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Wednesday, May 2, 2007
Doctor fights for health of foreigners in detention
By MASAMI ITO
In summer 2005, a man from Myanmar seeking asylum in Japan was found dead in his Tokyo apartment. But because he had no family here, the results of the autopsy were not released and the cause of death remains unknown to this day.
But Dr. Junpei Yamamura suspects the death was due to a lack of proper medical treatment in the immigration detention center where the man was held for a year and a half.
As a physician, Yamamura has spent the past decade treating foreigners in Japan — from illegal overstayers to asylum seekers. From 2002, he has been visiting the Higashi-Nihon Immigration Center in Ushiku, Ibaraki Prefecture, once a month, where he monitors the mental and physical problems of the detainees.
One of the detainees Yamamura met was the Myanmarese man.
The man had extremely high blood pressure, which could lead to cerebral hemorrhage or heart attack, Yamamura said. Although the man had been seeing the in-house doctor, the prescribed medicine was not working, Yamamura noted, and with this concern, he submitted his medical opinion in writing, advising the detention center to release him. Several months later, in June 2005, the man was given a provisional release, a special permit that must be renewed.
Two weeks later he was dead.
"I think the Immigration Bureau officials were relieved that he didn't die in the detention center," Yamamura said. "If his release had been (slated for) a couple of weeks later, he could have died in there."
During his monthly visits to the Higashi-Nihon Immigration Center, Yamamura sees an average of seven or eight detainees, sometimes up to 10. Based on a questionnaire he has them fill out beforehand, Yamamura spends about 30 minutes meeting each person in the small visiting room.
After several meetings, Yamamura writes up a medical report with his opinion on why the detainee should be released, and has the inmate give a copy to Immigration Bureau officials.
"I hope the report contributes to the detainee's provisional release," Yamamura said. "But even if it doesn't, it is just as important to let the immigration officials know that they are being watched."
Yamamura has been vocal about the problems inside the detention centers, stressing mental and physical abuse by officials as well as lack of proper medical treatment.
In March, he published "Kabe no Namida" ("Tears Behind the Walls") with five other people actively supporting people seeking asylum, including a lawyer and a staffer from the human rights organization Amnesty International. They hope to educate the general public on "the reality of the situation regarding the immigration detention centers," Yamamura said.
The first part of the book gives a general overview of the detention centers and problems with how inmates are treated. It notes that anyone in violation of immigration law can be detained, whether they be asylum seekers, illegal overstayers, elderly, young, pregnant or ill. Families are ripped apart, the book says, and young children get taken away to child-welfare centers while their mothers and fathers are locked up separately inside the detention center.
Lengthy detentions are also a big problem, the book points out, because once deportation orders are issued for immigration law violators, they can be held for an indefinite time. Locked within the detention center, the detainees have no idea what the future holds — it could be months or more than a year or two before they are given a provisional release or deported back to their home countries.
For people seeking asylum after fleeing their country for fear of persecution, the mental pressure and terror of being sent back is intense, "and for some asylum seekers, deportation could mean death," Yamamura warned.
The second half of the book, written by Yamamura, focuses on "inappropriate and insufficient" medical treatment within the walls. Yamamura compiled a survey of 202 detainees between August 2003 and last January. Out of the 202, 135, or 67 percent, suffered various health issues, including psychogenic disorders, depression, high blood pressure, diabetes and posttraumatic stress disorder.
The survey also revealed that out of the 135 patients, 105 did not have an interpreter, 75 had no explanation from the doctor regarding their ailments, 93 expressed apprehension over their medication and 100 saw no improvement after taking medicine. And as for trust in the in-house doctor, 108 patients, or 89 percent, said they had none.
The main problem with medical care in the detention centers is that it lacks objectivity and transparency because the doctor's office is subordinate to the Immigration Bureau, Yamamura stressed.
The treatment of patients in the detention centers "should be observed carefully by a third-party medical organization," Yamamura said. "The in-house doctor's (job) is to put priority on detention . . . but what really needs to be considered is whether detention is medically correct or not."
The detention center doctor specializes in internal medicine and treats most of the patients regardless of their symptoms, Yamamura said, adding that treatment generally involves prescribing a large dose of medication. Yamamura recalled one detainee who was actually given 30 types of medicine to take a day.
"It is completely against medical ethics," Yamamura said. "These detainees need to be given proper medical care by a specialist — including a psychiatrist — and not an internal medicine doctor who just prescribes a large amount of medication."
Yamamura brought up the Jack Nicholson movie "One Flew Over the Cuckoo's Nest" about a mental hospital that conducts a lobotomy on a patient to control his violent behavior — a medical procedure now prohibited in most countries, including Japan.
"I believe the Immigration Bureau (is using treatment to get results similar to a lobotomy) through heavy medication," Yamamura said. "By heavily sedating the detainee patients, it becomes easier for Immigration Bureau officials to control them."