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 • 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 • 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. HEALTH CONCERNS INJURY-RELATED INFECTION ARI HOSPITALS AND MED TEAMS PSYCHOLOGICAL IMPACT ELDERLY ISSUES SHELTER AS OF 1200 HRS EDT 3 APRIL 2011 LOGISTICS & TRANSPORTATION

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 • 11,600 dead and 16,450 missing to date • 20 International Search & Rescue teams from 15 countries responded • 17,000 homes and buildings destroyed, 138,000 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 JAPAN EARTHQUAKE AND TSUNAMIBACKGROUND OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 COE Update: 30 March 2011 US Geological Survey NOAA Center for Tsunami Research Near the Port of Ishinomaki the tsunami left boats stranded in the streets, and many buildings totally destroyed. Photo: IFRC

SITUATION • EMERGENCY RESPONSE • Continuing winter weather remains a challenge for affected areas. On 30 March, the UN reported that the temperature dropped below zero in many coastal towns and snowfall was reported in the afternoon. • Priority needs remain: fuel, prefabricated housing, clothing and medicine. • As rainfall begins to increase in April in the lead up to the rainy season which starts in mid June in the Tohoku region and continues for about six weeks, the coastal areas of Iwate, Miyagi, Fukushima and Ibaraki are preparing to tighten their early warning systems. The March 11 earthquake had caused the land to depress in certain areas and tsunamis have damaged embankments, making these areas particularly vulnerable to flooding. • The vast majority of key infrastructure such as highways, ports and airports has been restored and there have been improvements in electricity, gas and water supply, but in the worst affected areas it could take some time before these vital services are up and running. Most of sewage systems in the affected area are still not functioning. • BUILDINGS- Latest assessments report that 16,950 homes and buildings were destroyed and another 138,000 were damaged. • ROADS AND TRANSPORTAION NETWORKS - At least 2,126 roads, 56 bridges and 26 railways have been destroyed. While key transport routes are open it is still impossible to travel on many of the smaller roads and there are reports that some areas remain cut-off from all assistance by road. • SHELTERS • There are currently 170,500 displaced people living in 2,230 evacuation centers in 17 prefectures. The number of people in evacuation centers is decreasing slightly whereas the number of evacuation centers has increased by 200 in the last two days. That is because 174 have opened in Aomori Prefecture in the north. • Improving the living conditions at the shelters in the worst affected areas is the biggest priority otherwise there will continue to be an increase in the number of cases of cold and hygiene-related illnesses. • It is estimated that around 74,000 children remain displaced. • POPULATION NEEDS OUSIDE THE SHELTER • It is still unknown how many people are living outside evacuation centers but the number is certainly large. • Many people who were originally living in evacuation centers have returned to their homes even if they were damaged and without water and power. These people do not receive basic supplies from the municipal authorities but are becoming the focus of attention by local NGOs and volunteers. • REMAINS RECOVERY • On 1 April the Japan’s Self Defense Force and the US military have launched a three-day joint operation to recover the bodies of people still unaccounted for in the coastal areas of Miyagi, Iwate and Fukushima. • More than 11,600 people have died and 16,450 remain missing in these prefectures. • The operation does not include the 20 kilometer exclusion zone around the Fukushima Nuclear Power Plant where there are believed there could be a significant number of bodies. Many of the missing are feared to have drifted offshore. • A total of 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. • Diving units from the Japan Coast Guard will also be deployed to search in rivers and flooded areas. • Recovering the bodies of the missing is seen as an important step in helping the country to move on. OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 COE Update: 30 March 2011 USAID Fact Sheet #14: 31 March 2011

SITUATION • GAS– Gas supplies have been restored to roughly 32 per cent of households and 340,000 households remain without. • FUEL • Because 4 out of 7 supply bases of liquefied petroleum (LP) gas are not operational, the Ministry of Economy, Trade and Industry will release 40,000 tons from the national reserve for the first time from 4 April. • The fuel shortage remains a serious issue in the affected areas, exacerbated by a limited number of operational fuel stations and increasing needs. The Government plans to spend US$210 million (1.7 billion JPY) to procure tankers and install makeshift fuel stations. FOOD - The Emergency Disaster Response Headquarters reports that an estimated 14 million meals have been delivered to evacuation centers and hospitals in the affected areas as of 1 April. Approximately 1.5 million meals were delivered on 30 and 31 March. In addition, approximately 3 million meals are in transit. The figure does not include distribution of food items by municipalities, NGOs, private sector, and Japan’s Self Defense Force. WATER– As of 1 April, 87.9 per cent of water has been restored to buildings and only 260,000 households in eight prefectures are still without running water. Currently 320 water trucks are deployed and 200 more will shortly deliver water to those without access to tap water. ELECTRICITY - As of 1 April 96.3% of electricity has been restored in the Tohoku leaving approximately 180,000 households remain without power. DEBRIS - In Miyagi prefecture, debris amounts to approximately 15 to 18 million tons, which is roughly equivalent to 23 years worth of waste for the prefecture. The prefecture only has the capacity to dispose of 0.8 million tons per year and officials say it will take three years to remove all the debris, not including cars and boats. COMMUNICATIONS - As of 30 March: Some 118 927 telephone lines remain out of service. (Some companies provide free "pay phone" and specially laid out "payphone" in 16 prefectures). A reported 2 046 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. EDUCATION – The academic year starts in April, but ~1,700 public schools (70%) have been damaged in the three most affected prefectures. Many schools and universities are still being used as evacuation centers. In the three worst affected areas, approximately 1,700 (70 per cent) of public schools have been damaged, and among them, 291 primary and junior high schools have so far no prospect of resuming their classes. • RADIATION CONTAMINATION • The Joint FAO/IAEA Food Safety Assessment Team has completed its mission and presented its report to the Japanese Cabinet Office, Ministry of Foreign Affairs, Ministry of Health, Labor and Welfare and the Ministry of Agriculture, Fisheries and Forestry on 31 March. The IAEA members of the Team are returning to Vienna on 1 April. • TEPCO conducted an analysis of soil, as part of monitoring activity of the surrounding environment, at five sampling points in the premises of the Fukushima Daiichi NPP. The soil samples on 21 and 22 March were analyzed and plutonium 238, 239 and 240 were detected. However, the density of detected plutonium was such that it would not pose major impact on human health. • The Japanese Ministry of Health, Labor and Welfare. Reported analytical results covered 2 samples taken on 15 March and 109 samples from 27-31 March: • Analytical results for 98 of the 111 samples for various vegetables, spinach and other leafy vegetables, fruit (strawberry), seafood, various meats (beef, chicken and pork) and unprocessed raw milk in eight prefectures (Chiba, Fukushima, Gunma, Ibaraki, Kanagawa, Niigata, Tochigi, and Tokyo), indicated that iodine-131, caesium-134 and caesium-137 were either not detected or were below the regulation values set by the Japanese authorities. • Analytical results in Chiba, Fukushima, Ibaraki and Tochigi prefectures for the remaining 13 of the total 111 samples for spinach and other leafy vegetables, parsley and beef indicated that iodine-131 and/or caesium-134 and caesium-137 exceeded the regulation values set by the Japanese authorities. OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 COE Update: 30 March 2011 USAID Fact Sheet #14: 31 March 2011

