A child born to a mixed couple - i.e., one with an East Jerusalem
mother and a father from the West Bank, Gaza or Jordan - is not
automatically entitled to health insurance. Even when the family
resides within the municipal borders of what the Government of
Israel recognizes as Jerusalem, and the mother is recognized as a
resident and covered by health insurance according to the natioI1al
health insurance law, residency for the child is not extended
automatically. Instead, the mother must file a request that the
newborn be insured, and then undergo a National Insurance Institute
(NII) investigation that examines both her eligibility and that of
her family for health insurance. If the NII reaffirms its
recognition of her as a resident, then her child and husband will
be entitled to health insurance. However, this investigation may
last between a few months to a year, and even then, some Kupot
Holim (Sick Funds), will not give the child services unless it is
issued with a temporary identity number - a procedure which, for
different reasons, lasts even longer.
Coping in Emergency
Undoubtedly, any prolonged investigation period exposes children to
serious health risks. To verify whether the Israeli Health Ministry
is prepared to cope with such emergency cases of children falling
ill while their case is under investigation, Physicians for Human
Rights (PHR) contacted numerous Health Ministry officials over a
period of nearly a year. No office was able to provide a solution
to this problem.
When an urgent case reaches human-rights organizations or the
press, authorities tend to resolve it and provide insurance
coverage, at least for a short period. The death of a child is not
looked upon favorably by the Israeli authorities, as it may
endanger quiet and systematic implementation of overall government
policies in Jerusalem.
Nonetheless, death remains a threat for East Jerusalem children.
There, the death rate for babies is twice that of West Jerusalem
babies. According to Ma'ariv, reasons cited by the Health
Ministry's Jerusalem district doctor to explain this fact include:
endogamy, insufficient pregnancy examinations, differences in the
quality of the health services, and the activities of pharmacies
and doctors operating without licenses. All these causes - with the
exception of intermarriage - can be significantly reduced if
national health insurance is extended to all Israeli residents
alike. The fact remains that a child of a "mixed couple" is not
automatically entitled to health insurance. Even when a baby is
recognized as a resident of Jerusalem, parents are still confronted
by difficulties when trying to register with a Kupat Holim,
although the law is clear on this point: Kupat Holim must provide
services, even to those without an ID number. Instead, the health
of a child is sacrificed to arguments on budgets and bureaucracy
between the NII and the different Kupot Holim.
Ordeal in Jerusalem
Manal is a Jerusalem resident who has never left the city. Her
problem started when a child, Sa'ad, was born to her and her
Jordanian husband. Shortly after birth, Sa'ad was taken to Makassed
Hospital in East Jerusalem in the fear that he was suffering from
jaundice. He was then diagnosed as having heart failure as well as
jaundice. It was clear that the baby needed several operations in
the near future. Only after PHR's intervention with the NII did
Manal obtain a clear statement confirming that her son was eligible
for health insurance. However, their ordeal did not end here. Since
Sa'ad was not issued with a temporary ID number, Kupat Holim Leumit
refused to provide services or referrals for his treatment in
hospital. Only after another PHR intervention and a Ha'aretz
investigation into the case did Kupat Holim Leumit agree to cover
services, referring to the action as a "favor." Sa'ad is now well,
after being operated on in Hadassah Hospital and hospitalized in
Shaare Zedek Hospital according to all his needs.
The story of Georgette is not as clear cut, as there is an ongoing
argument concerning her residency status. Her story attests to the
possible risk of losing health insurance as a result of ID
confiscation or loss of residency rights.
At the beginning of the long closure in March 1996, Georgette's
husband, a Gaza resident, was forced to leave his family and return
to Gaza according to the orders of the closure. Georgette gave
birth to their second child while her husband remained in Gaza. The
baby was premature and required long hospitalization in the
intensive-care unit, as well as follow-up care. It was a difficult
period and Georgette needed her husband at her side, but he was
denied a permit to come. Georgette, a Jerusalem resident, was not
aware that she was entitled to health insurance for her children,
since the Interior Ministry had not bothered to inform her that
applications for family reunification were separate from medical
rights, which can be secured separately. After correspondence and
endless telephone calls with the Interior Ministry, Georgette was
advised to turn to the NII for medical insurance for her
children.
