Mai, a non-Japanese woman living in Japan gave birth to a boy in January 2023 at home. She was not expecting such an early delivery. It was her first experience of giving birth to a child. Nobody was around. When the baby was born, she was troubled. She did not know what to do. She wrapped the baby with a towel. Gradually, the baby was getting cold. His lips turned purple. She immediately called an ambulance.
The ambulance took her and the baby to a hospital with Neonatal Intensive Care Unit (NICU). According to the hospital staff, the baby was in an asphyxia state, but recovered through treatment. The baby was discharged in early February after a month of treatment with the warm and loving care of the medical staff. It should have been the happy ending of the story. But the story did not end there.
Mai was discharged about a week after giving birth to her baby. She often visited the hospital to see her baby thereafter. Every time she came to the hospital, the hospital management asked her how she was going to pay the cost of hospitalization. Mai did not know how to respond since she did not have the money to pay the cost of hospitalization. The hospital social worker called CHARM for information on delivery fee support for people who do not have medical insurance. I went to the hospital with an interpreter to meet with Mai. I found out that Mai's baby was born pre-mature.
Support for Pre-mature Babies
Babies born pre-mature are covered by the Infant Medical Care for pre-mature babies, or Yo-iku iryo in Japanese. The hospital social worker had been contacting the city office for this medical service, but the city hall official said that the application could not be made, since the child's mother was not a registered resident in the city.
Infant Medical Care is provided for in Article 20 of the Maternal and Child Health Act. The law applies to anyone, regardless of nationality. The government has also made it clear that it applies to every child regardless of the residence status of the mother. The city office staff had no knowledge of this. After showing the legal basis, the city office admitted that Infant Medical Care for pre-mature babies applied to Mai's baby. The payment for the cost of hospitalization was settled between the hospital and the city office.
The baby was discharged but he was not covered by health insurance because the mother was holding a temporary visa. We accompanied Mai to the city office to register the baby as a resident. A new-born baby can be registered temporarily sixty days before the actual formal registration (this is known as Keika Taizaisya in Japanese). The Citizen's Department in the city hall, which supervises medical services throughout the city, confirmed that this system applied in the case of Mai's baby. The city office agreed that Mai's baby could be registered as a resident and be covered by health insurance. It was a happy ending, but only after many negotiations between CHARM staff and hospital Medical Social Worker (MSW). If Mai had not had any support from an NGO and MSW, her request for birth registration would have certainly been rejected at her first visit to the city office. The majority of non-Japanese residents have no access to supporters or interpreters since NGOs supporting non-Japanese residents are not many and cannot reach out to all their communities.
Reason for Coming to Japan
Mai came to Japan to study hoping to get a professional license to work in Japan. With a student visa, she studied in a Japanese Language School for two years and then proceeded to a vocational school for a year. During these years, she was never given information about Health Insurance. She knew she could not go to hospitals or clinics since she did not have a health insurance. She decided to leave the vocational school when she could not cope with the study, and could not pay her tuition. She lost her residence status when she left the school according to the immigration office and therefore she could not renew it. But the situation was different in 2020. Due to COVID-19 pandemic, international flights were cancelled and people could not go home. She was given a temporary visa for ninety days with a permission to work for twenty-eight hours.
Mai stayed in Japan for two years with temporary visa, which neither allowed her to register as a resident nor become a member of health insurance system. She was able to work for twenty-eight hours per week, but her income was so small that it barely covered rent and daily necessities.
Despite this difficult situation, Mai overcame the pitfalls of the system and the lack of information from the city office staff with the help of NGO workers, interpreters, MSW and others who all supported her. Mai was able to bring her son out of the hospital after treatment. But for others who were in a similar situation with Mai, their isolation can lead to tragedy.
The Case of a Trainee
Le Thi Twi Lin worked as a Technical Intern Trainee at a farm in Kumamoto prefecture. Trainees are covered by health insurance, thus she could to go to a hospital if she wanted to. But in reality, she and her fellow trainees could not take a leave of absence to go to the hospital during work hours.
She also signed a document with a provision that she agreed to go home if she got pregnant. Thus, when she got pregnant she could not have pre-natal check-up or talk about her pregnancy with anyone. She gave birth to twin boys alone at home, but they were still-born. She must have been shocked by the death of her babies. She prepared for their funeral alone. She wrapped the babies with towels and placed them in cardboard boxes along with a note about their names. She placed the boxes on a shelf for a day. However, she was arrested for doing this and was prosecuted for abandonment of the still-born babies. Both the "Kumamoto District Court and the Fukuoka High Court found her guilty, with the latter sentencing her to three months in prison, suspended for two years, in 2022." However, on appeal, the Supreme Court overturned her conviction in its decision on 23 March 2023. The only difference between the cases of Lin and Mai is that Lin's babies were still-born and she was not able to call for help immediately.