SITUATION CURRENT ASSESSMENT • HEALTH • Emergency medical needs have decreased as a number of medical teams are now active in the devastated sites. Focus is now turning towards care for the elderly. • People continue to face cold temperatures with insufficient heating, including in the evacuation centers. Hypothermia has been reported, particularly among the elderly. • Tohoku University reports that cases of pneumonia among the elderly living in evacuation centers in Miyagi are increasing. During 20 to 26 March, the University received 40 referrals from two local hospitals, a level 10 times above the average. . • Long term psychosocial support will be needed for survivors including emergency workers. Preliminary key mental health areas identified are pediatric mental health and survivor’s guilt. Continued assessment is necessary. • As of 26 March, 52 deaths in shelters have been reported, particularly among the elderly. • DRINKING WATER • Media report for the first time, radiation has been confirmed in ground water below Unit 1 in Fukushima Daiichi nuclear plant. • Radioactive elements detected in the tap water in Iitate Village, Fukushima Prefecture have steadily decreased to a level acceptable for drinking. GoJ’s advice for not consuming tap water was lifted on 1 April for most areas. • As of 1 April, tap water from Fukushima Prefecture: Date City (Tsukitate Small-Scale Water Supply Utility) and Iitate Village (Iitate Small-Scale Water Supply Utility) cannot be used for infant feeding. • FOOD SAFETY • On 31 March, radioactivity in 25 of 76 food samples exceeded the provisional regulation values. Of the total 699 food samples that have been tested to date,124 food samples from Chiba, Fukushima, Gunma, Ibaraki, Tochigi, Tokyo exceeded the provisional regulation values. • According to WHO, media report cesium has been found for the first time in meat from Fukushima Prefecture. 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 JAPAN A A A A A A A R A A PUBLIC HEALTH COMMUNICABLE DISEASES SANITATION WATER MENTAL HEALTH RADIATION SURVEILLANCE FOOD WASTE\DEBRIS SEWAGE R A R R A A R A A R B JAPAN OVERALL PH/MEDICAL ASSESSMENT OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 IAEA Briefing on Fukushima Nuclear Accident 31 March 2011 AMDA Emergency Bulletin #12: Japan Earthquake and Tsunami 2 April 2011

GOVERNMENT OF JAPAN RESPONSE • COORDINATION • The GoJ’s Emergency Management agencies are leading the response through the Emergency Response Team, headed by Prime Minister Naoto Kan. The Chief Cabinet Secretary’s office is coordinating volunteers and NGO’s through its Volunteer Coordination Unit. • The Tokyo Metropolitan Government announced that it will deploy about 1,000 officials to Miyagi and Iwate to reinforce prefectural government offices involved in emergency response. The Metropolitan Government is planning to station at least 100 officers per day in the affected prefectures from 2 April until at least mid May to provide non-emergency services and manage evacuation centers. • OCHA support to the GoJ Emergency Response Team ended 1 April. • As rainfall begins to increase in April in the lead up to the rainy season, the coastal areas of Iwate, Miyagi, Fukushima and Ibaraki are preparing to tighten their early warning systems. • LIVELIHOODS - Over 22,700 people (18,201 in Miyagi, 3,282 in Iwate and 1,243 in Fukushima) have gone to local employment offices for jobs and benefits. Prefectural governments say the roughly 800,000 displaced workers should be given priority for construction and debris removal work. • SHELTER • The number of shelters has increased by 200 in the last two days in efforts to improve living and sanitary conditions. However, movement from evacuation centers to temporary shelters will soon intensify. The GoJ is also beginning to accommodate evacuees in public housing. • Starting in May, GoJ will provide $1 million JPY ($10,000) to each family who lost their homes. • HEALTH & MEDICAL CARE • The MHLW has coordinated the deployment of doctors, pharmacists, social workers, dentists, care managers, child welfare and psychological specialists from various medical institutions. 142 teams, consisting of 640 members, are responding in Iwate, Miyagi and Fukushima. WASH - The Emergency Disaster Response Headquarters reports that approximately 5.5 million bottles of water have been delivered to evacuation centers in the affected areas so far. FOOD - The Emergency Disaster Response Headquarters reports that an estimated 14 million meals have been delivered to evacuation centers and hospitals in the affected areas to date. Approximately 1.5 million meals were delivered on 30 and 31 March and 3 million means are in transit. The figure does not include distribution of food items by municipalities, NGOs, private sector, and Japan’s Self Defense Force. AGRICULTURE - The Ministry of Agriculture, Forestry and Fisheries says 24,000 hectares out of 900,900 hectares of agricultural land in Iwate, Miyagi, Fukushima, Ibaraki, Chiba and Aomori have been damaged by the tsunami. In the most affected prefectures of Iwate, Miyagi and Fukushima, nearly all fishing ports sustained significant damage. Agriculture and fisheries are one of the biggest industries in the region and aid to these sectors will be critical for the reconstruction of livelihoods. EDUCATION – The GoJ seeks to vacate schools current serving as evacuation centers prior to the beginning of the school year in April. The Prefecture of Iwate and the Ministry of Education are considering establishing boarding schools for children orphaned by the disaster. • NOTE: • People who are able to live in their homes still require assistance as they have no access to food, water and basic supplies. These people are no longer receiving supplies from local authorities but are becoming the focus of local NGO’s and volunteers. • A Japanese-US military operation is underway to recover the bodies of those still missing. 18,000 of Japan’s Self Defense Force personnel and diving units from the Japan Coast Guard will be deployed The MHLW is supporting local government in the management of the dead. WHO-WPRO SitRep No. 23: 1 April 2011 OCHA SitRep No. 16: 1 April 2011

