Israel And cOVID-19 - History

Israel And cOVID-19 - History

On Sunday, a new Israeli government was sworn in. After more than 500 days of successive interim governments, there is now a duly elected one. However, celebration was limited — and not because of the 100+ degree heat wave currently gripping the country. Among Tel Aviv denizens, few feel their will had been served in the creation of this new government.

Tel Aviv residents voted overwhelmingly for the Blue and White Party. Almost all those voters cast ballots for Blue and White because they believed the time had come to replace Prime Minister Benjamin Netanyahu. Yet, although 52% of the country voted for parties who pledged to replace him, Netanyahu was sworn in as Prime Minister, once again. Yes, it was slightly different this time. Benny Gantz was sworn in as the alternate Prime Minister alongside him. Moreover, Netanyahu even mentioned the date when Gantz is scheduled to replace him as Prime Minister. However, few believe that transition will ever happen.

I could fill this page attempting to explain the strange two-headed government that has been forged, with cabinet ministers who report to one or the other of the two leaders. I could write about a coalition that is the largest in Israel’s history, with 36 cabinet ministers, and new ministries that serve no real purpose, and will no doubt cause more harm than good. I could talk about the complete disconnect between the creation of new ministries, staffed with administrators, advisors and drivers, that will no doubt cost hundreds of millions of dollars, at a time when Israel faces its most difficult economic challenges in decades (experiencing an unemployment rate of over 20%).

However, instead I want to discuss the confusion and near sense of hopelessness felt by the more than a million voters who chose Blue and White and the Labor Party, both of whom have entered Netanyahu’s fifth government, after the leaders of both parties repeatedly stated the one thing they would not do is sit in a government led by a Prime Minister who was under indictment.

I excuse my fellow Tel Avivians for feeling a bit like a schizophrenic at a time like this, for I share their sense of anxiety and disequilibrium. On one hand, for the realists among us, who recognize that due to the betrayal by several new coalition members — two from Blue and White and one from Gesher-Labor, there was no path to form an alternate coalition without Netanyahu. As a result, the only other alternative would have been a fourth election, along with another transitional government. Netanyahu would have remained at the helm, acting as if he had the full powers of a duly elected government behind him.

On the other hand, despite the feeling of having been double-crossed, Gantz’s decision to become part of Netanyahu’s coalition did deliver some benefit to Blue and White voters. For many, it constitutes a clear improvement to have Avi Nissenkorn, former head of the Histadrut, as Minister of Justice, as opposed to leaving that essential ministry in the hands of Amir Ohana, whose goal has been to systematically undermine the Justice system in the time leading up to the Netanyahu trial, which starts next week.

For Blue and White voters, it is certainly better to have Benny Gantz serve as Defense Minister, in place of Naftali Bennett, who is ideologically committed to Israeli sovereignty over the entire West Bank.

And the list goes on. In the eyes of Blue and White voters, it is clearly better to have a government barred from implementing any significant action without Gantz’s agreement.

While these achievements are all good in the view of Blue and White and Labor voters, the question remains — were the colossal concessions worth it?

Was avoiding a fourth election worth seeing those who voted for Blue and White and Labor abandon their most fundamental promises? Was it right for Gantz and his compatriots to decide that their voters' votes deem it retroactively acceptable for a Prime Minister to run for office and form a government again, despite having been charged with a series of crimes he committed while he served as Prime Minister — including bribery?

Was discarding several of the moral values certain leaders continually claimed to hold dear worth it to stop some of the worst attacks on the judiciary in the history of the country? Can anything excuse having been forced to agree to the unilateral annexation of parts of the West Bank — a position Blue and White and Labor oppose?

In his speech on Sunday, Defense Minister Benny Gantz asserted he had entered the government to unite the nation and heal the divisions. But whom does Gantz think he is uniting? While at this point, many of his voters support his entry into the government — because there seems little choice — Gantz is undoubtedly no longer their leader; almost all Blue and White voters feel profoundly betrayed. Gantz’s entry into the government united no one, it merely avoided another election, and another interim Netanyahu Prime Ministership. Perhaps that is good enough for some, but for many, it’s another bitter disappointment.

Tokyo Olympics to allow up to 10K domestic fans at each event

Israel’s rapid rollout of the Pfizer vaccine has become the gold standard in inoculation strategies — with more than half of eligible people in the Jewish state now fully or partially vaccinated, according to a report.

Older and at-risk groups, the first to be vaccinated, are seeing a dramatic drop in infections, according to Reuters.

The country reported a 53 percent drop in new cases and a 39 percent decline in hospitalizations among these groups from mid-January until Feb. 6, Eran Segal of the Weizmann Institute of Science in Rehovot told the news outlet.

There was also a 31 percent reduction in severe cases, Segal added.

In the same period, new cases among people under age 60 — who became eligible for jabs later — dropped 20 percent, according to Reuters.

However, hospitalizations and severe cases rose 15 percent and 29 percent, respectively.

For its report, Reuters said it interviewed leading scientists in Israel and abroad, Israeli health officials, hospital chiefs and two of the country’s largest health care providers.

People wait to receive the COVID-19 vaccine at a medical center in Tel Aviv, Israel. Gideon Markowicz via Xinhua/Sipa USA

The country’s vaccination program has provided a database offering insights into how effective the shots are outside of clinical trials, and at what point countries might achieve herd immunity.

