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 A 9.0 magnitude earthquake hit Japan, unleashing a tsunami. HEALTH PSYCHOLOGICAL IMPACT ELDERLY POPULATION SHELTER LOGISTICS & TRANSPORTATION CULTURAL CONSIDERATIONS FUKUSHIMA NUCLEAR ACCIDENT AS OF 1300 HRS EDT 29 MARCH 2011

2. EARTHQUAKE AND TSUNAMI • On 11 Mar 2011 05:46 UTC, a 9.0 magnitude earthquake struck 400km north-east of Tokyo off the coast of Japan, triggering a tsunami that flattened parts of the northeast coastline. The waves were as high as 15 meters in the worst affected areas, destroyed everything in their path, and went 6 km inland. • 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. • 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. • The initial tsunami was reportedly as high as 33 feet at the port of Sendai, the prefecture capital located some 180 miles (300 km) from Tokyo and 128 km from the epicenter. The JMA reported that the highest tsunami wave was more than 49 feet high in Mekawa, Miyagi. • According to the Geospatial Information Authority and the UN, the tsunami inundated 400 km2 in four prefectures (an area equivalent to 20% of the area of Tokyo) About 190 out of 300 km of waterfront in Iwate, Miyagi and Fukushima was partially or entirely destroyed. • DEATH AND DESTRUCTION • The earthquake and tsunami have resulted in a death toll of 10,901 with an additional 17,649 missing. • Approximately 250,000 people are sheltering in over 2,000 evacuation centers, mostly in northeastern and eastern Japan.. • Police say the number of deaths is likely to rise further as there appear to be many cases in which entire families are missing with no one left to file reports. • The natural disasters also damaged or destroyed more than 139,000 buildings and 2,000 roads. • As of 27 March, approximately 200,000 households remain without power, mostly in the Tohoku region. Water supply to 490,000 households in 10 prefectures has yet to be restored. More than 90% of telecommunications has been restored, but 126,541 phone line still remain out of service. JAPAN EARTHQUAKE AND TSUNAMIBACKGROUND 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. 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

3. CATDAT AND EARTHQUAKE-REPORT.COM

4. SITUATION • Because of the amount of debris, the lack of fuel, and restricted access on the roads until recently, emergency workers have been unable to move people to centers where they could receive assistance. As a result, they are still trying to supply of food, water, warm clothing, and medicine to 2,000 evacuation centers, as well as provide critical medical, mental health and sanitation services. • Thousands of people are living in their homes without electricity and water. There is no access to basic supplies unless they are able to get them from one of the bigger evacuation centers. • EMERGENCY RESPONSE • Harsh weather with rain, snow storms and sub-freezing overnight temperatures is expected to continue through 29 March. Authorities in Miyagi Prefecture say lack of fuel limits use heaters. 210,000 households (516,600 people) do not have electricity and one million people are without gas. A lack of fuel, coordination and logistical issues are still the biggest challenges facing Japan’s emergency relief operations • The JMA is urging people to be on the alert for continuing aftershocks. Aftershocks are less frequent,, but the possibility of aftershocks of 7.0 magnitude or higher could still occur and trigger more tsunami. • 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. • Some of the 2,000 evacuation 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.) • 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. • 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) 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 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 I-131 on March 24, 2011, the water in Tokyo is safe for drinking. • On 22 March, the 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 SitRep No. 14: 28 March 2011OCHA SitRep No 13: 25 March 2011 WHO-WPRO SitRep No. 19: 28 March 2011 WHO-WPRO SitRep No. 15: 24 March 2011 USAID 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 - Water supply to 170,000 households has improved since 25 March, but the Ministry of Health, Labor and Welfare (MHLW) reported on 27 March that 652,254 households in 10 prefectures were without water. In the worst affected areas,itcould take a month before water is restored. •The Emergency Disaster Response Headquarters says approximately 4.3 million bottles of water have been delivered to evacuation centers in the affected areas. •MHLW is coordinating emergency water supply to the affected areas. 488 water trucking vehicles are currently on the ground: 213 vehicles in Miyagi, 39 in Fukushima, and 82 in Iwate. ELECTRICITY - As of 27 March, approximately 200,000 households remain without power, mostly in the Tohoku Region. COMMUNICATIONS - More than 90% of telecommunications has been restored, but some 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 and sewer lines were damaged or destroyed throughout the quake area. It is unclear 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 - In Miyagi, debris is estimated at15 to 18 million tons; equivalent to 23 years worth of waste for the prefecture. It 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 of Japan (GoJ) plans to cover most of the removal costs. GAS - Slow improvement: Some 379,292 households remain without gas supply. Fuel- Gasoline is being provided to evacuation centers by freight train and tankers from areas both north and south of the affected Tohoku region. Some refineries remain out of operation. BUILDINGS - So far, some 137,000 buildings are estimated to be damaged;18,778 were completely destroyed • RADIATION CONTAMINATION • I-131 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 warning, as the measured values have decreased. • Radiation has also been detected in sea water collected 30km from the coast, near the nuclear plant. The MHLW expressed the need to study the long-term impact it may have on marine life. • Surveillance of seawater near the NPP sites found I-131 at 1,250 times safety level 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 GoJhas ordered residents not to consume or sell the vegetables, or drink tap water or milk there. Seafood is being monitored in Ibaraki and Chiba prefectures. The MHLW expressed the need to study the long-term impact it may have on marine life. • d OCHA SitRep No. 14: 28 March 2011OCHA SitRep No 13: 25 March 2011 WHO-WPRO SitRep No. 19: 28 March 2011 WHO-WPRO SitRep No. 15: 24 March 2011 USAID Fact Sheet #13: 24 March 2011

