REPORTS FROM THE FIELD

Health care - f ir refugees in - -

northeast Somalia

Una MacAskill

31 Gleniffer Road Renfrew PA4 ORD, U.K.

EDITOR’S INTRODUCTION

Between 1978 and 1980, warfare, persecution and drought forced large numbers of refugees across the disputed border from Ethiopia into Somalia. By September 1980, the population of refugees in Somalia had reached an estimated 800,000. These displaced people, mainly ethnic Somalis, but including about 100,OOO Oromos, were mostly gathered by the authorities into a collection of temporary camps in four regions of the country. These camps were dependent on the combined efforts of the Somali Government, the Office of the United Nations High Commissioner for Refugees, and a variety of Western relief agencies for supplies of food, medical care, and other services.

This report outlines the experiences of one British relief agency nurse in one of the camps - Darey Ma’ane, otherwise known as Boroma 1 - in the West Galbeed region of northwest Somalia. The author, Una MacAskill, arrived at Darey Ma’ane camp in October 1980 on the day it was opened. She was the first member of the Save the Children Fund (SCF) medical team, which, with assistance i n the early days from a group of Oxfam nurses, established n continuing programme of nutritional and medical assistance for a camp population which is estimated to have peaked at about 80,000 people.

The population consisted of farmers and pastoralists forced out from the Jijiga area of Ethiopia. Their general condition as they moved in from transit areas and from the surrounding countryside was poor, with high levels of malnutrition amongst the children. The immediate objective of the agency was to provide a readily available supply of supplementary rations to all malnourished children under 5 years of age, and to institute intensive therapeutic feeding for the most severely malnourished. The author’s initial task, which was largely precluded by the overwhelming increase in numbers over the first days, was to register, weigh and measure arriving children in order to facilitate the subsequent opening of feeding centres and to establish a baseline nutritional assessment in the child- population against which the effective coverage of the programme could be assessed.

As the conditions in Darey Ma’ane camp stabilized over the next few weeks, and as additional agency personnel arrived, it became possible to set up a system of feeding centres and paediatric clinics based on the internal administrative layout of the camp. The arrival of a water engineer significantly improved the water supply available to the population. Between November and January, the struggle by both the Somali administration and the expatriate team to provide an expanding, severely afflicted population with minimal food supplies, began to have an impact on the very high levels of malnutrition and infection - conditions which, at their height in November and December, were causing the deaths of an estimated 300 to 500 people each month. Then, in subsequent months. the provision of nutritional support was extended to other high-risk populations in the camp, clinic services were expanded and a training programme for local staff was developed.

The author arrived in Somalia in September 1980. and spent 3 weeks working in Agabar camp. After the decision by SCF to provide help in Darey Ma’ane, she moved to the town of Boroma. a short distance from the site of the new camp, accompanied by two other SCF staff.

REPORT

I arrived in Boroma town with another nurselmidwife and nutritionalist from SCF on 12th October 1980. The District Commissioner of Boroma and the Deputy Regional Refugee Commissioner met us at the ‘orientation centre’ - i.e. the basketball court and general meeting place for the town - and we were given a speech of welcome. We wanted to stay at the hotel in town but somewhat to our surprise we were treated as important guests of the town and given rooms in the State House.

Early next morning we were escorted to the camp approximately 7 km from the town in hilly countryside. The terrain was rocky, with sand covering and a lot of thorn bushes and trees. The road was uneven but solid.

The site of the camp, at an average altitude of about 4,500 ft was very hilly with gullies and crevasses. The \oil was sandy over fairly soft rock with a little weed cover near the dry river bed.