Teams are analyzing vaccine effectiveness in younger groups of Israelis, as well as people with diabetes, cancer and pregnant women — representing a patient base at least 10 times larger than those in clinical studies.

“We need to have enough variety of people in that subgroup and enough follow-up time so you can make the right conclusions, and we are getting to that point,” Ran Balicer, chief innovation officer of HMO Clalit, told Reuters.

Israel is providing Pfizer with a unique opportunity to study the real-world impact of the jab developed with Germany’s BioNTech, though the company said it remained “difficult to forecast the precise time when herd protection may start to manifest.”

That is because there are multiple variables at play, including social distancing measures and the number of new infections generated from each case, known as the reproduction rate.

Despite its success with the vaccination program, Israel has lowered expectations of emerging quickly from the pandemic due to mounting cases, which a third national lockdown has struggled to contain amid the rapidly spreading UK variant of the bug.

On a positive note, however, the Pfizer/BioNTech shot appears to be effective against the more contagious strain, which makes up about 80 percent of new cases.

“We’ve so far identified the same 90 percent to 95 percent efficacy against the British strain,” Israeli Health Ministry chief Hezi Levi told Reuters.

People shopping at the market of Jerusalem’s Old City, Jerusalem. EPA/ATEF SAFADI

“It is still early, though, because we have only now finished the first week after the second dose,” he said, adding: “It’s too early to say anything about the South African variant.”

Israel began its vaccination program on Dec. 19 after paying a premium for supplies of the Pfizer/BioNTech shots quickly.

The country began vaccinating people over 60 and gradually opened the program to the rest of the population as it digitally tracked each step of the process — down to in which arm the patient was jabbed and what vial it came from.

Approximately 3.5 million Israelis have been inoculated.

A man receives a COVID-19 vaccine from a nurse in the Ultra Orthodox city of Bnei Brak, Israel. EPA/ABIR SULTAN

One week after receiving the second dose, 254 out of 416,900 people were infected, according to leasing health care provider Maccabi.

Comparing this against an unvaccinated group revealed an efficacy of 91 percent, according to Maccabi, and 22 days after full vaccination, no infections were recorded.

Did Israel recently reach ‘herd immunity’ already?

A Palestinian laborer who works in Israeli settlements receive a second dose of the Moderna COVID-19 vaccine in the Barkan industrial area near of the West Bank town of Nablus, Sunday, April 11, 2021. Majdi Mohammed, Associated Press

Israel may have hit some level of herd immunity already, a big win in the ongoing fight against the novel coronavirus, according to The Times of Israel.

Eran Segal, a computational biologist at the Weizmann Institute of Science, recently told The Times of Israel that the country reached “a sort of herd immunity” with 4.9 million people fully vaccinated and a 97% drop in case numbers.

  • “It is possible that Israel has reached a sort of herd immunity and regardless, we have a wide safety net,” Segal said. “I think that makes it possible to remove some of the restrictions immediately.”
  • Segal said recent religious holiday events such as Purim and Passover did not lead to a spike in cases.
  • “If confirmed, Israel could be the first country in the world to hit the milestone of herd immunity,” according to The Times of Israel.

The U.S. may not reach herd immunity until Thanksgiving

Why herd immunity is important

Experts believe herd immunity — where enough people have been protected against the novel coronavirus, either through antibodies or the COVID-19 vaccine — will be met when 70% of people are protected, as I wrote for the Deseret News.

So, really, herd immunity will likely lead to the return to normal.

How close is the United States?

Axios reports that the United States will hit a “vaccine wall” soon. This could happen because the supply of the COVID-19 vaccine meets the demand for it. Experts will soon turn their focus “to convincing holdouts to get vaccinated” since the majority of those who want the vaccine will have gotten it.

Latest Updates

The results are all the more striking, experts said, because Israel is contending with a worrisome new variant of the coronavirus. The variant B.1.1.7 now accounts for up to 80 percent of the samples tested in Israel.

First identified in Britain in December, the variant has spread to 72 other countries and may be up to 50 percent more transmissible than other variants.

Israel leads the world in vaccinating its citizens. So far, more than a third of its population of more than nine million people has received a first dose of the Pfizer-BioNTech vaccine and nearly two million people have received a second dose.

The first target was citizens over age 60, an age group that accounted for 95 percent of the more than 5,000 Covid-19 deaths in Israel. According to the Health Ministry, 84 percent of that age group has been vaccinated.

As a relatively small country with a highly digitized, universal health system, Israel became an attractive testing ground for Pfizer. As a result, Israel made a deal with the company, offering data in exchange for a steady supply of vaccines.

Despite its successes, Israel remains vulnerable. After a dip in new cases at the end of January, the average rate is climbing back up again. The contagiousness of the B.1.1.7 variant may be partly to blame, along with lower compliance with the current lockdown compared to previous ones. And all but a handful of Palestinians in the occupied territories are still waiting for vaccines, leaving them and Israelis less protected in any new surges.

There is also no telling what would happen if a more worrisome variant began spreading in Israel. A variant first identified in South Africa is not only more contagious, but might also render vaccines less effective.

At the same time, Israel’s much-vaunted vaccine program appears to have hit a snag as the numbers of those vaccinated dropped dramatically last week, suggesting that the country’s initial enthusiasm may be waning. The slowdown left some vaccination centers deserted this week.

