Issues and Lessons Learned from the Relief Activities for Persons with Disabilities Affected by the Great East Japan Earthquake
Sayako Nogiwa
Representative of Tohoku Office, Association for Aid and Relief, Japan (AAR Japan)
0. Association for Aid and Relief, Japan and Persons with Disabilities
The Association for Aid and Relief, Japan (AAR Japan) has worked in more than sixty countries and regions since its establishment to support Indochinese refugees in 1979. AAR Japan began providing support for persons with disabilities when it distributed wheelchairs at a refugee camp on the Cambodia-Thailand border in 1989. The first persons with disabilities AAR Japan provided support to were those who had their disability due to landmines or fighting, and the support was undertaken as part of its support for refugees. Since then, support for persons with disabilities has been broadened to include the following seven fields: (1) providing physical therapy and rehabilitation services (Afghanistan, Tajikistan, Laos), (2) producing and distributing wheelchairs (Laos, Cambodia, Tajikistan), (3) providing vocational training (Myanmar, Cambodia, Laos, Tajikistan), (4) conducting community-based rehabilitation (CBR) projects (Myanmar), (5) providing emergency support to persons with disabilities during disasters (Sri Lanka, Myanmar, Philippines, Indonesia, Pakistan, Haiti, Japan, Turkey), (6) participating in and providing advice at conferences both in Japan and overseas, and (7) running programs to provide support for the lives of children with disabilities (Myanmar). Within these fields, the organization conducts various activities in numerous countries.
Assistance to persons with disabilities is one of the five main types of activities that AAR Japan undertakes, and the other ones are emergency assistance, mine/uxo action, action against infectious diseases, and raising public awareness.
1. The Great East Japan Earthquake and persons with disabilities
The news crew for Japan Broadcasting Corporation's Fukushi (Welfare) Network program stated that the mortality rate due to the Great East Japan Earthquake for persons with disabilities (2.06%) was twice that for the general population (1.03%). In addition, at facilities with many bedridden elderly residents, more than half of the residents perished. A survey of Hyogo prefecture clearly reveals that for the Great Hanshin-Awaji Earthquake, half of the fatalities were 65 or older, and according to the National Police Agency, at least 65% of victims in the Great East Japan Earthquake were 60 or older.
After surviving the earthquake and tsunami, persons with disabilities still faced the harsh life of an evacuee. Persons with physical disabilities found it extremely difficult to use the toilets at temporary housing, which required them to climb on top of a 60-cm-high entrance step. At one elementary school used as an emergency shelter, a little girl in a wheelchair got stuck in front of the draining boards placed in front of the gymnasium. That scene left me with an indelible impression. The flyers posted at emergency shelters were useless for persons with visual impairment. There were cases when people with psychosocial or intellectual disabilities were forced out of emergency shelters, and there was one case when a person with a hearing impairment was thought just to be quiet, but he was unable to communicate that his physical condition was deteriorating and ultimately died. Why has Japan, which is supposed to be an developed county, become one with such major obstacles. In this report, I would like to overview what is required of future disaster control taking into consideration the experience and lessons learned from the activities undertaken by AAR Japan to support persons with disabilities affected by the Great East Japan Earthquake.
2. Emergency relief activities (from three days after the disaster) and its lessons: While the government was severely damaged
AAR Japan entered the devastated area two days after the disaster hit and undertook a wide range of activities. One of these activities was distributing emergency relief items, and AAR Japan distributed relief items to a total of almost 180,000 people affected by the disaster, mainly consisted of persons with disabilities and the elderly.
On March 14, 2011, AAR Japan visited the Disabilities and Welfare Section of Miyagi Prefectural Government in order to obtain the information related to the overall situation, and the section manager provided us with a list of facilities for persons with disabilities in the prefecture saying, “We tried to check with the facilities in each area on if people are alright but cannot get through by phone. Please check on people's safety when you deliver the emergency items.” AAR Japan threw a lot of staff into the effort, loaded up cars with supplies, and made the round of welfare facilities, delivering supplies and checking on people's well-being.
