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Overview of Recovery and Community-based Resilience in Fukushima from 2011 to 2023 After the Nuclear Power Plant Accident: Focusing on the Projects of Community-based Resilience

Published online by Cambridge University Press:  12 December 2025

Yurie Kobashi,
Arifumi Hasegawa and
Shunichi Yamashita
Yurie Kobashi*
Affiliation:
Global Exchange Center, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, JapanDepartment of Radiation Disaster Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
Arifumi Hasegawa
Affiliation:
Department of Radiation Disaster Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
Shunichi Yamashita
Affiliation:
Global Exchange Center, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
*
Corresponding author: Yurie Kobashi; Email: tenten-y@fmu.ac.jp
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Abstract

Objective

We aimed to describe representative activities related to radiation risk management and community-based revitalization in Fukushima following the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident by chronological phase and provide an overview of effective recovery projects and future prospects.

Methods

We systematically reviewed projects and research on the FDNPP accident in PubMed. For convenience, we defined the first, second, and third phases as 2011-2014, 2015-2018, and 2019-2023, respectively. The main project, purpose, organization, core location, and validation in each phase after the disaster were briefly summarized.

Results

We found that lessons learned from the FDNPP disaster have been continuously and professionally conveyed across generations, regions, and nations by effectively disseminating easy-to-understand information, avoiding any misunderstanding and prejudice. A continuous flow of scientists, researchers, and trainees from Japan and abroad to the affected areas will create a positive cycle of attracting people and residents, eventually accelerating recovery and contributing to the development of safe and vibrant communities in disaster-affected areas.

Conclusions

Continued efforts are required to enhance expertise at the field level, strengthen organizational capabilities, and promote international cooperation, thereby ensuring that a similar nuclear accident never happens again.

Keywords

Fukushima Daiichi Nuclear Power Plant accidentrecoverycommunity-based resilienceFukushima Institute for ResearchEducationand Innovation (F-REI)

Information

Type
Review Article
Information
Disaster Medicine and Public Health Preparedness , Volume 19 , 2025, e348
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Thirteen and a half years have passed since the Great East Japan Earthquake on March 11, 2011 and subsequent Tsunami and Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. In the Fukushima Prefecture, along with the application of lessons learned through the on-site practice of radiation emergency medicine (REM), reconstruction efforts are becoming significant issues from a social science perspective.Reference Kobashi, Hasegawa and Yamashita1 These efforts include long-term recovery from a nuclear accident—specifically, how to concretely support the challenges faced by returners following the gradual lifting of the initial evacuation orders.

In the Soviet Union, the Chornobyl Nuclear Power Plant accident occurred during the Cold War, and the World Health Organization’s Radiation Emergency Medical Preparedness and Assistance Network (WHO-REMPAN) initiative was launched in 1987.2 From the outset, this initiative aimed to globally develop and strengthen REM implementation to prepare for future accidents. Additionally, the WHO collaborated closely with the affected countries to mitigate and minimize the persisting negative effects of the nuclear power plant disaster by promoting sustainable development and a healthy environment, which was affected by uncertain complicated consequences of environmental factors, especially by radiation fallout on human health, including mental health. WHO also worked together with multiple partners to reduce the scientific and public knowledge gap and help affected communities achieve an optimal level of physical, mental, and social health and well-being after the Chornobyl accident.Reference Yamashita, Carr and Repacholi3, Reference Reiners, Schneider and Akashi4 Notably, based on the experience of the Chornobyl disaster, the WHO-REMPAN has swiftly contributed to the preliminary evaluation of radiation doses and public radiation exposure measures, especially following the FDNPP accident.5, 6

In contrast, Fukushima Medical University played a crucial role in the education of specialized medical professionals, research, and the provision of clinical care as part of regional health initiatives immediately after the disaster. Since 2015, the Fukushima Medical University contributed to Japan’s nuclear disaster medical support system, played a crucial role in public health responses to radioactively contaminated areas in Fukushima Prefecture, and greatly contributed to the training and education in advanced REM after an accident. Moreover, in 2018, Fukushima Medical University became a WHO-REMPAN Collaborating Center and has since strengthened its cooperation with Hiroshima University, Nagasaki University, and the National Institutes for Quantum Science and Technology-Institute of Radiological Sciences (QST-NIRS).

