On the "Hospital Ship," a Trump Card for Disaster Medicine: The Front Lines of Large-Scale Disasters and Digital Disaster Prevention - December 4, 2025, Democratic Party for the People, Representative Tomoe Ishii, House of Representatives, Special Committee on Disasters, General Questioning (Full Transcript)

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Questioning

Hospital Ships and Digital Disaster Prevention

Representative Tomoe Ishii
I am Tomoe Ishii of the Democratic Party for the People and Independent Club. I am from Matsuyama City, Ehime Prefecture. Having worked in the medical field, I would like to address disaster medicine in this committee. Thank you for your time. Let us begin. First, I would like to ask about hospital ships in the event of a large-scale disaster.

The other day, Prime Minister Takaichi held the government's first comprehensive nuclear disaster prevention drill since taking office in Ehime Prefecture. The drill assumed a magnitude 7 earthquake, the loss of cooling functions at the Ikata Nuclear Power Plant, and the Prime Minister's declaration of a state of emergency. All cabinet ministers participated, along with Ehime Prefecture, surrounding municipalities, and 20,000 residents in a large-scale exercise.

This was the first time in 10 years that this government-led comprehensive nuclear disaster prevention drill was held in Ehime Prefecture. The site includes the Sadamisaki Peninsula, the narrowest in Japan, and the drill verified evacuation procedures in the event that roads are severed. In particular, when roads are cut off, rescue from land becomes extremely difficult, making the securing of medical care during disasters a top priority.

In that context, the mechanism for providing medical care on ships, created by member-sponsored legislation in 2021, is truly a hospital floating on the sea, and great expectations are placed on hospital ships. First, please look at Document 1. The ship in the photo is the US Navy hospital ship USNS Mercy, shown when it made a port call in Japan. It has 1,000 beds, the ability to perform surgery, an 80-bed intensive care unit, and a 20-bed post-operative recovery room, providing advanced medical care comparable to a university hospital. In Japan, the consideration of hospital ships began following the lessons of the Great Hanshin-Awaji Earthquake, and their necessity was also called for after the Great East Japan Earthquake, where coastal areas suffered devastating damage. The Cabinet Office has been leading the study in preparation for a Nankai Trough mega-earthquake or a Tokyo inland earthquake.

During the Noto Peninsula Earthquake, I saw on the internet how disaster medical support ships operated by NPOs were active, and I felt that hospital ships are absolutely necessary for Japan, which is surrounded by the sea. I am very hopeful that these hospital ships will finally begin operation in January 2026.

Therefore, I would like to ask Minister Akama: Could you tell us how far the current preparations and development status for the start of hospital ship operations have progressed?

Minister of State Akama
I will answer. Regarding the use of ships for medical care, or so-called hospital ships, the operation is scheduled to begin in January 2026, and regarding its progress: the development plan for the medical provision system utilizing ships was approved by the Cabinet in March of this year. Currently, we are working intensively in cooperation with relevant ministries and agencies toward the start of operations in January 2026 as I just mentioned.

More specifically, we are currently in discussions to conclude agreements within this year regarding the securing of medical personnel, the securing of ships, and cooperation with medical organizations and private shipping companies.

In addition, as you mentioned that they are on par with university hospitals, there is the matter of equipment, so we are currently procuring the necessary items. Furthermore, to improve the effectiveness of hospital ships, we conducted a field exercise using an actual ship on the 16th of last month, and we are currently working on coordination among stakeholders and improving their proficiency.

In any case, since operations are set for January 2026, we intend to make every effort to ensure the system is fully prepared. That is all.

What are the main challenges in ship-based medical operations?

Representative Tomoe Ishii
Yes, thank you. Since we are in the final stages toward operation, please ensure that preparations are thorough.

I often use large ferries when traveling from Ehime to Osaka, and I have experienced many times leaving at night, staying overnight on the ship, and arriving in the morning. Modern large ferries are equipped with private rooms, do not sway much, and are quite comfortable. I believed that utilizing these large ferries as hospital ships was very feasible, so I have high expectations for their operation. However, in the event of a disaster, it involves temporarily chartering large or medium-sized ferries that are currently in regular operation, and I believe there are various challenges.