Immediately after the disaster, there was no gas, water, or electricity, and people were particularly happy to get food that did not require cooking, hygiene products such as wet-wipes and diapers, and fuels including diesel, kerosene, and gasoline. On the third day after the earthquake, Miyagi Disabilities and Welfare Section informed AAR Japan that because of the power outage, 3,000 liters of diesel and kerosene for power generators had to be procured within three days, in order to keep artificial respirators working. AAR Japan quickly made the necessary arrangements and delivered the fuel to the facilities.
Starting one month after the disaster, AAR Japan got into the full swing of delivering office equipment, home electrical appliances, and welfare equipment so that welfare facilities could relaunch operations as soon as possible. Some facilities received the relief items, which came from AAR Japan, for the first time since the earthquake hit about two months ago. AAR Japan has delivered relief items to persons with disabilities and the elderly who did not have access to their necessary support.
During the emergency phase, AAR Japan strived from a humanitarian aspect to play a supportive role in ensuring the rights of persons with disabilities that the government was expected to be responsible for. This role entailed making use of AAR Japan's experience in providing relief activities overseas and the distinctive characteristics of the private sector - that is, flexible and prompt responses to disasters. With the Great East Japan Earthquake, non-governmental organizations such as AAR Japan played a particularly large role, as local governments had quite severe damage. By staying in contact with various bodies such as the welfare sections of each prefecture, Japan Disability Forum (JDF), Takurorenraku-kai (a liaison group of voluntary welfare facilities for the elderly), and social welfare councils, AAR Japan could have an understanding of what was actually happening in the disaster affected areas and could deliver relief items, in a quick and flexible manner.
3. Recovery support activities (from three months after the disaster) and its lessons: Persons with disabilities who fell through the cracks of the system
Although taking a different form when efforts moved to the recovery phase, basic conditions stayed the same. Three months after the earthquake, AAR Japan started to work on rebuilding, and these efforts included repairing fifty-seven facilities for persons with disabilities and the elderly, and installing equipment such as bread makers at temporary workshops for persons with disabilities. AAR Japan also provided the vehicles for welfare facilities.
The Ministry of Health, Labour and Welfare (MHLW) issued its Deliberation on Central Government Subsidies for Reconstruction of Welfare Facilities, etc. Following the Great East Japan Earthquake notification dated April 26, 2011, which indicated that not only would payment typically take 1 - 2 years but also that facilities would be responsible for some of the expenses. Therefore, it was unclear to what extent the government could promptly handle requests. After consulting with the welfare sections of the various local governments and JDF, AAR Japan moved forward with repair work, mainly for facilities that were in danger of failing before the central government subsidies were paid. Here, too, AAR Japan played a supplementary role to the government.
However, this cannot continue to forever. A report by Miyagi Disabilities and Welfare Section stated that “structures such as rented ones are not eligible for central government subsidies, and in cases that the subsidy procedures and repair plans do not fall within the stipulated period, financial support should be provided by non-governmental organizations if the business agreed,” (March 2013 Monthly Normalization; page 33). AAR Japan's support for repairs was provided from a humanitarian perspective to protect the safety and health of the beneficiaries, not to take on all the responsibilities that the government finds it difficult to fulfill. In future, it is also important that the government is aware of their role and handle it.
Some people fell through the cracks of not only the system of central government subsidies but also that of the Disaster Relief Act. The act applies to people living in temporary housing, not evacuees staying at home. However, since conditions remained scary with frequent aftershocks and power outages, AAR Japan distributed home power generators and pedal operated aspirators to adults and children with severe multiple (intellectual and physical) disabilities who were living at home. There are many needs like these, which even though related to people's survival were not met by government programs.
4. Media (from immediately after the earthquake to one year later)
I would like to take a look at AAR Japan's relationship with the media and general media trends below.
