Israel, 1954

Histadlut (General Federation of Labor), which served the needs of
the Jews of Palestine during the Mandate. Hadassah's work was
both preventive and curative. It established hospitals and clinics
in various parts of the country, and conducted a network of
public health services. The Kupat Holini organized the working
population in a comprehensive health insurance scheme, financed
by voluntary contributions, and also ran clinics and several
well-equipped hospitals. Thanks to these institutions, the
Jewish community of Palestine boasted one of the lowest infant
mortality rates in the world, and enjoyed a life expectancy fully
in accord with Western standards.

Mass Immigration & the Health Services

These health services, adequate for a normal community of
700,000, were obviously quite inadequate for the masses of none-
too-healthy immigrants who entered the country after May, 1948.
Mass immigration not only doubled the population, but, since it was
non-selective, and excluded no one on grounds of ill-health, physical
disability or poverty, it added a mammoth strain on the country's
health services. Nearly 50,000 immigrants were over 60; many were
chronically sick and required immediate hospitalization. Almost
20% were children under nine. In May, 1948, only a few dozen

1

beds for chronic cases were available in the country, and only 225
beds for infants and children. Moreover, over 50% of the immigrants
came from the Middle East, North Africa and Asia and brought with
them scant understanding of basic hygiene. Coming from the most
primitive areas, many who arrived suffered from chronic diseases
never treated and often never diagnosed. Many were Mind. From
Europe came large numbers of men and women who suffered from
permanent disabilities incurred in Nazi camps. All had known
physical suffering. These were only a few of the health problems
faced by the State upon its establishment.

The Ministry of Health

The health of the population (1,670,000 as of December, 1953),
is the responsibility of the Ministry of Health. In six years,
the Ministry, which started with a handful of officials inherited
from the Mandatory administration, has grown into a vast complex
organization employing over 4,000 persons, including 380 doctors
and nearly 1,900 nurses. It runs 19 hospitals with 4,330 beds, and
maintains 14 District Health Offices which cover the entire country.

Its medical services include maintenance of hospitals, mother
and child care, sanitation, epidemiological services, an anti-malarial
service, prevention and treatment of tuberculosis, mental hygiene,
public health laboratories and nursing and pharmaceutical services.
It also carries out public health education. Six percent of the ordinary
budget is spent on health services.

Other Medical & Health Agencies

Government health services are supplemented chiefly by Kupat
Holim, the Hadassah Medical Organization and by various other
smaller agencies.

Kupat Holim gives medical aid to 970,000 persons who pay or
are dependents of contributors to its health insurance scheme. It
maintains 14 hospitals, 810 dispensaries, 10 convalescent homes and
165 infant welfare stations.

Hadassah Medical Organization, sponsored by Hadassah,
Women's Zionist Organization of America, provides most of the
curative and some of the preventive services in the Jerusalem area.
It maintains 3 hospitals with 700 beds (Jerusalem, Beersheba and

2

MAY 5 1954

Safad) ; 27 clinics and 34 "Mother and Child Care" stations in Jeru-
salem and vicinity; and a school for nurses.

There are a few other sick funds, operating modestly, which
provide medical treatment and hospitalization to insured members
through private doctors and hospitals.

Malben cares for immigrants who, due to age, sickness or per-
manent disability, cannot be absorbed normally. (See page 7).

The Anti-Tuberculosis League maintains clinics for the pre-
vention of tuberculosis.

Magen David Adom (Red Shield Society), the Israel equiva-
lent of the Red Cross, runs a countrywide network of first-aid and
ambulance stations.