6. SITUATION CURRENT ASSESSMENT • HEALTH • Local media reports that 53% of hospitals with 100 beds or more are closed or only partially operational in the 3 hardest hit prefectures. Out of 255 hospitals, 17 are closed and 117 are operating on a limited scale. In most hospitals, this is due to a shortage of staff and medicine, damaged buildings and equipment, and/or delayed restoration of utilities. 46 hospitals said they didn’t have the capacity to meet local demands. • 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. (as of 25 March) • 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%). • 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. • People continue to face cold temperatures with insufficient heating, including in the evacuation centers. Hypothermia has been reported, particularly among the elderly. • 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 • NOTE: • Improvements in living conditions of displaced persons will be necessary to prevent further spread of infectious disease. • The medical activities in Ohtsuchicho will be suspended until Apr. 15th (for the first time since the tsunami hit) • The elderly and medically fragile are particularly vulnerable to hypothermia and other stressors present. RADIATION SURVEILLANCE FOOD WASTE\DEBRIS SEWAGE 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 • TRANSPORTATION & INFRASTRUCTURE • The GoJ is setting up ‘makeshift service stations’ at evacuation centers and elsewhere in the affected areas to address fuel shortages. The Self Defense Force will provide 10 to 20 locations with 1,000 200 liter drums of free fuel. • ELECTRICITY & GAS • Approximately half a million people remain without power, mostly in the Tohoku region. • 359,079households remain without gas supply. • SHELTER - The Ministry of Land, Infrastructure and Transportation says that only 8% of the land needed for the construction of temporary shelters has been secured. Approximately 19,500 public housing units across 47 prefectures are now available for displaced families. Public housing is needed as there are an estimated 99,000 evacuee families living in evacuation centers with minimal access to basic services. They will need to move into public housing while temporary shelters are being constructed. The sheer scale of the destruction means that about 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. • LIVELIHOODS - The Ministry of Health, Labor 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. • HEALTH & MEDICAL CARE • The Ministry of Health, Labor 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. • 96 teams, consisting of 514 members are responding to Iwate, Miyagi and Fukushima from the National Hospital Institution, Japan Red Cross Society, and Japan Medical Association, etc. • Some 225 pharmacists are deployed to Miyagi (156), Fukushima (53), Iwate (14), Ibaragi (2) by the Japan Pharmaceutical Association and the Japanese Society of Hospital Pharmacists • The GoJhas scaled up their relief effort as residual needs persist. 106,000 personnel from the Self Defense Force, 8,481 from the police force, and 4,600 teams (19,000 people) from the Fire and Disaster Management Agency have been deployed. The GoJhave also deployed 23 psychosocial support teams. • 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 toaccept any patients due to lack of resources including staff. • There have been sporadic cases of influenza but no large outbreaks. • DEBRIS REMOVAL - The GoJ 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. • 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 will take more than a year. NOTES: People who are able to live in their homes still require assistance as they have no access to food, water and basic supplies; these are largely delivered to major evacuation centers and shelters. OCHA SitRep No. 14: 28 March 2011 IFRC Info Bulletin No. 5: 28 March 2011 WHO-WPRO SitRep No. 19: 28 March 2011

