Israel's Coronavirus Blind Spot: The Arab Community

Just 1% of confirmed coronavirus cases in Israel are found in Arab cities and towns. Reasons may include lack of access to tests, fear of stigma and the fact that infection is more common in upper classes

Jack Khoury
Nir Hasson
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Israeli policemen patrol East Jerusalem, March 25, 2020
Israeli policemen patrol East Jerusalem, March 25, 2020Credit: Ohad Zwigenberg
Jack Khoury
Nir Hasson

Not enough epidemiological studies are being conducted in Arab communities in Israel, a Health Ministry map showing places visited by people who later tested positive for the novel coronavirus suggests.

The map shows no exposure clusters in large Arab cities, while displaying hundreds in nearby Jewish communities. The relatively low number of confirmed COVID-19 in Arab locales also points to possible undertesting for the virus.

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In Tamra, northeast of Haifa, there are eight confirmed cases of COVID-19 but no indication on the map of where any of these people were in the two weeks preceding their diagnosis. That goes for Kalansua, Taibeh and Tira, while Kadima-Tzoran, Tel Mond and Tzur Yigal show 15 points. Nazareth has just two exposure points, while Migdal Ha’amek has dozens.

Tamra
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The disparity is particularly obvious in Jerusalem: While the map areas for West Jerusalem and Jewish neighborhoods in East Jerusalem are covered with location pointers showing exposure points, there isn’t even one for the Palestinian neighborhoods, despite having 16 confirmed cases of COVID-19 as well as 330,000 of the city’s residents.

Medical professionals in East Jerusalem have claimed that the Health Ministry was insufficiently prepared for an outbreak in the area. One man, speaking on condition of anonymity, claims the ministry does not conduct epidemiological tests in East Jerusalem and that as far as he knows, area residents who may have been in contact with a coronavirus patient don’t receive text messages instructing them to self-isolate.

Nazareth and Migdal Ha'emek
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There is also a problem relating to diagnosis of the illness: Magen David Adom paramedics don’t go into the city’s Palestinian neighborhoods, particularly the ones that are on the other side of the separation barrier, and very few residents have been tested for the virus in hospitals or in their homes.

According to Health Ministry figures given to local authorities in Israel’s Arab community, only 38 residents of Arab communities have tested positive for the virus. The figures do not include East Jerusalem or mixed Arab-Jewish cities such as Acre, Haifa, Lod and Ramla. In the general population, 3,460 people have tested positive.

Undertesting may not be the whole story. Israeli Arabs travel abroad less than Israeli Jews, and higher-income areas of the country have higher numbers of residents who are in isolation after having returned from abroad or having contact with a coronavirus patient.

Yair Assaf-Shapira, a researcher with the Jerusalem Institute for Policy Research, found that communities in the ninth income decile, that is the top 80-90 percent of earners, had an average of 11 people in quarantine per 1,000 population, compared to 3.2 per 1,000 in the lowest-earning communities.

Fear of stigma may also pay a part in the undertesting of Arab Israelis. “There are people who are embarrassed or who fear that [testing positive] will have social or economic ramifications,” Dr. Khaled Aouda told Haaretz. He is a member of the national health committee established by the Higher Arab Monitoring Committee and the committee of Arab local authority heads.

Jerusalem
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“We are trying to step up our information campaign and to refer people to the testing facilities,” he said.

The medical director of the Nazareth Hospital EMMS, also known as the Scottish or the English hospital, Dr. Fahed Hakim, said the number of people asking to be tested for the coronavirus has risen, but is still small. “I see the numbers and I’m very concerned that there will be an outbreak. For that reason we are appealing to our public with two main messages: One, follow the instructions and do not go around outside, and two, don’t be embarrassed to ask to be tested if you have symptoms.”

A senior medical figure in East Jerusalem echoed Hakim’s comments, saying he knew a few Palestinians in the city who are afraid to call Magen David Adom. “They’re scared they’ll be placed in isolation, that people will look at them as if they have rabies.”

Self-isolation by socioeconomic index group
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One woman refused to be tested in her home for the virus, fearing that tongues would start wagging if neighbors saw people in protective gear entering her home. She went to a testing facility instead.

“Our fear is that there will be a major outbreak, and that will put everyone under pressure,” said Aouda.

“I called for a lockdown from the first day, since it’s impossible to deal with all the exceptions” from the emergency regulations, said Tamra Mayor Suhail Diab. “We also call on Magen David Adom and the Health Ministry to pick up the pace of testing in the Arab community; if not we’ll lose control,” he added.

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