Health Absorption of Immigrants

In May 1948, the Government assumed full responsibility for
the health of all new immigrants, until their transfer to places of
settlement. A special Health Service for new immigrants was set up
from 1948 to 1950 when the majority of all immigrants remained
in reception camps until their final settlement. This special Service
consisted of a chain of free polyclinics, hospitals, sick bays (over
1,000 beds) , maternal and child welfare centres, day and night nur-
series for infants (nearly 2,000 beds) , dental treatment, convalesence
and inoculation. In 1950, the camps were practically abohshed and
Maabarot (transitional villages) were established. The inhabitants
of these villages were economically independent, but the Govern-
ment continued to provide most of their hospitalization and to carry
out certain specific functions in the field of preventive medicine.
Most residents of maabarot eventually became members of sick
funds, usually of the Histadrut's Kupat Holim.

Hospitals

By the end of 1948, Israel had 63 hospitals, totalling 4,626 beds.
By December, 1953 the number of hospitals had risen to 87, the
number of beds to 10,609. The expansion of hospitalization facil-
ities was becoming increasingly a Governmental function and the
percentage of Government-maintained hospital beds had risen from
I4.67o in 1948 to 41% at the end of 1953.

3

ISeiv wing of the Beilinson Hospital

Health Personnel

Israel has some 3,500 doctors, or one doctor to 470 inhabitants.
Although this is the highest rate in the world (in U.S. 1:710, the
United Kingdom 1:870, Egypt 1:4,200), the majority of these doc-
tors are no longer young, and only the new graduates from the
Hebrew University— Hadassah Medical School can ease the severe
shortage of young doctors, especially in outlying districts. About
1,000 dentists and dental surgeons are registered. There are 700
registered pharmacists and*the number of nurses, of all categories,
exceeds 4,000, although state-registered hospital and public health
nurses number less than 1,500.

Mother and Child Care

There are now 369 Mother and Cliild Care Centres throughout
the country maintained by the Ministry of Health, Kupat Holim,
Hadassah or various municipalities. In 1948 there were only 110

4

such centres. (48 were opened in 1953 alone). Approximately
11,000 pregnant women, 32,000 babies and 40,000 infants between
one and four, were under such care in 1953. The infant mortality
rate is universally recognized as a yardstick for gauging the efficiency
of Health Services. The following table shows the advances achieved
due, in great measure, to the work of the Mother and Child Care
Centres :

Infant Mortality per 1,000 Live Births
(Jewish population only (0-12 months)

Year

Rate

1947

29

Period of mass immigration

1949

52

1950

47

1951

39

1952

38.7

1953

35.8

The infants mortality rate among the Arabs of Israel has also
reacted sharply to the introduction of modern medical and hygienic
methods and showed a decrease from 67.7 deaths per 100 live births
in 1952 to 60.3 in 1953. In Egypt and Jordan the rate is 200 and in
Iraq 300 per 1000 live births.

The School Hygiene Service in 1953 covered some 182,000 school
children in 609 elementary schools.

Tuberculosis

The total number of TB beds available in Israel is 1,870, of
which 600 are in Government hospitals, 750 in hospitals run by
Malben.

From November, 1949 to December, 1953, 770,000 persons were
tuberculin-tested and 320,000 persons vaccinated.

Diagnostic operations are carried out jointly by the Government
and the Anti-Tuberculosis League by means of mass X-Ray exam-
inations in clinics and mobile units. A new TB clinic was opened
in Raanana in February, 1954 and a central TB clinic for the entire
Tel Aviv-Jaffa area opened in May. The Anti-Tuberculosis League
will open its clinics in Beersheba, Acre, Ascalon, Hadera, and
Rehovot.

Despite the high percentage of active tuberculosis in Israel since
1948, tuberculosis control and preventive measures have kept the
incidence of TB in check, and during 1953 the death rate from
TB for all ages was only 10.4 per 100,000 inhabitants, about the
same as in countries with the lowest rate. (In the U.S.A. the rate for
1950 was 22.5) .

Malaria

Malaria, one of the most prevalent and deadly endemic diseases,
(there were districts with a 100% incidence rate) , is fast becoming
a comparative rarity. The number of new malaria cases fell from
1,091 in 1949, to 275 in 1953— a drop of 74%. This improvement
is underlined by a comparison of the total number of malaria cases
—3,011 in 1950, and only 390 in 1953— a drop of 87%o.

