Professional Documents
Culture Documents
October, 2002
Some of the major conclusions are a product of our cooperation with Adv.
Dori Spivak and his students in the Human Right Center, Tel-Aviv
University.
Contents
Introduction…………………………………….….….... 3
Conclusions……………………………………….……. 42
Responses………………………………....…………….. 45
1 We
have recently finished a full updated report on asylum seekers and
refugees in Israel together with Adv. Anat Ben-Dor of the Tel-Aviv
University clinic for legal clinical aid. The report will be available in
our office and web-site as of November, 2002.
2
Introduction
During the late 1980s and early 1990s, Israel saw the arrival of a
growing number of migrant workers2. As a result of the closure
policy prevalent at the time, which prevented Palestinians from the
West Bank and Gaza Strip from working within Israel, the
government acceded to pressure from employers and issued them
permits allowing them to bring migrant workers into the country,
mainly for construction and agriculture. By the end of 1997, the
number of migrant workers holding visas was already at 85,000.3
Some migrant workers who initially held valid visas have since then
lost this status for various reasons. Workers who “escaped” their
employers, either because of disagreements, extreme exploitation, a
desire to secure increased earnings on the black market, or various
other reasons will automatically lose their valid visa. In addition to
visa-holding workers, a large number of workers have arrived and
have been working in Israel since the 1990s without visas at all.
Most of these workers come from countries in which it is impossible
to obtain an Israeli working visa, such as Latin America, West and
South Africa and Eastern Europe. All the while Palestinian workers
have continued to enter Israel from the Occupied Territories
whenever the closure is lifted. While some return home at the end
of the day, others will stay in Israel for a week or longer.
3
The National Health Insurance Law is one of the finest
achievements of the Israeli welfare state. It establishes the
eligibility of any resident in Israel to a minimum 'basket' of health
services as defined by the law. In other words, any person holding a
resident’s certificate (citizens are also residents) is entitled to health
services through one of the HMOs. The HMO is not permitted to
reject a member on the grounds of their religion, race, sex or state of
health. This eligibility is connected to the payment of health tax by
all employees and self-employed persons, but is not conditioned on
payment. Even a person who, for whatever reason, fails to pay
health tax or is not a member of an HMO, but who holds a
resident’s certificate, is entitled to the full health basket. As noted
above, all migrant workers, by definition, are not residents. They
hold working permits which far “lesser” status than those of
residents. The National Health Insurance Law, consequently, does
not apply to them.
4
The reality for adults who do not hold visas − the largest group
within the population of migrant workers in Israel − remains,
however, the same as in the early 1990s. These workers have no
eligibility or access to health services and no attempt has been made
to provide them with such. Chapter Three will examine this group
and will include a number of proposals and conclusions.
5
Chapter One: Children
1A. The Current Situation
No information is available regarding the number of children born
in Israel to the families of migrant workers or brought into Israel
from their country of origin. This lack of information is a by-
product of the fact that, from the standpoint of the Israeli authorities,
these children effectively do not exist, even if they were born in
Israel and have lived in the country all of their life. They have no
civil status in Israel and do not appear in the State’s population
registry. While Israeli hospitals issue a certificate testifying to the
birth of a child and the Ministry of Interior registers the child in the
population registry. These procedures do not apply to migrant's
children.
6
children into the education system.
7
1B. Health Services for Migrant Children.
February 2001 – February 2003
In 1999, PHR-Israel, together with The Association for Civil Rights
in Israel and The National Council for the Child, initiated a number
of lobbying activities. These included submitting a High Court
petition which stated that the National Health Insurance Law should
be applied on migrant children based on the UN Convention on the
Rights of Children which prohibits discrimination between children
on various grounds, including their parents’ status and social
origin6.