I believe we must prepare while anticipating everything, including dispatch coordination to disaster areas after a disaster occurs, the situation at the ports where they will dock, and the securing of human resources. I would like to ask what the main challenges in ship-based medical operations have been during the demonstration experiments and drills conducted so far, and what the current status of consideration is.

Cabinet Councilor Kamahara
I will answer. Medical care utilizing ships during large-scale disasters is a complex activity implemented by various specialized fields such as disaster response, medicine, and shipping. Therefore, we believe it is important to first ensure a coordination and cooperation system among these diverse stakeholders to implement smooth and effective ship-based medical care.

Also, in order to dispatch ships to disaster-stricken areas, it is a prerequisite that shipping routes are cleared and port mooring facilities are in a usable state. Therefore, we believe it is necessary to confirm procedures through drills and the like so that we can quickly grasp this information and dispatch ships promptly while ensuring the safety of the vessels.

In addition, since activities will take place in the special environment of the sea and on board a ship, I recognize that it is necessary to secure and train personnel who are well-versed in ship-based medical care, in coordination with medical organizations and others, alongside achieving proficiency through training and the like.

While addressing these issues, I intend to continue working on the enhancement and strengthening of the ship-based medical service provision system. That is all.

Representative Tomoe Ishii
Thank you very much. In the event of a large-scale disaster, we must also anticipate the possibility of aftershocks or tsunamis occurring, so we must also consider moving to a safe location. I believe it is necessary to consider how to secure accepting municipalities outside the disaster area and to examine coordination with them.

Also, regarding medical supplies, at the current stage, it is set up so that in addition to the medical team preparing them, the affected municipality is to arrange them, and I believe this places a heavy burden on them, especially when they are already struggling with land-based disaster relief.

I believe support from municipalities that have not been affected is absolutely necessary, and since I believe the government must take the lead in that coordination, I would like to ask for the government's support.

What are the challenges when utilizing private ships as hospital ships?

Representative Tomoe Ishii
As shown in Document 1, currently, regarding hospital ships in Japan, the law states that the government will independently possess medical ships, but for the time being, we are to respond by renting existing private ships, such as large ferries. I believe a key issue will be whether they can truly be used promptly in the event of a disaster.

For the time being, while we will be concluding agreements to utilize private ships, could you please tell me what the current challenges are and what assumptions are being made for their utilization, such as the transport of equipment to be used and how to handle the areas available for use on board?

Cabinet Councilor, Cabinet Secretariat, Kamahara
I will answer. Regarding the securing of ships, as the member pointed out, in the Development Promotion Plan decided by the Cabinet in March of this year, it is stated that until we possess our own ships, we will utilize existing private ships based on the cooperation of private ship operators.

We are currently in discussions with multiple private car ferry operators toward concluding agreements, but in order to ensure they can be used smoothly when a disaster occurs, I believe it is necessary for medical professionals to become accustomed to the structure and characteristics of the ships through training using ships that may potentially be used, while also deepening their understanding of ship-based medical care on a daily basis.

Also, I believe it is necessary to make a request for dispatch after conducting sufficient coordination, such as confirming the safety of shipping routes and ports when a disaster occurs. We intend to continue sufficient discussions and coordination with private car ferry operators to advance the development of a system that makes ship-based medical activities more effective. That is all.

Representative Tomoe Ishii
Thank you. I believe we will be concluding agreements for the rental, but I think we must anticipate all possibilities in contracts with private operators, expecting that large-scale disasters will be long-term.

If we had a government-owned hospital ship like the USNS Mercy, I believe we could provide more advanced medical care with better facilities. I know it will cost money, but since this is a matter involving human lives, I ask that you please proceed with the introduction of government-owned hospital ships in parallel.

What is the government's backing for basin flood control measures and the digitalization of disaster prevention?

