While Israel Plans to Offer Medical Coverage for Elderly Ukrainians, Asylum Seekers Still Need to Wait

Hundreds of African asylum seekers who are over 60 and live in Israel have no social or other benefits and live in limbo. Meanwhile, they watch as Israel plans to provide coverage to refugees from Ukraine

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The Terem urgent care clinic in Tel Aviv's Central Bus Station, March 31, 2022
The Terem urgent care clinic in Tel Aviv's Central Bus Station, last month. 'I don’t see why the state should differentiate between Ukrainians, and Sudanese or Darfurians,' says Haroon, from Sudan.Credit: Hadas Parush
Bar Peleg
Bar Peleg
Bar Peleg
Bar Peleg

She sits in a corner, confined to a wheelchair. One of her legs was amputated three years ago. She suffers from diabetes, and a person with her status (or lack thereof) has no other choice. Since then her situation has deteriorated. She is now slowly losing her sight.

This is T. (Haaretz is in possession of her full name), 68, who lives in a modest apartment in the Hatikva neighborhood in south Tel Aviv. She is alone, lonely and at constant risk of losing the little she owns and being cast out to live in the street.

T., who is from Eritrea, arrived in Israel about 20 years ago and is still defined as an asylum seeker – that's it. She has therefore never been entitled to health insurance. If she had been, she might now be standing on two legs. And yet at the end of March, the state publicized a new scheme enabling provision of medical services to Ukrainian refugees and, for the older adults among them, a kind of medical insurance.

But when T. came to Israel decades ago, together with many other Eritrean and Sudanese asylum seekers, none of the authorities were quick to act on their behalf. Even then, some of them were old, and they haven’t gotten any younger – only more accustomed to hearing unfulfilled promises and, mainly, to experiencing rejection.

A physician at a Terem emergency clinic in Tel Aviv, March 31, 2022. For some of the foreign nationals living in the country, the health problems only grow worse.Credit: Hadas Parush

There are currently 285 asylum seekers over 60 years of age in Israel; on paper they are supposed to be on pension or planning for it, and even eligible for assisted living accommodations. But in fact they are totally on their own, as their stories continue to reveal, certainly that of T. A relatively simple procedure could have saved her leg – catheterization, according to the doctors. But despite repeated requests to the Health Ministry, no funding was found for her.

“I haven’t been out of the house in three years, except to the doctor," she tells Haaretz. "I’ll die soon. I only ask for help, this isn’t life.”

T. breaks down in tears frequently during our conversation, saying that without the support of her local community, life would be even harder for her.

The state is familiar with T.’s story: It was described in a petition to the High Court of Justice last year. The petition, filed by several organizations – Assaf, the Aid Organization for Refugees and Asylum Seekers in Israel; the Association for the Law in the Service of Old Age; Physicians for Human Rights; and the refugee aid group HIAS – called for Israel’s social security and health insurance laws to be extended to cover older asylum seekers who cannot work and who receive no benefits from their employers.

For some of these foreign nationals, the health problems only grow worse. For example, B., 63, needs an operation to remove the right lobe of his lung due to a tumor. But the operation costs 40,000 shekels ($12,488), which he doesn’t have. His is one of the seven patients who approached Physicians for Human Rights and whose full story appears in the High Court petition. Meanwhile, the organization is trying to find a hospital that will agree to bear the cost and save B.’s life.

The story of A., 67, is also described in the petition. He suffers from pain in his limbs that can be resolved by surgery, but lacking the ability to pay for it, is forced to rely on painkillers. If he had proper social benefits, A. would also have the right to a place in an assisted living facility – which was granted to eight Ukrainians in recent days. But he doesn’t.

Waiting for care at the Terem emergency clinic in the Tel Aviv's bus station. 'There is no difference between refugees,' says the Health Ministry. Credit: Hadas Parush

Now A. waits, not for a doctor or an operation, but for a court ruling.

First, the state asked to set a hearing date in the High Court only in the second half of 2022. Then in early March, the state informed the court that an inter-ministerial committee had decided to grant health insurance to foreigners who cannot return to their country of origin, as reported in Haaretz. But the date this insurance scheme will take effect is still unknown. According to an official in Health Minister Nitzan Horowitz's office, an invitation for bids for a provider of this service is due to be published in a few weeks. Until a winner is chosen and the initiative is actually implemented – it might be too late for people who need immediate assistance.

Last week, Nimrod Avigal, the attorney representing Physicians for Human Rights and HIAS in the petition, submitted a new request to the court, arguing that the respondents (the Health Ministry and the Labor, Social Affairs and Social Services Ministry) were dragging their feet and claiming that the issue is complicated. However, he noted, less than 300 people are affected by this situation – and meanwhile Ukrainian refugees are receiving immediate responses.

About the same time, the Labor and Social Affairs Ministry published an “urgent call” for medical service providers for refugees; the results are expected in a few days. The bid calls for establishment of 20 centers throughout the country that will provide emergency care, lab services, medical imaging and other services.

“Suddenly, the respondents are pressed for time and they were to quickly put together a policy to arrange health insurance for those age 60 and over, and social services for Ukrainian citizens. Those same solutions were quickly organized, as they should be, in less than a month from the time the refugees entered the country, and an announcement was quickly issued in the media,” Avigal wrote the High Court.

Ukrainians over the age of 60 are eligible to receive a form of full health insurance to be provided by private companies contracted by the Labor and Social Affairs Ministry. Funding of 4 million shekels will be allocated for three months to the rest of the Ukrainian refugees, some 15,000 of them (among whom about 11,000 have already arrived in Israel). This is exactly the same sum that was allocated to one urgent-care clinic over a period of two years (2016-2017), to treat a much larger population of asylum seekers already living in the country.

For his part, Avigal and other lawyers are asking the High Court why the state does not equalize conditions for the greater community asylum seekers, to match those being offered to the Ukrainians. “Much has been written already and more will be written about the difference between ‘Black’ and ‘white’ refugees and unfortunately Israel is not unique in this,” the attorneys wrote.

Patients waiting at the Terem clinic in Tel Aviv's bus station, March 31, 2022. A High Court petition calls for Israel’s social security and health insurance laws to cover all older asylum seekers. Credit: Hadas Parush

The High Court has demanded the state to respond this week to these claims.

'Surprising' scheme

Tali Ehrenthal, CEO of Assaf, says that the manner in which the state has quickly undertaken to see to the needs of the Ukrainian refugees “is proof that Israel can care for the welfare and wellbeing of anyone who flees [here] and cannot return to their country.” She adds: “Implementation of such a program that serves one group alone is surprising, to put it mildly.”

Monim Haroon, a Sudanese asylum seeker and community leader in Israel, says: “This is a clear example of discrimination, there is no other way to explain it. We also were forced to leave our homes. I don’t see why the state should differentiate in its attitude between Ukrainians, and Sudanese or Darfurians." Haroon has had a temporary residence permit for the past three years and is therefore eligible for health care services, but he sees other refugees around him who have been forced to make do alone.

“It’s hard to call this anything but racism,” he adds.

Minister Horowitz's office provided this response: “There is no difference between refugees, and we are committed to giving a response to any person who comes to Israel and requests asylum. This is the right thing to do morally professionally, medically and economically as well.

"Therefore, at the behest of the health minister, the Health Ministry is promoting an arrangement for provision of medical insurance for asylum seekers through a local health maintenance organization, similar to the current arrangement for the children of people lacking residency status. Bids will be invited soon so as to select a service provider and determine the rate of payment and in the end, after years during which this issue was neglected, a proper medical response will be provided to the population of refugees in Israel.”

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