Control measures applied by the Ministry of Health during
1953 covered 743 localities.

The extent of the anti-malarial operations in 1953 is shown in
the following figures:

500 water courses, 1,400 kilometres (815 miles) long were sub-
jected to anti-malarial treatment, as well as thousands of
dunams of swamps, wells, and artificial lakes;

5,000 working days were spent on drainage, closing of wells and
cisterns, and extermination of water vegetation;

16,000 working days, and 525 tons of malariol were used in
spraying operations of swamp areas;

3,000 working days were spent in D.D.T. spraying of residential
quarters.

Epidemological Service

The incidence of communicable disease is low in com-
parison with that of neighboring Arab States, but is, at present,
higher than that of Europe or the United States. Recent changes in
that picture are the tightening-up of the notification system
and to the establishment of two new Public Health laboratories
in Haifa and Rehovot plus the enlargement of the one near Tel
Aviv. The incidence of diphtheria, for example, dropped in 1953
as much as 50% compared with 1952, and it is hoped that the anti-
diphtheria campaign now being waged will lower the incidence even

6

further. Typhoid incidence dropped from 6.8 per 10,000 in 1952
to 3.2 in 1953; clinical dysentery from 48.8 to 26.8 during the same
period; and bacillary dysentry from 13.8 to 10.0. Poliomyelitis also
dropped from 5.8 to 3.9.

Mental Health

The problem of mental disease is one of the gravest facing the
Ministry of Health. It is an immediate consequence of unselective
immigration and a tragic legacy of Nazi atrocities. A total of 2,681
beds are available for mental cases, but an estimated 4,000 are
urgently required.

The Ministry of Health maintains 5 mental hospitals with
1,450 beds; the Kupat Holim 2 institutions with 397 beds; and
private institutions comprise another 834 beds. Two new Government
Institutions are to be opened and the Kupat Holim is enlarging
its facilities. Most of the patients in private institutions are main-
tained at Governmental expense. The Government also runs three-
out-patient clinics for the treatment and prevention of mental disease.

Rehabilitation

Malben (Institution for the Care of Handicapped Immigrants)
was originally set up by the Israel Government, the Jewish Agency,
and the American Joint Distribution Committee to deal with all
those immigrants who, due to age, sickness or permanent disability,
could not be routinely absorbed into the nation's economy. By the
end of 1950, the American Joint Distribution Committee had as-
sumed sole responsibility for the financing of Malben's program.

In its four years of existence Malben has extended direct services
to some 35,000 immigrants. It has built 8 hospitals, a post-T.B. Rehab-
ilitation Centre, out-patient clinics in Tel Aviv and Haifa, 15 Old
Age Homes for over 2,000 aged persons, a village for 100 blind per-
sons and their families, a home for retarded children and 23 shel-
tered workshops for physically handicapped persons. In 1954 it
will service another 1,500 aged persons.

The Ministry of Health is building a modern Children's Centre
at the Assaf Harofe Hospital in Sarafand to deal with post-polio
rehabilitation. It is expected to open in May, 1954. In the meantime,
a Physiotherapists' School was opened last year to provide trained
personnel for rehabilitation work.

7

Community Health Centres

The success of the Community Health Centre opened in the
Jerusalem area last year by Hadassah led the Ministry of Health
to plan additional centres. Four pilot community Health Centres
will be opened in the first half of 1954, two in areas predominantly
Jewish (in conjunction with Kupat Holim and the local author-
ities), and two in Arab areas, also in conjunction with the local
authorities. These Community Health Centres, whose primary pur-
pose is preventive medicine, will include some 20 beds for maternity
cases, treatment of children and emergency cases. Each will contain
an out-patient clinic and a lecture hall to be used for demonstra-
tions and lectures on medical hygiene and kindred subjects as part
of a public health education campaign.

