Disasters

One year after the Fukushima nuclear crisis, Japan is facing a dilemma of how to clean up the disaster and how to meet current and future energy needs, says expert Charles D. Ferguson, even as the global nuclear industry continues to face the accident’s aftershocks.

One year after Japan’s triple disasters, questions persist about the ability of the world’s third-largest economy to rebound and how its struggling political system can mount serious reforms, writes CFR’s Sheila Smith.

A Japan Self-Defense Forces officer smiles as he holds a four-month-old baby girl who was rescued along with her family members from their home in Ishimaki City, Miyagi Prefecture in northern Japan, after an earthquake and tsunami struck the area. (Yomiuri Yomiuri / Courtesy of Reuters) 2011, of course, will be forever remembered as the year of Japan’s “triple disasters.” Only time will tell what this devastating experience will mean for the Japanese people and their society. For so many Americans, March 11 and its aftermath reminded us of why we so admire the accomplishments of Japan, and the civility and humanity of so many Japanese. From Kandahar to Canberra, from Seoul and Beijing, Japan’s friends around the globe responded—in part because of the tremendous scope of the tragedy, but also out of a sense of gratitude for Japan’s own effort to assist and befriend those beyond their own shores. The impact of the disasters is too broad to discuss here. But as a long time Japan watcher, several aspects of the disaster and its aftermath stood out. The first, and most widely recognized, is the depth of gratitude expressed by the Japanese people for their military, the Self Defense Forces (SDF). As Japan’s “first responder,” the SDF performed search and rescue operations, opened and sustained supply routes, and filled in the manpower for the local governments that lost staff as well as infrastructure and communications. In June, when I visited Ishinomaki, the SDF were just beginning to hand back governance tasks to an inundated municipal staff. Second, the disasters brought back into focus Japan’s Imperial family as the symbol of national unity. The Emperor spoke out in the early days as the nuclear disaster at Fukushima Daiichi unfolded to remind Japanese to remain calm and to have hope. He and the Empress also traveled back and forth to the devastated regions of Tohoku, visiting evacuation shelters and reassuring those who lost not only their homes but their family members as well. A third impression I had was how effectively Japan’s civil society coped with the trauma. Corporations and households alike jumped in to conserve energy at much higher rates than anticipated. The nascent disaster relief community was buoyed by an incredible wave of support, so much so that the NGO community found their capacities sorely tested. Volunteers streamed into the devastated areas, rolled up their sleeves, cleared debris, and dug out the remnants of homes from the tsunami’s mud. Anonymous donors left schoolbags, much needed personal goods, and in many instances, large envelopes full of cash for the hundreds of thousands of Tohoku residents stranded in evacuation centers. Nothing spoke louder to me of the national mood than the day that Japan’s women’s soccer team, Nadeshiko Japan, brought the World Cup home. It seemed that Nadeshiko’s victory released the country from the shock of the disasters, allowing a new sense of determination and pride to emerge. Several other trends in Japan this year were brought into sharp relief by the nation’s challenges. Japan’s process of political transformation remains a work in progress, and the search for a new form of governance and for new political leaders continues to keep all of us Japan watchers busy. We have a new prime minister, Yoshihiko Noda—the third from the new ruling Democratic Party of Japan. Legislators continue to wrestle with a parliament that seems designed more for the old single party system than for the new politics of alternating power. The “twisted Diet” may be with us for some time, but in 2011 it revealed a structural weakness that demands more attention from Japan’s politicians. An effort by the Liberal Democratic Party to vote then prime minister Naoto Kan out of office in June failed miserably, but it called attention to the fact that an opposition party could raid the ruling party in an effort to undermine the government. Local politicians took center stage this year, however. From the governors of Tohoku responsible for Japan’s quake response to the local mayors in the devastated towns and cities along the coastline, local leaders were the heroes on the front line of disaster relief efforts in Miyagi, Iwate, and Fukushima prefectures. Okinawa’s intrepid governor, Hirokazu Nakaima, continued his efforts to articulate his constituents’ sentiments in the never ending saga of disconnect between Tokyo and Okinawa. As the year ended, a dramatic electoral victory in Osaka’s double election transformed a governor into a mayor. Once elected, Toru Hashimoto immediately took his cause of reimagining Osaka on the road, and visited politician after politician in Tokyo to alert them that local leaders served their constituents rather than the national decision-makers. This year too was the year of the U.S.