Immediately after the earthquake, a reporter for Asahi Shimbun (one of the major newspapers in Japan) accompanied AAR Japan team when they delivered emergency relief items, and a piece on the activities of private organizations and issues in the disaster area appeared in the March 16, 2011 edition of the paper. Starting around two months after the earthquake, various news outlets including the Mainichi Shimbun (a major newspaper in Japan) and various local media (Iwate Nippo, Kahoku Shinpo, Fukko Kamaishi Shinbun, Iwate Broadcasting Co., Ltd. (IBC), Japan Broadcasting Company (NHK), etc.) had reports that focused on the issue of disabilities. Furthermore, the Mainichi Shimbun and Nihon Keizai Shimbun carried articles on needs related to support for people with disabilities one year after the earthquake. However, many of these pieces appeared only in the local section of papers. It is important to get these articles carried on the main pages of newspapers throughout Japan in order to reach a larger audience. Similarly, specials on issues related to disabilities were mainly limited to forums such as educational TV on NHK (public channel) and commercial channels, but having NHK and major broadcasters carry these stories would probably lead to the mainstreaming of disability.
5. Reconstruction support activities (from one year after the earthquake) and new issues
One year after the earthquake, there is no sign of a recovery in employment or the economy of the persons with disabilities in the disaster area. Therefore, AAR Japan is providing support for creating jobs at and expanding the sales channels for welfare workshops, in order to promote the participation of persons with disabilities in social and economic activities. AAR Japan is doing this because although this was an issue even before the earthquake (the government developed a plan to double and improve wages starting in 2007, but it has still not had an impact), and conditions have become more serious after the earthquake. Turning to the development of infrastructure for welfare services for persons with disabilities in Iwate and Miyagi prefectures, four staff members were temporarily transferred to related organizations, and support was provided for reconstruction and infrastructure development, such as working to improve disaster control guidelines. However, each area faces its own issues, and some areas in Fukushima that sustained substantial damage are still preparing for recovery and relaunching operations.
Since one year after the earthquake, AAR Japan has worked on awareness raising by presenting Japan's experience at conferences both in Japan and overseas, to promote international trends such as the Convention on the Rights of Persons with Disabilities in Japan.(i) On July 3 and 4, 2012, World Ministerial Conference on Disaster Reduction in Tohoku was held in Sendai-City, and the Prime Minister, Minister for Reconstruction, and Minister for Foreign Affairs attended the conference. The conference provided an opportunity to strongly communicate the need to support persons with disabilities from a human security perspective. In October, there are plans to make presentations of AAR Japan's experiences related to the Great East Japan Earthquake at the workshop on Community-based Disaster Prevention for People Vulnerable to Disasters held in Bangkok, Thailand, and the General Assembly of the Asia and Pacific Disability Forum (APDF) in Incheon, Korea.
However, these conferences may be a venue to share the issues that came to light through our effort to support persons with disabilities affected by the Great East Japan Earthquake, and we are not ready to inform the world of Japan's good experience. The particular issue depends on the each phase of the disaster.
The first thing that came to light during the emergency and recovery phase was that disasters expose persons with disabilities to various forms of life-threatening dangers (not only direct injury from the disaster, but other ones such as power outages) as discussed above and that there are many needs that cannot be fully handled by the government and existing laws. A major concern is when moving to the reconstruction phase is non-governmental organizations working under the government. Non-governmental organizations (NGOs) are strong in terms of flexibility and speed, and during the emergency support phase, when the government cannot sufficiently function, it is important that NGOs steadily move forward on their own path. However, now that it is more than one year and six months after the disaster, the government, which ensures the social rights of all, is supposed to play an important role. One year after the earthquake, a government affiliated party requested that NGOs provide support for a billion-yen facility for persons with disabilities. Is this truly an appropriate form of aid? Of course, it is probably important that the government and private sector complement each other and take the initiative in reconstruction efforts making use of their particular strength. Independent NGOs like AAR Japan do not normally stay on in a disaster area forever because of funding constraints, although Fukushima, which will take many years to rebuild, is an exception. From the emergency stage to the reconstruction stage, AAR Japan has provided support instead of the government based on the humanitarian aspect, but it is time to figure when we can pass the torch on.
