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.