Tens of thousands of foreign nationals without health insurance, including many asylum seekers, have been left without access to basic medical services after two of their major sources of medical care shut down almost simultaneously.
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First, a fund set up by Tel Aviv’s Ichilov Hospital to pay for non-urgent treatment has run out of money. As a result, the hospital said it will no longer treat uninsured people who can’t pay upfront, except for emergency patients, whom hospitals are obliged to treat by law. But the national health insurance program covers only legal residents, and many foreigners who aren’t legal residents can’t afford either to buy private insurance or to pay out of pocket.
Second, the Gesher clinic in Jaffa, which is financed by the Health Ministry and provides mental health services to asylum seekers, announced about 10 days ago that it is overloaded and will no longer accept new patients.
Two other clinics in Tel Aviv still serve uninsured foreigners, but they offer only limited services.
Tamet, an Eritrean asylum seeker, took her 12-year-daughter to Ichilov last week for treatment of a leg problem. Over the past eight months, the girl has undergone a series of tests to diagnose the problem, all paid for by Ichilov’s fund, and for three months, she has been waiting for an appointment with an expert who would recommend treatment. When she went for the long awaited appointment, the secretary said the doctor couldn’t see them unless Tamet paid 290 shekels ($75) because the fund’s money has run out. But Tamet, a single mother of four, can’t afford that sum.
Many other asylum seekers – including another of Tamet’s daughters, who had been receiving monthly treatments for asthma – have also had to suddenly stop ongoing treatments because the fund has run out.
Under a special agreement between the Health Ministry and the Meuhedet health maintenance organization, foreign nationals can buy health insurance from Meuhedet for 120 shekels a month. But many asylum seekers can’t afford that sum.
Gesher’s closure to new patients is no less problematic, because it’s the only clinic that provides mental health services to asylum seekers, many of whom were tortured and traumatized by Bedouin smugglers in Sinai en route to Israel. Since opening in early 2014, it has treated 610 people. But it operates only nine hours a week and has a waiting list of 200 people, some of whom have waited more than six months. Now, all those people will have nowhere to go.
There are almost 150,000 foreigners in Israel who lack legal status. That includes 41,000 asylum seekers, 15,000 illegal foreign workers and 91,000 tourists with expired visas. That total doesn’t include their thousands of children. And very few of these foreigners have health insurance.
They can still obtain treatment at Terem, an emergency health clinic run by the Health Ministry at Tel Aviv’s central bus station, or at a Jaffa clinic run by Physicians for Human Rights. But both clinics offer very limited services, and can’t replace the services Gesher and Ichilov used to provide.
Ichilov was treating hundreds of foreign nationals every year. But its fund, which comes out of its own budget, was slashed from 200,000 shekels last year to 100,000 shekels this year. Consequently, the money ran out mid-year.
When PHR, which used to refer many asylum seekers to Ichilov, asked where it should send them now, hospital director Prof. Ronni Gamzu said to send them to Terem. But in a letter to Health Minister Yaakov Litzman, Dr. Zoe Gutzeit, who heads PHR’s refugees and migrants department, and Michal Pinchuk, executive director of the refugee aid organization ASSAF, said this was no solution, because Terem already refers cases it can’t handle to the volunteer doctors at PHR’s clinic. This fact alone, they wrote, underscores the state’s failure to provide proper medical care for asylum seekers.
Terem, the letter continued, can’t provide the services a hospital does. Moreover, it’s the only government-sponsored clinic in the country that caters to asylum seekers, which means asylum seekers living elsewhere in Israel must travel to Tel Aviv for even basic medical care.
A 2014 state comptroller’s report harshly criticized the state’s failure to provide adequate medical services to asylum seekers. It said this failure seems to violate the Basic Law on Human Dignity and Liberty, as well as international conventions on social rights that Israel has signed.
