The Official Report of the National Diet of Japan Fukushima Nuclear Accident Independent ...

502 Pages·2012·13.54 MB·English

Introduction | page 1 The National Diet of Japan Fukushima Nuclear Accident Independent Investigation Commission
Introduction
Introduction | page 2 The National Diet of Japan Fukushima Nuclear Accident Independent Investigation Commission
The National Diet of Japan
Fukushima Nuclear Accident Independent Investigation Commission
(NAIIC)
To:
Mr. Takahiro Yokomichi, Speaker of the House of Representatives
Mr. Kenji Hirata, President of the House of Councilors
The National Diet of Japan
OUR INVESTIGATION, WHICH WAS COMMISSIONED BY THE ACT REGARDING THE
Fukushima Nuclear Accident Independent Investigation Commission on December 8, 2011,
adjourned today. This report is now entrusted to the members of the National Diet of Japan
for their review and use.
We would be grateful if you could spend time to read this report, which is the first
investigation report in the history of Japan’s constitutional government to be conducted by
an independent commission chartered by the Diet, in order to affirm and crystalize this first
endeavor and also to enhance and strengthen the functions of the Diet related to the monitoring
of nuclear power legislation and oversight of the administration. We sincerely request that you
tackle the numerous issues raised by this report using your collective wisdom.
We hope that our efforts over the past six months can be utilized to help those who are
still forced to live in shelters and for the future benefit of Japan.
Tokyo Electronic Power Company, Fukushima Nuclear Accident Independent
Investigation Commission
Chairman:
Kiyoshi Kurokawa
Members:
Katsuhiko Ishibashi Kenzo Oshima Hisako Sakiyama
Masafumi Sakurai Koichi Tanaka Mitsuhiko Tanaka
Shuya Nomura Reiko Hachisuka Yoshinori Yokoyama
Introduction | page 3 The National Diet of Japan Fukushima Nuclear Accident Independent Investigation Commission
Preface
THE FUKUSHIMA DAIICHI NUCLEAR POWER PLANT ACCIDENT IS NOT OVER.
This large-scale accident will forever remain part of the world’s history of nuclear power.
The world was astounded at the fact that such an accident could occur in Japan, a scientifi-
cally and technologically advanced country. Caught in the focus of the world’s attention,
the Japanese government and Tokyo Electric Power Co. (TEPCO) revealed, in their response
to the disaster, some fundamental problems underlying Japanese society.
The Fukushima Daiichi Nuclear Power Plant was the third nuclear power plant to start
commercial operation in Japan. Japan began to study the commercial use of nuclear power
in the 1950s. Following the oil crisis of the 1970s, nuclear power generation became part
of Japan’s national policy, unifying the political, bureaucratic, and business circles into one
entity promoting its use.
Nuclear power is not only the most incredibly powerful energy ever acquired by the
human race, but a colossally complicated system that requires extremely-high levels of
expertise as well as operational and management competence. Advanced countries have
learned lessons through experience and from many tragic events, including the Three Mile
Island and Chernobyl accidents. Authorities in charge of the world’s nuclear power have
maintained a basic stance of protecting people and the environment from all sorts of acci-
dents and disasters, while nuclear operators have evolved in sustaining and enhancing the
safety of equipment and operations.
Japan has itself dealt with a number of nuclear power plant accidents, small and large.
Most of these were responded to, but without sufficient transparency; sometimes they were
concealed by the organizations concerned. The government, together with TEPCO, the
largest of the country’s ten utilities, promoted nuclear power by advocating its use as a safe
energy source, while maintaining that accidents could not occur in Japan.
Consequently, the Japanese nuclear power plants were to face the March 11 earthquake
totally unprepared.
Why did this accident, which should have been foreseeable, actually occur? The answer
to this question dates to the time of Japan’s high economic growth. As Japan pushed nuclear
power generation as national policy with the political, bureaucratic, and business circles in
perfect coordination, an intricate form of “Regulatory Capture” was created.
The factors that contributed to this include: the political dominance by a single party
for nearly half a century; the distinct organizational structure of both the bureaucratic and
business sectors, characterized by the hiring of new university graduates as a group; the
seniority-based promotion system; the lifetime employment system; and the “mindset” of
the Japanese people that took these for granted. As the economy developed, Japan’s “self-
confidence” started to develop into “arrogance and conceit.”
