For decades, Israel’s healthcare system has been a rare source of national pride and a place where the Israeli-Palestinian conflict seemed to stop at the hospital door.
Jewish and Palestinian citizens of Israel have worked side by side as doctors, nurses and medical professionals, saving lives together every day. Patients routinely entrust their lives to caregivers without asking about their national identity.
In operating rooms across the country, a Palestinian surgeon and a Jewish anesthesiologist – or vice versa – work as a single team. Despite wars, political polarization and relentless incitement, only in exceptional cases have patients refused treatment because of the identity of a caregiver.
This was never just a comforting cliché. It was one of the greatest civic achievements Israeli society has produced. But there was a critical mistake: it was assumed this success could sustain itself.
Israel’s public healthcare system, widely regarded as one of the world’s finest, is, in fact, a binational institution. Although Palestinian citizens of Israel make up about 20% of the country’s population, they account for roughly 40% of the healthcare workforce and an even larger share in some of the sub-professions.
One of Israel’s most essential public services therefore depends on regular and close cooperation between members of two national communities living in an unresolved national conflict.
Despite this reality, Israel has never developed a management philosophy that recognizes healthcare as a binational realm with all the opportunities and challenges that this entails.
Professional ethics and national identity
For years, it was assumed that professional ethics would always prevail, that the white coat would set aside national identities, that as long as hospitals continued to function, there was no need to actively manage the relationships, tensions, and unique dynamics created in this shared environment. The Hamas attack of October 7, 2023, and the war that followed shattered this assumption.
Over the past year, the Abraham Initiatives and the Galilee Society have conducted one of the most comprehensive studies ever undertaken on Jewish-Arab relations within Israel’s healthcare system.
Combining quantitative and qualitative research and with dozens of meetings involving hospital executives, health fund managers and medical professionals, we sought to understand how the system coped with the unprecedented strain of war and what lessons must be learned to strengthen it for the future.
The findings were both encouraging and troubling: The shared workplace did not collapse, but it did change.
Among healthcare workers, 60% reported experiencing tension or hostility during the war, and 70% said they had nowhere to turn when problems arose.
The research concluded that 80% of healthcare workers believed that the system needs an organized institutional strategy to strengthen Jewish-Arab relations in the workplace.
But the data points to a broader reality: Israel has become a country whose major public institutions are increasingly binational, yet it continues to manage many of them as though they were nationally homogeneous.
Organizations operating across deep national divides face management challenges fundamentally different from those of homogeneous workplaces. Ignoring those differences does not make them disappear; it simply leaves institutions unprepared when crises inevitably emerge.
Whether the setting is a hospital, a university, a police unit, a mixed city, a government ministry, a shopping mall, or a private company – every institution in which Jewish and Palestinian citizens of Israel work together requires a management philosophy tailored to a binational environment.
In other words, managing a binational workplace should become as routine a leadership responsibility as managing budgets, safety, professional standards, or human resources.
The fact that Israel’s healthcare system continued functioning during its darkest hours is a remarkable tribute to the professionalism and commitment of its employees.
But precisely because they have carried this burden so successfully, the state can no longer rely solely on their resilience instead of assuming institutional responsibility. Managing binational workplaces is not merely about creating a respectful work environment; it is also about improving organizational performance.
An institution that fails to address tensions between employees, especially when members of the minority group experience intimidation, exclusion, or pressure to remain silent, will eventually weaken teamwork, trust, and the quality of its services. In healthcare, these are not abstract concepts; they have direct consequences for patient care and, ultimately, for human lives.
Effective management begins by recognizing that these tensions are not temporary malfunctions that will simply disappear on their own. They are not a bug. They are a feature of life in a shared society.
This recognition should lead to practical action: training managers, establishing support and protection mechanisms for employees, creating clear protocols for addressing incitement and harassment, building safe spaces for dialogue and systematically measuring how effectively organizations manage Jewish-Palestinian workplaces. What gets measured gets managed.
Today, a growing number of Palestinian citizens work in hi-tech companies, government ministries, banks, factories, financial institutions and major businesses. More and more Israeli organizations are becoming binational workplaces in practice.
If the Health Ministry embraces an Anti-Fragility approach – one that sees crises not only as threats but also as opportunities to learn, adapt, and emerge stronger – it will do far more than strengthen Israel’s hospitals. It could pioneer a new model for managing Israel’s increasingly binational institutions.
Healthcare is not the final destination, but a testing ground where Israel can learn how to build the shared institutions its future will increasingly depend on.
The writer is the CEO of the Abraham Initiatives.