UN Human Rights Council Fukushima Report Extremely Critical Of TEPCO And Government

Human Rights Council
Twenty-third session
Agenda item 3
May 2, 2013

Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development. Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, by Anand Grover

Mission to Japan (15 – 26 November 2012)

“11. The nuclear accident in Japan has affected the right to health of evacuees and residents alike and has had an impact on physical and mental health, particularly of pregnant women, older persons, and children. The precise health implications of radiation exposure are still not clear, as long-term health effects of low-dose ionizing radiation are still being studied. The evacuation has caused the breakdown of families and communities, giving rise to mental health concerns, especially among first responders, older persons, mothers and children. 

12. The enjoyment of the right to health is dependent on underlying determinants such as safe and nutritious food, access to safe and potable water, a healthy environment and housing.19 
The accident caused widespread contamination of soil, water, food and the environment. Authorities in Tokyo, Fukushima, Ibaraki, Chiba and Tochigi therefore imposed restrictions on the consumption of tap water when radioactive iodine and caesium higher than the permissible limit were detected in tap water.20
13. The right to health requires the State to ensure availability and accessibility of quality health facilities, goods and services.21 This includes information that enables individuals to make informed decisions regarding their health. Further, monitoring the health of people for adverse effects of radiation and providing timely healthcare is an important aspect of fulfilment of the right to health. 
The State is also required to have in place evidence-based policies for the decontamination of affected areas to restore the life and health of people at the earliest. Finally, transparency and accountability in governance,22 access to remedies 23 and participation of affected population 24 in decision making processes are necessary to the enjoyment of the right to health.
Information on the nuclear accident and evacuation
15. Access to information is an essential component of the right to health, as it enables individuals to make informed decisions regarding their health. Information about the nuclear accident, including contaminated and potentially contaminated areas should be made public immediately and in a coordinated manner. In addition, an effective emergency response system requires that the public be provided with useful, timely, truthful, consistent and appropriate information promptly throughout a nuclear or radiological emergency.28
16. According to the independent investigation committee, the System for Prediction of Environment Emergency Dose Information (SPEEDI), a computer-based system for estimating potential radiation contamination based on real-time information, was not utilized by the Government in a timely and efficient manner.29
Consequently and contrary to IAEA requirements for a nuclear emergency response,30 on 11 March 2011, only 20 per cent of Fukushima residents near the plant came to know of the accident.31 Most people in the 10km radius were informed of the accident simultaneously with evacuation orders on 12 March 2011.32
17. Evacuation zones, designated by the Government, were based on proximity to the nuclear plant, rather than on scientific data indicating areas likely to be contaminated due to radioactive plume. Mandatory evacuation zones were periodically altered from a radius of three kilometers from the Daiichi plant to ten and later to 20 km.
33 Voluntary evacuation was eventually endorsed within the 20-30km radius area.34 Evacuation orders for some areas with high radiation doses were not issued until one month later. On 22 April 2011, the Government issued evacuation orders for areas up to 50km north-west of the plant, including Katsurao, Iitate, Namie, and parts of Minami-soma and Kawamata, due to high dose radiation detected in the area35 brought by winds carrying radioactive material from the plant. People in these areas thus remained exposed to high-dose radiation for a significant period. Even after SPEEDI was used, the resulting data was not made immediately available to the public.36
(AGreenRoad- This is a pattern in ALL nuclear disasters and accidents. The public is NOT warned until it is too late. Coverup’s, denials and minimizations are the standard operating procedure, until it is impossible to do this any longer.)