The “single-track elites”—who make their way to the top of their organization according
to the year of their entry into the company or the ministry—pursued the critical mission
of abiding by precedent and defending the interests of their organization. They assigned a
higher priority to this mission over that of protecting the lives of the people. Hence, while
being aware of the global trends in safety control, Japan buried its head in the sand and put
off implementing necessary safety measures.
We do not question the exceptional challenge entailed in the response to the vast scale
of the disaster created by the earthquake, tsunami and the nuclear accident on March 11,
2012. Furthermore, we understand that the accident occurred a mere eighteen months
after the historical change in power, the birth of a new (non-Liberal Democratic Party) gov-
ernment for the first time in some fifty years.
Were the government, regulators and the operator prepared to respond to a severe
nuclear accident? Did they truly understand the weight of responsibility they bore in their
respective positions? And were they fully committed to fulfill those responsibilities? To the
contrary, they showed questionable risk management capabilities by repeatedly saying that
circumstances were “beyond assumptions” and “not confirmed yet.” This attitude actually
exacerbated the damage that eventually impacted not only Japan, but the world at large.
Undeniably, this accident was a “manmade disaster” that stemmed from the lack of a sense
of responsibility in protecting the lives of the people and the society by present and past
government administrations, regulators and TEPCO.
Introduction | page 4 The National Diet of Japan Fukushima Nuclear Accident Independent Investigation Commission
Nine months after this massive accident, the Fukushima Nuclear Accident Independent
Investigation Commission was established by a unanimous resolution of both the House
of Representatives and the House of Councilors of the National Diet, which represent the
people of Japan. It is the first investigation commission in Japan’s history of constitutional
government, and is independent both from the government and from the operator, as set
up under the National Diet of Japan.
To investigate what was at the center of this accident, we could not but touch upon the
root of the problems of the former regulators and their relationship structure with the oper-
ators. The Commission chose three keywords as the bases of our investigative activities: the
people, the future and the world. We defined our mission with phrases such as “conducting
an investigation on the accident by the people for the people,” and “to submit recommen-
dations for the future based on the lessons learned from the mistakes,” and “to investigate
from the standpoint of Japan’s status as a member of international society (Japan’s respon-
sibility to the world.)” This report is the fruit of six months of investigative activities carried
through with a few constraints.
About a century ago, Kan-ichi Aasakawa, a great historian born and raised in Fukushima,
blew the whistle in a book titled Nihon no kaki (“Crisis for Japan”). It was a wake-up call con-
cerning the state model of Japan after the victory in the Japanese-Russo War. In his book, he
accurately predicted the path that Japan, with its “inability to change,” would take after the
war’s end.
How now will Japan deal with the aftermath of this catastrophe, which occurred as a
result of Japan’s “inability to change”? And how will the country, in fact, change subse-
quently? The world is closely watching Japan, and we, the Japanese people, must not throw
this experience away. It is an opportunity, in turn, to drastically reform the government that
failed to protect the livelihood of its people, the nuclear organizations, the social structure,
and the “mindset” of the Japanese—thereby regaining confidence in the country. We hope
this report serves as the first step for all Japanese to evaluate and transform ourselves in
terms of the state model that Japan should pursue.
Last but not least, I strongly hope from the bottom of my heart that the people of Fuku-
shima—particularly the children upon whose shoulders rest the future of Japan—will be
able to resume their lives of peace as soon as possible. I would also like to express my deep-
est gratitude to the people all over of the world who extended their warm assistance and
encouragement in the wake of this devastating accident. My sincere thanks also go to the
many people who kindly cooperated and supported our investigation, the members of the
Diet who unswervingly strove to make this National Diet’s investigation commission a real-
ity, and all the staff of the commission office for their many days and nights of work.
The National Diet of Japan
Fukushima Nuclear Accident
Independent Investigation Commission
Chairman
Kiyoshi Kurokawa
Introduction | page 5 The National Diet of Japan Fukushima Nuclear Accident Independent Investigation Commission
This page is intended solely as a convenience for the non-Japanese-reading global audience, and
is not included in the Japanese report as it is.
Sendai
Niigata
Fukushima
Minamisoma
Nihonmatsu
Fukushima Daiichi
FUKUSHIMA Nuclear Power Plant
PREFECTURE
20 km
30 km
Iwaki
Sendai Fukushima Daiichi
Nuclear Power Plant
Fukushima
Iwaki
Tokyo Mito
Narita
Tokyo International
Airport
The Commission has been expected to fulfill the following mandates in accordance with
the NAIIC Act:
1. To investigate the direct and indirect causes of the Tokyo Electric Power Company
Fukushima nuclear power plant accident that occurred on March 11, 2011 in conjunc-
tion with the Great East Japan Earthquake.