8
It is important to emphasize the great advantage of the arrangement:
the basket of health services received by children from migrant
families joining the arrangement is equal in all respects to the basket
of services enjoyed by Israeli children. The HMO cannot refuse to
insure a child on the basis of his medical condition or origin8. The
scope of registration, however, has been disappointing. No more
than eight hundred children have been registered out of several
thousand we believe to be living in Israel. The reasons for this are
unclear, though we believe that there may be a number of problems
with the arrangement that may be the cause. These will be discussed
below.
9
of government insurance does not exist in their
country of origin. They will express reservations
and a mistrust of insurance that is "a promise" to
cover future services if necessary. Some families
have had negative experiences with private medical
insurance schemes marketed in Israel and have lost
confidence in insurance altogether.
10
M. is a Colombian citizen. Her husband was deported from Israel
and she is currently raising two children by herself. Her 11 year-old
son suffers from behavioral problems at home and at school. M. is
barely able to support her two children. Her son can undergo
diagnosis within the education system, but cannot receive ongoing
psychological treatment, since he, like his brother and mother, does
not have medical insurance. When we told M. about the possibility
of receiving full insurance through Kupat Holim Meuchedet, she
replied that there was no way she could meet the payment - she
would have to pay 370 NIS every month for medical insurance for
her two children. PHR-Israel, through the 'Open Clinic for Migrant
Workers' has no funding available to help the family pay the
insurance9. 'Mesila' – the Municipal Welfare and Assistance Center
for Foreigners – is also unable to help, since it too has no special
funds. There exists no procedure in which the Ministry of Labor and
Social Affairs or the Ministry of Health can provide support in such
a case. At the time of writing, these children are not insured with an
HMO as part of the administrative arrangement.
11
Chapter Two: Documented Migrant Workers
Since the 1990s work visas have been contingent on the purchase of
private medical insurance by the employer. This requirement has
allowed for the creation of a private market with an enormous
turnover.10 Competition has led to reduced policy prices, but not to
improved standards. Indeed, the opposite is true: there has been a
constant decline in the quality of health coverage provided by the
insurance companies. In previous reports, PHR-Israel detailed the
numerous loopholes in these policies and described the typical
behavior shown by insurance companies and employers towards
workers with visas who were misfortunate enough to become ill
during their stay in Israel. Insurance policies not only excluded a
wide range of treatments (such as chronic and malignant illnesses),
but also included clauses designed to force insured to leave Israel
once they became ill (as in the case where treatment can be
postponed). It is no coincidence that insurance policies have
become known as “flight ticket policies.” This was the situation
prior to October 2001, at which time the Health Services Order
came into effect. The order was intended to regulate the private
market and impose restrictions that would benefit the insured.
12
2B. The Right to Health of Documented Migrant Workers
13
2C. The Health Services Order to the New Law for the
Employment of Migrant Workers: A Happy End?
Advantages:
The order includes various mechanisms for appealing the
decision of the insurance companies, and protects the insured
(at least on paper) against arbitrary decisions by the company.
The order includes most of the services in the basic basket of
services received by Israelis.
Disadvantages: (see flow chart below):
Since the enactment of the order, PHR-Israel has been
monitoring its implementation together with the Human
Rights Program at the Tel Aviv University. In dealing with
the insurance companies we have discovered their attempts to
return to the norms practiced prior to October 2001 and their
14
endeavors to use various schemes to rid themselves of sick
workers.
We do believe, however, that the level of health services has
improved as a result of the order and of NGOs inspection.
Experience has shown that migrant workers who enjoy the support
of their employers, and turn to us for assistance are often successful
in receiving the health services to which they are entitled.
Unfortunately, the current situation has not provided a solution for
who will lose their eligibility for health services following the loss
of their work permit for whatever reasons.
11 For other devastating aspects of the "chaining" policy, see Hot Line for
Migrant Workers publications www.kavlaoved.org.il
15
will refuse to renew the policy even if it covered treatment
expenses during the previous period. Without health
insurance the employee is unable to renew his working and
staying permit and loses his official status.
