World Report
Israeli clinic provides lifeline for refugees A Tel Aviv health clinic run by the Israeli Ministry of Health and the Terem urgent care network is dedicated to helping the country’s refugee and immigrant population. Talha Burki reports.
Hendrik Schäfer
Roughly 2000 km separate Eritrea and Israel. By foot, it is a ferocious journey. Eritrean border guards are instructed to shoot people fleeing the country without permission. Those who make it over the border must traverse Sudan, and sneak into Egypt. The last leg of the crossing, over the lawless Sinai peninsula, is fraught with danger. Criminal gangs prey on travellers, kidnapping and torturing them. These days, entering Israel illegally from Egypt is extremely difficult: a security fence spans the border, replete with barbed wire, surveillance cameras, and motion detectors. But 2006–12 saw an influx of around 37 000 Eritrean and 14 000 Sudanese migrants. “These people marched hundreds of kilometres, we have several hundred victims of torture and many people are suffering from post-traumatic stress disorder”, explains Michael Dor, former Deputy Director of the Medical Services Division in Israel’s Ministry of Health. Health-care provision for those who are in Israel illegally is patchy. Emergency wards are obliged to treat everyone in need, regardless of legal status. The National Health Insurance Law, which covers all Israeli citizens, also entitles every child in the country to free health care, including the full immunisation programme. But substantial gaps remain, and it was with a view to providing free health care for those not covered by law that Dor established a clinic in south Tel Aviv, now known as the Public Clinic Terem, in 2008. Aside from people who came illegally into the country, there are around 100 000 foreign citizens who have remained in Israel after their work permits have expired. All are entitled to use the clinic. “The police and immigration services are not allowed to come near to the clinic—absolutely 1384
not”, explains Dor. “They do not get any reports from my staff; people feel safe using our services.” Initially, volunteer general practitioners saw patients three times a week. The demand was overwhelming, and under the leadership of director Orel Ben-Ari, the clinic began to grow. It caught the attention of the government. A US$1·5 million grant from the Israeli Ministry of Health facilitated a move to the current facilities in Tel Aviv’s Central Bus Station.
“‘...we have several hundred victims of torture and many people are suffering from post-traumatic stress disorder.’” In 2013, Terem, a nationwide urgent care network, began a partnership with the clinic. “The collaboration allowed us to greatly expand our services to patients and complemented the chronic and primary care services already provided by our volunteer physicians and nurses”, Jenna Berent, assistant director of the clinic, told The Lancet. The Ministry of Health funds an emergency care wing, supported by a laboratory and an imaging centre. But Dor, who this year received the government’s highest civilian honour, the President’s Award, for his work with refugees, was determined to preserve the clinic’s original ethos. “I thought it was very important to keep the volunteer part of our work”, he affirmed. So a second wing is run by volunteers from all over the world. “They help us with everything from reception services to scheduling patients and sending them to the physician”, said Berent. The centre has recruited a cadre of volunteer specialists, including endocrinologists, gynaecologists, infectious disease experts, and paediatricians. Seven
full-time Eritrean employees act as medical translators. “Health-care providers must consider special cultural health beliefs and practices”, stressed Berent. “The Eritrean staff have a key role at the clinic putting patients at ease and helping to bridge the cultural and linguistic barriers between the medical staff and the patients.” Public Clinic Terem sees around 20 000 patient visits every year. As a community, refugees are particularly vulnerable to skin diseases, largely because of overcrowded living conditions and daycare centres. “We have implemented several health promotion and disease prevention activities on skin infections, and in some cases, have visited kindergartens and schools to educate teachers and parents on prevention methods”, said Berent. A mother-to-mother programme links Eritrean women with women from the host community, in an effort to help with the child-rearing process. “Everybody that I work with here and at other aid organisations, government agencies, and hospitals, has the same understanding—everyone deserves good health care”, concluded Berent. The fall of Muammar Gaddafi has reopened the route from Africa to Europe via Libya. Coupled with the erection of the security fence, this means that illegal immigration into Israel is likely to tail off. Official estimates for the first half of 2013, after the fence was mostly completed, placed the number of illegal African entrants into Israel at less than three dozen. “I think it could be quite safe for the government to offer some kind of basic insurance to the refugees who are already in Israel”, argues Dor. “And I hope in 10 years we would be able to give them full insurance.”