2. To investigate the direct and indirect causes of the damage sustained from the
above accident.
3. To investigate and verify the emergency response to both the accident and the con-
sequential damage; to verify the sequence of events and actions taken; to assess the
effectiveness of the emergency response.
4. To investigate the history of decisions and approval processes regarding existing
nuclear policies and other related matters.
5. To recommend measures to prevent nuclear accidents and any consequential
damage based on the findings of the above investigations. The recommendations
shall include assessments of essential nuclear policies and the structure of related
administrative organizations.
6. To conduct the necessary administrative functions necessary for carrying out the
above activities.
For the full text of the NAIIC Act, see the Appendix 4 of the “Act regarding Fukushima Nuclear
Accident Independent Investigation Commission,” which is omitted in the English version. The
Japanese version thereof is available at http://law.e-gov.go.jp/htmldata/H23/H23HO112.html
Introduction | page 6 The National Diet of Japan Fukushima Nuclear Accident Independent Investigation Commission
Overview of the Investigation
On October 30, 2011, the Act regarding the Fukushima Nuclear Accident Independent
Investigation Commission (the NAIIC Act) was enforced, and on December 8, 2011, the
Chairman of the Commission and nine other members were appointed by the Speaker and
the President of the National Diet with the approval of the Diet.
Chairman:
Kiyoshi Kurokawa
Members:
Katsuhiko Ishibashi Kenzo Oshima Hisako Sakiyama
Masafumi Sakurai Koichi Tanaka Mitsuhiko Tanaka
Shuya Nomura Reiko Hachisuka Yoshinori Yokoyama
Advisors to the Commission:
Itsuro Kimura Tatsuhiko Kodama Tatsuo Hatta
Reviewers:
Takao Iida Makoto Saito Jun Sugimoto
Isao Nakajima Takeshi Matsuoka
Office of Administration:
Toru Anjo, Director General
Sakon Uda, Managing Director of Investigation
Significance of the commission’s establishment
within the Diet
The Commission was established with the purpose of conducting an investigation into the
nuclear power accident for the Diet, which is one of the three branches of the Japanese gov-
ernment, independent of the parties directly involved in the accident, namely, the Tokyo
Electric Power Company and the government (the administration), any other related par-
ties, in order for Japan and its government to regain national and international trust.
As the Commission was established within the Diet, it possessed powerful investiga-
tive authority for the investigation into the accident, including the legal power to request
the submission of relevant documents and the power to request the Joint Council of the
Houses of Representatives and Councillors to invoke parliamentary investigation rights.
The Commission exercised the former power in order to obtain various documents related
to 13 issues. The latter—parliamentary investigation rights—could have been exercised
if cooperation was not forthcoming despite all our efforts, and the Joint Council of both
Houses had deemed it necessary following a request by the Commission. This power was
not actually invoked thanks to the cooperation of all the witnesses and other related parties
necessary for the investigation.
Introduction | page 7 The National Diet of Japan Fukushima Nuclear Accident Independent Investigation Commission
Fundamental basis for the establishment of
the Commission
With regard to the fundamental basis for the establishment of the Commission, the follow-
ing agreement was made at a high-level meeting of the Joint Council of the Committees on
Rules and Administration of respective Houses on the Accident at the Fukushima Nuclear
Power Plants of the Tokyo Electric Power Company: [1]
1. The investigation is to be conducted thoroughly by experts from a logical, objective
and scientific perspective, without bias for or against nuclear power.
2. While thorough information disclosure is the principle in the investigation, whether or
not to disclose should be determined appropriately in order not to hinder the purpose of
the investigation, which is to look into the cause and factual truth of the accident.
3. A global perspective should be emphasized in order to prevent future nuclear acci-
dents around the world.
4. The investigation’s priority should be on human safety, rather than the structural
safety of nuclear reactors.
5. The investigation should be conducted with the understanding that it is concerning
nuclear power in a country prone to earthquakes and tsunamis.
6. The investigation should result in recommendations to benefit Japan’s future, and
provide an opportunity to reaffirm the function of the Diet within the separation of
the three branches of government.
