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away from his terror-stricken hometown, NaNomi yearned things would get better.I met NaNomi in a medical center for migrants located in south Tel Aviv. Here, at the heart of the Tel Aviv metropolitan area, an estimated 17,000 uprooted Sudanese and Eritreans are currently living.Most of them have not been granted “refugee” status by Israel and are considered asylum-seekers. NaNomi is one of them. He is an articulate guy with a deeply moving story that brings tears to your eyes.NaNomi tells me about leaving his loved-ones in Chad and about his fear that he may never see them again. He describes the exhausting journey (from Sudan to Cairo to Libya to Israel) that brought him here. First, he arrived to the Israeli desert and a group of soldiers found him there. He was then transported to a prison-like facility set up for illegal immigrants. What he encountered there was not the Israel he had imagined. He suffered humiliations from security personnel (“filthy parasite” and “dead monkey,” they called him). He did not have enough food. He was kept outdoors at all times, sleeping between the sheets of an improvised tent, exposed to significant outside winds. NaNomi was barely given the chance to speak. He had to fight just to be able to show documents that prove that several of his family members had been massacred in the war. He also had newspaper items that confirmed that his hometown was the epicenter of violence.Yet, the papers were invisible, he says, and made no change: NaNomi was not recognized as a refugee.The next step, he feared, would be a transfer back to Sudan. Several of his fellow inmates had been sent back to their countries weeks or months after arrival, and NaNomi knew that he could easily have the same destiny. One morning, NaNomi’s name was announced. He was asked to pack his belongings and get on a bus. He had no idea where the bus was going. On board, after taking a seat, he fell asleep. When he woke up he saw “a beautiful land that seemed like a dream.”It was the outskirts of Tel Aviv. Apparently, the detention center filled to capacity and there was a need for more space.NaNomi still believes it was God’s hand that made it possible.He arrived to the big city, thrilled to get his freedom back. He met Sudanese men and women everywhere and very quickly found an apartment, tiny and dirty but with more humane standards than his previous space. He started working in a coffee shop, cleaning tables and washing dishes. He learned some Hebrew from his colleagues and was earning some money. Things started looking brighter for NaNomi. But that is not where his story ends.One day, while NaNomi was polishing a window at work, dizziness struck him.He admits that his recollection of those moments is partial (because he lost consciousness) but he believes that his back hit a solid surface after he fell from a ladder. He was lying on the ground with significant pain and for several minutes could not move his legs. A passer-by provided first aid and then accompanied him to a nearby hospital. NaNomi was evaluated by doctors in the Emergency Room but it was soon discovered that he had no health insurance. His job supervisor, who was legally responsible for getting insurance for him, failed to issue one. NaNomi contacted his employer but the latter stopped answering calls. The doctors wanted to operate on NaNomi (he had an unstable fracture of a vertebra) but in the absence of further proof of his legal status (or insurance) they decided to wait. After NaNomi presented them with additional forms that he had received upon entering Israel, the surgeons proceeded and cleared him for the procedure.But then the hospital required funding for the operation. It took five more days for donations from humanitarian activists to be received before surgery was performed. Eventually, NaNomi’s spine was operated on. But instead of receiving subsequent medical care in the rehab service to restore his functionality, NaNomi was sent home. There were no financial means to allow him full-scale treatment.To apply for health insurance, he needed an employer. To get an employer, he needed to work. But with his devastating back injury – how could he work? I sit with NaNomi, furious about an insurance mechanism that betrayed the very person it was supposed to protect.NaNomi was not a ruthless murderer or an evil criminal. He was an innocent victim of a horrendous civil war that tore his family apart. The Sudanese guy escaped intolerable oppression to regain his safety and well-being. Instead, he found himself trapped in a convoluted maze of bureaucracy that posed a threat to his health and existence. And the more he learned about the insurance rights of asylum- seekers in Israel, the more dismayed he became.In Israel, an asylum-seeker cannot purchase health insurance without having an employer. That means that absent a job, access to regular health services is obstructed. In the case they change jobs (or employers), asylum-seekers lose their previous insurance and have to wait several months before a new one can be issued. In addition, there is no routine monitoring to make sure employers are purchasing insurance for their workers (which is the employers’ duty) or that the insurance is up-to-date.There are many other hurdles facing people like NaNomi. If they have a preexisting medical condition, they will most likely be excluded by insurance companies.Many are not even told about their sick leave rights or their insurance plan.And even if they do get insurance, it will generally not include a variety of bread-and-butter services ranging from psychological support and pregnancy-related tests to nursing care during hospitalizations.In medicine, we are taught to think in terms of acuity and urgency. When we encounter multiple patients with different problems, those with the most immediate needs are first to get proper care. Doing so, we not only apply our moral judgment (sicker patients suffer more and deserve quicker remedy) but also promote public health (maximizing the health benefit to a group of people).The refugees and asylum-seekers living in Israel should enjoy all the benefits held by Israeli citizens when it comes to medical support and utilization. Individuals who have had little or no access to health care for most of their lives should get more – not less – resources to guarantee their viability and survival.We have to tune our ears to the horrifying stories of people like NaNomi. We have to feel their misery and to palpate their losses. And we must do all we can to help relieve the emotional and physical wounds of individuals traumatized by a terrible genocide.Lets use our god-given compassion and sense of justice. Lets stop denoting asylum- seekers as a “problem” and instead treat them as what they are (refugees).Lets stop referring to them as the harbingers of disease but help them become thriving members of our society. Lets help NaNomi, his sisters and brothers.We would only do ourselves good if we bestow upon them all the privileges of a human being.Ohad Oren is a graduate of the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Israel Please note: The patient’s name has been changed to protect his confidentiality.
Refugees in Israel: Give them rights, don’t strip them of their dignity
Many are not even told about their sick leave rights or their insurance plan.
