rikuzentakatais the first municipality in the earthquake/tsunami area to start the registration process. The media is reporting mixed feelings towards the registration as while evacuees are keen to leave the evacuation centers where access to basic services is extremely limited, they are also concerned about remaining in the areas destroyed by the tsunami. At least 8,800 temporary housing units will be built in the prefecture. • The Special Task Force for Livelihood Support of the Affected Population says 40,500 government apartments are available in addition to the 19,500 public housing units offered for displaced families, making a total of approximately 60,000 apartments. Among them, 42,145 are immediately available. According to the NOTE: The transition of evacuees from shelters into planned housing will support the improvement of the health concerns associated with mass sheltering OCHA SItRep No 18 : 28 March 2011 WHO-WPRO SitRep No. 17: 26 March 2011 OCHA Sit Rep 13: 25 March 2011 COE-DMHA: 26 March 2011

21. LOGISTICS AND TRANSPORTATION • TRANSPORTATION • The Ministry of Land, Infrastructure, Transport and Tourism (MLIT) announced that most (94%) of the main roads reaching to the affected Pacific coastal areas have been repaired. • The Tohoku Expressway, which was closed following the disaster, is now open to ordinary traffic. The GoJ hopes this will accelerate assistance, recovery and reconstruction activities. An increase in volunteers and NGOs working in the affected areas is expected as a result. Up until now, only authorized emergency vehicles were allowed to use the highway. • As of 26 March, 2 035 damaged roads have been reported from 11 prefectures (Aomori, Miyagi, Yamagata, Akita, Tokyo, Ibaragi, Tochigi, Saitama, Gunma, Chiba and Iwate). There were reports of 56 damaged bridges in four prefectures. Many roads and highways have remained closed. Assessments from Fukushima were not yet completed. • All 15 ports in the affected area are available for “disaster measures”. • 13 airports in the affected areas are open for scheduled and chartered flights, and Sendai Airport which was heavily affected by the tsunami is open for 24-hour operations for humanitarian flights. • As of 26 March, 36 damaged rail lines in three prefectures were reported. About 30 local trains in the affected area remain out of service. • The Tohoku bullet train has also resumed services between Morioka, Iwate and Shin-Aomori today. However, it will be some time before the train can carry passengers along its full 670 km stretch from Tokyo to Aomori. According to NHK, the Tohoku bullet train is expected to resume full service as early as late April, East Japan Railway said, while briefing the transportation ministry on Tuesday. The route runs through affected regions and service has only been resumed in sections near the two terminals, but the train cannot run in the middle section. The company says the work will take more than a month but the line sustained relatively minor damage. • 55 sewage disposal plants remain non-operational. • The International Civil Aviation Organization (ICAO), on behalf of the International Atomic Energy Agency (IAEA), International Maritime Organization (IMO), the World Health Organization (WHO) and the World Meteorological Organization (WMO), issued a joint statement on the continued safety of air transport operations in Japan. These five organizations confirmed that there are no restrictions to normal air transport operations at Japan’s major airports, including both Haneda and Narita. • LOGISTICS • The bad weather is hindering emergency response efforts; helicopters that used to deliver relief supplies have been grounded, and authorities must rely on road transport. • The shortage of fuel is still the biggest obstacle to delivering relief supplies and keeping people warm. • The GoJ has enacted a plan to redirect 38,000 kiloliters per day of fuel from the oil refinery factories in Hokkaido and western Japan by surface transportation. This was the average daily demand of fuel in the Tohoku area before the disaster, and has been secured. The Ministry of Economy, Trade and Industry (METI) is planning to transfer 300 tanker vehicles operating in western Japan to the Tohoku area, and 100 out of 500 fuel stations will supply emergency vehicles carrying relief items with fuel. It has also requested the oil refinery industry increase their production from the current level of 80% capacity to 95% capacity. • The GoJ says 8,670,000 liters of fuel has been delivered to the affected areas to date. The delivery capacity has improved over the week, with 1,390,000 liters and 780,000 liters delivered in the last two days. According to the METI, the GoJ has made progress in establishing the supply chain of petroleum to the Tohoku region, securing a supply of 22,000 kilolitres per day. The areas surrounding the Fukushima Power Plants are also receiving emergency fuel. • As of 21 March, capacity had recovered to around 3.9 million barrels per day (mbpd) more than the usual daily demand of 3.6 mbpd. (Yomiuri, 23 March) The first oil tanker to arrive since the disaster docked near a storage facility in Shiogama, Miyagi, which is a key oil shipping base. The tanker arrived with 2,010 kiloliters of gas, heating oil and light oil. Debris clogs a road under a bridge. Photo: IFRC WHO-WPRO SitRep No. 17: 26 March 2011OCHA Sit Rep 13: 25 March 2011COE-DMHA: 26 March 2011

