The Hidden Epidemic: Standing by Japanese Health Care Workers in a Time of Crises

The Covid-19 pandemic has left our world in disarray. The pandemic has enormously affected millions of people, and it also sheds light on the already existing patterns of inequality and abuse. The most vulnerable and marginalized groups in societies are affected the most, with many having to deal with the problems of rising unemployment, food insecurity, discrimination, and the death of millions a (Amnesty International, 2021).  All over the world, healthcare workers are frontline responders against the virus. Nevertheless, in this time of medical emergency, Japanese healthcare workers are facing an epidemic of their own, namely fear and stigmatisation (CBS News, 2020). 

• Background

In European countries such as Germany, Austria and Italy, to name a few, medical workers and nurses received standing ovations and applause from the public, who expressed solidarity and gratitude for their works. The overworked and underpaid workers are perceived as the everyday heroes during the pandemic (Drees, Seng and Miske, 2021). Since the Covid-19 outbreak in 2019, healthcare workers tirelessly shoulder long working hours, shortages of protective equipment, changes in the working environment, as well as a high risk of infection (JNA, 2021). According to the International Council of Nurses, by the end of October 2020, 1,500 nurses from 44 countries had died due to Covid-19, with total health worker fatalities as high as 20,000 (ICN, 2020).  This data portrays the risk healthcare workers expose themselves every day. 

Halfway across the world, people treat healthcare workers quite differently. In Asia, health care workers often face discrimination and harassment during the pandemic. In Singapore, several nurses were asked to move out of their apartments due to the fear of infection (Min, 2021). In Indonesia, some health workers were threatened to be charged for defamation, if they dared to speak out about their grievances at work (Maulia and Damayanti, 2021). In India, nurses were chased by a mob throwing stones at them, as they are perceived to be the drivers of the pandemic (Semple, 2020). While these kinds of treatments also happen outside the Asian region, the dislike towards health workers is more visible in Japan. 

• Symptoms of the hidden epidemic  

The Japanese community is characterised by “a deep-seated fear of being cast out of one’s group and a strong yearning to blend in”. Studies suggest it may stimulate a blaming and shaming culture (Jecker and Takahashi, 2021). This is reflected in the discrimination and harassment against mostly female medical workers in contact with Covid-19 patients. A survey conducted in 2020 by the Japanese Nurse Association showed that 20.5% of nurses claimed that they had faced discrimination and prejudice in their job, alongside frequent verbal abuse from patients (JNA, 2021). Of the 7904 nurses reporting discrimination and prejudice, mostly said, “their families or relatives also received verbal abuse from surrounding persons”. 

Figure 1: “Details of discrimination and prejudice [individual nurses] (among 7,904 persons who responded that “discrimination and prejudice existed”)” (JNA, 2021)

Furthermore, health care workers have stated to be scared to go home, in fear of being seen by their neighbours. Additionally, the hospitals caring for Covid-19 patients received death threats on multiple occasions, as well as calls threatening to set the hospital on fire (Denyer and Kashiwagi, 2020). 

The discrimination does not stop on the health workers. Their families are also discriminated against and treated badly. With many schools and day-care centres closed, healthcare workers with children have an additional burden to carry. Unfortunately, their children face an even more daunting reality as they often get shut out of childcare services and schools due to the risk of a possible infection from their parents. It left mostly female workers with no other choice, than to take time off from their work to take care of their children, who were deprived of such vital facilities (Craft, 2020). In 2020, an apparent member of a parent-teacher association called the Gifu University Hospital demanded the workers to keep their children away from the prefectures’ schools (Katanuma and Reynolds, 2020). Other times, children became targets of cyberbullying and slander, with their photos being distributed online (Mainichi, 2021) (Munesue, 2021). Some children are also forced to take PCR tests and submit them, before entering several facilities (Kyodo, 2020). 