16
17
arrival in Israel she received a working and staying permit, and her
employer provided her with medical insurance through the 'Shiloah'
insurance company. At the end of February 2001 she was diagnosed with a
malignant tumor. 'Shiloah' announced that it would not renew the insurance
policy, but that it would be willing, beyond the letter of the law, to finance
outpatient services for a period of three months only. Since M. no longer
held valid medical insurance, the Ministry of the Interior refused to extend
her staying and working permit (since the visa was contingent on a valid
health insurance policy). Not only did M. find herself fighting a terrible
disease, but she had also become an illegal alien in Israel. On July 2, 2001,
M. underwent her third chemotherapy treatment. However, since the three-
month period set by 'Shiloah' had reached its end, and the company refused
to pay for the treatment. M. had no choice but to cover the cost of
chemotherapy (1,600 NIS ) by herself and she withdrew the limited
savings she had managed to accumulate during her years of work in Israel.
It should be noted that two weeks after leaving her sick bed, and before she
had fully recovered from the operation to remove the malignant tumor, M.
was obliged to return to work in order to earn the money needed to remain
in Israel. On October 16, 2001 – the day the new Medical Services Order
took effect – a hearing took place in the matter of the petition submitted by
PHR-Israel to the High Court of Justice, demanding that M. receive a
temporary working permit and medical treatment and calling for the
amendment of the new order. The State's representative refused to agree to
any compromise suggested by the Court, and the Court itself declined to
any compromise suggested by the Court, and the Court itself declined to
provide M. with any protection. M. was unlucky enough to fall ill during
the period when the Ministry of Health was procrastinating before issuing
the new order. She received no help from the Supreme Court of Justice, a
fact that was criticized by attorneys from the human rights field. What
would have happened had M. fallen ill after October 16, 2001? Would she
have received all the treatments she required? Perhaps not. Our experience
shows that the insurance company could have raised various arguments
(prior medical condition, loss of working capacity) and the employer could
have fired M. and ceased policy payments.
M. is a Romanian nursing worker who worked for some two years for an
elderly woman suffering from Alzheimer's disease. M. was insured through
the 'Shiloah' insurance company. On November 6, 2001 – ten days prior to
the introduction of the new order – M. went to the physician, was
diagnosed as suffering from cancer and began receiving treatment. At first
the insurance company covered treatments, but subsequently it began to
limit medication payments, claiming that these costs were limited in
accordance with the policy. Fortunately, the new order had already taken
effect. After legal intervention by Attorney Dori Spivak from the Human
18
Rights Program at the Tel Aviv University the insurance company dropped
its case. M.’s state of health is now satisfactory – she is in complete
remission and has an excellent chance of recovery.
She now faces a second crisis. Her most recent insurance policy was
purchased for one year, ending October 2002. The insurance company has
already announced that it will not renew the policy. This means that M.
will be unable to receive additional medical treatment. Moreover, since she
cannot receive a working permit without being medically covered, M. will
become an illegal alien and at risk of deportation. The elderly woman for
whom M. cares cannot manage without her help. On May 2002, PHR-
Israel sued the insurance company in court, demanding that insurance be
renewed and arguing that failure to do so strip the Health Services Order of
any meaning. We should emphasize that at least in this case the employee
is receiving real support from her employer. Were M.’s employer to
dismiss her – as other employers have done – her chances would be much
worse.
A few days after filing the statement of claim the elderly woman for whom
M. had been caring passed away. We do not know now whether M. will be
able to receive legal protection despite the fact that she has not lost her
capacity to work. At present M. still requires health services, but she has
no job and is at grave risk of losing her working permit.
12 We use different terms for the same population: without visas, non-
documented, illegally employed etc.