On arrival at the camp, we were introduced to the camp administration who were very welcoming and hospitable. They were a mixture of Somali nationals and Somali refugees from Jijiga, Ethiopia and they had all been posted to the camp under secondment from the Ministry of Education. They were mostly friends of long standing who had worked in other camps and had applied to work at Boroma 1. Following out meeting with them, we then met the German Red Cross team - (1 doctor, 1 nurse, 1 mechanic). The doctor and nurse were conducting a clinic session with a Somali nurse and four Red Crescent

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85 REPORTS FROM THE FIELD

volunteers in a makeshift tent. The mechanic was digging a well in the tug bed (seasonal river bed) with the aid of some volunteer refugees. There was a school teacher from Boroma town who spoke German acting as interpreter.

The first ‘section’ of the camp was settling in and the second ‘section’ was arriving in family groups, carrying all their belongings, bringing their animals with them. (A section is approximately 400 families, therefore approx- imately 2 4 , 0 0 0 people were already on or around the site.) The bulk of the first section were families who had stayed at the transit camp nearby for a long time as one or more of each family had been too sick or badly nourished to travel to the previously opened camp.

On reaching the site of the camp they had begun immediately to cut down trees surrounding the site of the camp and build shelters - the traditional aquals. They are made of cardboard or sacking over the bent wooden frames, and dress material or traditional heavy matting which looks like mobile thatching and is more or less weatherproof.

We toured around the camp, met some refugees and then spoke with the camp administration about the approximate eventual boundaries of the camp and the approximate distribution of the population over this area. We found the area chosen by our Field Director as a possible site for our camp compound and agreed that it was the best place to set up camp.

This was situated just above the German Red Cross and the Somali Red Cross site so that it kept the medical teams in the same area. There was quite a lot of pressure put on us to be situated within the camp administration compound - both from the camp administration and more particularly from the District Commissioner of Boroma and the Deputy Refugee Relief Commissioner.

There was one feeding centre functioning at the camp, run by the Red Cross, which fed twice a day, but there was no searching for severely malnourished children and entry into the feeding scheme, though initially determined by the weight/ height index, was mainly by eye assessment complemented by attempts by refugees to wear down the will of the organizers. Therefore, there were quite a lot of well-nourished children there. This feeding centre was situated 10 m from the doctor’s clinic.

On the basis of the situation as we saw it that first day, the nutritionalist suggested that the best things to do initially were to:

(a) weigh, measure and register all small children (less than 110 cm height) for entry into one of the feeding programmes (either supplementary or therapeutic); (b) set up feeding centres (i.e. buildings of some sort); (c) find staff to run the feeding centres; (d) train staff in their different activities.

Before my fellow team members left me alone, they helped me begin weighing and measuring the children. We went from aqual to aqual along the roughly defined rows beginning with section one. A Somali school teacher from Boroma appeared to help with interpreting, having been sent by the District Commissioner in Boroma. Seven to eight refugees, two who could read and write a little, arrived to

assist us in the work, having been sent by camp administration in some cases or spontaneously volunteering. No-one was forced to work with us, so in that sense, all were volunteers.

The Medical Officer from Boroma District arrived in camp to introduce himself and offer any assistance and he brought to camp the local district Public Health Nurse and Midwife whom he promised would help with the work we were beginning.

By nightfall, the numbers had reached around 10,000. I remained in the camp with my own tent, while my five colleagues went off to work in another camp.

The next 3 weeks

Over the next 3 weeks, I continued the task of weighing the children, going from aqual to aqual over the first five sections. The population expanded dramatically at the rate of 4,000-5,000 per day. I sought the assistance of section leaders to organize the refugees in setting up feeding centres for the more malnourished children, and arranging for the construction of shelters for the children to sit in while waiting for food. I inlisted the help of the refugees, going round the aquals asking for people to help cook and look after the children. The refugees had been organized by the small but efficient Somali camp administration into sections of 2,000 to 3,000 people, and these groups selected workers for me. I looked in particular for sensible and responsible older women, for young girls to do simpler tasks, and for a couple of people in each centre who could read numbers. The camp administrators were extremely helpful, giving me CSM and dates from the general ration for supplementary feedin

1 arranged with the W%P representative in Hargeisa to obtain milk, oil and sugar, and these arrived after about 3 weeks, together with tinned chicken.