8. JAPANESE RED CROSS SOCIETY • Japanese Red Cross Society (JRCS) staff and volunteers are providing emergency relief, medical support and psychosocial support to many vulnerable communities across the three worst affected prefectures of Iwate, Miyagi, and Fukushima. JRCS is planning how to strengthen its relief response transitioning into supporting the wider early recovery effort. • JRCS reported that many evacuees are now getting three meals a day but are still in need of non-food items. They are providing support to thousands still living in evacuation shelters. • JRCS is deeply concerned about the psychological well-being of the affected populations, especially of children. JRCS has assigned a trained psychosocial support provider (PSP) to almost all deployed medical teams. The national society has 2,369 nurses who are trained and ready 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 is some concern over a lack of medicine for the treatment of various chronic conditions. • The JRCS has received over US$400 million in financial support. • 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. • As of 28 March, JRCS has deployed 397 medical missions involving more than 2,400 staff members. The JRCS teams have a significant role in supporting the local health facilities as they have mobile clinics serving more remote and hard-to-reach areas. For patients severely injured, the JRCS domestic emergency response unit (DERU) also assisted in the evacuation by helicopters to referral hospitals. • A Family Links web site has been opened 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 • A total of 125,530 blankets, 25,146 emergency kits (composed of portable radio, flashlight, wrapping cloth, booklet on emergency health care) and 11,000 sleeping kits (composed of a sleeping mat, pillow, eye-cover, earplug, slippers, socks) have been distributed. • 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. Photo : Japanese Red Cross Society NOTE: Evacuees have been enduring bitterly cold weather with several falls of sleet and snow. These conditions have also hampered emergency relief efforts. Priority needs are fuel, prefabricated houses, sanitation materials, clothing, medicines and household appliances. Fuel (for heating and transport) is critical. About half of the service stations are closed; many of the half that are open are only serving emergency and other priority vehicles. JRCS Emergency Relief 3: 23 March 2011 IFRC Info Bulletin 5: 28 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. • 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 Chairman of the Nuclear Regulatory Commission, Dr. Gregory Jaczko, traveled to Tokyo on 28 March to convey directly to his Japanese counterparts a message of support and cooperation, and to assess the current situation. Chairman Jaczko said, "Our nuclear experts are working closely with their Japanese counterparts, and we both continue to share expert analysis as we move forward to address this challenge. I reconfirmed in my meetings that we are prepared to provide any assistance we can in the days to come." • 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. • 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 24 March, the water in Tokyo is safe for drinking. • 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. • 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. KI tablets should only be taken on the advice of emergency management officials, public health officials or your doctor. U.S. Embassy Tokyo News Update: 28 March 2011 U.S. Embassy Tokyo News Update: 28 March 2011 U.S. Embassy Tokyo News Update: 28 March 2011 U.S. Embassy Tokyo News Update: 25 March 2011 USAID Fact Sheet #13: 24 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 • PACAF has generated 299 sorties moving 1,144 passengers and more than 2507.9 short tons (5,015,800 lbs) of cargo in support of Japan Relief Efforts. • Number of AF Personnel deployed in support of relief operations:  751 • Number of PACAF aircraft deployed in support of relief operations:  18 • PACAF generated 2 sorties and moved 33.5 short tons (67,000 lbs) of cargo. • USAF MH-53 flew local missions in support of relief operations. • USAF RQ-4 is currently airborne for ISR operations • USAF C-17 delivered 33.5 short tons of cots from Kunsan to Yokota to Misawa • U.S. Army • Since 25 March, Logistics Task Force 35, assisted U.S. Marine units in clearing debris from the runway and taxiways at Sendai Airport. Over 1,000 destroyed vehicles have been removed that littered the area. • U.S. Marines • 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. • Marines assigned to the 31st Marine Expeditionary Unit, used landing craft utility vehicles assigned to Assault Craft Unit to deliver 15,000 pounds of relief supplies, including food, water, and health and comfort kits. In addition, the team transported commercial electric utility vehicles, a fuel truck, a water resupply vehicle and a civilian work crew all from the Tohoku Power Company. UNITED STATES RESPONSE (DOD-OPERATION TOMODACHI) The recovery and salvage ship USS Safeguard (T-ARS-50) sails the waters of Hachinohe, Japan, to assist in salvage recovery operations in support of Operation Tomodachi. U.S. Navy Flight directors assigned to Naval Air Facility Misawa walk onto the flight to guide aircraft through the snow. U.S. Navy NOTES: Through available logistical capabilities, DOD was able to reach the hardest hit areas in time to rescue victims and deliver critical supplies and services. PACOM Relief Updates - 27 March 2011 DOD News: 28 March 2011

11. Since Operation Tomodachi started, U.S. 7th Fleet forces have delivered more than 230 tons of HA/DR supplies to survivors of the tsunami and earthquake, in support of Japan Self Defense Force efforts. • USS Blue Ridge , flagship for the United States Seventh Fleet, remains at sea in the vicinity of Okinawa.  The ship is serving as the floating headquarters for 7th Fleet commander Vice Adm. Scott Van Buskirk and his staff of about 300, who are filling the role of Joint Force Maritime Component Commander, or “JFMCC”, under the Joint Support Force is overseeing all U.S. military assistance to Japan.  • Commander, Fleet Activities Yokosuka handed over the second of two water barges on 26 March to the Japan Maritime Self Defense Force. Together with the first barge sent on 25 March, a total of 500,000 gallons of fresh water is en route to 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 27 March. 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. • 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, 19 ships, 140 aircraft and 18,282 personnel are in the area of operation.  In the past 24 hours, the fleet scheduled 22 aid flights for Humanitarian Assistance Disaster Relief (HA/DR) supply deliveries. • Commander Task Force 76 continued harbor clearance operations in Hachinohe on 27 March. USNS Safeguard 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 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. • USNS Carl Brashear conducted at-sea replenishment of fuel and humanitarian supplies on 27 March with the USS Essex amphibious ready group, which includes USS Harpers Ferry , USS Germantown and USS Tortuga.  Essex accepted 148 pallets of HADR supplies for future missions. USNS Pecos conducted additional replenishment efforts with USS Chancellorsville, USS Shiloh , USS Preble and USS Mustin. • The USS Essex amphibious ready group conducted a resupply of Oshima Island, off the coast of Kessennuma on 27 March.  The ship launched two Landing Craft Units 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 . • The USS Curtis Wilbur returned to Yokosuka for resupply on March 26, making it the first U.S. Navy ship to return to Yokosuka since March 22. UNITED STATES RESPONSE7th FLEET NOTES: Frigid temperatures have caused requests for fuel to be repeated time and time again from survivors to Navy personnel delivering aid packages. Navy divers from Commander Task Force 73 Salvage Unit, Underwater Construction Team 2 and Explosive Ordnance Disposal Mobile Unit 5 prepare a diver's suit before entering harbor port of Hachinohe to survey the waterways. U.S. Navy PACOM Relief Updates - 27 March 2011

