When a Pregnant Woman Has No Papers, Must She Give Birth at Home?

On the afternoon of November 3, 2004, Salma Srakhin and her husband Uda arrived at the emergency room of Be'er Sheva's Soroka Medical Center. Salma's waters had broken in her seventh month of a twin pregnancy. Uda has permanent resident status in Israel, while Salma has no status anywhere. In the petition that the Srakhins later filed with the Administrative Court, they related that "the reception clerk refused to admit the petitioner to the delivery room, claiming that without an identity card, she would not be admitted to the hospital even if she was in grave condition."

Uda says he presented the hospital receptionist with a number of other documents, but she refused to even look at them.

The Srakhins went home, where Salma gave birth to premature twins. They then went back to the hospital with the newborns, who were admitted to the neonatal ward and remained there for about a month.

The Patients' Rights Law states that "in a medical emergency, a person is entitled to unconditional urgent medical care." It is difficult not to view a woman in labor as a medical emergency; a mother of twins who goes into labor in her seventh month is triply so. The Srakhins thus sent an urgent complaint to Yoav Apowitzer, Public Complaints Coordinator for the Association for Civil Rights in Israel (ACRI), stating that "the reception clerk acted in contravention of the law when she sent the woman in labor home and conditioned her receipt of care on the existence of an identity card."

Soroka's spokesperson, Inbar Darom-Guter, told Haaretz in response that the emergency room clerk had "asked for an identity card, and when she was told that the woman had none, she explained to the husband that his wife would be assigned a temporary number and he would be asked to sign a promissory note, which is standard practice. The husband announced that he would not sign, took his wife and left. The clerk called out to the couple a number of times, saying that they should return to receive medical treatment, but unfortunately, they chose to leave."

Darom-Guter said that 60 percent of the births at Soroka are to Bedouin women. "In all cases, patients arriving at the emergency room receive care without preconditions relating to payment," she added.

Soroka's Public Complaints Department sent a letter to ACRI noting that this incident had been discussed with the hospital's administration. "Patient admission procedures are clear and are not open to interpretation or mistakes," stated the letter. "Administrative arrangements are no reason for withholding treatment."

The letter also noted that the procedures had been reviewed with the reception personnel, "in order to avoid a repetition of such incidents."

One of the documents that Uda showed the receptionist was a signed affidavit from ACRI attorney Bana Shagri-Badarna bearing Salma's photograph. This was supposed to serve as a kind of substitute identity card. The Srakhins are members of the Al-Azzama Bedouin tribe, hundreds of whose members have no legal status whatsoever.

"Uda phoned me from the hospital," recalled Shagri-Badarna. "He did not mention the promissory note, saying only that they would not admit [his wife] because she had no identity card - that the affidavit did not help. The issue of the promissory note was not raised until after we sent a complaint."

Sizable debts

The Srakhins now have four children, and have accumulated sizable debts at Soroka from numerous visits there. It is unlikely that signing the promissory note would have deterred them.

This story does have a happy ending, however. The Srakhin twins, Omar and Zinab, now almost two years old, and the other two Srakhin children are apparently the only Al-Azzama Bedouin in recent years to finally obtain permanent residency status. Omar required urgent surgery while his parents were in the midst of High Court of Justice hearings concerning their legal status. Without health insurance, he could not have the operation. The justices therefore quickly ordered the Interior Ministry to grant the children permanent residency status. Their mother, on the other hand, is still waging her legal battle for such status.

This dramatic story clearly illustrates the problem of children with no status. No status means no health insurance and no medical care except that provided by well-baby clinics - one reason why Physicians for Human Rights has joined forces with ACRI in the struggle to obtain legal status for all Al-Azzama tribe members.

Children with no status also have difficulty attending school. S., an eight-year-old girl whose parents have no status, started school only this year. Legally, the children of Bedouin with no status are eligible for education just like the children of foreign workers. The education system issues them fictitious identity numbers. Sometimes, however, schools do not know how to deal with unregistered children and refuse to enroll them, and the parents have no strength to protest.

Yifat Lipner, spokeswoman for the Education Ministry's Southern District, responded that a circular issued by the ministry's director general states that "every school-age child living in Israel for three continuous months must attend an institute of learning," even if he has no civil status. Other Education Ministry sources said that registering children for school, even those with no legal status, is the local authority's responsibility, and that S. did not go to school last year because her father did not register her.

Hundreds of people living in Israel have no official status - in any country. Without documents, they cannot work legally, have no health insurance and are in constant danger of being arrested. Haaretz is covering their struggle in a series of articles.