19
3A. The Current Situation
Non-Documented Migrant Workers most likely constitute the
majority of the migrant (non-Jewish) population in Israel. To date,
no law, regulation or arrangement has been issued in the purpose of
providing health care services to this population and there is no real
migration policy e.g. there is no regulated way for the provision of
civil status to a Non-Documented Migrant. As illegal aliens in
Israel, these migrants face the constant threat of deportation. The
principal authorities involved in their fate are the Ministry of
Internal Security (the police), the Israel Prison Service and the
Ministry of the Interior, which is in charge of issuing deportation
orders13. The number of Non-Documented Migrant Workers is
currently estimated between 100,000 and 200,000 or more,
depending on the source of the estimate. This number includes
workers who had a working permit but who lost their legal status,
and others who arrived in Israel as tourists or with another kind of
status.
20
in more complex medical situations.
2. Private clinics and medical centers. Costs at these clinics
are usually high, since they are intended for prosperous
Israelis seeking immediate, quality health care services.
3. Hospitals and medical centers in East Jerusalem and the
West Bank. Due to the prevailing security situation, East
Jerusalem provides the only possibility for receiving medical
services at a low cost compared to Israel.
4. Private clinics and physicians in Israel offering
inexpensive services. These are generally physicians who
are “doing a favor” and earning relatively small sums in
return for providing services to migrant workers. Often these
are physicians who speak the migrants’ language; in other
cases these are physicians attempting to survive in the private
market (e.g. chip dental services for the poor).
5. Emergency hospitalization: According to the Patients’
Rights Law, “in a medical emergency situation, a person is
entitled to receive urgent medical treatment without
condition.”14 It must be pointed out that hospitals may try to
collect payment from patients following urgent
hospitalization - emergency hospitalization is not free in
Israel and the hospital will not be reimbursed. The inevitable
result of this situation is that hospital administrators will put
pressure on the medical staff in the emergency room and
wards. Payment is often mentioned and even presented as a
condition, in spite of the above-mentioned law that prohibits a
financial condition for the provision of a medical service. An
excuse for that may be that the law does not clearly define
what is considered an emergency. Our impression is that the
practiced definition of emergencies in emergency rooms is
becoming increasingly narrow as hospitals face growing
21
financial pressure15. The cost of one day’s hospitalization for
a “tourist’ (i.e. a person who is not a documented Israeli
resident) is approximately 3,000 NIS, 600$. Hospitalization
debts quickly transform into “bad debts” that cannot be
collected from the patients.
6. 'Mother and Child' clinics. Enforced by the Municipality of
Tel Aviv and subsequently adopted by the Ministry of Health,
today any pregnant mother, regardless of her status, is entitled
to register at the 'Mother and Child' clinics and to pay the
same fee paid by Israeli women. In return, she will be entitled
to pregnancy inspection and immunizations of the infant.
7. The cost of hospitalization for birth should be covered by
National Insurance Institute, even if the mother is not legally
employed, provided that she has worked for more than six
months prior to delivery. In practice, however, hospitalization
costs are covered only in cases where the employer has paid
National Insurance fees regardless of the employees' status.
This entitlement is therefore accessible to Non-Documented
Migrants, yet it is difficult to obtain.
The Open Clinic for Migrant Workers opened in 1998 and continues
to expand. Over the past years, the number of patients attending the
clinic has risen sharply. We are greatly concerned that it will be
impossible to maintain a high level of services on a voluntary basis
for much longer. The Clinic consists of three treatment rooms
15 e.g. in cases where the immediate danger is not obvious,
hospitals tend to deny the service.
22
staffed by one or two physicians and a nurse. It opens almost every
day of the week in the afternoon. Dozens of physicians, nurses and
staff volunteer in the Clinic, and dozens more provide additional
voluntary services. A number of medical institutions also provide
services, mainly consultations but also tests, for reduced fees, at
regular private rates or for free. Since the Clinic's opening more
than 10,000 new files have been opened, yet the number of visitors
is even higher. In 2001 alone, some 2,500 new files were opened
and approximately 6,000 patients attended the clinic (not including
referrals to volunteer physicians). In other words, 40% of those
attending the clinic were new patients. Every month, 60% of cases
are seen by a family physician, approximately 70 patients see a
pediatrician and approximately 60 see a gynecologist.
