TABLE OF CONTENTS
3. LITERATURE REVIEW
4. RESEARCH DESIGN
II. INTERVIEW QUESTIONS
The presence of African asylum seekers is a relatively new phenomenon in Israel. Only since 2005 people have begun to flee to the Jewish country. The majority comes from repressive regimes in Eritrea and Sudan. And it was only until 2012 that they could cross the border from Egypt to Israel, before a wall was erected that immediately stopped the migration flow (PRI, 2015). It has been almost 15 years since the arrival of the first wave of migrants, but the life of African asylum seekers still continues to be harsh in Israel. To this day, only 14 people have received official refugee status, while there are currently 35,000 asylum seekers either still waiting for their asylum procedure to be finished or they have been denied the refugee status and are only temporarily allowed to stay in the country. The legal status of asylum seekers in Israel comes essentially without any basic liberties and people face the threat of deportation on a daily basis. Asylum seekers lack access to healthcare services and usually do not have an official work permit, which forces migrants to work under illegal and exploitative conditions in order to earn their income. Furthermore, many asylum seekers have experienced torture and exploitation on their way to a safe country, for example in the Sinai Desert, where Bedouin clans have set up torture camps to hold the refugees hostage and force their families to pay a ransom (Lijnders, 2012). Seeing these biographies and the unsafe working conditions in Israel, access to healthcare services becomes a very important aspect of an asylum seeker’s life. Thanks to a volunteer service in the TEREM Public Health Clinic in Tel Aviv, which is one of few clinics in Israel that is open to people without health insurance, I had the opportunity to conduct research with asylum seekers themselves and to give them a voice in the matter. This paper thus aims to address the research question: How satisfied are asylum seekers with healthcare services in Israel? The question is specifically framed in a way that encourages asylum seekers’ advocacy and participation in the discussion, because previous research has too often only talked about asylum seekers’ needs and not with the asylum seekers themselves. Two interviews with an Eritrean and a Sudanese asylum seeker in the TEREM clinic have shed a light on the general situation and satisfaction of asylum seekers with healthcare services in Israel. Resulting from the findings of the interviews, the study also proposes governmental action that can and should be done to address and improve the satisfaction of asylum seekers with the healthcare sector in Israel.
The remainder of this paper will proceed as follows: in the next chapter, the relevant terms will be defined, followed by a literature review of existing research. Then the research design will be discussed as well as the content of the interviews and the relevant findings. After a short elaboration of the limitations, the study will be concluded.
It is important to differentiate between different groups of migrants living in Israel. For one, there are asylum seekers, mostly from the African continent, that are applying for asylum and are waiting to receive the refugee status. Asylum seekers are usually granted the temporary stay visa, which has to be renewed every few months for the duration of the asylum request. If the state of Israel denies asylum seekers the right of asylum, they are either deported or, if their country of origin is deemed unsafe, they are tolerated to stay in Israel however, without any access to the welfare system (ASSAF, 2018). Although the status of an asylum seeker is supposed to be temporary, the Population, Immigration and Border Authority in Israel counts 34,370 asylum seekers from Africa, mostly Eritrea and Sudan, who for the most part have been living in Israel for almost a decade (ASSAF, 2018). At the moment there are still more than 15,000 Eritrean and Sudanese asylum applications waiting to be checked (ASSAF, 2019).
The second group is refugees, which under the 1951 Geneva Convention is a protected status for people fleeing their home country because of persecution, war or violence (UNHCR, 2019). An official refugee has access to the local welfare system as well as an unlimited permit to stay in the country. Currently, in the state of Israel there are only 14 official refugees, 13 Eritreans and one Sudanese (ASSAF, 2019). This equals a recognition rate of under 0.5% of all asylum requests. Israel thus exhibits the lowest recognition rate in the Western world (Hotline, 2019). The third group are labor migrants, which are, similar to asylum seekers, not citizens of Israel and therefore do not have access to the welfare system unless they pay or their employer pays for private insurance. Foreign workers are not a homogenous group, because they are employed in different sectors of the economy in Israel and their rights and privileges furthermore depend on their country of origin. For instance, in the caregiving sector a lot of workers are from the Philippines and India (PIBA, 2016, 7) and are used for cheap labor with horrendous working conditions, with employers or recruiting agencies sometimes taking away their passports and not allowing any rest or vacation time. At the same time, there also exists labor migration in the high-tech sector, meaning well-paid, highly qualified foreigners working in Israel, usually including insurance and other welfare benefits. In practice it is hard to differentiate between asylum seekers and those labor migrants working under exploitative conditions, especially irregular labor migrants that used to have an official working contract, but lost that without leaving the country (PIBA, 2016, 8), because both groups live without proper access to the welfare services and depend on a voluntary healthcare sector.
