A magnitude-6.8 earthquake struck Kumamoto Prefecture in southwestern Japan on Tuesday, leaving at least 36 people dead and thousands displaced amid oppressive summer heat. Emergency responders continue to search for survivors amid shifting aftershocks and temperatures nearing 100 degrees Fahrenheit (around 38 degrees Celsius), presenting a dual crisis for the affected region.

Four days after the quake, which generated over 300 aftershocks according to the Japan Meteorological Agency, more than 9,000 residents remain sheltered in evacuation centers across Kumamoto. Rescue teams are facing difficult conditions, particularly at the heavily damaged Aeon shopping mall where the second floor collapsed, killing seven individuals. Five people were rescued alive from the rubble. Kumamoto police official Takeshi Ueda described the rescue efforts as relentless but perilous, citing the unstable steel framework and sweltering heat trapped inside the building.

Local officials emphasize the urgency of ongoing relief efforts, noting that the situation echoes the 2016 Kumamoto earthquakes which ultimately claimed over 270 lives, many due to secondary health complications related to extended stays in overcrowded shelters. This disaster is further complicated by the summer climate, as the region experiences some of its hottest temperatures on record during the recovery period.

Since the earthquake struck during peak summer heat, hospitals have reported dozens of heatstroke cases among residents. Japan’s chief cabinet secretary, Minoru Kihara, called the crisis a “double disaster” at a Friday press conference, pledging national government assistance to provide air conditioning equipment to evacuation shelters.

Infrastructure damage south of Kumamoto City is severe, with roads cracked and buildings flattened, especially near the epicenter in Yatsushiro. Many residents there have sought refuge in local evacuation centers, such as a converted middle-school gymnasium, where around 280 families are sheltering. Although some facilities have air conditioning, many still lack adequate cooling, worsening the risk of heat-related illnesses. Atsuko Koide, a city official managing the site, pointed out that facilities without air conditioning are essentially unusable during this heatwave. She added that patients suffering from heatstroke had returned from damaged homes to the shelters, highlighting the challenge of balancing debris clearance and health risks.

Residents like 73-year-old Masae Taniguchi are facing daily struggles to resume normal life. A former worker at the nearby Nippon Paper Industries factory—where nine people died in a chimney collapse after the quake—Taniguchi has electricity but no running water at home, requiring multiple trips in the heat to collect water from a groundwater source. She described the earthquake as relentless and terrifying, stating at one point she feared for her life.

Relief officials warn that without restoration of basic utilities like power and water, displaced residents will continue relying on community shelters. With temperatures expected to reach up to 40 degrees Celsius (104 degrees Fahrenheit) in parts of the prefecture, efforts to mitigate the health risks posed by the combined effects of natural disaster and intense heat remain critical in the days ahead.