Health Policy and Systems
Kotaro Kanenaga, BA
Clinical Staff
Graduate School of Biomedical and Health Sciences, Department of Rehabilitation Medicine, Hiroshima University
Hiroshima, Hiroshima, Japan
Yukio Mikami, MD
Professor
Hiroshima University
Hiroshima, Hiroshima, Japan
Makoto Asaeda, PhD
Researcher
Hiroshima University
Hiroshima, Hiroshima, Japan
JRAT (Japan Disaster Rehabilitation Assistance Team) is a nationwide organization that provides rehabilitation support during disasters, coordinating professionals and deploying teams to prevent secondary health problems. It also conducts training and preparedness activities in peacetime. The 2024 Noto Peninsula Earthquake exposed major challenges in establishing effective rehabilitation services in evacuation shelters, especially in preventing decreased activity and functional decline in older adults. This study aimed to identify issues in disaster rehabilitation systems through a survey of prefectural governments, disaster-related organizations, local JRATs, and support personnel involved in the response.
Design: A questionnaire survey was conducted among:
• 44 prefectural governments
• 3 national disaster-related organizations
• 3 Ishikawa-based organizations
• 35 local JRATs
• 451 shelter support team members
• 135 on-site logistics staff
• 104 central logistics staff
Results: Among prefectures, 75.0% had a disaster rehabilitation department and 68.2% knew of JRAT activities, but only 38.6% had formal agreements with local JRATs. During the earthquake, 68.6% of local JRATs reported insufficient deployable personnel. Over 40% of shelter support members noted difficulties in information sharing, and both shelter and logistics teams cited unclear role distribution. Additionally, 60% reported unclear welfare equipment procurement procedures. Organizational issues included 14.3% lacking an administrative office and many relying on a single part-time staff member, with limited operation manuals. Moreover, 64.3% of shelter support personnel lacked disaster rehabilitation certifications, and only 43.9% had attended JRAT training.
Conclusion: Multiple challenges were identified in disaster rehabilitation systems. Strengthening local JRAT structures, improving regional coordination, establishing clear procedures for agreements with prefectures, and implementing standardized training programs will be essential for future responses.
