A. came to Israel from Eritrea in 2011 at the age of seven. The son of asylum seekers, he did not have an official status in the country but benefited from an arrangement that allowed children in his situation to get insurance coverage at one of Israel’s HMOs. Since A. suffers from severe epilepsy, that made the difference between a life with constant seizures and the ability to purchase subsidized drugs that would give him a normal life.

The day that A. turned 18, however, everything changed. “He came to us and told us that, until then, he had been treated by the HMO,” says Zoe Gutzeit from Physicians for Human Rights Israel. “But suddenly, his HMO membership card wasn’t working anymore and he was no longer eligible. He suffers from epilepsy, and his family doctor has written that his life would be in danger if he stopped taking the drugs. Although we have a volunteer clinic where a neurologist will keep tabs on him, he has to buy the drugs himself and without a subsidy from the HMO, that will cost hundreds of shekels a month.”

A. found himself without health insurance since the arrangement the State of Israel reached with the Meuhedet HMO only grants insurance to statusless minors, not adults. The state, therefore, is putting these children in a trap: on the one hand, at least in the case of family members of asylum seekers from Eritrea, the state grants them group protection and is not deporting them, since their lives would be in danger if they are sent back to the home country. On the other hand, Israel does not grant them an official status that would give them access to basic services such as health insurance.

Meuhedet, as mentioned, refused to continue giving A. insurance since he was statusless and, because the National Insurance Law does not apply to him, it is entitled to do so. The only options available to A. were bad ones, as Gutzeit explains: wither purchasing tourist insurance or finding a job that would grant him insurance as a foreign worker. However, both of these options are expensive and, in any case, do not cover epilepsy drugs, which, in A.’s case, is a preexisting condition documented before the new insurance would begin.

In the end, a temporary solution was found after Physicians for Human Rights Israel got involved. Despite turning 18, A. is still in high school, and Meuhedet agreed to insure him until he graduates. That gives him about six months of breathing space. It is unclear what happens after that.

The previous Israeli government advanced a process that could have provided a partial solution: the creation of health insurance for asylum seekers, including adults, who cannot be deported from Israel. In October 2022, a tender was issued for the new service, but experts are doubtful that the new government will put the plan into practice.

30,000 Statusless Minors

Cases like that of A. will only become more common in the coming years. According to estimates from the Population and Immigration Authority, submitted in response to a query from Shomrim last year, there are currently around 30,000 minors living in Israel with no legal status. This includes the children of asylum seekers, like A., children of foreign workers, or even the children of tourists who remained in Israel after their visas expired. There are also the children of Palestinians who came to Israel under varying circumstances. Many were born in Israel, speak Hebrew, study in the Israeli education system and do not have any other country to call home.

“There are thousands of children in Israel who have no legal status; some of them were born here, and they have no horizon or any process through which they can hope to become permanent residents in the future,” says Gutzeit. “This is the root of the problem. Beyond the very extreme cases that we have started to see, I expect that we will see many more of them; there’s a systemic problem here of children who have found themselves in a situation that they did not choose and they are unable to get medical treatment the moment they become adults. It’s not responsible and it’s very unethical.”

The previous Israeli government advanced a process that could have provided a partial solution: the creation of health insurance for asylum seekers, including adults, who cannot be deported from Israel. In October 2022, a tender was issued for the new service, but experts in the field are doubtful that the new government will put the plan into practice.

The issue becomes even more acute when the statusless minors in question have been removed from their parent’s custody by welfare authorities. Usually, when the welfare authorities remove a statusless minor from the parents’ custody (with the approval of the courts), the Welfare Ministry first tries to find local family members who can raise the minor back in their country of origin. If this is not possible, the minor is sent to a government-run facility or a foster family. The state appoints a legal guardian and ensures that the minor has a roof over their head and is registered in an educational framework. However, the state does not take any steps to resolve the minor’s future status, as reported by Shomrim last year.

