Hospital Care Cut in West Bank : Israeli Doctors and Arabs: Politics, Ethics in Collision

In the halls of Jerusalem hospitals, physicians whispered about the case of a 14-year-old Palestinian boy suffering from leukemia who was denied admission to an Israeli hospital because the government would not pay for a bone marrow transplant, the expensive treatment he needed.

The boy, named Samir, wasted away and died in a West Bank hospital, physicians and newspapers said. Several doctors vowed that it would never happen again. It probably has.

According to a recent complaint in Parliament and to newspaper reports, hundreds of Palestinians have suffered adverse effects--some, like Samir, even death--because of a decision by military authorities in the occupied West Bank to sharply curtail hospital care for needy Arabs living under Israeli rule.

In some cases, up to 80% of hospitalization days were cut back by the authorities for the treatment of grave diseases that hospitals in the occupied area are unequipped to handle.

The West Bank’s military-dominated Civil Administration argued that Palestinians, by reducing tax payments during the Arab uprising, are due fewer services. Despite this rationale, a number of doctors were repelled by the decision, which has become a slow-burning scandal.

“I think some of us made it clear that they are not going to fight the intifada (the uprising) through the conscience of physicians,” said Jonathan Halevi, director of Shaare Zedek Hospital in Jerusalem.

The issue has come down to a conflict between politics and ethics, policy and morality. And the breach reveals one of the ways that Israel’s handling of the prolonged Arab uprising has spilled over into Israeli society itself.

Reserve soldiers increasingly are telling of beating Arab stone throwers. Lawyers have begun to question the mass jailings of Palestinians without trial. And now, physicians in some of the country’s leading hospitals are shaking their heads over what they see as the erosion of humanitarian standards. Some draw comparisons that were once thought impossible.

“I don’t much like to think of analogies to the Nazis, but in the sense that this is going on and people don’t know about it or, if they do, many don’t care, the relation is unavoidable,” said Ruhama Martons, a physician who is trying to collect money to treat Palestinians. “Like the good German, we don’t see, or, if we do see, we repress our reactions.”

The cutbacks began last summer, but it took some months for doctors to take notice. In the beginning, Arabs were simply turned away at the door if they had no government guarantee of payment.

Patients Just Stopped Coming

Izhar Ardan, a hematologist at Hadassah Hospital, the most prestigious such facility in Israel, said: “The patients just began not to come, and some of us thought, ‘Oh, maybe he couldn’t get here, maybe he has moved.’ You ask yourself from time to time, ‘Where is he? Is he alive?’ After a while, realization sets in, and it is painful.”

As severe cases began to come to the attention of doctors, some took extraordinary action. One was reported to have treated a Palestinian under the name of a Jewish patient who had just died. Halevi, the director of Shaare Zedek, took in a burn victim who required skin grafts. He guaranteed most of the $50,000 fee himself and then telephoned the Civil Administration to demand the money. The government paid.

“I made the decision that no one should die because of the cutbacks,” he said.

Personal intervention has now become an important weapon of the discomfited doctors.

Amiram Eldor, a cancer specialist at Hadassah, said: “When I have a grave case, I call the Civil Administration. If they don’t want to pay, I tell them I will go to the journalists. That scares them.”

Day Care Still Covered

Physicians try to put treatment on a day-care basis, for which the government still pays. They are also setting up means of supplying sophisticated medicines to West Bank hospitals so that treatment can be carried out there. In some cases, anti-cancer treatment is carried out on the West Bank with drugs provided by Israeli hospitals.

But in many cases, ad hoc steps are inadequate. In an article on the subject, the newspaper Yediot Aharonot related the case of Ibrahim, a 16-year-old cancer patient from the West Bank, who received chemotherapy as an outpatient after having been refused hospitalization.

The boy traveled an hour each way to Hadassah Hospital to take heavy doses of cancer-killing drugs. The treatment caused severe pain and nausea.

“Once we had an appointment and the soldier at the roadblock wouldn’t let us pass, even though we had the note,” Yediot Aharonot quoted Ibrahim’s father as saying. “The boy showed him the intravenous needles that he had in his arm, but that didn’t help either.”

‘Totally Zonked Out’

A physician added: “Ibrahim arrives here after his traveling (and is) totally zonked out. He throws up on the way to Jerusalem from the tension and anxiety, and throws up on the way home and at home because of the medication.

“Here, when a patient suffers from nausea, we give him an injection against nausea directly into the (veins). At home, Ibrahim has no possibility of receiving this. . . . There is no doubt that his condition requires hospitalization, and there is no doubt that the hospitals on the West Bank cannot give him the required treatment.

“But we must remember that on the whole, Ibrahim is lucky. He is one of the few that still arrives in Hadassah and receives treatments. There are others who don’t.”

Ardan, the hematologist, defined the health results this way: “If, before, patients maybe had a 70% chance of cure or remission, now they have much less.”

Some Doctors Hardened

Other doctors, under the cloak of anonymity, tell of colleagues who are hardened to the Arabs and to whom the disappearance of West Bank patients is as it should be.

The West Bank governors say the cutbacks are caused only by money problems, but their position is undercut by a major contradiction: In the occupied Gaza Strip, where authorities operate under a similar budget crunch, the reduction in health services was kept to about 10%, and overnight care in Israeli hospitals continues.

Public complaints against the West Bank policy have come from three main sources: dissident members of Parliament, rabbis who consider the policy a breach of Jewish law and policy-makers in Washington, where, according to diplomatic sources in Israel, the State Department has privately expressed concern to the Israeli government.

Confined to West Bank

Leftist legislator Dede Zucker, in a letter to Defense Minister Yitzhak Rabin, complained: “The limitation of services is done only by the administration in Judea and Samaria (the biblical names for the West Bank). The administration in Gaza decided not to do harm and not cut down on health services. Therefore, there is no basis for the claim that this is done ‘out of necessity and not voluntarily.’

“The argument is over the propriety of harming health services,” he added. “I suggest that you reconsider the policy, change it and act (as in) a civilized country, where human life stands above challenge and (where) budget cuts do not serve as reasons to prevent vital medical care.”

The policy remained in place.

Yitzhak Sever, a physician who heads the West Bank health care department, maintains that the cutbacks carry no political message.

‘Not Collective Punishment’

“This is not collective punishment,” Sever said. “In the present situation, we cannot afford to give the treatment we gave before.”

The precise budget for the West Bank, where 1 million Arabs live, is kept secret. Sever said the reduction in hospitalization was cut by 50%, not 80%, as reported in Parliament and by Israeli groups monitoring health care. Because of a recent increase in revenues from West Bank taxpayers, the level of care is rising, he argued.

“There is no policy of using hospital care against the residents of the West Bank,” Sever said.

‘Luxury’ Goes by Board

He noted that, in the past, complex illnesses among the poor were treated in Israel whether insurance was paid up or not but that this was a “luxury.”

“It is a question of high expectations,” he said. “Before, everything was covered. Now, no.”

Itzik Peterburg, who directs health care in the Gaza Strip, which is home to 700,000 Palestinians, took a different view of Israel’s responsibilities. Although the occupation government there has also suffered budget problems, it decided to make cuts in other areas.

“I had to slice 10% from my budget,” he said, “but I am fighting even to get that back. We have decided health care is a priority.”