Residents ’ Concerns Regarding Schools Designated as Evacuation Shelters

Objective: The purpose of this study was to investigate the perceptions of residents who are knowledgeable about the schools used as shelters. Methods: The target group was comprised of teachers and guardians of children enrolled in 4 schools, which were selected in the vicinity of District B, which was severely damaged by heavy rain in 2014. A qualitative descriptive study design was used. Results: The number of surveys collected was 1702 (collection rate 62.2%). A total of 1017 clauses were entered, and 85 codes were generated for 7 categories. The guardians and teachers believed that there was a discrepancy between shelter capacity and the real situation; citing a lack of information, and ill preparedness of the schools for disasters as some of the problems. Based on the knowledge and experiences from previous disasters, they responded that there was inadequate management, and evacuees faced difficulty living comfortably in the shelters. Conclusion: In order to use school facilities during any disaster, it is important for residents to recognize the need to solve problems, and to work with


Introduction
As the global climate changes, there are widespread changes in weather patterns associated with intensity and frequency that are causing massive damage and affecting human life. Japan is no exception to this global trend. In August 2014 and July 2018, Hiroshima prefecture recorded copious rainfall causing a disastrous landslide, which led to the deaths of many residents, and the destruction of buildings due to sediment-related disasters. According to the Director-General for Disaster Management of the Cabinet Office of Japan Central Government, an evacuation advisory was issued during the excessive rainfall that occurred in August 2014, and approximately 164000 people were evacuated from 68813 households. 1 There were 77 deaths reported and massive damage was caused by the landslide. 2 During the torrential rainfall in July 2018 which claimed 115 lives in the disaster areas as of July 30, 3 384 evacuation shelters were opened to accommodate 4270 evacuees. 4 In each of the disasters, the delay in evacuation was considered to be an issue based on disaster prevention. 5 The government has been considering various measures to encourage the early and voluntary evacuation of residents who are likely to face such disasters. In 2019, the method of displaying the evacuation information was changed, and a system was established to communicate the same instructions to residents at an early stage.
A major reason why people do not evacuate is, as Morss states, the case of "hurricane fatigue." 6 This can occur in places such as Florida, which is often hit by many hurricanes in 1 season. People felt that the evacuation information simply disturbed their lives, and they became tired of leaving their homes. Some residents and business owners decided to stay behind to protect their properties, either from looters or the storm itself. 7 Residents' fatigue is not only caused by hurricanes; it has also been noted in the events of forest fires. The authorities fear that as these catastrophic wildfires become routine, residents are also likely to progressively ignore repeated calls for evacuation. 8 Fatigue occurs in all disasters, not only in hurricanes and wildfires. Hence, it is also reported as disaster fatigue. The evacuation behavior is furthermore affected by several factors such as gender, age, number of children, income, etc. 9 Some people do not evacuate their homes due to economic reasons or the time and effort required to pack their belongings. 10 The low frequency of natural disasters is 1 of the reasons for the delay in residents' evacuation. 11 In Hiroshima, residents usually do not evacuate due to the low frequency of disasters. A report on the heavy rain disaster that occurred in July 2018, indicated the existence of people who did not evacuate even after receiving the instruction. 12 This showed that it was difficult for inhabitants to prepare for unforeseen natural disasters. 13,14 Children are most likely to evacuate during natural disasters. The evacuation plan was also related to evacuation guidelines and resources. 15 As schools are the center of the community, which provide an environment for children to study safely, these become evacuation shelters for local residents in the event of disasters. 16 In Japan, 94.9% of 28613 public elementary and junior high schools are designated as shelters. 17 During the Kumamoto Earthquake in April 2016, 366 of the 596 public schools in Kumamoto Prefecture were used as evacuation shelters, and these schools ensured a large proportion of the necessary supports. 18 People live in schools after a disaster because they have lost their homes, or to escape the damage of a secondary disaster. Another reason for extending the length of stay of evacuees is that basic emergency supplies are distributed free of charge to evacuation centers. Schools are primarily educational institutions and are designed according to the institutional guidelines; hence, causing various problems and inconveniences when used as temporary shelters. 19 As a result, it became difficult to carry out evacuation preparations in accordance with the standards described in the Sphere handbook. 20 The teachers of the schools used as evacuation centers who needed to continue children's education took on the management roles in the evacuation centers. After disasters, teachers also faced difficulties in performing their other regular duties such as ensuring the children's safety throughout the school days. 21,22 Teachers are involved in setting up shelters, and their roles are limited only to supporting administrative work. 23 They also endeavor to minimize disruptions and prepare the learning environment for children. 23 Teachers are also, not only responsible for managing the shelters, but also look after the waste disposal in case of dysfunctional toilets, and lead the fair distribution of food and water. 21 Requests concerning problems are directed to the teaching staff of the schools that becomes shelters, pushing them into managerial positions. 24 As a consequence, these additional responsibilities increase their burden and exhaustion. 25 There are few reports available that provide information about what life looks like in temporary shelters and the situations that the evacuees face or have to face. 26,27 Advance preparation could be arranged based on the awareness of evacuees. Residents' independent development of evacuation shelters to prepare for disasters will bring together the region, and provide the basis for reconstruction. 28 Residents' imagination of life after an evacuation is likely to predict the disaster itself and to promote evacuation. The purpose of this study is to clarify the concerns about schools becoming shelters so that the residents themselves can prepare by imagining life after a disaster.

