Table of Contents
Over the past two years, Physicians for Human Rights-Israel (PHR-Israel) has undergone a transformation regarding its approach to gender-linked issues in general and to women’s right to health in particular. Whereas in the past our projects for women concentrated mainly on issues related to childbirth, prenatal care, family planning and domestic violence, our current projects aim to address women’s health in a comprehensive way, addressing issues of access as well as cultural, psychological and socio-economic factors involved in realizing the right to health. We employ a multilevel methodology that combines direct medical aid with empowerment, casework and advocacy, public outreach and campaigning.
Target groups
PHR-Israel fields applications from women from a wide range of communities. Handling casework enables us to learn the problems typical to each group in enjoying the right to health, and to plan projects suitable to each. Our projects primarily target members of excluded and marginalized groups.
Activities
Below is a short outline of the health challenges facing women from different communities under Israeli control, and a description of PHR-Israel’s current response and plans for the future.
1. Palestinian women in the Occupied Territories
Background
Palestinian women in the Occupied Territories suffer from a double limitation on their freedom of movement, stemming both from the system of separation and control enforced by the Israeli military occupation, and from cultural limitations enforced on women’s movement in public spaces. These limitations hinder the access of women living in rural areas to healthcare, and have led to a sharp increase in the number of home deliveries, as well as delays in provision of expert care, which is usually available only in urban centers. Moreover, in addition to suffering chronic financial difficulties imposed by the ongoing occupation, women are allocated only very limited funds specific to their needs by the Palestinian Ministry of Health. As a result, there is a shortage of medical follow-up mechanisms for women, and there are nearly no health education and preventive programs tailored specifically to the needs of women.
Response
PHR-Israel has been running weekly or bi-weekly “mobile clinics” to rural regions in the West Bank since 1990, in which medical care is provided jointly by Israeli and Palestinian medical professionals for a single day. Over the years it became clear that gynecological services were necessary due to impaired access to expert care in the urban centers. In addition, the project noted the fact that many women avoided visiting male gynecologists, and that there was a low awareness of women’s health needs in these communities.
During 2006 the project, in cooperation with the Palestinian Medical Relief Society, constructed a mobile clinic program intended specifically for women living in rural communities. Both the program personnel and all volunteer medical personnel are exclusively women, in order to provide women with a supportive and open environment during medical care. Initial contact is made with local women who are already active in the community, and the mobile clinic is planned and organized jointly with them. Unlike other mobile clinics, women’s mobile clinics are conducted once a month and repeated four consecutive times in the same village, in order to enable a better interaction between the team and local women and to enable follow-up, critical discussion, evaluation and modifications as the program evolves.
Each excursion combines medical care with lectures and workshops, which aim to provide the women with basic information regarding common medical problems (e.g., hypertension and diabetes), prevention (e.g., self-examination for breast cancer) and human rights, as well as a higher awareness of their own right to health.
As regards casework and advocacy, the project fields appeals from both women and men, and handles cases on an individual basis. When outstanding violations against women are recorded (e.g., denial of access to emergency medical care during childbirth), the project appeals against State policies to the High Court of Justice, and makes reports of the violations available to the public and to policy-makers in Israel and in the international arena.
Future plans
The women’s mobile clinics program has been running in its current form for eight months. A report on the clinics and on the condition of women’s health in the West Bank will be published in late 2007, based both on the clinics themselves and on a questionnaire survey conducted with sample participants in the course of the year. The clinics will continue to function and evolve according to the responses we collect in the course of the first year of the program, and subject to funding constraints.
2. Bedouin women in ‘unrecognized’ villages in the Negev desert
Background
In the Negev desert in the south of Israel some 80,000 Arab-Bedouin live in 46 villages and encampments that are not recognized by the State. Although most of their inhabitants are Israeli citizens, the ongoing ‘unrecognized’ status of these villages denies them planning rights and connection to national electricity, water, sewage and road networks, and exposes them to repeated attacks on the part of the Israeli authorities, in the form of house demolitions, destruction of agricultural crops, and other violations. The residents suffer from impaired access to healthcare on all levels, due to a shortage of clinics, specialized care, preventive and follow-up services on site, as well as delays in emergency evacuation services. In addition to partial healthcare, the physical and environmental conditions in which the residents live have led to substandard hygienic conditions, as well as environmental health hazards (e.g., toxic chemical plants) in the area. More than 18,000 women live in these circumstances and suffer additionally from impaired access to antenatal and post-natal care. On a cultural level, limitations on women’s freedom of movement in public spaces mean that they can only visit a clinic with their spouse. The few clinics in the area are mainly staffed with male doctors, who cannot develop a relationship of trust with their female patients. Although half the women neither speak nor understand Hebrew, most clinic personnel do not speak Arabic. About 35% of the women in the villages live in polygamous marriages and second wives are not eligible for the social benefits usually granted to mothers.
