Smallpox vaccine 311.
“Do not oppress the stranger among us. You know how it feels to be strangers, for you, too, were strangers in Egypt.” – Exodus 23:9
Last week, six children with measles were hospitalized at the Dana-Dwek
Children’s Hospital of the Tel Aviv Sourasky Medical Center. This was an
exceptional occurrence, the likes of which we have not seen in years. We have
treated 12 patients with measles in Tel Aviv since the beginning of this year,
in contrast to only two patients hospitalized with the disease throughout all of
Domestic measles had been wiped out by 2000 in the United States,
but imported cases continued to feed small outbreaks, and 90 percent of the
cases reported in 2011 originated from abroad.
The situation is similar
in Israel. The children admitted to our hospital due to measles are the
offspring of African illegal migrants who infiltrated Israel through the poorly
secured border with Egypt.
The target of these immigrants is Tel Aviv,
where they hope to find work and eke out a living. The community of illegal
migrant workers has become a sizable portion of the population in south Tel Aviv
over recent years. These people are mainly from Eritrea and Sudan. Tel Aviv,
Israel’s metropolis, is a natural magnet for them since there are greater
opportunities to find the menial labor which, in desperation, they are more than
willing to accept for as long as they can extend their stays in the
At the beginning of 2012, this population reached almost 100,000
people living in the most harsh conditions. They are all indigent illegal
migrants, and they have no medical insurance. Their illegal status precludes
their obtaining regular employment with insurance benefits.
they have neither primary care nor preventive treatment and, lacking
alternatives, they turn directly to our emergency room for help. Ours is Tel
Aviv’s main municipal medical center and, as such, it is at the forefront of
treating migrants with no legal status in the country.
patient population brings with it a mix of especially difficult medical problems
with special therapeutic needs. The number of women who came from Eritrea and
Sudan and gave birth in our medical center doubled within one year and reached
more than 400 births annually. Among them were multiple and premature
deliveries, as well as twice as many emergency cesarean sections than the rate
in the general Israeli population. These babies were hospitalized three times
more often in the neonatal intensive care unit, and dramatically increased our
infant mortality rate (by almost 1 percentage point).
The Africans come
from countries in which malaria, tuberculosis and AIDS are endemic. They carry
with them a number of serious diseases that are rampant in the areas from which
In 2010, for example, the vast majority (84%) of the 45 cases
of malaria diagnosed in our hospital were Africans, and most of them (85%)
involved the vivax malaria strain that requires highly specialized treatment to
remove the parasite from the liver.
These migrants also have a relatively
high rate of active tuberculosis, and the number of cases diagnosed among them
by our physicians doubled in 2011. A patient even suspected of a pulmonary
tubercular infection needs to be hospitalized in a special isolation room. Many
of these refugees also suffer from extrapulmonary tuberculosis (in the spine, or
central nervous system) that requires special interventional diagnostic
procedures and biopsies performed under general anesthesia in an operating
The reported rate of carriers of HIV ranges from 0.5% to 5% in the
countries from which these migrants originate.
Indeed, one-third of the
new HIV carriers that we diagnosed in recent years (some 50 to 60 new carriers
every year) are Africans. The treatment for HIV carriers from Africa is more
complex and difficult than that for Israeli carriers. Because they do not have
health insurance, only pregnant women and newborns who are HIVpositive are
entitled to antiretroviral therapy. Moreover, the HIV carriers are
characteristically diagnosed with advanced AIDS-associated illnesses requiring
prolonged hospitalization, extensive and repeated laboratory tests and treatment
with expensive drugs.
It is indisputable that the massive infiltration of
illegal workers and their families into Israel over the past few years has added
a considerable workload to the Tel Aviv Sourasky Medical Center, which treats
most of the ones who suffer from serious infectious diseases that require
hospitalization and complex, expensive medical treatment. The government should
bear the responsibility for their healthcare. It does not.
government agencies could have arranged for health insurance, or they could have
directly funded their treatment, but government officials have failed to take
charge. Our government had the option not to do anything.
do not have that option. The expenses of our hospital for treating illegal
migrants amounted to NIS 7 million for both 2009 and 2010, soaring to NIS 27m.
in 2011 ($7.5m.).
This expenditure is not funded by any government
agency: it is paid for with the hospital resources that were earmarked to
benefit the citizens of Israel who are often treated side-by-side with the
migrant patients. Nevertheless, the message conveyed to the medical team by
hospital management is clear and unambiguous and based on inflexible medical
ethics: treatment of this population must be in every way identical to the
treatment given to Israeli citizens, and no financial considerations can be
allowed to enter into the medical decision- making process.
others, the medical community cannot compromise its commitment to “not oppress
the stranger among us.”The writer is CEO of the Tel Aviv Sourasky
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