Spouses of healthcare workers face similar situations. Many are suspended from work, or they must choose, whether their spouses or they will tender resignation, as said by a man whose wife was a nurse (Kyodo, 2020). Other than that, healthcare workers are told by their families not to come home. The situation has added additional burdens on the already stretched workforce. Consequently, many nurses have left their profession in reaction to the fear of themselves and their families being stigmatised and discriminated against. Discrimination and prejudice do not only cause fatigue among health workers, but also weaken the healthcare system itself, by making effective tracing impossible (Mainichi, 2021). A state-run hospital conducted a survey in June and July 2020, stating that, nearly 1 in 3 children between the ages of 6 and 17 said they would want to keep it a secret if they caught the coronavirus (Denyer and Kashiwagi, 2020). As rightfully put by the Japanese Red Cross, the fear of being infected hinders the fight against the Covid19 pandemic. People who experience symptoms will not get tested, hence, no one can stop the virus from spreading, and the pandemic continues (Japanese Red Cross, 2020). 

• National laws prohibiting discrimination and harassment  

3.1 The Japanese Constitution

The Japanese Constitution, promulgated in 1964, forbids discrimination based on “race, creed, sex, social status or family origin” in Article 14 (Sakuraba, 2008). Nevertheless, this law, which addresses the right to equality, does not explicitly mention the r profession as a source of discrimination, and this gap has made health workers more vulnerable. In 2012, the former Japanese Prime Minister Shinzo Abe took office with a promise to dedicate efforts to the empowerment of women. Whilst being warmly welcomed at first, a report published by the World Economic Forum in 2019 portrayed that Abe’s policies had little impact on the betterment of women’s social status (Pitchford, 2020). Despite a peaking female participation in the labour market, numerous women’s rights issues had yet to be addressed by the government (Mahoney, 2020). 

3.2 Anti-Harassment Law

As a reaction to these critics, the Japanese government introduced a new law in 2020 aimed at protecting women in the workplace (Pitchford, 2020). The anti-harassment law in Japan forces companies to ban harassment in the workplace, which was often reported to be conducted by people in a higher position against their subordinates, by the 1st of June 2020. The law is set out to eliminate the practice of “power harassment” in Japanese companies. “Power harassment” is hereby categorised into six practises, namely physical abuse, emotional abuse, deliberately isolating an employee, overworking an employee, consistently assigning work below an employee’s skill level, and infringing on an employee’s privacy (Pitchford, 2020). The law is considered to be the first law prohibiting sexual harassment at the workplace, making Japan no longer the only high-income OECD country without a law prohibiting sexual harassment (HRW, 2018). While the law does protect Japanese female healthcare workers from the often-faced sexual harassment at the workplace, it does not apply to the overall discrimination and harassment directed at them by society. 

In fact, there is neither a national law in Japan which prohibits harassment in general, nor a law that forbids discrimination on the grounds of profession (FindLaw, 2008). This makes harassment only illegal when it can be considered as power harassment. Furthermore, women and LGBTQ+ people are still not lawfully protected from discrimination in employment (Pitchford, 2020). In conclusion, national laws have prohibited “power harassment” and sexual assault at the workplace. Nevertheless, there is still an absence of a national law that makes harassment itself illegal. Furthermore, there is no law against discrimination of the grounds of profession, which would make the above-mentioned practices illegal. 

• International human rights standards 

4.1 International Covenant on Civil and Political Rights

According to international human rights law, discrimination and harassment are prohibited. Japan signed the International Covenant on Civil and Political Rights in 1978 and ratified the covenant in 1979 (UN, 2020). Article 2(1) of the Covenant states that each State Party “undertakes to respect and to ensure to all individuals within its territory and subject to its jurisdiction the rights recognized in the present Covenant, without distinction of any kind”. Article 26 of the Covenant also addresses about the principle of non-discrimination and equality before the law. This ensures that everyone is subject to all rights mentioned in the Covenant. Article 17 (1) of the Covenant is applicable to the harassment cases suffered by healthcare workers in Japan. The article states that “no one shall be subjected to arbitrary or unlawful interference with his privacy, family, home or correspondence, nor to unlawful attacks on his honour and reputation”.  Harassment is a form of attacking one’s reputation and honour. Article 26 of the convent includes the prohibition of discrimination to access public services, such as childcare facilities. Furthermore, Article 26 provides that all persons are entitled to equal protection against discrimination, as well as prohibiting any discrimination in law “regulated and protected by public authorities” (OHCHR, 1989). By ratifying the Covenant in 1979 Japan is obliged to ensure the enjoyment of these rights for the people in their jurisdiction. In the case of violation of these rights, States Parties shall ensure effective and accessible remedies for individuals to take (OHCHR, 2004). 

