Fukushima nuclear disaster: did the evacuation raise the death toll?

Satoru Yamauchi was working in his soba noodle shop when the Tohoku earthquake struck on March 11 2011. He remembers escaping to high ground, then going home to rescue his dog, making it back in time to see a “white wall” — the tsunami — roaring in from the Pacific.

The destruction was beyond his imagination. But Mr Yamauchi, and his family, survived. Even their home in the town of Naraha was just high enough to escape the water. Then the next day, city hall ordered an evacuation: there was trouble at the Fukushima nuclear plant, and a friend at Tokyo Electric, the plant’s operator, said it might be serious.

The family headed south and spent three days in an evacuation centre. It was desperately cold. Mr Yamauchi was pressed into duty as a cook, even as the rumours surrounding the condition of the reactors grew ever more terrifying. “My children were saying: ‘We don’t want to die from radiation. Let’s go to Tokyo. Let’s go to Tokyo.’”

So the family moved to the Japanese capital, 200km away, which is where their troubles really began. For the past seven years they have struggled with cramped conditions, money troubles, bullying at school, depression, lack of purpose and the insidious fear of a death sentence from radiation exposure. “Psychologically we were wrecked,” says Mr Yamauchi. “I’m still taking pills for high blood pressure.”

As life slowly returns to normal in Fukushima — visitors to the plant no longer need radiation suits, a face mask is sufficient — it is becoming increasingly clear, say experts, that the evacuation, not the nuclear accident itself, was the most devastating part of the disaster. It reaped a terrible toll in depression, joblessness and alcoholism among the 63,000 people who were displaced beyond the prefecture; of those, only 29,000 have since returned.

There were 2,202 disaster-related deaths in Fukushima, according to the government’s Reconstruction Agency, from evacuation stress, interruption to medical care and suicide; so far, there has not been a single case of cancer linked to radiation from the plant. That is prompting a shocking reassessment among some scholars: that the evacuation was an error. The human cost would have been far smaller had people stayed where they were, they argue. The wider death toll from the quake was 15,895, according to the National Police Agency.

Zero evacuation may be implausible. At the height of the crisis there were fears of much worse contamination. The question is rather whether people should have been kept away for weeks, not years. “With hindsight, we can say the evacuation was a mistake,” says Philip Thomas, a professor of risk management at the University of Bristol and leader of a recent research project on nuclear accidents. “We would have recommended that nobody be evacuated.”

Fukushima prompted a global turn away from nuclear power and correspondingly higher carbon emissions in countries such as Germany and Japan. Yet if much of the suffering was proved to be avoidable, it might change that calculation. The future of nuclear energy, as well as the correct response to other catastrophes that cause evacuation, may rest on learning the right lessons from the disaster.

The nuclear accident, the worst since Chernobyl in 1986, unfolded after the tsunami knocked out power supplies at the Fukushima Daiichi plant. As workers fought desperately amid the rubble and water, three of the reactors lost cooling, leading to hydrogen explosions and the release of nuclear contaminants into the atmosphere. Ultimately, those three suffered meltdowns.

The first evacuation, of those within a 2km radius of the plant, was ordered on the evening of March 11, just hours after the tsunami. The following morning the exclusion zone was expanded to 10km, but with high radiation levels recorded at the site boundary after the first explosion that day, it was further extended to 20km around the plant, taking in the Yamauchi’s home in Naraha.

Disaster related deaths by age

Evacuations took place in an atmosphere of panic and disorganisation. Large buses simply turned up at town halls and people got on with whatever they could carry. The sick and vulnerable suffered most.

“If you compare nursing homes that evacuated with those that didn’t, the death rate was three times higher among those who moved,” says Sae Ochi, a doctor at the Japan agency for medical research and development who has worked in Fukushima. Of the disaster-related deaths, 1,984 were people over the age of 65.

The physical effects on evacuees living in temporary accommodation were acute. People who had previously walked had to drive. Farmers used to the outdoors were cooped up inside. Higher rates of liver dysfunction, diabetes and hypertension were recorded.

“The thing we worry about most is disaster-related suicides,” says Koichi Tanigawa, a professor at Fukushima Medical University. The impact of the disaster on people’s mental health got worse over time, with suicides peaking in 2013, when 23 Fukushima disaster victims took their own lives. “Initially, everyone was really determined, but they got tired and that’s when depression started to increase,” says Dr Ochi.

The human cost: Fumio Okubo

The case of Fumio Okubo is a stark example of how the evacuation affected the elderly. Aged 102 at the time of the disaster he lived 30km inland from the plant, in Iitate.

As people began to leave the area. his day care service shut, trapping him at home. Then at lunchtime on April 11, a month after the disaster, he learnt, via television news, that a complete evacuation of the village, which lay along the fallout path from the reactors, had been ordered. “I don’t want to leave,” his daughter-in-law (pictured above with a photograph of Mr Okubo) recalled him saying, according to court filings. “I’ve lived too long.”

That night Mr Okubo hanged himself. Plant operator Tokyo Electric was recently ordered to pay his relatives ¥15.2m ($142,000) in damages.