22. Suggestions for Aid Workers: • Japanese have a strong sense of community. Society distinguishes between the “in” and “out” group (e.g. linguistically). Workers should be able to recognize when this is being expressed indirectly. • Avoid references to the numbers 4 & 9 (4= death, 9= suffering). Pay special attention to the context in which these numbers are used. • Foreign media is often perceived as exaggerating the severity of the event. Be sensitive to using hypothetical language to avoid resentment toward help. • The bureaucracy of aid work can often be frustrating and time-consuming. Be aware of how this impacts your delivery of services. • Concerns mount over the growing number of displaced and the intended long-term care of needy populations, such as the elderly. Suggestions of creating a second, permanent home for them have been posed. • Residents living in the non-evacuated areas around plants report feeling “isolated”. Access to resources has been difficult as some transportation companies refuse to deliver goods to these areas. The government is now encouraging residents to voluntarily leave the area though they do not intend to expand designated areas. • Japan has strict rules regarding garbage separation that could cause delays in clean-up efforts. CULTURAL CONSIDERATIONS People sit in a closed junior high school being used as a shelter following the March 11 Great East Japan Earthquake, in the Iwate Prefecture city of Kamaishi on March 17. (Mainichi) Mainichi Daily News: 26 March 2011

23. YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT (FUKUSHIMA NUCLEAR ACCIDENT ) MAP NUCLEAR POWER PLANT • At the quake-hit Fukushima nuclear power plant, high radioactive density detected in 3 turbine buildings may further delay work to restore the cooling systems for the overheated fuel rods. • Tokyo Electric Power Company says that on Sunday, 27 March 2011, it detected 100,000 times the normal density of radioactive substances in the leaked water in the Number 2 reactor's turbine building at the Fukushima Daiichi nuclear power plant. • The water surface had a high radiation level of more than 1,000 millisieverts per hour. • In similar tests conducted earlier, about 10,000 times the normal radioactive density had been detected in the turbine buildings of the Number-1 and -3 reactors as well. RADITION IN FOOD RADITION IN WATER RADITION IN SEA WATER RADITION IN SOIL HEALTH EFFECTS JUST IN TIME TRAINING Lighting becomes available on Saturday, March 26, 2011 in the control room of Unit 2 reactor at the stricken Fukushima Daiichi nuclear power plant. Photo: AP

24. Fukushima Daiichi Nuclear Power Plant - Located on the Eastern coast of Japan, the six nuclear power reactors at Daiichi are boiling water reactors (BWRs). • The earthquake on 11 March severed off-site power to the plant and triggered the automatic shutdown of the three operating reactors - Units 1, 2, and 3. The control rods were successfully inserted into the reactor cores, ending the fission chain reaction. The remaining reactors - Units 4, 5, and 6 -- had previously been shut down for routine maintenance purposes. Backup diesel generators, designed to start up after losing off-site power, began providing electricity to pumps circulating coolant to the six reactors. • Soon after the earthquake, a large tsunami washed over the reactor site, knocking out the backup generators. While some batteries remained operable, the entire site lost the ability to maintain proper reactor cooling and water circulation functions. • Over the following days there was evidence of partial nuclear meltdowns in reactors 1, 2, and 3; hydrogen explosions destroyed the upper cladding of the buildings housing reactors 1, 3, and 4; an explosion damaged reactor 2's containment; and multiple fires broke out at reactor 4. Fears of radiation leaks led to a 30 km (18-mile) radius evacuation around the plant. • Radioactive material was released on several occasions after the tsunami struck. This occurred due to both deliberate pressure-reducing venting, and through accidental and uncontrolled releases. • These conditions resulted in unsafe levels of radioactive contamination in the air, in drinking water, and on certain crops in the vicinity of the plant. Radioactive materials exceeding national safety limits have been found in milk, 11 types of vegetables grown in Fukushima Prefecture. JAPAN EARTHQUAKE AND TSUNAMIBACKGROUND OCHA Sit Rep 13: 25 March 2011 WHO-WPRO SitRep No. 17: 26 March 2011 USAID Fact Sheet #13: 24 March 2011 IAEA Update: 26 March 2011 US Geological Survey NOAA Center for Tsunami Research

