Japan: Relief provided by Red Cross is more than just food and blankets

Published: 25 March 2011 17:02 CET

By Sayaka Matsumoto, Japanese Red Cross Society and Francis Markus, IFRC

Even as a trained psychosocial nurse, Akemi Nitta is at a loss to try to capture in words the overwhelming impact of the emotions she faced, supporting grieving survivors as they identified the bodies of loved ones in the Japanese Red Cross Society’s hospital in Ishinomaki.

“I don’t know what words I can use to describe those people’s situation best. Whatever words we have used to talk about previous disasters, these descriptions seem totally inadequate to describe this situation,” she says.

For more than a week, Nitta worked as part of an eight-member team of dedicated psychosocial workers in the hospital following the disaster. One of their primary responsibilities was looking after the families, whose loved ones were assigned a black tag in the triage process, meaning that they were deceased.

“It’s not a matter of accepting or not accepting this person’s death; people don’t have a choice. They just have to face the situation,” says Nitta who has now returned to Yamanashi Red Cross hospital.

Amid the despair and numbness, there were shades of hope and comfort. In one family, a son brought the body of his 70-year-old mother to the hospital, not knowing whether his brothers were alive or dead. The next day, they appeared at the hospital, having heard that their mother was there. “She brought us here to meet up again,” one of the siblings said.

With nowhere else to lay bodies but in the car park of the hospital, some families want to take their loved ones back to a resting place at home. For many, however, nothing was left of their home after the tsunami.

The Japanese authorities, right across the disaster region, have to bury bodies rather than cremate them according to local tradition, simply because too many have lost their lives in this disaster. In such a situation, it’s all too easy for even trained psychosocial workers to feel inadequate.

“I could only do my best, that’s all I can say. I was beside the families and I felt affection for them and I cried. According to our psychosocial manual, the care giver can cry, but should try not to break down in tears,” Nitta says.

Many of the sources of comfort that help people come to terms with the death of a loved one are simply impossible to find in the aftermath of a tsunami, such as looking at a picture of a loved one or hearing their last words.

“The hurt of the people in this situation is so great, they can’t feel anything. So when things return to normality a bit, the emotions will burst out. People will feel anger, sadness and frustration that they can’t take anywhere. At that stage, there should be somebody or some system there to receive those emotions.”

Helping to plan the future roll-out of psychosocial support in the aftermath of this disaster is where psychology professors Kazuki Saito and Jun Maeda come in. They have just returned to Tokyo for consultations at the headquarters of the Japanese Red Cross after establishing a rotating system of psychosocial support teams at Ishinomaki.

“After most disasters Japan has experienced in the past, provision of basic relief is established within one to three days. This opens the way for survivors’ emotional reactions to be addressed through psychosocial support,” says Saito. The scale of devastation and the displacement experienced after the earthquake and tsunami in the north-east of Honshu Island made it impossible to wait until people’s physical situation stabilized, so relief and psychosocial support were delivered simultaneously.

Despite all of their experience, including the 2004 Indian Ocean tsunami and Hurricane Katrina in the United States, nothing could have prepared Saito and Maeda for what they saw on reaching Ishinomaki, in the heart of the tsunami-battered prefecture of Miyagi two days after the disaster.

 “We saw 20 dead bodies on a concrete floor, we saw the civil defence forces lining up bodies by the roadside,” says Saito. Despite the calm and professional demeanour of both men, it is impossible not to be affected by such experiences.

Clearly, the psychosocial welfare of Japanese Red Cross Society’s own psychosocial support personnel is itself an issue needing careful attention. Mr Saito says that when staff finish their rotations, they will be asked to fill in a questionnaire to give a picture of their own emotional state.

Experts say that it’s important to recruit local people to carry out psychosocial support in order for them to be able to relate to survivors in their familiar dialect. There’s also a need to ensure that the techniques are adapted, as a high proportion of the survivor population are elderly.

“It’s important to introduce community activities such as exercises, as well as their normal habits such as chatting and drinking tea. Older people also need health advice because that is their worry. But they also need some peaceful time too,” says Dr Jeyathesan Kulasingam, the IFRC’s health and psychosocial support delegate, with experience of the Sichuan earthquake operation in China, where the welfare of the elderly was also a major concern.

It’s understandable that psychosocial support will be a vital part of the humanitarian operation as Japanese Red Cross Society gears up to meet the needs of the hundreds of thousands of survivors of this disaster, not just in the immediate aftermath, but in the coming months and even years.