18. A coordinated and effective response at local and national levels is a key goal of emergency preparedness.37 Japan‘s emergency response did not meet up to the requirements. Poor coordination between the authorities was evident when the Fukushima authorities initially ordered evacuation of the 2km area, after which the Government ordered a 3km evacuation area.38 Due to insufficient training in the response system, including inefficient use of SPEEDI, 573 deaths have been certified by the Government as nuclear disaster-related deaths‘.39
Regrettably, the Government did not give prompt orders for administering stable iodine after the nuclear accident. Even though some municipal authorities had stocks of stable iodine, they were not distributed. Some municipalities, such as Futaba and Tomioka, distributed stable iodine without orders from the Government.46 
During the meeting with officials of the Fukushima Medical University, the Special Rapporteur learnt that the decision to administer stable iodine had been delayed because of apprehension of potential harmful side effects that iodine prophylaxis could cause. However, it is an accepted position in radiological medicine that even where the absorbed dose is less than 100mGy, stable iodine should be administered, as it does not entail any significant health hazards.47
B. Monitoring the health effects of the nuclear accident 
22. In the immediate and long-term aftermath of a nuclear accident, the right to health necessitates rigorous and prolonged monitoring of individual health, as the health effects of radiation exposure are not always immediately known or treatable. Though experiences from the Three Mile Island and Chernobyl accidents provide invaluable guidance, a narrow appreciation of the accidents would not provide proper guidance. The Special Rapporteur encourages the Government to monitor any increased morbidity and leukaemia, since they have been detected among the survivors of Chernobyl and Three Mile Island.48 
Due to limited knowledge regarding the health effects of long-term exposure to low-dose ionizing radiation, the Government‘s orders for resettlement of residents into areas with accumulated dosage of 20 mSv/year and less should be followed by long-term health monitoring of affected people. 
23. The health management survey in Fukushima is implemented by the prefecture authorities, which reportedly received 78.2 billion Yen from the Government, in coordination with the Fukushima Medical University. It comprises a basic survey and four detailed surveys. The basic survey estimates levels of external irradiation among residents. 
The detailed surveys include a thyroid ultrasound examination for all children in Fukushima aged up to18 years, a comprehensive health check for all residents from the evacuation zones, an assessment of mental health and lifestyles of all residents from the evacuation zones, and recording of all pregnancies and births among all women in the prefecture who were pregnant on 11 March 2011.49
24. Despite the funding reportedly given by the government mentioned above, during the visit, the Special Rapporteur heard concerns about the slow progress of implementing the survey due to the reported lack of capacity of the Fukushima authorities. He urges the Government to assume the central role in the implementation of the survey and make more financial and human resources available for its implementation. 
Basic health management survey
25. Three months after the nuclear accident, Fukushima authorities sent the health management survey to people who had resided in the prefecture on 11 March 2011.50 
The objective was to evaluate individual radiation exposure from March 2011 to July 2011.51 Basic data collected will be used in health examinations of the target population and in their future long-term health care.52
26. The basic survey would gather information about the whereabouts of individuals during various periods from 11 March to 11 July 2011, and the consumption of food, dairy products and water between 11 March and 31 March 2011.53 The survey did not inquire into the health status of the individual at the time of the accident or in the time following the accident. A standard medical question regarding injuries – conventional/radiation induced/combined – around the time of the accident was absent from the survey.54 
In contrast to other surveys, it did not incorporate questions enquiring into the cancer history of the respondents, including cancer diagnosis, thyroid disorders, radiation treatment, prior exposure to ionizing radiation at work and risk factors such as smoking.55
Moreover, follow up treatment for children in A2 categories will take place after two years. This may be too long a period to check the rate of growth of a tumour, which is an indicator of increased risk of malignancy.63
According to the latest official information, 186 out of 38,114 children examined in 2011 fell into category B (0.5 per cent) while, in 2012, 548 children out of 94,975 were in that category (0.6 per cent).64
31. During the visit, the Special Rapporteur was informed that the Japan Thyroid Association was instructed against providing secondary examinations to children in the A2 category. Parents and children will therefore have to wait for the second round of check-ups after March 2014, before they are able to take any mitigating action against possible thyroid cancer. The Special Rapporteur calls on the Government to remove such barriers which prevent people from exercising their right to health and to ensure that children and parents are able to access second opinions and secondary health examinations, as required under the right to health.
32. The Special Rapporteur was also informed that parents of children found it difficult to access the results of their children‘s thyroid check-ups due to red tape and the cumbersome freedom of information act procedure that Fukushima authorities insist on applying to parents‘ requests. Though confidentiality of information is an important aspect of the right to health, it should not become a barrier to obtain information regarding one‘s own health records. In accordance with the right to health, the State is required to ensure an individuals‘ right to informed decisions regarding his/her health by enabling them to access information relating to their health, which will have a bearing on their decision-making ability. 
