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Whilst all Japanese nationals are entitled to universal healthcare, the rules and requirements for access effectively exclude a large proportion of Japan’s homeless persons. The largest homeless community, approximately 7757 people, is found in Osaka prefecture and its capital Osaka City, where men aged 50 to 60 account for three quarters of the homeless population. Too young to collect a pension and too old to compete for a decreasing pool of jobs, many suffer from chronic conditions such as hypertension and diabetes that require ongoing access to medical care.
Nishinari Socio-Medical center in the heart of Kamagasaki, the city traditionally considered the core for daily workers and the homeless of Osaka, remains the only response to the medical needs of the homeless, but the structure is well beyond its capacity. Without healthcare or social services, people have scattered into riversides, parks and train terminals.
MSF has made several attempts to establish a fixed health center in the area to restore healthcare for the homeless, but discrimination against this population is fierce and widespread and has prevented the establishment of a fixed clinic. MSF has met with continual opposition from some of the local communities and authorities.
In 2005, MSF mobile clinics visited four parks on alternating weeks and conducted 1268 medical consultations, following 270 patients on file. The team treated chronic conditions including hypertension, diabetes, joint pain and gastritis and referred those requiring hospitalization or specialised care to health facilities in the area. Patient histories were also collected in 2005, enabling the MSF team to better understand the mechanisms of sociomedical exclusion.
MSF has worked in Japan since 2004.