Japan: Shelter Life and Preventable Deaths

Evacuees resting in a Japanese school-gymnasium evacuation shelter with partitioned sleeping areas

Japan: Shelter Life, Car Sleeping, and Preventable Deaths After the Shaking

Overview: the disaster that kills after the disaster

In the 2016 Kumamoto earthquakes, more people died from the aftermath than from the shaking itself. Japan formally recognises this category as 災害関連死 (disaster-related death): deaths caused by evacuation conditions, interrupted medical care, exhaustion, cold, dehydration, blood clots, and stress, rather than by collapsing buildings.

This matters twice over. First, nearly all of it is preventable with knowledge that takes ten minutes to learn. Second, these deaths are compensable under the condolence grant system — families frequently never apply because they assume a death weeks later "doesn't count."

First: 避難場所 and 避難所 are not the same thing, and confusing them kills

This is the single most dangerous terminology problem in Japanese disaster response, because the words look almost identical.

指定緊急避難場所 (shitei kinkyū hinan basho) — "designated emergency evacuation SITE." A place to escape from an immediate hazard. It may be nothing but open ground, a hilltop, a rooftop, or a park. It is designated per hazard type — a site designated for earthquake is not necessarily safe for tsunami or flood. You go here to survive the next few minutes or hours.

指定避難所 (shitei hinanjo) — "designated evacuation SHELTER." A facility where you can stay — usually a school gymnasium or community centre — with water, food, toilets, and information, for days or weeks.

The lethal error is going to a 避難所 that sits inside a tsunami inundation zone because you think "shelter" means "safe." In a tsunami, go to the designated 避難場所 for tsunami — upward — not to the shelter you know. Check your municipality's hazard map now, and note which sites are designated for which hazard. Many signs display hazard icons (earthquake, tsunami, flood, landslide, fire) showing exactly what each site is rated for.

Economy class syndrome (エコノミークラス症候群) — the car-sleeping killer

After Japanese earthquakes, large numbers of people sleep in their cars: aftershocks make buildings frightening, shelters are crowded and lack privacy, and people with pets, infants, or disabilities feel unwelcome. This choice is understandable and it has killed people, notably in Kumamoto in 2016.

Sitting still for long periods in a cramped seat, dehydrated, causes deep vein thrombosis — a clot forms in the leg, travels to the lung, and causes a fatal pulmonary embolism, often when the person finally stands up.

If you sleep in a vehicle: 1. Drink water regularly — at least a cup every two hours while awake. People deliberately dehydrate themselves to avoid using scarce toilets, and this is exactly what causes clots. Fix the toilet problem instead; do not fix it by not drinking. 2. Move your legs every hour while awake: ankle pumps (point and flex 20–30 times), knee raises, calf squeezes. 3. Get out and walk for a few minutes at least every two to three hours in daylight. 4. Sleep as flat as you can. Recline the seat fully, use luggage to level the footwell. Sleeping upright is the highest-risk position. 5. Loosen tight clothing, especially at the waist and knees. Do not sleep in a belt or tight jeans. 6. Wear compression socks if available; they are worth adding to a go-bag. 7. Warning signs of a clot: pain, swelling, warmth or redness in one calf — usually one leg only. Then sudden breathlessness or chest pain, which is an emergency. Do not walk it off; call 119. 8. Also fatal in cars: carbon monoxide. Never run the engine for heat with snow or debris blocking the exhaust pipe, and clear the tailpipe after every snowfall.

Shelter life: the TKB problem

Japanese disaster medicine talks about TKB — トイレ (Toilet), キッチン (Kitchen), ベッド (Bed) — the three things that determine whether a shelter keeps people healthy or makes them ill.

Toilets. Sanitation collapses first and drives everything else. When toilets are filthy or scarce, people stop drinking to avoid them, and dehydration produces clots, kidney problems, and confusion in the elderly. Use 携帯トイレ (portable toilet bags) — keep them in your home kit; they work on a normal toilet bowl with the water off. Wash or sanitise hands rigorously: norovirus and influenza outbreaks in shelters are routine and, in a crowded gym, spread within days.

Kitchen. Early shelter food is carbohydrate-heavy — rice balls, bread, instant noodles. Over weeks this produces real deficiencies. Prioritise protein and vegetables when supply allows, and flag dietary and medical needs (diabetes, allergies, swallowing difficulty, infant formula) to shelter staff early rather than going without.

