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Page 1: Physicians for Human Rights Israel

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PHRI Impact Report 2019 Physicians for Human Rights Israel

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Table of Contents

Foreword by PHRI President Prof. Raphael Walden & PHRI Chair Dr. Mushira Aboo-Dia

PHRI’s Timeline

2019 in Nutshell

The Right to Health of Palestinians in the Occupied Palestinian Territory

The Right to Health of Prisoners & Detainees in Israeli Prisons

The Right to Health of Asylum Seekers & other Status-less People in Israel

A Human Rights Lens on Medical Ethics

The Right to Health of Israeli Citizens and Residents

2019 Financials

Our 2019 Partners

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"When I first found out that I was rejected for a permit, I couldn’t understand: why would they reject me? It is not like I have a tank! I immediately left the house and started screaming wherever I went. I was crying for two days straight. When I finally got the medical permit, I couldn't sleep from excitement and I was awake at 6 am that day, and I even had friends sleeping over because they were excited for me.”

Mohamed Saleh13 years old, Gaza Strip

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Palestinian-Jewish cooperation is an increasingly rare sight these days, especially when it comes to working towards mutual values such as justice, compassion and equality. We believe that the medical field, at its core, is an environment in which these values exist and a framework from which these values can be promoted. We come from very different backgrounds: Prof. Raphael Walden is an Israeli Jew whose family survived the horrors of the Holocaust, Dr. Mushira Aboo-Dia is a Palestinian citizen of Israel who grew up facing institutional discrimination. Yet, our shared values and shared occupation bind us together and motivate us to continue our work at Physicians for Human Rights Israel (PHRI).

For us, PHRI represents something bigger than its direct humanitarian work. When we volunteer at PHRI’s Clinics - which treat Palestinians in Gaza and the West Bank, asylum seekers, and other uninsured individuals in Israel - we have a practical impact on patients’ lives. Yet, medicine goes beyond medical care. Interacting with patients teaches us about strength, resilience and hope, while our volunteer work enables us to stand up for what we believe is true, focusing on our commonalities as a means of promoting change.

In the following pages, you will find 2019 narrated as a chronicle, seen through the eyes of our patients, volunteers, and staff members. It is a story of the trust we were given by our patients, volunteers, partners and supporters in Israel, in the occupied Palestinian territory, and around the world, and the work that was done in an increasingly hostile climate. We thank you all for that.

Now, at the start of a new decade, we ask you to join us in our work to provide timely humanitarian care and engage in political activism, so that all can access what seems so basic - the right to health.

Medicine Goes Beyond Medical Care

PHRI President Prof. Raphael Walden

& PHRI Chair Dr. Mushira Aboo-Dia

F O R E W O R D

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PHRI President Prof. Raphael Walden

& PHRI Chair Dr. Mushira Aboo-Dia

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2000PHRI receives the Child Protector Award from Prime Minister Ehud Barak

1998PHRI launches the Open Clinic to assist migrants living in Israel with no other options for non-emergency treatment

2010PHRI receives the Right Livelihood Award, the alternative Nobel Prize

2019PHRI receives the New Israel Fund UK’s Human Rights Award

PHRI's Timeline

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1988A group of Palestinian and Israeli doctors travel to Gaza for the first time as a Mobile Clinic and decide to found PHRI

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2019 in a Nutshell Over

12,500patients treated in Gaza and the West Bank through the Mobile Clinic

2,304medical professionals trained in Gaza, the West Bank, and Israel

Medication and medical equipment worth more than

2 million NISsent to Gaza 4,810

visits by asylum seekers and other status-less people in our Open Clinic

Over

7,000 hours contributed by healthcare workers in our Clinics and beyond

More than

50,000Israelis continually exposed to violations of the right to health on social media

68petitions to Israeli courts

219denials of exit permits from the occupied territories challenged331

treatments funded for Palestinians in hospitals and outpatient clinics

More than

1,100students of medical professions learned about the nexus between health, medical ethics, and human rights

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"For me, medicine is not about the actual disease or treating the affected organ, it's about those impacted. Medicine, practiced right, lets you see the life of the most disadvantaged and understand what help must look like. It’s about bringing treatment directly to those who otherwise have no access to it. I feel it is my obligation to speak up for them. If I only say these things to myself and my students, without actually practicing what I preach, then I am only doing half of what I am supposed to do.”