Overview of the investigation
The investigation included more than 900 hours of hearings, and interviews with 1,167
people. In order to conduct a thorough investigation, we made nine site visits to nuclear
power plants, including the Fukushima Daiichi Nuclear Power Plant, the Fukushima Daini
Nuclear Power Plant, the Tohoku Electric Power Company Onagawa Nuclear Power Plant,
and the Japan Atomic Power Company Tokai Dai-Ni Nuclear Power Plant. To date, we have
held three town-hall meetings, during which we were able to hear firsthand the opinions
of more than 400 evacuees. We also visited twelve municipalities within the designated
evacuation area—Futaba, Okuma, Tomioka, Namie, Naraha, Kawauchi, Hirono, Katsurao,
Minamisoma, Tamura, Iitate, and Kawamata—to conduct comprehensive interviews. We
also conducted questionnaire surveys of the local residents and workers at the nuclear
accident site. The Commission checked all the survey questionnaires and attempted to
create a report that is easy to understand. We received 10,633 responses to our survey of
local residents. A total of 8,066 respondents wrote comments in the free-comments sec-
tion in the questionnaire, and 431 respondents also provided their opinions using the back
of the questionnaire or its envelope. For the survey targeting the contractors and workers
at the site of the Fukushima Daiichi Nuclear Power Plant on March 11, we received 2,415
responses from the employees of TEPCO and cooperating companies. The Commission also
conducted three research trips overseas to gain a global perspective. Information collected
from foreign countries is reflected in the report.
The Commission carried out thorough research using relevant documents and materials
in addition to these hearings in order to conduct an objective investigation. A total of over
2,000 requests for documents and materials were made to TEPCO, regulatory authorities,
and other relevant parties.
To ensure the maximum degree of information disclosure, all 19 of our commission
meetings were made open to the public, and 38 individuals who were in responsible posi-
tions at the time of the accident were invited. All the commission meetings were broadcast
on the Internet with the exception of the first one held after the visit to the Fukushima
Daiichi Nuclear Power Plant.[2] A total of nearly 60 hours of live video was broadcasted. This
video was viewed by a total of 800,000 people. There were also over 170,000 comments from
[1] See the speech delivered by Chairman Tadamasa Kodaira at the third “Joint Council of the Committee on Rules
and Administration of Both Houses on the Accident at the Fukushima Nuclear Power Plants of the Tokyo Electric
Power Company” available at: www..shugiin.go.jp/index.nsf/html/index_kaigiroku.htm
[2] http://naiic.go.jp
Introduction | page 8 The National Diet of Japan Fukushima Nuclear Accident Independent Investigation Commission
the public posted to the Commission’s accounts on social media sites such as Facebook and
Twitter. While all the minutes of the Commission meetings have already been published,
they are attached as references to this report [in Japanese]. In addition, the meetings were
also shown on the Internet to the world with simultaneous interpretation.
In addition to the English version of the executive summary, which has been released
simultaneously with the Japanese version, the entire report will also be published in English
in the future. *
Please refer to the appendix [in Japanese] for the summary of the Commission meetings
and to the supplemental materials [in Japanese] for the minutes of meetings. **
It has been 16 months since the accident at the TEPCO Fukushima Nuclear Power Plant.
During this period, a number of attempts have been made not only by the government and
TEPCO, but also by other organizations and institutions to verify the accident, the results
of which have been published in the form of reports and books, and in the media. This has
not been limited to Japan, but also to reports made by various international organizations
or reported from overseas.
The content of this report may partly overlap with such publications. The significance of
making the witness hearings conducted by the Commission open to the public lies in the
fact that such hearings open to the public provided a basis for each individual who watched the
hearings to understand the causes of the accident from various perspectives, and enabled them
to make a comparison with the information available through other media, in order for them
to determine what should be done in the future. That was the purpose of the public hearings.
The Commission conducted its investigation and produced the report with this in mind.
* Please note that this document is an English translation based on the report in Japanese as of July 5th 2012.
**The English Summary of the Commission’s meeting is available at http://naiic.go.jp/wp-content/
uploads/2012/09/NAIIC_Eng_Commission_Meeting_report.pdf.