Reviewing past responses to accidents can offer insights into future prospects based on the principles of self-help, mutual assistance, and public assistance after any incident or disaster. Thus, in this study, we aimed to systemically summarize projects and previous literature on the FDNPP accident, focusing on various efforts toward community-based recovery and assistance for the return of affected individuals in areas forced into evacuation. Finally, the new challenge of reconstruction and revitalization of Fukushima will be introduced.

Methods

Literature Review

We performed a literature review of projects and research on the FDNPP accident in PubMed. The search strategy was as follows: “("Fukushima Nuclear Accident"[Mesh] OR “Fukushima*” [Title/Abstract])) AND ("Radioactive Hazard Release"[Mesh] OR “Natural Disasters”[Mesh] OR “Disasters”[Mesh:NoExp] OR “Disaster Planning”[Mesh] OR disaster*[tiab])”. In total, 2885 studies published between 2011 and 2023 were identified. In addition, we surveyed the changes in the project and research with years after the disaster.

Using KH Coder, we analyzed the text content of the 2885 articles to understand the overview of the project and research in Fukushima after the disaster. We followed the analysis method used in previous studies.Reference Radianti, Majchrzak and Fromm7, Reference Natsukari, Higuchi and Tsujimoto8 Briefly, we created an Excel database including the titles and publication years of all articles. Subsequently, we registered the compound terms and removed the non-meaningful terms. Finally, a co-occurrence network was generated (Figure 1). In addition, the correlation between the subgroups in the co-occurrence network and year of publication was surveyed (Figure 2). We defined the first, second, and third phases as the years 2011-2014, 2015-2018, and 2019-2023, respectively, modified in correspondence with our previous study.Reference Kobashi, Hasegawa and Yamashita1 In subgroup 15, we identified the terms, “nuclear,” “power,” and “daiichi,” which also appeared in subgroup 1; thus, we included subgroup 15 in subgroup 1.

Figure 1.

Co-occurrence network map.

Subgroup 1: Radiation risk assessment; Subgroup 2: Fukushima Daiichi Nuclear Power Plant accident; Subgroup 3: Distribution of radioactive substance; Subgroup 4: Radiation effects on health; Subgroup 5: Sediment in water environment; Subgroup 6: environmental measurement; Subgroup 7: Cesium contamination; Subgroup 8: Transfer; Subgroup 9: Residents in Fukushima; Subgroup 10: Emergency response; Subgroup 11: Fukushima health management Survey; Subgroup 12: Evacuation zone; Subgroup 13: Affected area; Subgroup 14: Lessons learned

Figure 2.

Map of co-occurrence network and correlation between subgroup and published year.

The red color scale shows a correlation with the later phase after the disaster, and the blue color scale shows a correlation with the earlier phase after the disaster.

Results

A co-occurrence network was created for the titles of articles published between 2011 and 2023 after the nuclear disaster in Fukushima. Subgroup 01 showed the group of terms for “Radiation risk assessment,” and subgroup 02 showed the group of terms for the “Fukushima Daiichi Nuclear Power Plant accident.” Additionally, subgroup 03 showed the group of terms for “Distribution of radioactive substance,” whereas subgroup 07 showed the group of terms of “Cesium contamination.”

Subgroups 1 (Fukushima Daiichi Nuclear Power Plant accident), 6 (Environmental measurement), 7 (Cesium contamination), and 10 (Emergency response) showed relative correlations with the earlier phase. Subgroups 11 (Fukushima Health Management Survey), 9 (Residents in Fukushima), and 13 (Affected area) showed relative correlation with the later phase.

From the perspective of these changes in the project and surveys with different phases after the accident, the present literature introduced representative activities related to risk management and community revitalization in radiation-affected areas following the FDNPP accident by phase and provides an overview of the current situation and future prospects.

Representative Projects in Fukushima Prefecture in Different Phases

The main community-based projects in Fukushima during each phase after the disaster are listed in Table 1. The co-occurrence network in Figure 2 shows a strong correlation between the first phase and “Emergency response” and “Environmental measurement.” Based on the representative community project, “Evacuation order and lifted order,” “Decontamination,” and “Radiation Disaster Medical Center” were associated with “Emergency response.” Primary dose assessment from WHO was associated with “Environmental measurement.” On the other hand, the co-occurrence network showed a strong correlation between the later phase and “Residents in Fukushima” and “Affected area.” Based on the community-based project, reconstruction of facility in community and national initiative framework or institute might be associated with “Residents in Fukushima” and “Affected area.”

