The Suzu General Hospital in the early afternoon of Jan. 25 was eerily quiet, given that it is the only public hospital in a city hard hit by the Noto Peninsula earthquake.

The waiting lobby was empty, and the lights were off at the checkout counter, where no one was working.

“I can only assume that the decrease in patients is due to the decrease in the number of people living here,” Kazukimi Ishii, 58, director general of the hospital, said as he sat in a chair in the lobby. “Before the earthquake, the population in Suzu was around 12,000, but now it is sensibly less than half.”

Suzu, located at the northern tip of the peninsula in Ishikawa Prefecture, was already an aging and shrinking city before the Jan. 1 earthquake. The disaster appears to have hastened an exodus from the municipality, threatening to end local medical care.

Suzu General Hospital has 13 departments, including internal medicine, surgery, orthopedics and neurosurgery.

The quake cut off the water supply to the hospital, and surgeries, which used to be performed 200-300 times a year, were suspended.

In the aftermath of the quake, hospital staff were busy dealing with emergency patients and people in need of drug prescriptions. But from mid- to late-January, the number of those patients drastically decreased.

As of 2020, 52 percent of Suzu’s population was aged 65 and over. It was the highest “aging rate” among cities on Japan’s main island of Honshu.

Suzu was also Honshu’s smallest city, based on population.

When the New Year’s Day quake hit, Suzu was home to about 6,000 households.

More than 5,500 homes in the city were damaged or destroyed in the disaster.

The hospital’s lobby was overflowing with injured patients and evacuees. Almost every hospital worker was personally affected by the earthquake.

Within three days, the hospital was walking a tightrope in securing drinking water and food.

The Disaster Medical Assistance Team (DMAT) arrived on the evening of Jan. 3, and began transporting patients to other hospitals and facilities the following day.

Overall, DMAT took about 1,000 people from hospitals and elderly care facilities out of the Noto Peninsula.

In addition, nearly 5,000 people who were staying in evacuation centers and other emergency facilities had been taken to “secondary” evacuation centers in Kanazawa and other cities as of the end of January.

Some have left their quake-hit hometowns, including Suzu, apparently for good.

The National Institute of Population and Social Security Research predicted that Suzu’s population would shrink to 5,000 by 2050.

“It looks like we have warped there just in three weeks,” Ishii said.

Ninety percent of the hospital’s approximately 250 employees, including part-time workers, have continued to work.

But Ishii is concerned about the future.

“If the number of people leaving the workforce is going to increase, it will be from here on out,” he said.

“Damaged homes, children’s education, caring for parents … what will happen to this city?” Ishii said. “I never had time to think about the future, but now I have to think about many things.”

What is worrisome is a possible negative cycle.

If the number of residents continues to fall, patient levels will decline and staff will leave the hospital. If medical care in Suzu cannot be provided due to labor shortages, the population outflow will accelerate. And those who have left Suzu on a temporary basis may be unable to return.

On Feb. 1, the hospital resumed some outpatient services, such as internal medicine, surgery and pediatrics.

“We have made some progress,” Ishii said. “It is precisely because of this situation that the medical field must be firm.”

Like Suzu, many other municipalities in the disaster-stricken area are aging and shrinking.

The demographics on the Noto Peninsula are different from those in other areas of Japan that have experienced devastating earthquakes.

In the 1995 Great Hanshin Earthquake, the aging rate in seven hard-hit cities and towns was about 13 percent. The aging rate in Iwate, Miyagi and Fukushima prefectures was about 24 percent in 2010, a year before the Great East Japan Earthquake and tsunami hammered the Tohoku region.

The aging rate in Suzu, Wajima, Noto and Anamizu in the northern part of the Noto Peninsula was 49 percent as of 2020.

The combined area is about 1.8 times the size of Tokyo’s 23 wards, but there are only five hospitals with 20 or more beds.

Each of the four municipalities has at least one public general hospital, and they have been the focal point of local medical care.

According to the Ishikawa prefectural government, as of late 2020, 72 percent of doctors working at clinics in the four municipalities were over 60 years old.

Therefore, general hospitals have also played a central role in the function of family doctors in these communities. And yet, there were talks about reorganizing care facilities before the quake.

“There was a shortage of doctors, nurses, pharmacists, laboratory technicians, and all other personnel,” a prefectural government official said.

“Even if we have facilities, we cannot maintain them if we don’t have people who can work there.”

Compared with the Great East Japan Earthquake, the number of victims of the Noto Peninsula quake has been small.

However, with half of residents on Noto being elderly, the earthquake has greatly disrupted the balance of supply and demand for medical care.

Older people with pre-existing medical conditions are more likely to become ill in the harsh post-disaster environment. Remaining in the disaster area itself increases demand for medical services and care.

But there is an overwhelming shortage of medical workers and care takers in the region.

Relocating people from disaster areas is expected to prevent disaster-related deaths. And local officials and DMAT teams have worked to bring this to the forefront of their activities.

However, exclusive devotion to relocation could worsen the problem.

Teruhiro Sejima, 55, a director of a clinic in Noto who has provided medical treatment since the quake struck, is increasingly concerned about the effects from wide-area transport and secondary evacuations.

“How will we provide medical care to those who live here and need it now?” he said. “If medical care is withdrawn, the town itself will disappear.”

The Noto Peninsula disaster and its effects on medical care will be probably not be considered “unique” in the future.

Wajima’s aging rate as of 2020 was 46 percent.

By 2035, a quarter of Japan’s municipalities will have the same aging rate, and by 2050, half of them, according to an estimate of the National Institute of Population and Social Security Research.

(This article was compiled from stories written by Akiyoshi Abe, Yuki Edamatsu, and senior staff writer Tokiko Tsuji.)