Study Design
In this study, we conducted a qualitative descriptive study design.

Study Population and Site for Survey
The study population was comprised of teachers and guardians of children enrolled in 4 schools (2736 people as of February 2018) that were selected by the school board and principal in the vicinity of District B, City A, which was severely damaged by the landslide in August 2014. The survey was conducted in March 2018. Teachers and parents who refused to investigate were excluded.

Data Collection
A questionnaire survey was conducted with 2736 teachers and guardians in a total of 4 public elementary schools in City A.
They cooperated in 2 surveys, 1 was a composite questionnaire by a municipal survey, and another was a survey of free text methods. In this study, the freely described responses were analyzed. Parents and teachers were free to write their opinions and concerns about the shelter.

Analytical Method
Each free response was divided into clauses by their meanings. Clauses were coded by their semantic content and categorized by a similar semantic content. The semantic contents underwent repeated discussion by 3 researchers who were familiar with qualitative research, and the contents of the analysis were confirmed until saturated. The researchers summarized the clauses into concept categories based on the semantic content in each phrase and provided their supervision to divide into categories.

Outline of the Survey Population
Out of 255 teachers reached, 145 provided responses (56.9%). A set of survey forms was circulated to each household for parents and distributed to 2481 households. Survey return was 1557, and the return rate was 62.8%. A total of 1702 teachers and guardians were enrolled in this survey. Among the respondents, 91.0% were women, and 50% of them were in their 40s (49.9%). Few respondents (17.0%) have encountered natural disasters, and even fewer (8.7%) experienced natural disasters at the workplace. A small proportion of them (1.6%) had evacuated to shelters. The demographic characteristics of the study population are presented in Table 1.

Classification of the Responses of Subjects
There were 1017 clauses (raw responses) that were entered and among them, 61 clauses were written by the teachers. In total, 85 codes (separation of raw responses with a meaning), which were made by their semantic content, were generated for 7 categories. The clauses were classified into 37 subcategories according to their semantic content (Table 2). There was no subcategory consisting solely of the clauses written by the teachers. In particular, among the 7 categories, those with a large number of descriptive clauses are shown in detail. Categories are indicated by [ ], subcategories are indicated by < >, and clause quotations are indicated by "".

1) [Discrepancy between Shelter Capacity and the Perceived Need]
This category consists of the following 2 subcategories: <Many evacuees in shelters>, and <Insufficient facilities for the number of evacuees>.

1) <Many evacuees in shelters>
"Since it is a school with more than 1000 students, I think it would be difficult to function as a shelter." "The school is small related to the population." "Since there are so many residents, I think it will be very confusing if members of a child's family or local community evacuate." "50% of people are in residents' associations, and I can see confusions occurring." 2) <Insufficient facilities for the number of evacuees> "Since there are so many residents, there will be a large number of evacuees and a lack of space." "If everyone evacuates, wouldn't the space per person become equivalently smaller?" "Since there are many residents and many elderly people, can enough space be secured by the school alone? The toilets are particularly of concern." "Are there enough toilets? Definitely, there are not."

2) [Schools are Not Adapted for Disasters]
This category consisted of 4 subcategories: <Is the school suitable as a shelter?>, <Cannot evacuate to the designated shelter>, <Disaster infrastructure is not in place>, and <Schools cannot become shelters>.
1) <Is the school suitable as a shelter?> "The school building is old," "Is the building durable enough?" "I am worried about landslides on the mountain behind the school," "The school is built on low ground, and so it cannot be said to be safe." "I am anxious about the durability of the elementary school itself," "The school gymnasium was repaired, but the gymnasium itself is old, so it might be safer at home, they say." 2) <Cannot evacuate to the designated shelter> "I'm concerned that I won't be properly shown to another shelter if I can't get into the shelter." "If there are a lot of people, what happens when you can't enter the shelter?" 3) <Disaster infrastructure is not in place> "I heard (from the children) that the toilet was difficult to flush." "Will mobile phones connect?" "Are there charging facilities?" 4) <Schools cannot become shelters> "I am worried because I heard that the school will not be a shelter." "I think the school didn't become a shelter. We don't have a designated evacuation shelter nearby our home; I would pick up my child from school and get back home because it took a long time to go to the shelter in other areas."