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. • JRCS is concerned about the psychological well-being of the affected populations, especially of children. They assigned trained psychosocial support providers (PSP) to almost all deployed medical teams. The national society has 2,369 nurses trained to provide PSP services. In addition, some PSP teams were deployed to conduct assessments in the affected areas and support medical teams in conducting health checks. There are shortages of medicine for the treatment of chronic medical conditions. • The Japanese Red Cross Society has received a record $725 million from more than 1.1 million local donations. • JRCS in-country capacity: 47 branches, each equipped with special equipment to with nuclear, biological, or chemical disasters, 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. • 346 domestic Emergency Response Units and medical teams of the Japanese Red Cross Society (JRCS) have completed their mission as of 01 April, 27 remain in the three most affected prefectures and 117 are on standby. • A Family Links web site is operating in cooperation with ICRC (in Japanese, English, Chinese, Korean, Portuguese, and Spanish). As of 28 March, 5,619 people have been registered: http://www.familylinks.icrc.org/eng/familylinks-japan • JRCS has also handed out more than 125,500 blankets, 26,100 emergency kits (including radios, flashlights and other supplies), 11,000 sleeping kits (including pillows, camping mats, ear plugs, etc.) and clothing to families in evacuation centers. • In order to reinforce and mobilize the network of volunteers, volunteer centers have been established at the headquarters of JRCS, and 4 branches in the affected prefectures. • Media reports that the Ishinomaki Red Cross Hospital found that sanitation and hygiene environment is deteriorating in 30 per cent of the 314 evacuation centres that they have assessed in Ishinomaki, Higashi-Matsushima and Onagawa in Migyai. Excreta disposal is a particular challenge. • In response to damages caused to the Fukushima nuclear power plant, the JRC remains prepared to support those evacuated from the exclusion zone. All of the JRC branches (47) are equipped with special equipment to cope with nuclear, biological or chemical disasters. Staff with the Japanese Red Cross help unload boxes of emergency kits at an elementary school's gym in Ofunato City, Iwate prefecture. The kits are destined for survivors, who are living at evacuation centers in the affected areas. Photo: Kathy Mueller/IFRC • 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. OCHA SitRep No. 16: 1 April 2011 COE Update: 30 March 2011 JRCS Emergency Relief 3: 23 March 2011 IFRC Info Bulletin 5: 28 March 2011

The USAID team is working to manage the overall USG response effort in Japan in coordination with the U.S. Embassy in Tokyo. • 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. • 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. • U.S. Government officials are consulting with health experts and radiation experts, in both the United States and Japan, and are continuously monitoring tap water samples for radioactive iodine. In accordance with guidelines that apply to water in the US, and based on analysis of tap water samples for radioactive iodine on 24 March, the water in Tokyo is safe for drinking. • 27 March, DART staff participated in an assessment of Miyagi Prefecture, with staff from OCHA, the U.N. World Food Program, and the GoJ. DART staff noted concerns regarding adequate access to sanitation facilities in evacuation centers; local officials reported plans to improve sanitation conditions, such as setting up portable toilets. • USG Funding Announced and Committed as of 31 March 2011:: • USAID/OFDA Assistance =$6,825,286 • Department of Defense (DoD) Humanitarian Assistance = $63,051,000 • Total USAID and DoD Assistance for the Earthquake and Tsunami = $69,876,286. • MESSAGES FROM US EMBASSY – JAPAN • 31 March, In response to the situation at the Fukushima Daiichi Nuclear Power Plant, the United States Nuclear Regulatory Commission (NRC), the Department of Energy, and other technical experts in the U.S. Government have reviewed the scientific and technical information they have collected from assets in country, as well as what the Government of Japan has disseminated. Consistent with the NRC guidelines that would apply to such a situation in the United States, we continue recommending, as a precaution, that U.S. citizens within 50 miles (80 kilometers) of the Fukushima Daiichi Nuclear Power Plant evacuate the area or take shelter indoors, if safe evacuation is not practical. • March 29 Update from Ambassador Roos (Video Update) • (Updated 31 March, 6 p.m. JST) The U.S. Embassy is continuing to make potassium iodide (KI) available to U.S. citizens who have not been able to obtain it from their physicians, employers, or other sources. It is not recommend that anyone take KI at this time, as there can be side effects from the drug. It should only be taken on the advice of emergency management or 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. UNITED STATES RESPONSE COE Update: 30 March 2011USAID Fact Sheet #14: 31 March 2011 U.S. Embassy Tokyo News Update: 29 March 2011U.S. Embassy Tokyo News Update: 31 March 2011 U.S. Embassy Tokyo News Update: 28 March 2011U.S. Embassy Tokyo News Update: 31 March 2011

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. To date the DOD has contributed the following items: 185 tons food, 2,041,689 gallons water and 5,625 gallons fuel. • U.S. Air Force • PACAF has generated 377 sorties moving 1,274 passengers and more than 2984.2 short tons (5,968,400 lbs) of cargo in support of Japan Relief Efforts. • Number of AF Personnel deployed in support of relief operations: 745 • Number of PACAF aircraft deployed in support of relief operations: 25 • PACAF generated 1 sorties and moved 0 short tons of cargo. • U.S. Army • Fifteen members of the U.S. Army Japan Band were in the Sendai Area on 31 March conducting a bi-lateral band concert with a band from the North East Army Japan. The concert was held at the Touho Junior High School. This is there second concert scheduled for 2 April. • U.S. Marines • As of March 31, there were approximately 850 Marines from III MEF/MCBJ in mainland Japan in support of Operation Tomodachi. • As of March 31, 1st Marine Aircraft Wing units have flown 540 sorties, totaling 841 hours of flight time while delivering more than 497,800 pounds of cargo in support of Operation Tomodachi. • Sendai airport aviation, school cleanup, and debris removal ongoing. • Installation of shower units are ongoing at Oshio and Oonashima. UNITED STATES RESPONSE (DOD-OPERATION TOMODACHI) HIGASHI MATSUSHIMA, Miyagi, Japan — A convoy of Marines and sailors with Task Force Fuji, Joint Support Forces Japan, alongside Japan Self-Defense Force members delivered 15 barrels of diesel fuel to a supply distribution point here March 30. (4/1/2011-Lance Cpl. Mark W. Stroud, Marine Corps Bases Japan) Members of the Japan Self Defense Force Northeastern Army Band and the U.S. Army Japan Band play a concert for Japanese locals at a displacement camp, Toho Middle School, Tagajo City, Japan, March 30. U.S. Marines NOTES: The DOD has now moved from supporting emergency efforts to assisting in rebuilding ports, reopening airports and clearing debris to allow for recovery efforts to begin in earnest. Joint Support Force Relief Update: 31 March 2011