4.2 Convention on the Elimination of All Forms of Discrimination against Women

In 1979, the UN adapted the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW). The international treaty that aimed at protecting women’s fundamental rights and promoting equality between men and women, came into force in 1981. Article 1 of CEDAW defines discrimination against women as “any distinction, exclusion or restriction made on the basis of sex […] in the political, economic, social, cultural, civil or any other field”. Furthermore, discrimination against women includes gender-based violence, that is defined as “physical, mental or sexual harm or suffering, threats of such acts, coercion and other deprivations of liberty”. Hence, this article is applicable to the discrimination of female healthcare workers in Japan. The Convention is not limited to discriminatory actions by Governments, but rather implies that State Parties must take action to abolish discrimination against women by any person (CEDAW, 1992). Article 11 (1) further elaborates on the explicit right to work and equal treatment in the workplace. “The right to health and to safety in working condition”, as enshrined in this treaty under Article 11(1), have been violated in above analysed cases (CEDAW, 1979). The female healthcare workers are expected to work while facing unsafe working conditions. Nurses work with self-installed fans to provide better circulation, handmade gowns and missing protective equipment (Takahashi, 2022). The Article does not only refer to the risk of infection, but also includes the abuse and harassment faced at their workplace. Article 12 holds the states accountable for providing measures to “eliminate discrimination against women in the field of health care in order to ensure […] access to health care services, including those related to family planning” (CEDAW, 1979). This article emphasises the illegality of denying female healthcare workers access to health services they depend on.  For example, in Japan, a pregnant hospital nurse was denied a medical examination by a gynaecologist, due to the fear that she might spread the virus (Kyodo, 2020). 

4.3 Convention on Violence and Harassment 

Other than that, Japan has become a State Party to the 2019 International Labour Organization’s (ILO) Violence and Harassment Convention, after introducing the national law addressing power harassment (HRW, 2020). This convention outlines the international standards for safety and equality in a workplace. The scope of the convention includes not only harassment and discrimination at the workplace, but also protection of workers during their commute to and from work (Violence and Harassment Convention, 2019). This is relevant for the above-mentioned situations since many female health workers experienced harassment on their way to or from work. The Convention recognizes severe effects of violence and harassment on an individual, and hence requires States which become Parties to take legal action to prevent and punish violence and harassment in the workplace. Japan has yet to fully implement this provision. 

4.4 Universal Declaration of Human Rights

Lastly, the Universal Declaration of Human Rights (UDHR) sets out a common standard of rights every human should enjoy. Despite not being legally binding, the Declaration outlines a foundation for other international human rights laws, which is significant to these cases. Article 2 highlights the universality of rights enshrined in the UDHR, stating that “everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind” (UDHR, 1948). Furthermore, the declaration protects individuals from discrimination in Article 21(2) stating that everyone deserves “equal access to public services in his country” (UDHR, 1948). The right to work, as states in Article 23 protects individuals from discrimination in the world of work and unemployment. Article 25(1) amplifies this, by adding the right to an adequate standard of living, including social services, housing, and medical care. The declaration continues with Article 26(1) which ensures the right to education (UDHR, 1948). The discrimination and harassment of Japanese healthcare workers and their families violate several human rights. First, denying healthcare workers access to public services and limiting access to services to achieve an adequate standard of living, such as housing and medical care, is a violation of Articles 21 and 25 of the UDHR. Secondly, the healthcare worker’s spouses are prohibited to go to work, which is a violation of Article 23 concerning the right to work. Lastly, the healthcare workers’ children suffer from discrimination and harassment as they are denied their right to an education, which is granted by Article 26 of the UDHR. 

