No-one has died due to radiation released after the Fukushima nuclear crisis and this is unlikely to change, the UN says. But the mental health impact for the nuclear evacuees is a different story.

The UN’s expert panel on radiation risk has published its full verdict on the aftermath of the devastating Fukushima nuclear accident in March 2011. On the one hand, it is good news.

“No radiation-related deaths or acute diseases have been observed among the workers and general public exposed to radiation from the accident,” the report reads. “No discernible increased incidence of radiation-related health effects are expected among exposed members of the public or their descendants.”

So not only has no-one died or become severely ill as a result of radiation leaking from the devastated plant, which went into meltdown after an earthquake and tsunami rocked Japan, but the UN says no-one is expected to be in future, either. For many radiation experts, this has come as no surprise.

Professor Gerry Thomas, chair in molecular pathology at Imperial College, London, tells Channel 4 News: “Japan did the right things [when Fukushima Dai-ichi power plant went into meltdown]. It was not perfect. There were mistakes, but everyone makes mistakes in these kinds of situations. Things they did like cutting the food chain, which it is important to do quickly, were effective.

“We knew they had kept the radiation doses as low as they could, and there is plenty of evidence that what they did was right.”

So far so good. But there’s more to the UN report – and much more to the story.

Nobody has died from the radiation, but it may actually have killed their souls. Professor Niwako Yamawaki

The report itself goes on to say: “The most important health effect is on mental and social well-being, related to the enormous impact of the earthquake, tsunami and nuclear accident, and the fear and stigma related to the perceived risk of exposure to ionizing radiation.

“Effects such as depression and post-traumatic stress symptoms have already been reported.”

Mental health is outside the panel’s remit; but another researcher, this time from the field of mental health, puts it much more strongly.

Professor Niwako Yamawaki, from Brigham Young University, studied the mental health impact of the aftermath of the disaster in one evacuated town called Hirono in Fukushima prefecture.

Her verdict?

“When I think about that [the line that no-one has died from radiation-related illness], I kind of laugh. Nobody has died from the radiation, but it may actually have killed their souls,” she tells Channel 4 News.

Dead souls

Professor Yamawaki worked with local social workers to interview around 250 former Hirono residents, out of a town of around 5,000 people. The results of her study, completed in 2012, were shocking.

While only two people died in the town after the tsunami, the majority of residents remain profoundly affected by the tragedy. More than half were found to display “clinically concerning” symptoms of post-traumatic stress disorder, and two-thirds reported depression symptoms.

The long-term mental health impact of major natural disasters has been well-researched: but these statistics from Hirono are higher than following other similar events. Professor Yamawaki believes it is the ongoing fear of radiation and impossibility of returning home, as well as the triple impact of the earthquake, tsunami and nuclear accident, which have caused the unusually high prevalence she found.

Other reports have linked suicides to the triple-disaster; and a Japan Times editorial suggested that 1,656 people in Fukushima prefecture had died due to stress-related illnesses and other maladies in the wake of the crisis, a higher number than those who died of injuries directly linked to the events of 11 March.

“In addition to the natural disaster, the people in Hirono also experienced manmade disaster, which is the nuclear plant. So they are fighting with an invisible threat,” says Professor Yamawaki.

Fukushima Medical University is also tracking the mental health of the displaced population, and regularly publishing its findings. In its latest results, reported in February, it found that 16,242 adults needed support out of 66,279 who responded to the survey – and 1,474 out of 11,203 children. That is around a quarter of the adult population – less than the Hirono findings, but still far higher than the general population. It is also worse than for those who were just affected by the tsunami and earthquake, who, figures show, are growing more positive over time despite the horrific impact of the events themselves.

One of the major issues for people living near Fukushima is that they cannot go back to their lives, and that fear and uncertainty about the future is having a dire psychological effect. Tens of thousands are still living in temporary accommodation, torn away from everything they knew in an instant: visitors to the area report dropped newspapers, stopped clocks and even unmade beds as the population fled early in March 2011.

Professor Yamawaki says this is a major issue in one of the more “collectivist” – or community-led – areas of Japan.

“The community is the base of their sense of self,” she says. “It’s really hard to get over. The majority of people have not come back to their home. They don’t even know when they can go home.”

It could help to set up sessions in the temporary housing areas, where the community could drop in, have tea and discuss their experiences, rather than parachuting in counsellors, she suggests. But that is expensive, and the university’s efforts are already under some financial pressure. But perhaps there is another, more radical solution: letting the evacuees go home.

Time to go home?

For Professor Thomas, and indeed many other experts, this is effectively a no-brainer. The radiation levels in much of the area around Fukushima, she says, are now so low that they would pose no risk to human health. Indeed, in some areas, citizens are being encouraged to return.

The UN panel estimates adults in the Fukushima prefecture will get lifetime effective doses “of the order of 10 millisieverts or less”, if remediation efforts do not reduce levels further.

It’s really hard to get over… They don’t even know when they can go home. Professor Yamawaki

To put that into context, Professor Thomas has some other statistics. For example, the International Committee on Radiological Protection (ICRP) says that people should be exposed to no more than 1 millisievert over background radiation over a year. This is the level Japan wants to see before allowing people to move back to affected areas as well.

But this level is seen by many experts as quite a low bar (and it is one that much of Fukushima crosses anyway, although levels are patchy). Epidemiologically, the level is more like 100 millisieverts over background radiation – and even then, Professor Thomas says, you would need to see huge numbers exposed at this level to find increased incidence of cancers.

For example, breast cancer patients are given 50 sieverts in radiotherapy, and very few come back with secondary cancers as a result of this, she says.

Even in Chernobyl, the world’s worst nuclear accident – which saw a much higher initial release of radiation than Fukushima – the radiation numbers are low (although, perhaps unsurprisingly, there are similarly high rates of mental health issues even two decades on). For some areas just outside the exclusion zone, 6 million residents over 25 years had the equivalent radiation dose of one CT scan, says Professor Thomas.

“I think we are over-cautious,” she says. “But rules are rules. It’s a double-edged sword. They want to go back, but people do not feel safe. I would like to see people given the opportunity to move back and monitor their dose themselves.”

But the fear of radiation continues.

“There are generations of fear. We were told radiation was scary as children – and for Japan there is the memory of the atomic bombs. But this is different. If we could get rid of this idea that tiny doses of radiation will cause huge problems, it would really help people come to terms with it,” says Professor Thomas.

And there’s another, more profound issue for the nuclear refugees.

“People could go back and Japan is starting to let people go back if they want to,” says Professor Thomas, who visits the area regularly. “The problem is, there is no infrastructure, no jobs. It’s all very well to say you can go back but there is nothing to go back for – no jobs, sometimes no houses because of the tsunami. Who would go back?”

Professor Yamawaki agrees: “To go back? It is so difficult. Think if you were them. They are desperate to go home but there is no job there, the community is broken down, the majority of our participants are old. They want to go home but at the same time it’s not the same home.”

She just hopes that their plight is not forgotten as the initial disaster retreats further in peoples’ memories. The third anniversary was in March this year.

“I just don’t want people to forget about them. Still a lot of people are suffering,” she says.