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, 16 ships, 130 aircraft and 13,076 personnel are in the area of operation. • The Sendai airport is now open for military flights – and soon to be opened for commercial flights as well -- 7th Fleet’s focus has shifted to harbor clearance, consolidating relief supplies at airfields ashore, and preparing to assist with clean-up of debris. • USNS Safeguard and USS Tortuga, Mobile Diving and Salvage Unit 1, Explosive Ordnance Disposal Mobile Unit 5 and Underwater Construction Team 2 conducted additional surveys in preparation for port clearance operations at the port of Miyako. Visual surveys show extensive damage including commercial and pleasure craft sunk, concrete pier supports washed ashore and a permanent pier destroyed. Tortuga launched a Landing Craft Unit equipped with side scan sonar to survey additional areas of the port. During the survey, the dive team discovered the remains of a victim of the tsunami of March 11, who was removed by the Japan Maritime Self Defense Force. • The USS Essex and the 31st Marine Expeditionary Unit are planning for Operation “Field Day”, a clearing and clean up mission on the remote island of Oshima off the coast of Kessennuma. The effort will include clearing the port, and clearing debris from local schools and government buildings. The island is dependent upon ferry service to and from the mainland as the primary method for travel to/from the island and clearing the port allows this vital lifeline to resume. • Helicopters from Marine Medium Helicopter Squadron 262 moved 13 pallets of relief supplies to Misawa, where they will be moved via C-130 aircraft to Sendai. JGSDF and civilian relief authorities will distribute the items to disaster areas as needed. The JGSDF has opened most roads in the disaster areas, and are able to move most goods to displaced persons via ground transportation. • Since Operation Tomodachi started, U.S. 7th Fleet forces have delivered more than 250 tons of relief supplies to survivors of the tsunami and earthquake in support of Japan Self Defense Force efforts. • USNS Rappahannock transported 312 pallets of water from Gwangyang, South Korea. USNS Carl Brashear arrived in Sasebo. Both Pecos and Carl Brashear are taking on fuel and ships stores prior to returning to the fleet • A P-3 aircraft conducted a search and rescue flight down the east coast of Japan to search for debris at sea that could interfere with shipping. • The first of two U.S. Navy barges containing 500,000 gallons of fresh water from Commander, Facilities Activities Yokosuka was moved to the Fukushima Daiichi nuclear power plant on 31 March. The second is scheduled to arrive on 1 April. Japanese authorities will use the fresh water to replace salt water currently in some of the reactors. • USNS Bridge conducted resupply at sea with USS McCampbell, USS Preble, USS Chancellorsville, USS Mustin, USS Cowpens, and USS Shiloh, ships of the USS Ronald Reagan Carrier Strike Group, supplying fuel and additional supplies. Most of the relief supplies on these ships have been moved ashore to airfields in Misawa or Sendai where the JSDF can better access them to deliver to people in need. UNITED STATES RESPONSE7th FLEET Japan Ground Self-Defense Force Lt. Gen. EijiKimizuka, commanding general of Joint Task Force Tohoku, listens to Col. Andrew MacMannis, commanding officer of 31st Marine Expeditionary Unit, talk about operations taking place aboard the USS Essex. U.S. Navy NOTES: A video documenting the work of the Joint Support Force relief efforts is available on YouTube. Joint Support Force Relief Update: 31 March 2011

UN OFFICE FOR THE COORDINATION OF HUMANITARIAN AFFAIRS (OCHA) - reporting and providing coordination support functions to the GoJ and has a temporary presence at the JICA Tokyo International Center in Japan. • On 31 March, OCHA led a joint mission to Rikuzen Takada, one of the worst affected towns in Iwate Prefecture. The mission included representatives from the Ministry of Foreign Affairs, the Cabinet Secretary’s Office, WFP and the USAID’s Disaster Response Team (DART). The purpose of the mission was to determine the residual humanitarian needs in Iwate Prefecture to better inform reporting and to bring any gaps to the attention of the Government of Japan. • WORLD FOOD PROGRAMME (WFP) • WFP this week 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. • 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)The Joint FAO/IAEA Food Safety Assessment Team has completed its mission and presented its report to the Japanese Cabinet Office, Ministry of Foreign Affairs, Ministry of Health, Labor and Welfare and the Ministry of Agriculture, Fisheries and Forestry on 31 March. • The Agency, in agreement with the Japanese government, will dispatch two reactor experts to Japan. They will hold meetings with the Nuclear Safety Commission, NISA, TEPCO and other Japanese counterparts from Monday 4 April 2011 onwards. The objective of this visit is to exchange views with Japanese technical experts and to get first-hand information about the current status of reactors at Fukushima Daiichi, measures being taken and future plans to mitigate the accident. • 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 local governments. 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 HIGH COMMISSIONER FOR REFUGEES (UNHCR) - At the request of the GoJ, UNHCR is providing 1,794 solar lanterns for Miyagi Prefecture. The GoJ has 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 UNICEF Press Rel: 23 March 2011 UNICEF Press Rel: 24 March 2011 WFP News Rel: 01 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 OCHA SitRep No. 16: 1 April 2011

The GoJ has received 134 offers of assistance from countries as well as 39 offers from international organizations. It has accepted relief items from 29 countries and international organizations. • GoJ says the need for further international assistance is limited and any support should clearly be in accordance with the GoJ’s criteria: • 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.) • SAVE THE CHILDREN estimates that about 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 who have lost everything. 500 hygiene kits are ready for distribution at the Sendai warehouse. • 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 is assessing the post-disaster needs of isolated coastal villages in north Sendai that have yet to receive humanitarian assistance. Information from assessments of evacuation centers has been communicated to the Japan regional office of International Medical Corps to facilitate coordination efforts. • While shortages of food and water have improved, there is still a need for medications, packaged baby foods, and other supplies. • IIMC’s assessments include: Minami-Sanriku, Kesennuma, Riken-Takata, East Matsushima and areas north of Ishinomaki. • Visited East Matsushima on 27 March 2011 and found cell phone service operational and limited supplies available. OTHER ORGANIZATIONS OF INTEREST One of the more than 2000 shelters temporarily housing some 175,000 people. Photo by Paula Bronstein (Getty Images) for AmeriCares. • AMERICARES is airlifting an emergency shipment of medical aid • Contains 35,000 pounds of medicines, medical supplies and hygiene items and will be received by Tohoku University Hospital in Sendai. • The Americares team is also launching a “flash grants” program to help maintain or expand emergency activities by smaller Japanese community orgs. and NGOs. OCHA SitRep No. 16: 1 April 2011 IMC: 29 March 2011 AmeriCares: 1 April 2011

