Most Israelis don't reside in the Negev and that majority may not always realize how vast the distances are between Negev locales. Eilat is nowhere near Beersheba, for instance. Thus, when patients from Eilat, often very sick people, are forced to undertake arduous journeys for many hours to receive ambulatory care in a Beersheba hospital, something is amiss. Yet this is precisely what has been happening ever since Clalit Health Services announced the closure of all outpatient clinics at Josephthal Hospital, Eilat's only medical center. This move follows an earlier Clalit announcement that it is putting Josephthal up for sale to the highest bidder private or otherwise and that, whether or not a buyer is found, the facility will be shut down at the end of the year. The crisis has been triggered by the Treasury's failure to provide over NIS 17 million promised for 2005 to Josephthal. The Treasury refuses to transfer the subsidy so long as it and Clalilt remain at odds over issues involving funding for the 2006-2007 budget. The Health Ministry is pleading with both antagonists to stop bickering at the expense of patients, but thus far to no avail. A similar scenario was played out a year and a half ago. For patients subjected to the expense and hardship of long bus rides back and forth to clinics where they're unknown and which are anyway overcrowded, it doesn't much matter which of the parties in the recurrent conflict has justice on its side. Josephthal is the only hospital that caters to the residents of the entire Arava region, as well as to numerous tourists, divers and soldiers in the area. Josephthal is plainly indispensable. An entire region cannot be left without minimal emergency services, to say nothing of the other health care needs which even a small hospital provides. Josephthal is indeed small. The 40-year-old facility contains only 65 beds and there are financial consequences to size. While other Israeli hospitals are jam-packed, Josephthal is never more than 70 percent full. This means operating at a loss. Indeed, it has never made money since its founding. Right now it's NIS 27m. in the red. Josephthal's entire annual budget is NIS 70m. It was obvious from the hospital's earliest days that it would be dependent on public financing; indeed the understanding in the 1960s was that half its budget would come from the government. At best, however, the Treasury foots the bill for no more than 20%. Moreover, Josephthal has trouble recruiting medical staff because it's judged "geographically undesirable." Eilat offers few opportunities to engage in medical research or lucrative private practice. The upshot, according to the hospital, is the need to lure doctors via higher salaries. Since it is unthinkable that Eilat would remain without its own hospital and rely on facilities three hours away by car more by public transport, for patients unable to drive we would like to see the Finance Ministry and hospital managers come up with creative solutions that put the interests of patients first. When Clalit withholds essential services and its medical staffs declare a nationwide solidarity strike, it knows that it is resorting to hardball tactics. When the Treasury denies financial life support to a vital, but insolvent, outlying hospital, it knows it's playing an equally ruthless game in order to force Clalilt's hands on other contentious issues. Each side holds the hospital and the patients to ransom. Something must be done to end such reciprocal hostage taking and extortion. Both sides cynically exploit the suffering of patients some of whom, incidentally, are prohibited from traveling by their physicians. We call on the hospital workers not to strike and the Finance Ministry to immediately provide the desperately needed funds. In the longer term, legislation is called for to earmark monies specifically and unconditionally to institutions such as Josephthal, so as not to make them pawns in unconscionable power plays. Finally, it wouldn't be a bad idea if Clalit actually did manage to sell Josephthal to some other health care provider which might do better at making a go of it, and wouldn't entangle Josephthal in issues that divide the Finance Ministry and Clalit elsewhere.