The treatment Georgette received at the NII branch in East
Jerusalem provided both disinformation and humiliation. In one of
my conversations with the clerk in charge there, he claimed that,
in Arab society, a woman usually followed her husband, and so
Georgette should go to Gaza. Further investigation revealed that
the NII recognized Georgette as a Jerusalem resident. Later on,
information was received that this recognition translated into
health insurance coverage for Georgette's children as well.
However, since Georgette had moved to Gaza for a period of three
years immediately following her marriage, her request for family
reunification was rejected. The Interior Ministry now claims that
she does not reside in Jerusalem, denying her, thus, residency
rights in the city.
Georgette's children received health services thanks to NGO
intervention with the NII. However, unless the decision of the
Interior Ministry changes, the entire family is at risk of losing
its rights. In the meantime, the father is unable to live with his
family, excluding short periods when he obtains entry
permits.
Georgette's case is illustrative of a large number of cases where
families leave Jerusalem's municipal borders and consequently lose
their residency rights, including the right to health insurance. It
should be understood that people leave Jerusalem, among other
things, due to a shortage of housing and difficulty in finding work
- all problems stemming from Israeli policies.
Dire Health Consequences
The above are examples of the dangers faced by all East Jerusalem
residents - children and adults alike - due to a policy that does
not automatically respect their right to health insurance. The
absence of an orderly health system and regular medical check-ups
has dire consequences on all. However, it is especially hazardous
during pregnancy and early childhood. A woman whose pregnancy is
considered "high-risk" must be treated in specialized clinics.
Chronic illnesses tend to accelerate during pregnancy and must be
controlled so as not to harm both mother and child. The lack of
close follow-up during this period may harm the baby, resulting in
premature birth, motor problems, deafness, metabolic disorders,
etc. Once a baby is born with such defects, it must have access to
treatment within a supportive health system.
It is clear that once an illness is diagnosed and it reaches crisis
level, the families do turn to hospitals in East Jerusalem, such as
Makassed and Augusta Victoria. Yet, for some children, even this
might be too late. Furthermore, hospitals cannot supply the
community with preventive health care. It remains Israel's
responsibility to develop such a system: it is the right of East
Jerusalem residents as much as it is that of all Israeli citizens,
regardless of the political settlement that will be reached between
Israelis and Palestinians concerning the final status of
Jerusalem.
Health should never become, nor should it ever be, part of a
political struggle:
States Parties must show respect and ensure the right set forth in
the present Convention to each child within their jurisdiction
without discrimination of any kind, irrespective of the child's or
his or her parents' or legal guardian's race, color, sex, language,
religion, political or other opinion, national, ethnic or social
origin, property visibility, birth or other status. (UN Child
Convention, Article 2)
States Parties recognize the right of the child to the enjoyment of
the highest attainable standard of health and to facilities for the
treatment of illness and rehabilitation of health. States Parties
shall strive to ensure that no child is deprived of his or her
right of access to such health care services. (UN Child Convention,
Article 24)
According to Physicians for Human Rights' estimations, a population
of approximately 10,000 children is at risk due to an Israeli
discriminatory policy in East Jerusalem. Although there is no doubt
that these children are under Israel's jurisdiction, Israeli
bureaucracy neglects the commitments to the conventions cited
above.
This paper was presented at the conference "The Child's Right to Be
Registered - Unregistered Children in Jerusalem and the Quiet
Deportation," jointly organized by Defense for Children
International (DCl) - Israel, Ha-Moked, the Jerusalem Legal Aid
Center (JLAC) and the Palestinian Society for the Protection of
Human Rights (LAW), May 1997.