Medical Schools

The Hebrew University — Hadassah Medical School, the only
one in Israel, opened in May, 1949 as a joint enterprise of the
Hebrew University and the Hadassah Medical Organization. Its
first classes were composed of students who had commenced their
medical studies abroad, and by the end of 1953 180 degrees of
Doctor of Medicine had been granted.

One of the main problems is the absence of proper accomoda-
tions due to the inaccessibility of medical school buildings on Mount
Scopus. The problem will be solved only with the erection of the
new Medical Center west of Jerusalem.

A School of Dentistry and a School of Pharmacy were added in
1953.

There are 11 schools for state-qualified nurses, attached both
to Government and other hospitals. Besides these, there are 12 schools
for practical nurses, graduate courses for public health nurses and
midwives, for tuberculosis and mental nursing. Other schools train
auxiliary and baby nurses.

Advisory Medical Council

In order to sercure the maximum cooperation of the medical
profession in the public health drive, an Advisory Medical Council,
consisting of forty outstanding medical men was appointed in 1953
by the Ministry of Health. The Council meets once a month in
Jerusalem to discuss recommendations submitted by various com-
mittees. There are fourteen expert committees on Mother and Child
Health, Industrial Hygiene, Epidemology, Nutrition, Medical Leg-

8

Mobile clinic in Arab village

islation, Psychiatry, Tuberculosis, Professional Education, Dentistry,
Social Insurance, Forensic Medicine, Budgeting, Pharmacology,
Hospitals.

Medical Services for Arabs

Government Medical and Health Services, as well as those main-
tained by the Municipalities, the Sick Funds and Hadassah, are
available to all citizens, Jews and Arab alike. Therefore no sep-
arate services had to be provided for Arabs in any area of mixed
population. In places inhabited mainly or exclusively by Arabs,
special basic services were set up since neither the Arab community
nor Arab local authorities ever made any efforts in this direction.
Special courses for Arab nurses and social workers were held and
graduates of these courses now work in all-Arab areas.

A T.B. hospital, 3 maternal care clinics, 4 mobile medical
services, 23 local and district clinics, as well as ambulance services
were established in Arab areas. Two new Community Health Cen-

9

tres will be added to the list. A unique problem is that of the semi-
nomadic Beduin in southern Israel, for whom any standard pat--
terns of medical and health services are inapplicable. Special medi-
cal services, however, were created to meet their special needs. Two
clinics were established in tribal centres, and a medical team headed
by an Arabic-speaking doctor with considerable experience of
tropical diseases visits tribal tents regularly. That over 400 Beduins
were hospitalized since 1950 is a most significant record of achieve-
ment. Even more revolutionary is the fact that last year, 1953, a
Beduin mother gave birth to her child in a hospital minus the
attendance of tribal midwives.

More important, perhaps, than these statistical records of im-
proved health standards in the Arab community is the startling
social impact of services which have created awareness of modern
medicine, personal hygiene and sanitation for the first time in the
history of the Arab masses.

Conclusion

Although its problems might well have overwhelmed an older
and larger organization, and despite the meagre resources at its
disposal, the Israel Health Services, both governmental and institu-
tional, have achieved an unbroken and extraordinary record of
achievement and progress:

1. The health standards of new immigrants from entirely back-
ward counrties was rp^sed considerably in a short time.

2. No major epidemics occurred, despite ominous predictions.

3. Nearly all cases of T.B. discovered were hospitalized.

4. The number of hospital beds greatly expanded.

5. The number of beds for mental cases quadrupled.

6. Several hundred polyclinics were built for new immigrants
in new workers' quarters and in new housing scheme areas.

7. The infant mortality rate was greatly lowered.

8. The maternal mortality rate was lowered to 0.8 per thousand
live births, which compares well with the most progressive
and efficient countries in the world.

9. Life expectation at birth rose from 65.2 years in 1949 to
67.3 years in 1951 for males, and from 67.9 to 70.1 years for
females. (The respective numbers for the white population
of the United States were 65.9 and 71.5).

10

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