23
13 5 31 70 11 52 9
24
3B. International Rights and Norms
Given the serious nature of this matter − the right to health of Non-
Documented Migrants − we found much too few references to this
subject in the various international conventions to which Israel is a
signatory. The matter is discussed in the UN Convention on
Economic, Social and Cultural Rights and in an ancillary note on
the subject of health. The following quotes may seem far-reaching,
but given the possible financial expenditure involved and the size of
the population without visas in Western countries, they are actually
modest and unduly vague.
According to Note 14 to Article 12 of the UN Convention on
Economic, Social and Cultural Rights:
“Countries… are obliged to refrain from imposing
restrictions or preventing the equal access of any
person − including prisoners, detainees, minorities,
asylum seekers and Non-Documented Migrant
Workers, to preventative, therapeutic and palliative
medicine; to refrain from implementing discriminatory
practices as state policy.” 16 (Translation: PHR)
25
Documented Migrants?
26
medical services through a government agency (CPAS23)
whose objective is “to ensure a decent existence for any
person present in Belgium.”24 It is important to note that the
definition of “emergency’ in Belgium appears in a royal edict
from 1996, and also includes “preventative and therapeutic
medical assistance that may be provided in an ambulatory
framework and in a hospital/institution.” In contrast to the
process we have identified in Israel, the definition of
“emergency” reflected in daily use by Belgian physicians has
extended rather than narrowed the legal definition.
27
can lead to their deportation.
28
humanitarian medical services for those who cannot access the
public health system. In Los Angeles, for example, we know that
there is a network of clinics similar to our own, but operated by the
local authorities. These clinics provide health services for groups
without medical insurance. In Barcelona, 'Doctors Without Borders'
(MSF) operates the “Fourth World” project − a clinic serving Non-
Documented Migrants as well as homeless people and drug addicts
who do not have access to the public health system.
The following proposals are new to the Israeli public debate in the
matter of health care for migrant workers. Some contradict each
other, while others are complementary.
29
remain unresolved in the hospitals’ accounts. As noted
above, Ichilov Hospital in Tel Aviv, for example, notes that
the debt for 2001 was in excess of 1 million NIS − an
increase of 70% over the figure for 1997. Cumulated debt
over the years now totals 4.8 million NIS. The prevailing
principle of “paid emergency hospitalization” seems to cause
more damage than good. It endangers patients who refrain
from obtaining treatment; hospitals may break the law by
conditioning treatment on payment; emergency rooms may
face undue pressure due to the financial considerations; and
the practical definition of the term “emergency” may be
narrowed, influencing the entire system. For a comparison
with the situation in European countries regarding emergency
hospitalization, see section above.
30
3.Legalization B: The second possibility for legalization is to
allow for the option of temporary and permanent residency
status, which may even lead to naturalization. Such a step
would be a real revolution in Israeli immigration policy.
Proposal of this type will no doubt create shock waves in the
Israeli mainstream media. Natural candidates for such an
arrangement might include families that have been in Israel
for many years, particularly those with children who were
born, raised and reached maturity in the country, and for
whom Israel constitutes the center of their lives. This is, of
course, a relatively small group, but it might be the first step
in the long road for immigration policy in Israel. We should
recall that once a person is recognized as a resident (even a
temporary one), he is entitled to social services and above all
− to national health insurance. For the present, it is probably
realistic to demand legalization (residency) at least for adults,
who came to Israel as children or were born here, raised and
have reached maturity in Israel, and who are not familiar with
any other society. Let us give one example of legalization:
On January 22, 2000, Belgium initiated a process of
"regularization" through which all Non-Documented
Migrants could apply for a visa. One of four categories for
applying for a visa was "serious illness" - a criterion - a
criterion currently included under the heading of
"humanitarian reasons"28.
