Guest post by Niv Michaeli. Niv worked over the last decade in several Israeli human rights NGO`s, mostly for B'Tselem and Physicians for human rights – Israel (PHR). He currently works as a project coordinator at PHR prisoners’ and detainees’ department, promoting equal medical treatment for prisoners and efficient oversight mechanisms in the Israeli penal system. He is a law student at Sapir colleges and a fellow at HIAS-Israel refugee law program. This is the fourth instalment of Border Criminologies’ themed series organised by Maayan Ravid on ‘Border Control and the Criminalisation of African Asylum Seekers in Israel’.

In this post, I will discuss first the unique situation of migrants and asylum seekers in Israeli prisons, and then I will address the health services in the Israeli prison system in general. The last part examines the legal framework that enables the violation of the right to health for prisoners in the Israeli Prison Service (IPS). I argue that systematic flaws in the legal framework and its implementation affect the entire prison population, including migrants and asylum seekers.

The main detention center for asylum seekers and migrants is called Saharonim and is operated by the IPS. As part of its responsibilities the IPS is responsible for providing migrants and asylum seekers equal treatment to any other inmate. However, the medical treatment offered to them is largely limited to the basic treatment provided in the prison’s clinic, and only in extreme cases does it include further provisions. In practice, patients are often told that it is not possible to provide care in the existing treatment framework, and that they should pursue healthcare after they are released.

The underlying assumption is that the prison term of detainees is short, and as such, there is no urgent need to carry out further examination and treatments. This practice not only overlooks the pain suffered by those detainees, but also ignores the fact that, in some cases, migrants and asylum seekers might be held in detention for many years. It also does not take into consideration that the majority of migrants imprisoned are not entitled to healthcare outside of prison as they lack any legal status in Israel, and accordingly remain without regular access to welfare services, except in emergencies.

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Physicians for Human Rights (PHR) has, over the years, documented several cases where migrants and asylum seekers who suffer from certain medical problems, like HIV/AIDS, tuberculosis and schizophrenia, remain imprisoned, despite there being no legal justification for their continued detention. The decision was rather based on the fact that outside they would not have access to medical treatment or adequate living conditions and they would pose a threat to public health; thus leading to the criminalisation of illness and an absurd situation where ill people are detained so they can receive appropriate treatment.

While the above mentioned is unique to migrants and asylums seekers, the majority of obstacles that restrict access to the right to health affect the entire prisoner population. These include: long waiting periods for medical examinations, insufficient mental health services, interference of non-medical considerations in deciding upon treatment and lack of proper medical oversight system within the prison system.

In 1995, the National Health Insurance Law (NHIL) was passed in Israel and was intended to lay out the obligations of national healthcare providers, known as ‘health funds,’ to provide medical care to all residents of the State of Israel and regulate their insurance. The backdrop of the legislation, as articulated in clause 1 was that ‘state health insurance according to this law, shall be based upon the values of justice, equality, and mutual aid.’ Similarly, in clause 3, it determined that ‘all residents have the right to healthcare…. healthcare services shall be given with respect to human dignity, protection of privacy, and preservation of medical secrecy’. In spite of the law’s egalitarian terminology, scholars have discussed in detail its limitations, and more specifically its exclusion of soldiers and prisoners because their healthcare is provided by other institutions.

However, the legislation of the Prison Service does not cover a wide range of basic aspects that are regulated under the NHIL. According to the Ministry of Health (MOH), clinics in detention facilities do not qualify as clinics according to public health law, and as such, the MOH has no review or supervisory authority to monitor their function; thus severely affecting the right of prisoners to healthcare. This was also highlighted by the United Nations Committee against Torture (UN-CAT) periodic report on Israel. The UN-CAT recommended that the Israeli State separated the prison medical system from prison authorities in order to minimize the entry of non-medical considerations that are unrelated to the patients’ best interests.

What is more, IPS regulations claim the right to deny medical treatment under budgetary concerns and IPS medical staff judgment. In 2005, PHRI submitted a petition (case number 2808/05; in Hebrew) on behalf of a Palestinian prisoner who required a kidney transplant which the IPS refused to fund. The Court determined that because the prisoner ‘is under the responsibility of the state - it is required to give him the medical treatment as would be given to a citizen of the state through public healthcare’ (author’s translation). Despite this ruling, we still find incidents in which the IPS avoids providing essential treatment because of budgetary concerns. Such cases are reflected in the recent IPS refusal to provide prisoners the expensive new generation treatment to hepatitis C (case number 28629-08-15; in Hebrew).

The IPS clinics, which operate in many of its detention facilities, are staffed by physicians who could have any specialization, contrary to the trend in public healthcare where physicians trained in family medicine carry out primary healthcare. In cases where prisoners require consultation of expert physicians or advanced testing, they are referred to the IPS medical center or hospitals located in proximity to detention facilities. Delayed processing by administrative staff leads to appointments made long after the medical recommendation. It is estimated that waiting times are between seven and twenty times longer than in the general healthcare system (IPS journal 2010). There are several explanations for this disparity. First, in light of security concerns, most examinations and consultations are held in the prisons’ own centralized medical center, to which expert physicians have to arrive from the nearby Asaf Harofeh Medical Center, rather than transferring prisoners to civilian hospitals. Alongside security concerns, there is also a financial incentive for the IPS to refer prisoners to its medical center or the Asaf Harofeh hospital with which the IPS has a special arrangement. Second, medical appointments outside the prison, which were already made, are often cancelled because of prison staff unavailability to accompany prisoners to their examination.

Physicians for Humans Rights Israel (PHRI) responds to hundreds of prisoner complaints each year regarding the lack of medical treatment. The limitations on the right to health for migrants and asylums seekers who are imprisoned in Israel are compounded by legal restrictions and their lack of legal status, rendering them even more vulnerable to the general flaws in health services offered in the Israeli penal system.

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How to cite this blog post (Harvard style) 

Michaeli, N. (2018) Healthcare in Israel’s Prison Service. Available at: https://www.law.ox.ac.uk/research-subject-groups/centre-criminology/centreborder-criminologies/blog/2018/10/healthcare (Accessed [date]).