M., a Sudanese asylum seeker, was being treated at Ichilov for a serious eye problem that prevents him from working. He had an operation on his left eye earlier, and one for his right eye, in which is completely blind, was scheduled for next month. But last week, Ichilov told him the operation would be canceled unless he pays the thousands of shekels he already owes. “I don’t know what to do,” he said.
Kubrom, an Eritrean asylum seeker, was told following an MRI that he needs an urgent operation on his head. Due to severe gallstones, he was also advised to have his gall bladder removed. But Ichilov told him he can’t have the operations unless he pays the 90,000 shekels ($23,000) he already owes.
“I have terrible pain all night,” he said via a translator. “I can’t sleep. I throw up whatever I eat.”
He added that if he had the operations, he’d be able to work and pay off the debt. But the hospital said it wanted the money upfront.
PHR’s executive director, Ran Goldstein, said he blames the Health Ministry, not Ichilov. He said it’s “ridiculous” for a patient who could be cured with “100 shekels worth of antibiotics” to be allowed to deteriorate to the point where he needs expensive emergency treatment costing thousands of shekels.
“Unfortunately, we have to tell our patients, some of whom have chronic illnesses or need vital operations, that to get treatment in Israel, they have to hope they get worse,” he said. “Only then will the hospitals admit them.”
Goldstein blamed the ministry’s failure to provide proper medical care on “the government’s racist policy,” which “doesn’t see people who live here as having rights.” His proposed solution is to expand the national health insurance plan to cover people who aren’t legal residents.
A doctor from Ichilov noted that the hospital had financed its treatment fund entirely on its own, but now, economic problems have forced it to cut back. He said that Ichilov administrators, like PHR, believe the Health Ministry should start picking up the tab.
He also agreed with PHR that doing so would make economic sense, and even used a similar example: When someone complains of a cough and a fever, performing a simple blood test to diagnose an infection that can be cured with “antibiotics costing a few dozen shekels” is preferable to letting him deteriorate to the point where he needs emergency hospitalization.
The fact that Gesher stopped taking new patients just a few days after Ichilov’s fund ran out was pure chance. But together, they create a sense that the health system for asylum seekers has completely collapsed.
Sheyzaf Zach, who heads the advocacy and support center of the refugee aid organization ASSAF, said Gesher’s shutdown is another case of penny wise, pound foolish. Failing to give traumatized asylum seekers basic mental health services means they are liable to deteriorate to the point where they need psychiatric hospitalization, he said.
An Ichilov spokesperson said that for years the hospital provided asylum seekers and foreign workers with more extensive treatment than any other hospital in Israel, all “out of its own budget.” The fund was set up three years ago to finance non-urgent medical treatment, but “the hospital will continue to provide urgent medical care to this population just as it does today.”
The Health Ministry said that with regard to the question of insurance coverage, it merely “carries out the policy of the Prime Minister’s Office.” But it stressed that “within the limits of its budget,” it does provide medical services to people without legal status, including via the Terem clinic. These services include doctors’ exams, lab tests, medications, pregnancy care, births, vaccinations and much more.
In addition, hospitals treat all urgent cases, it said, while full medical service is provided at both shelters for victims of trafficking and the Holot open detention facility for asylum seekers.
While Gesher was forced to stop taking new patients due to a shortage of funds, the ministry is looking into offering mental health services via the Terem clinic in Tel Aviv, its statement continued.
Moreover, it said, though Ichilov’s fund for non-urgent care was financed entirely by the hospital, the ministry effectively contributes to funding urgent care by all hospitals, because treating patients who lack insurance increases the hospitals’ deficits. The ministry then covers these deficits “with Israeli taxpayers’ money, to the tune of 20 million shekels a year.”
Finally, though the national health insurance plan will cover only legal residents unless and until the government’s policy changes, “the ministry is currently drafting proposals for insurance solutions for people without legal status,” it said. “When the internal ministry process is completed, they will be presented to the relevant government ministries.”