31
services to which it would be entitled. Interestingly,
insurance companies consider Non-Documented Migrants as
a potential market and have already made efforts to market
their private insurance policies in this sector; one of the
HMOs recently joined the race in an attempt to penetrate this
untapped market. This situation suggests that, at least as far
as the private market is concerned, insurance for migrants is
considered to be a viable economic proposition. Yet, in our
opinion, official arrangement supported by legislation or
regulation must be the basis for any insurance program.
Otherwise, it will be impossible to supervise the actions of
the insurance providers (private companies or HMOs), and
they will, therefore, continue to apply the unacceptable norms
that have characterized the private medical insurance market
for migrants before October 2001.
32
local authority and the government, should also partake in funding.
33
Chapter Four: Small Groups with Special Needs
Over time, the number of diagnosed carriers and patients has risen
and available slots in special programs have been filled. Physicians
and the AIDS Task Force volunteers fear that they will no longer be
able to guarantee proper help for foreign carriers and patients.
34
government, and suggested possible ways of solving the situation.
35
in the past and are now being held forcibly by the Israeli legal
system, should receive full health services preceding the trial.
In October, 2002, the state attorney replied prior to the court hearing
stating a plan for almost full medical insurance to 50 migrant
women that were brought to Israel, traded and victimized are now
part of the testimony project.
36
Press Release
January 31, 2002
Two women held in police custody in the south of Israel, who are
serving as witnesses for the state in the prosecution of sex traders
and pimps, are not receiving medical treatment. The Israel Police
has reneged on its responsibility to provide medical care for these
women, and asked PHR-Israel to ‘find them a physician.” The
instruction to contact NGOs with this request came from senior
sources in the national police headquarters.
This is not the first time that the Israel Police has refused to finance
medical treatment for women held in its custody. In the past, PHR-
Israel and the Assistance Center for Detained Employees have seen
women in a serious medical condition due to procrastination and
delays in referral to a physician by the police.
The number of people that are living in Israel and seek political
30 We have recently finished a full updated report on asylum seekers and
refugees in Israel together with Adv. Anat Ben-Dor of the Tel-Aviv
University clinic for legal clinical aid. The report will be available in
our office and web-site as of November, 2002.
37
asylum is estimated in the hundreds. Processing of asylum seekers
was recently transferred from the UN Commission for Refugees to a
domestic Israeli inter-ministerial body. This body is to be guided by
the UN Convention on the Status of Refugees (1951) and the
appendices thereto, to which Israel is a party. Refugees form a small
group of people in Israel. Most of them have undergone suffering,
turmoil and sometimes torture before reaching Israel.
Currently, an asylum seeker (i.e. a person who passed the first stage
and his application for refugee status is under investigation) is
supposed to receive a work visa, which legally enforces the
employer to arrange for medical insurance. In practice, nothing
works. Asylum seekers encounter extensive bureaucratic problems,
for reasons that are unclear to us, some of them appear as
deliberately planed. Approval the working visa is conditioned on
payment of a fine for illegal entry into Israel; the work visa is
limited to specific professions (nursing, construction, agriculture),
and so on. In short, this entitlement of asylum seekers does not
solve any of their problems, including the problem of health
coverage. Asylum seekers are just like any Non-Documented
Migrant.
Despite the numerous restrictions imposed by Western European
countries on the entrance of refugees, many of these countries have
made sure that asylum seekers (in the investigation stage) enjoy
some access to health services:
38
The Situation in the West31
39
story;
"In my country, I was a Red Cross employee and a political activist
opposing the Communist regime. While I was at university, I met some
friends my own age and we founded a group… [the political situation
began to deteriorate and a number of armed militias were formed – PHR]
If you give weapons to people, to youngsters, you may think that they will
protect you, but they already sense the power they have and they try to use
their weapons to get things. I tried to persuade people – at least in our
province – not to take weapons and not to send their children to the
militias. One night the militias came and took my uncle and murdered
him. He left behind two wives and children. I wanted the murderers to be
put on trial, but I didn’t have any evidence. Then the militias took control
of the capital city. There was shooting during the day and curfew at night.
