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The right to health among Palestinian Arabs in Israel

April 2008

Synopsis

This report attempts to survey the exercising of the right to health

among Palestinian Arabs in Israel. Prior to this report, no comprehensive

mapping had ever been conducted of all aspects of the issue of the rights to

health of Palestinian Arabs in Israel, rights which are specified in

international treaties and in the National Health Insurance law.

There are 1,449,000 Palestinian Arabs living in Israel, constituting 20%

of the population. Some 54% of Palestinian families in Israel are poor (in

comparison to 14.7% among Jews); only 32.2% of 17-year-olds are entitled to

matriculation certificates (in comparison to 50.1% among Jews), and the

proportion of work-seekers is inestimably higher in Arab settlements than in

Jewish settlements. Poverty, low educational qualifications and unemployment,

together with lower availability of medical services and a shortage of suitable

infrastructures create problems in access to existing services, and are

responsible for the large gaps in health standards between Arab and Jewish

Residents.

Palestinian men and women in Israel live shorter lives and are sicker

than Jewish men and women:

The life expectancy of Arab women: 78.1 compared to 82.7 for Jewish

women;

The life expectancy of Arab men: 74.6 compared to 79.2 for Jewish men.

The infant mortality rate among Moslem Arabs is 7.3 deaths per 1,000 live

births and 15.5 per 1,000 live births among Negev Bedouin, compared to 3.1

among Jews;

Of the ten settlements with the highest rate of general hospitalization,

eight are Arab settlements and 2 are Jewish. In the Arab settlement of Jedida-

Maqar, the general hospitalization rate is 254.9 per 1,000 inhabitants compared

to 29.9 per 1,000 in the Jewish settlement of Modi'in Ilit.

The highest rate of toothlessness among those aged 65 plus exists among

the Arab population (67.2%).

The Palestinian population of Israel has fewer primary care clinics,

fewer physicians and fewer emergency services

A comparison of availability of community medical services for Arabs and

Jews was conducted on the basis of six Arab settlements and six Jewish and/or

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mixed settlements. The information was taken from the website of Clalit Health-

fund and relates to residents insured in this health-fund alone:

In five out of the six Jewish settlements, there were more physicians per

1,000 insured members than in the Arab settlements. For example, in the Arab

settlement of Tamra, there are 1.37 physicians per 1,000 as against 2.78 per

1,000 in Netivot; in the Arab settlement of Um el Fahm there are 1.47 per 1,000

as against 2.54 per 1,000 in Tiberias;

In five of the six Jewish settlements, there is a wider range of

professional specializations in comparison to Arab settlements. For example, 14

specializations in Um el Fahm as compared to 28 in Tiberias; in Shfaram 10 as

against 16 in Dimona;

In four of the six Jewish settlements, there is a greater number of

weekly office hours of physicians in comparison to Arab settlements. For

example, in Rahat there are a total of 24.19 weekly surgery hours per 1,000

insured members compared to 38.56 in Bnei Baraq; 28.26 in Nazareth per 1,000

insured members compared to 37.39 in Ramleh.

Moreover, there is not a single government hospital, psychiatric

institution or public geriatric institution in any Arab settlement.

The only Arab settlements with Magen David Adom stations are Sakhnin and

Rahat. This compares to 90 stations in Jewish settlements (including mixed

towns), where emergency services are available.

Palestinian inhabitants of Israel suffer from low accessibility to health

services

More than 275,000 (19%) of Palestinian Arabs in Israel reported that they

decided to forego a medicine or treatment because of the cost;

568,000 reported that they decided to forego a prescription drug in 2003

because of financial constraints;

318,000 (22%) reported that the participation fees for drugs and services

constituted a heavy burden for them;

In 2003, 64% of the Arabs did without dental treatment because of

financial constraints (compared to 42% among Jews);

Palestinians in Israel suffer from a shortage of infrastructures

essential for healthy living

In some 70% of Arab local councils, sewage disposal is not dealt with

effectively;

Only 52% of Arab local councils have received the highest grade with

regard to garbage removal, as against 91% of Jewish councils;

The unrecognized Arab villages in the Negev, where 80,000 Bedouin Arabs

live, lack electricity and water networks, have no sewage system or garbage

removal arrangements and no paved roads;

The State deprives Palestinian inhabitants of their civil status and

thereby denies them basic rights

Many Palestinians, mainly Palestinian women who are married to or wish to

marry residents, are denied official status in Israel; the Ministry of the

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Interior denies status to many Palestinian Arab residents, and mainly women

married to residents of the Occupied Territories. The denial of status entails

revoking of the rights granted by the National Insurance Institute and hence

denial of access to national health insurance.

The health indices of both Jews and Arabs have improved over the years.

Notwithstanding, with regard to certain major indices, the rate of

'improvement' for Israeli Arabs is slower than for Jews. Additional gaps in

availability and accessibility of medical services, and in conditions essential

for health all these together constitute proof of inadequacy of the

achievements of the State National Health Insurance Law and the Israeli public

health system.

The inequality in health and health services constitutes a violation of

the obligation of the State of Israel in accordance with the international

treaties to which it is a partner, and the values of the State National

Insurance Law which it enacted ("justice, equality and mutual aid"). This

inequality also extracts a personal and human price in the form of higher

disease and mortality rates, and a heavy social cost.

Written By: Shlomit Avni

Translation from Hebrew: Chaya Galai