Dr. Leeor ShacharGeneral Practitioner, Open Clinic Volunteer

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The Right to Health of Palestinians in the Occupied Palestinian Territory

The Palestinian medical system continued to face enormous challenges. In Gaza, the Great March of Return and high numbers of wounded protestors compounded the pre-existing difficulties of the healthcare system, including unavailability of beds, equipment, and medications. This is coupled with severe medical exit permit restrictions by Israel, as well as increased bureaucratic hurdles in overturning permit decisions.

Responding to the growing needs of patients, PHRI increased its activities in Gaza, including delivery of medication, education, and training for local staff. In 2019, PHRI sent medication worth over 2 million NIS to Gaza’s hospitals, including therapeutic milk for babies and insulin for diabetic patients.

Over 12,500 patients received direct medical care in our

Over

12,500people benefited

from direct medical treatment

Photo: Salah Haj Yahya/PHRI

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Mobile Clinic in Gaza and the West Bank. To develop the capacities of Gaza’s health workers, hands-on training was provided to hospital staff during 9 visits to Gaza, including in over 175 complicated operations. PHRI also held 7 conferences in Gaza for over 1,650 medical professionals, providing professional guidance on cutting-edge techniques and critical problems, including mental health challenges. To train Palestinian medical professionals

to respond to mass trauma, PHRI brought 30 doctors and nurses from Gaza and the West Bank to attend a three-day simulation workshop focused on emergency medicine at Tel Hashomer hospital in Israel.

In 2019, PHRI chose to highlight the impact of the closure through a focus on the most vulnerable of communities, specifically women and children. On International Women’s Day, in tandem with an all-female medical delegation

to Gaza, PHRI launched a report on the challenges facing female patients who need to exit the Strip for medical treatment. The report received widespread media coverage in 19 local and international publications, while its findings were published in the renowned Lancet Global Health journal. Several medical organizations around the world joined the outcry and issued letters to the Israeli authorities that underlined the need for these patients to swiftly access treatment.

The Right to Health of Palestinians in the Occupied Palestinian Territory

219denials of exit permit challenged, nearly half of them successfully

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PHRI also focused on child separation, whereby the Israeli authorities prevent children exiting Gaza for medical care from being accompanied by their parents. After assisting over 50 families who had been separated, PHRI issued a ground-breaking report on the phenomenon. The report’s conclusions, in an unprecedented step, were echoed by the UN Committee on Economic, Social and Cultural Rights, which called on the Israeli authorities to allow parents to accompany their children. Our work here was complemented by advocacy tours in, for example, Berlin, Brussels, and Bern that highlighted the health needs of vulnerable populations.

PHRI also addressed the disastrous health impact of the occupation through a focus on the daily practice of forcible home entries. Forcible home entries are a commonplace occurrence in the West Bank and happen when armed soldiers abruptly enter Palestinian homes, usually in the middle of the night. These raids are sometimes accompanied by the arrest of the inhabitants.PHRI’s team of volunteer doctors,

The Right to Health of Palestinians in the Occupied Palestinian Territory

1,900doctors in Gaza trained in the

latest medical techniques

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social workers, and psychologists assessed the impact of the practice through an in-depth survey of over 70 individuals, including children. The survey results show far-reaching mental health consequences resulting from forcible home entries, characterized by traumatic stress, such as panic attacks, hyper-arousal, and ongoing insomnia. The results will be published next year in a joint report, together with Israeli human rights organizations Yesh Din and Breaking the Silence. Meanwhile, PHRI worked to build the community’s resilience and held 6 conferences for medical personnel and educators to provide tools for dealing with the trauma that results from forcible home entries.

