Asylum seekers’ children don’t exist. At least not formally. Although they are born in Israel, they are not entitled to birth certificates or ID numbers, and their names are not entered into the system. The only official record that they were born is a meaningless “live birth” certificate, issued by the hospital to the child’s status-less mother.
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This absence of any legal status, combined with difficult living conditions, do not bode well for the health of these children, most of whom are the offspring of asylum seekers from Sudan and Eritrea. They spend much of their early years in unsupervised, makeshift day-care “centers,” referred to as “babysitters” by the local communities. They are usually located in crowded, dank converted apartments or bomb shelters.
According to estimates, there are between 70 and 80 of these “babysitters” functioning in Tel Aviv, each caring daily for between 40 and 80 children from newborns to seven-year-olds. In total, between 4,000 and 6,000 children are cared for at these day-care centers in Tel Aviv, with 2,500 of them under the age of 3. In the last two months, five infants have died in these centers.
Public health laws do not apply to asylum seekers and other migrants without status. They are entitled to emergency treatment at hospitals, but not to regular medical care at local clinics. Their children, however, are entitled to slightly more, especially during infancy, as they do receive Health Ministry sanctioned infant care.
“We know that many people without status visit infant clinics and are responsible about vaccinations. So it’s wrong to say they get nothing from the government – they get vaccinations,” says Dr. Adiya Barkai, who used to run the mother and child department at the Health Ministry, and has volunteered for many years with the organization Physicians for Human Rights. “It also explains why there aren’t outbreaks of diseases like the measles and rubella. Aside from that, they get no regular medical care in their communities, meaning children with chronic diseases, or asthmatic children are not monitored.”
PHR conducted a study on the medical state of children with status-less parents who visited the organization’s clinic between December 2013 and June 2014. Barkai says that 30 percent of the children in every age group suffered from infections in their respiratory systems – due to asthma, bronchitis or lung or nasal infection. “Any other child which such symptoms wouldn’t go to school or day-care that day. Here, this doesn’t happen,” she says.
The most severe problem, however, is the adverse effects these babysitters have on children’s development. “Due to the lack of stimulation – because they are often kept there without any games, or physical contact — they simply grow up like little plants. We definitely see issues with the children’s development in relation to their environment. Everyone knows what happens to children who lie in bed all day and are given a bottle once every few hours. These children suffer not only from lack of proper nutrition, but also from physical, cultural and spiritual issues that stem from the uncertainty of their situation. Many of them suffer from moderate to serious depression,” says Barkai. The most acute cases are sent to hospital emergency rooms, where they receive excellent care, she adds.
Refugees’ children do have the possibility of receiving medical care like other children in Israel, through a special health insurance program that was created over a decade ago. In 2001, the Health Ministry launched an initiative to regulate provision of health insurance for children of status-less parents through the Meuhedet health maintenance organization. The agreement was signed with Meuhedet and lasted until the end of 2014.
“The arrangement itself was important, and allowed for children without status to be insured. It was also cheaper than private health insurance,” says Elisheva Milikowsky, who runs the department of migrants and people without status for PHR, “though it often caused problems and didn’t really provide assistance.”
This insurance, which would entitle migrants’ children to the same healthcare service as Israeli children, cost 195 shekels per month for one child, or 384 shekels per month for two or more children. Still, according to PHR, over 60 percent of migrants’ children do not have insurance. According to Milikowsky, for many of these families with two or more children, 384 shekels represents over a tenth of their monthly salary. Also, the insurance is problematic because it is voluntary for parents, unlike with Israeli children, who automatically receive insurance from the government.
“Many migrant parents do not understand the Western concept of health insurance or why it is necessary, and they don’t see the logic in paying insurance fees for someone who is healthy,” says Milikowsky, adding “there are also more than a few cases in which the family had insurance, but one of the parents lost their job, and stopped paying for a few months. A debt is incurred, and a few months later, when they want to continue paying, they can’t, because of past debt.”
Former Health Minister Yael German (Yesh Atid) raised the possibility of applying the public health laws to children without status, but it’s doubtful that this will actually happen. In the meantime, the Health Ministry is expected to issue a tender for the HMOs to provide adequate insurance that would provide medical coverage through local clinics.