"People who were normally stable were suddenly a burden on health services," because suddenly they could no longer get the treatments for their managed conditions due to distribution and manufacturing disruptions, Garfield says.
Fortunately, Japan was well equipped to handle such a disaster and was able to distribute medication relatively quickly. Volunteer medical teams from elsewhere in the country came in to provide services for the ill and displaced. But, as Garfield points out, although these temporary visiting health workers were helpful, they could not replace the long-time doctors that patients had relied on prior to the disaster.
Of course, no matter how prepared a country is a massive disaster is devastating for individuals. People who lost their homes, villages and family members, and even just those who survived the quake, will likely continue to face mental health challenges and the physical ailments that come with stress, such as heart disease. "Much of the damage was really psychological—the stress of not knowing, of being relocated," U.C. Berkeley's McKone says.
Experts on the ground in Japan agree. "Mental health is the most significant issue," notes Seiji Yasumura, a gerontologist at Fukushima Medical University's Department of Public Health. Stress, such as that caused by dislocation, uncertainty and concern about unseen toxicants, has been linked to increased risk for physical ailments, such as heart disease. So even if radiation risks are low, "people are still worried," he says. And that can also lead to unhealthy behavioral changes, "including dietary choices, lack of exercise and sleep deprivation"—all of which can have long-term negative health consequences. Many of the survivors are elderly, whom either lost a partner or even an entire family. As after the Kobe earthquake of 1995, the Japanese government has created housing for these disconnected older adults. But, as Garfield notes, "the government can't buy you a new family."
There are also what Garfield calls, "the immeasureable, imponderable" effects of the disaster. Those who relocated from the prefecture report having experienced discrimination and, especially immediately following the accident, were considered somehow "contaminated." Traditional Japanese values also prize stoicism, which means that people who are suffering mental or even physical distress might be less likely to seek the care they need.
As in previous disasters, however, new services have developed to meet new needs. Awareness of the mental health burden has lead to a spontaneous outpouring of help from around the country. In some ways, Garfield says, "the victims are probably getting better care than they were before."