Impacts of the mass and long evacuation on local community and handicapped people after the Fukushima Daiichi nuclear power plant accident - Report from the Genpatsu frontline district - 大規模避難における問題点 南相馬からの報告 Minamisoma Municipal General Hospital Assistant Director Tomoyoshi Oikawa, MD 南相馬市立総合病院　及川友好 2015/03/15 in Sendai

Cities around the Fukushima Daiichi Nuclear Powerplant 南相馬市立総合病院 Minamisoma Municipal General Hospital Cities around the Fukushima Daiichi Nuclear Powerplant Soma Minamisoma Namie Futaba Ohkuma Tomioka Naraha Hirono 1F: Fukushima No.1 Nuclear power plant 2F: Fukushima No.2 Nuclear power plant 1Fから20km圏内　　　　　20~30km圏内 20km from 1F 20-30km from 1F

震度６の地震の後、8mを超す大津波が南相馬市を襲った (3月11日15時37分） Terrible Tsunami 8 meters tall followed by the earthquake with a seismic intensity of 6 2011 March 11th 15:37 Minamisoma

南相馬市内避難所 Shelters in Minamisoma 震災の後、146の避難所が設置されたが、1か月後には5か所に集約された。 3月13日：南相馬市内避難所（石神一小） １次避難 Minamisoma City Evacuation Center (Ishigami Daiichi Elementary School) 2011.Mar.13 南相馬市内避難所　Shelters in Minamisoma 震災の後、146の避難所が設置されたが、1か月後には5か所に集約された。 殆どの避難所が7か月以内に閉鎖、最後の避難所は2012年2月23日に閉鎖した。 Just after disaster, 146 shelters was set up. All shelters was aggregated into 5 large refuges within 1 month. Most of the shelters was closed within 7months. Last shelter was closed 2012.Feb.23

南相馬市 福島第一原子力発電所から10km~40km地点に位置する 居住区では最も原発に近い地方自治体 The Genpatsu frontline district Minamisoma city is located in 10~40km away from Fukushima Daiichi nuclear power plant where residents are able to live in 南相馬市 福島第一原子力発電所から10km~40km地点に位置する 居住区では最も原発に近い地方自治体 Governmental instruction 20km in radius : evacuation zone : 2011.Mar.12~ 20-30km in radius: indoor restriction zone: 2011.Mar.15 evacuation-prepared zone: 2011.Apr.22~2011.Sep.30 These restrictions were lifted except for 10km in radius 政府指示 20km　　圏内 ： 避難指示：2011年3月12日 20~30km圏内 ： 屋内退避指示： 2011年3月15日 緊急時避難準備区域：2011年4月22日～2011年9月30日

2011.Mar.15~Mar.18　：　2nd Evacuation of Citizen to Other Prefectures by Bus There was no choice but the long distance evacuation to avoid nuclear contamination 放射線の被曝を避けるためバスによる市民の２次避難が行われた

Mass and long distance evacuation in hospital in 2011. Mar 　　 Mass and long distance evacuation in hospital in 2011.Mar.20 Hospital also had no choice 107 inpatients remained in hospital had to be transported to over 200km away institutions by self-defense viechles 病院でも同様に遠隔地の病院へ 全患者107人が搬送された。

at Fukushima Medical Univ 107 96 92 4 新潟県への搬送患者 Patients taken over in Niigata Prefecture 福島医大への搬送患者 at Fukushima Medical Univ 11

Impact of long distance and mass evacuation 大規模避難と避難は地域社会に 何をもたらしたか

Population in Minamisoma City ’Emergency Evaluation Preparation Zone’ 震災前後の南相馬市居住人口比較 number of residents Population in Minamisoma City before and after the 3.11 71561 51534 （72％） ’Emergency Evaluation Preparation Zone’ Lifted on 9/30/2011 2011.May.8 24163 residents As a result, three years later we have only 70% of the population compared to before the disaster. The Minamisoma-city age distribution has shifted towards more elderly and fewer children.  