Water supply for the centres came from wells in the bed of the tug - the dried-up river bed running through the camp. There was one deep well at this time, and the refugees were also digging small surface wells. I arranged for a patrol to be organized around the well to stop people defecating there. Water for cooking was brought by the mothers of children who attended the feeding centres. Supply at that stage was not a problem.

I would start in the morning at around 8 am, going around the aquals measuring children, to select those who most needed feeding (the feeding centres themselves could be operated by selected refugees). I would continue screening children until about midday. and then return to the hottest 3 hours of the day. I started screening again at about 3 pm, continuing until it began to get dark at about 6 pm. I slept in the camp, in a small field tent.

I tried to get some of the Red Crescent Somali girls who were working for the German Red Cross team, who had transferred to Boroma 1, but the German team wanted to keep these girls to assist in the surgical clinic they had set up. Nonetheless, some of the unattached Somali Red Crescent people who had been running supplementary feeding programmes in the transit camp also transferred,

86 REPORTS FROM THE FIELD

and set up small feeding points in various parts of Boronia 1 .

'I'hings were going slowly due to several factors. Sometimes my interpreter was very late back to work in the afternoon so that I couldn't start till 4.30 and darkness fell at b.30 p i 9 so it made i t a very short working afternoon. Sometimes the children were very frightened of the aaden (white person) so that it was a real fight to get a correct weight or height measurement. Sometimes the children would be collecting wood or water for their mother or be :tuay with their mother doing the same.

A major difficulty was persuading the refugees to bring tlicir children to the centres. The refugees would generally t i u l sick children only a few cups of unboiled water a day. I urgently needed resources to locate these children - people io go round the aquals rounding up the sick children and h i n g i n g then1 to the centres.

After 3 weeks, Mary-Jean, the first of my colleagues arrived. This improved the work tremendously, and the xed with which i t was done thereafter was largely due to her energy and drive. We talked over the possible strategies ;Ind a rearrangement was made. We set up a weighing cwitre section by section to speed things up, which was a very good move. Somali nurses helped out with the weighing ;I nd measuring and registration to get it completed quickly.

During this time nine sites for feeding centres had been chosen and we asked the help ofthe camp administration to get sonie type of building situated at each site. This they did vcrv well, especially impressive was their threats to put wciion leaders in prison if their buildings were not completed within a week, as a result of the work going too \ lowly to keep us happy. Only two centres were not co t i1 11 let ed wi th in this t i me!

Thc buildings were wooden framed - just 9/10 ft by 3/4 ft diameter tree branches/trunks which were supports w i t h 1 in. diameter sticks as the walls, bound together with '\tring' made of bark stripped from the thorn trees. A cover of sacking was sewn onto this frame to protect food and children froni being covered in dust froni the wind. The buildings were partitioned so that there was a cooking/food storage area and a feeding area for the children to sit down

Mary-Jean had also come across two women who had been involved i n feeding programmes in the Ogaden who volunteered to show other workers how to mix the food and gencrally how t o r u n the feeding programme.

Oxfani feeding kits had been ordered when we had first realized that we would need nine feeding centres and so ihcsc arrived to kit out the feeding centres adequately. Each l'ecding centre had one large cooking pot of about 100 1. c.npacity to feed approximately 2 W 3 0 0 children. (We i.eally needed two large pots so that we could feed four times ;I day, as each pot needed to have 2 hours preparation on the log fire to get the food to boiling point and to boil for 10-20 niin utes.)

I n November, five Oxfani nurses arrived, and the Gernian lied Cross team left. Each of u s then took responsibility for one feeding centre, concentrating on supervising the iwepration of feeds, inspecting hygiene and trying to make \urc th;it the children's hands and faces were washed before

111.

feeding sessions. We would then go round the aquals in our sections to search for sick children.

