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A massive tsunami following an earthquake of magnitude 9.0 hit the northeastern part of Japan on 11 March 2011, causing catastrophic damage in coastal areas of the country. The death toll may have exceeded 20 000, with most deaths having been caused by drowning. As of 4 September, the National Police Agency has confirmed 15 763 deaths and has reported 4282 persons as missing.1–3 This tragedy implies a partial failure of Japan's long-term efforts on preparation and emergency response plans for its frequent earthquakes and tsunamis. Having frequently sustained devastating tsunami damage in the past, the severely damaged areas, particularly the Sanriku coast in the northern part of the affected region, were well equipped with extensive coastal defences and sophisticated tsunami warning systems.4 5 These technology-oriented measures, however, could not provide effective protection against this once-in-a-millennium tsunami.
This failure propelled Japanese authorities to recognise their over-reliance on technical solutions in their current approaches to disaster mitigation and to make a shift to more balanced solutions, which assume technological limitations and put greater emphasis on evacuation and land use.4 6 7 The alternative approaches aim to promote community-based efforts in developing detailed evacuation plans and in targeting aspects of residents' behaviour. Epidemiological data, such as geographical and demographic risk distribution, should be used to guide such measures. The health sector and injury control experts should contribute in this regard by collecting and analysing epidemiological data. However, currently in northeastern Japan, preventing post-disaster health problems is a more pressing issue.
Before the 2011 tsunami, Japan's disaster countermeasures had made continual progress by reducing risk factors when weaknesses became apparent during natural disasters. However, the tsunami on 11 March 2011 exposed major limitations in Japan's emergency response plan for tsunamis. This paper provides an overview of Japan's experience in developing disaster preparation …
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