Japan Tsunami: What's Ahead After Massive Earthquake, Nuclear Crisis

As Japan races to prevent a nuclear meltdown in the wake of an 8.9 magnitude earthquake and ensuing tsunami, frightening uncertainties abound. At least 10,000 quake-related deaths have been reported and it’s feared that the ultimate toll could be much higher. Amid a desperate search for survivors, millions more are without power, heat and water.

Another terrifying question is whether a meltdown can be averted and how serious rising levels of radioactivity are likely to be.  Although officials don’t expect another Chernobyl, explosions been reported at the crippled reactors and 180,000 people have been evacuated.  The Japanese government is distributing iodine tablets to help block a radioactive form of iodine that can otherwise build up in the thyroid, potentially causing thyroid cancer. Two other types of dangerous particles that a broken reactor can spew are strontium-90, which can trigger bone cancer and leukemia, and cesium-137, which raises cancer risk.

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What’s ahead for Japan? While each natural disaster is different, lessons from earlier catastrophes offer insights about possible threats to the survivors’ health and safety that urgently need to be addressed now and in the future. Last year, John Howe III, MD, president of Project HOPE, a humanitarian relief organization, told me that after a massive earthquake, such as the one that devastated Haiti, leaving more than 1.5 million homeless, there are three distinct phases to disaster relief:

• The acute crisis of utter devastation and chaos.  With roads, bridges and entire towns swept away, the immediate focus is reaching and rescuing survivors who may be in the water clinging to wreckage or are trapped under rubble. Other major health concerns are providing clean water, food, and shelter and getting medical supplies to the injured. While the majority of tsunami deaths are due to drowning, traumatic wounds like broken bones and head injuries can also be fatal, particularly if not treated quickly. If radiation does reach dangerous levels, another potential hazard is acute radiation syndrome (ACS). Initial symptoms, which can occur within minutes to days of exposure to high doses, include nausea, vomiting and diarrhea, followed by skin damage. 

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• The “quiet crisis” of rehabilitation and chronic disease. After the Haiti earthquake, many trapped survivors had such severe injuries that arms or legs had to be amputated, creating an urgent need for rehabilitation and therapy to help them relearn skills like walking. For those already in poor health due to chronic diseases like diabetes, lack of medical supplies and destruction of hospitals created additional hazards through lack of access to crucial medications and treatments. Should a massive release of radiation occur, recovery from acute radiation syndrome can take several weeks to two years, according to the CDC, while those who don’t recover typically die within months. However, hundreds of tsunami survivors have been scanned for radiation exposure and so far, no illness has been reported.

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• The “unseen crisis” of lingering threats. The effects of a major natural disaster can last months or even years. Long after most relief agencies have left the scene, survivors can face new health risks, such as the outbreak of cholera in Haiti months after the quake, when new floods contaminated the water supply in some regions, leading to an outbreak of cholera, as I reported in the GE healthymagination blog in November. As long as a large number of survivors are displaced and living in crowded temporary camps, infectious disease remains a risk, making vaccinations and sanitation measures a key priority. Other scary long-term risks include the possibility of radiation-related cancers, which may not show up until years after exposure, and birth defects in babies born to women exposed to radioisotopes during pregnancy.

Along with restoring primary health services, housing, and clean water, another key long-term priority is providing mental health services, since earthquakes, tsunamis and other disasters can leave even those who are physically unscathed with debilitating post-traumatic stress disorder, marked by nightmares, terrifying flashbacks, panic attacks and other symptoms. Growing recognition of the emotional aftermath of a natural disaster or other mass trauma, such as a terror attack, has inspired an approach known as “psychological first aid” to help people feel safer and more secure, but it’s not yet known if it’s effective for preventing PTSD.

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