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 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. • The Japan Committee for UNICEF has received generous donations of supplies including bottled water, clothing, diapers and toys, some of which have already been distributed. UN OFFICE FOR THE COORDINATION OF HUMANITARIAN AFFAIRS (OCHA) - OCHA has conducted its second visit to Miyagi Prefecture accompanied by the World Food Program (WFP), USAID’s Disaster Assistance Response Team (DART), the Cabinet Office, with support on the ground by the NGO Peace Boat and local government. The team visited three evacuation centers in Ishinomaki - two official and one unofficial. There are approximately 144 evacuation centers in the city of which 36 are official. 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. 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 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 14: 28 March 2011 UNICEF Press Rel: 23 March 2011 UNICEF Press Rel: 24 March 2011

13. OTHER ORGANIZATIONS OF INTEREST • 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. • IMCs 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. • 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. • International Medical Corps’ 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 supplies available but limited. • 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. • 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 on Sunday. 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. OCHA Sit Rep 14: 28 March 2011 IMC: 25 March 2011 World Vision 28 March 2011 MSF 28 March 2011 Piles of Debris clutter Roads after disaster. Photo: World Vision.

14. 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. Coordination of operations at shelters, at the High School, and general communications are still difficult there due to lack of road access. • Majority of patients at Ohtsuchi High School are those with chronic diseases. • An AMDA doctor accompanied a local volunteer to deliver mobile clinical services to a remote community in a mountainous area where assistance hadn’t reached. Community contained 50 households, most of them elderly with chronic diseases. Due to the patients abnormally high blood sugars and pressure, mobile clinic services will be delivered on regular basis. • Kamaishi City: Medical volunteers are regularly allocated to the disaster headquarters in Kamaishi City. 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 MAP: Seeds Sit Rep 8 : 28 March 2011 NOTE: All offers of assistance should be directed to the GoJ. AMDA International Emergency Bulletin 10: 27 March 2011

15. OTHER ORGANIZATIONS OF INTEREST Relief Operations by Japanese Humanitarian Organizations in Major Affected Cities Seeds Sit Rep 8 : 28 March 2011

16. 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. • More than 50 medical teams from the Japanese Red Cross Society are stillproviding basic health care to survivors of the earthquake and tsunami. Here,staff visit an evacuation center in Yamada, Iwate prefecture. Photo: KathyMueller/ IFRC • The National center 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. • 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. 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

17. HEALTH – CONCERNS • Communicable Diseases • There have been sporadic cases of influenza but no large outbreaks. An internet-based ad-hoc surveillance system has been developed by the Infectious Disease Surveillance center, National Institute of Infectious Diseases (http://www.syndromic-surveillance.net/hinanjo/index.html). Data are not available as of 27 March. • 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%). • 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 of these cases occurred between 17 and 21 March. • Non-communicable Diseases • 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. • It was 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. • Hypothermia • People continue to face cold temperatures with insufficient heating. Hypothermia has been reported particularly among the elderly population in the evacuation centers. • What is Hypothermia? • When exposed to cold temperatures, your body begins to lose heat faster than it can be produced. Prolonged exposure to cold will eventually use up your body’s stored energy. The result is hypothermia, or abnormally low body temperature. • Body temperature that is too low affects the brain, making the victim unable to think clearly or move well. This makes hypothermia particularly dangerous because a person may not know it is happening and won’t be able to do anything about it. • Hypothermia is most likely at very cold temperatures, but it can occur even at cool temperatures (above 40°f) if a person becomes chilled from rain, sweat, or submersion in cold water. • Victims of hypothermia are often (1) elderly people with inadequate food, clothing, or heating; (2) babies sleeping in cold bedrooms; (3) people who remain outdoors for long periods and (4) people who drink alcohol or use illicit drugs. 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 CDC - Hypothermia

18. HEALTH – HOSPITALS • As of 25 March local media reports that 53% 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. 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. . • 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 center 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. • 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 15 out of 170 elderly died within one week after evacuation) • Most of the patients are elderly, unable to ambulate or feed themselves • Tube feeding supplies are exhausted, resulting in malnutrition • The army has installed a generator, which operates for two hours in the evening, allowing doctors to perform the most important tasks. Photo: IFRC • The Israeli Army has opened a field hospital in a village in Japan's north-eastern Miyagi prefecture on 29 March 2011, one of the areas worst hit by the March 11 earthquake and tsunami. The hospital will operate in Kurihara for a month. Officers prepare a ward in the new field hospital to receive patients Israel Today Magazine OCHA Sit Rep 13: 25 March 2011WHO-WPRO SitRep No 18 27 March 2011 WHO-SitRep No. 19 28 March 2011COE-DMHA: 26 March 2011