Table 1.

Representative projects of recovery and community-based resilience in Fukushima prefecture with time flow after disaster

The first, second, and third phases were defined as 2011-2014, 2015-2018, and 2019-2023, respectively.

ICRP = International Commission on Radiological Protection; WHO = World Health Organization; IAEA = International Atomic Energy Agency; UNSCEAR = United Nations Scientific Committee on the Effects of Atomic Radiation

Projects in the first phase (2011–2014)

During the emergency phase, the most vital and required action in the community affected in Fukushima was the evacuation order in the contaminated area, which was subsequently lifted. Notably, the return of evacuees was performed for the people who were willing to return and were not developed to force people to return; there was freedom of choices at all times. Under this situation, the International Commission on Radiological Protection (ICRP) has started a dialog initiative in the community of Fukushima Prefecture, which led to the evaluation of a rapid assessment of issues arising from the accident to improve the System of Radiological Protection.Reference González, Akashi and Boice9, Reference Lochard and Schneider10 As of 2024, the areas under evacuation orders in Fukushima Prefecture have been reduced from approximately 12% to 2.2% of the entire prefecture area.11 The Japanese government aims to lift all evacuation orders in the future. A series of radiation dose assessments report from the WHO as primary dose assessment was a vital reference for the decision to lift evacuation order in particular zones.5 The consensus-building by the low-dose working group in December 2011, which set an annual dose of under 20 mSv as the benchmark for evacuation and return, was a crucial turning point in Japan.12 Yet, there was the existence of a debate on the reference level of 20 mSv; for instance, the acceptable annual doses were different for individual situations. In addition, the government’s efforts to reduce radiation doses in affected areas through decontamination were continued, and international reports by the United Nations Scientific Committee on the Effects of the International Atomic Energy Agency (IAEA).13 and Atomic Radiation (UNSCEAR).14 This committee compiled and shared obtained information, providing global evidence for reducing residents’ anxiety in community and gradual advancing the strategy of their return to affected areas.

Furthermore, Fukushima Medical University, the only medical university and core medical center in Fukushima Prefecture, played a vital role in establishing the Radiation Disaster Medical Center to provide emergency radiation medical care during the decommissioning process and establishing the Fukushima Health Management Survey to protect the long-term health of the residents in affected area.Reference Yasumura, Hosoya and Yamashita15 As of 2024, Fukushima Medical University continues to play a vital role as a central hub in protecting residents’ health.

Projects in the second phase (2015–2018)

As the evacuation orders were gradually lifted in zones to prepare for the lifting of evacuation orders, the construction and development of schools and medical facilities in the community were promoted. The construction of medical and nursing facilities were particularly crucial because many of the returners were healthy older individuals.Reference Moriyama, Morita and Nishikawa16–Reference Kobashi, Nishikawa and Morita18 Radiation risk communication played a vital role, and these practices were implemented in the community.Reference Takamura, Taira and Yoshida19–Reference Yamashita, Suzuki, Suzuki, Shimura and Saenko24

Since 2017, various universities and other institutions have been involved in reconstruction projects under the Fukushima Innovation Coast Framework promoted by the Reconstruction Agency,25 leading to diverse disaster recovery projects. Of these efforts, radiation risk communication and social science approaches have steadily accumulated achievements.Reference Takamura, Orita and Taira26, Reference Murakami, Takebayashi and Takeda27 For instance, the Great East Japan Earthquake and Nuclear Disaster Memorial Museum, established in 2019 as part of the Innovation Coast Framework to convey the experiences of the complex disaster to future generations, had attracted 300 000 visitors by 2024.28 Various ministries and agencies, including the Reconstruction Agency; Ministry of Economy, Trade, and Industry; Ministry of Education, Culture, Sports, Science, and Technology; and Fukushima Prefecture government, have been involved in the Fukushima Innovation Coast Framework. Industrial developments and population growth were anticipated through initiatives such as the Fukushima Robot Test Field and Fukushima Hydrogen Energy Research Field, which were subsequently linked to the Fukushima Institute for Research, Education, and Innovation (F-REI).

Projects in the third phase (2019–2023)

The Fukushima Reconstruction Knowledge Project aims to promote recovery and reconstruction through university knowledge and experience.29 Research and education are promoted in the following areas: radiation, risk communication, agriculture, robotics, and energy. To date, 21 projects in are ongoing.

