MIYAKO, Japan — Shoichi Nakamura is having trouble sleeping and eating. Her brother, sister-in-law and their child have been missing for a week. She’s been to three evacuation centers and pored over countless lists at disaster centers.

That has left her with a dilemma she shares with a growing number of Japanese in the wake of the March 11 earthquake and tsunami: When do you give up hope that your relatives are alive? And how do you mark the death in tradition-bound Japan without cremating the body?

“I think the tsunami took my brother,” said Nakamura, 58, who works at a cleaning service, barely audible as she huddled on a blanket in the Yamaguchi Elementary School gym, her slippers neatly placed on the edge. “But another part of me doesn’t want to give up searching. I’m sick wondering what to do.”

The official toll of dead and missing exceeds 21,000, leaving flattened seaside communities struggling to ensure the dead are treated with dignity amid huge shortages of nearly everything needed to hold a funeral service. Gymnasiums, schools and even bowling alleys have become makeshift morgues for bodies that have been recovered.

Given the backlog, the Health Ministry said last week it would waive rules requiring relatives to obtain local permission before burials or cremations. But as time goes on, there will be more and more services without bodies.

Lacking a body makes it difficult to have a proper “oshoushiki,” or funeral ceremony, Nakamura said. Instead of using the remains of her brother and his family, who disappeared from their seaside village, she may have to use another family’s bone chips or ashes as a stand-in. The Buddhist priests have declared that an acceptable alternative, she said.

“I hear City Hall may give them out,” she said.

Other options include collective ceremonies, known as “godousou,” or cremations of the clothes, photographs, or personal items of the deceased in lieu of a body. Even a pinch of dirt from the spot the dead were last seen may have to do in some cases.