**7. Media exposure and social and financial support for the Israeli Syrian medical assistance programme**

From the beginning the medical assistance programme was initiated according to local and operational requirements rather than as a result of a considered national strategy. This was reflected by the fact that no agreed budgetary arrangement existed. The costs were considerable, not the least of which was the provision of expensive re-usable medical devices that in many cases were lost to the hospital after the discharge of the patients. The former head of ZMC in a television interview stated that he was proud of the opportunity to express universal humanitarian values but that no one was footing the bill, which ran into hundreds of millions of shekels. Hospitals began to run up considerable deficits. This affected their ability to continue everyday operations. In 2017 this came to a head with the outbreak of industrial action at the Nahariya hospital. At a governmental level, there was a predictable interdepartmental dispute with the ministries of defence, health and

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have been better served.

*Treating the Enemy: Victims of the Syrian Civil War in Israel*

the treasury all trying to shift financial responsibility on another department. On the other hand, local communities in the Galilee, both Arab and Jewish, opened their hearts and pockets with a constant stream of philanthropic donations both of money and articles. Yet while this surprising response reflected the quality of Israeli society, it was insufficient to bridge the budgetary deficiencies. In addition, hundreds of foreign delegations of journalists, diplomats, politicians and public organisations visited the hospital and the patients (while being careful not to photograph faces), and these sometimes also resulted in valuable donations and support, but still not sufficient to cover the huge costs incurred. It is important to stress that while for the most part the existence and nature of the humanitarian programme were never a secret, no major publicity initiatives were undertaken by the government. The publicity that occurred was mostly restricted to occasional reports by news agencies and written and video reports in online sites [9]. Surprisingly, this meant that large parts of the Israeli public itself were not aware of the programme and its nature, and this was even truer abroad. It could be argued that this lowprofile publicity policy was a mistake, yet the whole issue was highly sensitive from Israel's standpoint, and there were arguments for limiting exposure. Interestingly, the head of ZMC has been invited to light a flaming torch at the national independence celebrations in 2019 as a tribute to the people who worked in the programme and its results, yet this is taking place only after the programme has ceased. This no doubt reflects the dilemma that Israel faced and faces with respect to the public face

**8. Legal and ethical aspects of the Israeli medical assistance programme** 

One of the important points to study with regard to this programme was the legal and ethical framework in which it took place. The patients who came to Israel came for different reasons. At the start many were unconscious when they crossed the border so that one could not talk about voluntary or consensual transfer. Once in Israel, the individuals were the legal responsibility of the IDF and military law, yet their status was ill-defined. Unlike prisoners of war or refugees, groups that are covered by clear frameworks of international convention and law, the Syrian patients were not defined as either nor were they tourists. They came or were brought usually without documentation of any kind. This meant that these patients had no defined legal standing nor, therefore, defined protection. It is certainly my belief backed by extensive experience and exposure that the human and medical rights of these patients were rigorously safeguarded at all times by the dedicated medical and hospital staff that treated them, yet nevertheless the theoretical possibility of a breach of rights existed, and if this had occurred in practice, the patients would have had little legal or other recourse beyond the unsure solution of military law. This must certainly be a source of concern for any similar scenario whether in Israel or in any other country faced with a similar situation. An example of this nonoptimal situation was the restriction on transferring patients to other medical facilities in Israel in the case of need. The limitation on this was enforced and backed by a decision of the Israel Supreme Court. In one prime example, a paediatric patient requiring a bone marrow transplant could not be treated in Israel (for medical and social reasons) and needed transfer to an academic centre in an Arab country. This could not be done via the safe and direct route through Israel but rather via a return to Syria. Although in this case the transfer was completed without incident, it was certainly arguable that the patient's best interests could

*DOI: http://dx.doi.org/10.5772/intechopen.87936*

of this programme.

**for Syrians**

*Treating the Enemy: Victims of the Syrian Civil War in Israel DOI: http://dx.doi.org/10.5772/intechopen.87936*

*Education, Human Rights and Peace in Sustainable Development*

vascular disease, diabetes and neurodegenerative disease.

