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Palestine: No Road, No Money, No Treatment


No Road, No Money, No Treatment

A story of a lack of accessibility to health

Fatma, two years old, is the daughter of Abed and Fathiya *. The family resides in a tent in an unrecognized village south of Be'er Sheba.

Fatma suffers from Hydrocephalous (accumulation of liquid in the head which leads to swelling), and she has a paraplegic vesicostomy (for draining urine via an opening above the bladder) implanted in her body, needed due to a spinal cord injury which caused paralysis below the waist and developmental problems. She also suffers from repeated urinary tract infections, from significant increase in the size of the heart chambers and from anemia.

The parents speak little Hebrew, and are not literate in any language whatsoever. The accessibility to their rights is thus impeded. The father does not work, nor does he receive any welfare payments- the family is not recognized by the Welfare Services, and the child does not receive a stipend as do most Israeli children.

Their accessibility to health rights- physically, economically and culturally- is severely limited.

Physically: Even though their village is one of the few in which there is a clinic, it is not equipped to deal with their specific and unique needs. The child is cared for at "Alin" Hospital in Jerusalem (over 120km from the village) and in a center for child development in Be'er Sheba (some 37km from the village). Without a car, the parents find it difficult to reach Be'er Sheba and to reach Jerusalem is unfeasible since there is no public transportation and the costs of the trips are not returned by the Sick Funds (HMOs).

Economically: Every X-Ray, outpatient examination, para-medical treatment or visit to a specialist, requires a payment. Fatma may arrive at the hospital for 10 different treatments each month, which can cost up to NIS200 ($45) a month, even before the first medicine is bought. For a family which is sustained by a small stipend, these costs are significant. The costs of traveling involved are also very expensive. In 2003, Fatma only made two of the four needed trips to Jerusalem, due to the parents' inability to cover the travel costs.

Culturally: The difficulty in communicating with the medical personnel, as dedicated as they might be, is immense because of the language barrier. However, cultural differences lead to misunderstandings which harm the child's treatment. The medical staff worked very hard in order to teach the mother the physiotherapy techniques to use on her daughter, however the attempt to explain the catheterization device for draining urine, which could have helped avoid having to create an opening above the bladder, failed and the less preferred opening was made.

Beyond receiving a handicap pension, neither the law nor the Sick Funds provide solutions for this family. In 2003, following legislative changes, the burden of co-payments for visits to specialists was placed on the families, even in the event that the family is living on welfare. Other treatments were always the burden of the families even before the recent changes. Traveling costs are only covered for dialysis and oncology treatments. This is yet another example of how poverty, equal opportunity and health are inherently interconnected.

Link to PHR-Israel report on the unrecognized Negev villages entitled "No Man's Land": http://www.phr.org.il/Phr/downloads/dl_157.rtf

The report can also be downloaded in Hebrew: http://www.phr.org.il/phr/Downloads/hefker-ver-sofi-light.pdf

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