After Japan’s major nuclear accident in 2011, approximately 150,000 Fukushima residents were ordered to evacuate. Beginning in 2015, the evacuation orders have been systematically lifted. However, the health impacts of allowing residents to return to homes in areas previously uninhabitable due to nuclear radiation remain poorly understood.

Declaring radiation levels to be safe does not necessarily eliminate the concerns of residents about the effects of radiation exposure. Rebuilding medical, welfare, and commercial infrastructure and services takes time. Nontangible community elements, such as mutually dependent social networks, also require time to be re-established. Nevertheless, the Japanese government prioritizes policies that encourage evacuees to return home as soon as it is safe to do so.

Post-disaster evacuation situations and subsequent return home pose substantial—and as yet relatively unknown—mental and physical health threats for those affected, especially those in vulnerable groups, such as the sick, the elderly, and children.

Here we report a case of an elderly female evacuee with dementia, who was prevented from returning home after her hometown evacuation order was lifted, began exhibiting marked behavioral abnormalities. Loss of emotional ties that were created while she was housed in temporary accommodation appeared to be a critical contributing factor.

In April 2017, some of the health impacts of the 2011 Great East Japan Earthquake, tsunamis, and resultant Fukushima Daiichi nuclear power plant disaster (Okuma, Fukushima Prefecture, Japan) were presented at the 19th Congress of the World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) in Toronto, Canada. A panel discussion was then opened by asking audience members about their experiences in their own countries, and how they would suggest taking steps to reach the goals of the Sendai Framework for Disaster Risk Reduction 2015-2030. This paper summarizes the presentation and panel discussion, with a particular focus on the common problems identified in understanding and reducing health risks from disasters in multiple countries, such as the ethical and practical difficulties in decision making on evacuating vulnerable populations that arose similarly during the Fukushima nuclear disaster in 2011 and Hurricane Ike’s approach to Galveston (Texas USA) in 2008. This paper also highlights the need for greater integration of research, for example through increased review and collation of evidence from different disaster settings to identify common problems and possible solutions, which was identified in this panel session as a precursor to fulfilling the goals of the Sendai Framework.

Leppold C, Ochi S, Nomura S, Murray V. The Great East Japan Earthquake, tsunamis, and Fukushima Daiichi nuclear power plant disaster: lessons for evidence integration from a WADEM 2017 presentation and panel discussion. Prehosp Disaster Med. 2018;33(4):424–427

Due to the lingering aftermath of a nuclear catastrophe being mostly out of sight, the peripheral victims of the Fukushima disaster were no longer able to discern the boundary between the here of the safety zone and the there of the afflicted area. What ensued after this geographical unification was psychological unity in which the harmony-conscious ethics of the Japanese were excessively fortified, formulating what is often called the code of wa (harmonious integration), which implicitly coerced all to speak from hisaisha no tachiba (the standpoint of the afflicted people). Kyoko Iwaki, a doctoral student at Goldsmiths, University of London, after fourteen years as a theatre journalist in Japan, provides in this article a socio-psychological analysis on how the code of wa materialized as the unwritten law after the catastrophe, and argues how in Current Location (Genzaichi), playwright-director Okada Toshiki grapples with this code by developing a post-Fukushima aesthetic. By pertinently using the apparatus of ‘fiction’ as a guise for relieving the audience of the code, Okada develops a theatre language that voices discord in content, yet accord in form, permitting the characters to speak both from the here and the there.

The prediction of future disasters drives the priorities, urgencies, and perceived adequacies of disaster management, public policy, and government funding. Disasters always arise from some fundamental dysequilibrium between hazards in the environment and the vulnerabilities of human communities. Understanding the major factors that will tend to produce hazards and vulnerabilities in the future plays a key role in disaster risk assessment.

The factors tending to produce hazards in the 21st Century include population growth, environmental degradation, infectious agents (including biological warfare agents), hazardous materials (industrial chemicals, chemical warfare agents, nuclear materials, and hazardous waste), economic imbalance (usually within countries), and cultural tribalism. The factors tending to generate vulnerabilities to hazardous events include population growth, aging populations, poverty, maldistribution of populations to disaster-prone areas, urbanization, marginalization of populations to informal settlements within urban areas, and structural vulnerability.

An increasing global interconnectedness also will bring hazards and vulnerabilities together in unique ways to produce familiar disasters in unfamiliar forms and unfamiliar disasters in forms not yet imagined. Despite concerns about novel disasters, many of the disasters common today also will be common tomorrow.

The risk of any given disaster is modifiable through its manageability. Effective disaster management has the potential to counter many of the factors tending to produce future hazards and vulnerabilities. Hazard mitigation and vulnerability reduction based on a clear understanding of the complex causal chains that comprise disasters will be critical in the complex world of the 21st Century.