The Blackwell Companion to Medical Sociology

412 Ofra Anson
immigrants. Immigration doubled the Israeli population during the first four
years after independence (1948±53); immigration from former communist countries
increased the population by 15 percent duringthe period 1989±95. Second
is the open door policy, aimed at encouraging all Jews of the diaspora to
immigrate to Israel (Anson et al. 1996; Bernstein 1997). This policy is grounded
in the ideology that only Israel is the right and safe place for all Jewry, and that
Israeli society is obliged to adapt itself to the immigrants' needs and to ease their
absorption. Accordingly, major social resources are invested in both outreach
efforts in the diaspora and in absorption programs.
Beyond the health risks associated with migration as a stressful life event for
the individual migrant, an open door policy also entails public health risks.
Israeli society must therefore handle a necessary tension between the values of
free immigration on one hand, and the value of protecting and promoting its
members' health, particularly at periods of mass immigration, on the other. The
open door policy thus affects patterns of health, the burden on the health
services, and on the quality of health care provided.
Migrants import patterns of illness, which reflect the health patterns and the
available health services of their country of origin, presenting the health services
with different challenges. The mass immigration during 1948±54 included refugees
from post-World War II Europe, North Africa, and Asia. Many of these
immigrants were in poor health, the result of malnutrition and high prevalence
of infectious diseases, psychiatric conditions, chronic illnesses, and disability
(Shuval 1992). Some of these conditions, such as trachoma, body lice, and
trichophytosis seriously threatened public health. The physical and sanitary
conditions in the temporary camps and settlements presented further health
risks (Hacohen 1994). Frequent epidemics of dysentery and a polio epidemic
increased infant mortality from 29 per 1,000 live births in 1947 to 52 per 1,000
in 1949.
In recent years, two distinct immigration waves, one from Ethiopia, and the
other from the former communist countries, posed new challenges. The Ethiopian
immigrants arrived in Israel after a long period of social disorganization,
the result of a transition from their home villages to Sudan or Addis-Ababa,
where they stayed for up to two years in temporary camps. Those who survived
the hardships of the exodus were, of course, younger and healthier. However,
intestinal parasites were highly prevalent in this group, up to 80 percent accordingto
some reports, and, compared to the Israeli population, so were infectious
diseases, in particular tuberculosis and AIDS. Immigrants from Ethiopia comprised
36 percent of the new TB cases in 1993 and 40 percent of the known HIV
positive cases in 1995, though they comprise only 1.3 percent of the Jewish
population (Health Israel 1998). These figures should be cautiously interpreted,
however, as only Ethiopian immigrants are routinely screened for theses conditions.
The patterns of disease brought in by immigrants from the former communist
countries are completely different, reflectingthe difference in age structure,
sanitary conditions, and the health services in these countries. The age structure
of these immigrants was older than that of the Israeli population as a whole,
mainly as a result of lower fertility: 19 percent were children aged 0±15 and 15