Kitty McMaster, Associate Member, Immigration and Human Rights Law Review
I. Introduction
In spring 2022, Shanghai residents who tested positive for COVID-19 were often sent to Fangcang, or “square-cabin,” shelter hospitals—converted exhibition halls and stadiums used for centralized quarantine. Inside one site, rows of cots stretched across the floor under lights that stayed on all night, while residents described shared toilets, no showers, and little privacy.
This Blog explores how China’s Fangcang quarantine system, initially developed as an emergency public health measure, evolved into a regime that blurred the line between medical isolation and coercive confinement, raising serious human rights concerns. Part II provides background on COVID-19, China’s “Zero-COVID” strategy, and the origins and stated public health rationale of Fangcang shelter hospitals. Part III assesses Fangcang through three overlapping legal lenses—liberty and security of person, children’s protections when liberty is restricted, and the right to physical and mental health—showing how compulsory placement and degrading conditions can transform quarantine into de facto detention and trigger core human rights protections. Finally, Part IV proposes a rights-protective framework for future outbreaks: enforceable minimum standards for quarantine facilities and a least-restrictive-means default that prioritizes supported home quarantine whenever feasible.
II. Background
Before turning to the legal analysis, this Part provides the factual, policy, and legal backdrop for Fangcang shelter hospitals. It first explains how COVID-19’s rapid spread and surging caseloads during the initial Wuhan outbreak in late 2019 and early 2020 created the pressure that led to the development of Fangcang shelter hospitals. It then traces how that emergency model was later scaled under China’s “Zero-COVID” policy, culminating in Shanghai’s mass quarantine sites and setting up the core tension of this article: when isolation becomes compulsory and conditions deteriorate, a public health intervention can begin to function as coercive confinement. This background Part also introduces the legal frameworks used later in the discussion. The analysis that follows considers Fangcang through Article 3 of the Universal Declaration of Human Rights (“UDHR”), Article 37 of the Convention on the Rights of the Child (“CRC”), and Article 12 of the International Covenant on Economic, Social and Cultural Rights (“ICESCR”). The UDHR is not a treaty that binds China in the same way as a ratified convention, but it provides a widely accepted human-rights framework; the CRC and ICESCR, by contrast, supply treaty-based standards relevant to state-imposed confinement and health conditions.
A. COVID-19 and the Rise of Fangcang Hospitals
Coronavirus Disease 2019 (“COVID-19”) is an infectious disease caused by the SARS-CoV-2 virus.[1] The disease spreads primarily through airborne respiratory particles released when an infected person breathes, talks, coughs, or sneezes, making transmission especially likely during close contact or in shared indoor spaces.[2] Symptoms vary, but commonly include fever, chills, and sore throat; while most people recover without treatment, those at higher risk can develop severe illness and require medical care.[3]
Because the virus spreads rapidly within households and communities, many public health responses prioritized isolating infected individuals to curb onward transmission, especially during surges, when case counts rose quickly and hospitals faced serious bed shortages.[4] Wuhan, the capital city of Hubei province, was the epicenter of the initial outbreak in late 2019 and early 2020. There, isolating the growing number of COVID-19 patients within conventional hospitals was not feasible.[5] The resulting pressure led to the development of Fangcang shelter hospitals in February 2020: large-scale, temporary facilities created by converting public venues, such as stadiums and exhibition centers, into centralized spaces where mild-to-moderate cases could be isolated.[6]
In response, Chinese officials and experts developed the Fangcang shelter hospital model as a rapidly deployable system that combined “isolation, triage, basic medical care, monitoring and referral, and essential living and social engagement.”[7]
B. From COVID-19 Crisis to Fangcang Quarantine
In Shanghai, residents were repeatedly screened through neighborhood or compound testing, and under China’s March 2022 protocol a positive antigen or suspected case was supposed to get immediate nucleic-acid confirmation or be moved in a “closed loop” for testing; once confirmed positive, the person was put into centralized isolation rather than allowed to isolate at home.[8]
Inside Shanghai’s National Exhibition and Convention Center, a cavernous hall built for trade shows, the Fangcang quarantine site looked more like an emergency dormitory than a hospital: rows of cots stretched across the floor, personal belongings hung from makeshift dividers, and people who had tested positive but felt mostly fine tried to sleep under lighting that never went dark.[9] One resident told the Associated Press that “the lights stay on all night,” and described bathrooms and the frustration of not finding a hot shower.[10] Video footage from inside one center showed residents packed into camp beds separated by less than an arm’s length, sharing scarce facilities: more 200 people, four toilets, and no showers.[11]