Comprehensive health management survey
33. The comprehensive survey seeks to review health information, assess the incidence 
of various diseases and improve the health status of the respondents. The target population is restricted to residents of the evacuation zone specified by the government and residents of Yamakiya in Kawamata-machi, Namie-mach and Iitate-mura.65 
Due to high levels of contamination in the soil, water and foodstuff, including marine life, there is a possibility of internal irradiation.66 Following the Chernobyl accident, increased morbidity due to diseases of the endocrine, haematopoietic, circulatory and digestive systems have been found among those affected.
67 The comprehensive health management survey should therefore include check-ups for internal radiation exposure. Radioactive caesium has already been found in urine samples of people as young as 8 years old in Japan.68 However,the survey does not include urine tests for people under the age of 16 years.69 
Tests should also be conducted to check for radioactive strontium71 as it presents a large risk for internal radiation exposure via ingestion of contaminated agricultural crops and can cause leukaemia.72
34. The Special Rapporteur was informed that whole-body counters, used for measuring internal exposure to gamma radiation, are not available in healthcare facilities throughout Fukushima prefecture, as required.
35. The Special Rapporteur commends the Government for lowering the permissible limit of radionuclides in food for consumption.73 Careful scientific sampling is important to measure radioactivity in food. He however notes dissatisfaction among people about government sampling and preferred community measurement centres. It is important that the Government take steps in bridging the trust deficit with the people of Japan.
Mental health survey
36. The right to health extends not only to provision of medical health facilities, goods and services but also to facilitating an environment within which the affected population is enabled to enjoy the right. The State is therefore under an obligation to minimize the effect of the accident on the mental health of people by, among other things, reducing stress and anxiety related to radiation exposure and separation from families. 
37. The effect of nuclear disasters on mental health has been documented in the context of Three Mile Island and Chernobyl.74 A year after the Three Mile Island accident, mothers had an excess risk of experiencing clinical episodes of anxiety and depression.75 
After the Chernobyl accident, women with young children were found to be most vulnerable to the mental health effects of the nuclear accident,76 and its continued impact on mental health 
was visible even after six years of the accident.77 
In a study conducted by the IAEA, a significant amount of stress and anxiety was found to be related to the Chernobyaccident.78 Moreover, post-traumatic stress disorder reportedly have high prevalence rate among survivors of man-made disasters.79
38. The Fukushima nuclear accident resulted in breakdown of families and communities and feelings of isolation. The Special Rapporteur personally observed the anxiety and stress among evacuees, residents and their families, which were related to the effect of radiation leakage on health, especially of children, cost of evacuation, loss of livelihoods as well as uncertain future and delays in receiving compensation that hindered rebuilding of their lives.
39. The Special Rapporteur notes with concern that the mental and physical health of children has been especially affected by the lack of outdoor activities, safe areas to play and restrictions on activities in school. 
He calls on the Government to make quality mental health facilities, goods and services available and accessible to residents of Fukushima, evacuees and their families, with a focus on vulnerable groups such as first responders and children when they want it. The Government should also provide and support programmes such as recuperation camps organised by NGOs to reduce stress and anxiety of the affected communities.
40. The Government developed a detailed mental health survey for residents of the evacuation zone. However, the target population does not include all people who have been affected by the accident. As with the comprehensive health survey, the survey should at least include residents of the voluntary evacuation zone. Further, the response rate was less than 50 per cent.
80 The Special Rpporteur welcomes the Govenrment‘s effort to provide direct care to those who require it per the survey. Efforts are still required to ascertain and deliver services to the rest of the target population. Though the survey inquires about the responder‘s experience during the earthquake, tsunami and nuclear accident, it is important to record past experiences with radiation exposure as it may be an aggravating factor. 
Pregnancy and birth survey
41. The obligation to respect, protect and fulfil the right to health is a continuous obligation and extends to progeny. The pregnancy and birth survey, however, is based on the assumption that the Chernobyl accident did not significantly increase child anomalies or foetal deaths.81 
The survey includes antenatal health, delivery records and mental health of women.82 It does not include a provision to either monitor the health of the foetus or the health of the child after birth. With a view to ensuring the highest standard of physical and mental health, the Special Rapporteur encourages the Government to revise the survey and take into account studies, which have linked in utero radiation exposure with mental disability.