As the feeding centre began to operate, we were concerned about the number of very severely nialnourished/ dehydrated children we saw and did not feel that we were doing sufficient to help them so we put up a Blue Disaster Tent in out camp compound to be used as a small 24 hour ;I

day rehydration treatment centre. This was i n progress for 2 weeks run by the two Oxfam nurses and we had to conclude that it was not feasible to continue its function for several reasons:

(a) The chances of success even given excellent conditions were remote. (b) Quite often, the parents took drips out and rentovetl nasogastric tubes when our backs were turned. (c) The parents frequently removed the children as wc were doing things they did not like. (d) Working long hours with almost no returns was detrimental to our morale, making us less able to carry out the more mundane work which would have the most beneficial effects in the long-run. (e) Most ofthe children in the rehydration unit died in o t t r care which was bad propaganda for our work. (0 Parents continued to use traditional cures in additiun to our care (e.g. giving fermented camels' milk, burning the abdomen with red-hot sticks to cure the 'liver' disease or whatever they thought was the problem).

By the time the main SCF team of a doctor, an engineer and nine more nurses arrived we had seven feeding centres functioning - not perfectly but reasonably adequately and had at least weighted and measured and registered all thc children brought to the weighing stations over the whole camp.

With the arrival of the full SCF team, it became possible to consolidate the supplementary feeding programme and to make a start on the longer tern1 tasks. These were:

I . Provision of supplementary rations to other 'at risk' groups, including malnourished children over 5 years old, sick children and adults, and pregnant and lactating mothers. 2. Providing the best possible water supply. 3. Initiating an immunization programme. 4. Setting up mother and child (MCH) clinics tor preventive care. 5. Setting up ante-natal clinics. 6. Giving health education to the refugees by training Con1 ni u nity Health W or ken. 7. Providing general niedical care for the canip :I whole. 8. Starting a TB programme and clinic.

The main effort was put first into supplementary feeding and therapeutic care for children.

Feeding had been started on a twice daily basis and then. as soon as feeding centres were coping well with this, an extra two feeds per day were started for the severely malnourished children. Their working day in the feeding

REPORTS FROM THE FIELD 87

centres began at 6 am for the first feed at 8 am - CSM porridge, the last feed was aY 4 pm, so that cleaning and clearing up could be completed by nightfall.

Each feeding centre employed the following:

Donkey madwoman for water supply 8 cooks 2 guards 2 clerks.

From this number, the Somali staff elected a ‘boss’ for the feeding centres to act as spokesman for the group and to liase with the leaders of the sections which were serviced by the feeding centres. The supervisors were responsible for ensuring that their feeding centre was running properly.

A head cook was elected too, so that each feeding centre arranged their coverage to make sure that older women and young girls were mixed and so there would always be responsible women at the feeding centre.

Drums which had contained cooking oil for general rations were utilized as water storage. People with donkies/camels with water drum paniers were hunted out and their services were asked for as water collectors/ carriers. Due to the very hilly terrain and the distances to cover, we employed one ‘donkey man’ (women) or camel man/woman’ per feeding centre. The exchange for this service was 2 kg maize/day for the donkey and extra rations for the owner.

After the German team left, their senior Somali nurse carried on with their clinic. In addition, working from feeding centres and supervising nurses from the Somali Red Crescent, the expatriate nurses began to develop child welfare and ante-natal clinics. In each section a clinic was designated as a therapeutic centre, and one SCF nurse remained their full-time to supervise, and to run a paediatric clinic. The supplementary feeding centres required less direct supervision.

