(CNN) -- While rescue efforts continue in Sendai, the city that lies just 80 miles (130 kilometers) east of the earthquake epicenter, the long-term future of the metropolis and surrounding area looks uncertain.
Kyung Lah has reported from the outskirts of the city on Sunday morning describing the shell-shocked population organizing themselves to clear roads, clean up and assist official efforts in searching for missing people, while fearing more aftershocks and tsunamis.
But even when a semblance of normality returns to the city of around one million people the disaster could compound the problems facing the region; namely the flight of young people to larger cities and a rapidly ageing population.
"A trend across Japan has been moving out of the rural areas to Tokyo," says CNN correspondent Kyung Lah.
"The area (around Sendai) has experienced a brain drain and economic drainage (as young people leave the area). It was already struggling to keep ahead and to keep the local industries going; agriculture and fishing. The last thing that this community needed was for its infrastructure to be wiped out."
The capital of Miyagi prefecture, Sendai is the largest city in northern Japan, less than a two-hour bullet train ride away from Tokyo.
The city lies on the flat, coastal plain between the Ohu Mountains and the Pacific Ocean. Most the eastern suburbs of the city hit by the tsunami are low lying with hills in the city center only around 40 meters (140 feet) high.
While far from the country's manufacturing heartland that lies to the south and west of Tokyo, Sendai is a regional hub with six universities around the city, which have helped develop the region's technological industries.
Miyagi prefecture has tried to diversify its industries away from agriculture and fishing to attract and keep a younger and educated workforce.
The regional government also has been trying to make the area's traditional industries of farming and fishing more attractive to a younger population, but across Japan approximately three fifths of farmers are over 65.
The destruction of fishing and agriculture infrastructure may compound the difficulties the industries face, although there may be a shorter term boost, says analysts, from the Japanese government greatly increasing public spending to rebuild.
For those currently in the city there are more immediate problems of water, food and fuel supplies.
Schools and hospitals in Sendai have been turned into shelters, and volunteers were handing out bottles of water, CNN's Kyung Lah reported from the city.
"Somehow we can hang in there," says Yasue Schumaker, a native of Sendai who has been living in Hawaii for 15 years, but in the city caring for her mother.
"We don't' have any water, electricity or gas. They've just announced that it could take days to get gas for everybody. We definitely need water and food. I don't think people have enough food or water. People prefer to stay in the car as they're feeling aftershocks. It's very cold."
Dean Irvine contributed to this report