Items excluded from the investigation
The following points were excluded from the scope of our investigation due to the priority
placed on the required resolution of the issues listed in Article 10 of the NAIIC Act:
1. Matters related to the future energy policies of Japan, including the promotion or abo-
lition of nuclear power;
2. The treatment and disposition of used nuclear fuel rods;
3. Matters that would require on-site visits to reactors with dangerous levels of radioactivity;
4. Matters related to the cost of handling accidents, such as those for compensation and
decontamination;
5. Issues related to where to place responsibility in the case of accident-related cost sur-
passing the nuclear operator’s paying capacity;
6. Issues concerning the governance function of investors and the stock market over the
nuclear power plant business that leads to the prevention of accidents;
7. Issues related to the reactivation of each nuclear power plant;
8. Specific design issues that would normally be dealt with by the government in rela-
tion to policies and regulations;
9. Issues related to clarifying the actual conditions of the reactors after the accident and
the process of decommissioning, as well as the issues concerning the revitalization of
the areas surrounding the nuclear power plants; and
10. Other matters excluded from the scope of investigation by Commission members’
agreement.
Introduction | page 9 The National Diet of Japan Fukushima Nuclear Accident Independent Investigation Commission
Conclusions and
recommendations
Introduction | page 10 The National Diet of Japan Fukushima Nuclear Accident Independent Investigation Commission
Conclusions
Shared recognition
TEPCO’s nuclear power plant accident in Fukushima following the Great East Japan Earthquake
that occurred on March 11, 2011 was a major accident in world history. As of June 2012, when this
report is going to be submitted, the accident has still not ended; damage continues to be done.
Details of the current status of the damaged reactors have not been made clear, and it
is uncertain whether they can withstand future natural disasters such as earthquakes and
typhoons. The extent to which environmental pollution can be contained in the future is
also unclear, with the process for decommissioning the nuclear power plant expected to
take a long time and face unpredictable situations. In addition, the livelihoods of the affect-
ed residents have not recovered, and fears of health hazards have yet to be resolved.
The Commission recognizes that “the impact of the accident still continues, and
that responses are urgently required, to the vulnerability of the building and equip-
ment at the Fukushima Daiichi Nuclear Power Plant after the accident and also to the
residents’ damages.” In addition, we are seriously concerned about the view that “upon
this report’s submission, the accident may be turned into a past event.” This accident,
which has had a tremendous impact on Japan as well as on the world, is still ongoing,
and should be intensely monitored and scrutinized on a continuous basis by an inde-
pendent third party (See Recommendation 7).
With such a shared recognition of the situation, the Commission conducted the investi-
gation as follows.
Fundamental causes of the accident
The fundamental causes of the accident already existed prior to March 11, 2011 (3.11).
According to the investigation of the Commission, as of 3.11, the Fukushima Daiichi Nuclear
Power Plant was presumably in a vulnerable condition, incapable of withstanding an earth-
quake and tsunami. Tokyo Electric Power Company (TEPCO) as the nuclear operator, the
Nuclear Safety Commission (NSC) and the Nuclear and Industrial Safety Agency (NISA) as
the regulatory authorities, and the Ministry of Economy, Trade and Industry (METI), as the
government body promoting nuclear power, all failed to correctly prepare and implement the
most basic safety requirements, such as assessments of the probability of damage by earth-
quakes and tsunamis, countermeasures toward preparing for a severe accident caused by
natural disasters, and safety measures for the public in case of a large release of radiation.
In 2006, NSC revised the old guidelines for anti-seismic standards, while NISA requested
the nuclear power operators in Japan to carry out the Seismic Safety Assessment (anti-
seismic backcheck) as new guidelines.
TEPCO notified NISA that the deadline for their final report on the anti-seismic back-
check would be June 2009. However, the anti-seismic backcheck did not proceed, and with-
in the company, it was postponed to January 2016. Although TEPCO and NISA were aware
of the need for structural reinforcement in order to conform to new guidelines, no part of
the required reinforcements had been implemented on Units 1 through 3 at the time of
the accident. NISA regarded that such anti-seismic reinforcement should be taken autono-
mously by the operator, and implicitly approved the situation as TEPCO substantially
lagged in taking action. After the accident, TEPCO claimed that there was no significant
damage to Unit 5 according to a visual survey, but this did not mean that there had been no
damage caused by the earthquake to Units 1 through 3.
By 2006, NISA and TEPCO were aware of the risk that a total loss of power at the Fuku-
shima Daiichi Nuclear Power Plant might occur if a tsunami were to reach higher than the
level of the site. They were also aware of the risk of reactor core damage deriving from the
dysfunction of seawater pumps in the case of a tsunami larger than that assumed in a Japan
Society of Civil Engineers assessment. NISA knew that TEPCO had not taken any measures