The result that did not materialise was sickness from radiation. “At present, there are no cases of cancer relating to radiation, and that includes workers at the plant,” says Dr Tanigawa. Among 173 workers exposed to radiation above occupational safety limits, there may eventually be a handful of incidents of cancer, he says. But the maximum dose to Fukushima residents was below those levels. “Statistically speaking, there should be no detectable increase in cancer in the general public.”

Anti-nuclear campaigners point to more than 100 diagnoses of thyroid cancer in Fukushima children. But doctors say radiation cannot be the cause, since the disease typically takes four or five years to develop after exposure, and the cancers were found immediately. Rather, the thyroid cases were a result of screening every child in the prefecture using ultrasensitive equipment.

Detection rates in Fukushima were similar to those found using the same equipment in other Japanese prefectures. “If we go looking for thyroid cancer then we’ll find it through a screening effect,” Dr Tanigawa says.

Avoiding deaths from radiation was the whole point of the evacuation. The crucial question is how sick people would have been had they stayed. Prof Thomas has published calculations using UN radiation data from Fukushima and standard models of how it translates to disease. He found modest risks.

“The sort of dose for even the worst-affected villages was something that was accepted in the nuclear industry 30 years ago,” he says. In the worst-affected towns of Tomioka, Okuma and Futaba he found that evacuees extended their lives by an average of 82, 69 and 49 days respectively, thanks to the radiation they avoided.

In Mr Yamauchi’s hometown of Naraha, the decrease in lifespan avoided through evacuation was just a couple of days. In a few places, the figure was negative because people evacuated to areas with higher levels of radiation. Evacuation makes relatively greater sense for the young, who are more sensitive to radiation, and have more length of life to lose.

But purely based on an economic calculation of cost and benefit, the evacuation was not worth it, says Prof Thomas. The expected compensation bill to evacuees is ¥7.9tn ($74bn). Add in the terrible health consequences of disrupting lives “and it becomes many more times not worth doing”. The lifetime risk of death from a 100 millisievert dose of radiation — more than any resident actually received ��� is about 0.5 per cent.

In retrospect, the evacuation looks excessive. Less clear is whether those in charge at the time could have acted any other way. Naoto Kan, the prime minister who ordered the evacuations, says his decision was correct. In the terrifying days after the accident, he was presented with nightmare scenarios of massive radioactive contamination requiring an evacuation within a 250km radius of the plant.

“There were 50m people in that area, including the entire population of Tokyo. The capital would have been a ghost town,” he says. “Given this scenario was possible, then basically we had to order an early evacuation.”

Mr Kan was not alone in that decision. Based on its own independent understanding, the US told its citizens to evacuate an even wider area of 50 miles around the stricken plant. The one mistake Mr Kan identifies is not evacuating faster in villages along the fallout path north-west of the reactors. “That was inexcusable to the victims,” he says.

Prof Thomas draws a distinction between evacuation while the disaster was continuing and relocation in its aftermath. He compares it to an evacuation last year below the Oroville Dam in California, where residents were swiftly returned to their homes once the dam was stabilised.

But Dr Ochi wonders if it was possible to keep people in place, even once the nightmare scenarios were averted. “If you look now simply at the amount of radiation then it would have been better not to evacuate,” she says. “[But] people were scared, and it wouldn’t have been possible to get food and fuel to them.”

Instead of second-guessing the decisions taken in Fukushima, she says, it is more important to think about better ways to manage an evacuation in the future. Japan’s new nuclear contingency plans include an evacuation within 5km and orders to shelter in a 30km radius in the event of a similar disaster.

“Perhaps the most crucial thing is to say — at the time of the evacuation — under what conditions you should return,” she says. Safe radiation levels are a matter of dispute among scientists, but people are unlikely to trust a figure set after the accident. Ms Ochi also says it is safe to take time over evacuating the sick because only cumulative radiation exposure is dangerous.

Prof Thomas takes her arguments a step further. “The first thing to realise is that relocation is probably going to be a bad idea,” he says, suggesting that nuclear companies start providing real-time health information on the risks of living around their plants. “This is what your loss of life expectancy is from the current level of contamination,” he says. If people realise it would only be a few days, they can make an informed decision to stay.

“People understand temperature very well,” says Dr Tanigawa. “They need that understanding of radiation.”

What these approaches require, however, is a sophisticated understanding of risk and public willingness to act on it. It is indisputable that nuclear power means some risks. An accident such as Fukushima means some radioactive contamination, and staying in a contaminated area means some long-term increase in the risk of cancer.

As for Mr Yamauchi, he is returning to Fukushima to reopen his noodle shop. “Will we be able to manage there? I don’t know,” he says. The evacuation order for Naraha was lifted in 2015, but the population is still a fraction of what it was. He worries about radiation and is distrustful of the plant’s operator, Tepco, and any official suggestion that the health risks are under control. “There’s absolutely no need for nuclear power,” he says. “With just one mistake, terrible things happen.”

Letters in response to this article:

If it was my family, I’d want them out of there / From Dr Paul Dorfman, University College London, UK

Calculations took account of cancer’s long incubation period / From Philip Thomas, University of Bristol, UK