Arab-Palestinian Citizens of Israel: Discrimination in Access to Health; Lower Health Indicators

Arab-Palestinian Citizens of Israel: Discrimination in Access to Health; Lower Health Indicators

PHR

Since the founding of the State of Israel, the Arab-Palestinian minority in the country has suffered systematic discrimination as compared to Israel‘s Jewish citizens in allocation of public funding and in access to services and conditions that are preconditions for a healthy life. This document outlines some basic disparities in allocation of specific resources relevant to health, and the resultant inequalities in basic health indicators, with special focus on the Bedouin-Arab community in the Negev desert in southern Israel, which has the lowest health indicators in the country. Factors such as poverty; discriminatory budget allocation; access to education, employment and safe housing; and access to basic services including clean water, sanitation and electricity, are known to be health-defining factors. Their restriction ultimately results in significant health inequality between Jews and Arabs[1].

General inequalities in allocation of resources relevant to health:

•  There is not one Arab town with an operating governmental hospital, mental health clinic, or a geriatric nursing home.[2]

• Arabs Constitute about 20% of those using Social Services. Nonetheless, local departments for social services in Arabs communities receive only 10% of available funds.[3]
• The access of several Arab Municipalities to water is restricted due to debts to “Mekorot” – the Israeli national water company. For example, the Arab town Jisr al-Zarqa has no  regular access to water supply, a key determinant of health, since August 2011 due to a debt of some of its citizens and the council[4].
• A study conducted by the Galilee Society revealed that 54% of the Israeli population living in close proximity to quarries, a serious health hazard, is Arab-Palestinian. As one gets closer to the quarries the number of Jewish residents decreases as the number of Palestinian residents grows.[5]

Lower health indicators:

A glance at the Ministry of Health’s 2010 report on inequality in health[6], together with its report Israel‘s State of Health, 2010, published in September 2011, reveals that  social inequality translates into significant disparities in health criteria:

ñ                The mortality rate from heart disease among Arabs is 60% higher than among Jews.

ñ                There are large disparities in infant mortality rates between Jews and Arabs: While a decrease in infant mortality in recent years led to an average of 3 deaths for every 1000 live births among the Jewish population, among the non-Jewish population the average in 2009 was 7 deaths per 1000 live births.

ñ                The gap in life expectancy between Jewish and Arab men grew from a gap of two years (in favor of Jewish-Israeli citizens) in 1998, to a gap of 3.7 years in 2008.

ñ                Although strokes occur in the Arab population less frequently than in the Jewish population, the rate of mortality from a stroke among Arab men is 20% higher than among Jewish men, and the mortality rate among Arab women is 70% higher than among Jewish women.

ñ                The most recent data on diabetes mortality rates indicate higher rates among the Arab population: 2.2 times more among Arab men than among Jewish men, and 2.8 times more among Arab women than among Jewish women.

ñ                Between the years 1979 and 2007 there was an increase in cancer rates among both Jews and Arabs, but the increase is far steeper in the Arab population: In these years there was an increase in cancer cases (of all kinds) of 37% among Jewish men, and of 27% among Jewish women. During the same period, there was an increase of 140% among Arab men, and of 150% among Arab women. Regarding the two most common forms of cancer, breast cancer and colorectal cancer, there was an increase in diagnosed cases among Arabs, while the numbers remained stable among Jews.

ñ                Cancer mortality rates decreased in the Jewish population between 1979 and 2007  with a 19% decrease among men and a 21% decrease among women. In the Arab population the rates of cancer mortality increased by 13% among men and 33% among women.

ñ                The highest smoking rates are among Arab men: 48.8% of Arab men over the age of 21 smoke, compared to 31.3% among Jewish men of the same age. The rate of people engaging in physical exercise is lower among Arab women and men in comparison to Jews: 15.4% of women above the age of 21, and 23.8% of men above the age of 21 among the Arab population, compared to 32.8% among Jewish women and 38% among Jewish men.

The Right to Health of the Bedouins in the Negev Desert: Extreme Exclusion

Some 90,000 Arab-Bedouin citizens of Israel live in villages that are ‘unrecognized’ by the state. This lack of formal recognition means that the villages are disconnected from basic infrastructure such as water, electricity[7], roads, garbage clearance services, and have restricted access to education, welfare and social services. Seven towns were constructed by the state specifically for Bedouin populations displaced from their ancestral villages and lands. Despite the fact that some of these towns have existed for 30 years, they also suffer from a lack of infrastructure, and from the highest poverty and unemployment rates in Israel.[8] In 2002, all seven towns were included among the 10 towns classified in cluster 1, the lowest cluster in Israel’s socio-economic scale.[9] The health indicators for Bedouin are accordingly the lowest in the country.