Mass quarantine fit China’s “Zero-COVID” policy, which aimed at maximum suppression of outbreaks through measures, such as mass testing, contact tracing, border quarantine, and lockdowns.[12] Because COVID spread efficiently within households—estimates placed household transmission between 46–66%—removing infected individuals from their homes was intended to cut off a major route of onward spread.[13] Centralized facilities also worked as a triage layer; mild cases could be monitored and transferred if they deteriorated.[14] By concentrating food, care, and supervision in one location, mass isolation was framed as a way to break transmission chains quickly and avoid broader, longer lockdowns.[15]
C. International Legal Standards on Liberty, Health, and Child Protection
International human rights law provides the baseline for evaluating quarantine conditions. The Universal Declaration of Human Rights (UDHR), adopted in 1948, recognizes in Article 3 that everyone has the right to life, liberty, and security of person, protections that extend to state-imposed confinement, including quarantine.[16] For children, Article 37 of the Convention on the Rights of the Child (CRC) requires that any deprivation of liberty be lawful, used only as a last resort, and limited to the shortest appropriate period, while also requiring humane treatment, respect for dignity, and family contact whenever possible.[17] Article 11 and 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) further recognize the right to the highest attainable standard of physical and mental health, including not only medical care but also safe water, adequate food, housing, sanitation, and healthy environmental conditions.[18] Together, these standards show that quarantine cannot be justified by public health alone if it is imposed without adequate protections for liberty, dignity, and basic health needs.
With that factual and legal background in place, the discussion can turn to whether Fangcang remained quarantine in any meaningful sense once confinement became compulsory and conditions deteriorated.
III. Discussion
This Discussion evaluates Fangcang-style mass quarantine through three human rights frameworks: the right to liberty and security of person under the UDHR, children’s protections under CRC Article 37, and the right to health under ICESCR Article 12. It then proposes a rights-protective approach to quarantine grounded in enforceable facility standards and a least-restrictive-means principle that prioritizes supported home isolation when feasible.
A. Compulsory Quarantine and the Right to Liberty
Fangcang-style compulsory quarantine raises concerns under UDHR Article 3, which protects life, liberty, and security of person.[19] Even outside the criminal context, Article 3 provides a useful framework for evaluating state-imposed confinement and the conditions under which it occurs.[20] When quarantine operates through compulsory confinement, rigid control of movement, and conditions that undermine personal safety, it raises serious concerns under Article 3, particularly when confinement is triggered not by wrongdoing, but by illness.[21]
Reporting from Shanghai’s Fangcang quarantine facilities illustrates how a public health measure can become a liberty concern when compulsory confinement is coupled with degrading living conditions.[22] Under China’s Zero-COVID policy, individuals who tested positive were required to quarantine at designated sites and could not leave until they produced two consecutive negative PCR tests.[23] Release was therefore controlled by the state, not the individual.
Inside the facilities, conditions often resembled custodial warehousing rather than medical isolation. Reuters described rows of camp beds separated by less than an arm’s length, with video showing more than 100 people crowded onto a single floor.[24] Larger exhibition centers housed thousands of residents side-by-side without walls or showers, under lights that remained on around the clock.[25]
Liberty is restrained when confinement is mandatory and release depends on administrative clearance, and bodily security is compromised when the state confines sick people in overcrowded, unsanitary, sleep-disrupting conditions with inadequate basic provisions—treatment unfit for anyone, especially someone who is sick. [26]
B. How Fangcang Quarantine Undermines Children’s Rights
Article 37 of the CRC requires humane treatment, respect for dignity, and continued family contact except in exceptional situations.[27] Fangcang facilities were often created by converting stadiums and exhibition halls into rows of temporary beds.[28] When children are confined inside these facilities and are not free to leave, the measure constitutes a deprivation of liberty within the meaning of Article 37.[29] As a result, the confinement must be lawful, non-arbitrary, used only as a measure of last resort, and limited to the shortest appropriate period of time.[30] It must also ensure preserve humane treatment.[31]
The Shanghai approach in 2022 raised additional concerns under Article 37 because of the separation of COVID-positive children from their parents.[32] Reports indicated that parents were not permitted to accompany infected children and were often given limited information about their whereabouts or condition.[33] One parent was told that her daughter “was fine” but was not provided photographs or direct contact.[34] Images of crying children in isolation facilities circulated widely.[35]
Images of babies crowded together, including several sharing a single cot, underscored the vulnerability of children within these facilities.[36] When confinement conditions fail to account for children’s developmental needs and dependency on caregivers, they raise serious concerns under Article 37’s requirements of dignity, proportionality, and humane treatment.[37]