ASSOCIATION OF MEDICAL DOCTORS OF JAPAN (AMDA) ) has 98 relief personnel working in the impacted area: 37 doctors, 17 nurses, 2 midwives, 1 assistant nurse, 3 pharmacists, 37 coordinators • Iwate Prefecture (Kamaishi City and the town of Ohtsuchicho): • AMDA team working at Futaba Elementary School in Kamaishi city. • Doctors from the Iwate Prefectural Hospital arrived in the evacuation center of Kamaishi City • Also setting up a vehicle with equipment to provide the IV drip. Reaching the larger evacuation centers in Kamaishi City. Logistics remain an issue. • Miyagi Prefecture (the town of Minamisanriku-cho): • AMDA personnel have been working in two teams at Shizugawa Elementary School and Shizugawa Junior High School. 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 is also providing mobile clinic services. • .Depressive symptoms, panic disorders and suspected influenza cases were found among some of the patients, however, the most pressing issue is providing medications for chronic diseases. • Psychiatrist and Psychotherapist in team are treating those who have symptoms of stress or mental disorder. OTHER ORGANIZATIONS OF INTEREST (Map) Seeds Sit Rep 11 : 1 April 2011 NOTE: All offers of assistance should continue to be directed to the GoJ. Elderly woman waiting for assistance . Photo: JustGiving AMDA International Emergency Bulletin 12: 1 April 2011

RELIEF OPERATIONS BY JAPANESE HUMANITARIAN ORGANIZATIONS IN MAJOR AFFECTED CITIES OTHER ORGANIZATIONS OF INTEREST Seeds SitRep 11 : 1 April 2011

HEALTH – CONCERNS • Non-communicable Diseases • Priority high-risk conditions for NCD management include patients on dialysis, those with Type I Diabetes, those requiring respiratory support or acute coronary care and those post-organ transplant. Other priorities include patients with diabetes mellitus, heart disease, asthma, cancer and chronic lung disease. • Patients with major NCD are particularly vulnerable to exacerbations of their conditions. Factors contributing to this include interruption of regular medical treatment, severe situational stress and anxiety, overcrowding and reduced living standards, shortages of water and regular food supplies, degraded environmental conditions and physical injuries. • Tohoku University reports that cases of pneumonia among the elderly living in evacuation centers in Miyagi are increasing. • Hypothermia • People continue to face cold temperatures with insufficient heating. Hypothermia has been reported particularly among the elderly population in the evacuation centers. • Communicable Diseases • There have been sporadic cases of influenza but no large outbreaks. An internet-based ad-hoc syndromic surveillance system has been developed 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%). Results are as follows: influenza A positive - 107(31.9%) and influenza B positive - 5(1.5%). • Influenza-like-illness activity is being monitored in elderly populations due to their high risk status. • There have been 2 cases of tetanus (one each from Miyagi and Iwate prefectures) and 2 cases of legionella from Miyagi prefecture (25 March). The diagnosis occurred between 17 and 21 March. • A survey of sanitary situations in evacuation centers in Ishimaki, Higashi, Matsushima and Onogawa. Around 40% (107/272) toilets had sanitary-related problems. • Acute gastroenteritis (50 cases of diarrhea and 20 of vomiting) and UTI such as cystitis have been reported by media. NOTE: Improving living conditions at shelters in the worst affected areas is the biggest priority to prevent continued increase in numbers of cold cases and hygiene-related illnesses. OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 NISA –News Release No.61: 29 March 2011 CDC - Hypothermia

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

INJURY-RELATED INFECTION • BACKGROUND • Skin protects the body from infection, however when individuals are injured through punctures, scrapes, scratches, or rips of the skin is compromised & infection can occur leading to serious health complications if untreated. • As of 30 March the GoJ has reported 2,778 injuries with thousands still missing. • Injury-Related (IR) Infections remain a serious concern. WHO reports IR infections likely endemic in quake zone, with the potential for acute impact on population. • Risk of IR Infections among rescue workers is HIGH. • Wound Depth – the deeper the wound the more likely complications such as infection will occur. • Size of object – Larger or longer objects can penetrate deeper into tissue increasing risk of infection. • “Cleanliness” of Penetrating Object – Dirtier objects (including rust) are more likely to deposit dirt & debris into wound increasing risk of infection. • Redness, warmth, tenderness & soreness • Swelling or discharge from wound • Fever • Immediate Emergency Attention is needed if wound smells bad, discharge is thick & brown/gray, tissue around wound discolors, or if swollen glands in armpits or groin can be felt. EVALUATING SEVERITY OF WOUNDS (A SIMPLIFIED APPROACH) • RISK FACTORS ASSOCIATED WITH INCREASED RISK OF INFECTION • Older Age & individuals with chronic conditions including diabetes & cancer. • Individuals with Immune system disorders & malnutrition. • Paralysis or other limited mobility. • Note: hospitalization may increase the risk for infection by some antibiotic resistant organisms. • Common complications range in severity and may include: • Death of surrounding tissue (muscle, connective tissue & bone). • Spread of infection to the bloodstream & other organs. • Septic shock, organ failure, & death. SIGNS OF INFECTION • POTENTIAL COMPLICATIONS ASSOCIATED WITH INFECTION • JAMA PATIENT PAGE- Vol. 294, No. 16 • WHO-WPRO SitRep No. 21: 30 March 2011 • AMERICAN COLLEGE of FOOT & ANKLE SURGEONS – foothealthfacts.org • MEDICAL ASPECTS OF RADIATION INCIDENTS Handbook