25. FUKUSHIMA DAIICHI NUCLEAR POWER PLANT NOTE: Radiation levels are at levels high enough to impact human health at the Fukushima power plant. The situation at the Fukushima Daiichi plant remains very serious. Environmental Radioactivity in Fukushima Prefecture Radiation Information: The restoration of off-site power continues and lighting is now available in the central control rooms of Units 1, 2 and 3. Also, fresh water is now being injected into the Reactor Pressure Vessels (RPVs) of all three Units. Radiation measurements in the containment vessels and suppression chambers of Units 1, 2 and 3 continued to decrease. White "smoke" continued to be emitted from Units 1 to 4. Pressure in the RPV showed a slight increase at Unit 1 and was stable at Units 2 and 3, possibly indicating that there has been no major breach in the pressure vessels. At Unit 1, the temperature measured at the bottom of the RPV fell slightly to 142 °C. At Unit 2, the temperature at the bottom of the RPV fell to 97 °C from 100 °C reported in the Update provided yesterday. Pumping of water from the turbine hall basement to the condenser is in progress with a view to allowing power restoration activities to continue. At Unit 3, plans are being made to pump water from the turbine building to the main condenser but the method has not yet been decided. This should reduce the radiation levels in the turbine building and reduce the risk of contamination of workers in the turbine building restoring equipment. No notable change has been reported in the condition of Unit 4. Water is still being added to the spent fuel pools of Units 1 to 4 and efforts continue to restore normal cooling functions. 28 March IAEA Situation Report 27 March IAEA Situation Report 26 March IAEA Situation Report WHO-WPRO SitRep No. 17: 26 March 2011 Unit:μGy/h≒μSv/h(micro gray/hour≒microsievert/hour) Fukushima Prefecture International Association via World Village Translation

26. FUKUSHIMA DAIICHI NUCLEAR POWER PLANT IAEA: Summary of Reactor Unit Status – 27 March

27. FUKUSHIMA DAIICHI NUCLEAR POWER PLANT WHO Situation Report No. 16 WHO Situation Report No. 15 IAEA Update 24 March 2011 • IAWA Update ((2100 UTC) 20 March 2011