Mortality was surprisingly low among in-patients, <5%. Considering the severe condition in which many arrived, the complications and lack of medical documentation, this was an impressive achievement. The work of the orthopaedics department in limb salvage and rehabilitation was especially noteworthy with its chief being invited to lecture worldwide and the author of many books and articles. However, the medical and nursing staffs of all departments worked with commendable skill and efficiency for their patients. Nor were the psychological and social aspects neglected. Psychologists and medical clowns ("dream doctors") working in Arabic provided invaluable support for these unfortunate people, who found themselves in a strange country, a country which all their lives they had been taught to hate, fear and despise, suffering severe pain and disability and above all being completely dependent on the goodwill and skill of caretakers with whom they had almost nothing in common. Social workers also worked hard to provide relief both as facilitators and educators, contact providers between the medical and military authorities and also provide the basics which the patients completely lacked such as clothes, toiletries, reading material and for the children toys and even tablet computers. Arabic-speaking teachers also provided educational materials and teaching

**7. Media exposure and social and financial support for the Israeli Syrian** 

From the beginning the medical assistance programme was initiated according to local and operational requirements rather than as a result of a considered national strategy. This was reflected by the fact that no agreed budgetary arrangement existed. The costs were considerable, not the least of which was the provision of expensive re-usable medical devices that in many cases were lost to the hospital after the discharge of the patients. The former head of ZMC in a television interview stated that he was proud of the opportunity to express universal humanitarian values but that no one was footing the bill, which ran into hundreds of millions of shekels. Hospitals began to run up considerable deficits. This affected their ability to continue everyday operations. In 2017 this came to a head with the outbreak of industrial action at the Nahariya hospital. At a governmental level, there was a predictable interdepartmental dispute with the ministries of defence, health and

*Israeli Experience in Medical Care and Humanitarian Support of Syrian Refugees* [8], written and edited by the staff of ZMC. A general summary will be given here. Approximately 80% of the in-patients treated were male, and about 20% were under the age of 18. Patients were treated in almost every department of the hospital but especially in intensive care, surgery, orthopaedics, paediatrics and obstetrics. Of note, 24 babies were born to Syrian mothers in ZMC during the duration of the programme. Many of the patients suffered from injuries during combat either directly or collaterally. Among these were severe limb injuries, head and neck, abdominal and chest injuries, and those requiring and plastic surgery. Often these patients required very prolonged treatment including repeated surgery, treatment for severe infections, pain relief and nutritional resuscitation. Almost all patients came with no medical records or documentation, making assessment doubly difficult. Patients who had received medical care in often from severe complications such as botched procedures, multiple resistant bacterial infections, and severe pathogens (such as polio which broke out in various places in Syria). In addition, increasingly patients arrived in Israel with medical problems such as congenital malformations, genetic disease, cancer as well as "routine" disorders such as cardio-

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programmes.

**medical assistance programme**

the treasury all trying to shift financial responsibility on another department. On the other hand, local communities in the Galilee, both Arab and Jewish, opened their hearts and pockets with a constant stream of philanthropic donations both of money and articles. Yet while this surprising response reflected the quality of Israeli society, it was insufficient to bridge the budgetary deficiencies. In addition, hundreds of foreign delegations of journalists, diplomats, politicians and public organisations visited the hospital and the patients (while being careful not to photograph faces), and these sometimes also resulted in valuable donations and support, but still not sufficient to cover the huge costs incurred. It is important to stress that while for the most part the existence and nature of the humanitarian programme were never a secret, no major publicity initiatives were undertaken by the government. The publicity that occurred was mostly restricted to occasional reports by news agencies and written and video reports in online sites [9]. Surprisingly, this meant that large parts of the Israeli public itself were not aware of the programme and its nature, and this was even truer abroad. It could be argued that this lowprofile publicity policy was a mistake, yet the whole issue was highly sensitive from Israel's standpoint, and there were arguments for limiting exposure. Interestingly, the head of ZMC has been invited to light a flaming torch at the national independence celebrations in 2019 as a tribute to the people who worked in the programme and its results, yet this is taking place only after the programme has ceased. This no doubt reflects the dilemma that Israel faced and faces with respect to the public face of this programme.
