COVID-19 Vaccination Distribution in Israel: Advocating for Equality

Two weeks into Israel’s COVID-19 vaccination distribution plan, roughly 1.87 million of its 9 million citizens had received the COVID-19 vaccination—more than 16 percent of the population. By January 4, Israel had inoculated a higher proportion of its population than any other country, a major testament to its highly mobilized, universal health-care system. This success is in part due to Israel’s legacy National Health Insurance program, which assures all permanent residents in Israel access to both hospital and community clinics distributed geographically throughout the country. Israel’s National Health Insurance Law provides that its medical insurance system “shall be based on principles of justice, equality and mutual assistance.” Yet even as Israel’s coronavirus caseload rises and the presence of a new strain of the virus necessitates a third nationwide lockdown, Israel’s vaccination success is a public health accomplishment is worth celebrating.

At the outset of the coronavirus pandemic, the New Israel Fund launched its Crisis Action Plan, a strategic plan to ensure that amid Israel’s public health emergency, the most marginalized and vulnerable communities would be included in the government’s response to the crisis. Through the worst moments of crisis, NIF and our grantees on the ground in Israel have been working to make sure that all communities have equitable access to public health information, treatment, and prevention measures (e.g. adequate testing, PPE)—as well as equitable access to economic relief. As Israel continues to acquire and distribute the COVID-19 vaccine, we have called for the most marginalized and overlooked populations to also gain access to the vaccine.

As is the case elsewhere around the world, the pandemic has not affected all sectors of Israeli society equally. The most vulnerable and marginalized communities have often borne the brunt of the pandemic’s economic and health impacts. Yet in Israel, it seems that the vaccination process so far is intended to be rolled out using the same priority guidelines across communities—elderly, high-risk, and health-care workers first, etc. In some instances, access to Israel’s medical system and to vaccinations required advocacy from Israel’s civil society. According to Israel’s Ministry of Health, roughly 80% of vaccinations were delivered through Israel’s HMO (kupot cholim) clinics. By month’s end, Israel’s plans to vaccinate the majority of its high-risk population, including its front-line health-care workers and citizens and permanent residents over 60.

Watch below our discussion with Yachad, Ran Goldstein, the Executive Director at Physicians for Human Rights Israel, and leading Israeli human rights lawyer Michael Sfard about Israel’s legal obligations are towards the Palestinians living in the occupied territories:

Refugee and Asylum Seekers

Israel’s Population and Immigration Authority estimates that over 200,000 “status-less people”—migrants and asylum seekers—live in Israel. These people are not entitled to National Health Insurance coverage. Because they are disproportionately employed in the hospitality and service sectors, the pandemic forced this community further into economic precarity. Their exclusion from the National Health Insurance coverage and reliance on private insurance through their employers has meant that, in the wake of mass layoffs, the majority of this population was cut off from the country’s health-care system.

Two weeks into the COVID-19 crisis, thanks to strenuous advocacy from NIF’s grantee, Physicians for Human Rights – Israel (PHRI), Israel’s Ministry of Health moved to make medical treatment for COVID-19 accessible to status-less persons without insurance. On March 15, 2020, the Head of Medical Management at Israel’s Ministry of Health instructed ambulance services and hospitals to provide “all necessary services…to all people, for all reasons.”

While in practice these communities still face discrimination, asylum seekers, refugees, and migrant workers will be able to obtain COVID-19 vaccinations. While this population is disproportionately younger, those who are age 60 and over and are eligible have been vaccinated largely through Israel’s hospital system. Israel’s Health Ministry has announced that those without insurance will be entitled to vaccinations, subject to the general guidelines prioritizing vaccinations to the elderly and those in high-risk groups.

In January 2021, the Zulat Institute for Equality and Human Rights authored a position paper in partnership with PHRI, entitled The Right to the Vaccine, recommending the government provide free vaccinations to the entire population, including migrants, asylum seekers, and the Palestinian population in the Occupied Territories. Among other recommendations, the paper makes the case that Israel has a responsibility to ensure these vulnerable populations are vaccinated, not only as a matter of Israel’s public health interest (immunizing widely to break the chain of infection), but because every person, regardless of their place of birth, has the right to live in health.

Palestinian Security Prisoners

In late December 2020, Israel’s Public Security Minister Amir Ohana instructed Israel’s Prison Service not to administer the vaccine to Palestinians security prisoners, contrary to the guidance of Israel’s Health Ministry, which placed these prisoners in the second tier of those slated to receive vaccination. Since the outset of the pandemic, NIF’s grantees have fought for the rights of incarcerated people.