INJURY-RELATED INFECTION • TREATMENT OF INJURY-RELATED INFECTION • INJURY-RELATED INFECTION & RADIATION EXPOSURE • Radiation damage to cells occurs within microseconds of exposure. • Cellular damage is generally most severe in rapidly reproducing cell types including: stem cells and lymphocytes (a type of white blood cell that functions in the immune system). • Open wounds can allow radioactive contamination to enter the body. • Among individuals with high exposure to radiation, a condition called Neutropenia is common. It is a condition in which white blood cell counts, an important component of normal immune system function, is low. These individuals are therefore at increased risk of injury related infection. • Individuals contaminated by radioactive materials who have sustained injuries requiring medical care should immediately receive all necessary and life-saving actions, without regard to healthcare worker contamination. • Living patients who have been exposed to radioactive contamination due not pose an acute threat to health care providers. • Treatment depends on type of wound, degree of infection, & type of bacteria responsible for infection. • All wounds should be thoroughly cleaned, foreign objects should be removed, and any pus drained. • Laboratory tests may be required and are used to diagnose bacterial wound infections , to identify the microorganism responsible for infection, and to determine susceptibility to specific antimicrobial agents. • Prescription antibiotics may be necessary to treat infection. • ALWAYS finish antibiotics prescription even if infections seems to have cleared up. • NOTES: • Injuries involving open wounds (including punctures, abrasions, and lacerations) should be cleaned thoroughly and covered with sterile bandages. • Medical attention should be sought if there are signs of infection. The WHO considers risk of injury related infections to be HIGH among rescue workers WHO-WPRO SitRep No. 21: 30 March 2011 JAMA PATIENT PAGE- Vol. 294, No. 16 MEDICAL ASPECTS OF RADIATION INCIDENTS Handbook NLLIC Easy Read Fact Sheet: Wound Care & Preventing Infection

MEASLES AND ARI WHAT IS ACUTE RESPIRATORY INFECTION? • The disease burden for Acute Respiratory Infections (ARI) is estimated at 94 037 000 DALYs (WHO, 2002 ) and 3.9 million deaths (WHO, 2002 ). ARI are among the leading causes of death in children under 5 years but diagnosis and attribution are difficult and uncertain. • In low-income countries, lower respiratory infections are the leading cause of death worldwide, in high-income countries they are the fourth main cause of death, and world-wide they are the third cause of death with over 4 million deaths each year according to the World Health Organization (WHO) • The main diseases that cause ARI are: • Streptococcus pneumoniae • Respiratory syncytial virus • Parainfluenza virus type 3 • Influenza ARI is often associated with other life-threatening diseases such as measles. A study reports 62% of all deaths are attributable to ARI but most of these were associated with measles. When measles deaths are excluded the proportion falls to 24%. Measles is a highly contagious viral disease, which affects mostly children. It is transmitted via droplets from the nose, mouth or throat of infected persons. Initial symptoms, which usually appear 8–12 days after infection, include high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards. There is no specific treatment for measles and most people recover within 2–3 weeks. However measles can cause serious complications, including blindness, encephalitis, severe diarrhea, ear infection and pneumonia. Measles can be prevented by immunization with the Measles, Mumps, and Rubella vaccine (MMR). ACUTE RESPIRATORY INFECTION Characteristics of Measles HOW DOES ARI AFFECT CHILDREN? About 20% of all deaths in children under 5 years are due to Acute Lower Respiratory Infections (ALRIs - pneumonia, bronchiolitis and bronchitis); 90% of these deaths are due to pneumonia. Signs on an ARI are cough and difficulty breathing. Young infants with fast breathing or chest indrawing should be suspected to have serious bacterial infection. Source: WHO MeaslesWHO Acute Respiratory InfectionsWHO Acute Respiratory Infections in ChildrenWHO Leading Causes of Death

HOW COULD ARI AFFECT THE DISASTER? Acute Respiratory Infection (ARI) is a significant threat in in shelters. Shelters have very close living conditions and it is very easy for disease to spread. Hypothermia may amplify respiratory illness, which means that there is an even greater risk for those in Japan who do not have proper shelter. ACUTE RESPIRATORY DISEASE IN JAPAN ARI AND THE JAPAN EARTHQUAKE Doctors Without Borders/Médecins Sans Frontières (MSF) has found respiratory illness in the crowded living conditions found in the shelters. The elderly and children are often more at risk for respiratory infection. With Japan’s high population over the age of 65 it is important to take preventative measures for reducing the risk of disease. This image shows healthy people wearing masks to prevent disease. WHAT ARE PRECAUTIONS FOR ARI? • The following precautions should be used to help prevent ARIs: • Facemasks for both the healthy and the sick • Alcohol disinfectant easily available • Increased hand washing • Notes: • Availability of appropriate medical equipment (masks, alcohol wipes) and sanitary conditions are part of an effective strategy to prevent the spread of ARI Source: Respiratory illness and hypothermiaMSF Respiratory IllnessElderly Respiratory Infection

HEALTH – HOSPITALS . • According to OCHA, hospitals providing emergency response services in the three most affected prefectures are gradually building back capacity. • Of the 33 major hospitals in these prefectures, 26 are now accepting both inpatients and outpatients. • Media reports that sufficient medical supplies are now reaching key hospitals. • The challenge is the onward distribution to a network of local hospitals and clinics, which is being hampered by a lack of pharmacists. • In the non-affected prefectures, there are over 390 public hospitals (about 3,400 available beds). • 690 elderly people and people with disabilities in evacuation centers have been moved to special facilities (e.g. nursing homes). Standby beds have been prepared in special facilities : 35,557 beds for elderly, 8,756 beds for people with disabilities, 7,148 beds for children with disabilities. Additionally, 919 beds are available in shelters. • The Ministry of Health, Labor and Welfare, in cooperation with the Japan Association of Dialysis Physicians, requested prefecture and city governments to set up a system for accepting dialysis patients outside of affected areas. A father holds his feverish son at the Ishinomaki hospital emergency center, as patients coming from the earthquake shelters get medical care Photo: Getty Images SITUATION OF HOSPITALS DESIGNATED IN DISASTER (31 MARCH): A worker with the Japanese Red Cross takes care of a patient coming from the earthquake shelters, at the Ishinomaki hospital. Photo: Getty Images OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011

