To examine the challenges and practical realities of providing end-of-life care in welfare evacuation centers following the Noto Peninsula earthquake in Japan, and to identify lessons for improving disaster preparedness in similar settings.

Case 1: A man in his late 90s was transferred to a welfare evacuation center after contracting COVID-19 in a general shelter. He arrived with fever and marked physical decline. Acetaminophen was administered to relieve his fever and provide comfort. His condition gradually worsened, and eight days after arriving at the evacuation shelter, he died peacefully while being closely observed by medical staff. Case 2: A man in his 60s with a history of smoking and alcohol use was found bedridden and incontinent at home and was subsequently moved to a welfare evacuation center. Two days after evacuation, he complained of leg and back pain, which was suspected to be due to arterial occlusion. He was monitored and provided with supportive care at the center, however, pain control remained inadequate. Four days after evacuation, he was found in respiratory arrest and was confirmed dead.

These cases underscore the need for establishing unified guidelines and external support frameworks for end-of-life care in disaster settings. In a disaster-prone country like Japan, scenario-based training and the integration of trained volunteers are essential to ensuring dignified care for vulnerable evacuees.