Nearly 300 people have died following the world’s biggest-ever single-day election, which took place this month in Indonesia—not through protests or civil unrest, but exhaustion.

According to Indonesian officials, 272 election staff have collapsed from fatigue-related illness in the 10 days following the country’s April 17 vote. An additional 1,878 were ill, according to a General Elections Commission (KPU) spokesperson. They are manually counting the country’s paper ballots, and with a population of 270 million people, that’s a task to make anyone feel weary.

Indonesia is the fourth most populous country in the world. It’s estimated that 80% of the country’s 192 million eligible citizens voted, meaning 150 million people turned up to the polls. Multiply that by the five ballot papers each person had the option to punch out, and that’s up to 750 million ballots that need to be counted—by hand.

AP Photo/Tatan Syuflana Government employees prepare a Kafka-esque number of ballot boxes ahead of Indonesia’s elections.

It was the first time the country has held its presidential elections at the same time as its regional and national votes. This made it the largest single-day election in human history. The government says it will provide compensation to the families of the deceased.

Working yourself to death

Death from overwork is a scarily common occurrence around the world. In 2013 in Indonesia, an advertising copyeditor slipped into a coma and died hours after tweeting “30 hours of work and still going strooong.” That same year in London, a 21-year-old Bank of America intern suffered an epileptic seizure allegedly brought on by working 72 hours straight. Also in 2013, a 31-year-old journalist in Tokyo was found dead of heart failure in her bed (paywall), still clutching her mobile phone, after working 159 hours of overtime in a single month.

In Japan, they even have a word for it: karōshi, which translates to “overwork death.” It’s defined as the sudden death by cardiac arrest or suicide of an employee who’s worked more than 80 to 100 hours of overtime a month. In 2017 in Japan, 92 people died from a stroke or heart attack caused by long work hours, and 98 workers committed or attempted suicide, according to the labor ministry. Japanese businesses are desperately trying to shift this cultural expectation; one company has even taken to blasting the Rocky theme song at 6pm to try and get employees to leave on time.

The 190 people who died of karōshi in 2017 are just the instances that the Japanese government officially recognizes—the real number is estimated to be much higher. Figures for death by overwork in China range from to 1,600 a day to 600,000 a year, for example.

Stanford University organizational behavior professor Jeffrey Pfeffer notes the Western world is not immune. “I didn’t think the workplace would be the fifth leading cause of death in the United States,” Pfeffer said while discussing the research for his book Dying for a Paycheck. “And when I talk to HR people, they say the numbers we have are certainly wrong: They are too low.”

Back in Indonesia, the official results of the 2019 presidential election aren’t due to be announced until May 22. That means another three-plus weeks of hand-counting ballots for the KPU staff. Incumbent president Joko Widodo is around 10 percentage points ahead of opposition leader Prabowo Subianto, according to exit polls, and both men have declared victory.

But Subianto is alleging voter fraud. If his claims stick, then the entire country might be forced to a recount. By hand.