C. Public Health Without the Conditions for Health
ICESCR Article 12 recognizes the right of everyone to the highest attainable standard of physical and mental health.[38] That right does not disappear simply because the state labels confinement “quarantine.”[39]
Human rights analysis of COVID responses often focused on restrictions such as lockdowns and travel bans.[40] The right-to-health framework, however, asks a different question: whether the state’s measures actually protected physical and mental health while exercising emergency powers.[41] Once the state compels individuals into centralized quarantine, it assumed responsibility not only for containment, but for ensuring that the conditions of confinement meet minimum health standards.[42]
The conditions described above—including overcrowding, inadequate sanitation, and sleep disruption—implicate the underlying determinants of health protected by Article 12.[43] In a qualitative study of Fangcang hospital patients in Wuhan, patients described living in a “huge dormitory” with little personal space, difficulty sleep due to noise, inadequate washing facilities, and psychological distress, including fear and uncertainty.[44]
By confining COVID-positive people in overcrowded, unsanitary, and sleep-depriving facilities with inadequate hygiene and nutrition, the Fangcang quarantine regime undermined the “underlying determinants” of health and therefore failed to respect Article 12’s guarantee of the highest attainable standard of physical and mental health.[45]
D. Solutions: Rights – Protective Quarantine
The historical record and the human-rights frameworks discussed above point to the same conclusion: quarantine cannot be coerced solely by its stated public-health objective. The question is also how the state structures confinement, what conditions it imposes, and whether less restrictive alternatives remain available. Those lessons inform the two safeguards proposed below.
1. Set Enforceable Minimum Standards for Quarantine Facilities
If the state compels people into centralized quarantine, it assumes an affirmative duty to operate those sites as health-protective facilities, not warehouses.[46] The World Health Organization’s guidance on repurposing buildings for quarantine and isolation outlines minimum standards precisely because improvised sites can fail in essential areas, such as hygiene, infection control, and safe operations.[47] Likewise, ICESCR Article 12’s right-to-health framework treats access to safe water, sanitation, adequate food, housing, and healthy environmental conditions as baseline obligations.[48]
A rights-compliant quarantine facility must therefore ensure adequate space, sanitation, access to hygiene, nutrition, sleep, and medical monitoring.[49] These are not aspirational goals; they are the minimum conditions required when the state restricts liberty in the name of public health.[50]
2. Implement a Least-Restrictive-Means Approach
A second safeguard is structural: quarantine policy should be designed around the least-restrictive-means principle, meaning that centralized confinement should be used only when it is genuinely necessary for public health and when less intrusive options are insufficient.[51]
The Office of the United Nations High Commissioner for Human Rights has emphasized that emergency measures must be necessary, proportionate, non-discriminatory, time-limited, and as minimally intrusive as possible.[52] In practice, this supports a tiered model. Home isolation should be the default where individuals have safe living arrangements, can separate from others, and can receive support for food and medical needs. Community-based facilities should be used only when home isolation is not feasible.[53] Even then, those facilities must provide private, sanitary living space and reliable access to food and necessities.[54]
Taken together, these safeguards would help keep quarantine tied to public health necessity rather than coercive confinement.
IV. Conclusion
Fangcang shelter hospitals began as an emergency public-health response, but Shanghai’s experience shows how compulsory mass quarantine can cross into de facto detention when exit is state-controlled and conditions degrade dignity and safety.[55] Evaluated under UDHR Article 3, CRC Article 37, and ICESCR Article 12, the central concern is the use of illness as a basis for coercive confinement without adequate safeguards or minimum conditions necessary to protect physical and mental health.[56]
The solution is straightforward: enforce clear facility standards and adopt a least-restrictive-means approach that prioritizes supported home-quarantine whenever feasible.
[1] Coronavirus disease (COVID-19) (Fact Sheet), World Health Org. (Nov. 27, 2025), https://www.who.int/news-room/fact-sheets/detail/coronavirus-disease-%28covid-19%29 [https://perma.cc/4X7Y-RCV9].
[2] Id.
[3] Id.
[4] Simiao Chen, Zongjiu Zhang, Juntao Yang et al., Fangcang shelter hospitals: a novel concept for responding to public health emergencies, 395 THE LANCET 1305, 1305–06 (2020), https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)30744-3.pdf [https://perma.cc/T85D-FCDT].
[5] Id.
[6] Id. at 1306.
[7] Id. at 1307.
[8] You Wu, Xiaoru Feng, Mengchun Gong et al., Evolution and Major Changes of the Diagnosis and Treatment Protocol for COVID-19 Patients in China 2020–2023, 2 HEALTH CARE SCI. 135, 149 (2023) [https://perma.cc/C79A-YBH2].