The vaccination program has encountered resistance among some groups, particularly ultra-Orthodox Jews and Arab citizens, two communities that have been hit hard by the virus.

The government and health networks are launching new efforts to bring in more people to get vaccinated. Israel’s health networks made vaccines available to anyone 16 or older this week. Experts advising the government recommended allowing only those teachers who have been vaccinated back into the classroom.

As an additional incentive once lockdown restrictions are eased, they are recommending limiting attendance at cultural or religious gatherings to people who have been fully vaccinated, have recovered from Covid-19 or can show a recent, negative test.

Galia Rahav, the head of the Infectious Disease Unit and Laboratories at the Sheba Medical Center in Tel Aviv, said the main takeaway from the new research was that it was “very critical” to vaccinate the nearly half a million Israelis over 50 who have not been inoculated “as quickly as possible.”

Experts have also pointed to gaps in the Weizman Institute study that remain to be filled.

Hagai Levine, an epidemiologist at Hebrew University-Hadassah in Jerusalem, cautioned that the researchers observed only broad trends in the country rather than tracking individual people who had been vaccinated.

As a result, the study raises a number of questions it can’t answer. It’s not clear, for example, why the researchers only saw a decline in cases, severe illness, and hospitalization three weeks after the start of the campaign. In the clinical trial on the Pfizer-BioNTech vaccine, researchers observed the first signs of protection roughly 10 days after the first dose.

It’s possible that the impact was slower in Israel because the vaccination campaign was directed primarily at older people, whose immune systems may have taken longer to mount a defense.

“The message to the world is even if you are vaccinating at a crazy rate like Israel, even so, you will have to have patience,” Hagai Rossman, a co-author of the Weizmann study, said. “There is no magic wand.”

Other countries may not experience quite the benefit that Israel has recorded from its vaccine. Keeping the vaccine cold — it has to be stored at temperatures below -76 degrees Fahrenheit to remain effective — during transportation could be difficult in some places.

Still, Dr. Hanage said that other countries should be heartened by Israel’s results and see them as an incentive to vaccinate as many people as possible as quickly as possible.

“I actually think that the recent results should be quite comforting,” he said. “Overall, I think it’s good news.”

Isabel Kershner reported from Jerusalem, and Carl Zimmer from New Haven, Connecticut.

COVID-19 Information

*** Effective January 26, all airline passengers to the United States ages two years and older must provide a negative COVID-19 viral test taken within three calendar days of travel. Alternatively, travelers to the U.S. may provide documentation from a licensed health care provider of having recovered from COVID-19 in the 90 days preceding travel. Check the CDC website for additional information and Frequently Asked Questions.

Country-Specific Information

Israel has confirmed cases of COVID-19 within its borders. Please see the Israeli Ministry of Health (MOH) guidance and/or the U.S. Centers for Disease Control and Prevention’s (CDC) instructional videos and guidelines regarding personal movement, gatherings, transportation, and businesses (see MOH guidance).

The U.S. Centers for Disease Control and Prevention (CDC) issued a COVID-19 Travel Health Notice Level 2 – Travelers at increased risk for severe illness from COVID-19 should avoid nonessential travel to Israel. For further information on COVID-19 and returning to the United States, please visit the CDC website for guidance on travel:

U.S. citizens who wish to travel to the United States should arrange for immediate departure to the United States, unless they are prepared to remain in Israel, the West Bank, or Gaza for an indefinite period. The U.S. government has no plans to arrange repatriation flights in Israel at this time.

COVID-19 Testing

  • Are PCR and/or antigen tests available for U.S. citizens in Israel? [Yes]
  • If so, are test results reliably available within 72 hours? [Yes]
  • For information on limited humanitarian exemptions to CDC’s requirement that all U.S. bound travelers present a negative COVID test, please review the following page:
    • Humanitarian exemptions to this order will be granted on an extremely limited basis and will only be considered when the country of departure lacks adequate COVID-19 testing capacity. To submit information in support of an exemption, email one of the following: for U.S. citizens, [email protected] or [email protected] for non-citizens [email protected] or [email protected]
    • If the location you are traveling to requires getting tested before leaving Israel, you can schedule a testing appointment at your own expense with one of the medical centers in Israel offering coronavirus tests.
    • The Israeli Ministry of Health (MOH) maintains a list of medical centers for viral COVID-19 testing: Many local hospitals, clinics, and laboratories offer testing for travel purposes. Travelers are responsible for the costs of their own tests and any associated medical care. Testing in a state hospital costs NIS 297 max per test. The cost can change from time to time. Please ensure that the test provider you choose will provide test results that comply with CDC guidelines and those of your airline.
    • Please contact an Israeli healthcare provider and/or the Israeli Ministry of Health for further testing information.

    COVID-19 Vaccine Information

    • Has the government of Israel approved a COVID-19 vaccine for use? [Yes]
    • Are vaccines available in Israel for U.S. citizens to receive? [Yes]
    • Which vaccines are available in Israel?
      • The BNT162b2 vaccine manufactured by Pfizer, Inc. and BioNTech

      Entry and Exit Requirements

      • Are U.S. citizens permitted to enter? [Yes]
      • U.S. citizens who are not Israeli citizens/residents must apply in advance to the Israeli government for a permit to enter or transit Israel.
      • The Population and Immigration Authority is responsible for processing permits for foreign nationals to enter or transit Israel who are not Israeli citizens/residents. Applications must be submitted to the Office of the Population Authority or to the Israeli representative at the foreigner’s place of residence:
      • Is a negative COVID-19 test (PCR and/or serology) required for entry? [Yes]
        • Please see the Israeli Ministry of Health COVID-19 Air Transportation website:
        • Are health screening procedures in place at airports and other ports of entry? [Yes]
        • Israeli visas can only be extended by the Israeli government. For questions regarding Israeli visas, please contact your local Israeli embassy or consulate. You may also contact the Israeli Population and Immigration Authority (PIBA).