Response
In addition to ongoing casework and advocacy, In mid-2006 PHR-Israel initiated a year-long “women health leaders” course in the town of Beer-Sheva for women from unrecognized villages. The course, a series of lectures, workshops and interactive encounters, aims to provide participants with a basic knowledge of public health issues and rights, as well as ensure that Arab-Bedouin women have an understanding of health as a basic human right, for which the state is responsible, and to equip them with basic tools to demand this right from the State institutions.
The course curriculum contains topics related to health and public health; women's and human rights; human rights agents in the field and their activities (e.g. advocacy groups, women's organizations); tools and mechanisms to realize health rights; and skills for self-organization.
Participants are twenty-five women from ten villages, from different age groups, educational backgrounds and living conditions. In addition to the project coordinators, a large number of PHR-Israel’s volunteer medical staff provides lectures and workshops. All moderators and lecturers are women.
Future plans
PHR-Israel hopes to complete the training course with a core group of “women’s health leaders”, who will themselves select focus areas for their community action.
Pending funding, the project will follow-up with in-service ongoing training for the graduates upon completion of the first course. A report on the project will be published in 2007. Components we hope to add or extend include basic computer and language skills courses, and a First Aid course.
PHR-Israel would consider opening an additional intensive training course in 2008, funding permitting.
Additional activities planned for this year include continuing our ongoing advocacy for the establishment of Mother-Child Health Centers in the unrecognized villages, as well as advocacy for an increased number of Arabic-speaking staff in the clinics.
3. Stateless women, asylum seekers, migrant workers and trafficked women
Background
An estimated 70,000 to 80,000 women live in Israel with no legal status at all, and are not eligible by law for civil or social rights, including health. These include illegalized migrant workers, victims of human- and women-trafficking, asylum seekers, and, since 2003, some 35,000 victims of the amended Citizenship and Entry into Israel Law. The Law amendment prevents the unification of mixed Palestinian-Israeli (citizens of Israel) and Palestinian (residents of the Occupied Palestinian Territories (OPT)) families inside Israel. Those who have been most impacted by this law are Palestinian women living in Israel who are married to Palestinian-Israeli citizens and Palestinian-Israeli women married to residents of the OPT. The former are denied civil status in Israel and the corresponding social rights. The latter are revoked of their social rights by The National Insurance Institute despite being recognized by the Ministry of the Interior.
Since more men and fathers than women have been deported from Israel by the Israeli Immigration Police, many of illegalized migrant workers in Israel today are women and mothers, who are under considerable strain to find medical care for themselves and their children. Women who have been victims of human-trafficking networks are not only ineligible for social rights and healthcare, but are also often exposed to sexual abuse, and are vulnerable to sexually transmitted diseases, in addition to suffering other severe hardships.
Response
PHR-Israel’s Open Clinic for Migrant Workers, staffed daily by volunteer medical staff, provides medical aid to all stateless people in the form of consultations in family medicine, gynecology, psychiatry and other medical fields. Pregnant women are provided with counseling regarding their rights and referred to follow-up and prenatal care. When necessary the clinic refers women to lab tests and examinations with PHR-Israel volunteers outside the clinic or to hospitals that have reached prior arrangements with the organization.
The clinic received a prize for maternity and gynecology – when? Exact name of prize?
As regards migrant working women, the project handles appeals of women in need of medical care, advocating on their behalf with employers, insurance companies and the Israeli authorities wherever possible.
The project handles cases of physical or sexual abuse on the part of employers or of traumatized refugees in court and provides psychological counseling or expert opinions if necessary.
PHR-Israel was instrumental in ensuring health benefits for trafficked women who are waiting to give evidence in court against the men who traded them, and still monitors implementation of their health rights.
Future plans
As regards the victims of the new amendment to the Israeli citizenship laws, PHR-Israel plans to launch a comprehensive program in cooperation with Kayan, a Palestinian, Israel-based feminist NGO, whose ultimate objective is to grant victims of the amended Citizenship Law full social rights, including national health insurance, irrespective of their civil status.
The action will operate on multiple levels, working to alleviate acute human suffering and prevent a humanitarian crisis that could ensue should some 35,000 Palestinian women living in Israel not obtain access to health care. The action includes both health service provision for members of the target and intense political and legal advocacy work to utilize the current bureaucratic channels to access health rights in Israel and to promote legislation that is non-discriminatory and protects the health rights of the target group. The action will work to support the rights of the target group by countering racist public opinion and overturning discriminatory legislation that is violating their rights. As the action is focused on the health needs of women, included in the advocacy work is the promotion of an Arabic domestic abuse hotline and improved battered women's shelter services for Palestinian women in Israel. In parallel, three position papers related to the health rights of stateless Palestinian women in Israel will be published and the issues further promoted through coordinated media work. The public shall be informed of this critical issue to generate support for the advocacy work and ensure sustainability of the results.