-Japan alliance. Operation Tomodachi, the U.S. name for its assistance to Japan after the Great East Japan Earthquake, was deeply appreciated, and almost all of us who visited Japan this year were thanked repeatedly and sincerely for the outpouring of U.S. aid, both public and private, in Japan’s time of need. For all of the political hiccups of the past couple of years, the Washington-Tokyo corridor was well traveled. Vice President Joseph Biden, Secretary of State Hillary Clinton, and Secretary of Defense Leon Panetta all visited Tokyo. All told, high level meetings between American and Japanese leaders totaled ten, with many of those occurring in the multiplicity of meetings in and around the Asia-Pacific. Finally, 2011 has put the economy back on top of Japan’s priority list. The cost of rebuilding in the wake of the earthquake will be far greater than anyone initially imagined, especially if we include the cost of reorienting Japan’s energy policy away from its 30% reliance on nuclear power. The yen soared in value, a defining if uncomfortable reality for those in government and in business. The decision to join the Trans-Pacific Partnership topped the list of “to dos” on the diplomatic agenda, and the drive to open the Japanese economy, symbolized by Prime Minister Noda’s gamble on trade talks with Washington and its partners, brings back some divisive tensions within both of Japan’s political parties. For all of the political and economic challenges that remain, I suspect that most Japanese will be grateful to see the end of 2011. 2012 will be a brighter year.

The IPCC has issued a special report on “Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation” (SREX). It’s an immensely useful document. Those of us whose research focuses on policy responses to climate change are bombarded daily with new studies that claim to have established that this or that cataclysmic outcome (devastating drought, mass species extinction, hurricanes galore) is a virtual certainty. But I’ve picked through too much bad climate-related work, including in top journals like Science and Nature, to simply accept every peer reviewed paper on faith. Indeed while these studies are often compelling, it’s difficult to separate those that are genuinely solid from ones that rest on less stable ground. That’s why institutions like the IPCC, and reports like this new one, are so valuable. I take three big messages from from the study. The first is that there are a host of extreme events – particularly much larger numbers of unusually hot days and heat waves – that are virtually guaranteed given current emissions trends. The second is that there are a bunch of other worries – including, most prominently in the report, more intense cyclones – that are quite likely to materialize. The third, though, is that for many of the risks that people often talk about, ranging from greater drought to increased odds of big floods, there remains enormous disagreement that isn’t reflected by some of the more breathless reports about recent scientific work. I don’t want to suggest that this is reason for avoiding action on climate change – fifty-fifty odds of widespread drought is plenty bad for me. Nonetheless, the nuanced parsing of the literature is helpful. I’d be remiss if I didn’t flag a handful of problems with the study, in part because I think there are some lessons to be learned for future IPCC reports. The SREX exercise was aimed at assisting with adaptation planning. It thus models a wide range of emissions scenarios, one of which is far more benign than anything one might expect given current policy. As a result, some of the conclusions in the report are muddied, since it’s sometimes impossible to tell whether a particular outcome is uncertain because of limited climate knowledge or because the outcome will depend on the emissions path. In many cases, the report elaborates on distinctions between the emissions cases, but it does not do that consistently enough. The study executive summary is also being released several months before the actual study, which won’t be out until February. Flaws in past IPCC summaries have typically been brushed aside with allusions to the more sophisticated full reports. But the IPCC knows that it’s the first release – in this case the executive summary – that will get all the attention. They should have waited until they could release the whole thing before they went public. Relatedly, the study seems to have been rushed into print so quickly that figure and table captions are in different parts of the document from the figures and tables themselves. That’s a fine format for journal subsmissions, but it makes the study absurdly difficult to read. Some of the travails of the IPCC over the past few years have clearly taught its leaders lessons about how to approach uncertainty, particularly in its summary documents. But they still have some way to go in polishing the operation.