  • After Minister Ohana’s statement, Adalah – The Legal Center for Arab Minority Rights in Israel sent an urgent letter to senior Israeli officials, demanding they immediately reverse the decision to withhold the vaccine from those Israel designates as “security prisoners.” Attorney Dr. Hassan Jabareen’s letter emphasized that withholding vaccinations from Palestinian prisoners violates the Public Security Ministry and the Israel Prison Service’s mandated responsibility to protect the lives and health of prisoners in accordance with Israel’s Basic Law: Human Dignity and Freedom, which states that, “All persons are entitled to protection of their life, body and dignity.”
  • PHRI and the Association for Civil Rights in Israel publicly objected to Ohana’s announcement, calling the decision a “politically motivated directive” and urging that “the responsibility for prisoner health should be moved from the Public Security Ministry and the Israel Prison Service to a body whose first priority is health.”
  • Israel’s Ministry of Health clearly stated that Minister Ohana’s directives were unlawful and that vaccinations would be made available to prisoners according to the original schedule of priorities. On January 7, the attorney general’s deputy for criminal affairs, Amit Merari sent a letter to Ohana informing him that he must allow vaccinations of Palestinian security prisoners, stating that he has no authority to “punish” prisoners by depriving them of their basic rights. Yet, Ohana refused to vaccinate elderly prisoners. In the face of the minister’s obstinance, a group of five civil society organizations, HaMoked: Center for the Defence of the IndividualRabbis for Human RightsAdalah: The Legal Center for Arab Minority Rights and the Association for Civil Rights in Israel, and led by PHRIpetitioned the High Court of Justice to require that Israel’s Prison Service (IPS) vaccinate the entire population of people in Israeli prisons, according to the schedule of priorities issued by the Ministry of Health.

Palestinians Living Under Occupation

While Israel has made impressive progress in vaccinating its own citizens, it has developed no comprehensive plan to provide vaccination to Palestinians living under occupation. From the outset of the pandemic, NIF’s grantees have been working to ensure that marginalized communities, including Palestinians living under occupation, are not excluded from the government’s crisis response. That has meant continually reminding the public and petitioning Israel’s government to uphold its legal responsibilities under international law to provide for the health and wellbeing of the occupied population. Israel’s government disputes the claim by international legal scholars, rights groups, and international bodies like the United Nations and World Health Organization (WHO) that Israel is obligated as the occupying power to ensure the public health needs of Palestinians living under occupation.

  • On December 15, 2020, PHRI petitioned the Ministry of Health’s director general and the Coordinator of Government Activities in the Territories (COGAT), the branch of Israel’s military responsible for administering Israel’s government policies in the Occupied Territories, to inquire whether Israel’s purchasing plan for the COVID-19 vaccine “included populations under Israeli control who do not have the option of purchasing vaccines without Israeli mediation.” PHRI urged these bodies to uphold Israel’s “obligation to implement the right to health of the residents subject to its control,” a duty established under numerous international conventions. While Hamas and the Palestinian Authority have responsibilities to provide for the health of the populations to the extent of their ability, provisions of such services do not absolve Israel of its overall obligation to ensure the health of the occupied populations under its control.
  • In January 2021, Gisha – Legal Center for Freedom of Movement issued a position paper titled Israel’s Obligation to Gaza in a Pandemic and Post-Pandemic Reality, addressing Israel’s responsibilities to provide for public health in Gaza, including a recommendation that the government of Israel “ensure that the coronavirus vaccine is available and distributed swiftly, and where necessary, contributing to covering the costs of the vaccine and its distribution.”
  • In December 2020, 18 Israeli, Palestinian and international health and human rights organizations, including NIF grantees AdalahB’Tselem – The Israeli Information Center for Human Rights in the Occupied TerritoriesGishaPHRIHaMoked, and others, called on Israel to provide sufficient vaccines to Palestinian health-care systems.

Ghada Majadli, director of the Occupied Territories Department for PHRI made a public case for Israel’s responsibilities toward Palestinians living under occupation, writing in Haaretz, “One of the [main arguments] made by Israel regarding the demand that it meet its commitment – whether under international law or due to its humanitarian obligation – is that the transfer of authorities and responsibility for health services to the Palestinian Authority, as part of the interim accords [Oslo II], absolves it of responsibility, including the responsibility to halt the spread of the virus. This argument contravenes countless international conventions regarding epidemics and infectious diseases and, above all, the right to health for people living under occupation.”

Yet, as Majadli told the Associated Press, “Israel still maintains control over many aspects of the Palestinians’ lives, whether checkpoints, importing goods and medication, and controlling the movement of people.… The Palestinian health system, whether in the West Bank or the Gaza Strip, is in dire condition, mainly [because of] restrictions imposed by Israel.”

NIF CRISIS ACTION PLAN