19. 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. • . • Children themselves are psychologically vulnerable but also can be quite resilient, if a sense of normalcy returns as quickly as possible. • The JRCS/IFRC team commented on the tremendous dignity of the affectedcommunities. However, one medical personnel commented that this stoicismmay hide a deeper shock that is being suppressed. A lot of survivor guilt has been observed by trained personnel. People were quick to share smiles with each other and they tend not to show one’s own grief and suffering easily at this stage. 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:

20. 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. • Many evacuees complain of symptoms related to acute stress such as insomnia, flash backs, survivors guilt and digestive symptoms such as diarrhea and constipation • A survey on mental health issues in Iwate prefecture. Some 73 shelters were investigated. Around 60% of the shelters have patients who need immediate psychosocial support. • Children with missing or dead parents are being recorded and services are being provided to them by local government and pediatric mental health care providers. • 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 • The Ministry of Health, Labor and Welfare is coordinating mental health needs by location and deployments of mental health workers to the sites • As of 27 March, a total of 21 mental health care teams have been deployed to provide psychosocial support to the affected areas, including Iwate, Miyagi, Sendai City and Fukushima. • 17 pediatric mental health care providers have been dispatched by MHWL to Iwate. • 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 websitehas been set up to provide information for counselors and teachers • MHLW has also received requests from the social welfare facilities in the affected areas for dispatching social workers. • Depressive symptoms have been increasing among the evacuees. • 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

21. 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. • It was reported that there were 15 out of 170 elderly who died within one week after evacuation • 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. • As reported in The Lancet, Japanese troops recently discovered 128 elderly patients, some comatose, deserted in an abandoned hospital less than 10 miles from the Daiichi power plant. • 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: • Clean blankets and heat-generating mechanisms are urgently needed to help maintain patient hygiene, prevent bed sores, and generally protect the elderly and disabled. • 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 used to treat hypothermia. Japanese families eat dinner at a shelter in Kesennuma, located in the northeast of Miyagi prefecture. IFRC News: 25 March 2011COE-DMHA update: 26 March 2001MSF NEWS: 25 March 2011 WHO-WPRO SitRep No. 18: 27 March 2011OCHA SitRep No. 13: 25 March 2011RESQ Products Inc- TREATING HYPOTHERMIA

22. SHELTER AND EVACUATION • 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. • 245,508 people are displaced and/or evacuated and 193,213 people were staying in 2,038 evacuation centers across the country. Fukushima Prefecture has the largest number of evacuees, 89,130. Miyagi Prefecture has 84,462 evacuees followed by Iwate Prefecture with 43,879 evacuees. • Most evacuees 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. • Hypothermia has been reported particularly among the elderly population in the evacuation centers. • The number of people staying outside their prefectures following the nuclear power plant accident in Fukushima Prefecture fell to 33,748 by March 27. • As of 26 March, 52 deaths in shelters were reported, particularly among the elderly. • Fuel is being provided to evacuation centers by freight train and tankers from areas both north and south of the affected Tohoku region. • Majority of evacuation centers reported availability of three meals a day. • 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. Many of those evacuated had to sleep on floors of public buildings. The Japanese Red Cross Society providing blankets and other relief items. Photo courtesy of Tatsuya Sugiyama/Japanese Red Cross 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. 19: 28 March 2011 COE-DMHA: 26 March 2011 IFRC Info Bulletin: 28 March 2011

23. SHELTER AND EVACUATION • 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 National Police Agency, 99,000 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 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. • 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. • 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. OCHA SitRep No 18 : 28 March 2011 WHO-WPRO SitRep No. 19: 28 March 2011 COE-DMHA: 26 March 2011 IFRC Info Bulletin: 28 March 2011

24. LOGISTICS AND TRANSPORTATION • 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 fuel supply, while steadily improving, is tightly rationed and hampering full access. Up to 700 tanker trucks have been mobilized from other parts of the country to ease the situation. • A logistics concept of operations that sets out a methodology 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. • A JRCS/IFRC team reports about half of the petrol stations closed and of the half that were open, many were serving only emergency and other priority vehicles (including JRCS vehicles). North of Sendai, open petrol stations had long queues. • 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 9,819,000 liters of fuel has been delivered to the affected areas to date. The delivery capacity improved last 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 kiloliters per day. The areas surrounding the Fukushima Power Plants are also receiving emergency fuel. • 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. Significant progress has been made in clearing roads of debris. • To date, 129 landslides have occurred and four dykes are reported collapsed. Damage to roads, bridges and railroads are reported in 2,127 places. Main highways are mostly now reopened. • As of 27 March, 2 086 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. • As of 27 March, 36 damaged rail lines in three prefectures were reported. About 31 local trains in the affected area remain out of service.  • 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. • 15 of 15 ports in the afflicted area are usable. (multipurpose piers are partly available (Excluding Aomori Port) • Railway service stopped on 31 lines of 10 operators in Tohoku. (including Tohoku and Yamagata Shinkansen) 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. Rows of people line with jugs in hopes of filling for home heating fuel as massive shortages(Wally Santana / AP Photo) OCHA SitRep No. 14: 28 March 2011 WHO-WPRO SitRep No. 18: 27 March 2011 IFRC Info Bulletin No.5: 28 March 2011 MLIT Report Outline: 28 March 2011

