For days, neighbors lost sight of a man in his 50s who frequently took taxis from his temporary housing in Fukushima Prefecture to go out drinking.

A relative using a key borrowed from the local government office opened the man’s front door and found him dead at the entrance. The cause of death was apparently liver cirrhosis.

“The psychological stress from a life as an evacuee may have pushed him more toward the alcohol that he already loved,” a local source said.

In the five years since the accident started at the Fukushima No. 1 nuclear plant, 2,024 evacuees, including the hard-drinking man, have officially died of causes, often psychological, related to the 2011 triple disasters.

That death toll exceeds the 1,604 Fukushima residents who were directly killed by the Great East Japan Earthquake and tsunami.

Over the same five-year period, the number of people who died of acute radiation exposure to substances spewed from the stricken plant is zero.

Life in evacuation has taken a heavy toll.

“The results cannot be simply attributed to the advanced age of the evacuees,” said Akira Isaka, an adviser to the Futaba county medical association who conducts health checks on evacuees. “A decrease in exercise due to life as an evacuee, stress, uncertainty about the future or the sense of hopelessness from having lost one’s purpose in life–an accumulation of all such factors has likely led to a worsening of their physical and psychological health.”

The evacuee who died in spring last year was originally from Katsurao, a village from which all residents were ordered to evacuate after the nuclear accident. The man lost his job on a ranch there.

An evaluation committee consisting of individuals from neighboring municipalities certified the man’s death as related to the 2011 disasters.

Certification of deceased individuals who were responsible for maintaining the livelihood of a household entitles bereaved family members to 5 million yen ($44,000) in condolence money from the central and local governments. For bereaved family members of all other individuals, a payment of 2.5 million yen is made.

Another evacuee whose death was certified in February 2015 as disaster-related was Hiroshi Monma. He was 70 when he died in July 2014 from complications arising from pneumonia.

Monma once taught at a senior high school in Namie, Fukushima Prefecture.

According to his wife, Shoko, 73, Monma’s health declined rapidly after they evacuated to Tokyo following the nuclear accident. Six months later, he often could be heard muttering, “There is no use in living.”

Although there are more certified disaster-related deaths than direct deaths from the quake and tsunami, doctors involved in the certification process believe the number may not tell the entire story.

Many bereaved family members do not submit applications for such certification because it requires detailed health records.

The number of suicides among Fukushima disaster victims is also much higher than in the two prefectures that were also hard hit by the quake and tsunami.

According to Cabinet Office statistics, 80 evacuees in Fukushima Prefecture had killed themselves as of the end of 2015.

The annual number of suicides in Iwate and Miyagi prefectures has declined over the past five years. But the number in Fukushima for 2015 was 19, up from 15 in 2014.

Signs of depression were seen in 10 percent of residents of the 12 municipalities that were declared evacuation zones, according to a Fukushima prefectural government study. Although that ratio was an improvement over the level immediately after the nuclear accident, it is still about three times the national average.

“The only way to deal with the situation is to continue steady efforts to encourage evacuees to undergo periodic health checks and to increase their opportunities for exercise,” said Tomoyoshi Oikawa, deputy chief of the Minami-Soma Municipal General Hospital.

Mitsutoshi Kamata, 60, who heads a neighborhood association for temporary housing built adjacent to a residential area in Otama for evacuees from Tomioka, believes the displaced residents should look out for each other.

About 60 homes have been built for Tomioka evacuees in Otama.

Kamata came up with the idea of having the evacuees use yellow flags to show they are OK.

Yellow ribbons are a universal symbol of hope for those waiting to see their loved ones come home. Kamata’s idea stemmed from the flying of a yellow ribbon in a popular movie titled “The Yellow Handkerchief” in English and starring Ken Takakura.

Every morning, yellow flags the size of handkerchiefs are raised in front of each home’s entrance, showing that the seniors living alone inside are fine. The flags are lowered at night.

One evening, the flag was still up in front of the home of an elderly man living by himself. He was found complaining of pain. The flag might have saved his life.

“We will not be able to prevent solitary deaths just with the flags,” Kamata said. “It is important to have people around you who might realize something is wrong.”

(This article was written by Yuri Oiwa, Makoto Takada and Mana Nagano.)