Early on the contribution of the relatively untrained Somali nurses was limited in terms of the responsibilities expected of them in this highly abnormal situation. They had little knowledge of drug doses, nor did they know how to give drugs. They didn’t examine patients effectively, nor would they regularly refer sick children for special feeding. As an example, if one of these nurses had only a limited supply of a particular drug, she (he) would give small amounts to many children, rather than reserving it to get an effective course of treatment for those who needed it most. We did what we could to help, but in these particular circumstances it was clear that the camp was not the place for basic training. There were similar problems with the training of refugees to be community health workers, the Somali nurse responsible was untrained in teaching, and severely overworked. As a result, the training of refugees in basic public health methods was relatively ineffective initially, but the Somali nurses who arrived later were much better prepared for refugee work. Despite these problems, the relations with the Somali staff and refugees was excellent. (A letter written from the camp and reprinted with the author’s permission captures some of these feelings. 1

“All the people we have dealings with are very friendly and helpful, extremely hospitable and a lot are also very affectionate towards us. The Camp Administration is probably the best in Somalia - very energetic, clear and far-sighted, caring, honest and hard working. That team is organized by the Camp Commander, who is a young man, is a refugee himself and has exceptional abilities for getting the most out of his staff and the refugees themselves. He is by nature extremely charming, which probably makes his job easier, but nonetheless, he does not use that in place of hard work or good thinking - one of the lovely people of this world. The local town people, such as the doctor, the main nurse/ midwife/ health visitor, school teacher, the District Commissioner are more than friendly and are very helpful towards us. both at camp and in town. Maryan the nurse, works 3 days at camp with us to teach and run a basic midwifery course for the traditional midwives in addition to her own supervisory role within the town. She is tremendous, great fun, a hard worker and has lots of initiative. so she’s a real boon to the work. Almed, the doctor, is also one of the best people I’ve ever come across. He looks in on the camp every day at some point, helps our doctor or stands in for him when he is away. He’s got a good sense of humour too, really good company and has these very English phrases such as ‘Oh, really.’

He calls on us when he needs some extra help in the hospital for an emergency operation - there have been some bad accidents near the border so we all have our little taste of ‘High Drama’ every so often. He’s a very good surgeon and works under very, very primitive conditions, but at least the town is small enough to be able to ask the generator operator to continue past midnight so that the surgery can continue under reasonable light.”

As the programme developed, our camp work came to include feeding of malnourished children, teaching community health to trainee volunteers from within the camp, treating sick children, advising and teaching mothers on nutrition, cleanliness, water problems, running MCH clinics, ante- and post-natal clinics for a child population of approximately 25,000 under fives and 27,000 6-15 year olds. We aslo ran a TB clinic from 12th January 1981 onwards. The numbers under treatment for TB increased daily, until 310 were registered in early May.

The main problems in the first few weeks 1. The Red Cross team wished me to devote my time to

curative care, i.e. help in their clinic and maintain intra- venous therapy on severely dehydrated and malnour- ished children.

2. The need for measles immunization. 3. Slowness in getting feeding centres built. 4. Slowness in getting feeding centres functioning. 5. Lack of personnel (refugees/local) to promote public

6. Losing sight of goals and being sidetracked. 7. Rapid movement of population into the camp. 8. Misinformation about other camps. 9. Water. 10.Hospital.

health education.

88 REPORTS FROM THE FIELD

Point 1: Pressure to provide curative care. This proved to be a major issue which was not easily overcome. A compromise was reached, with the Red Cross team doing the curative work and SCF working on the preventative side - a good split of responsibilities. The problem was highlighted in that SCF had the long-term medical responsibility for the camp but only had one nurse there. The Red Cross had very kindly offered their services until SCF had a doctor and a few more nurses in situ. The Red Cross had been working in the transit camp, and were used to doing short-term stop gap care that was necessary in that situation. They were very tired and overworked; the doctor was run-down and ill; and morale was low. It was also expected of them that all medical personnel would be under the complete direction of the doctor, he being the senior medical person in the camp.

The curative service- had to be offered, but perhaps at a different level. The preventative service had to be started, and it had to be started immediately. The compromise was agreed. and we went our separate ways.

Point 2: The need for measles immunization. In retrospect, looking at this early period, I believe the most important task was immunization against measles. A non-immune population of badly nourished children was being drawn together from a wide area, and settled in this relatively dense camp. 1 would like to have been able to organize an immunization programme during the first days, using one of the jet-injector guns. Although it was impossible in this setting to get a clear idea of the death rate, or the specific causes of death. I believe that several hundred people died during the tirst month, many of them children, and that measles was a significant factor.