        Movement Restrictions

        • Is a curfew in place? [NO]
        • Ministry of Health up-to-date guidance during the current COVID-19 surge, including restrictions on the economy, education, gatherings, and travel, rules and information about restricted areas can be found here.
          • The Government of Israel may institute local or nation-wide lockdowns on short notice to contain the spread of COVID-19. This may include closing most businesses curtailing residents’ movements, which may impede movement inside and between cities and a general curfew. The latest information can be found on the Israeli Ministry of Health website.

          Quarantine Information

          • Are U.S. citizens required to quarantine? [Yes]
            • Please refer to the Israeli Ministry of Health’s instructions for quarantine and health precaution instructions, or call *5400 (in Israel only).
            • If you are not vaccinated or recovered, you will have to go into isolation and comply with isolation requirements and guidance. .

            Transportation Options

              • Are commercial flights operating? [Yes]
                  • Flights to and from airports in Israel may be suspended or rerouted by the Israeli government at any time. Airlines may also cancel their flights with little or no warning, making availability limited and unpredictable. Flight arrivals and departures have been subject to frequent change, and we anticipate that continuing to be the case.
                  • Unfortunately, the embassy is not able to assist with arranging commercial travel options. U.S. citizens in Israel are encouraged to contact their airline directly for the most up to date information.
                    American Airlines: Local: 03-721-9497, U.S.: 1-800-433-7300
                    United Airlines: Local: 03-5116787, U.S.: 1-800-225-8610
                    El Al Airlines: Local: 03-977-1111
                    Delta Airlines: Local: 03-513-8000, U.S.: 1-800-221-1212
                  • Is public transportation operating? [Yes]
                    • Public transport may be suspended or cancelled at any time. See the National Public Transport Authority

                    Fines for Non-Compliance (if applicable)

                        • Non-compliance with safety measures could result in fines, business closure, or imprisonment.

                        West Bank
                        Country-Specific Information

                        The areas of the West Bank under Government of Israel control fall under the Israeli guidelines listed above. The areas of the West Bank under Palestinian Authority control fall under the Palestinian Authority guidelines listed below.

                        The Palestinian Authority has confirmed cases of COVID-19 within the West Bank.

                        The West Bank has been under a state of emergency since March 5, 2020. The Palestinian Authority may institute local or West Bank-wide lockdowns on short notice to contain the spread of COVID-19. This may include closing most businesses curtailing residents’ movements, which may impede movement inside and between cities a general curfew and closures of the crossings between the West Bank and Israel. The latest information can be found (in Arabic only) on the PA Ministry of Health website.

                        Mark Langfan

                        This year&rsquos Munich Security Conference may go down in history as the COVID-19 viral super-spreader &ldquoevent of the century," if not in all of recorded history. That&rsquos because the Munich 2020 event took place from February Friday 14-Sunday 16, and Iran&rsquos Foreign Minister Javad Zarif attended.

                        Unknown to apparently all the high security-minded attendees, FM Zarif was likely carrying much more than the dark secret that the COVID-19 virus had already begun rampaging through the highest echelons of the Iranian government and society. FM Zarif , or one of his minions, was likely carrying the actual COVID-19, and infected who knows how many of the world&rsquos highest and most influential politicians at the Munich event.

                        In fact, US Senator Chris Murphy, Democrat from Connecticut, not only met FM Zarif, but met him in Zarif&rsquos hotel suite where there was likely a rat&rsquos nest of COVID-19. Unless drastic steps are taken, Sen. Murphy may become the Typhoid Mary of COVID-19, and infect the entire US Senate and House of Representatives.

                        As of February 28, 2020 there were officially 210 actual deaths in Iran. Unofficially, there have been over 500 reliably reported Iranian deaths. But, what is very unusual about the Iranian deaths is that a large number of extremely high ranking government officials in Tehran, the capital, have actually caught the disease and have died. The officially &ldquoFirst reported&rdquo Iranian case was on February 19. Working backward from the 19th, that means COVID-19 was likely already circulating in Iran from middle-to-late January when FM Zarif, or one of his staff, could have caught the disease.

                        The key part is the number of deaths. To go form &ldquozero&rdquo to officially 210 deaths in four weeks likely means that there are a lot of undiagnosed carriers. Also, Iran is probably underreporting the death toll. Assuming the 500 COVID-19 deaths, and 1% death rate that means that there are about 50,000 Iranians who already have the disease, with a huge number in Tehran and the Iranian government itself.