• Conclusion 

The hidden epidemic plaguing Japan’s healthcare workers and their families simultaneously threatens the greater good. The hostile treatment has a tremendous effect on the health workers and those closest to them. Even though the Japanese government has made some efforts to counter discrimination at the workplace, their efforts need to be maximized. 

Currently, healthcare workers and their relatives are often treated inhumanely and are consequently denied some of their human rights. Initiatives, such as the information campaign put out by the Japanese Red Cross aimed at fighting the hidden epidemic of fear and stigma need to be further promoted (Luu, 2020). Societies’ deep-rooted fears of the virus and its infection must be faced, not only so the healthcare workers and their relatives can enjoy their rights, but also to put an end to the Covid-19 pandemic. 

• References 

Amnesty International. (2021). Amnesty International Report 2020/21 The State of the World’s Human Rights.

CBS News. (2020, May 5). Japan: Health care workers face discrimination & harassment over COVID-19. Business & Human Rights Resource Centre. https://www.business-humanrights.org/pt/%C3%BAltimas-not%C3%ADcias/japan-health-care-workers-face-discrimination-harassment-over-covid-19/ 

CEDAW (1979). Convention on the Elimination of All Forms of Discrimination against Women. United Nations Human Rights Office of the High Commissioner.

CEDAW. (1992). CEDAW General Recommendation No. 19: Violence against Women. Committee on the Elimination of Discrimination against Women. https://www.legal-tools.org/doc/f8d998/pdf/&ved=2ahUKEwi4r8KY2dX#:~:text=General%20comments&text=The%20Convention%20in%20article%201,or%20that%20affects%20women%20disproportionately.

Craft, L. (2020, April 28). Japan’s overstretched doctors and nurses battling widespread abuse along with COVID-19. CBS News. https://www.cbsnews.com/news/japans-overstretched-doctors-and-nurses-battling-widespread-abuse-along-with-covid-19/ 

Denyer, S., & Kashiwagi, A. (2020, September 14). In Japan, coronavirus discrimination proves almost as hard to eradicate as the disease. Washington Post. https://www.washingtonpost.com/world/asia_pacific/japan-coronavirus-discrimination/2020/09/13/e82e5aa4-eea0-11ea-bd08-1b10132b458f_story.html 

Drees, C., Seng, M., & Miske, J. (2021, November 19). a-03910aac-fa93-41ab-a940-08c8b95ae337. DER SPIEGEL, Hamburg, Germany. https://www.spiegel.de/gesundheit/die-corona-lage-auf-den-intensivstationen-die-werden-alle-ein-boeses-erwachen-haben-a-03910aac-fa93-41ab-a940-08c8b95ae337 

FindLaw. (2018). When is harassment illegal? Thomson Reuters business.

HRW. (2018, December 2). Japan: End Workplace Harassment, Violence. Human Rights Watch. https://www.hrw.org/news/2018/12/02/japan-end-workplace-harassment-violence 

HRW. (2020, January 15). World Report 2020: Rights Trends in Japan. Human Rights Watch. https://www.hrw.org/world-report/2020/country-chapters/japan

ICN. (2020, October 28). ICN confirms 1,500 nurses have died from COVID-19 in 44 countries and estimates that healthcare worker COVID-19 fatalities worldwide could be more than 20,000. ICN – International Council of Nurses. https://www.icn.ch/news/icn-confirms-1500-nurses-have-died-covid-19-44-countries-and-estimates-healthcare-worker-covid 

Japanese Red Cross. (2020, April 21). 【日本赤十字社】「ウイルスの次にやってくるもの」 [Video]. YouTube. https://www.youtube.com/watch?v=rbNuikVDrN4

Jecker, N. S., & Takahashi, S. (2021). Shaming and Stigmatizing Healthcare Workers in Japan 

During the COVID-19 Pandemic. Public Health Ethics.