83 Further, the Government should explore the still unclear relation between inutero exposure and leukaemia.84
Health of the nuclear power plant workers
42. In the aftermath of Chernobyl, workers involved in cleaning operations and first responders were exposed to the highest doses of radiation.85 
During the Fukushima accident, an estimated 167 workers were exposed to more than 100mSv of radiation, a dose level unequivocally recognized to increase the risk of cancer.86 
Two operators received doses above 600mSv.87 In addition, first responders face a high prevalence of post traumatic stress disorder in man-made disasters.88
43. The law requires medical check-up of all workers who have worked in controlled areas every six months89 and guidelines provide for additional medical check-ups of workers exposed to 50 mSv/year of radiation.90 Despite this, the Special Rapporteur was concerned to learn that the results do not always get reported to the Government. In order to protect the right to health of workers, it is important to give health check-ups regularly and report their results. While acknowledging the Government‘s reiteration that health monitoring of nuclear workers is carried out under relevant laws and regulations, the Special Rapporteur notes concerns by nuclear power plant workers that such health monitoring is not conducted.
44. The Special Rapporteur was informed that many workers employed in the nuclear power industry are poor and some even homeless, increasing their vulnerability. Even though the law91 requires compulsory medical check-ups for workers when they are hired, a significant number of workers, employed through layers of sub-contractors for short periods of time, are not provided with proper and effective monitoring of their health.92 
The Government should take all measures to provide an environment that does not exacerbate their vulnerability and provide access to affordable and quality health facilities, goods and services at all times to all workers.
Evacuation Zones 
45. In December 2011, the Government categorized evacuation zones in areas affected by the nuclear accident. Areas with radiation dose exceeding 50mSv/year were designated as restricted areas; entry in such areas is prohibited for five years. Entry has been restricted to areas with radiation dose between 20mSv/year to 50mSv/year, and residents are allowedto return for short periods, but staying overnight is prohibited. In areas where radiation exposure is below 20mSv/year, people are returning. 
46. The Ordinance on Prevention of Ionizing Radiation Hazards in Japan (article 3), which requires that areas where radiation dose exceeds 1.3mSv/quarterly be designated as controlled zones. The recommended limit of radiation exposure for the general public is 1mSv/year.93 
In Ukraine, the 1991 law ‗On the status and social protection of the citizens who suffered as a result of the Chernobyl catastrophe‘ limited radiation dose for living and working without limitations to 1mSv/year. 
47. The dose limit of 20mSv/year is being applied by the Government due to the nuclear emergency. In this behalf the Government seeks support from the letter issued to it by the ICRP, recommending a reference level of 1mSv/year to 20mSv/year for determining an area as inhabitable after the nuclear accident.94 The ICRP recommendations are based on the principle of optimisation and justification, according to which all actions of the Government should be based on maximizing good over harm.95 
Such a risk-benefit analysis is not in consonance with the right to health framework, as it gives precedence to collective interests over individual rights. Under the right to health, the right of every individual has to be protected. Moreover, such decisions, which have a long-term impact on the physical and mental health of people, should be taken with their active, direct and effective participation. 
48. The Government assured the Special Rapporteur that it was safe to inhabit areas with radiation dose of up to 20mSv/year, as there was no excessive risk of cancer below 100mSv. 
However, even the ICRP acknowledges the scientific possibility that the incidence of cancer or hereditary disorders will increase in direct proportion to an increase in radiation dose below about 100mSv.96 Furthermore, epidemiological studies monitoring the health effects of long-term exposure to low-ionizing radiation conclude that there is no lowthreshold limit for excess radiation risk to non-solid cancers such as leukaemia.97 
The additive radiation risk for solid cancers continues to increase throughout life with a lineardose-response relationship.98 Health policies put in place by the State should be grounded in scientific evidence. 
Policies should be formulated so as to minimize the interference with the enjoyment of the right to health. In setting radiation dose limits, the right to health dictates limits that have the least impact upon the right to health of people, taking into account the greater vulnerability of such groups as pregnant women and children. 
