G.G. came to Israel four and a half years ago, and was a devoted caretaker for an elderly Israeli until she herself became sick. Her employer fired her after learning that she had cancer of the uterus and ovaries. She had a hysterectomy in February, followed by two chemotherapy treatments. She was supposed to have at least two more, but her insurance company informed her that it was not required by law to pay for additional treatments. It did, however, offer her a return flight to the Philippines.

The loss of the ability to work is one of the worst problems faced by the 102,000 labor migrants currently in Israel legally. Next month the Knesset is to hold a series of deliberations on the demand by Physicians for Human Rights (PHR) to end these workers' complete dependence on private insurance companies and transfer their health care to the health maintenance organizations. The proposal is expected to meet fierce opposition from the companies that take in more than $60 million a year from insuring work migrants. Advertisement


G.G. supports four children in the Philippines, including a retarded child. She is afraid that if she returns home, she will be unable to find work, and thus prefers to stay in Israel and hope that the cancer does not return. She feels well now, and has temporarily replaced a friend who went to the Philippines on vacation. She does not know what she will do in January, when the friend returns. Perhaps she can find another temporarary job, although since she no longer has a permanent position, she might not be able to renew her expired work visa.

Dr. Bella Kaufman, a senior oncologist at Sheba Medical Center, Tel Hashomer, who also volunteers with PHR, believes that had G.G. receive the full course of chemotherapy as prescribed, her chances of recovery would be high since the treatment is preventive. The insurance company's occupational physician, however, ruled that G.G. had lost her ability to work.

"That's the method. Almost every foreign worker who develops cancer is declared as having lost the ability to work and is sent out of the country," Kaufman says.

By law, if an occupational physician declares a work migrant unable to perform the job for which he or she was brought to Israel due to illness or accident, and the worker does not return to the job within 90 days, even if he or she receives treatment, the insurance company can cancel the worker's policy. Without health insurance, he or she cannot legally work in Israel.

"In effect, the worker's right to treatment is maintained as long as he is fit and healthy," the coordinator for foreign workers at PHR, Ran Cohen, says. "The law perpetuates the treatment of foreign workers as objects that can be replaced when they 'break down.'"

"It's a lot cheaper to buy the worker a flight back to the Philippines for $600 than to pay for medical treatment in Israel," Cohen continued. He says that the occupational physicians who determine work disability are in a conflict of interest with regard to the insurees, because they are on the insurance companies' payroll. Since the passage in 2001 of the Foreign Workers Law, PHR has handled the cases of 1,200 workers who were refused treatment by their insurance companies.

Attorney Dori Spivak of the Buchmann Faculty of Law, Tel Aviv University, has appealed hundreds of work disability rulings. Most ended with a finding for his client or an arrangement allowing for medical treatment.

That was the case for B.Y., a Filipino with a cancerous growth in his left arm. An insurance company doctor ruled that he would not regain his ability to work and his insurance was canceled. A counter-opinion was issued, according to which B.Y. would be fit to work within two months. The insurance company accepted the counter-opinion and reinstated his policy, and B.Y. did return to work.

Dr. Joshua Goshen, who has written many opinions on behalf of insurers, says he can count on the fingers of one hand the number of times that he has declared a foreign worker unable to work. According to PHR and Spivak's records, however, there are more than a handful of such cases. They cite, for example, that of a 36-year-old woman with salivary gland cancer that had metastasized. Goshen ruled that she would be unfit for work for at least 90 days, while a counter-opinion gave her a 75-percent chance of recovery. The insurer reinstated her policy.