As a result, the day after the minors turn 18 and become legal adults, they are left with no status and no rights – and, in most cases, no support network. According to the Welfare Ministry, as of June 2022, there were 130,000 such minors living in Israel.

“Before they took out insurance for me, I had lots of problems, physical problems, too,” says Nastya Ostapenko, 19, who came to Israel from Uzbekistan when she was two. “I was the only one who would always feel that I am missing out on all that. I’m different.”

‘You Feel Like You Don’t Belong, Even Though You’re Like Everyone Else’

Nastya Ostapenko, now 19, came to Israel from Uzbekistan with her mother and two half-brothers when she was two years old. Her mother started the process of applying for Israeli citizenship since she was in a relationship with an Israeli citizen, but that relationship ended a few years later and they split up. Since then, the mother has been trying in vain to get legal status in Israel. For now, she and her children have no status whatsoever in the country.

In 2017, Nastya was removed from her mother’s custody, after the Family Court ruled that the mother was not a functioning parent and was incapable of raising her daughter. At 13, Nastya went from framework to framework, with the threat of remaining statusless hanging over her head the whole time. “I had to take unofficial jobs and I couldn’t get a normal job,” she tells Shomrim. “I can’t get a driver’s license. I can’t do anything. I can’t even get a certificate saying I completed 12 years of high school because of these problems. They didn’t want to register me for the matriculation exams because I didn’t have a status. I’m simply stuck, and I always feel different – and when you’re in a boarding school, that’s the hardest thing there is.”

Even though she was entitled to health insurance as a statusless minor, the issue remained unresolved for years. “Before they took out insurance for me, I had lots of problems, physical problems, too. And then you see how one friend goes for a test and then another one – and I can’t. At the age when all of my friends went to get their identity cards, I was the only one who would always feel that I am missing out on all that. I’m different. You feel like you don’t belong, even though you’re like everyone else. I do cleaning chores like everyone and get punished like everyone, but I do not have the same rights as they do.”

When she was 15 or 16, she says, she was transferred to a close hostel in Jerusalem, where, at long last, the medical insurance to which she was entitled was arranged. This allowed her to get treatment, including for psychological problems she was experiencing. Just before her 18^th birthday, there was a sharp decline in her mental health, which ended with her being hospitalized in a psychiatric ward. According to documents attached to Nastya’s legal files, the doctors who treated her were worried that, without medical insurance, they would be unable to continue treating her and providing her with the medications she desperately needed. In the event of an additional decline, the doctors worried she could be a danger to herself or others.

In the end, the director general of the Population and Immigration Authority, Tomer Moskowitz, decided to grant Ostapenko residency status for one year on humanitarian grounds. He did so, he wrote, “to allow her to get the treatment that she needs in order to integrate as smoothly as possible into Israeli society.”

Even though she now has resident status, Ostapenko will still have to wait six months to become eligible for HMO insurance, in accordance with the National Health Insurance Law – just like a new immigrant who comes to Israel. “What happens if something happens to me in those 180 days?” she asks. “Will I fall into debt just for going to the ER? Even though I have approval and was a member of an HMO in the past, why can’t they do it differently? God forbid that my mental health deteriorates again and I won’t be able to differentiate between reality and illusion and I leave the house… Where will I go?”

“The main problem originates from the fact that these children grow up in Israel with no status and that causes them untold damage,” says attorney Dana Yaffe, clinical director of the Clinic of International Human Rights at the Hebrew University of Jerusalem, who represented Ostapenko during the legal process. “Although the state does agree to give them health insurance when they are minors, but, at the same time, it does nothing to address a situation that is inevitable – when they reach the age of 18 and are no longer wards of the state, then they will have no eligibility for health insurance or to work legally.

“The state must take care of these young people in accordance with the approach adopted here, whereby young people without family support need to continue getting state help even after they turn 18, through all kinds of programs. The focus has to be on statusless minors, for whom the problem is even more acute.”