Japan's new Prime Minister Yoshihiko Noda speaks during a high-level meeting on nuclear safety and security at the United Nations headquarters in New York September 22, 2011 (Shannon Stapleton/Courtesy Reuters). Japan’s newest prime minister, Yoshihiko Noda, arrived in the United States this week for his much anticipated first meeting with President Obama, and a debut at the UN General Assembly—the first conversation there since the March 11 earthquake-tsunami disaster struck. U.S. officials seemed upbeat about the prime minister’s meeting with President Obama. Yet, media questioning about the infamous Futenma Marine base on Okinawa set off another round of speculation about the state of the relationship. Earlier in the week, at a George Washington University conference hosted by Professor Michael Mochizuki, the governor of Okinawa, Hirokazu Nakaima, laid out current political realities in Okinawa and argued the U.S.-Japan governments’ plan to relocate the marine airfield was too difficult to realize. The governor presented his thinking on how to proceed, a position that surprised few of us who have been watching Okinawa politics of late. Pressure is building again here in Washington, as Congressional budget cuts loom, and the governor spent some time on Capitol Hill with Senators Levin, McCain and Webb sharing his thoughts. But Prime Minister Noda presented a broader—and more strategic—agenda during his New York visit. He clearly articulated his priorities for Japan. In the public remarks before his private meeting with President Obama, Noda forcefully reminded us that his top priority is the recovery of Japan from the devastation of the great East Japan earthquake and the restoration of Japan’s economy. He thanked the United States for its support in the immediate aftermath of that tragedy, and singled out U.S. Ambassador to Japan John Roos for his tremendous effort in leading the U.S. response on the ground. The prime minister startled some by speaking out on his immediate concerns about the global economy, saying he worried about a double dip recession. The need for the United States and Japan to help stabilize the global economy as they seek to address their own national economic needs was clearly on his mind. This week, as the specter of Greece’s default looms large, and as the volatility of global markets continues, Noda clearly understands the need for the United States, Japan, and Europe to find a common approach to avoid catastrophe. The next day, at the UN High-Level Meeting on Nuclear Safety and Security, Prime Minister Noda presented an update on the situation at Fukushima Daiichi nuclear plant. He expects that cold shutdown of the reactors will be accomplished within this year, ahead of schedule, and thanked the 2,000 workers on the plant site who have made this possible. In addition, he outlined Japan’s reporting to the International Atomic Energy Agency (IAEA), its efforts to analyze the accident, and its plans to convene an international conference next year co-hosted with the IAEA to announce the results of the analysis and “lessons learned.” Nuclear safety reform is one of Japan’s top priorities, and Prime Minister Noda made it clear that he is committed to having Japan play a leading role in enhancing the safety of nuclear power generation worldwide. Reform of Japan’s own nuclear safety standards, and the oversight mechanisms for implementing them, will be completed in concert with the IAEA, and the development of the global capacity to respond to—as well as prevent—any future nuclear accidents will be strengthened. In addition, Japan’s prime minister made a personal pledge to continue to work with Washington and others on nonproliferation and nuclear security enhancements. Let’s hope that Prime Minister Noda’s calm and clear articulation of his priorities, and of our bilateral agenda for cooperation, sets the tone for our next several months of alliance dialogue. Squabbling over Futenma is an indulgence we can no longer afford. We need a serious review of alternative options to solve this problem now so that Washington and Tokyo can turn their attention to their broader strategic agenda.

Damage to Japan’s Fukushima Daiichi nuclear power plant has reignited debate over the safety of nuclear power and highlighted questions over aging power plants, safety procedures, and waste disposal.