28. RADIONUCLIDES IN FOOD Two prefectures (Ibaraki, Tochigi) reported iodine-131 in unprocessed raw milk, but the measurement results were below the regulation values set by the Japanese authorities. In addition, iodine-131 was not detected in any of the samples taken from the remaining four prefectures (Chiba, Gunma, Kanagawa and Saitama) and Tokyo. Cesium-137 was not detected in any of the samples. Deposition of radioactivity is monitored daily by Japanese authorities in all 47 prefectures. From 24 to 25 March, the daily level of deposition decreased in all but one prefecture. The highest value was observed in the prefecture of Ibaraki, where on 25 March a deposition of 480 becquerel per square meter for iodine-131 was observed; the highest value for cesium 137 was measured in Yamagata at 150 becquerel per square meter. For the Shinjyuku district of Tokyo, the additional deposition of iodine-131 and cesium-137 on 25 March was below 200 becquerel per square meter. For two prefectures (Ibaraki, Tochigi) iodine-131 and cesium-137 were reported in spinach and other leafy vegetables above the regulation values set by the Japanese authorities. However, iodine-131 and cesium-137 were either not detected or were below the regulation values, in all of the samples taken from the remaining four prefectures (Chiba, Gunma, Kanagawa and Saitama) and Tokyo. In all six prefectures and Tokyo, no iodine-131 and cesium-137 were detected in leeks, or measurements were well below the regulation values set by the Japanese authorities. The Prime Minister of Japan, Mr. Naoto Kan, has issued instructions to food business operators to cease, for the time being, the distribution of, and for the public to cease the consumption of, certain leafy vegetables (e.g., spinach, komatsuna, cabbages) and any flower head brassicas (broccoli, cauliflower) produced in Fukushima Prefecture. Seafood testing has been put in place for Ibaraki and Chiba Prefectures. Many countries within and outside the Western Pacific Region have put in place food control measures and testing to regulate food, milk, feed, etc. NOTES: Though radioactive iodine has a short half-life of about 8 days and decays naturally within a matter of weeks, there is a risk to human health if I-131 is ingested in food. Monitoring of levels in food and water is essential to ensuring the safety of the population. The presence of elevated radiation levels in food and water may impede nutrition and hydration in the impacted areas, potentially exacerbating the health issues already emerging in some locations (e.g. influenza, gastroenteritis, hypothermia). IAEA Update: 26 March 2011OCHA Sit Rep 13: 25 March 2011 FDA Radiation Safety: 23 March 2011

29. RADIONUCLIDES IN DRINKING WATER Recommendations relating to the restriction of drinking water consumption, based on measured concentrations of iodine-131, remain in place in seven locations (in one location for both adults and infants, and in six locations for infants). DRINKING WATER The Nuclear Safety Commission of Japan guideline value for the restriction of drinking water intake include: I-131 at or above 300 Bq/kg* and cesium-134 or cesium-137 at or above 200 Bq/kg*. FUKUSHIMA PREFECTURE Levels of radionuclides found in samples taken from Itatemura exceeded guideline values. Residents were advise to refrain from consuming drinking-water. Levels of I-131 in drinking water samples collected from Date City, Kawamata, Koriyama, Tamura, Minamisoma and Iwaki exceeded the guideline value for use by infants. Residents were advised to use bottled water. .OUTSIDE FUKUSHIMA PREFECTURE Radioactive iodine was detected in treated water at water treatment facilities surrounding Tokyo. Residents were advised to discontinue the use of tap water for infants less than 1 year of age. RESPONSE More than 240,000 of 500ml water bottles have already been distributed, with priority given to families with an infant less than 1 year of age. MHLW has also suggested pregnant and breast-feeding women should adhere to a guidance value of 100 Bq/kg or less. The UN World Health Organization (WHO) warned members of the general public against self-medicating with potassium iodide (KI) or with products containing iodide as a precaution against nuclear radiation. WHO advised that KI should only be taken when there is a clear public health recommendation to do so, as indiscriminate use can cause adverse side-effects. A child holds a bottle of mineral water distributed to a nursery in Tokyo a day officials reported that radioactive iodine in the city's tap water measured more than twice the level considered safe for babies. The label reads "Emergency drinking water. Water collected at the foot of Mount Fuji for storage.“ The Associated Press:March 24, 2011 *Japanese guideline values are an order of magnitude lower than the internationally agreed Operational Intervention Levels for I-131(3,000 Bq/kg), Cs-134(1,000 Bq/kg) and Cs-137(2,000 Bq/kg). IAEA Updates: 26 March 2011 WHO FAQs: 25 March 2011 WHO-WPRO SitRep No. 17: 26 March 2011 OCHA Sit Rep 13: 25 March 2011