                        Wikipedia states that the following high Iranian government officials have confirmed COVID-19: &ldquoAs of 27 February 2020, three senior Iranian officials had been diagnosed SARS-CoV-2 positive: deputy Health Minister Iraj Harirchi , Vice President for Women and Family Affairs Masoumeh Ebtekar, and Chairman of Parliament's National Security and Foreign Affairs Committee Mojtaba Zolnour. Iran's first ambassador to the Vatican, Hadi Khosroshahi, died from COVID-19 in Qom on 27 February.&rdquo

                        These are all high ranking people in the Iranian government. If this is a sample of the infection reach, there are surely many more government officials infected. Also, the &ldquoChairman of Parliament's National Security and Foreign Affairs Committee Mojtaba Zolnour&rdquo is very likely somebody FM Zarif had close contact with, or one of Zarif&rsquos staff had close contact with before the Munich Conference. In short, FM Zarif and his entourage were likely COVID-19 super-spreaders at the Munich Event.

                        The meeting was actually very extensive and detail and went on for a significant amount of time because Sen. Murphy wrote that he discussed numerous complex and serious issues with FM Zarif. They talked Yemen, hostages held by Iran, and what Sen. Murphy describes as the &ldquoassassination&rdquo of of Iran&rsquos arch-terrorist Soleimani. Such deep and weighty issues must have taken at least an hour. That means Sen. Murphy and his staff were in FM Zarif&rsquos personal quarters, where all Zarif&rsquos staff was circulating, for at least a full hour.

                        In other words, not only has Sen. Murphy probably caught the deadly COVID-19, he has also likely infected his entire &ldquoextended family.&rdquo If Sen. Murphy, or one of his staff, has contracted COVID-19, expect Washington DC to go into a total panic.

                        What is Coronavirus?

                        Coronaviruses are a family of hundreds of viruses that can cause fever, respiratory problems, and sometimes gastrointestinal symptoms too. The 2019 novel coronavirus is one of seven members of this family known to infect humans. In the past three decades, it has jumped from animals to humans.

                        The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes. At this time, there are no specific vaccines or treatments for COVID-19. However, many ongoing clinical trials are evaluating potential treatments.

                        Related Articles

                        Inside Israel's ultra-Orthodox coronavirus hot spots – where even the mayor is sick

                        Coronavirus: The five days at an evangelical superchurch that set a time bomb in Europe

                        Israeli army to provide aid to ultra-Orthodox city under coronavirus closure

                        Understanding contagion

                        Today we know that these group assemblies were likely counterproductive, more likely to help the spread of disease than to stop it. But there is no hint in early rabbinic writings of the understanding that disease has natural causes, or the awareness that illness could be contagious or that this contagion could be avoided. These understandings were beginning to proliferate throughout the Roman Empire at the time, but only seem to have made inroads into Jewish thought during the Talmudic age (3rd-5th centuries C.E.). But even in the Talmud the idea that one should take action to avoid disease is far from mainstream, only appearing rarely in the massive legal corpus and often contradicted elsewhere.

                        In one place (Bava Kama 60b) the rabbis advise that during a plague one should stay at home, adding that the fourth century Babylonian rabbi Rava kept his windows shut during an epidemic. The Talmud goes on to advise that when traveling during an epidemic one should stick to the sides of the road rather than walk down the middle as in other times. Assuming that the middle of the road was busier than its shoulders, this is not bad advice, even if the logic given for it was that is that the Angel of Death who usually travels on the side of the road (and thus these are to be avoided normally) walks down the middle of the road at the time of plague.

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                        At times the Talmud seems to argue against the concept that disease is contagious, calling on Jews to avoid the urge to distance themselves from disease and trust in God. In one such section (Nedarim 40a) we are told that the students of the second century sage Rabbi Akiva refused to visit one of their number who had fallen ill. We are told that Akiva went to visit the student himself, and that he recovered, prompting him to teach that visiting the sick helps them recover and thus those who refuse to visit the sick are as guilty as those who spill blood. In fact, the rabbis decreed that it is a Jewish obligation, a mitzvah, to visit the sick, based on the biblical precedent of God visiting Abraham while he was recovering from his circumcision.

                        In the entire collection that is the Talmud we only find one section in which the rabbis seem to advise that contagious disease be avoided, but even here the point of the story seems to be that this is folly. Ketubot 77b describes a mysterious affliction called ra&rsquoatan that causes watery eyes, a runny nose, drooling, and attracts flies. According to the Talmud the disease is caused by the afflicted being conceived right after his parents let blood. The Talmud advises the following treatment: 1. Make a potion of grasses, nut shell, hide shavings, mugworts and date flowers. 2. Apply it to the patient&rsquos head to soften his skull. 3. Cut the skull open and remove the insect lodged in his brain with myrtle leaves and tweezers. 4. Burn the insect (otherwise it will find its way back to the patient&rsquos brain).

                        The Talmud then elaborates on the measures the rabbis took to avoid catching it. Rabbi Yohanan avoided the flies that sat on those plagued by this disease Rabbi Zeira wouldn&rsquot sit downwind from one who had it Rabbi Elazar wouldn&rsquot enter the tent one suffering of it and Rabbi Ami and Rabbi Asi wouldn&rsquot even eat an egg laid on a street where one afflicted by the disease lived. These methods are probably intended to seem ridiculous and are contrasted with the actions of Rabbi Yehoshua ben Levi, who would go visit those suffering of this disease to study Torah with them. &ldquoTorah,&rdquo he is said to have said, &ldquobestows grace on those who learn it, does it not protect them from illness?&rdquo

                        Yet as time went by, the view that epidemics had natural causes and that disease was contagious took hold among prominent rabbis, augmenting the biblical and Talmudic view that these are the work of God. By the High Middle Ages, the time of the Rishonim, these views seem to be taken for granted by prominent rabbis.