25. RECOVERY OF TRANSPORTATION Full Map Available at: MLIT Japan GSI

26. 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 GoJis 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

27. YALE/TULANE ESF-8 PLANNING AND RESPONSE PROGRAM SPECIAL REPORT (FUKUSHIMA NUCLEAR ACCIDENT ) MAP BACKGROUND • An earthquake of magnitude 6.5 occurred at 22:23 UTC on 27 March near the east coast of Honshu. NISA has confirmed that there have been no abnormal radiation readings at the Onagawa nuclear power plant, the closest to the epicenter, whose three units remain in cold shutdown since the earthquake of 11 March. As of 02:30 UTC today, there were no reports of any problems at nuclear plants in Japan related to the latest seismic event. • Overall at the Fukushima Daiichi plant, the situation is still very serious. • NISA informed the IEC that a meeting is planned with TEPCO to determine the origin and path of water in the turbine buildings of Units 1 to 4. As seen with the contaminated workers, high dose rates in the turbine buildings and contaminated water in the basements can hamper recovery efforts. • On 27 March, deposition of I-131 was detected in 9 prefectures, and deposition of Cs-137 in 4 prefectures. • The highest values were observed in the prefecture of Tochigi with 320 b Bq/M2 for I-131 and 73 Bq/M2for Cs-137. • In the other prefectures where deposition of I-131 was reported, on 27 March, the range was from 6.4 to 110 Bq/M2 . For Cs-137, the range was from 16 to 61 Bq/M2. • In the Shinjyuku district of Tokyo, the daily deposition of I-131 on 27 March was 100 Bq/M2 while for Cs-137 it was 36 Bq/M2 • No significant changes were reported in the 45 prefectures in gamma dose rates compared to 26 March. NUCLEAR POWER PLANT GAMMA READINGS RADITION IN FOOD RADITION IN WATER RADITION IN SEA WATER RADITION IN SOIL HEALTH EFFECTS

28. 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. In sampling done from 16 March – 27 March, radioactive materials exceeding national safety limits have been found in over 20% of tested milk, vegetable, and food samples sourced in Fukushima, Ibaraki, Chiba and Tochigi Prefectures. FUKUSHIMA DAIICHI NUCLEAR POWER STATION 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

29. FUKUSHIMA DAIICHI NUCLEAR POWER PLANT NOTE: Radiation levels are at levels high enough to impact human health at the Fukushima power plant. The crisis at the Fukushima Daiichi plant has still not been overcome and it will take some time to stabilize the reactors. Environmental Radioactivity in Fukushima Prefecture (Monday March 28) Electrical power has been restored at Units 1, 2 and 3 and fresh water is now available on the site. The pumping of contaminated water from the basement floor of Unit 1's turbine building into its main condenser is in progress, whereas at Unit 2 that process has not begun because the steam condenser is full. At Unit 3, the pumping of contaminated water and in particular where it is going, are under consideration. The issue is also being examined for Unit 4. Pressure is still high (0.376/0.443 MPaG: 27 March) for Unit 1 but it is in a stable condition. Temperatures measured at the feed water nozzle and at the bottom of the Reactor Pressure Vessel (RPV) continue to decrease slightly at Units 1 and 2, except the temperature at the feed water nozzle of Unit 1's RPV, which has slightly increased to 274 °C. The pumping of fresh water into the reactor pressure vessel of Unit 1 is to switch from the use of fire trucks to temporary electrical pumps running on offsite power on 29 March. At Unit 2, this switch was carried out on 27 March, with a diesel generator as backup in case offsite power is interrupted. Fresh water is also being injected continuously into the reactor pressure vessel of Unit 3, albeit currently pumped by fire trucks. The switch to temporary electrical pumps for this unit is planned for 28 March. On 27 March at Unit 3, water was sprayed into the spent fuel pool using a concrete pump truck, and seawater was also pumped in through the spent fuel cooling system. It is planned to start pumping fresh water into the spent fuel pool on 29 March. It is also planned to commence pumping freshwater into the spent fuel pool of Unit 4 on 29 March. Three workers who had radioactive exposure on 24 March will be discharged on 28 March without any complications. Unit:μ Gy/h≒μ Sv/h(micro gray/hour≒micro sievert/hour) Fukushima Prefecture International Association via World Village Translation 28 March IAEA Situation Report WHO-WPRO SitRep No. 19: 28 March 2011

