A Question Israelis and Americans Share: Should Refugees and Immigrants Receive Free Healthcare?

One of the major goals of the Wexner Israel Fellowship is to strengthen the ties and understanding between Israel and the American Jewish community.  Class 28, currently working towards their Masters degrees at Harvard’s Kennedy School, has therefore started a new tradition.  We are conducting informal conversations on burning issues in Israeli society with prominent members of the Jewish community from the Boston area (many of them Wexner Heritage alumni).  Each of these "fireside chats" takes place in a Jewish community member’s home, where a Fellow presents a pressing issue in the area of their expertise, followed by an open discussion that may also address, compare and contrast similar challenges within American society.

In our second fireside chat, we presented the issue of medical treatment of illegal immigrants in Israel, particularly the African immigrants who came recently, primarily from Eritrea and Sudan.  Most of them are protected from deportation to their countries of origin because of their ongoing conflicts but have varying degrees of medical coverage, which presents an ethical (and of course political) question for israelis.  There are about 40,000 of these African immigrants who entered Israel illegally through the Egyptian border.  Some of them got married and had children (it is estimated that there are about 15,000 children, most of them born in Israel).  As these immigrants survived a long and tough journey from their home country to Israel, they are generally young and healthy people.  Nevertheless, this population presents a medical challenge as they have common and unique health problems. Like any other population, they suffer from acute and chronic diseases, like hypertension, diabetes and cancer.  Some of them also have infectious diseases, like HIV and Tuberculosis (but in much lower rates than is sometimes perceived by the public). Others suffer from psychological and orthopedic problems as a result of kidnapping and torture that they went through in the Sinai desert.  Pregnant women and children require special care, including preventive measures like prenatal screening and counseling, immunizations and developmental assessments.

For those who are working full-time, employers are mandated to pay for private health insurance.  This insurance fails to cover the costs of long-term medical conditions that cause work disability, as employers can stop paying for workers' insurance once they stop working, even if due to health reasons.  For those who don't have health insurance, a few services  have been developed by the Israel Ministry of Health (MOH) or by local NGOs like Physicians for Human Rights (PHR) or international aid organizations.  The most important services include: free access to emergency rooms and hospitalization services when needed for urgent care, including deliveries (no pre-payment is required to get those services); primary care clinics like the MOH 'Refugees Clinic' and the PHR 'Open Clinic', both in Tel-Aviv; and the MOH 'Gesher' psychiatric clinic.  For children, there is a voluntary MOH subsidized health insurance which is almost identical to the health insurance that Israeli children receive from the National Health Insurance Law.

There are two instances in which the MOH gives full health coverage — to people who reside in the shelter for human trafficking victims and to the 'Holot' detention center (in the Negev).  In these two places, the residents get primary care on-site while consultations, hospitalizations, emergency care, etc., are given in Beilinson and Soroka general hospitals, respectively.  The services given in the hospitals are the same as for Israeli citizens, which means there is some scarcity in the periphery.

PHR is trying to advocate for a social residency status which would separate the immigrants' residential status from their rights to health and other social benefits.  The lack of comprehensive health insurance causes people's health to deteriorate, since their simple chronic illnesses were not dealt with at an earlier stage and this further taxes the system.

Because of the Americans present, we also compared the treatment and law regarding immigrants and refugees here in the USA.

We had a wonderful conversation, with most of us concluding that to prevent a moral and financial burden on the Israeli Health System, and for the good of the people, we should continue to support complete medical coverage for immigrants and refugees.

Mushira Aboo Dia, WIF Fellow (Class 28), is a specialist in Obstetrics and Gynecology at Hadassah Medical Center.  Apart from being a senior physician in the delivery room, Mushira serves as an on-call doctor in the Bat Ami Sexual Assault Treatment Center and works in the high-risk pregnancy clinic in the Women’s Health Center of Clalit Health Services in Beit Shemesh.  In 2014, she was appointed Administrative Director of Women’s Health in the Palestinian population of East Jerusalem by Leumit Health Services.  Mushira is also the co-chairperson of Physicians for Human Rights Israel, where she has volunteered in the open and mobile clinics since 2004.  She can be reached at mushiraa@gmail.com.

Eyal Jacobson, WIF Fellow (Class 28), serves as Deputy Director of Medical Affairs at the Ministry of Health and works as a family physician.  In the Ministry of Health, Eyal is actively engaged in policy-making and regulation of the Israeli healthcare system, with special interests in development of medical professions, end-of-life care and advance care planning, emergency department operations and management and healthcare services to uninsured special populations. Eyal graduated from the MD, PhD program at the Technion — Israel Institute of Technology Faculty of Medicine.  He can be reached at Eyal_Jacobson@hks17.harvard.edu.