The Right to Health of Palestinians in the Occupied Palestinian Territory

175complicated surgeries

in Gaza hospitals to treat patients and train local staff

Photo: PHRI

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"My name is Muhammad Al-Akhras, I am a general surgeon. I had the chance to carry out surgeries on four occasions with PHRI volunteers, performing colorectal and biliary surgeries using a minimally invasive technique which no one else is teaching in Gaza. These were wonderful opportunities, but I am not able yet to use this technique as I would need several months of continuous learning. Ideally, I would like to come to Israel for a fellowship. Meanwhile, I continue to consult with these surgeons on the phone when I need to, and look forward to their next visit."

Dr. Muhammad Al-AkhrasGeneral Surgeon Dar Al-Shifa Hospital, Gaza City

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The Right to Health of Prisoners & Detainees in Israeli Prisons

To address the root cause of most right to health violations in prisons, PHRI launched a landmark report which focused on the need to transition responsibility for the medical system in prisons from the Israel Prison Service (IPS) to a national medical authority. The report — based on two decades of work and dozens of individual cases — advocates for deep structural changes in the prison health system. The report was launched at a conference at Tel Aviv University, with a panel discussion headlined by a former Supreme Court Justice and the Immediate Past-President of the World Medical Association. Nearly 100 academics, physicians, and practitioners were in attendance. Simultaneously, PHRI raised public awareness of the challenges prisoners currently face under the prison healthcare system through a successful social media campaign, which saw over 200 shares and reached 50,000 Israelis. The report’s conclusions were also consistently featured in mainstream media, with

159prisoners received

individual assistance Photo: ActiveStills

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lengthy items published in Yediot Ahronoth, one of Israel’s most popular newspapers and top radio stations, such as Army Radio, reaching hundreds of thousands of readers and listeners.

Building on public momentum, PHRI held targeted meetings with high - level stakeholders, including the Association of Public Health and Public Defender’s Office. The Israel Medical Association declared its support for the report’s findings and PHRI was subsequently invited to present the report in academic institutions around Israel. Following the overwhelmingly positive response to the report, PHRI decided to hold an annual conference on health in prisons, together with the Bar Ilan University Criminology Faculty and the Association of Public Health.

PHRI continued with its campaign to provide medical treatment to prisoners with Hepatitis C, and, through a petition in the Supreme Court, made historic progress; the Israel Prison Service — after years of neglect — committed to carrying out Hepatitis C screening tests for incoming prisoners who belong to vulnerable groups. Much work remains, including expanding screening tests to all incoming prisoners as well as raising awareness of the disease among prisoners, but this crucial step forward will greatly assist in mitigating the disease’s impact.

The Right to Health of Prisoners & Detainees in Israeli Prisons

250letters to the authorities,

including the Prison Service and Ministry of Health, challenging violations of prisoners’ health

Photo: ActiveStills

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PHRI’s efforts to change global standards on physicians’ involvement in torture bore concrete fruit, with the World Medical Association publishing a groundbreaking statement on solitary confinement. The new position, which places strict limits on the practice and forbids physicians’ involvement in it, closely reflects PHRI’s appeals to key international high-level figures. Locally, PHRI challenged the medical community’s adherence to medical ethics in the high-profile case of Samer Arbid, a Palestinian prisoner who underwent torture. Through concerted outreach to the Israel Medical Association, international medical organizations, and a legal petition, PHRI raised awareness of the presence of potential dual loyalty considerations and the need to uphold medical ethics in similar cases. Following this campaign, PHRI was ultimately successful in overturning the initial refusal of Arbid’s hospital to share his medical records with his wife and legal team.

The Right to Health of Prisoners & Detainees in Israeli Prisons

35media items published

in mainstream Hebrew & Arabic publications

50,000Israelis exposed to the need to remove prison healthcare

from the Israel Prison Service

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The Right to Health of Asylum Seekers & Other Status-less People in Israel

After over a decade of consistent governmental neglect, coupled with ongoing poverty, asylum seekers and other uninsured communities are suffering from increasingly complex and chronic medical conditions. Unfortunately, certain segments of the medical establishment have begun to demonstrate a lack of support for these communities’ right to health. Moreover, at the beginning of 2019, the Ministry of Health threatened to temporarily close the Gesher Mental Health Clinic, the only mental health facility available to the community, ahead of opening a new service and without offering any alternatives during the closure period.