30. FUKUSHIMA DAIICHI NUCLEAR POWER PLANT IAEA: Summary of Reactor Unit Status – 28 March

31. FUKUSHIMA DAIICHI NUCLEAR POWER PLANT WHO-WPRO SitRep No. 19: 28 March 2011 IAEA Update 28 March 2011

32. GAMMA DOSE RATES IN µSv/HOUR15-27 MARCH Natural Background: 0.1 µSv/hour • Two IAEA teams are currently monitoring radiation levels and radioactivity in the environment in Japan. • One team made gamma dose-rate measurements in the Tokyo and Chiba region at 3 locations. Gamma-dose rates measured ranged from 0.08 to 0.13 microsievert per hour, which is within or slightly above the background. • The second team made additional measurements at distances of 30 to 46 km from the Fukushima nuclear power plant. At these locations, the dose rates ranged from 0.5 to 3 microsievert per hour. At the same locations, results of beta-gamma contamination measurements ranged from 0.02 to 0.3 MBq/M2 IAEA Briefing on Fukushima Nuclear Accident (28 March 2011, 14:30 UTC)

33. RADIONUCLIDES IN FOOD The GoJ is considering lowering the standard for radiation found in food in Japan as the current criteria is too strict and should be more in line with international standards. Farmers in Fukushima Prefecture have been asked to postpone planting crops until the radiation level of the soil is fully analyzed and determined to be safe. Deposition of radioactivity is monitored daily by Japanese authorities in all 47 prefectures. On 27 March, deposition of I-131 was detected in 9 prefectures, and deposition of Cs-137 in 4 prefectures. The highest values were observed in the prefecture of Tochigi with 320 Bq/M2 for I-131 and 73 Bq/M2 for Cs-137. In the other prefectures where deposition of I-131 was reported, on 27 March, the range was from 6.4 to 110 Bq/M2 For Cs-137, the range was from 16 to 61 Bq/M2 . In the Shinjyuku district of Tokyo, the daily deposition of I-131 on 27 March was 100 Bq/M2 while for Cs-137 it was 36 Bq/M2 .No significant changes were reported in the 45 prefectures in gamma dose rates compared to yesterday. Many countries within and outside the Western Pacific Region have put in place food control measures and testing to regulate food, milk, feed, etc. Samples reported from 26 to 27 March in six prefectures (Fukushima, Gunma, Ibaraki, Niigata, Tochigi and Yamagata) reported I-131 in asparagus, cabbage, celery, chive, cucumber, eggplant, leek, mushrooms, parsley, tomato, spinach and other leafy vegetables, strawberries and watermelon. One sample of hana wasabi taken on 24 March in Fukushima prefecture was above the regulation values set by the Japanese authorities. Cs-137 was also measured above the regulation value in the same sample of hana wasabi, but in the remaining five prefectures, Cs-137 was not detected or the results were below regulation values. Tables: Results were received from 95 food samples on 27 and 28 March. Of the total 531 food samples which have been tested, 99 food samples were above the provisional regulation value from 6 prefectures (Chiba, Fukushima, Gunma, Ibaraki, Tochigi, Tokyo). • 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. • 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 • It is still too early to draw conclusions for expected concentrations in marine food. FDA Radiation Safety: 23 March 2011OCHA SITREP 14: March 28 2011WHO SITREP 19: 28 March 2011IAEA Update: 28 March 2011

34. RADIONUCLIDES IN DRINKING WATER Recommendations relating to the restriction of drinking water consumption, based on measured concentrations of I-131, remain in place in seven locations (in one location for both adults and infants, and in six locations for infants). • 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 Cs-134 or Cs 137 at or above 200 Bq/kg; an order of magnitude lower than the internationally agreed Operational Intervention Levels FUKUSHIMA PREFECTURE Fukushima-ken Environmental Radioactivity Monitoring Center continued to monitor radioactivity in tap water at 9 points within the prefecture on a daily basis since 16 March. I-131 measurements peaked at 348 Bq/L in Tamura City on 17 March and have generally declined since then. I-131 peaked at 293 Bq/L in Kawamata town on 18 March; and peaked at 185 Bq/L in Minamisouma city on 19 March. I-131 peaked at 965 Bq/L in Iitate village (iitoitaki shita area) on 20 March. I-131 levels have been on a generally downward trend following the peaks and are now below 100 Bq/L in those locations. In Iwaki city, I-131 levels have generally been around or below 100 Bq/L since 16 March but a spike at 215 Bq/L was seen on 24 March. I-131 in Iwaki city dropped to 100 Bq/L on 25 March and 85.7 Bq/L on 26 March. 14 Monitoring of I-131 and Cs-137 in drinking water is on-going. I-131 has been monitored by the Japanese authorities in 2 of 10 samples taken in the Fukushima prefecture with values of 60 and 90 Bq/L. .OUTSIDE FUKUSHIMA PREFECTURE I-131 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. Data from Ibaragi Prefecture is available from Hitachiota City (Mizuhu area) from 22 March onward and from seven other locations from 23 March onward. I-131 peaked in Hitachiota City (Mizuhu area) at 245 Bq/L on 22 March and declined to 29 Bq/L the following day. No new data is available for Hitachiota City (Mizuhu area) since then. On 23 March, I-131 levels peaked in Hitachi city (Moriyama) at 150 Bq/L, Hitachi city (juo) at 298 Bq/L, in Hurukawa city at 142 Bq/L, in Tokai village at 188.7 Bq/L, and in Kasama City at 170 Bq/L. I-131 levels peaked in Toride city at 106.5 Bq/L on 24 March. I-131 levels have been on a generally downward trend following the peaks and are now below 100 Bq/L in the afore-mentioned locations. In Chiba Prefecture, data are available from the Kashiwai and Kuriyama water purification plants on one date, 25 March. I-131 was measured at 130 Bq/L at Kashiwai and 45 Bq/L at Kuriyama on that date. Cesium levels have generally been below detectable levels in the above-mentioned locations with sporadic findings well below levels of concern. A child looks at a bottle of mineral water distributed to a nursery in Tokyo Thursday, March 24, 2011. Photo: AP/Kyoto News • 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. IAEA Updates: 28 March 2011 WHO FAQs: 25 March 2011 WHO-WPRO SitRep No. 19: 28 March 2011 OCHA Sit Rep 14: 28 March 2011