The Case of Wishma
Rathnayake Liyanage Wishma Sandamali, or Wishma, was a Japanese language school student in Nagoya. She came to Japan with a dream of teaching English to children. She started with a Japanese Language School but had to leave school because she could not afford to pay her tuition. After she left the language school, she could neither change nor renew her temporary visa. She sought help from a man, a fellow national. Unfortunately, he abused her until she could not bear it any more. She ran away from his home to seek help from the police.
In cases of domestic violence, under the law, the police should provide protection to victims and refer them to domestic violence shelters. In Wishma's case, the police did not do so. The police checked her residence card and found that her visa had expired. The police reported her case to the Immigration Bureau. She was detained in August 2020 at a regional detention center of the Immigration Bureau. Immigration officials tried to convince her to go back to her country since she did not have a proper permission to stay in Japan. Wishma refused to go back to her country because the man who abused her threatened to wait for her in Sri Lanka and kill her. But the Immigration Bureau considered her case as "deportation evasion" case or Sokan-kihi-sya in Japanese.
About six months later, in February 2021, she became ill and asked for help. The Nagoya Immigration Bureau Detention Center refused to give her medical help. For several days, she asked for drip infusion but her request was ignored. On 6 March 2021, Wisma died while in detention.
Mai and Wishma both started their lives in Japan as students in Japanese Language Schools as many young non-Japanese do. These young women came to Japan with vision to realize their dream. They worked within twenty-eight hours per week as allowed for students. But the income from the twenty-eight-hour work was not enough to support their daily needs and tuition. They had to leave school. Under the immigration law, students who leave school would no longer have a reason to stay in Japan. They have to leave Japan right away.
In case of Wishma, she was abused not only by her fellow national but also by the police and officials at the Immigration Bureau.
People have different reasons for quitting school and, in the case of non-Japanese, for asking to continue to stay in Japan. Each person should be given a chance to consult and seek help if needed. The Japanese who cannot continue with schooling because of financial or other reasons look for a job or seek other means of support, and have family or friends to help them. However, the non-Japanese who quit school are subject to deportation for lack of permission to stay.
The Ministry of Justice proposed in 2021 an amendment to the Immigration Law. The proposed amendment included forced deportation of people who do not obey the order of deportation. This was the "deportation evasion" (Sokan-kihi-sya in Japanese) proposal. The proposed amendment would cover the case of Wisma as well as those of people who are applying for refugee status and whose application has been denied three times.
Bar associations as well as organizations all over Japan supporting the non-Japanese went out on the street to demonstrate against the proposed amendment of the law. The bill was turned down due to strong opposition from the citizens.
A proposal to amend the law has been submitted again to the Diet. The Liberal Democratic Party Justice Committee approved the submission on 24 February 2023. The committee discussion has not been disclosed to the public. The Minister of Justice did not make any comment on the matter at a press conference. If the new proposal is the same as the 2021 proposal, a person like Wishma will be subject to deportation and not protection.
Residence status determines access to medical and welfare services. Mai had a temporary visa after she left vocational school. She had no access to health insurance because of her residence status. Her presence in Japan shows that holders of temporary visa are not only temporary visitors like tourists. People similar to Mai, Lin and Wishma have temporary visa and have different reasons and needs for medical and welfare services. But because of their residence status, they are not properly cared for.
When Mai went to the city office to seek help, she was denied service twice. The city office admitted that she was eligible for medical services only when she went with NGO supporters who had legal knowledge and documents. Non-Japanese who are holders of temporary visa and those who do not have any visa are not regarded as residents and not subject to local government service and protection. The attitude of outright denial of request for service represents structural segregation. The city office staff felt no guilt in not providing protection to a person in need. The staff prioritized rules instead of attending to the needs of the person seeking help. If these cries for help were listened and attended to, a person like Wishma did not have to go through the traumatic experience of continued abuses which led her to death.
Deporting non-Japanese who refuse to leave Japan under the proposed amendment of the Immigration Law is a very violent act of inhumanity. People have reasons why they cannot go back to their country and their voices need to be listened to in order to prevent any further problems.
Structural segregation puts non-Japanese who have temporary visa at risk of failing to stay safe and healthy. NGOs face limitation in countering the wall of structural segregation. We in the NGO sector advocate for change at the macro level and do what we can at grassroots level by providing information, accompanying non-Japanese to government offices and dispatching interpreters to medical institutions and staying with them in their time of need.
Rieko Aoki is the Executive Director of the Center for Health and Rights of Migrants (CHARM) which provides service on the medical needs of non-Japanese residents.
For further information, please contact CHARM through its website: www.charmjapan.com.
 See Maternal and Child Health Act (Law no. 141, 1965), in Japanese language, www.mhlw.go.jp/web/t_doc?dataId=82106000&dataType=0&pageNo=1.
 See response to a question by Masako Owaki, member of the Upper House of the Japanese Diet, in Session No. 147-26, 26 May 2000.
 KYODO, Top court acquits Vietnamese trainee of abandoning stillborn twins, Japan Times, 24 March 2023, www.japantimes.co.jp/news/2023/03/24/national/crime-legal/vietnamese-trainee-twins/.