The project also plans to advocate for full government coverage of prenatal care and costs of childbirth for migrant working women, which they currently have to pay for.
4. Israeli citizens
Background
Two main factors may influence the access to healthcare of women with Israeli citizenship, who are eligible for national health insurance. The first is geographical. Specialized medical services and medical care of higher quality are as a rule located in central Israel and in the larger cities. The number of medical staff is also much higher in these regions. People who live in the northern, and especially the southern regions (defined in Israel as “peripheral areas”) receive services of poorer quality and must wait longer for specialized care. Government budgeting for these regions, in health as in other fields, is lower than in the center.
The second factor affecting the health of women in these regions is poverty, which is significantly greater in peripheral areas. Poverty as such is known to be directly linked to poorer health, but it also means that patients cannot afford supplementary health insurance programs in addition to the basic services offered under national health insurance. Government-subsidized basic services have eroded over time to a relatively narrow range of services since the introduction of semi-private supplementary services in 1995, and now entail co-payment. This means that poorer people have access to poorer healthcare standards. Women are especially affected by these phenomena, since they are generally responsible for the management of healthcare in the family, and thus bear responsibility for struggling for appropriate healthcare not only for themselves but also for their children.
Palestinians who are citizens of Israel enjoy full civil and social rights on paper, but in practice suffer from structural and financial discrimination that is a result of racially discriminatory policies on the part of the government. One of the main forms of exclusion from full health rights is misinformation on the part of the National Insurance Institute and other government organs responsible for provision of healthcare. Citizens are not informed of their rights, forms and information sheets that are published are usually available only in Hebrew, despite the fact that Arabic is an office
ial language in Israel, and in addition, applicants must contend with a hostile bureaucracy when demanding their rights.
Response
In 2006 PHR-Israel initiated a training-course for women living in the town of Beer-Sheva in the south of Israel, aiming to empower them in management of their own health as well as encourage them to be active on health issues on the community level.
During its first stage the program gathered ten women for a year-long series of meetings, lectures and workshops, provided exclusively by female lecturers and moderators, in which the women were provided with information on women’s health issues, received information and training regarding health rights and health activism, discussed behaviors and attitudes in an interactive way, and finally mapped the main barriers to health in their community and planned a focused course of advocacy and activism in their own communities. The project was guided by PHR-Israel coordinators, but aims to enable women to continue the project independently in the community.
Casework: PHR-Israel fields applications from all prisoners and detainees, and addresses problems piecemeal, without singling out women as a group. Complaints of medical negligence are more numerous among migrant, trafficked and stateless women.
Future plans
A report on the empowerment program will be published in 2007. In addition, PHR-Israel has been requested by graduates of the course to provide ongoing guidance and joint action in the next phase of the program, identifying targets for advocacy, legal action and public campaigns. The overall target chosen is the issue of inequality in the quality and availability of medical services provided between central and southern Israel, and PHR-Israel’s coordinators will work jointly with the course graduates, employing a PR agency to promote these objectives.
Legal activities planned for 2007 include demanding subsidized contraceptives for women over the age of 18, in order to prevent the use of intrusive procedures such as repeated abortions on the part of poorer women.
Additional activities include writing and distributing ‘Know Your Rights’ information sheets and posters in Arabic among members of Palestinian and mixed communities in Israel, providing easy-to-follow guidelines to health rights under Israeli law and how to demand them from State institutions.
5. Women prisoners
Background
Women constitute a small minority of people held in Israeli custody. Israeli, Palestinian and migrant women are incarcerated either in Israel’s prison for women, or in the women’s wing of three other prisons. Healthcare is provided to inmates, but no special programs are tailored to meet the special needs of women. The main damage to the health of incarcerated women as such is psychological, not only due to the fact of imprisonment, but also because of the interdependence of mothers and their children. Mothers are allowed to live with their children until they are two years old, after which they are separated, leading to psychological hardship.
Response
Casework: PHR-Israel fields applications from all prisoners and detainees, and addresses problems piecemeal, without singling out women as a group. Complaints of medical negligence are more numerous among migrant, trafficked and stateless women.
Future plans
Survey: The project is now examining the possibility, pending funding, of visiting women prisoners in order to gauge information regarding provision of gender-specific medical care, such as gynecological examinations, preventive care and menopause-linked care.
Ruchama Marton MD
President & founder of Physicians for Human Rights, Israel