To rise to the challenge, PHRI used a multifaceted strategy, incorporating innovative holistic health approaches in the Open Clinic’s work while appealing to an increasing variety of key stakeholders. Through a new triage protocol, which allows for better identification of the most vulnerable patients, PHRI was

4,810 patient visits to PHRI’s

Open Clinic Photo: PHRI

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able to identify two groups requiring additional assistance: Eritrean women with chronic pain and Sudanese patients suffering from somatization. To respond to their respective needs, PHRI established an exercise group to alleviate pain and a support group geared towards psychoeducation and tools to address somatic pain. The triage protocol also provided PHRI with more accurate information on the patients’ various needs and social determinants of health. As a result of increased data-gathering efforts, PHRI communicated with private insurance companies, hospitals, and health funds. Leniencies for individual patients vis-a-vis the Deposit Law — which requires asylum seekers to deposit 20% of their salaries in a specially marked fund — were also secured, preventing their further impoverishment.

To tackle growing apathy from the medical establishment, PHRI placed additional emphasis on increasing ground-level cooperation with surgeons and a variety of hospital administrations. Through these collaborations, we raised further awareness of the needs of the community and received specific discounts for costly operations needed by our patients in a wide variety of institutions.

The Right to Health of Asylum Seekers & Other Status-less People in Israel

3,690 referrals to specialists

for further care

Photo: PHRI

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As a result of the ongoing election rounds and local paralysis, PHRI decided to focus its advocacy on health solutions for this community, specifically through a national health insurance plan, in the international realm. PHRI succeeded in securing historic recommendations from the UN Committee on Economic, Social and Cultural Rights, which demanded that Israel establish a new policy for the community that expanded access to basic rights, including the right to health. Specifically, the Committee directly echoed PHRI’s stance and urged Israel to extend national health insurance to asylum seekers and migrant workers while expanding mental health services. Combined with ongoing appeals to the Ministry of Health, State Comptroller, and other key stakeholders, this pressure ensured that - despite the Ministry’s warnings - the Gesher Mental Health Clinic continued to function until a new service opened in September 2019.

Despite a growing awareness of the need for national health insurance plans, the Ministry of Health, as it did in 2018, continued to exclude undocumented migrant children, including children of work migrants whose visas had expired and children of tourists whose tourist visas had ended from government subsidized insurance plans, leaving them with medical care only in cases of emergency. PHRI reached out to

The Right to Health of Asylum Seekers & Other Status-less People in Israel

3,618volunteer hours

at the Open Clinic

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the Israel Medical Association and mobilized them to join our legal petition at the Supreme Court, a step of enormous symbolic significance. Simultaneously, we appealed to the Israeli medical community through publishing in a prestigious pediatrics medical journal. In a successful first step in our campaign, in its response to PHRI’s petition the Ministry of Health was persuaded to overturn its earlier position of denial of government-subsidized insurance to children of undocumented migrant workers, though children of tourists without a visa remain excluded.

The Right to Health of Asylum Seekers & Other Status-less People in Israel

150individual cases submitted

to the Ministry of Health and private insurance companies

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A Human Rights Lens on Medical Ethics

Our Ethics Committee guided national medical authorities and medical teams by providing a human rights lens for questions of medical ethics, addressing issues such as dual loyalty of health professionals and how political, security or economic considerations have affected institutional decision-making.