Representative Tomoe Ishii
Next, I would like to ask about the digital utilization of basin flood control measures against heavy rain disasters and the like. In Ehime Prefecture, rivers flooded due to the West Japan Heavy Rain Disaster, and the entire town was submerged, causing great damage. In Imabari City, for the first time in the prefecture, they developed a monitoring system using AI in collaboration with a company, where the AI monitors the water levels of the target area 24 hours a day, 365 days a year, and is able to predict the water level one hour later and notify relevant parties from the system even during late-night hours or when weather conditions change suddenly.

Because of this, the burden of flood control measures can be reduced, and furthermore, it has become possible to secure preparation time for initial responses. I believe that the accuracy and speed of this prediction are the keys to protecting lives.

Regarding disaster prevention measures utilizing digital technology, every municipality is competing to develop and introduce them on their own, so we are looking forward to further backing from the government.

I would like to ask for Minister Makino's views on the digitalization of disaster prevention toward national resilience. Thank you.

Minister of State Makino
I will answer Representative Ishii. As you pointed out, I believe that the utilization of technologies such as digital and AI is important to address the shortage of personnel for infrastructure development and management.

In the First Medium-Term Plan for National Resilience Implementation formulated in June of this year, we have positioned the advancement of national resilience policy through the use of new technologies such as digital as a pillar of our measures, and we have also positioned measures such as further improving the prediction accuracy of linear precipitation zones and typhoons using cutting-edge digital and other new technologies, as well as enhancing river information and developing unified information collection and provision.

We will continue to steadily promote efforts for national resilience by utilizing cutting-edge digital and AI technologies. That is all.

Representative Tomoe Ishii
Thank you. I believe the use of AI in disaster prevention will help protect the lives of our citizens, so I ask that you please continue to advance these efforts.

Efforts toward labor-saving in basin flood control

Representative Tomoe Ishii
Next, I would like to ask about digitalization in basin flood control. Please look at Document 2. In Misato Town, Shimane Prefecture, a demonstration experiment is being conducted where AI is used to remotely operate levee floodgates, allowing them to open and close automatically.

During heavy rain, floodgates are opened and closed to prevent rivers from overflowing, but because this has been done manually by people until now, it has involved danger. During the Great East Japan Earthquake, many fire brigade members lost their lives while working to close floodgates.

Now, auto-gates that can open and close automatically are becoming more widespread. Please look at Document 3. This shows the Ministry of Land, Infrastructure, Transport and Tourism's efforts toward digitalization. During disasters, there have been people who lost their lives by going to dangerous areas to call for evacuation.

Furthermore, in rural areas where population decline is significant and aging is progressing, we must implement efficient measures by minimizing human labor as much as possible to protect residents from large-scale disasters.

Therefore, I would like to ask the Ministry of Land, Infrastructure, Transport and Tourism: could you tell us about the current efforts and how you intend to realize this labor-saving in basin flood control—disaster prevention measures that can be done without people present?

Hayashi, Director-General of the Water and Disaster Management Bureau, Ministry of Land, Infrastructure, Transport and Tourism
I will answer that. As the risk of water-related disasters due to climate change increases, social conditions are changing significantly, including further progress in population decline and the aging of society with a declining birthrate. We believe it is important to promote basin flood control by utilizing various technologies, including digital technology, and to advance labor-saving and sophistication.

For this reason, for example, regarding small-scale culverts and sluice gates, we are proceeding with the transition to flap gates that open and close automatically by utilizing water level differences from the perspective of labor-saving and sophistication. Furthermore, as you pointed out, we are currently considering the automation of culvert opening and closing operations using digital technology, including the use of AI.

In addition to this, we are also advancing efforts beyond culverts and sluice gates. For example, we are building an information infrastructure and platform to centrally manage and share data so that various basin data can be effectively utilized in daily operations and disaster operations.

Also, to automate and streamline the acquisition of data and information, we are advancing efforts such as grasping disaster information using satellites (inaudible) and the like. To ensure the safety and security of the public, we will continue to actively utilize digital technology to promote basin flood control.

Representative Tomoe Ishii
Thank you very much. I will conclude my questions here. Thank you.