HEALTH – 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. • 142 teams, consisting of 640 members are responding to Iwate, Miyagi and Fukushima from the National Hospital Institution, Japan Red Cross Society, Japan Medical Association, etc. • 634 pharmacists are deployed to Miyagi (427), Fukushima (144), Iwate (59), Ibaragi (3) by the Japan Pharmaceutical Association and Japanese Society of Hospital Pharmacists. • The Japanese Nursing Association has dispatched 256 nurses to Iwate (27), Fukushima (2) and Miyagi (49). 30 Nurses have been mobilized to Iwate and Miyagi. • 1 dentist, 1 dental hygienist and 1 driver for a round clinic will be dispatched to Iwate from 31 March to 14 April. • Some 280 caregivers (home helpers) for elderly people and people with disabilities are in Iwate (89), Miyagi (98) and Fukushima (93). 8,126 caregivers are on standby. • Some 121 public health teams have been deployed to evacuation centers and public health centers in Fukushima, Iwate, Sendai and Miyagi. An additional 10 teams have been mobilized or on standby for health-related services. • As of 31 March, a total of 20 mental care teams of 95 members have been deployed to support Iwate (7), Miyagi (10), Sendai City (2) and Fukushima (1). Some 17 pediatric mental care providers have been dispatched by Ministry of Health, Labor and Welfare to Iwate, and 396 pediatric psychological care providers are on standby • 22 “Kokoro no kea” (“Care of the Heart [for mental wellbing]” ) teams (106 workers) are working on the ground in Iwate, Miyagi, Sendai city, and Fukushima). • Various free telephone and email consultation services have been set up for mental health and psychological support. • Regarding identified non-communicable disease needs, facilities for supporting dialysis and rheumatism patients, and telephone consultation services for cardiologists, have been put in place. Some 270 bags of dialysis liquid and 2,000 dialyzers have been delivered to Miyagi Prefecture. • 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. PUBLIC HEALTH CARE TEAMS DEPLOYED TO EVACUATION CENTERS AND PUBLIC HEALTH CENTERS AS OF 29 MARCH OCHA SitRep No. 16: 1 April 2011COE Update: 30 March 2011 SEEDS SitRep #10: 29 March 2011WHO-WPRO SitRep No. 23: 1 April 2011

HEALTH – PSYCHOLOGICAL IMPACTS Psychosocial support to disaster victims is important to reduce morbidity, disability, and social problems. Those delivering psychosocial support services need to be familiar with victims’ culture and way of life. • The Japanese Red Cross Society (JRCS) says the disaster has psychologically affected children. The National Society has 2,369 nurses who are trained and ready to provided PSP services. In addition, some PSP teams were deployed to conduct assessments in the affected areas, as well as to provide support. • MSF plans to support a team of 6 psychologists, from the Japanese Society of Certified Clinical Psychologists, who will treat victims of the disaster. • Currently, it is difficult to make complete estimates of the disaster impact on mental health. Rapid surveys are being prepared/sent to Japan to identify mental health needs. Preliminary key mental health areas identified are pediatric mental health and survivor's guilt. Based on evolving situation on the ground, continued assessment is necessary • Coordination meeting of relevant MHPSS NGO agencies will be called in the second week of April in Sendai. This meeting is planned to be called by the government, the Ministry of Health, Ministry of Social Welfare, and others • As of 30 March, 22 mental health care teams with 166 members have been deployed to provide psychosocial support to Iwate, Miyagi, Sendai City and Fukushima. • A survey on mental health issues in Iwate Prefecture found that around 60% of the 73 shelters investigated had patients who needed immediate psychosocial support. • The MHLW has prepared a mental care guidebook that is being distributed to affected municipalities; a websitehas been set up to provide information for counselors and teachers. • 17 pediatric mental health care providers have been dispatched by MHWL to Iwate, and 396 pediatric psychological care providers are on standby. • The GoJ has also deployed 23 psychosocial support teams, as the specific area becomes an increasing need. • Based on the identified mental health and psychosocial needs, several response activities have been coordinated. Official government information indicate that, as of 29 March, 22 "Kokoro no kea" ("Care of the Heart [for mental wellbeing]") teams (106 workers) are working on the ground (7 in Iwate, 11 in Miyagi [3 in Sendai city], and 1 in Fukushima). Some 17 pediatric mental health care providers have been dispatched by the Ministry of Health, Labor and Welfare (MHLW) to Iwate (as of 31 March). • 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 Information Bulletin No.5: 28 March 2011 WHO-WPRO SitRep No 21: 30 March 2011COE Update: 28 March 2011 WHO-WPRO SitRep No. 23: 1 April 2011COE Update: 30 March 2011

ELDERY ISSUES Japan is one of the oldest countries in the world. About 23 percent of Japan's 127 million people are age 65 or over In the coastal areas struck by the tsunami, that number rises to nearly 30 percent. The elderly are particularly vulnerable to disruptions in food, water, medical services, and regular schedules of essential medication. They are also highly susceptible to hypothermia and pneumonia—significant risks due to heating interruptions and blanket shortages in some shelters and hospitals. Those remaining in their homes are faced with no electricity, shortages of fuel and kerosene, and are struggling to run heaters and cook hot meals. With less resilience and weakened immune systems, the elderly are at a much higher risk than others to falling ill. Japanese Red Cross medical teams have been treating the elderly for hypothermia and infectious diseases such as influenza. There were 15 out of 170 elderly who died within one week after evacuation. People on their wheelchairs rest at an evacuation center in Kesennuma, Miyagi Prefecture in northern Japan, after an earthquake and tsunami struck the area, (REUTERS/Kyodo) Social welfare facilities have identified accommodation facilities for at least 35,000 elderly. Around 280 caregivers for the elderly and people with disabilities are responding in Iwate, Miyagi and Fukushima. Another 8,126 caregivers are on standby. The Association of Medical Doctors of Asia (AMDA) has begun shifting its target to the highly-demanded elderly nursing from Apr. 1st. • NOTE: • The elderly are particularly vulnerable to illness due to preexisting chronic diseases, weakened immune systems, and susceptibility to infectious diseases. An elderly woman cries in the devastated town of Rikuzentakata in Iwate prefecture. OCHA SitRep No. 16: 1 April 2011WHO-WPRO SitRep No. 23 1 April 2011 AMDA SitRep No. 12: 2 April 2011CSIS 31 March 2011

SHELTER AND EVACUATION • 245,508 people are displaced and/or evacuated and there are currently 170,500 displaced people living in 2,230 evacuation centres in 17 prefectures mostly in the north of Japan. In Miyagi, Iwate and Fukushima, 146,628 evacuees are living in some 1,245 evacuation centers • The number of people in evacuation centers is decreasing slightly whereas the number of evacuation centers has increased by 200 in the last two days, as174 have opened in Aomori Prefecture in the north. Improving the living conditions at the shelters in the worst affected areas is the biggest priority, otherwise there will continue to be an increase in the number of cases of cold and hygiene-related illnesses. • OCHA reports that there are still significant humanitarian needs that are not being met because of coordination and logistical issues. The biggest concern is the extremely poor sanitation conditions at the evacuation centers. Local media has also reported that hospitals in the areas are reporting a steady increase in cases of nausea, gastroenteritis, and diarrhea which is evidence that sanitary conditions are deteriorating in the centers. • The shortage of fuel is still an issue and as soon as it is readily available it is expected that people in shelters will move out of the centers and into non-affected areas. Fuel is being provided to evacuation centers by freight train and tankers from areas both north and south of the affected Tohoku region. • While basic needs for food, water, toiletries and medicines are being met the situation is serious and more sustainable solutions are being sought. In addition, there are still thousands more that are living in their cars and who 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. • 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. • The Tokyo Metropolitan Government announced it will deploy 1,000 officials to Miyagi and Iwate from 2 April until at least mid May to help manage evacuation centers. • The construction of temporary shelters is continuing in the affected prefectures. Some prefectures have revised their plans upwards in order to respond to the needs. Iwate Prefecture announced that they are increasing the number of temporary shelters from 8,800 to 18,000, which will cover 40,000 to 50,000 people. Miyagi Prefecture which is requesting 10,000 houses be built has announced that construction of 1,195 shelters will start on the 5 April in 11 towns and cities. Currently, construction is underway for 1,207 shelters. The Socioeconomic Effects of the 2011 Tohoku Earthquake - Daniell, Vervaeck, Wenzel - CATDAT COE Update: 30 March 2011 IFRC Info Bulletin: 28 March 2011 OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011