3) [Life is Disrupted at Shelters]
This category consisted of 7 subcategories: <Unstable provision of daily necessities>, <Evacuation is difficult and affects human relations>, <Privacy cannot be ensured>, <Environment with a high mental burden>, <Children cannot continue studying>, <Want to evacuate with my pet>, and <Daily life of children is restricted>.

1) <Unstable provision of daily necessities>
"Since there is only 1 main road, what would we do for supplies when it is blocked by a disaster?" "The shelter is on a mountain, so is food okay?" 2) < Evacuation is difficult and affects human relations > "My children are noisy, and I'm worried about disturbing others." "The evacuees might become frustrated and feel the voices of the children to be louder and harder to bear than usual." "I don't want to fall out (with other evacuees)." "The housing complex is small, so there will be new problems when we return to normal life if trouble occurs in the shelter." "The most worrisome thing is the group being disturbed by a selfish individual." 3) <Privacy cannot be ensured> "The gymnasium cannot be used (when the school becomes a shelter). The playing field is made into a parking lot, and the children cannot play outside. They cannot do physical activities or receive physical education." "I think a school is the place to raise the spirits (of children) that have dropped (due to the disaster). I am worried that this venue will be unavailable for a long time."

4) [Insufficient Management of Shelter Environment]
This category consisted of 5 subcategories: <Environment is unsanitary>, <Unclear management system>, <Crime may occur>, <Environment of the shelter is not suitable for daily life>, and <Insufficient consideration for those with special needs>.
1) <Environment is unhygienic > "I can easily imagine the hygiene management issues and the environment getting worse." "Will we have infectious diseases, etc.?" "It's hard to have a bath."  2) <Unclear management system> "Is there proper consideration for the elderly, children, and other socially vulnerable people such as pregnant women and wheelchair users?" "Who will give information and instructions regarding facilities?" 3) <Crime may occur> "Since strangers are coming and going, I'm worried about crime prevention." "Where will we keep cash and valuables?" "We can't be sure there are no suspicious people about, so we can't take our eyes off the children." "A sexual assault may occur when a woman or girl is alone." 4) <Environment of the shelter is not suitable for daily life> "The gymnasium (that is now the shelter) has insufficient temperature control." "The shelter is hot in the summer and very cold in the winter, so I'm worried about what to do." 5) <Insufficient consideration for those with special needs> "I have an allergic child, so I am worried about what to do if my child develops symptoms during evacuation." "My child has a food allergy, so my child can't eat anything during an evacuation." "My child is hard of hearing and hyperactive, so I am worried about disturbing others." "Can my son with his developmental disabilities tolerate the change in environment and living in a large group?" "I have a disabled mother. Is it possible for her to use the toilet in a wheelchair?"