Points 3 and 4: Slowness in getting feeding centres built and functioning. I made the mistake of not realizing that the feeding had to be started immediately, even without some \helter, and that proper pre-registration was taking far too long, and resulting in more malnutrition and more severe malnutrition. There was not the same feeling of need among the refugees for having feeding centres or shelters which I had, which created conflict. I assumed that they wanted their sick and malnourished children fed, but this is contrary to their beliefs about the care of sick children. Their culture starves sick children until the evil spirit has gone. Likewise, only very limited fluid is allowed - equivalent to 300-400 nil a day. Many had avoided being sent to the previously opened camp because they had heard that all the children died there from malnutrition and diarrhoea, so 1 assumed that they were aware of the need for feeding centres. In actuality, they believed that feeding centres were the places where children contracted diarrhoea and disease. Sick children should also stay at home according to their beliefs.

Most of the population was nomadic, so working together is not a well-practiced art, and there were many squabbles and differences of opinion which held up the work.

I also thought that if the children were fed without proper shelter, then there would never be any push for shelters to be built and that therefore none would be built.

Point 5: Lack of personnel to promote public health education. In fact many people were available, and doing less urgent work, but I did not publicize the need for this enough, perhaps due to the feeling that I’d asked the camp administration for so much help already and they had too much to do themselves. If I’d pushed hard enough in the right places, I could have taught in 1 week basic public health and hygiene to a good core group of people. They, in turn, would then have had sufficient knowledge to disperse and teach the same things to small groups of the population throughout the camp.

Point 6: Losing sight of goals and being sidetracked. Having a medical team with an entirely different concept of health needs and priorities made me less sure that the goals I’d set were the right ones; therefore time was wasted over worrying about this and at the same time concentration in the planning and reassessment of the needs was lost to a certain extent. It was not possible for me to discuss my work problems with the other medical staff, so I lost the good chance of self-criticism and reinforcing of good ideas that usually accompanies discussion.

Point 7: The rapid movement of population into the camp. The population grew so rapidly that the camp appeared to be in complete disarray in every way. No-one could keep up with their work. The camp administration, trying to register the people as they arrived, could only cast a cursory glance and families could spend little time in getting the ages of children or even number of children in a family correct. The clinic tent had large queues forming early in the morning. Many people seemed to ignore the designated latrine areas and used the tug bed, despite the presence of a patrol to guard against this. Food was in very short supply, mainly because the authorities refused to believe the camp administration’s statistics. The refugee population found it very difficult to accept this situation of food supply, and were therefore less amenable to suggestions of work and co-operation. Many of the refugees were probably physiologically incapable of much work.

The rapid population rise occurred because people had been sitting in the hills around the transit camp (i.e. close to Boroma town). and not registering at the transit camp because of the fear of being sent to the previously opened camp. Their general health and nutritional status was very poor in many cases, because the refugees had to live vcry frugally while in the hills.

Point 8: Misinformation about other camps. Many people had information and ideas about how other camps were run and organized, and about the amounts and variety of food available for each person, and knew of all the facilities in the camps (e,g, “All children are fed extra porridge and milk - why don’t we get it for our children? You are keeping it” or “There are five items of food available and you are only giving us maize”). Almost half the population had the same traditional leader who was also in camp as a refugee, and he wished to be camp commander. So he spread many rumours to cause unrest, aiming to have the commander removed to make way for him.

REPORTS FROM THE FIELD 89

Point 9: Water. Water was collected by each family individually in the traditional way from surface wells dug in the tug bed. In the situation most refugees were familiar with - small populations using one stretch of tug - wells of this sort would supply clean, drinkable water in reasonable quantities. In the camp, however, thousands of people were using a stretch of tug only at the most 2 km long, with the added burden of an upstream well and pumping station supplying the water for Boroma town, a large boarding school, and some irrigation projects. Neither quality nor quantity were good.