As the possibility of adverse health effects exists in low-dose radiation, evacuees should be recommended to return only when the radiation dose has been reduced as far as possible and to levels below 1 mSv/year.
In the meantime, the Government should continue providing financial support and subsidies to all evacuees so that they can make a voluntary decision to return to their homes or remain evacuated. 
Government monitoring stations
50. The State should facilitate access to information about radiation levels in the affected areas, as this knowledge is crucial to decisions people make and have a bearing on their health. The Special Rapporteur was pleased to observe that the Government has set up monitoring stations to monitor the ambient air dose in Fukushima Prefecture. The Government informed the Special Rapporteur that around 3,200 monitoring stations have been installed in the prefecture. stations. However, the air dose measured by these fixed stations only reflects the radiation dose in the immediate vicinity of the instrument. 
Readings by fixed monitoring stations do not reflect the actual and varied dosage levels in nearby areas, which may be higher than that at the monitoring station. Reliance on unrepresentative information unwittingly exposes people, especially vulnerable groups such as children, to higher radiation levels. During the visit, the Special Rapporteur observed substantial variance, including in schools and public areas used by children, as well as radiation ‗hot-spots‘ close to the monitoring stations that were not reflected. Such incidents have regrettably led many people to doubt the reliability of Government monitoring stations.
Information in school textbooks
51. The State should ensure accurate and scientifically sound information on radiation and radioactivity is provided to children and, where appropriate, their parents to facilitate informed decision making regarding their health. Additionally, respecting the right to health requires the State to refrain from misrepresenting information in health-related matters. 
The Special Rapporteur was informed about the Fukushima official curriculum for compulsory radiation education in public schools. The supplementary reading and presentation materials mention that there is no clear evidence of excess risk of diseases, including cancer, when exposed for a short time to radiation levels of 100mSv and below. This gave
the impression that doses below 100mSv are safe. 
As noted above, this is not consistent with the law in Japan, international standards or epidemiological research. Additionally, the Special Rapporteur notes that the textbooks do not mention the increased vulnerability of children to the health effects of radiation. Such information may give children and parents a false sense of security, which may result in children‘s exposure to high levels of radiation. 
The Special Rapporteur urges the Government to ensure accurate representation of the health effects associated with nuclear accident and include methods of preventing and controlling health problems in a manner that is effective, age-appropriate and easy to understand. The Act on Special Measures Concerning the Handling of Radioactive Pollution was promulgated in August 2011 to create a legal framework for decontamination activities. 
However, the ‗Basic Principles‘ and fundamentally important regulations under the Act did not come into force until January 2012. The Act covers the planning and implementation of decontamination work, including collection, transfer, temporary storage, and final disposal of contaminated material.99 The Special Rapporteur notes with appreciation the Government‘s efforts, and those of municipalities under the Basic policy for Emergency Response on Decontamination Work, towards decontamination. However, decontamination policies should have already formed part of the regulatory framework for the nuclear power industry.100 This would have enabled the Government to undertake decontamination activities earlier than November 2011. 
53. Areas for decontamination extend beyond Fukushima prefecture and are prioritized by radiation levels, with a focus on living environments for children.101 By August 2013, the aim is to reduce by 50 per cent the exposure in areas with radiation levels of less than 20mSv/year for the general public and by 60 per cent for children. Exposure dose is to be reduced to less than 20mSv/year by March 2014 in areas with radiation between 20-50mSv/year. 
Demonstration projects were established to secure the safety of workers in areas with radiation above 50mSv/year. The long-term goal is to reduce radiation levels below 1mSv/year.102
54. Although the right to health is subject to progressive realization, the obligation to formulate and implement deliberate, concrete and targeted steps is an immediate obligation of the State. It is regrettable that there are neither specific measures nor a timeline for decontamination beyond 2013 and to levels less than 1mSv/year. The Special Rapporteur urges the Government to urgently formulate a long-term decontamination policy with the aim of reducing radiation to less than 1mSv/year at the earliest. 