In April 2023, the Japanese government established the F-REI in Hamadori, Fukushima Prefecture. The F-REI is considered an integrated development of the Fukushima Innovation Coast Framework, which played a central role in promoting recovery from the disaster. This institute was established after formulating the essential concept of F-REI, amending the Special Measures for Fukushima Reconstruction and Revitalization, and forming the essential plan for the development of new industries and research.30 Following these steps, approximately 70 staff have started work in a temporary office in Namie Town. Over the next 7 years, approximately 100 billion yen will be allocated for operations, with an annual budget of approximately 15 billion yen. Most of these funds are expected to be allocated as commissioned research and project funds through public solicitations over the coming years.

According to the Japanese government guidelines, the F-REI aims to become a global symbol of hope for the reconstruction of Fukushima Prefecture and Tohoku region, promoting the enhancement of science, technological capabilities, and industrial competitiveness in Japan, contributing to economic growth, and improving the quality of human life. F-REI focuses on 5 core areas: “Robotics,” “Agriculture, Forestry, and Fisheries,” “Energy,” “Radiation Science, Medicine, and Drug Development, & Industrial Applications of Radiation,” and “Collection and Dissemination of Data and Knowledge on Nuclear Disasters.” The first 55 projects in these 5 areas have already commenced. Once the construction of the F-REI facilities is completed in the near future, the institution aims to attract several hundred researchers from Japan and abroad to conduct world-class research and development.

Discussion

Achievement from the point of view of Fukushima Medical University

Our findings highlight the critical of Fukushima Medical University, which is the only medical university and core medical center in Fukushima Prefecture. Fukushima Medical University has already been approved to participate in 2 of the 5 focus areas of F-REI: “Radiation Science, Medicine and Drug Development, & Industrial Applications of Radiation” and “Collection and Dissemination of Data and Knowledge on Nuclear Disasters.” In the 2024 fiscal year, Fukushima Medical University has finished the public application review process, and 3 commissioned projects have officially commenced. In the field of “Radiation Science, Medicine, and Drug Development, & Industrial Applications of Radiation,” the Advanced Clinical Research Center at Fukushima Medical University is working on developing the world’s first treatment for malignant pheochromocytoma using the alpha-emitting radionuclide astatine-211.

The prominent achievements of Fukushima Medical University following the FDNPP accident have been recognized by the Japanese government, leading to the inclusion of the following statement in the F-REI’s basic framework: “In particular, collaborations in drug discovery and medical fields, based on the distinctive prior research conducted by institutions such as Fukushima Medical University, will be promoted. This aims to pioneer advanced medical applications of radiation in cancer treatment and drug development in Japan, thus novel future for the disaster affected region will be created as it overcomes the negative legacy of the nuclear accident.”31 In other words, Fukushima Medical University is working toward overcoming the negative aspects of the nuclear disaster and striving to actively participate in the F-REI based on previous achievements.

Throughout this process, collaborative projects with international organizations play a key role. Specifically, in the spring of 2024, Fukushima Medical University joined the IAEA-led project “Rays of Hope Cancer Initiative,” which aims to promote the equitable use of radiation therapy in cancer treatment in low- and middle-income countries. This initiative not only addresses the challenge of medical radiation exposure but also holds significant importance in the safe use of radiation. Joining in this project is expected to aid in rebuilding the regional healthcare system in Fukushima Prefecture, particularly by realizing a healthy and long-lived society through advanced medical applications of radiation and novel drug development, concentrating health care-associated industries in Hamadori, ensuring sustainable development of research through the training and education of nuclear medicine experts, and contributing to the revitalization and urban development of the Hamadori region.

In the fifth focus area of F-REI, "Collection and Dissemination of Data and Knowledge on Nuclear Disasters,” Fukushima Medical University aims to contribute by collaborating with the Fukushima Prefecture Health Management Survey conducted by the Radiation Medical Science Center. Fukushima Medical University also expands the joint graduate school with Nagasaki University, Division of disaster and radiation medical science, building on research achievement in nuclear disaster medicine and disaster recovery science. In particular, the decommissioning of the FDNPP and management of tritium-treated water remain crucial issues, and Fukushima Medical University is expected to play a significant role in education, training, and radiation medical care in the field of public health emergencies and recovery. Internal exposure to radioactive iodine, particularly among infants and young individuals, has become a significant concern following nuclear accidents.