Talha Burki www.thelancet.com Vol 385 April 11, 2015
Israeli clinic provides lifeline for refugees A Tel Aviv health clinic run by the Israeli Ministry of Health and the Terem urgent care network is dedicated to helping the country’s refugee and immigrant population. Talha Burki reports.
Hendrik Schäfer
Roughly 2000 km separate Eritrea and Israel. By foot, it is a ferocious journey. Eritrean border guards are instructed to shoot people fleeing the country without permission. Those who make it over the border must traverse Sudan, and sneak into Egypt. The last leg of the crossing, over the lawless Sinai peninsula, is fraught with danger. Criminal gangs prey on travellers, kidnapping and torturing them. These days, entering Israel illegally from Egypt is extremely difficult: a security fence spans the border, replete with barbed wire, surveillance cameras, and motion detectors. But 2006–12 saw an influx of around 37 000 Eritrean and 14 000 Sudanese migrants. “These people marched hundreds of kilometres, we have several hundred victims of torture and many people are suffering from post-traumatic stress disorder”, explains Michael Dor, former Deputy Director of the Medical Services Division in Israel’s Ministry of Health. Health-care provision for those who are in Israel illegally is patchy. Emergency wards are obliged to treat everyone in need, regardless of legal status. The National Health Insurance Law, which covers all Israeli citizens, also entitles every child in the country to free health care, including the full immunisation programme. But substantial gaps remain, and it was with a view to providing free health care for those not covered by law that Dor established a clinic in south Tel Aviv, now known as the Public Clinic Terem, in 2008. Aside from people who came illegally into the country, there are around 100 000 foreign citizens who have remained in Israel after their work permits have expired. All are entitled to use the clinic. “The police and immigration services are not allowed to come near to the clinic—absolutely 1384
not”, explains Dor. “They do not get any reports from my staff; people feel safe using our services.” Initially, volunteer general practitioners saw patients three times a week. The demand was overwhelming, and under the leadership of director Orel Ben-Ari, the clinic began to grow. It caught the attention of the government. A US$1·5 million grant from the Israeli Ministry of Health facilitated a move to the current facilities in Tel Aviv’s Central Bus Station.
“‘...we have several hundred victims of torture and many people are suffering from post-traumatic stress disorder.’” In 2013, Terem, a nationwide urgent care network, began a partnership with the clinic. “The collaboration allowed us to greatly expand our services to patients and complemented the chronic and primary care services already provided by our volunteer physicians and nurses”, Jenna Berent, assistant director of the clinic, told The Lancet. The Ministry of Health funds an emergency care wing, supported by a laboratory and an imaging centre. But Dor, who this year received the government’s highest civilian honour, the President’s Award, for his work with refugees, was determined to preserve the clinic’s original ethos. “I thought it was very important to keep the volunteer part of our work”, he affirmed. So a second wing is run by volunteers from all over the world. “They help us with everything from reception services to scheduling patients and sending them to the physician”, said Berent. The centre has recruited a cadre of volunteer specialists, including endocrinologists, gynaecologists, infectious disease experts, and paediatricians. Seven
full-time Eritrean employees act as medical translators. “Health-care providers must consider special cultural health beliefs and practices”, stressed Berent. “The Eritrean staff have a key role at the clinic putting patients at ease and helping to bridge the cultural and linguistic barriers between the medical staff and the patients.” Public Clinic Terem sees around 20 000 patient visits every year. As a community, refugees are particularly vulnerable to skin diseases, largely because of overcrowded living conditions and daycare centres. “We have implemented several health promotion and disease prevention activities on skin infections, and in some cases, have visited kindergartens and schools to educate teachers and parents on prevention methods”, said Berent. A mother-to-mother programme links Eritrean women with women from the host community, in an effort to help with the child-rearing process. “Everybody that I work with here and at other aid organisations, government agencies, and hospitals, has the same understanding—everyone deserves good health care”, concluded Berent. The fall of Muammar Gaddafi has reopened the route from Africa to Europe via Libya. Coupled with the erection of the security fence, this means that illegal immigration into Israel is likely to tail off. Official estimates for the first half of 2013, after the fence was mostly completed, placed the number of illegal African entrants into Israel at less than three dozen. “I think it could be quite safe for the government to offer some kind of basic insurance to the refugees who are already in Israel”, argues Dor. “And I hope in 10 years we would be able to give them full insurance.”
Talha Burki www.thelancet.com Vol 385 April 11, 2015