55. The Special Rapporteur notes the special attention paid by the Government to vulnerable groups such as children in conducting the decontamination by proritising decontamination of schools and playgrounds. However, isolated decontamination of schools and playgrounds is not sufficient, as winds can deposit radiation from surrounding areas on already decontaminated sites. Decontamination of schools and playgrounds should therefore include surrounding areas, such as roads, ditches and fields, which can be radiation hot-spots. The decontamination policy should address radiation hot-spots, as a priority, because they can exist even within areas where radiation dose is less than 20 mSv/y. 
56. The Special Rapporteur notes that the Government is encouraging participation of the community in undertaking decontamination. He, however, recalls that the State is mandated to fulfil the right to health by giving necessary information and protective equipment to individuals engaged in hazardous activities.103 
While the Act on Special Measures requires provision of appropriate information or equipment for individuals engaging in decontamination activities, the Special Rapporteur is concerned that in some areas these requirements were not strictly followed. He therefore calls on the Government to provide information, safety equipment and appropriate protective gear to residents who voluntarily undertake decontamination activities.
Storage of contaminated materials 
57. Decontamination activities involving the removal of 5-10cm of topsoil104 pose challenges for the Government regarding safe storage of the contaminated soil. Currently,authorities are storing the radioactive debris in residential areas in sandbags covered with plastic or by burying it underground, including under playgrounds, in protective containers. 
During the visit, the Special Rapporteur did not find any signs informing people of the presence of radioactive materials in these areas, contrary to the right to health. 
58. The Special Rapporteur was informed that temporary and final storage and disposal facilities would be prepared to deal with the contaminated waste, estimated to be 2.3 million tonnes.105 However, there were no concrete plans for the storage of the radioactive debris. As the contaminated waste is stored in residential areas and under playgrounds, thereby posing a health hazard to residents, establishing temporary storage facilities away from residential areas is urgently required. The Government should formulate a timeline and take urgent measures towards establishing temporary and final waste storage and disposal facilities, with active participation of the community in the decision-making process.
E. Transparency and accountability 
Transparency and independence in the regulatory framework
59. The reports by the Nuclear Accident Independent Investigation Commission and the Investigation Committee on the Accident at Fukushima Nuclear Power Stations of TEPCO
set up by the Parliament and the Government respectively, criticise the close association between the nuclear regulatory bodies and the Federation of Electric Power Companies in Japan, which greatly reduced the independence of the regulatory bodies. 106 As a result, the regulatory bodies failed to hold TEPCO accountable for non-compliance with domestic and international safety standards, compromising the safety of the Daiichi plant.107
60. Transparency in governance and in implementing national policies and regulatory frameworks is key to the right to health. Effective transparency and independence of the governing and regulatory authorities also ensures accountability. 
The Special Rapporteur notes that recognizing the need for independence and transparency, the Government created the Nuclear Regulation Authority (NRA). Accountability of TEPCO
62. The Special Rapporteur is pleased to note that nuclear operators are strictly and absolutely liable for injury resulting from nuclear operations in Japan.108 This renders private non-State actors liable for violating the right to health of individuals and is consistent with the State‘s obligation to protect the right to health. 
63. However, the Government‘s acquisition of TEPCO‘s majority stakes in June 2012 has arguably helped TEPCO to effectively avoid accountability and liability for damages. Payment of compensation is made from government funds, funded by taxpayers. The Special Rapporteur was informed that TEPCO would have to repay the Government eventually. Nevertheless, under the current arrangement, the taxpayers may have to continue Compensation and relief measures64. 
Where a violation of the right to health occurs, victims should have access to effective remedies, including adequate reparation and compensation. The provision of compensation and other forms of relief are also essential to the recovery of individuals affected by the nuclear accident65. 
After the nuclear accident, TEPCO provided 120 billion Yen in financial security for claims,109 even though compensation costs estimated by TEPCO were around 4,500 billion Yen. 
The Government, therefore, established the public-private Nuclear Damage Liability Facilitation Fund in September 2011.110
66. The Dispute Reconciliation Committee for Nuclear Damage Compensation was created to formulate guidelines for payment of compensation due to a lack of guidelines within the existing Compensation Act.111 The Special Rapporteur notes that the original compensation application forms comprised around 60 pages and 2,215 sections, accompanied with a 158-page instruction manual.112 He was also informed of the delays caused at the Dispute Settlement Centre, which hinder the availability of compensation for the affected population. While these application forms have since been streamlined, the Government should address concerns frequently raised by affected persons regarding TEPCO‘s attempts to reduce compensation levels and delay settlement. 
