Visiting Japan's First Leprosy Sanatorium: A Dark History of Discrimination

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Departing from a dock near JR Hinase Station in Bizen City, Okayama Prefecture, our boat headed across the Seto Inland Sea toward Nagashima Island. The destination was the National Sanatorium Nagashima Aisei-en, Japan's first national sanatorium for people with leprosy, which opened in 1930 and is now located in the city of Setouchi.

As of June 21, 2025, the day of the cruise's second trip this year, 68 people lived at the facility. Their average age was around 89, and most had been residents for over 60 years.

The island is also home to another national sanatorium, Oku Komyoen. Out of Japan's 13 national sanatoriums for leprosy, two are located on this island.

Approaching the Island

About 50 minutes after departure, the boat passed under the Oku-Nagashima Bridge, which connects the island to the mainland. The bridge spans just 30 meters. Before it was built in 1988, the island could only be reached by boat. As the vessel moved past floating oyster rafts, more than 80 passengers prepared to disembark.

Nagashima has a circumference of about 16 kilometers. On this cruise, participants walk the same paths once taken by people quarantined for leprosy. The tour, created to fight stigma and discrimination, offers a chance to learn about the history of forced isolation. Commentary is provided by Tomohisa Tamura, 48, the curator and head of the sanatorium's historical museum. The tour course marks its 10th anniversary this year.

At the pier, passengers were greeted by Shinji Nakao, 91, president of the residents' association at Nagashima Aiseien. Standing beside Tamura, he said, "It might seem like a sightseeing trip to you, but for us, arriving here felt like being locked away. I hope you can begin to understand what that experience was like."

*Inside the detention facility at the National Sanatorium Nagashima Aisei-en.*

Arrival and Isolation

The first stop was the old quarantine pier, where boats once brought patients ashore. Some parts near land still remain, but much of it has crumbled over time. This was where many patients said goodbye to their families and the outside world.

Tamura shared a memory: "One person told us, 'My mother said we were going on a trip. While I was getting a medical exam, she left.'"

Near the pier stands the former intake facility, now registered as a tangible cultural property. New arrivals were stripped of money and cameras, then bathed in disinfectant. After a short stay there, they were assigned to their living quarters.

The tour continued to the site of a former detention cell, once used to confine patients who broke rules or attempted escape. From there, the group continued uphill to the ossuary.

*The cell where escaped patients were held. It has since been filled in.*

Shame and Stigma

Because leprosy was once mistakenly believed to be hereditary, patients' families often faced discrimination. Many were too afraid of public shame to reclaim the remains of their relatives. As a result, more than 3,700 people who died at the sanatorium were never returned to their hometowns. Many are enshrined here under the names they used in the facility rather than their real ones.

*The ossuary at the National Sanatorium Nagashima Aisei-en.*

Leprosy, also known as Hansen's disease, is caused by the bacterium Mycobacterium leprae, named after the physician Gerhard Armauer Hansen, who discovered it. The disease can damage peripheral nerves and lead to skin ulcers or deformities. However, it is only weakly contagious.

Lasting Discrimination

An effective treatment became available in the late 1940s, and today the disease is fully curable with medication. All current residents have already been treated and cured. Many, however, live with lasting disabilities caused by the disease.

"Their disability just happens to have been caused by Hansen's disease," Tamura explained. "It's no different from someone disabled by a stroke or a car accident."

Despite the availability of treatment, Japan continued to isolate patients without medical justification for decades. Human rights abuses included forced sterilizations and abortions. The Leprosy Prevention Law, which mandated isolation, was not repealed until 1996.

In 2001, the Kumamoto District Court ruled the policy unconstitutional and ordered the government to compensate former patients. A later ruling in 2019 also recognized the harm done to families and upheld compensation for them.

Because this history remains unknown to many, the museum at Nagashima Aiseien offers detailed exhibits about the sanatorium's past. Promoting understanding of leprosy helps reduce stigma, fear, and discrimination.

*Disinfection bath at the detention facility.*

A Call for Understanding

"What's needed to foster understanding is interest," said Tamura. "I hope more people will expand the circle of awareness." He reminded visitors that creating a society that respects human rights is up to each individual. "Building a world where everyone can live with dignity — that's how we carry on the hopes of the residents. I've passed the baton to you."

Although visits by schools and organizations declined during the COVID-19 pandemic, numbers rebounded in 2024. Around 500 groups and 12,000 people came to the island, nearly matching pre-pandemic levels. All six cruises scheduled for 2025 are already fully booked.

"I want to reach people who may not be interested [in this history] yet," Tamura said. "Even if they come just because they like boats, I hope they'll visit."

As the group prepared to leave, Nakao offered a final message: "Please share what you've experienced with others."

The current residents hope more people will come to understand the realities of leprosy and life in the sanatoriums. By passing on what they've learned, visitors can help build a future free from prejudice and discrimination — the first step toward a more inclusive society.