                        For example, the 13th century Spanish rabbi Nachmanides, in his commentary on Genesis, explained that Lot&rsquos wife was turned into a pillar of salt to stop her blasphemous thoughts from spreading like &ldquothe plague and infectious diseases that are carried in the air.&rdquo His contemporary rabbi Bahya ben Asher also of Spain (1255-1340) explained that during the plague caused by Korah&rsquos rebellion, discussed above, Aaron separated Korah&rsquos company from the rest of the Israelites &ldquoso that the bad air of the plague wouldn&rsquot stick to them.&rdquo Clearly, Bahya subscribed to the Miasma Theory of Disease, which remained in vogue until the 19th century, according to which disease was caused by polluting vapors in the air.

                        But these realizations did not lead to new rational methods for limiting the spread of disease just yet. Instead the 13th century saw the appearance of new method to stop epidemics, one that rabbis heavily rely upon to this day: the reading of ancient legal texts that describe the particular method used by the priests of the Second Temple to burn incense.

                        As said, the Book of Numbers says that a plague was stopped by Aaron burning incense. Since the Temple is no more, Jews may not burn incense to God any longer. But as with other Temple-related acts of worship, Rabbinic Judaism sees the reading of texts about Temple rituals as equivalent practices.

                        At a synagogue in Mea She'arim, Jerusalem during normal times, March 13, 2017 Gil Cohen-Magen

                        In this case, the Zohar, which appeared in 13th century Spain, relates a legend about the 4th century Palestinian rabbi called Rabbi Aha, who arrived at a town ravaged by an epidemic. The townsfolk ask for his advice and he tells them to assemble their 40 most pious men in the synagogue. After they studied the Talmudic passages concerning the incense in groups of ten in each of the four corners of the synagogue, the epidemic stopped.

                        The ceremony that this passage of the Zohar inaugurated began to spread throughout the Jewish world and has been used by Jews ever since. Not that it seems to have done anyone any good. When the Black Death ravaged Europe in the mid-14th century, Jews died in great numbers, and though it is oft repeated that Jews died at lower rates than their Christian neighbors, there is little if any evidence of this. Possibly the idea that Jews were for some reason less susceptible to the disease was a rationalization to explain why Christians reacted to the Black Death by indiscriminately slaughtering Jews. Epidemics to this day often lead to the persecution of minorities.

                        Science arises

                        More scientific methods to contain the spread of disease began to be adopted in rabbinic thinking in the 16h century. Rabbi Samuel ben Moses de Medina, a 16th-century rabbi of Spanish origin writing in Thessaloniki, mentions in passing in a legal decision concerning an inheritance that the deceased suffered from &ldquoa kind of disease that those who suffer of it are not visited.&rdquo Thus it seems that in at least some communities the requirement to visit the sick was lifted in cases of infectious disease.

                        Not that this was universally accepted. Moses Isserles, a highly influential rabbi in 16th century Krakow, wrote in a legal decision concerning a man trying to get out of a contract to rent an apartment because he found out the man&rsquos wife suffered from an infectious disease: &ldquoWhat he said that it is an infectious disease is utter nonsense, and anyone who is moved by his heart says so, because it is the Lord who sickens and heals. If we found according to the opinion of the renter then all laws concerning the visiting of the sick would be nullified, as we did not find anywhere a distinction between infectious disease and noninfectious disease, except for the matter of one plagued by Ra&rsquoatan who was not to be visited.&rdquo Isserles further says that in any case the disease in question was everywhere in the city and no home was exempt anyway.

                        On the other hand, Isserles did rule that one should escape a city when an epidemic appears in it, saying: &ldquoOne mustn&rsquot rely on miracles or risk his life&rdquo (Yoreh De&rsquoah 116:5). And he did in fact flee Krakow in 1555 when an epidemic started there.

                        Things really began to change in the 19th century when cholera arrived in Europe. It was during the cholera outbreaks of the 1830s that the first experiments with social distancing took place, with many municipalities banning large gatherings. In 1831, Rabbi Akiva Eger of Pozna, Poland called on Jews to limit the number of congregants praying together in a synagogue to 15: &ldquoConcerning the matter of prayer in the synagogue, it is my opinion that it is true that assembling in a small place is incorrect, but it is permissible to pray group after group, each time a little, about 15 people.&rdquo Eger even went as far as to permit a police officer to be stationed at the entrance to synagogues to ensure that this limit was not exceeded.

                        Similarly, during the cholera epidemic that struck Lithuania in 1848, the important rabbi Israel Salanter permitted Jews to carry out relief work on the Sabbath and even went as far as telling his congregants not to fast on the Day of Atonement.

                        During the Spanish Flu pandemic of 1918, municipalities around the world banned gatherings, and some synagogues held services outdoors some apparently even suspended services altogether during the height of the epidemic.

                        But these measures pale in comparison to the adjustments people and Jews everywhere have to adopt during the current Covid-19 pandemic.

                        While rabbis have been advising penitential prayers be added to the daily prayer as well as the reading of those Talmudic texts concerning the burning of incense, the closing of synagogues in such a large scale, including in Israel and in the U.S., by far the two largest Jewish communities in the world, is completely unprecedented. An analysis of the places appearing on the Health Ministry&rsquos coronavirus contact tracing studies shows that more than 30 percent of those infected in public spaces visited synagogues and yeshivas or were exposed there to the virus.