30. RADIONUCLIDES IN SEA WATER • Surveillance of seawater near the NPP sites indicates 1250 times above safety level (Iodine-131) for seawater at 330 m from Daiichi plant. This is much higher than the 147 times safety level detected earlier on 23 March • On 23 March, the Ministry of Education Culture Sports Science and Technology (MEXT) began surveillance of coastal waters near the Fukushima Daiichi NPP site. Air and seawater samples have been collected on 23 and 24 March in coastal waters along transects that are separated by 10 km intervals. Sampling has been performed along each transect to a distance of about 30 kmsoffshore. The results released by MEXT are summarized on the right. Surveillance of seawater near the NPP sites indicates 1,250 times above safety level (Iodine 131) for seawater at 330 m from Daiichi plant. This is much higher than the 147 times safety level detected earlier on 23 March. • New data for 21 to 25 March on radionuclide concentrations were made available for the discharge area 330 meters south of the pipeline of Fukushima Daiichi. • The levels are generally quite high and vary significantly with time. The highest levels were detected at 25 March with, for example, 50 000 becquerel per liter of iodine-131, 7,200 becquerel per liter of cesium-137, and 7 000 becquerel per liter of cesium-134. • Other short lived radionuclides were also reported. No new data has been reported by Japan from the monitoring stations located about 30 km offshore. • New data from monitoring of the marine environment, carried out from 24 March 22:55 UTC to 25 March 03:32 UTC about 30 km offshore, show a decrease in both cesium-137 and iodine 131. • The contamination at these locations is influenced by aerial deposition of fallout as well as by the migration of contaminated seawater from the discharge points at the reactor. • The measured radiation doses rates above the sea remain consistently low (between 0.04 and 0.1 microsievert per hour). The first results of model predictions received from the SIROCCO Group at the University of Toulouse are being assessed. Values exceed maximum permissible concentrations • NOTE: • The maximum permissible concentrations in seawater are 40 Bq/L for I-131 and 90 Bq/L for Cs-137. Values in excess of the Iodine-131 limit have been detected at sampling points 1-3, 1-4, 2-1 and 2-2. • MEXT is continuing to monitor the situation. IAEA Updates: 26 March 2011 WHO FAQs: 25 March 2011 WHO-WPRO SitRep No. 17: 26 March 2011 OCHA Sit Rep 13: 25 March 2011

31. NHK reported on 25 March that Japanese authorities had detected a concentration of a radioactive substance that was 1,600 times higher than normal at a village 40 kilometers away from the Daiichi nuclear power plant in Fukushima Prefecture. • The disaster task force in Fukushima surveyed radioactive substances in soil about 5 centimeters below the surface at six locations around the plant from last Friday through Tuesday. • The results announced on Wednesday showed that 163 000 becquerels of radioactive Cesium-137 per kilogram of soil has been detected in Iitate Village, about 40 kilometers northwest of the plant. RADIOACTIVITY IN SOIL OCHA Sit Rep 13: 25 March 2011 WHO-WPRO SitRep No. 17: 26 March 2011 USAID Fact Sheet #13: 24 March 2011 IAEA Update: 26 March 2011 US Geological Survey NOAA Center for Tsunami Research