For FY2012, one year after the disaster, MHLW will provide Iwate, Miyagi, and Fukushima prefectures with a budget for projects related to the reconstruction of infrastructure for welfare services for persons with disabilities, and the three prefectures will outsource the work to related non-governmental organizations. By all rights, when the national, prefectural, or municipal government outsourced a project, it was desirable to have a system so that the government could conduct detailed checks of progress and that the experience gained by NGOs could be tied to future policies. However, these projects are single year projects, and the conditions are extremely difficult for NGOs, too, since the following year's budget has not been secured and the medium- and long-term future direction of projects has not been set at all. Because of this, to ensure the projects do not undermine the leadership of both local governments and NGOs and their sustainability, it is necessary to revise the framework so that central government rules are not applied uniformly and that the system can be freely operated to match local needs.
In the final section, we will look at what we can do to help reconstruction and build society that is kind to everyone including persons with disabilities.
(i) The Convention on the Rights of Persons with Disabilities embodies international principles adopted by the United Nations in 2006 in order to ensure the basic human rights and dignity of persons with disabilities. As of the writing of this piece, 106 countries had ratified the convention. Japan ratified it in 2014.
6. What we can do - creating a “Society for ALL” through planning by related stakeholders including persons with disabilities, government, and NGOs' partnership
Until now, there are numbers of issues concerning related laws and the government; however, what we can probably do regardless of where we are positioned is coordination and cooperation.
In the case of Miyagi Prefecture, the first conference spearheaded by the prefecture was put on at the end of May, two months and a half after the disaster. Ultimately, three conferences were held in 2011, but participation was limited to about ten organizations, and there was no person with disabilities. This year, the first meeting to exchange opinions was held in September, rather late for such an event. Of course, these will continue to be held in the future, and it is hoped that they will become meetings in which not only information is exchanged but objectives are shared and solutions to problems are worked out. Even in Iwate, no person with disabilities served as a member of the Welfare for Persons with Disabilities Promotion Committee. In Fukushima, the prefecture never had a coordination meeting that all disability organizations participated in. On the other hand, at the meeting held by the private-sector JDF to exchange opinions on various topics, many persons with disabilities from each prefecture attended, and persons with disabilities also attended the Iwate Platform for Persons with Disabilities Conference. There were, however, no government officials, and the responsible person in each prefecture did not receive the valuable real-time information.
On the frontline of disaster support overseas, coordination meetings for individual sectors referred to as “cluster meetings” are immediately held after a disaster hits, and anyone who wants to, including persons with disabilities, are able to attend, which shows that it is not an exaggeration to say that Japan is far behind the times.
Points that should be improved through public-private partnership, became apparent as lessons, for each phase discussed above, emergency response, recovery, and reconstruction. For the emergency response stage, in order to improve emergency shelters that are full of barriers and non-functioning fukushi (welfare) emergency shelters such that persons with disabilities do not use, shelters that anyone can use should be arranged throughout Japan. In addition, at the Thirty-seventh Committee for Disability Policy Reform, there were calls that temporary shelters during the recovery stage should be designed barrier free from the beginning, and universal design should be incorporated into public housing for disaster victims during the reconstruction phase. This is a demand for the development of a living environment that anyone can use at each stage of disaster, and it is an extremely appropriate request for Japan whose population is graying. In addition, items such as the Disaster Relief Act and central government subsidies must be revised to make them more flexible to meet needs, and it would be desirable if persons with disabilities took part in at the planning, proposal, and preparation stages.
As for reconstruction phase, it is important that we promote it together with the Convention on the Rights of Persons with Disabilities. This also involves having the perspective of persons with disabilities play an important role in society. The reconstruction plan touts creating a society that is kind to persons with disabilities and the elderly, and government affiliated persons have stated that “it is important to gain an understanding of the diverse needs of numerous parties, such as women, children, the elderly, and persons with disabilities.” However, if this is not made truly effective through coordination and cooperation, society will always remain full of obstacles for the vulnerable. Each one of us must play a major role in the future.