On January 1, 2024, at 16:10 (Japan Standard Time), an earthquake with a magnitude of 7.6 and a maximum seismic intensity of seven occurred in Japan, with its epicenter on the Noto Peninsula in Ishikawa Prefecture. The epicenter depth was shallow at 16 km, and tremors were observed across almost all of Japan. In the Noto region, which was the epicenter of the earthquake, many buildings collapsed because of the violent shaking. The earthquake also triggered a tsunami that damaged at least 160 ha in Suzu City and Noto Town [1]. A large-scale fire occurred in Kawai-machi, Wajima City, destroying more than 200 buildings, including stores and homes. Owing to the earthquake, electricity and water supplies were cut off, and communication was disrupted. More than 1,000 aftershocks, including earthquakes with a seismic intensity of five or higher, occurred within a week, forcing more than 20,000 residents of the Noto region to evacuate [2]. This earthquake was one of the largest disasters in Japan in recent years. Even after two weeks from the disaster, the full extent of the damage remains unknown. The search for missing people and support for disaster victims is ongoing.

Immediately after the earthquake, the authors visited Wajima City, the disaster area, and conducted disaster relief activities. We patrolled Wajima City and checked the conditions of the roads and evacuation centers. We also conducted health observations of the evacuees at the evacuation centers. This study discusses the characteristics of the disaster and proposes future issues regarding disaster relief.

The authors visited disaster-affected areas and examined the damage situation in Wajima City and the status of the evacuation centers. The authors also spoke to the evacuees and experts working on the ground. This report integrates and discusses the results of site visits, information broadcasts by public institutions, and previous research.

The Noto area, where the Noto Peninsula earthquake occurred, includes three cities and four towns: Wajima City, Suzu City, Noto Town, Nakanoto Town, Anamizu Town, Shiga Town, and Hakui City (see Figure 1). On January 5th, four days after the earthquake, we visited Wajima City, which was hit hard. The expressway was closed as it entered the Noto area. We drove along the prefectural roads.

Prefectural roads were undulated and damaged in several places. Many utility poles fell, and buildings were damaged everywhere. Prefectural Route 1, which connects to Noto, experienced landslides in several places, narrowing the width of road for vehicle to travel. Prefectural Route 1 had alternating traffic, making it prone to traffic jams. The east-west coastal road leading to Wajima was closed because of landslides and road collapses (see Figure 2).

We entered Wajima City and saw the city destroyed. A large building collapsed (see Figure 3), and a wide area of ​​Kawai-machi was destroyed by fire (see Figure 4). We stayed there for a week and toured the evacuation center. The evacuation center was without water. They cooked with water brought in by Self-Defense Forces. Because water cannot be flushed down toilets, it was solidified with a coagulant before disposal. The evacuation center was managed by evacuees. The evacuation center leader, who was also an evacuee, took command, and the evacuees worked together to sort and cook the relief supplies. The population of Noto is aging. Many people gathered at the evacuation centers were older adults. At the evacuation center, the amount of exercise among the evacuees decreased. The sanitary environment at the evacuation center could not be considered adequate. Some evacuees got sick. However, there were no regular rounds for medical professionals. Infectious diseases were prevalent in many evacuation centers. Influenza and new coronavirus infections were particularly common. In Japan, when a large-scale disaster occurs, a Disaster Medical Assistance Team (DMAT), a trained medical team with the mobility to act during the acute phase of a disaster, is activated [3]. DMAT also implements measures for infectious disease control. However, owing to the widespread damage caused by this earthquake, infection control measures were delayed.

Many evacuation centers in Wajima City were isolated because roads were cut off. We visited an isolated evacuation center on foot on January 10^th (see Figure 5). Village residents gathered at the evacuation center. Most were older adults. The power outage continued, and communications, such as mobile phones and the Internet, were unavailable. Evacuees at the isolated evacuation center did not know exactly what the conditions were in the Noto area. The Self-Defense Forces transported the supplies needed at the isolated evacuation centers. The evacuees said that there was no intervention by medical professionals.

Additionally, a phenomenon in which the sea floor is rising has been observed on the north coast of the Noto Peninsula [4]. This caused many ports to become unavailable. The port of the isolated area we visited had also become unusable due to upheaval. Perhaps for this reason, Self-Defense Force ships were anchored slightly offshore, and Self-Defense Force members were transporting supplies in rubber boats (see Figure 6).

This earthquake was characterized by transportation being blocked owing to geographical factors, which made infrastructure restoration and support activities difficult. Under such circumstances, it is important for disaster victims to manage their own evacuation centers. In addition, support teams that can operate independently are required in evacuation centers in remote areas where the support of DMAT teams cannot reach sufficient levels. To prepare for a disaster, administrative agencies and support teams need to plan in advance what they will do in the event of a disaster.

Disaster recovery is expected to take a long time. There are concerns that evacuation centers run by local governments could pose health risks if people stay in these centers for long periods. We hope that medical professionals intervene as soon as possible. The next severe disaster could occur in Japan soon. We hope that our experience of this disaster can be used to prepare for future disasters.