http://www.youtube.com/watch?v=KFB_99rtYn8 At about sixteen minutes into this video, the al-Jazeera film crew tour a polluted creek and visit an illegal refinery in Bodo. I have traveled in the Niger Delta and sometimes thought I had gone to hell: the Satanic glow at twilight from the ubiquitous gas flaring, the pervasive rotten-eggs stench of sulfur, and even the translucent glow of the polluted waters. Environmental degradation is an important driver of an ongoing, low-level insurrection by people dependent on various forms of aquaculture, which often involves sabotaging oil facilities that only makes the pollution worse. A 2006 assessment (Doc) by the Nigeria Federal Ministry of the Environment, assisted by the UK World Wildlife Federation and other NGOs, estimated that oil spilled in the Niger Delta over the past fifty years was about fifty times the volume spilled by the Exxon Valdez in Alaska in 1989. More recently, the United Nations Environment Programme (UNEP) has released a study evaluating oil pollution in a specific region, Ogoniland, with scientific rigor. The report makes specific recommendations with the goal of a thoroughgoing clean-up. Deidre LaPin provides an excellent analysis of the background to the report and a quick summary of its findings and its conclusions here. It is easy to blame the international oil companies for degradation of the Niger Delta environment, all the more so when Exxon is reporting that its profits world-wide increased by 69 percent during this year’s first quarter while Shell’s are up 30 percent. But, the real story does not lend itself to a morality tale. “Bush refining” (illegal mom-and-pop refining operations) supplied by “bunkering” (oil theft by puncturing pipelines) substantially contributes to the pollution, as the UNEP study acknowledges. More importantly, the Nigerian government is deeply involved with all elements of Delta oil and gas production through the state-owned Nigerian National Petroleum Corporation (NNPC), and all oil and gas is the property of the Nigerian state, and provides the state with about 65 percent of its total revenue and 95 percent of export earnings. NNPC owns a majority interest in the assets operated by Shell under a joint operating agreement, for example. Such partnership agreements require NNPC to fund its share of petroleum production, including pollution abatement efforts, making the federal government at least partially complicit in the degradation of the Delta environment. But the Abuja government too often fails to appropriate the funds necessary for the NNPC to fulfill its partnership obligations because of politicians’ other priorities. Cleaning up the Niger Delta will be expensive, and a big share of the cost will fall to the Nigerian state. Meeting those costs will require a rethink of how Nigeria spends its oil revenue with implications for the country’s entire political economy. Changes of the necessary magnitude will require enormous political will.

Akio Toyoda, center, poses with Iwate Governor Takuya Tasso, left, and Miyagi Governor Yoshihiro Murai before a meeting at Miyagi prefectural government in Sendai July 19. (Courtesy The Asahi Shimbun) Last month, I wrote an update on Japan’s efforts to cope with the Great East Japan Earthquake of March 11. One of the most dramatic discoveries during my trip to Tokyo was the buzz about the possibility that Japan’s continuing energy problems would encourage an exodus of industrial investment in Japan. The shock was not the uncertainty about Japan’s future, but rather that the companies that were losing faith in Japan as a site for future investment was none other than Japan’s own industrial leaders.    The idea that the current confusion in Tokyo over energy policy could become the straw that breaks the camel’s back of corporate confidence has only intensified in recent weeks. With 37 of Japan’s 54 nuclear reactors offline at the moment, the need for conservation efforts affects more than simply the region supplied by the Tokyo Electric Power Company in the northeast grid. The western metropolis of Osaka, Kyoto and the Kinki regions, all supplied by the Kansai Electric Power Company, are also expected to run short of electricity, and the government has issued a 10 percent target for electricity conservation in the coming months. The longer term question of how to recalibrate Japan’s energy policy has stalled all efforts to get Japan’s reactors up and running.    But the growing anxiety about Japan’s energy supply suggests an even more difficult question: will Japan’s industry continue to sustain confidence in national economic recovery as this larger question of energy policy is resolved? Or will the prognosis that Japan’s major corporations will escape overseas to sustain their own profits trump the national reconstruction effort?  After the recent distressful rhetoric, last week produced a more hopeful signal from one of Japan’s largest global corporations. Toyota Motors Corporation announced its new Tohoku revitalization initiative, including both donations to help offset the social impacts of the Great East Japan Earthquake as well as a broader investment plan for Toyota’s own operations. At the heart of this package is a consolidation of Toyota’s suppliers, and an investment in future production that is based on confidence in the ability of the workers and communities of Tohoku to rebuild. The Toyota decision stands out in the current mood in Tokyo for another reason. Toyota’s choice was all about business, but it was also a commitment to Japan’s recovery, and a clear signal that investing in Tohoku can be Japan’s road to recovery. Japanese corporations must invest in Tohoku and other regions of Japan that so badly need Japanese capital and jobs. Recovery cannot be achieved without private sector leadership, and foreign firms will not invest if Japan’s own companies are hesitant to do so. As important, Japan’s business leaders must continue to make their voices heard, and to assume greater visibility in the public discourse over Japan’s recovery. They must advocate, cajole and demonstrate the kinds of reforms needed for Japan’s recovery. In short, Japan’s entrepreneurs and manufacturers must stay in Japan and shape the future they believe in. *In the interest of full disclosure, Toyota Motor North America is part of a consortium of corporations that contribute to CFR’s Japan Program.

