System Failure: Health-Care Deficiencies in the World War II Japanese American Detention Centers

Figure 1.

Location map of the ten permanent detention camps. (Courtesy of Jeff C. Heller.)

In the months following Pearl Harbor, the U.S. government incarcerated more than 110,000 people of Japanese ancestry in ten remote concentration camps without due process of any kind (Fig. 1). When the camps closed, the War Relocation Authority (WRA) issued a series of reports evaluating nearly every aspect of camp administration and management. The authors described such noteworthy features as “careful advance planning” and responses to problems that “may have far-reaching significance for other agencies engaged in similar tasks.” ¹ The WRA analysts used mortality and reportable-illness statistics to compare the incarcerated people of Japanese ancestry with the U.S. population at large, noting that the imprisoned had better overall survivorship. The implication of this finding was that the health-care delivery system in these camps was excellent. Until now no one has reviewed the deficiencies of the WRA health-care system and challenged their favorable self-assessment.

The WRA analysis of their health-care delivery system was flawed for several reasons. First, comparing people of Japanese heritage with residents of the rest of the United States, the majority of whom were of Euro-American heritage, was not valid: genetics, culture, lifestyle, and behavioral and health-risk factors are major confounders between the two populations. Instead, they could have painted a more accurate picture by comparing imprisoned Japanese Americans with those of Japanese descent who had not been detained.

Second, while the WRA required all camps to complete the same monthly public health forms covering hospitalizations, communicable diseases, vital statistics, and general commentary, this semblance of organization and intracamp standardization of records was an illusion. They did not require forms to be completed by the same counterpart in each camp, raising the prospect of inconsistency. Further, each camp’s chief medical officer (CMO) decided arbitrarily which communicable diseases to report, and the selection varied from camp to camp; in some cases it appeared that the severity of the presenting illness, more than the specific disease itself, was the defining element for inclusion in the monthly report. Thus, comparison between the camps, much less with the population at large or any other population subgroup, is not possible because of the internal inconsistency of reporting. Yet in spite of the vagaries of the record-keeping system, a picture of health problems in each camp arises from other sources of information, such as WRA documents stored at the National Archives. For this study, I collected thirty-six life history interviews from formerly detained people and, for comparison, twenty-two testimonies from Japanese Americans who were not confined.

Conditions in the Camps and Their Effects

A number of factors compromised health care in the concentration camps: poor planning and design, adverse environmental conditions, the contamination of food and water, overcrowding, inadequate staffing, and racism. In the rush to incarcerate, the army transported tens of thousands to camps that were unfinished and poorly designed to meet the needs of the population. Interviewee Henry Kanegae reported that he and his family arrived at Poston in the Arizona desert to find the buildings and infrastructure incomplete. His sister fell into an open, unmarked water-main trench, which caused her to miscarry her first pregnancy. ²

In constructing the camps, the War Department appropriated the design of an army field base meant for young male recruits. There were no substantive provisions for families, young children, the elderly, or the invalid. The typical camp covered more than 640 acres of barren desert, high plains, or swamp (depending upon individual location). In preparation for the structures, the land was stripped of native vegetation—a practice that led to subsequent problems with dust control. Almost overnight, the centers became instant towns, ranging in population from 7,318 at Amache in Colorado to 18,789 at Tule Lake in northern California. ³ At their peak population, two sites even exceeded their official capacity. ⁴

Housing was in hastily built barracks that were...