67. The Special Rapporteur commends the passing of the Statute on Protection and Support for the Children and other Victims of Tokyo Electric Power Company Nuclear Power Plant Disaster (Victims Protection Law), which recognizes the right of victims to choose whether to evacuate or not. It includes persons voluntarily evacuating or living in areas outside the Government-designated zones, whose relief needs were reportedly neglected. The Law also contains provisions relating to long-term health impacts of exposure to radiation.
68. The Special Rapporteur is concerned that despite the Law‘s adoption in June 2012, implementing instruments have not yet been adopted. In implementing the Law, clarification is required with respect to ‗Covered Areas‘ under article 8. The Special Rapporteur believes that ‗Covered Areas‘ should include those where radiation levels exceed 1mSv/year. As the exact health effects of long-term exposure to low-dose ionizing radiation cannot be accurately predicted, the implementing measures should also expressly provide free, life-long health screening and medical treatment relating to radiation exposure for all affected persons. The 20-year time limit contained in the Civil Code should not apply to financial assistance for medical care related to the nuclear accident. 
69. The obligation to fulfil the right to health requires the State to ensure the provision of the underlying determinants of health by, inter alia, providing positive measures that facilitate enjoyment of the right to health. The Special Rapporteur urges the Government to adopt implementing measures to the Victims Protection Law and provide funding for relocation, housing, employment, education and other essential support needed by those who chose to evacuate, stay or return to any area where radiation exceeds 1mSv/year.
These measures should include relief packages reflecting the cost of rebuilding lives. 
G. Participation of vulnerable groups and affected communities70. The right to health requires the State to pay special attention to the needs of vulnerable groups. The State is also under an immediate obligation to prevent discrimination, especially against vulnerable groups in its policies or practice, even during times of resource constraint.
71. By August 2011, 146,520 people evacuated from Fukushima Prefecture.113 Owing to frequent changes in evacuation orders more than 10,000 people had to change evacuation centres three or more times, with some people moving as many as ten times.114 Even after evacuation orders were given on 12 March 2011 for areas within a 20km radius of the Daiichi plant, approximately 840 hospital and nursing home patients remained until 13 March 2011.115 
Additionally, 60 hospital patients died during evacuation.116 The stress, illhealth, and deaths, could have been prevented had there been coordinated evacuation orders and plans in place. In this context, mapping vulnerable groups and encouraging broad community engagement may help in creating more appropriate emergency responses with respect to vulnerable communities.117
72. Older persons, children, women and persons with disabilities are more susceptible to ill effects of disasters.118 During the visit, such groups shared grievances with the Special Rapporteur that they had no say in decisions that affected them. He was also pained to learn that evacuation centres often did not have an accessible environment for persons with disabilities73. 
Participation of the population at all stages of decision-making processes at national and community levels is a critical feature of the right to health framework. Health-related laws and policies should be instituted only with direct, active and effective involvement of communities, since they are most impacted by these decisions. The Special Rapporteur urges the Government to take this opportunity to ensure the effective involvement of communities in the health management survey. Community participation would also help the Government to address the concerns of the people moremeffectively, thereby creating a more efficient health system. 
74. The Special Rapporteur commends the Government for ensuring community participation in the Victims Protection Law. The Government should continue facilitating broad-based participation and effective engagement of affected communities with a view to addressing their concerns. 
Participation of affected communities also encourages community-led awareness raising and initiatives. Community participation should include participation of vulnerable groups, as it is crucial for their empowerment and creating an inclusive society.
75. The Special Rapporteur urges the Government to involve individuals and community organizations in current and future nuclear and health policies, including in data collection and radiation monitoring, planning evacuation centres, designing health management surveys, decisions regarding radiation levels and evacuation zones and in setting compensation amounts.