Discussion
Based on the knowledge of school facilities and geography, including information from previous disasters such as news reports; guardians and teachers believe there is [insufficient management of shelter environment], that 1 [cannot maintain health at a shelter], and 1 [cannot live a normal life in a shelter]. There is a [discrepancy between shelter capacity and the real situation], and the [school is not adapted to disasters]. Teachers listed more clauses in this category compared to other categories. This category suggests that they are aware of the risks presented by disasters and are concerned about the quality of evacuation shelters. The recognition of the risk of disasters includes the factors of [the situation after a disaster being unimaginable] and [a lack of information]. The subjects cannot imagine what will happen after a disaster, the <means of transportation during an evacuation is unreliable>, the <means to confirm well-being is ambiguous>, and they have <concern for the daily lives of the schoolteachers>. Additionally, they <don't know about the residential area> and <location of the home is a concern>. The fact that they <don't know how to live in a shelter> and <don't know where the stockpiles are> leads them to feel the <method of preparation for evacuation is unclear>. Few people experienced the disaster. There was no difference between the description of the person who experienced the disaster and the person who had never experienced the disaster. This experience will help to establish a message that addresses unjustified fears and concerns regarding the use of shelters by clarifying the concerns of those who might be evacuated.
People's worry and awareness both determine the level of flood risk recognition. The preparation for evacuation begins by recognizing the risk. However, risk recognition is influenced by experience, knowledge, gender, and culture; therefore, the action for preparation is treated as a separate issue. 13 Risk recognition with respect to evacuation shelters considers whether or not the evacuees have information on the current capacity of the shelters, and the possibility that they might not have considered the capacity of roads. 29 The subjects of this study know the size of the classrooms and gymnasiums, the surrounding population, and the number of people the schools can accommodate. Their risks can be perceived, and their concerns are specific. However, since the means of obtaining information is not clear, they do not take further action to improve this situation. They point out the discrepancy between the number of evacuees and the capacity of the shelter. The local governments are responsible for developing shelters, and they must consider the capacity of the shelter buildings. When choosing a shelter, the capacity of the shelter and road is an important matter that the local government needs to look into. These issues are reflected in the decisions made by residents when choosing evacuation shelters. Local governments need to make estimates based on the number of residents, the number of people that the evacuation shelters can accommodate, and various conditions such as weekdays, holidays, daytime, and night-time. 29 Announcing the results will alleviate the concern that there is a [discrepancy between shelter capacity and the real situation].
Guardians and teachers point out that, [schools are not adapted for disasters]. The standards of evacuation shelters are shown in the UNHCR Emergency Handbook. 30 Compared to these standards, residents consider the school as an emergency evacuation shelter. On the other hand, they think [life is disrupted at shelters]. Confusion between emergency evacuation shelters and evacuation shelters can be recognized among residents. First of all, it is necessary to inform the residents about the individual roles of the aforementioned shelters. Schools are constructed mainly for educational purposes. Standards have been established to achieve education safely. 31 There are standards that are followed for an evacuation procedure during a fire, but there are no standards provided for disasters. If the residents are familiar with the role of the emergency shelter, the residents could voluntarily conduct a survey on whether schools are appropriate as emergency evacuation sites, and consequently, propose improvements to the local government. In making their evacuation shelters, a strong infrastructural plan is necessary to understand more about their neighbors, which can help to ease the process of evacuation, 32 and encourages them to evacuate.
The parents and teachers believe there is [insufficient management of shelter environments], that 1 [cannot maintain health at a shelter], and that 1 [cannot live a normal life in a shelter]. Many clauses comprise these categories and suggest that many people believe that living in evacuation shelters is uncomfortable and causes distress. The quality of evacuation shelters is a major cause of hesitation and deterrent of evacuation. 20 Schools are contributing adequately to support the lives of residents as shelters; however, the safer and more comfortable schools may attract people even though the risk of disaster is low. Guardians who have children with disabilities, particularly, describe their concerns regarding environmental management, and maintenance of health. Parents as well as teachers stated that "children cannot study." Children and people with disabilities are most affected by disasters.

Disaster Medicine and Public Health Preparedness 5
Organizations working on social vulnerability and disasters often list children with disabilities as a group that is at particular risk when a disaster occurs. 33 Issues in evacuation shelters involving disabled children are predicted not only in Japan but also in every other country of the world. 34 This shows that no measures have been taken to accommodate these groups, 34 and the reason for this is attributed to the fact that the guardians of disabled children do not participate in deciding what measures ought to be taken to help them during such times. 33 Children with cognitive disabilities may not recognize signs of environmental hazards and imminent threats, 35 or may become anxious or confused in response to emergency signals. 36 This is consistent with the free response of the guardians in this study. Teachers also recognize these challenges. Therefore, the teachers need specialized training to deal with such situations that occur during disasters. 37 Guardians must reach out to the disaster management personnel to resolve this problem which has been highlighted through surveys. Teachers and guardians need to consider the measures for dealing with disasters during classes in order to reduce the resistance to evacuation. 37,38 The measures they considered suitable to implement should be publicly disseminated. Moreover, understanding the characteristics of children's daily lives deepens the cooperation among residents.

Limitations
The subjects in this study were teachers from elementary schools in a limited area and the guardians of the children who attended these elementary schools. Most of the respondents were female guardians. It is important to include a more diverse population, including elderly people, other family members, and a wider range of living categories. The residents' responses may be affected by the broadcast about shelters in the major disasters that have occurred so far. However, their places of residence are also close to the disaster area. Most of Japan is in, or near dangerous areas, and vulnerable to a variety of disasters. Therefore, the results might not be generalizable.

Conclusion
Parents and teachers of elementary schools are worried about the shelter's capacity, living environment, and robustness. Many of the subjects had not experienced the disaster and could not think of a specific situation. Clarifying the concerns of those who may be evacuated helps to establish a message that addresses unjustified fears and concerns about the use of shelters. Based on the knowledge of school facilities and geography gained from past disasters, parents and teachers need to work with the local government to resolve concerns. Resolving concerns may improve the quality of shelters and make residents feel closer to shelters.