In 2019, after two years of extensive work, the Ethics Committee was able to secure Maccabi’s Health Management Organization’s official dismissal of Professor Gideon Koren, ensuring accountability of health professionals at the highest rungs. Koren, a high-profile Canadian-Israeli doctor, was appointed as a member of Maccabi’s Helsinki Committee, which is in charge of authorizing clinical trials and teaching Good Clinical Practice. Koren, however, had an extensive background of medical misconduct, including publishing the findings of a study sponsored by a pharmaceutical company

Photo: ActiveStills

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that deliberately ignored the dangerous impact of the drug reviewed on certain patients. Professor Koren also ran drug tests that were unreliable and resulted in the removal of children from their homes by Canadian child protection services. With this dismissal, PHRI sent a powerful message to all medical institutions about the necessity to uphold ethical standards, especially by those in high profile positions. Initially, Maccabi insisted that despite this history, Koren could continue in his post as arbiter of medical ethics in clinical trials, but PHRI’s insistence and appeals to the Ministry of Health finally resulted in Koren’s dismissal.

Furthermore, the Ethics Committee challenged the Ministry of Health’s refusal to call out the neglect of Ya’qub Abu al-Qi’an by medical teams in Umm al Khiran. Al-Qi’an, who was shot by police officers during the planned evacuation of Umm al Khiran, was left to bleed for dozens of minutes, while police physicians, present at the scene, did not provide him with any medical assistance.

Finally, in light of the US opioid epidemic and growing opioid use in Israel, PHRI petitioned the Tel Aviv University Medical School to remove the Sackler name from its faculty, following the family’s involvement in the global epidemic. Although the Sackler name remains for now, critically, public awareness has grown, resulting in increased pressure on Tel Aviv University.

A Human Rights Lens on Medical Ethics

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T. is a 4-year-old who was born in Israel to a Filipino caregiver whose visa expired. She was rushed to the ER and was diagnosed with type I diabetes. Initially, the Ministry of Health declined her request to enroll in government subsidized insurance, which had been available for undocumented migrant children for nearly 20 years. As her mother could not afford private insurance, T. remained hospitalized, her doctors fearing that outside of the hospital she wouldn’t be able to get insulin and other necessary medications. Volunteer physicians referred her case to PHRI, who directly appealed to the Ministry of Health. T. was finally granted access to the insurance and now regularly receives the necessary medication. Following PHRI’s petition on behalf of children such as T. in the Supreme Court, all children of undocumented migrant workers now have access to government subsidized insurance.

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The Right to Health of Israeli Citizens and Residents

Israel continued to see low investment in health, resulting in continued health disparities and ongoing gaps in the provision of health services between the central and peripheral areas. Responding to the ongoing budget erosion during an election year, PHRI published an economic analysis of the needs of the Israeli healthcare system, entitled “The Missing Budget”. PHRI coupled this analysis with a public opinion poll of over 600 respondents that highlighted that the majority of the public opposed health budget cuts, preferring instead to reduce the security budget. Indeed, media coverage of PHRI’s analysis contributed to the focus on the healthcare system throughout Israel’s repeated elections.

The need to decrease health disparities and increase investment in health received international attention in the UN’s Committee for Economic, Social and Cultural Rights. Following PHRI’s appeals, the Committee called on Israel to “address the disproportionately poor health status of the Arab and the Bedouin community.” Critically, the Committee recommended that Israel increases allocations to

85social media posts and

newsletters on the right to health of Israeli residents

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the public healthcare sector, a direct reflection of PHRI’s stance. With this international stamp of approval, PHRI took part in a Supreme Court petition to protest governmental delay in establishing a second hospital in the Negev.

To generate greater public awareness of health disparities, PHRI distributed a survey to 600 Jewish and Palestinian citizens of Israel, which indicated that that medical services received by the Palestinian-Arab populations were significantly lower than those provided to the Jewish population. The survey received significant media attention, both in Hebrew and Arabic language press.

To further highlight the health needs of marginalized communities, PHRI worked with the transgender community to ensure access to critical treatments, specifically facial feminization operations. These surgeries are crucial to treat gender dysphoria yet in many instances, requests for financial coverage are denied by the Health Maintenance Organizations (HMO).