In May 199*, after the elections, we planned a large demonstration in the
capital in favor of peace and social progress. When we reached the square,
a car suddenly pulled up and militiamen began to shoot into the crowd.
Three people were killed and eight wounded. I felt that I mustn’t remain
quiet. I had to go out to the public and tell them what I had seen. I
identified the people in the car and wrote down its number. Two years
later, some people came to my house and told me they were police officers
and wanted to investigate the events at the demonstration. They arrested
me forcefully in front of my family. My little daughter began to cry and
one of the “policemen” pushed her with his foot and knocked her over.
They handcuffed me and put a black hood on my head. Since that day I
have not seen my family or my little daughter. She should be 14 years old
now. They took me to the cellar in the home of one of the commanders
and I began to realize that they weren’t the police, but one of the militias. I
spent about two weeks in the cellar. They shot my leg and cut me with a
knife on my lower back. They wanted to humiliate me because I was kind
of sophisticated and educated. During the two weeks they brought a
political friend of mine and told me that they were going to show me how
they would execute him, and they would do the same to me. I had to watch
them beating him. I was naked the whole time. Anyone could come in
and do whatever they wanted to me or watch me. They told me: “You’re
going to die anyway, but we want to torture you so you die slowly.” They
treated me like dirt, and did not give me any food or water. One of the
guys was my special torturer. I was half dead. I came from an educated
family, and I myself was an educated man. I had never been hungry, and I
had never even performed hard work. My father was an important man,
with possessions and houses. Suddenly everything fell apart. They told
me that they wanted to exchange me for friends of theirs who were in jail −
but I was in the opposition, why would the police want to exchange
someone for me? One day they came and told me there was no point, they
wouldn’t be able to exchange me. They should just kill me, but they were
waiting for the order. They sent someone to me who said he was a doctor.
He put me into bed and then left, leaving the door open. I managed to get
40
up and found an open window. I jumped out and ran away. I went back to
my home, which was completely abandoned. I just took some documents
and money and then ran to the home of my nephew, who was a policeman.
He hid me. They made me forged documents and he took me to the airport
in his car. I flew to a neighboring country where I tried to begin a new life.
I even bought an apartment and married a young woman I met there. She
hardly knew anything about my past. Sometimes I used to remember what
had happened to me. Everything went black. My brain got mixed up. I
went to a psychologist and began to have therapy. On the anniversary they
invited people from all the countries in the region, and people also came
from my country. Until then I had used a different name. I had to leave
the second country. I took my original passport and looked for an
embassy. By chance, completely by chance, I arrived at the Israeli embassy
and asked for a visa. I arrived in Israel in 1997 and my wife joined me
later. I went to the central bus station and made contact with other
immigrants from the same area. They found me a cheap apartment and a
cleaning job. Suddenly my wife was arrested for being an illegal alien and
she was put in Neve Tirzah prison. Since my previous job had arranged a
work visa for me, I tried to get her released. I went to attorneys and courts,
and eventually they let her out, but she wasn’t allowed to work. One day
the police came and arrested me. They told me that my visa was no good,
forged, and put me in jail. It was very hard for me in jail. At night I saw
black faces, like my torturers. It took me back to it all. I began to behave
strangely and talk to myself. Suddenly I remembered the worst torture, the
sexual torture, the pain and blood. The staged executions. I could actually
see the face of my torturer and feel him strangling me with an electric
cable. The physician in prison spoke to me like everyone else, for one
minute, and then said he had no time and gave me tranquilizers. I spent 20
days in jail. They wanted to send me to my country, because I had my
original passport. I told them that I had worked for the Red Cross, and
they sent a woman from the Red Cross and contacted the UN Commission
for Refugees. Only then, when a representative came from the UN
Commission for Refugees, did I finally manage to tell part of my true
story. When they released me, I was in a bad state. My wife also had a
hard time with me. She left home and moved in with friends. I used to
wake up at night with flashbacks, and I was sure I was in prison again [the
Crisis Center for the Victims of Sexual Violence and PHR-Israel helped D.
