The Supreme Court on Feb. 25 set stricter certification standards concerning atomic-bomb related diseases, thereby rejecting bids by three hibakusha plaintiffs for special monthly allowances and dwindling the hopes of future applicants.

The elderly plaintiffs sued the health ministry after it rejected their applications for the special monthly assistance for treatment of illnesses related to radiation exposure from the 1945 atomic bombings of Hiroshima and Nagasaki.

The main issue of the lawsuit was the definition of “periodic evaluations” that are required for certification and eligibility for the allowances.

The Supreme Court laid out guidelines for certifying those under periodic medical observation for atomic-bomb related illnesses in line with the ministry’s stricter rules.

Under the government’s multitiered certification system, those who were within a certain distance from ground zero when the atomic bombs were dropped on Hiroshima on Aug. 6, 1945, and Nagasaki three days later are certified as hibakusha and eligible for free medical care.

The certification also applies to people who entered the two cities within two weeks of the bombings as well as those in the wombs of their mothers in the two cities during the blasts.

Additionally, a monthly allowance of 34,770 yen ($315) is paid for further medical care if the hibakusha develop illnesses recognized by the government as likely to have arisen from radiation exposure.

And those certified as having an atomic bomb-related disease requiring more advance medical treatment receive the special monthly allowance of 141,300 yen.

To become eligible for this top-level certification and the special monthly allowance, the hibakusha must have a recognized atomic bomb-related illness that requires regular medical observation or treatment.

Various high courts have made different interpretations on what constitutes regular medical observation.

The Feb. 25 ruling by the Third Petty Bench of the Supreme Court settled matters by saying that a number of special circumstances must be established for such certification.

Under the court’s guidelines, the bomb-related illnesses must have a high risk of worsening or returning that require regular visits to the doctor for observation or aggressive medical treatment that goes beyond preventive care.

The top court rejected the lawsuit of the three plaintiffs because their symptoms had been stable for a long period and they no longer required regular medical treatment.

The guidelines will serve not only as a standard for future certification by the central government but also as a precedent for similar lawsuits.

The health ministry is also expected to use the guidelines for its assessments made every three years on whether to continue certifying those as having an atomic bomb-related disease.

Masanori Okada, a professor of administrative law at Waseda University in Tokyo, said the ruling was a very severe one for hibakusha because it was made from the standpoint of the government implementing the program.

“There are many aspects about the effects of the atomic bombings on humans that are still unknown,” Okada said. “There is a high need not only for the hibakusha but also the medical institutions for an extended period of observation of such individuals.”

He added that although the ruling did not totally slam the door on hibakusha seeking the special monthly allowances, certification could become extremely difficult to obtain if the central government uses the ruling in a mechanical manner to make its decisions.

In 2014, the central government issued a directive to local governments to appropriately reassess individuals with atomic bomb-related diseases conducted every three years. A health ministry committee raised the point that the reassessments had been made “for many years in a vague manner.”

The health ministry set its own standards on recognizing an individual as continuing to require periodic medical observation, saying certification should be denied for those with cancers that have been in remission five years since surgery.

The new standard led to a sharp increase in rejections of certification renewal applications.

Previously, only a few cases were rejected, but the rejection rate has now risen to about 20 percent.

Some hibakusha organizations said a number of individuals have given up seeking certification because of the amount of time that has passed since their surgery.

According to the health ministry, 145,844 people were certified hibakusha as of the end of March 2019, the first time the number has fallen under 150,000.

Those certified as having an atomic bomb-related disease numbered 7,269, or about 5 percent of all hibakusha.

The average age of those certified with bomb-related diseases is 82.65, and their numbers will likely continue declining, especially if the central government maintains its strict certification standards.

(This article was compiled from reports by Takuya Kitazawa and Sokichi Kuroda.)