Japan's players celebrate with the trophy after the victory against the U.S. in their Women's World Cup final soccer match in Frankfurt July 17, 2011. (Courtesy Reuters/Kai Pfaffenbach) What a game! The U.S. and Japanese women’s soccer teams faced off for the World Cup yesterday afternoon, and after an electric overtime comeback by the Japanese team, Nadeshiko Japan went on to win the match in penalty kicks. For soccer fans, it was a heart-stopping finale. For American fans who have been consumed with the vitality of their women’s soccer team, it was so close… But for the people of Japan, it was a miraculous demonstration of what determination and skill can bring. As team captain Homare Sawa said, on the morning of the final match, the opportunity to play was “a gift from the soccer god.”   What a reaction! Coming through the semi-finals against Mexico, Germany and then Sweden, Japan’s women’s soccer team took everyone by surprise. Like American fans here in the U.S., Japanese soccer fans gathered at sports bars and city auditoriums, energized by the power of their women athletes. Many of these dedicated fans got up in the middle of the night to watch the Frankfurt-based World Cup match. In the Monday morning interviews in Tokyo, there was not a dry eye in sight. Japan’s television announcers themselves could barely keep their voices steady, or their tears from overflowing. Like the Nadeshiko Japan athletes themselves, the country seems stunned but overjoyed. What timing! And here it is not just the timing of the kicks that made it into the net, or the resilience of the Japanese team that came in at the end to take the lead from their dynamic American adversaries. Sawa, in her post-game interview, said that above all she and her teammates hoped their victory gave Japan’s disaster victims a sense of power and hope. As incredible as these Japanese women athletes were on the field, we all understood that the women of Nadeshiko Japan knew it was not just soccer that was at stake. One of the players, Karina Maruyama, was a worker at the Fukushima Daiichi plant, and almost didn’t play because of the disaster. Coach Norio Sasaki reportedly reminded them of how much hope their presence in the finals alone brought to those at home. It was as if the entire country was playing in Germany. And, after they won, Japan’s athletes returned to the field with a sign thanking Japan’s friends around the world for their support in the wake of the March 11 disasters. Japan’s women’s soccer team will arrive home in Japan today, tired and probably still stunned by their World Cup victory. As in so many countries around the world, this will change the lives of generations of Japanese women. They have emerged at the top of their game, claiming the World Cup, and reminding their country—and the world—that Japan has what it takes to compete. The soccer god must be smiling, indeed. But for a devastated Tohoku, and for a deeply-exhausted Japan still grappling with the effects of the Great East Japan Earthquake, Japan’s women athletes are a godsend of a different sort. The women of Nadeshiko Japan have also shown the Japanese people that when Japan needs it the most, they really can muster the strength and the spirit to prevail.

