Asylum seekers’ access to health care in Israel We thank Talha Burki for his World Report (April 11, p 1384)1 about the work of Public Clinic Terem in Israel and we would like to take the opportunity to add some context to the piece. We greatly appreciate Public Clinic Terem’s work, but we would like to point out that, when asylum seekers started to arrive to Israel in 2006, the government remained passive. Non-governmental organisations provided relief while advocating for the inclusion of asylum seekers in Israel’s national health-care scheme as the only adequate and sustainable response to their health needs. Therefore, when the Public Clinic Terem was established in 2008 as another separate humanitarian provider, this was instead of asylum seekers’ integration into existing health-care structures, thus undermining a comprehensive solution.2 As a result, the 45 000–55 000 asylum seekers now residing in Israel have only patchy access to medical care.3 Throughout the years, state policies—including failure to assess asylum requests, denial of work permits and social support, and the constant threat of detention—have compromised the health of asylum seekers. Thousands of asylum seekers have given in to these pressures and—often while in detention—agreed to their so-called wilful departure, despite the dangers awaiting them.4 Recently, the Israeli Government has announced the imminent deportation of asylum seekers to Rwanda.5 We call on the Israeli Government to meet its moral and legal obligations with respect to its asylum-seeking population. Public Clinic Terem’s existence, although gratifying, is but a small step in that direction. For the sake of both scientific accuracy and ethical responsibilities, we urge the academic community to take account of the voices and perspectives of those aﬀected in their studies. www.thelancet.com Vol 386 July 4, 2015
HG is an asylum seeker in Israel. NG and TG declare no competing interests.
*Nora Gottlieb, Habtom Ghebrezghiabher, Tsega Gebreyesus [email protected]
Ben-Gurion University of the Negev, Beersheba, Israel (NG, HG); University of Illinois at Chicago, Chicago, IL, USA (NG); African Refugee Development Center, Tel Aviv, Israel (HG); and Johns Hopkins University, Baltimore, MD, USA (TG) 1 2
Burki T. Israeli clinic provides lifeline for refugees. Lancet 2015; 385: 1384. Gottlieb N, Filc D, Davidovitch D. Medical humanitarianism, human rights and political advocacy: the case of the Israeli Open Clinic. Soc Sci Med 2012; 74: 839–45. Gebreyesus TA. Sexual and reproductive health of Eritrean women asylum seekers in Israel. PhD thesis, Johns Hopkins University, 2015; 79–104. Human Rights Watch. Make their lives miserable: Israel’s coercion of Eritrean and Sudanese asylum seekers to leave Israel. New York: Human Rights Watch, 2014. Zonszein M. Israel to deport Eritrean and Sudanese asylum seekers to third countries. The Guardian (London), Mar 31, 2015. http://www. theguardian.com/world/2015/mar/31/israel-todeport-eritrean-and-sudanese-asylum-seekersto-third-countries (accessed April 27, 2015).
Human resources for health: a new narrative Countries worldwide have had profound and pervasive challenges in human resources for health. During the past two decades, several international reports (including WHO’s Global Health Workforce Alliance, and the Organisation for Economic Co-operation and Development’s reports) have identiﬁed policy issues and solutions to achieve a robust health workforce. On the basis of these reports, governments have made substantial investments. Many of the investments and most of the work has focused on addressing concerns about the numbers of skilled health workers (ie, midwives, nurses, physicians, and community health workers) without any investigation into the health needs of the population, the quality and efficiency of the health workforce, and the resulting requirements of the health system.
A more holistic approach needs to include planning for human resources for health within the broader contexts of the health and social system. This approach means development of a plan with solutions at many levels (ie, global level, health system level, and point-of-care level), and needs joint collaboration between governments, researchers, health system administrators, regulators, and health professionals. In the context of national, regional, and worldwide agendas and plans, including WHO’s development of the report Health workforce 2030; a global strategy on human resources for health, and in an eﬀort to address universal health coverage and the post-2015 sustainable development goals, including non-communicable diseases and health-system ﬁnancing, various actions, issues, and policy levers need to be considered. These actions include: dialogue and collaborative work between all levels in the health system; use of evidence to inform interprofessional education and practice strategies to support collaborative, communitybased health care; a shift from predominantly hospital-based care to care in the community; enhancement of use and efficiencies of policy and regulatory responses in health care and enable optimisation of services; address gender inequities and inequalities through inclusion of women at decision-making forums and policy-setting meetings; human resources for health planning integrated into national development frameworks, thus ensuring all factors impacting human resources for health are considered and integrated. The International Council of Nurses, working with nurses worldwide, is committed to providing the leadership to deal with these worldwide complex human resources for health and health-system challenges, with the focus ultimately on building healthier, resilient, and robust communities. As such, the Council is committed
For WHO’s Health workforce 2030; a global strategy on human resources for health see http://www.who.int/ workforcealliance/knowledge/ resources/strategy_ brochure9-20-14.pdf
For more on WHO’s Global Health Workforce Alliance see http://www.who.int/ workforcealliance/en/
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