Health care crosses borders

By Julian Wise - March 15, 2007

While Americans grapple with social justice and inequality within our borders, these matters are global concerns. A panel discussion at the Martha's Vineyard Hebrew Center on Sunday, March 18, titled "Israel Handles Inequality: Tales from a Children's Hospital, A Bedouin Village, and Tel Aviv," will gather professional Israeli women to discuss the inequality they encounter during their daily experiences. The audience will hear from pediatric surgeon Efrat Bron-Harlev, urban planner Ela Weber, and Ministry of Justice official Havatzelet Yahel as the three discuss how Israel is handling social pressures within its borders. The speakers are scholars at the Kennedy School of Government at Harvard University this year.

Ms. Bron-Harlev is the senior pediatric intensive care physician and knowledge manager at Clalit Health Services in Israel. She served in the Israeli Air Force for three years before attending medical school at Ben Gurion University in Be'er Sheva. In her medical work she witnesses the way health care highlights the divisions in Mideast society.

"Our health-care system is built in such a way that no matter how rich or poor you are you get good medical treatment and insurance," she said in a phone interview.

"This system is fighting inequality, which brings up the medical care in Israel so all citizens receive good health care. In the USA it is very different. Even basic insurance in Israel is much better than medical insurance you pay for here."

Prior to the Oslo Agreement, Palestinians participated in the Israeli health care system. After Oslo, they separated completely from the system, resulting in lower quality care for Palestinian citizens. When Palestinians require sophisticated treatments, they often return to the Israeli hospitals.

"Whenever there is a life threatening system, the Israeli health-care system will take care of our Palestinian population," Ms. Bron-Harlev says.

"It's a great problem to deal with and a great economic burden. It's completely inhuman not to treat patients with life threatening situations."

Israeli hospitals will often take in Palestinian patients with full knowledge the patients will not be able to pay for the care.

Ms. Bron-Harlev often sees pediatric patients leave Israeli hospitals to return to inferior medical care in the Palestinian health system.

"It's very sad because there is a lot of inequality we can't do anything about," she says.

She observes an interesting development when Palestinian families enter Israeli hospitals seeking pediatric care; the parents' initial suspicion and trepidation about the Israelis melts when they witness the dedication and care the Israeli medical staff extends to their children.

"Once time passes and a few days go on, we find ourselves becoming friends on a personal level and start talking," she says. "It's interesting to see the Palestinian parents talking to other patients in the ward, even Orthodox Jews. You get something very optimistic; amid inequality comes hope for understanding, that it's all human beings trying to get up in the morning, go to work, and get healthy."

While parents often come into the hospital with anxieties about interacting with Israelis, she says "I've never seen a situation where we would say goodbye as enemies," even when medical treatment is unable to save the child.

Ms. Bron-Harlev believes future peace in the region depends on both sides communicating on a professional and personal level.

"A lot of good work is being done between us and the Palestinians on an everyday basis that is a good relationship, but you always hear about the conflict.

Havatzelet Yahel is head of the Land Settlement Department of the Negev in the District Attorney's Office at the Israeli Ministry of Justice. She has dealt extensively with civil and administrative law inside Israel and is currently working with the Bedouin community within Israel to examine the legal stature of their polygamy practices. Her department is seeking the proper way to balance cultural tradition, Israeli law, and women's rights.

Approximately 165,000 Bedouins populate Israel and represent various tribes. Within Bedouin society, men have virtual control over women's lives. Fathers choose husbands for their daughters and polygamy is widely practiced.

"This creates problems between norms they are used to in the Israeli law," Ms. Yahel says, citing the Israeli legal code that bans polygamy.

As a civil lawyer, Ms. Yahel must weigh the right of Bedouins to continue their ancestral practices with the legal structure of Israeli society. Furthermore, Bedouin women are now speaking out for equal rights, declaring their desire to educate themselves and start businesses rather than be the third wife of a polygamist. Women's views are appearing in editorials and academic papers, encouraging Israel to enforce its anti-polygamy laws on Bedouin men.

"There is a dilemma because if the women will not allow their husbands to marry another woman, the husbands will send her away," Ms. Yahel says. "In Bedouin society women cannot live by themselves."

Without a husband, a Bedouin woman will be a pariah, denied economic opportunity and social status. At this point, Ms. Yahel is gathering information for the Ministry of Justice on the Bedouin dilemma. "What rules should we impose and what is the outcome?" she asks rhetorically.

Ela Weber is a director in the Planning Administration Department of the Ministry of the Interior, where she heads regional planning projects in Tel Aviv and the surrounding areas. Her academic background is in environmental studies and urban and regional planning. While serving in the army she became aware of the inequality that exists in Israeli society, particularly between various immigrant groups from around the world who have to make the adjustment to a new land.

After working in urban planning, she has come to see government strategies as a partial solution that can only succeed when it interfaces with ground-level activism from the communities it's striving to help.

"The government can't do this alone," she says. "It needs the people and the communities empowered in the sense that it will be a joint venture. If the government will be the only side to the story it will never work. Unless the communities are engaged, the outcome will be very disappointing. You want the community to go for coalition building."

She cites the various nationalities that make up Israel's immigrant communities, including North Africans, Asians, Russians, and those from the Near East. Some came with the built-in advantages of education, economic power, and knowledge of the Western world, while others have been slower to adapt.

"There has been successful immigration overall," says Ms. Weber, "but some have not caught on in the sense that they are equal to many long-lasting Israelis."

Ms. Weber cites the importance of local governments and NGOs to effect meaningful change on the neighborhood level.

"When the government is pushing from one side and local governments and NGOs are pushing from the other, that will be a serious partner to work with to achieve more equality," she says.

Inequality in Israel panel discussion, Sunday, March 18, 2 pm, M.V. Hebrew Center, Center Street, Vineyard Haven. Brunch served 1 to 2 pm. For more information call 508-693-0745.