Bed. Sleeping directly on a gym floor means breathing floor-level dust — a documented driver of respiratory illness — and it is very hard for elderly people to stand up from. 段ボールベッド (cardboard beds) are now widely deployed for exactly this reason: they lift sleepers ~30 cm off the floor, provide insulation from cold, and make standing possible. Ask for one; do not assume they are only for others.

Also: 1. Cold is a bigger threat than most people expect. A gymnasium floor in winter conducts heat out of the body all night. Insulate underneath you — cardboard, blankets, mats — before piling blankets on top. 2. Keep taking your medication. Interrupted treatment for hypertension, diabetes, epilepsy, and psychiatric conditions is a leading cause of disaster-related death. Tell shelter medical staff what you take. A photograph of your お薬手帳 (medication record book) on your phone is the fastest way to get a prescription reissued. 3. Move every day. Immobility in the elderly leads rapidly to loss of muscle and function that never fully returns (生活不活発病, "disuse syndrome"). Walking and light exercise are medicine. 4. Sleep and noise. Earplugs and an eye mask are trivially small go-bag items that materially protect health in a room of 200 people.

Welfare shelters (福祉避難所)

Municipalities designate 福祉避難所 — secondary shelters for people who cannot cope in a general shelter: elderly people needing care, people with disabilities, pregnant women, and families with infants. They have staff, accessible facilities, and quieter space.

They are chronically under-used because people do not know they exist. If you or a family member needs one, ask the general shelter's staff to arrange a transfer. Related: municipalities maintain a 避難行動要支援者名簿 (register of people needing evacuation assistance) — if you or a relative would need help evacuating, register in advance with the municipal welfare office.

Pets (ペット同行避難)

Japan's national policy is 同行避難 — evacuate together with your pet. This exists because people died returning for animals. Understand the practical limits: - 同行避難 means bringing the animal to the shelter; it does not guarantee the animal may stay in the same room. Most shelters keep animals in a separate area. - Bring a carrier or cage (many shelters require one), several days of food, medication, and a photo of you with the pet to prove ownership. - Practise: an animal that has never been in a carrier will not cooperate on the worst day of its life. - Some shelters accept 同伴避難 (staying together in the same space); this varies by municipality. Check yours in advance.

Staying home instead (在宅避難)

If your building is verified structurally sound, staying home is often healthier than a shelter — less infection risk, better sleep, more privacy. Japanese municipalities increasingly plan for this. Two cautions:

  1. Register at the shelter anyway. Supplies, information, and the 罹災証明書 process flow through it, and people who never appear on a shelter list are routinely missed for distributions. Go, register, collect supplies, and return home.
  2. Do not use the toilet if the drainage stack may be broken — in a mid- or high-rise, flushing when the stack below is damaged floods the apartments underneath. Use 携帯トイレ until the building is checked.

If someone dies later: apply anyway

If a family member dies in the weeks or months after the disaster — a stroke after evacuating, pneumonia contracted in a shelter, a chronic condition that worsened without medication, a suicide driven by the loss — this is potentially 災害関連死 and is compensable under the 災害弔慰金 system (up to ¥5,000,000 for a primary household earner).

A municipal review board decides each case. Keep medical records, the shelter registration, and a timeline of events. Bereaved families very often do not apply because they assume the link is too indirect. Let the board decide, not your assumption.

Quick reference

  1. 避難場所 = escape the hazard now. 避難所 = stay for days. Check which hazards your local site is rated for.
  2. In a tsunami, go up, to a tsunami-designated site — not to the shelter you happen to know.
  3. Car sleeping causes fatal blood clots. Drink water, pump your ankles hourly, walk every 2–3 hours, sleep flat.
  4. One swollen painful calf, then breathlessness = suspected pulmonary embolism. Call 119.
  5. Never idle an engine with a blocked exhaust — carbon monoxide.
  6. TKB: toilets, food quality, and getting off the floor determine who stays healthy.
  7. Ask for a 段ボールベッド; insulate underneath you before adding blankets.
  8. Keep taking your medication — photograph your お薬手帳 now.
  9. 福祉避難所 exist for elderly, disabled, pregnant, and infant needs — ask for a transfer.
  10. Pets: 同行避難 is national policy; bring a carrier, food, and proof of ownership.
  11. Staying home? Register at the shelter anyway, and don't flush if the drain stack may be broken.
  12. A death weeks later may still be 災害関連死 — apply for 災害弔慰金.

Sources and legal basis

Conditions and shelter provisions vary by municipality. Confirm your local hazard map and designated sites with your city/ward office before you need them.