[9] Shanghai quarantine: 24-hour lights, no hot showers, Associated Press (Apr. 17, 2022), https://apnews.com/article/covid-business-health-shanghai-d6a5e46da22086e7231abd271fa5cc59 [https://perma.cc/FGW4-HYZS].
[10] Id.
[11] David Kirton, Shanghai cases hit record as Xi reiterates urgency of COVID curbs, Reuters (Apr. 14, 2022), https://www.reuters.com/world/china/chinas-xi-says-sticking-tough-covid-curbs-will-bring-victory-2022-04-14/ [https://perma.cc/XVT4-4CP4].
[12] Id.
[13] Annelies Wilder-Smith, Alex R. Cook & Borame L. Dickens, Institutional Versus Home Isolation to Curb the COVID-19 Outbreak—Authors’ Reply, 396 LANCET 1632, 1632-33 (2020) [https://perma.cc/M35B-JJ87].
[14] Id.
[15] Id.
[16] Universal Declaration of Human Rights art. 3, G.A. Res. 217 (III) A, U.N. Doc. A/RES/217(III) (Dec. 10, 1948) [hereinafter UDHR].
[17] Convention on the Rights of the Child art. 37, Nov. 20, 1989, 1577 U.N.T.S. 3 (entered into force Sept. 2, 1990) [hereinafter CRC].
[18] International Covenant on Economic, Social and Cultural Rights arts. 11–12, Dec. 16, 1966, 993 U.N.T.S. 3. (entered into force Jan. 3, 1976) [hereinafter ICESCR].
[19] UDHR, supra note 16, art. 3.
[20] Id.
[21] Id.
[22] Brenda Goh, Camp beds and bread for Shanghai’s quarantined COVID cases, Reuters (Apr. 14, 2022), https://www.reuters.com/world/china/camp-beds-bread-shanghais-quarantined-covid-cases-2022-04-14/ [https://perma.cc/3MG6-RMNM].
[23] Id.
[24] Id.
[25] Id.
[26] Id.
[27] CRC, supra note 17, art. 37.
[28] Brenda Goh & Engen Tham, Shanghai separates COVID-positive children from parents in virus fight, Reuters (Apr. 2, 2022, 1:32 PM), https://www.reuters.com/world/china/shanghai-separates-covid-positive-children-parents-virus-fight-2022-04-02/ [https://perma.cc/36QA-3HWN].
[29] CRC, supra note 17, art. 37.
[30] Id.
[31] Id.
[32] Goh & Tham, supra note 28.
[33] Id.
[34] Id.
[35] Id.
[36] Id.
[37] CRC, supra note 17, art. 37.
[38] ICESCR, supra note 18, art. 12.
[39] Id.
[40] Kirton, supra note 11.
[41] Dainius Pūras, Judith Bueno de Mesquita, Luisa Cabal et al., The right to health must guide responses to COVID-19, 395 THE LANCET 1888, 1888–90 (2020), https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31255-1/fulltext [https://perma.cc/T6ZC-5333].
[42] Id.
[43] ICESCR, supra note 18, art. 12.
[44] Yaping Zhong, Huan Zhao, Tsorng-Yeh Lee et al., Experiences of COVID-19 patients in a Fangcang shelter hospital in China during the first wave of the COVID-19 pandemic: a qualitative descriptive study, 12 BMJ Open 1, 4 (2022), https://bmjopen.bmj.com/content/12/9/e065799.full.pdf [https://perma.cc/HPY6-7C7J].
[45] ICESCR, supra note 18, art. 12.
[46] World Health Org. Reg’l Off. for W. Pac., Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 1, 2–5 (Apr. 1, 2022), https://iris.who.int/server/api/core/bitstreams/41712e68-0564-440b-bfca-04208f17566b/content [https://perma.cc/HR4R-TFW2].
[47] Id. at 2–5.
[48] ICESCR, supra note 18, art. 12.
[49] Repurposing Facilities, supra note 46, at 2–5.
[50] Id.
[51] COVID-19 Guidance, Off. of U.N. High Comm’r for Hum. Rts., https://www.ohchr.org/en/covid-19/covid-19-guidance [https://perma.cc/XY9Q-RTCH] (last visited Feb. 15, 2026).
[52] Id.
[53] Id.
[54] Id.
[55] Goh, supra note 22.
[56] See UDHR, supra note 16, art. 3; CRC, supra note 17, art. 37; ICESCR, supra note 18, arts. 11–12.
