For Palestinian Children in Jerusalem, Severe Underdiagnoses of Developmental Delays, Study Shows

New research has identified several culprits, including insufficient government resources allocated for East Jerusalem families, language barriers and a distressing bureaucratic process

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An HMO branch in Jerusalem, February
An HMO branch in Jerusalem, FebruaryCredit: Emil Salman
Nir Hasson
Nir Hasson

For children in predominantly Palestinian East Jerusalem, new research reveals a significant shortfall in the diagnosis of developmental issues versus those in largely Jewish West Jerusalem and in Israel overall.

The study, conducted by the Jerusalem Institute for Policy Research, reports that understaffing at children's health centers, neglect on the part of health care providers and logistical issues – including language barriers and transportation issues – have all thrown up roadblocks to timely identification and diagnosis of, and assistance for, East Jerusalem children with developmental delays and disorders. Fewer than 3 percent of East Jerusalem children are diagnosed, compared with 10 to 15 percent in the country as a whole. 

“Even with the best of intentions, when there’s a physician one day in a given location, then a nutritionist another day and a playgroup a third day, the care providers never meet each other to consult and to track down children who need help,” says Dganit Levi, a sociologist at the institute who carried out the study together with Sarit Bensimhon-Peleg, deputy head of research at the Institute.

Most HMO-run diagnostic and treatment services for child development are located in West Jerusalem. “We have tried to explain that for a woman from East Jerusalem it’s not so simple to go to [West Jerusalem neighborhood] Givat Shaul or the west of the city,” says Bensimhon-Peleg, “certainly not in times of [Arab-Jewish] tension and certainly if she doesn’t speak Hebrew, and when there is fear and shame associated with the process.”

Furthermore, most of the medical services in East Jerusalem are not provided directly by the HMOs but, rather, by franchisees. These often rely on doctors who are not licensed in Israel and who don’t have the requisite qualifications.

According to Health Ministry regulations, every child should be seen by a developmental physician five times before their fifth birthday. In East Jerusalem, children are examined only twice by age 3 due to a shortage of doctors. Pediatricians in East Jerusalem often lack training in child development and don’t routinely perform appropriate testing on the children they do see. The study found there are only three Arabic-speaking child neurologists in Jerusalem, compared with 26 Hebrew-speaking ones.

The study's survey of 1,381 East Jerusalem parents showed that when developmental problems are first suspected, parents encounter bureaucratic difficulties and long waiting times. They need Hebrew-language skills and an ability to push through the bureaucracy, both of which many of them lack.

The researchers found an improvement in how such parents are treated, and in the handling of mild developmental delays in East Jerusalem children, following the introduction of a program run by the municipality's early-childhood division. Still, levels of detection and diagnosis here remain lower than in West Jerusalem and in the country as a whole.

The program includes supervised playgroups at children's health centers, where staff members can be alerted to children with difficulties and advise their parents. Nurses at the centers receive special training in child development, and the city has hired liaisons whose job is to ensure parents and children receive the services to which they are entitled. The program has also set up a Facebook page with information for East Jerusalem parents.

The researchers propose that all the HMOs work together to establish, with the assistance of the Health Ministry, a single child development center in East Jerusalem. An alternative, they have proposed, is to hold intensive East Jerusalem “diagnosis days” staffed by teams from the western part of the city.

The study was commissioned by the Jerusalem municipality and funded by the Jerusalem Foundation. 

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