35. RADIONUCLIDES IN SEA WATER • Contamination of the marine environment has occurred both by fallout or washout and discharges of contaminated water into the sea • On March 23, 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, 24 and 25 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 kms offshore. . • I-131 and Cs-137 were detected with highest activity concentration of about 80 Bq/L and 26 Bq/L in surface layer, respectively, at the 23 and 24 March. Data were reported for 26 March and they show now decreasing trend between 6 and 18 Bq/L for I-131 and „not detectable“ and 16.4 Bq/L for Cs-137 • Surveillance of seawater near the NPP sites indicates 1,250 times above safety level (I-131) for seawater at 330 m from Daiichi plant on 25 March and 1 851 times above the safety level on 26 March. • Measurements of the marine environment was carried out by Japanese authorities since 23 March and data reported to the IAEA for information and assessment. Measurement were done at 30 km off-short section on 8 locations, on 26 March on 4 Stations. • I-131 and Cs-137 were detected with highest activity concentration of about 80 Bq/L and 26 Bq/L in surface layer, respectively, at the 23 and 24 March. • Data were reported for 26 March and they show now decreasing trend between 6 and 18 Bq/L for I-131 and „not detectable“ and 16.4 Bq/L for Cs-137. • Dose rates were also given above seawater level on 26 March. They are between 0.041 and 0.100 micro-Sv/h • Levels at about 330 m east of the discharge area showed increasing concentrations with 74000 Bq/L for I-131, 12000 Bq/L for both radionuclides Cs-134 and Cs-137 • Modelling of the dispersion of radionuclides was initiated and first results were available. The results show an initial transport into north-east direction and the contaminated seawater could reach the 30 km off-shore sampling section between 7 and 14 days after release • It can be expected that the marine dispersion will take months or years to reach other riparian Pacific countries. At resent, the main transport of contamination takes place by atmospheric transport over long distances with high dilution capacity. IAEA Updates: 28 March 2011WHO-WPRO SitRep No. 19: 28 March 2011OCHA Sit Rep 14: 28 March 2011

36. On 27 March, deposition of I-131 was detected in 9 prefectures, and deposition of Cs-137 in 4 prefectures. The highest values were observed in the prefecture of Tochigi with 320 Bq/M2 for I-131 and 73 Bq/M2 for Cs-137. In the other prefectures where deposition of I-131 was reported, on 27 March, the range was from 6.4 to 110 Bq/M2. For Cs-137, the range was from 16 to 61 Bq/M2. In the Shinjyuku district of Tokyo, the daily deposition of I-131 on 27 March was 100 Bq/M2, while for Cs-137 it was 36 Bq/M2. No significant changes were reported in the 45 prefectures in gamma dose rates compared to yesterday. • A joint FAO/IAEA mission has arrived in Japan. The three-person team includes the Head of the IAEA Food and Environmental Protection Laboratory, an IAEA soil scientist, and a FAO food safety specialist from FAO’s headquarters in Rome. The food safety assessment team will provide advice and assistance on sampling and analytical strategies and will help interpret Japanese monitoring data. • 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 Bqsof radioactive Cs-137 per kilogram of soil has been detected in Iitate Village, about 40 kilometers northwest of the plant. RADIOACTIVITY IN SOIL • Radioactivity levels at the Fukushima Daiichi Nuclear Power Plant (NPP) remain low. The radiation levels in the surrounding prefectures continue to decrease although they are still above background levels. OCHA Sit Rep 14: 28 March 2011 WHO-WPRO SitRep No. 19: 28 March 2011 IAEA Update: 28 March 2011

37. HEALTH CONCERNS • CURRENT RISK • The GoJ’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 GoJ has evacuated individuals who were living within a 20-km radius around the Fukushima Daiichi plant. Those living between 20 km and 30 km from the plant are being asked to shelter indoors. • 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. • Monitoring of vegetables and milk has demonstrated I-131 in concentrations above Japanese regulatory limits.Cs-137 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. • I-131 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 I-131, 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 MarchWHO Japan Nuclear Concerns FAQ– Protective Measures 25 March

38. 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