JNA. (2021, March). JNA News Release Japanese Nursing Association (Vol.34). Japanese Nursing Association. https://www.nurse.or.jp/jna/english/ 

Katanuma, M. (2020, May 6). Children of nurses in Japan excluded from day care over virus fears. The Japan Times. https://www.japantimes.co.jp/news/2020/04/25/national/children-nurses-japan-excluded-day-care-coronavirus/ 

Kyodo. (2020, May 6). Virus stigma driving Tokyo’s front-line hospitals to edge of collapse. The Japan Times. https://www.japantimes.co.jp/news/2020/04/25/national/tokyo-front-line-hospital/ 

Kyodo. (2020, May 29). Front-line health care workers in Japan face discrimination over coronavirus. The Japan Times. https://www.japantimes.co.jp/news/2020/05/29/national/health-care-workers-discrimination-coronavirus/

Luu, H. (2020, September 6). Discrimination and Stigma in Japanese Society: The Case of COVID-19. Izanau | Jobs In Japan Made Simple. https://izanau.com/article/view/coronavirus-discrimination-japan 

Mahoney, L. (2020, March 20). Japanese women face discrimination, victim blaming, harassment as they seek equal rights. Japan Today. https://japantoday.com/category/features/opinions/japanese-women-face-discrimination-victim-blaming-harassment-as-they-seek-equal-rights 

Mainichi. (2021). Editorial: Japan must be tireless in addressing coronavirus-related discrimination. The Mainichi. https://mainichi.jp/english/articles/20210219/p2a/00m/0na/004000c 

Maulia, E., & DAMAYANTI, I. (2021, November 23). Seen and not heard: health workers in Asia bullied into silence. Nikkei Asia. https://asia.nikkei.com/Spotlight/The-Big-Story/Seen-and-not-heard-health-workers-in-Asia-bullied-into-silence 

Min, A. H. (2021, May 11). Healthcare workers being asked to move out, shunned in public a ‘very worrisome trend’: Gan Kim Yong. CNA. https://www.channelnewsasia.com/singapore/ttsh-covid-19-cluster-nurses-asked-to-move-out-shunned-1356371 

Munesue, T. (2021, January 20). Significance of a Human Rights-Based Approach to COVID-19 Response. Waseda University. https://www.waseda.jp/top/en/news/74246 

OHCHR. (1989, November). CCPR General Comment No. 18: Non-discrimination. Human Rights Committee. https://www.refworld.org/docid/453883fa8.html 

OHCHR. (2004). Human Rights Committee General Comment No. 31 on The Nature of the General Legal Obligation Imposed on States Parties to the International Covenant on Civil and Political Rights (ICCPR). Human Rights Committee. http://www.nuhanovicfoundation.org/en/legal-instruments/human-rights-committee-general-comment-no-31-on-the-nature-of-the-general-legal-obligation-imposed-on-states-parties-to-the-international-covenant-on-civil-and-political-rights-iccpr/#:~:text=General%20Comment%20No.-,31%20on%20The%20Nature%20of%20the%20General%20Legal%20Obligation%20Imposed,them%20for%20all%20individuals%20in 

Pitchford, S. (2020, July 2). New Anti-Harassment Law Introduced in Japan. Human Rights Pulse. https://www.humanrightspulse.com/mastercontentblog/new-anti-harassment-law-introduced-in-japan 

Semple, K. (2020, April 28). Health Workers Under Attack During Coronavirus Pandemic. The New York Times. https://www.nytimes.com/2020/04/27/world/americas/coronavirus-health-workers-attacked.html 

Takahashi, R. (2022, January 3). How the pandemic changed Japan’s health care system. The Japan Times. https://www.japantimes.co.jp/news/2022/01/02/national/pandemic-japan-health-system-changes/ 

1. (2020). Treaty bodies Treaties. OHCHR. https://tbinternet.ohchr.org/_layouts/15/TreatyBodyExternal/Treaty.aspx?CountryID=87&Lang=EN

Universal Declaration of Human Rights. (1948). Universal Declaration of Human Rights. United Nations. https://www.un.org/en/about-us/universal-declaration-of-human-rights 

Violence and Harassment Convention. (2019). Violence and Harassment Convention. International Labour Organization.