南相馬市の年代別居住人ロ（震災前後の比較) number of residents Comparison of the population of Minamisoma City before and 4 years after the 3.11 Green: Population by age before the earthquake (2011.Mar) Orange: Population by age after the earthquake (2015.Feb)

Table 4: Comparison of the Population Ratio of Minami-soma city and the national average by age category Comparison of the Population Ratio of Minamisoma city and the National Average by age category 震災前後の年齢別人口構成 　. 全国平均 National average 南相馬市 Minamisoma city 2011年11月 2011.Nov 2011年1月 (Before disaster) 2015年2月 (4yrs. after) 年少人口 (0-14 year olds) 13.1% 13.8% 9.0% 生産人口 (15-64 year olds) 63.6% 60.5% 48.1% 老年人口 (65 years and older) 23.3% 25.9% 32.9% 短期間で少子高齢化社会へ移行 Minamisoma city has turned to be aging society just after disaster

The impact of mass evacuation itself Mortality risk amongst nursing home residents evacuated Increase of stroke incidence rate 避難それ自体の影響 老人保健施設入居者の死亡率 脳卒中発症率の増加

Estimated pre- and post-earthquake survival. Mortality Risk amongst Nursing Home Residents Evacuated after the Fukushima Nuclear Accident Estimated pre- and post-earthquake survival. Research and discussion on The disaster-related death is not enough at all. I will show you our data about survival probability among Nursing home residents pre and post triple disaster that is upload to PLOS one Red line shows that after disaster all Nursing home residents took refuse in another prefecture and little residents could come back their Nursing home. It should be now debated that evacuation itself may have increased the disaster-related deaths and the incidence of chronic diseases . Nomura S, Gilmour S, Tsubokura M, Oikawa T, et al. (2013) Mortality Risk amongst Nursing Home Residents Evacuated after the Fukushima Nuclear Accident: A Retrospective Cohort Study. PLoS ONE 8(3): e60192. doi:10.1371/journal.pone.0060192 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0060192

南相馬市における東日本大震災の 脳卒中発症率への影響 Impact on stroke incidence rate of the Great East Japan Earthquake in Minamisoma city 南相馬市における東日本大震災の 脳卒中発症率への影響

Monthly incidence of Stroke Patients per 100,000 (population/age-quota adjusted) 　 1ヶ月毎の人口10万人あたりの入院者数(人口調整、年齢調整後） The Great East Japan Earthquake 2011.3.11 2013.12

Poisson regression analysis Relative Risk 95% C.I. P Value 性別　Gender 女性　female 1 NA 男性　male 1.77 1.52-2.06 <0.001 年齢　Age 35-64 yrs. over 65 yrs. 4.32 3.51-5.30 発症率　Incidence 震災前　pre disaster 震災後 post disaster 1.49 1.01-2.21 0.04 発症率ｘ年齢 Incidence ｘ age 1.02 0.70-1.48 we have been analyisisig these data by Poisson regression analysis. This table shows that relative Risk increased by 2.4 times after 3.11 and incidence of stroke increased in all age. 震災後相対リスクは2.4倍に Relative Risk increased by 2.4 times after 3.11

震災関連死の割合 Proportion of disaster-related deaths （2014/10/04 死亡届より） 直接死 Direct deaths 死亡届等 Deaths registration 震災関連死 Disaster-related deaths 合計 Total 福島県全体 Fukushima prefecture 1603 225 1777 3605 南相馬市 Minamisoma 525 111 458 1094 災害関連死は様々な要因で起こっているが、 大規模避難が最も重大な因子であったと考えられる。 Disaster-related death can be occurred by various factors Mass evacuation may be one of the most important factor

Please don’t forget 17の原子力発電所 51基の原子炉 銘記すべきこと 原発事故は起こり得る It is no doubt Nuclear power plant will be out of order 社会構造の破壊により 高齢化は促進する Social structure will turn to be aging society after mass Evacuation 大規模避難は深刻な悲劇（災害関連死）を引き起こす Mass evacuation itself makes severe tragedy (disaster-related death)　　 17の原子力発電所 51基の原子炉 Red circles indicate NPP in Japan

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