                        As of Sunday night, Anshel Pfeffer reports, one establishment in Bnei Brak &ndash which has become a coronavirus hotspot &ndash had put up a notice saying in Hebrew: &ldquoBy order of the Health Ministry, the study hall is closed. &rdquo This was followed by three lines in Yiddish saying &ldquo&hellipaccording to the government. The study hall is open, come in to learn and pray.&rdquo

                        Those rabbis in Israel who accept the containment measures and have called on their congregants to comply with the ban are admitting the sad fact that communal prayer and penance, the method used by Jews for millennia in the face of epidemics, is not only ineffective, it is counterproductive.

                        Israeli National Intelligence Culture and the Response to COVID-19

                        More than 2,600 Israelis (in a country with a population of around 9 million people) have already died from COVID-19. The government is now beginning to ease the lockdowns implemented after a second wave tore through the country. Restrictions are hard to enforce. Israel has a dedicated “coronavirus government cabinet,” but decisions are made under dramatic political pressure.

                        The Israeli intelligence community plays an active role in the fight against the pandemic. It analyzes the infection trends of Israeli civilians and recommends necessary national measures, provides surveillance over infected individuals, and even produces and provides necessary medical equipment. By contrast, the American intelligence agencies have played a different role in its country’s pandemic response. The intelligence community has broadened its traditional scope to include medical threats, or as the director of national intelligence has said, its focus will be “directed to the geopolitical and economic impact of the coronavirus pandemic, as well as its origins.” But Israeli intelligence exhibited a totally different paradigm. It leveraged its skills, rather than adhering to its formal roles.

                        Intelligence in Israel is focused on practice — and theory is sometimes considered a luxury. I should know. I have been encultured in this system through more than 25 years of service in the Israeli Defense Intelligence.

                        What is the “Israeli idea of intelligence?” In what way do Israelis perceive and practice intelligence different than Americans or Brits? What perceptions and beliefs underlie the way Israel refers to intelligence? I believe that cultural explanations can enrich our understanding of Israel’s intelligence community and foreign policy, which are two topics of great importance. This can be gained through understanding Israeli national intelligence culture.

                        The active role of Israeli intelligence can be seen as a manifestation of this culture, which is inclined towards action and direct influence, rather than towards structured reflection and “distance” from decision-making. In Israel, intelligence does not end with a finished analytical and objective product (although objectivity is still considered valuable). It has to provide recommendations for action, and it is often used as a tool to shape events.

                        Israeli intelligence tends to use friction in the Clausewitzian sense, rather than reflection. It is inclined towards understanding the environment by engaging it, not merely by analyzing it and anticipating future outcomes. Moreover, it mobilizes when national crises arise. This is how it usually acts and thinks regarding traditional national security issues, and this is how it acted vis-a-vis COVID-19.

                        Israeli Intelligence Fighting COVID-19

                        Israel’s intelligence community is comprised mainly of the Israeli Defense Intelligence (Aman), the Mossad, and the Israeli Security Agency (Shabak or Shin Bet). Aman is a directorate in the Israeli Defense Forces that also provides national- and defense-level intelligence. By contrast, the Mossad is subordinate to the prime minister’s office and is in charge mainly of special operations and intelligence activities outside of Israel. For example, it was recently involved in the peace accords between Israel and Arab countries. Shin Bet is also subordinate to the prime minister’s office, but it is in charge mainly of counter-terrorism, counter-intelligence, and counter-espionage inside Israel.

                        In Israel, unlike in the United States, there is no director of national intelligence. The American national intelligence estimates and intelligence community assessments are produced by the National Intelligence Council, which is under the office of the director of national intelligence. But in Israel, there is no one head of the intelligence community, at least not formally. When the intelligence services conduct and present their national intelligence estimates, each service has its own “slot.” Aman is considered to be in charge of the national intelligence estimate, although this has been challenged and debated over the years.

                        Despite the lack of organizational centralization, however, my personal experience has shown that the Israeli intelligence community maintains a high level of coordination and cooperation. This is probably more like birds flying in a focused, V-shaped “organic order” than as a disciplined structure with a well-defined leader. Discipline can hardly be considered an Israeli feature, but focus can.

                        Israeli intelligence agencies are indeed very focused on fighting the pandemic. The Israeli Defense Forces as a whole are a major participant in this fight. This is also very typical of Israeli security and defense systems, which are considered by Israelis not just as providers of defense but also as the core of Israel’s national security. Hence, it is not surprising that Israeli intelligence has performed much more than merely “medical intelligence” — an issue that is receiving much academic research lately. It has mobilized its capabilities and skills to conduct analysis of the spread of the pandemic inside Israel, and to actively fight the pandemic.

                        Aman is leading, alongside the Ministry of Health, the national Israeli COVID-19 research center, and practically providing civilian and health recommendations. According to Israeli media, this was an initiative of a colonel in Aman’s research and analysis division who offered to leverage Aman’s capabilities for the national fight against COVID-19. Aman’s technological and special operations units have provided technical assistance regarding ventilation machines. In September 2020, the Israeli government expanded the scope of information about Israeli civilians provided to military intelligence. Mossad has procured and provided crucial medical equipment, while Shin Bet is monitoring COVID-19 infections throughout the country.