32. HEALTH CONCERNS • CURRENT RISK • The Government of Japan’s recent actions in response to events at the Fukushima Daiichi nuclear power plant are in line with the existing recommendations for radiation exposure. The Government has evacuated individuals who were living within a 20-kilometre radius around the Fukushima Daiichi plant. Those living between 20 km and 30 km from the plant are being asked to shelter indoors. People living farther away are at lower risk than those who live nearby. • RISK OF RADIOACTIVE EXPOSURE FROM FOOD CONTAMINATION • There is a risk of exposure as a result of contamination in food. • However, contaminated food would have to be consumed over prolonged periods to represent a risk to human health. • The presence of radioactivity in some vegetables and milk has been confirmed and some of the initial food monitoring results show radioactive iodine detected in concentrations above Japanese regulatory limits. Radioactive cesium has also been detected. (See “Radionuclides in Food and Water” Slides for add’l details) • BASELINE HUMAN EXPOSURE TO RADIATION • Human beings are exposed to natural radiation (also known as background radiation) on a daily basis • On average, a person is exposed to approximately 3.0 millisieverts (mSv)/year, of which 80% (2.4 mSv) is due to naturally-occurring sources (i.e., background radiation), 19.6 % (almost 0.6 mSv) is due to the medical use of radiation and the remaining 0.4% (around 0.01 mSv) is due to other sources of human-made radiation. • ACUTE HEALTH EFFECTS • If the dose of radiation exceeds a certain threshold level, it can produce acute effects, including skin redness, hair loss, radiation burns, and acute radiation syndrome (ARS). • In a nuclear power plant accident, the general population is not likely to be exposed to doses high enough to cause such effects. • Rescuers, first responders, and nuclear power plant workers are more likely to be exposed to doses of radiation high enough to cause acute effects. • LONG-TERM HEALTH EFFECTS • Exposure to high doses of radiation can increase the risk of cancer. • Radioactive iodine can be released during nuclear emergencies. If radioactive iodine is breathed in or swallowed, it will concentrate in the thyroid gland and increase the risk of thyroid cancer. Among persons exposed to radioactive iodine, the risk of thyroid cancer can be lowered by taking potassium iodide pills, which helps prevent the uptake of the radioactive iodine. • The risk of thyroid cancer following radiation exposure is higher in children and young adults. • PERSONAL PROTECTIVE MEASURES (UPON EXPOSURE) • If you are coming indoors after radiation exposure, undress in the doorway to avoid further contamination in your home or shelter. Remove clothing and shoes and place them in a plastic bag. Seal the bag and place it in a safe location away from living areas, children, and pets. • Shower or bathe with warm water and soap. • Notify authorities that you may have contaminated clothing and personal belongings to be handled appropriately and disposed of according to accepted national procedures. • Potassium iodide pills are not “radiation antidotes”. They do not protect against external radiation, or against any other radioactive substances besides radioiodine. They may also cause medical complications for some individuals with poorly functioning kidneys. Potassium iodide should be taken only when there is a clear public health recommendation WHO Japan Nuclear Concerns FAQ 25 March WHO Japan Nuclear Concerns FAQ – Health Effects 25 March WHO Japan Nuclear Concerns FAQ – Human Exposure 25 March WHO Japan Nuclear Concerns FAQ– Protective Measures 25 March

33. HEALTH CONCERNS (RADIATION) • POTENTIAL HEALTH CONCERNS TO TRACK • (HISTORICAL PRECEDENTS) • Although current conditions do not suggest an emergency on the same level as the Chernobyl Accident, conditions to track may include the following: • Thyroid Cancer: A large increase in the incidence of thyroid cancer has occurred among people who were young children and adolescents at the time of the accident and lived in the most contaminated areas of Belarus, the Russian Federation and Ukraine due to the high levels of radioactive iodine released from the Chernobyl reactor in the early days after the accident. Radioactive iodine was deposited in pastures eaten by cows who then concentrated it in their milk subsequently drunk by children • Leukemia and non-thyroid solid cancers: Ionizing radiation is a known cause of certain types of leukemia (a malignancy of blood cells). An elevated risk of leukemia was first found among the survivors of the atomic bombings in Japan some two to five years after exposure. Recent investigations suggest a doubling of the incidence of leukemia among the most highly exposed Chernobyl liquidators • General Mortality:At Chernobyl, 134 liquidators received radiation doses high enough to be diagnosed with acute radiation sickness (ARS). Among them, 28 persons died in 1986 due to ARS. Other liquidators have since died but their deaths could not necessarily be attributed to radiation exposure. • Cataracts:The lens of the eye is very sensitive to ionizing radiation and cataracts are known to result from effective doses of about 2 Sv. The production of cataracts is directly related to the dose. Chernobyl cataract studies suggest that radiation opacities may occur from doses as low as 250 mSv. • Cardiovascular Disease:A large Russian study among emergency workers has suggested an increased risk of death from cardiovascular disease in highly exposed individuals DRINKING WATER RADIATION GUIDELINE LEVELS (& RISK) WHO Chernobyl Health Effects Fact Sheet April 2006WHO Japan Nuclear Concerns FAQs- Drinking Water Safety

34. JUST IN TIME TRAINING (Potential Health Effects from Radioactive Emissions) Dr. David J. Brenner, Director of the Center for Radiological Research at the Columbia University Medical Center, provides a 30 minute primer on radiation exposure, addressing the scientific facts and common misconceptions. His discussion focuses on the damage at the Fukushima Daiichi Nuclear Power Plant as well as the implications of the catastrophe on radiation preparedness efforts in the U.S. http://crlc.adobeconnect.com/rad_jit/