Medical services: partial and inadequate

The principle of non-discrimination in medical treatment, anchored in Israeli law, is not extended in practice to the unrecognized Bedouin villages in the Negev.  The prevention of access to adequate health services is used as a means to apply pressure and to force residents of the unrecognized villages to relocate to the government-planned townships and to relinquish ownership of their land. The state blocks provision of adequate infrastructure within the unrecognized villages and fails to offer essential services including healthcare clinics in all the villages. There are minimal facilities and health centers in the villages and currently only 12 health clinics serve a population of about 83,000 residents. In 34 of the unrecognized villages there are no medical services at all, including the village of Al-Fur’ah with a population of 3,885.

There are only ten nurses in the Bedouin villages: one nurse for every 3,751 inhabitants, whereas the ratio is one nurse for every 657 Jewish residents in nearby Kibbutzim and settlements. Additionally, there is one doctor per 3,116 residents of the unrecognized villages, compared to a ratio of one doctor per 892 Jewish residents in nearby Kibbutzim and settlements. The worst example is the unrecognized village of Talha Rashid where PHR-Israel discovered that the ratio is one doctor per 5,110 residents.

As regards the services that are available, medical clinics in the Negev[10] do not provide adequate services. In comparison with other health clinics in the country, those in the Negev provide a lower quality of service. In those health clinics in the unrecognized villages where healthcare services do operate, there are fewer reception hours of physicians, fewer laboratory examinations and fewer reception hours for laboratory examinations.

The average number of reception hours of physicians for every 1,000 residents in the unrecognized villages is 13 hours per week, as opposed to 21 hours per week in the nearby Jewish settlements[11].

There are no specialized medical services except for family medicine, no pediatricians[12] or gynecologists, and there is no pharmacist or pharmacy in any of the villages.

In addition, the clinics are difficult to access due to the lack of infrastructure. There are no roads or public transportation networks and the clinics are often located far from the residential areas in villages and towns, although very few villagers own vehicles.

Further, more than 50 per cent of the medical staff do not speak Arabic, creating a dangerous language barrier between the medical personnel and the patients, especially women and children, and part of the information leaflets and handouts are available only in Hebrew.

Only  90% of infants born to Bedouin families are vaccinated as part of the Health Ministry’s vaccination program, as compared to 99% of babies born to Jewish parents. In December 2009, the MOH announced the closing of 3 of the 8 the mother- child stations. After a joint appeal[13] lodged by Adalah, the Regional Council for the Unrecognized Bedouin Villages (RCUV)  and PHR-Israel, the MOH partially re-opened two of the stations. It should be noted that in March 2010, the State announced a new program to increase the rate of vaccination among Bedouin infants by offering special incentives for nurses willing to work in clinics in the Negev that serve the Bedouin population.

However, a large proportion of the 12 mother-child clinics that now serve the population in the unrecognized villages operate out of mobile caravans. The mobile units are usually located at the outskirts of the villages because of restrictions by the planning authorities. This prevents many of the women and children from visiting the clinics. In April 2011 the Regional Committee for Planning of Beer Sheva published a new plan for transportable structures[14] (including clinics and schools) in the unrecognized villages area. The plan ignored the needs of the Bedouin population and didn’t include 26 villages in the plan.

Basic determinants of health: Restricted access to clean running water and electricity

An estimated 60,000 Arab-Bedouins in unrecognized villages in the Negev have no access to running water[15]. The Goldberg Commission, the Israeli government’s official inquiry into the status of the Unrecognized Villages, found that the water situation is deplorable as water quality is poor and only a number of the inhabitants are connected to running water. Others are forced to make private connections to the main water pipe or transport water over great distances in water tankers. Water stored in tanks loses quality as the tanks are typically in poor condition and unhygienic thus posing a health risk to local residents, particularly children. Additionally, the fact that the water has to be transported dramatically increases the cost of water and accounts for 20 per cent of a family’s living expenses[16].

The government also prevents provision of access to the national electricity grid in the unrecognized Arab-Bedouin villages.