76. The Special Rapporteur urges the Government to implement the following recommendations in the formulation and implementation of its nuclear emergency response system:
(a) Establish regularly updated emergency response plans that clearly demarcate the command structures and specify evacuation zones, evacuation centres, and provide guidelines for assisting vulnerable groups;
(b) Communicate disaster management plans, including response and evacuation measures, to residents of areas likely to be affected by a nuclear accident;
(c) Release disaster-related information to the public as soon as a nuclear accident occurs;
(d) Distribute promptly iodine prophylaxis before or as soon as the accident occurs;
(e) Provide for prompt and effective usage of such technology as SPEEDI in gathering and disseminating information on affected areas;
77. With respect to health monitoring of the affected population, the Special Rapporteur urges the Government to implement the following recommendations:) Continue monitoring the impact of radiation on the health of affected persons through holistic and comprehensive screening for a considerable length of time and make appropriate treatment available to those in need; 
(b) The health management survey should be provided to persons residing in all affected areas with radiation exposure higher than 1 mSv/year;
(c) Ensure greater participation and higher response rates in all health surveys;
(d) Ensure that the basic health management survey includes  
on the specific health condition of individuals and other factors that may exacerbate the effect of radiation exposure on their health; 
(e) Avoid limiting the health check-up for children to thyroid checks and extend check-ups for all possible health effects, including urine and blood tests; 
(f) Make follow-up and secondary examination for children’s thyroid check-up available to all requesting children and parents;
(g) Simplify children’s and their parents’ access to information regarding their test results, while ensuring the protection of private information;
(h) Refrain from restricting examination for internal exposure to whole body counters and provide it to all affected population, including residents, evacuees, and to persons outside Fukushima prefecture;
(i) Ensure mental health facilities, goods and services are available to all evacuees and residents, especially vulnerable groups such as older persons, children and pregnant women;
(k) Monitor the health effects of radiation on nuclear plant workers and provide necessary treatment.
78. The Special Rapporteur urges the Government to implement the following recommendations regarding policies and information on radiation doses.
(a) Formulate a national plan on evacuation zones and dose limits of radiation by using current scientific evidence, based on human rights rather than on a risk-benefit analysis, and reduce the radiation dose to less than 1mSv/year;
(b) Provide, in schoolbooks and materials, accurate information about the risk of radiation exposure and the increased vulnerability of children to radiation exposure;
(c) Incorporate validated independent data, including that from the communities, to monitor radiation levels.
79. Regarding decontamination, the Special Rapporteur urges the Government to adopt the following recommendations:
(a) Formulate urgently a clear, time-bound plan to reduce radiation levels to less than 1mSv/year;
(b) Clearly mark sites where radioactive debris is stored;
(c) Provide, with the participation of the community, safe and appropriate temporary and final storage facilities for radioactive debris;
80. The Special Rapporteur urges the Government to implement the following recommendations regarding transparency and accountability within the regulatory (a) Require compliance of the regulatory authority and the nuclear power plant operators with internationally agreed safety standards and guidelines; 
(b) Ensure disclosure by members of the Nuclear Regulation Authority of their association with the nuclear power industry;
(c) Make information collected by the Nuclear Regulation Authority, including regulations and compliance of nuclear power plant operators with domestic and international safety standards and guidelines, publicly available for independent monitoring;
(d) Ensure that TEPCO and other third parties are held accountable for the nuclear accident and that their liability to pay compensation or reconstruction efforts is not shifted to taxpayers.
81. In relation to compensation and relief, the Special Rapporteur urges the Government to implement the following recommendations:
(a) Formulate, with the participation of the affected communities, the implementing framework under the Victims Protection Law;
(b) Include cost of reconstruction and restoration of lives within the relief package;
(c) Provide free health check-ups and treatment that may be required for health effects from the nuclear accident and radiation exposure;
(d) Ensure that compensation claims by affected persons against TEPCO are settled without further delay;
82. The Special Rapporteur urges the Government to ensure effective community participation, especially participation of vulnerable groups, in all aspects of the decision-making processes related to nuclear energy policy and the nuclear regulatory framework, including decisions regarding nuclear power plant operations, evacuation zones, radiation limits, health monitoring and compensation amounts.”
UN Human Rights Council Fukushima Report Extremely Critical Of TEPCO And Government; via @AGreenRoad