After building an extensive network of connections with transgender activists and communities, PHRI filed a historic petition against the Maccabi HMO. Following a hearing at the Tel Aviv District Court, the Ministry of Health, in a significant step forward, declared that the HMO must fully cover the expenses of facial feminization operations alongside other procedures needed

The Right to Health of Israeli Citizens and Residents

30 media items published in Hebrew and Arabic

Photo: ActiveStills

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More than

1,100students of medical professions learned about the nexus between

health, medical ethics and human rights

by the community, including top surgery, as well as any other surgeries that may be required in the future by transitioning patients.

During 2019, PHRI placed increased emphasis on building relationships with the Israeli public through highlighting its unique role in examining the nexus between social justice, the role of physicians, and human rights. This year, PHRI held its first crowdfunding campaign, raising more than 1 million NIS in 48 hours — unprecedented for a human rights organizations — with donations arriving primarily from Jewish and Palestinian Israelis. PHRI also published over 80 social media posts and newsletters on the obstacles to the right to health of Israelis citizens. Meanwhile, PHRI gave lectures on human rights and the right to health to over 1,100 medical students and health professionals and conducted 16 more lectures to the general public, meeting more than 300 people.

The Right to Health of Israeli Citizens and Residents

Photo: ActiveStills

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2019 FinancialsOperating Budget NIS 11,629,181/USD 3,266,623 including NIS 1,596,000 donated in volunteer hours

COST BY PROGRAM

PALESTINIANS IN THE OCCUPIED PALESTINIAN TERRITORY

PRISONERS & DETAINEES

THE OPEN CLINIC & STATUS-LESS POPULATION

PUBLIC OUTREACH & EDUCATION

OPERATING COSTS

24%

16% 9%

43% 8%

PRIVATE DONORS NIS 2,757,676

FUNDING BY INVESTOR TYPE (NIS)

36.27%

23.71%6.84%

5.43%

27.75%

FOREIGN GOVERNMENTS NIS 3,226,715

EUROPEAN UNION NIS 795,502

UN AGENCIES NIS 631,892

FOUNDATIONS NIS 4,217,396

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Partners

In addition to the hundreds of individual donors in Israel and abroad, PHRI thanks these organisations and foundations for their generous support.

Writing: Dana Moss | Production and Coordination: Fang Gleizes Design: David Moscovitz / David and Yosef Strategy and Branding

British Shalom Salaam Trust

The New Israel Fund

Medico International E.V

Medico International Switzerland

The Tel Aviv Municipality

Medici Per I Diritti (Medu)

The Samuel Sebba Charitable Trust

Secours Catholique (Caritas France)

Diakonia

UNHCR | The UN Refugee Agency

The Sigrid Rausing Trust

HILTI FoundationBread for the World The European Union

Swiss Agency for Development

and Cooperation

The British Embassy

Manos Unidas

Porticus

Firedoll Foundation

The Church of Scotland

TikvaGrassroots Empowerment

Fund

oPtHF occupied Palestinian territory

Humanitarian Fund

IBI Investment HouseSivmo

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9 Dror St. Tel Aviv-Jaffa 6813509 Israel

T 972.3.5133121 | F 972.72.3377681

We are funded entirely by donations. To donate online, visit https://www.phr.org.il/enDonations by bank transfers in NIS, USD and EURO can be made to Physicians for Human Rights Israel, Account 398005, branch 567 (Beit Asia) at Bank Hapoalim, 4 Weizman street, Tel Aviv, Israel 64239 Swift code POALILIT, IBAN: IL 32-0125-6700-0000-0398-005 Email [email protected] to get your receiptAll donations to PHRI are tax deductible according to art. 501(c)(3) Physicians for Human Rights Israel (PHRI) is a Non-Profit Organisation approved under Section 46 of the Israeli Income Tax Ordinance, Registration Number 580142214

Physicians for Human Rights Israel (PHRI) was founded in 1988 to promote a just society where the right to health is granted equally to all people under Israel’s responsibility, through humanitarian aid and policy change.

Our volunteer medical professionals provide services free of charge to people with limited or no access to health care. At the same time, PHRI works to change discriminatory and abusive policies towards Palestinians in the occupied territory, prisoners and detainees, status-less persons including asylum seekers and refugees, and Israeli citizens and residents.

WWW.PHR.ORG.IL

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