This discrimination is especially overt when dealing with chronic patients. For them, electricity is a crucial part of their treatment. A mapping prepared by PHR-Israel and the Regional Council for the Unrecognized Villages in the Negev, shows that 21% of the entire population are chronic patients in need of electricity on a regular basis as part of their treatment[17]. Electricity is needed for various purposes: storing medicines that require refrigeration, such as insulin injections for diabetics; operating electrical medical appliances, such as Ventolin for those who suffer from asthma or inhalation and respiration support appliances for other respiratory patients; cooling or heating the house in order to create conditions necessary for recuperation. The findings of the mapping show that the lack of electricity caused the deterioration of around 70% of the patients, out of whom 2% died[18].

The Impact of Discrimination on the Health of the Bedouin Citizens:

ñ                  Infant mortality: 2009 data indicates that the average rate of infant mortality among the entire Israeli population is 4 deaths per 1000 live births. In contrast, among the Bedouin population the average is 12.2 deaths to 1000 live births.[19] The Ministry of Health conducted a comparison between infant mortality rates in the ‘permanent’ townships constructed for Bedouin and in the unrecognized villages between 2001-2006, which showed that in four out of the five reviewed years, the infant mortality rates in the townships was only slightly higher. In four out of the five reviewed years, the infant mortality rate was about 5 times higher in the Bedouin population than the average in the entire country.[20] For example, between the years 1998-2002, the infant mortality rate in the township of Rahat was 13.2 to every 1000 live births. In the same years the infant mortality rate in the township of Tel Sheva was 12.2.[21] The more recent data of 2010 is alarming, showing a rise in infant mortality among Bedouin communities. In 2010, the general infant mortality rate among Bedouin communities rose to 13.6 per 1,000, as compared to 4.1 per 1,000 in Jewish communities in the same part of Israel[22]

ñ                  The rate of Bedouin babies born weighing less than 1.5 kg was higher than the rate in the general population: 1.4% compared with 1.1%. The phenomenon appeared as frequently in the permanent townships as it did in the unrecognized villages. A 2004 research revealed that 56.6% of Bedouin babies under the age of 6 months who lived in permanent townships suffered from anemia. 16.5% suffered from severe anemia. 9.9% suffered from zinc deficiency. 16.9% of Bedouin first- and second-grade schoolchildren were underweight[23].

ñ                  Heart disease mortality: A survey conducted for the years 1998-2002 showed that the town with the highest rate of mortality from heart disease among people over the age of 40 in Israel was the Bedouin permanent township of Ara’ara, with rates more than 8 times higher than the mortality rates in the lowest ranking (Jewish-)Israeli town, Gedera.

ñ                  A 2008 research found that 14.1% of Bedouin eighth-grade schoolchildren suffer from asthma, in comparison with 7.2% of Jewish eighth-graders. A second survey dating from 2009 found a slightly lower rate among the Bedouin students, of 10.7%[24].

The Prawer Plan:

On September 1, 2011, Israel approved the Prawer Plan as a means to ‘resolve and regulate’ Bedouin settlement in the Negev. An examination of the report reveals that it does not aim to implement the policy outlined by the Goldberg Commission. As a complementary to the Prawer Plan, the government announced a Five Year Plan to promote growth and economic development for the Bedouin population in the Negev.”[25]

PHR-Israel’s review of this Five Year Economic Plan accompanying the Prawer report reveals that it does not address or provide a solution for these health disparities, or for the social-economic issues mentioned above. The Five Year Plan does call for investments in infrastructure, education, and job creation, but the budget and its distribution raise many questions. The plan outlines an investment plan for the total amount of NIS 1,263 million. Of these, NIS 377 million are to come from the existing budgets of various government ministries, NIS 860 million are additional, and the American Jewish Joint Distribution Committee (JDC) and the Israeli Association of Community Centers are to invest another NIS 35 million. It should be mentioned that of the additional NIS 860 million, NIS 215 million are spread out over a period of 5 years and appear under the section for ‘Enhancing Personal Security’. This budget will be turned over to the Ministry of Interior for the purpose of reinforcing police forces in the area of the permanent Bedouin townships. This item is extremely significant, given the intention outlined in the Prawer plan and government decision to evict about 30 thousand Bedouins from their homes. The large sum raises further doubts and misgivings when compared to the low budget increases for education: NIS 95 million NIS, and health: NIS 9 million[26]

 Conclusion

The State’s intentional neglect of social inequalities in education, infrastructure, poverty and access to the job market have led to chronic disparities in health between Arabs and Jews. Successive governments have failed to address the disparities in health indicators among Jewish and Arab citizens of Israel; the Bedouin community is an extreme example of this failure.  PHR-Israel believes that only a national health strategy that will bring together all relevant ministries to address this issue can bring about real and lasting equality in access of Arab-Palestinian citizens to healthcare and to the basic determinants of health.