3. Literature Review
So far there has only been limited research on the topic of the health of asylum seekers and labor migrants in Israel. Three studies particularly focus on the healthcare sector in Israel and how migration plays a role in it. The first study by Nora Gottlieb, Dani File and Nadav Davidovitch (2012) has analyzed the tensions between humanitarian, human rights and political approaches and discusses the ambivalent role of the open clinic for asylum seekers and labor migrants in South Tel Aviv. The open clinic represents a humanitarian approach of charity, rather than a political approach, which would push for the government to step up and officially take responsibility for asylum seekers. The authors found that these different approaches exist, due to the fact “that ‘the right to health’ is a concept in constant change” (Gottlieb et al., 2012, 845), which is determined by the local environment and attitudes. Often it also stems from different understandings of ‘deservingness’ and what the asylum seeker or refugee population should essentially be entitled to. In the case of Israel, Gottlieb, File and Davidovitch observe that “human rights NGOs are torn between the pressures to support neo-humanitarian provision of services, classic human rights advocacy and a more political rights-based approach to health and social justice” (2012, 845). According to the authors, these rivalling approaches can however have the benefit of leading to an open discussion about the right to health and what it entails. The second study in the context of Israeli healthcare was conducted by Yonina Fleischman, Sarah Willen, Nadav Davidovitch and Zohar Mor (2015). These scholars focus on the irregular migrant population, which is comprised mostly of irregular labor migrants and asylum seekers, and what factors determine their health. They found that migration itself is a huge barrier to health, because it triggers several other barriers that are partly also common among low-income communities such as: prohibitive cost, poor and confusing organization of services, language barriers, perceived low quality of care, social isolation, lack of clear or consistent legislation, threat of deportation, inability to obtain work permits, poverty, harsh living as well as working conditions, and discrimination (Fleischman et al., 2015, 92). All these barriers adversely affect the health of irregular migrants and show that migration itself should be considered a social determinant of health in Israel. Lastly, the most recent study by Gottlieb and her colleages (2017) tries to reveal ways to improve access to healthcare for Eritrean asylum seekers in Israel. By conducting 445 interviews with Eritrean asylum seekers in Israel, they found that 95% of respondents are interested to be included in a health insurance scheme, while more than half of respondents were even willing to pay up to 300 NIS per month, which corresponds to 5 - 7.5% of their median monthly income (Gottlieb et al., 2017, 4). In comparison, Israeli citizens with a similar income only contribute 3.1 - 5% to their health insurance. Only 5% of asylum seekers were unwilling or unable to pay for health insurance. The authors’ finding negates the claim that asylum seekers are simply trying to exploit the host country’s social system and paves the way to negotiate a migrant insurance plan with the Israeli government.
4. Research Design
Drawing especially on the study by Fleischman et al. (2015), it is the aim of this paper to investigate the current situation of asylum seekers in Israel further and scrutinize how satisfied asylum seekers are with the healthcare system in Israel. The goal of this paper is 1) to investigate which of the barriers outlined by Fleischman et al. (2015) are seen as most relevant by asylum seekers themselves and 2) to give asylum seekers the opportunity to voice their opinion and to put them in a position of advocacy rather than seeing them as pure recipients of healthcare policies. Hence, this paper pursues a similar approach as previous research by Gottlieb and her colleagues, who have tried, by conducting interviews with asylum seekers themselves, to support participation of the Eritrean community in the political discourse as well as the strife for social and civil rights of asylum seekers (Gottlieb et al., 2017, 8). Especially when it comes to sensitive fields such as healthcare and personal health needs, it is crucial to notjust talk about asylum seekers, but to also talk with them.
To answer the research question “How satisfied are asylum seekers 'with healthcare services in Israel?” I have conducted two interviews with asylum seekers in the TEREM Public Health Clinic in South Tel Aviv. The clinic provides health services to anyone, “who does not qualify for medical coverage under the Israeli National Health Care Act (1994), and has no other source of coverage” (TEREM, 2019). This includes both irregular labor migrants and asylum seekers, most of which are from Eritrea and Sudan. The clinic is divided into two wings. There is the urgent care wing, which is funded by the Israeli government and operates 12 hours a day with paramedics and doctors. Second, there are specialty doctors in the other wing of the clinic, such as OBGYN, pediatrician, orthopedist, ENT, endocrinologist, general practitioner and others. These specialty doctors come to the clinic on a voluntary basis and provide, without being paid, medical consultation and treatment for up to 3 hours a day, whenever they are available.
Since the clinic currently conducts a study on hypertension patients, it was possible for me to participate in personal interviews with asylum seekers and ask my questions in attendance of a translator working for the clinic. Thanks to the translator, patients could answer in their local language and did not have to face any language barrier of speaking Hebrew or English. The two patients I interviewed were two males, both asylum seekers, who had been in Israel for more than 10 years and came from Eritrea and Sudan, therefore representing the two biggest countries of origin in the asylum seeker community. Both of the patients have hypertension, which means they come to TEREM on a somewhat regular basis, because they get medication to lower their blood pressure and their health status is monitored regularly.
- Quote paper
- Marla van Nieuwland (Author), 2019, Asylum Seekers and the Healthcare Sector in Israel, Munich, GRIN Verlag, https://www.grin.com/document/534864