SAITAMA -- "If a nail pierces my foot, I pull it out in saltwater. If I come down with a fever, I have a cold bath. They really work," a 26-year-old Kurdish man going by the pseudonym Mustafa told this reporter with a smile.

For a long time, Mustafa has been living in Japan on "provisional release," and he currently works at demolition sites. He has been injured at work on many occasions, including by stepping on nails, but tries to avoid hospitals as much as possible, instead getting by with his own treatment methods.

When a person is on provisional release from the immigration authorities, they lack legal residency and are not able to enroll in Japan's national health insurance program. For the uninsured, many hospitals calculate points for medical fees at about 1.5 times the normal level. This turns illnesses and injuries into financial risks, as a child's hospitalization for the flu alone can cost hundreds of thousands of yen (over $1,000).

Mustafa once came down with influenza, but at that time his Japanese girlfriend also contracted it, and he says they shared the medicine a hospital prescribed to her.

Unable to pay medical bills, returning home in despair

Hospitals themselves also face problems such as nonpayment of medical bills. In March 2024, in a small one-room apartment in Warabi, Saitama Prefecture, 25-year-old Kemal (a pseudonym), laid on a futon as his worried parents looked on with concern. Emaciated with sunken cheeks, the 25-year-old had gauze patches on his neck and abdomen that were stained yellow from tissue fluid.

Kemal arrived in Japan in January 2023. Soon after arriving he found work, but that June, his health took a sudden turn for the worse, and he was transported to a hospital in Tokyo. According to a doctor, the cause was neglected tooth decay. He had been in pain for a long time, but left it untreated, which led to a bacterial infection that spread throughout his whole body, leaving him unconscious and in serious condition. He underwent surgery at a hospital in Tokyo and remained hospitalized for some seven months.

After that, Kemal applied for refugee status and was issued an insurance card, but since he didn't have national health insurance at the time of his hospitalization, he was billed some 30 million yen (around $192,000) in medical fees. His parents had come from Turkey to look after him, but there was nothing they could do. The hospital suggested he pay the fee in installments, but he was not able to work and he didn't stand a chance of being able to pay.

Later, the family returned to their country. The day before they left, Kemal's father told this reporter in a pessimistic tone, "We can't do anything about such a large amount of money."

Ballooning medical costs for those on provisional release

Nonpayment of 30 million yen in a single case is an extreme example, but similar cases have occurred at hospitals around the Saitama Prefecture city of Kawaguchi.

A consultant at one general hospital in Kawaguchi said, "We don't know the nationalities of patients when we examine them, and there are also many uninsured Japanese people," but added, "The overall unpaid amount is in the range of tens of millions of yen (over $100,000). This includes some medical fees for people on provisional release." Some of those on provisional release are financially stable, and many pay the lump sum in cash or in installments to ensure the full amount is covered, the consultant said.

However, while it is possible to guide Japanese people in financial distress to the welfare system, the same doesn't apply to those on provisional release. "It's problematic in cases where ongoing treatment is needed, like with dialysis or with intractable diseases. The medical bills keep piling up, but they don't have permission to work, and they can't be linked to welfare, leaving them with almost no options," the consultant emphasized.

Having seen a range of cases in the past, the consultant said, "I live in Kawaguchi too, and I know that there are people on provisional release who work and who have been living here for a long time, sending their children to school. Rather than ignoring their existence, it would be better to have them surely pay tax and insurance premiums and include them in the system."

(Japanese original by Takuro Tahara, Saitama Bureau)