A bullet train arrives at JR Sendai Station after full service is restored on April 29 to the JR East Tohoku Shinkansen line following the Great East Japan Earthquake on March 11, 2011. (YouTube User Karibajct) As politicians in Tokyo continue to flounder in their efforts to look forward, it continues to impress upon me the importance of understanding what is going right in Japan’s recovery effort. Last time I shared a story that reflects the ability of individual Japanese to innovate and cope during the crisis. Today it is a story of Japan’s technological prowess—harnessed in the service of social need—that I want to share with you from my recent trip to Tohoku. For many Japanese and non-Japanese alike, nothing symbolizes Japan’s technological wizardry more than the Shinkansen, Japan’s high speed “bullet” train. Since it first impressed the world during the 1964 Olympics, the “bullet” train has gone through numerous upgrades and transformations, and has a spotless record of zero fatalities.    But for those in Tohoku, the Shinkansen is more than a fast train. It is the region’s lifeline. The Shinkansen’s return to Tohoku after the disaster interrupted operations on March 11 was met with great emotion, and symbolized the beginning of the painful journey to restoring life in the northeast.  What seems less appreciated is what actually happened in the midst of the earthquake. When the 9.0 magnitude earthquake struck at approximately 2:46 pm on March 11, the miracle was that no major structures carrying the Shinkansen were destroyed. Viaducts were reinforced against earthquakes, and these held even in the face of Japan’s largest recorded earthquake. JR East runs the 882-mile Shinkansen networkfrom Tokyo to Shin-Aomori in the north, and west to Nagano, Niigata, Shinjou and Akita—nearly double the 456-mile Amtrak Northeast Corridor connecting Washington, Philadelphia, New York and Boston. The company runs 310-415 trains, carrying about 241,000 passengers, daily. Even more incredible is the precision of JR East’s early earthquake detection system. When the coastline seismometer detected the first wave of seismic activity emanating from the epicenter offshore, the JR substation shut power to the entire Shinkansen system. Emergency brakes were then applied to all trains. At the time of the March 11 quake, two trains running at about 170 mph (270 km/hr) through the Sendai area were directly exposed to the 9.0 earthquake’s vibrations. The power supply to these trains was cut 9-12 seconds before the first wave arrived, followed by the application of their emergency brakes. The largest vibration hit the Shinkansen trains about 70 seconds after their emergency brakes were applied, and JR East estimates that by that time their speeds had dropped to 63 mph (100 km/hr). The sensitivity of this early warning system allowed a rapid drop in speed, and a smooth halt for the two trains immediately subjected to this tremendous earthquake. Twenty seven trains ran up and down the JR East Tohoku Shinkansen line at the time of the earthquake: fifteen were heading north to Shin-Aomori and twelve were heading south to Tokyo. In addition, 670 conventional trains were in operation on the JR East tracks. Friends of mine were in a train halfway between Tokyo and Sendai, and told me of their nearly twelve-hour wait in the stopped train before they were evacuated along the tracks to a nearby shelter. Calm and quiet, the passengers waited for word on what had happened, but only learned later of the extent of Japan’s calamity.     Yet not one passenger on that line was hurt; not one person lost their life. No Shinkansen trains were derailed. Station staff and train crew led all passengers to emergency evacuation areas before the tsunami arrived.    Damage to the JR East lines was extensive, however. 1,200 sites on the Shinkansen line were damaged, and around 4,400 sites on the conventional lines were affected by the earthquake. Additional damages were incurred as frequent aftershocks of magnitude 5.0 or more continued to affect the train lines. The tsunami damages were considerable on the seven lines along the coast that were directly hit by the wave (about 1,730 sites were affected by the tsunami alone). But the JR East’s crisis management and recovery effort was quick, and effective. 8,500 employees worked each day to return the Shinkansen to operation, and within 49 days of the Great East Japan Earthquake, the Tohoku Shinkansen arrived back in service to a community desperately in need of assistance.    Sendai station master Hideaki Watanabe proudly greeted the first train to return. From the photo above, clearly the people of Tohoku welcomed back the rapid rail system that sustains connections between the Tokyo metropolis and the rural northeast. But it was the technology and the commitment of Japan’s much admired Shinkansen operators that speak to the broader strengths of Japan. Precision and the pursuit of perfection are the hallmarks of Japan’s modern industry, and the Shinkansen reflects the technological resources available to Japan’s recovery.      But most impressive is not simply the amazing technology that allowed Tohoku to avoid further loss of life than might be expected, but rather the JR East’s story—like many stories one finds in post-March 11 Japan—reflects Japan’s capacity to organize that technology in support of a society that seeks to go further and do better at each step of its way forward.    This is the spirit that ought to lead Japan’s recovery.