Point 10: Hospital. A hospital was set up by the Red Cross team. This, as well as the clinic, was given kudos by the guaranteed appearance of the doctor twice daily, and the presence of all the trained Somali nurses. They were also the places for indiscriminate distribution of drugs. This has proved to be a long term problem. The refugee population is of the opinion that where there is western medicine there is a magic potion for all ills, and that there is no gain to be had from learning different ways of living (e.g. boiling water because it is polluted, feeding sick children, or washing sick children). The hospital was closed, and relatives looked after the sick or they were transferred to the hospital in Boroma.

Volcanic eruption in northern Japan

Hirotada Hirose

Tokyo Woman’s Christian University Zempukuji, Suginami-ku Tokyo 167, Japan

THE DISASTER

On 7th August 1977, Mt. Usu, a volcano in Japan’s northern island of Hokkaido, awoke from 30 years of dormancy with a major eruption that sent smoke 1,200 m into the sky. Sixteen more eruptions of various sizes followed during the next 6 days, depositing several tens of cm of ash on Toyako- Onsen, a hot-spring resort situated directly beneath the mountain. Most of the residents were evacuated to places of safety designated by the town authorities or to the homes of friends or relatives in other towns and villages. Except for maintenance personnel left at the inns and hotels, Toyako- Onsen became a ghost town.

Since Toyako-Onsen had been one of the most frequented hot-spring resort areas in Hokkaido, the eruption came as a severe blow to the tourist industry there. With the end of the summer tourist season approaching and the businesses that depended on tourists claiming that further continuation of the evacuation orders would ruin them, the mayor of Abuta (the town which includes Toyako-Onsen) rescinded the order for the daytime hours (from 8:OO to 1790) on 23rd August. Ther was, however, a disagreement between the town of Abuta, which wanted the evacuation order lifted as quickly as possible, and the police and prefectural authorities, who held that it was still too early and cited in support the view of the Volcanic Eruption Early Warning

Group* that the danger was not yet over. The town authorities dealt with this by lifting the evacuation order by stages. On 29th August, residents of certain areas were allowed to remain at home at night, and on 7th September, a month after it had been issued, the evacuation order was finally completely rescinded. The police, however, who had been critical of the lifting of the order from the outset, continued to restrict traffic in the area, so that tourism was not viable even with the evacuation order rescinded. The town authorities, pleading the cause of the inn- and shop- keepers, repeatedly asked the police to relax the traffic restrictions, and the police finally agreed on the condition that adequate safety facilities be provided in Toyako-Onsen. Tourism resumed on 23rd September, after what had been a difficult month and a half (Hirose, 1979; Watanabe, 1981).

RECONSTRUCTION AFTER THE DISASTER

Hokkaido as a whole suffered losses totaling Y67.9 billion from the eruption of Mt. Usu, with the city of Date and the towns of Abuta and Sobetsu bearing the greatest damage. The effect on Toyako-Onsen had been particularly severe, but the town authorities set to work to accomplish a speedy recovery and turn the calamity to their advantage. Within a year of the eruption, two new tourist attractions, a Museum of Volcano Science and a Pheasant Park, were opened i n Toyako-Onsen, and in 1980 work to equip an “adventure park” with facilities for field athletics. In addition to these efforts to renovate Toyako-Onsen as a resort town, a project has been undertaken to fill in a 20-m wide, 1.8-km long section of Lake Toya, plant trees and shrubs, and create a promenade ground. The first stage of this project will be completed in 1982, and the second in 1987. Since this promenade has been designated by the prefecture of Hokkaido as an emergency bypass route, the prefectural government will bear one-third of the Y4.1 billion

* A liaison committee of volcano researchers authorized by the national government to conduct and publish observ- ations of volcanoes during normal times and to predict the occurance and scale of volcanic activity.