receive basic psychological assistance – R.A.] I really like Israel and I
want to stay here, despite the problems. Life isn’t easy here, but I could
stay and live a reasonable life, but our problem is that we’re all the time
scared because of the documents. I still don’t have any idea what happened
to my large family and I haven’t seen my daughter."
Conclusions
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This report addresses a single key question: how can we ensure
access to health services for a population, which, by definition, lies
beyond the scope of Israeli social services? These men, women and
children live and work in Israel, but are not defined as residents and
are, therefore, unable to enjoy equal eligibility and access to health
services.
Major steps lie ahead. The greatest challenge lies in the ability of
Israeli society to cope with the problem of Non-Documented
Migrants who already constitute the majority of the migrant workers
population that, according to various estimates, totals between
200,000 and 300,000. Israeli society must recognize some
responsibility to provide essential health services to people who
contribute their working power to the Israeli economy.
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Part of the population of migrant workers can and should be
included in Israeli social systems on an equal basis
(integration), and should receive work or residency visas
(legalization). This step is clearly in the interest of the
Israeli public as a whole, and especially of low socio-
economic groups who suffer directly, not exactly from the
presence of migrant workers, but from the outcomes of their
conditions, e.g. no social benefits and almost no defense
from exploitation. The migrant condition reflects directly on
their low wages and pulls the entire wage scale down.
Israel is really a semi-welfare state that is surrounded by
large margins of black and grey labor market.
Even if our hopes materialize and Israel decides to adopt a
real immigration policy rather than behaving in an
'aggressively passive' fashion, it can be assumed that there
will still be some Non-Documented Migrants in Israel.
Some people (as few as possible, we hope) will always
remain outside of the circle of eligibility and accessibility to
basic health services. We believe that a system must be
developed that is capable of providing a minimum level of
health for these people for three principle reasons:
1) On the basis of the fundamental right to dignity and
the protection of life, and in order to prevent the loss of
life and irreversible injury due to the lack of access to
health.
2) To protect the health of the general public as a
whole, which may be affected by the presence of a
large population denied even minimum health services.
3) In order to come closer to Israel’s self image as an
enlightened welfare state.
levels and the image of various sectors.” The conclusion the director-
general of the Ministry of Finance drew from his economic
observations was that steps should be taken against foreigners, and
child benefit – which supports mainly the poorer section of society -
should be cut. We advocate a completely different approach: refraining
from injuring the weak in Israel, and integrating migrant workers in the
fabric of Israeli economic life (ending the “chaining” of workers to
employers, legalization, etc.) These steps will protect Israelis and non-
Israelis alike, will minimize the illegal labor market and will increase
the cost of employing migrant workers.
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We urge the health system to continue leading the field in this
respect and to integrate migrant workers into the social services
system. We urge it to continue efforts to integrate the children of
migrants on an equal basis, regardless of their parents’ status, and to
solve the serious problems faced by workers with visas due to their
employment conditions (the practice of “chaining” workers to a
specific employer) and to the policies of health insurance
companies. The Health Services Order must be amended; it should
adopt one of the models proposed in this report (or a combined
model) in order to develop a basic health system for Non-
Documented Migrants.
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Responses
The Health Minister, Mr. Eliahu Dahan, did not send any written
response. In answer to our phone call, his secretary replied that:
"The minister has read the report and he has no comment".
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