On Monday, about 100 patients were moved out of a hospital and into a temporary shelter at a high school gymnasium in Iwaki, said Chuei Inamura, a government official in Fukushima, the prefecture north of Tokyo that is home to a nuclear plant where authorities are struggling to stem radiation leaks from overheating reactors.
Two died in transit and another 12 while at the gym. Plans to transfer them to other hospitals were delayed by a shortage of vehicles and fuel and the fact that nearby hospitals were already full. By Thursday morning, the remaining patients had all been moved to other hospitals.
"We feel very helpless and very sorry for them," Inamura said. "The condition at the gymnasium was horrible. No running water, no medicine and very, very little food. We simply did not have means to provide good care."
Many of the rural, seaside towns hit by the tsunami were in economic decline and had seen an exodus of young people, who moved to major cities for work.
That may explain why many of those staying in temporary shelters are elderly.
At one, a junior high school in the city of Kesennuma, a few ointment tubes, bandages and boxes of aspirin and stomach and cold medicines were stacked on a table at a shelter at a junior high school.
"There's not enough," Keiko Endo, a 58-year-old nurse, said. "It's a problem."
Nearby sat a group of elderly men and women, a single kerosene heater doing nothing to warm a large drafty gym in chilly, often snowy weather.
"It's freezing, there are people who are sick and injured," Endo said. "People are mostly putting up with whatever's wrong. We're trying to comfort and help them, but we can't do too much."
The very sick can be taken by ambulance to a hospital, she added, but with no electricity and sketchy or no cell phone service, setting that up is often difficult.
Doctors Without Borders, the international assistance group, has seen cases of hypothermia, serious dehydration and respiratory diseases in some of the shelters, said Eric Ouannes, general director of the group's Japan affiliate.
"The consequence of the earthquake, but more the tsunami, has caused the loss of their prescriptions," he said. "Some don't remember what they were taking, how much, and what was the exact prescription. So that makes things a little more complicated."