Life in evacuation shelters is taking a severe psychological toll on those left homeless by Japan's devastating earthquake and tsunami, a situation likely to worsen as tens of thousands face the prospect of staying at least the rest of the year in temporary housing.
Though the suffering is spread out along Japan's ravaged northeast coast, the problem is particularly severe for Japan's "nuclear refugees," who were forced to flee from homes near the Fukushima Dai-ichi nuclear plant and have been told to expect to remain in limbo for the next nine months, at least.
"I have pretty much given up," said 63-year-old Eiichi Kogusuri, who lives in one of the country's biggest shelters, a sports arena housing nearly 1,000 refugees in the city of Koriyama, about 60 kilometers (40 miles) away from the nuclear plant.
"All I do every day is eat, sleep and watch TV," he said. "Every day seems so long. I'm in my 60s, I have no work. I have nothing to hold on to and I'm too old to start over."
Hiromichi Watanabe, a health official for Tomioka, a town of about 16,000 near the nuclear plant, said the condition of the evacuees from his town is deteriorating. Tomioka's residents have scattered all over the country, but many remain in shelters in Fukushima because they do not want to be completely uprooted.
Nearly three months after the disaster, evacuation shelters in and around Fukushima remain full.
"They can't think ahead to the future, and this is very hard psychologically," Watanabe said. "They don't know when they can go home. Families have been broken up. We need a solution."
According to government tallies, 98,500 people remain homeless and live in about 2,000 shelters around the country. That number pulls together both those who lost their homes in the March 11 quake and tsunami, and those who were forced to leave the 20-kilometer (12-mile) no-go zone set up around the Fukushima nuclear plant.
Some evacuees have found lodging with family or friends, while some others have been fortunate enough to move into government-supplied shelters, including prefabricated homes or hotels and hot springs resorts that have been rented out for that purpose. More prefab homes are being built, but not enough to meet demand.
Watanabe said psychologists have been called in to check on evacuees and are now making regular rounds at most major shelters. Medical doctors are also treating evacuees who show symptoms of depression.
"There is no doubt that we are seeing people dealing with a greater amount of stress," said Akinobu Hata, the director of the Fukushima Mental Health and Welfare Center. "Mainly, it is not serious mental illness, but rather complaints stemming from bouts of depression or other issues from daily life."
In the first two months after the disaster, nearly 3,000 evacuees in the disaster zone were hospitalized for symptoms related to stress, fatigue or poor sanitation and hygiene, according to a Kyodo News survey of hospitals. That does not include people who required treatment but not hospitalization, or who have been hospitalized since early May.
Hata said Fukushima is relying increasingly on local resources as medical teams from outside the region have begun to return home. The need among Fukushima's evacuees, however, is not diminishing.
Recovery is under way along the northeastern coast, as towns clean themselves out from under the rubble of the destruction and begin to rebuild. But at Fukushima Dai-ichi, the situation remains unstable and radiation levels continue to be relatively high in some locations. The government has suggested it will not even consider lifting the evacuation order around the plant this year.
"It's really hard," said Kogusuri, a single truck driver from Tomioka who lost both his home and his job. "It's like everything is just stuck where it is and you can't move forward."
Kogusuri said life in the shelter is regimented: communal and often crowded bathing areas, strictly defined meal times, lights out at 10 p.m. He has his own partitioned space, which is just barely big enough to lie down in but provides a modicum of privacy.
The floors in the gymnasium are hard, and only curtains separate the occupants. Out of courtesy to others, there is little talking, no music and no laughter.
Kogusuri's shelter is among the best in the disaster zone, relatively new, spacious and spotless. In other areas, evacuees still huddle on school or community center floors, with little or no air conditioning or heat, and far more restricted access to food, toilets and baths.
Even at the arena in Koriyama, however, officials said colds are common, particularly among young children, and insomnia is the rule.
More importantly, the fatigue of shelter life is wearing evacuees down mentally _ especially the elderly, who make up a disproportionate number of the evacuees.
Health officials say the unfamiliar surroundings have exacerbated symptoms of Alzheimer's disease among some older evacuees, while others who had been able to get around by themselves have become bedridden.
Watanabe, the Tomioka health official, said it is particularly difficult for evacuees to see the rest of the country move on, since they themselves cannot.
"We don't want to be forgotten," he said. "We want to go home."