SHELTER AND EVACUATION • 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. • 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. • Majority of evacuation centers reported availability of three meals a day. • 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. • Save the Children, reports that it estimates around 74,000 children remain displaced and that it plans to open 12 Child Friendly Spaces so far to assist those displaced children. They also are procuring 5,500 back-to-school kits for primary students who have lost everything, and have completed putting together 500 hygiene kits based at the Sendai warehouse for distribution. • Hypothermia has been reported particularly among the elderly population in the evacuation centers. • 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. OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 COE Update: 30 March 2011 SEEDS ASIA SitRepNo. 11: 1 April 2011 IFRC Info Bulletin: 28 March 2011 Residents living between 20 and 30 km from the wrecked Fukushima No. 1 nuclear power plant were urged to evacuate. AP Photo.

SHELTER AND EVACUATION • Rikuzentakata is 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. • 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. Also, 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. • Local authorities are facing difficulties in finding suitable land, as the coastal area in Tohoku is mountainous, making it difficult to find flat land, 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. • 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 Ministry of Land, Infrastructure and Transportation says that only 8% of the land needed for the construction of temporary shelters has been secured. The construction of temporary shelter is underway but far below the number requested by prefectures. The GoJ plans to have 30,000 houses built in the next two months. So far, land has been allocated for only 2,645 shelters. • In Iwate Prefecture, authorities are taking applications for the first 200 temporary shelters it is constructing. • A lack of clean water for evacuees’ personal hygiene is posing public health risks in some evacuation centers. Media reports that the Ishinomaki Red Cross Hospital found that sanitation and hygiene environment is deteriorating in 30 per cent of the 314 evacuation centers that they have assessed in Ishinomaki, Higashi-Matsushima and Onagawa in Miyagi. Excrete disposal is a particular challenge. The local social welfare office is conducting a training on drainage work and maintenance of toilets. • 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. Japanese government continues to respond to the catastrophic earthquake and tsunami. AP Photo. OCHA SitRep No. 16: 1 April 2011 WHO-WPRO SitRep No. 23: 1 April 2011 COE Update: 30 March 2011 IFRC Info Bulletin: 28 March 2011

LOGISTICS AND TRANSPORTATION • LOGISTICS • The shortage of fuel is the biggest obstacle to delivering relief supplies and keeping people warm. Up to 700 tanker trucks have been mobilized from other parts of the country to ease the situation. Because 4 out of 7 supply bases of liquefied petroleum (LP) gas are not operational, the Ministry of Economy, Trade and Industry will release 40,000 tons from the national reserve for the first time from 4 April. • Although 88% of gasoline, diesel and kerosene shipments have resumed to Tohoku region, there is still a serious fuel shortage. The areas surrounding the Fukushima Power Plants are also receiving emergency fuel. • The number of fuel stations operating is still limited and needs have increased due to the disruption in public transport and increased number of emergency vehicles. There are long lines and the public is restricted to 20 liters of fuel a day. The GoJ says it will spend US$209.9 million (JPY1.7 billion) to solve the emergency fuel shortage. • Disruption in supply chain sources many of which were concentrated in the east as well as significant shifts in demand patterns had an impact on the supply of certain essential items such as bottled water and fuel. • The GoJ says 11,257,000 liters of fuel have been delivered to the affected areas to date. Another 29,000 liters is in transit. Approximately 1 million liters arrived on 28 March. • GoJ has made progress in establishing the supply chain of petroleum to the Tohoku region, securing a supply of 22,000 kiloliters per day. The areas surrounding the Fukushima Power Plants are also receiving emergency fuel. • 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 fuel. Relief items are being delivered on foot in some places. • A logistics concept of operations to strengthen and enhance JRCS logistics capacity has been shared with the National Society but has yet to be discussed in detail. A more detailed plan of action is currently being developed, including enhancing logistics infrastructure, information flows, creating a logistics hub, shipping by sea/air options and increasing warehouses in the field. • TRANSPORTATION • The Ministry of Land, Infrastructure and Transport reports that 99% of highways and main roads have been repaired, excluding those near the Fukushima Nuclear Power Plant. Traffic on some main thoroughfares such as the Tohoku expressway has increased to 1.3 times traffic before the quake due to the large number of emergency vehicles. • ROADS: As of 1 April, 2,126 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. Although almost all main roads have been cleared, many local and residential roads are still impassable due to debris. More than 37,200 vehicles are now passing through the Tohoku Expressway per day, which is 1.3 times more traffic than before the disaster struck. • AIRPORTS:13 airports in the affected areas are open for scheduled and chartered flights. Sendai Airport is open 24-hours for humanitarian flights, but has inadequate warehousing for relief needs. The World Food Programme (WFP) has been asked to assist in improving warehousing. 71% of domestic flights have resumed in Japanese airports. • SEA PORTS:15 of 15 ports in the affected area are usable. (multipurpose piers are partly available (Excluding Aomori Port). • RAILWAY LINES: Railway lines are still under repair. As of 1 April, 26 railways have been reported as destroyed. Railway service has resumed for 62% of bullet trains and 60% of local trains. The interim assessment of the East Japan Railway Company has assessed half of the total railway tracks and found that 23 train stations and 22km worth of railway tracks have been completely washed away in the region. According to NHK, the Tohoku bullet train is expected to resume full service in late April. The route runs through affected regions, and repair work will take more than a month, but the line sustained minor damage. OCHA SitRep No. 15: 30 March 2011 WHO-WPRO SitRep No. 21: 30 March 2011 IFRC Info Bulletin No.5: 28 March 2011 MLIT 2011 Earthquake Outline 36th Report: 28 March 2011

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