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Israel’s Only Refugee Mental Health Clinic Works in Shadow of Closure

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A Sudanese refugee reacts to substance overdose and bystanders surround him in Levinsky Park in south Tel Aviv, Israel. Many refugees suffer various mental health disorders such as post-traumatic stress disorder (PTSD), anxiety, depression, alcohol and substance abuse, and in extreme cases, psychosis. Image by Isma'il Kushkush. Israel, 2018.

A Sudanese refugee reacts to substance overdose and bystanders surround him in Levinsky Park in south Tel Aviv, Israel. Many refugees suffer various mental health disorders such as post-traumatic stress disorder (PTSD), anxiety, depression, alcohol and substance abuse, and in extreme cases, psychosis. Image by Isma'il Kushkush. Israel, 2018.

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The Jaffa Community Mental Health Center, which hosts serval community clinics including the Gesher Clinic. Image by Isma'il Kushkush. Israel, 2018.

The Jaffa Community Mental Health Center, which hosts serval community clinics including the Gesher Clinic. Image by Isma'il Kushkush. Israel, 2018.

AN ENGRAVED POEM in Hebrew near the entrance of the drab government building in Jaffa, Israel, is the only clue as to what goes on inside. It reads:

“We are the generation
Of lonely people
Thirsty for touch
For a bit of compassion
We are the generation that snorts
Pills, searching to get
A clue to feel ­– what is love?”

The Gesher Clinic is the only clinic in Israel offering mental health treatment to mostly African asylum seekers. But it operates in the shadow of closure, starved of funds by a government that has been working very publicly to ensure that the kind of people it serves cannot settle long term in Israel.

Gesher opens its doors for just nine hours each week, spread across alternate days. It means a monthslong waiting list, and, for Tahila Guigui, a clinical psychologist who has worked here for three years, it means seeing as many as six patients in a three-hour shift.

“I saddens me, as a therapist, I always wish for my patients to leave me, not for me to leave them,” says Guigui.

The Gesher Clinic is funded by the Israeli Ministry of Health, and employees have been told the money will run out soon. While no timeline for closure has been made public, local media reported that the ministry has not solicited bids to outsource the clinic’s services.

“In the case where alternative solutions may be delayed, the Ministry of Health is examining the continued service through the Gesher Clinic, or alternatively, referral to existing regional mental health centers,” responded Eyal Basson, spokesperson for the Ministry of Health, in an email.

Israel currently hosts close to 38,000 African asylum seekers, mostly from Eritrea and Sudan. Many arrived through Egypt’s Sinai starting in 2006, fleeing dictatorship and war, until the Israeli government erected a security fence in 2013 along its southern border. Human rights groups estimate that up to 7,000 of the asylum seekers are victims of trafficking and torture, including rape.

While human rights groups consider most Eritrean and Sudanese asylum seekers to have legitimate claims for protection, politicians in the right-wing coalition government of Prime Minister Benjamin Netanyahu view them as economic migrants and refer to them as “infiltrators.”

Government plans in early 2018 to either jail or deport asylum seekers to Uganda and Rwanda sparked an international outcry.

The government then announced it had reached an agreement with the U.N. to officially resettle them in Israel and Europe, only to back away from its plan seven hours later after local political pressure.

Zoe Gutzeit, of advocacy group Physicians for Human Rights-Israel, says Israel has denied African asylum seekers basic rights like access to healthcare. “Israel refuses to recognize them as refugees having rights and worthy of compassion,” she says.

The uncertainty and political hostility has added to a litany of mental health problems for asylum seekers, from post-traumatic stress disorder (PTSD) to anxiety, depression, and alcohol and substance abuse. According to a 2016 study by the University of Haifa and Physicians for Human Rights, as many as three-quarters of men and up to six out of 10 women who crossed the Sinai Peninsula into Israel since 2010 suffer from PTSD symptoms.

Israeli humanitarian organizations had stepped in to fill some of the gaps and lobbied for legal recognition. The establishment of Gesher Clinic in 2014 was one of the few concrete signs that the Israeli government was listening.

Ido Lurie, a psychiatrist and one of pioneers at Gesher, recounts a story of what asylum seekers were facing before the clinic opened: “I was called for a home visit, at a shelter, in 2010. A young lady from Eritrea, about 19, was trying to hang herself.”

The woman had been raped by traffickers in Sinai and was pregnant. In a crowded stuffy shelter along with men, without any legal rights, family support or access to health services, including abortion, she tried to kill herself and the baby. “This is when we realized there was a health issue from Sinai,” Lurie says.

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Dr. Ido Lurie, a psychiatrist and former director of the Gesher Clinic. Image by Isma'il Kushkush. Israel, 2018.

Dr. Ido Lurie, a psychiatrist and former director of the Gesher Clinic. Image by Isma'il Kushkush. Israel, 2018.

Along with a local U.N. official, Lurie began advocating for a mental health clinic for asylum seekers. They received an initial donation from the German government and proposed the project to Israeli health officials, who accepted the partnership. They chose the name Gesher, which is Hebrew for “bridge.”

“It was a gradual thing, acceptance, but there was a need for it, so we did not have a lack of patients,” he says.

The clinic normally operates with two psychiatrists, two psychologists, one nurse and one social worker, along with Tigrinya, Amharic and Arabic interpreters. It has treated 800 patients to date; there are 300 current cases, and 200 are on the waiting list.

Guigui says many of the patients she sees suffer from “complex trauma,” having experienced repeated life-threatening events. Symptoms include headaches, nightmares, flashbacks, intrusive memories, insomnia, isolation, detachment, trembling and outbursts of anger. Between 10 to 15 percent of Gesher’s patients have been diagnosed with psychosis, at times requiring hospitalization.

Osman, 43, an asylum seeker from Sudan, has been in Israel for 10 years, having left Sudan, then Egypt, fleeing political persecution. When he first arrived, he was held for 16 months in a detention center, where he says he was mistreated. Another 18 months later, he was detained at the Holot detention center in southern Israel, which was established to hold African asylum seekers.

“I couldn’t sleep, couldn’t eat, couldn’t work, lost a lot of weight and was thinking of death all the time,” he says. In 2016, he began visiting Gesher and says the medication he received “at least helped me sleep.”

Some of the patients Guigui works with also include women and men who were repeatedly raped in Sinai. Opening up about the their experiences is not easy.

“For men who come from these societies … this is very hard and they are so lonely because they are not able to communicate their feelings inside the community, and outside they encounter racism a lot so they feel detached from every society,” she explains.

Treatment has helped many resume their lives. Patients have been able to go to work, socialize and live normal lives. “I have a patient who has a difficult story. She was raped and sold, over and over, she was suicidal, and today she works and has friends,” Guigui says.

While Gesher has positively impacted the patients, it has had to work with a skeletal staff under the constant threat of closure. Therapists would see patients outside their allocated work hours and even give some patients money to buy food, Lurie says.

In August 2016, as the number of patients grew, the clinic had to turn away new patients for eight months. By January 2018, Lurie resigned as director, citing “personal and professional reasons.” He was not replaced.

Gutzeit, from Physicians for Human Rights, says they have pleaded with Israel’s health ministry to keep the clinic open at least until an alternative can be found.

“If they cut this treatment, if they stop it … these people will remain not only without proper care, but also with little trust left, it could really damage their progress,” she says.

Lurie believes that the government can do more to keep the clinic open. For him, it’s an ethical issue. “We can’t turn away our heads, we can’t look away,” he says. “It’s part of the oath, the oath we take as doctors, to help whoever needs that, no matter what their status in Israel is.”