Survivors of an 8.9-magnitude earthquake and tsunami receive treatment at the Ishinomaki Red Cross hospital in Miyagi prefecture March 12, 2011. (Courtesy Reuters/Ho New) One of the most impressive accounts of disaster response came from Dr. Tadashi Ishii of Ishinomaki Red Cross Hospital. Dr. Ishii—a slender man, with graying hair and glasses dressed in jeans and a t-shirt—provided a concise and matter of fact account of his hospital’s response to the terrifying and chaotic days after the March 11 disaster. Barely two months before the earthquake and tsunami hit his community, Dr. Ishii was appointed Miyagi Prefecture disaster medical coordinator by his governor, and began building the network of relations between the local government, fire departments, police, Self-Defense Force, and other hospitals in the area. This modest beginning of Miyagi Prefecture’s local disaster planning was the foundation for what became the hub of the region’s medical response to March 11. But there were no plans, no drills, and no past experience upon which to formulate a response. Dr. Ishii and his team had to design their response effort and revamp that design—daily. Five years ago, the Ishinomaki Red Cross hospital had been moved inland, away from the Kitagawa River basin where it once resided. In the days after March 11, it became the region’s medical hub—tending patients from up and down the destroyed Tohoku coast. Twelve of the hospital’s seventeen ambulances had been swept away in the tsunami, and two of the three fire department emergency response units had been destroyed. Thus in the early hours of the disaster it became clear that medical emergency services would be unavailable. With only minimal information on the extent of the devastation, Ishinomaki Red Cross hospital anticipated three thousand patients, and set up a triage area within an hour. At first, patients arrived by police car or private autos. On the first day, only ninety-nine people arrived at the hospital, but by day three, 1,251 people streamed in for help. Self-Defense Force helicopters delivered those found on rooftops, in the ocean, and from inaccessible areas. Soaked by the tsunami and with no access to shelter, many of Ishinomaki’s patients suffered from hypothermia.  Dr. Ishii and his staff broke up into groups to visit evacuation centers to determine medical needs, and created a daily roster of needs and responses as they were understood. Doctors from around the country arrived to assist, and the main hospital building became the critical care station. Those with less than life-threatening needs were tended to in tents on the hospital grounds, and the parking lot became an outpatient care area. Emergency care needs were high for weeks as the city’s population remained confined to evacuation shelters.  Today, Dr. Ishii looks ahead to transitioning his community from a full emergency care effort that is focused primarily on a population sheltered in evacuation centers to one that returns health care services to a more normal footing. Acute care needs have lessened significantly, and patients now use a shuttle bus service to get to their medical appointments. Six thousand of Ishinomaki’s seven thousand temporary housing units have been built.   As evacuation shelters close and more of the population is dispersed to these new facilities, new challenges will emerge. Patients will rely on shuttle buses for transport to medical care, and the Ishinomaki Red Cross Hospital will return to normal medical service delivery. Mental health care and the need to get Ishinomaki’s residents back to work—and to a stable daily life—were clearly part of Dr. Ishii’s current concerns. When asked how his experience might be used for Japan’s disaster preparedness, Dr. Ishii was quick to argue that a localized response—one organized at the prefectural level and tailored to the needs and capacities of the community—would be best able to quickly and effectively respond to this kind of disaster. But one other ingredient seems quite clear. With no barriers to innovation, Dr. Ishii and his team created an effective and adaptive medical response effort. Japan needs this kind of innovation and this kind of leadership in building new approaches to problem solving. In the medical community, Japan needs doctors like Tadashi Ishii—a trained surgeon—who are willing to reach out beyond the hospital setting in considering how best to care for their community.   Dr. Ishii’s abilities and his adaptive response in the face of tremendous crisis are reasons to be optimistic that Japan will learn from this moment, and indeed will have much to teach us about enhancing disaster responsiveness. As important, his vision and ability to translate that vision into a working medical response proves that leadership and innovation are alive and well in Japan.