Perspective of F-REI

The approved proposal of Fukushima Medical University for the fifth focus area of the F-REI was aimed at resolving the issue of thyroid cancer in Fukushima, and further challenges have commenced. Reports from the WHO and International Agency for Research on Cancer highlight the importance of evaluating thyroid radiation exposure immediately after an accident, the need for a stable iodine intake for thyroid protection, and the concept of thyroid monitoring.32, 33 These remain crucial research tasks for future preparedness for radiation disasters.

Collaboration between the fourth and fifth focused areas of the F-REI projects will foster a strategy of radiation protection and promote the utilization of radiation in realizing safety “Theranostics,” which combines nuclear medicine diagnosis and treatment against any metastatic cancer. Furthermore, this will involve initiatives such as incorporating radiation education into elementary, middle, and high school curricula; conducting outreach activities; and promoting collaborative research through global networks with international institutions and overseas universities. These efforts will contribute to the accumulation of scientific and objective knowledge on the health effects of low-dose radiation exposure and the public understanding of the associated risks. Notably, the co-expertise process could open the mind of experts on specific topics of concern from the citizens point of view.

Limitations

The present study had limitations. It was not possible to cover all the reconstruction projects and countermeasures by the national government, local governments, and international organizations in the present study. Additionally, the present study was reviewed from the point of view of Fukushima Medical University.

Conclusions

The abovementioned efforts in Fukushima’s recovery made it possible to continuously and professionally convey the lessons learned from the disaster across generations, regions, and nations by effectively disseminating information that is easy to understand. This is expected to contribute steadily to the improvement of comprehensive health risk literacy, including radiation risk. Notably, Hamadori region of Fukushima Prefecture, which faces the challenges of a declining birthrate and aging population, is the site of an unprecedented nuclear disaster caused by a complex disaster.

Finally, 13 and a half years after the FDNPP accident, the environment surrounding Fukushima has changed significantly. There is concern that experiences and memories from the early days after a disaster are fading because of generational changes. Additionally, incorrect information and misunderstandings of Fukushima’s current situation have spread, leading to entrenched stereotypes about Fukushima and causing prejudice and discrimination. Issues such as reputational damage related to the discharge of tritium-treated water into the ocean are ongoing. From the perspective of the disaster cycle, the current recovery phase requires effective preparation for future nuclear accidents and disasters. While great expectations have been placed on the recently established F-REI, the WHO-REMPAN initiative and IAEA comprehensive support must continue to apply lessons from both Chornobyl and Fukushima with a strong commitment and ethics to never allow a similar nuclear accident again. Continued efforts are required to enhance expertise at the field level, strengthen organizational capabilities, promote international cooperation, and work together with residents respecting their autonomy of decisions.

Acknowledgments

We would like to thank the staff of Fukushima Medical University and all the stakeholders in Fukushima Prefecture who cooperated with the recovery and restoration of Fukushima.

Author contribution

The corresponding authors had full access to all data in the study and had the final responsibility to submit for publication. YK and SY contributed to manuscript writing and research design. All authors contributed to the review of the entire manuscript.

Competing interest

The authors declare none.

Funding

This study was supported by the Kaken-hi, under Grant Number 24K16778 (Y Kobashi).

Ethical statement

Not required.

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Figure 0

Figure 1.Co-occurrence network map.Subgroup 1: Radiation risk assessment; Subgroup 2: Fukushima Daiichi Nuclear Power Plant accident; Subgroup 3: Distribution of radioactive substance; Subgroup 4: Radiation effects on health; Subgroup 5: Sediment in water environment; Subgroup 6: environmental measurement; Subgroup 7: Cesium contamination; Subgroup 8: Transfer; Subgroup 9: Residents in Fukushima; Subgroup 10: Emergency response; Subgroup 11: Fukushima health management Survey; Subgroup 12: Evacuation zone; Subgroup 13: Affected area; Subgroup 14: Lessons learned

Figure 1

Figure 2.Map of co-occurrence network and correlation between subgroup and published year.The red color scale shows a correlation with the later phase after the disaster, and the blue color scale shows a correlation with the earlier phase after the disaster.

Figure 2

Table 1.Representative projects of recovery and community-based resilience in Fukushima prefecture with time flow after disaster