                        Many of these activities are beyond the agencies’ moral, legal, or professional scopes, at least formally. Aman is prohibited from dealing with internal Israeli matters. Shin Bet has developed its technologies to counter terrorism and insurgency, not to monitor Israeli civilians. Mossad conducts operations like obtaining Iranian nuclear archives more often than purchasing medical equipment abroad.

                        Moreover, a vibrant discussion is being conducted in Israel about whether providing an early warning for a global pandemic and analyzing it is an issue of national security, and therefore of national intelligence. Some Israeli scholars claim this is not the case, since not all analysis is intelligence analysis, and intelligence ultimately engages security matters and deals with secret information. Even the former head of the research and analysis division in Aman, Brig. Gen. Dror Shalom, claimed that this issue should be handled by a civilian and national intelligence entity. Although military and defense intelligence in Israel is practically also national intelligence, monitoring global pandemics does not seem to fall within the intelligence community’s scope. Instead, Israeli intelligence focuses on more traditional national security issues, with an overwhelming regional emphasis on the Middle East.

                        Scholars and practitioners in Israel have begun to discuss ethical and professional dilemmas stemming from the Israeli intelligence community’s active role in fighting COVID-19, especially in terms of civil-military relations. One major ethical dilemma concerns the “red line” between military intelligence and internal monitoring. More specifically, are Israelis willing to have their military officers conduct internal and civilian operations? One major professional dilemma concerns the very definition of “intelligence.” Is the Israeli intelligence community expected to monitor and analyze the effects of the pandemic worldwide? What skills does it have for this role? Brig. Gen. Shalom seemed to be aware of all these challenges, and so are the intelligence officers who practically conduct the analysis alongside the Ministry of Health. But still, it is hard to imagine a national task in Israel in which its intelligence agencies do not participate, even if this means confronting new challenges and creating a new paradigm for the practice of intelligence.

                        In the United States, the role of the intelligence community is rather different, and providing intelligence to policymakers on global health crises is fundamentally within its remit. Given the global span of U.S. interests, this is exactly what U.S. intelligence agencies should be doing.

                        And indeed, American intelligence probably provided an early warning for the emergence of COVID-19, and tried to understand its sources. It executed its traditional roles of collection and analysis and applied them to the medial issue. One exception might be the Intelligence Advanced Research Projects Activities’ call for developing advanced technologies to fight the pandemic. But still, one can hardly imagine the Defense Intelligence Agency conducting data analysis of the pandemic’s spread in New York City.

                        Israel’s National Intelligence Culture

                        Israeli intelligence favors innovation and adaptation over stagnation, informality over formality, action over reflection, initiative over protocol, result over process, and practice over theory. Although I have been a part of this culture for more than 25 years, I probably had to retire from active duty to fully grasp the importance of this cultural perspective. A few years ago, I began to conduct some theoretical work focused on strategic intelligence and Israeli national intelligence culture. I discovered a gap in the extant literature about this topic, since the cultural perspective is rarely used to analyze Israeli intelligence’s actions. I think this needs to change.

                        On the one hand, numerous studies have been written about Israeli intelligence, which is a major pillar of Israel’s (unwritten, unpublished, and informal) national security strategy. These studies include books and articles about the Yom Kippur War in 1973, and research conducted by the Institute for National Security Studies in Tel Aviv about the intelligence community and its challenges. Moreover, scholars have debated the subject in Intelligence – In Theory and in Practice, a journal published by the Center for Study of Intelligence Methodology in Ramat Hasharon. There are also lessons to be learned from memoirs of former intelligence officers. Moreover, Israeli scholars contribute to intelligence studies, such as Uri Bar-Joseph, Isaac Ben-Israel, Abraham Ben-Zvi, Shlomo Gazit, Yehoshafat Harkabi, Zvi Lanir, Ephraim Kam, and Shlomo Shpiro. Former senior Israeli intelligence practitioners, such as Brig. Gen. (res.) Itai Brun, have written about intelligence in recent years, bringing together theory and practice.

                        On the other hand, studies focused on Israeli national intelligence culture per se are scarce. National intelligence culture is a broad topic, with research gaining momentum in recent years. Current research is still focused on the United States and the United Kingdom, although this is also beginning to change. National intelligence culture can be characterized as a nation’s unique set of beliefs, values, and concepts that create the context for the theory and practice of intelligence. It encompasses all three aspects of intelligence that Sherman Kent, the dean of U.S. intelligence analysis, pointed to: organization, product (knowledge), and process. National intelligence culture can be thought of as having reciprocal interactions with strategic, political, military, and organizational cultures.

                        Naturally, there can be many cultures of intelligence inside one nation, with divergences between organizations, periods in time, and different roles of intelligence (collection, analysis, and operations). But writ large, one can find at least some common ground for the theory and practice of intelligence, which is characteristic of a specific nation.

                        The American intelligence culture, for example, is considered to be “truth-seeking.” The main role of the American intelligence community is to be objective, reveal the truth, and transmit this to decision-makers. Interestingly, this traditional view of intelligence is open for debate, and has been challenged lately, even in War on the Rocks.

                        The Israeli national intelligence culture is different. It seems that Israeli intelligence is in a constant state of change and revolution, albeit without always having the relevant theoretical foundations. One could argue, of course, that the American intelligence community is also in a constant state of reforms, especially since the terrorist attacks in 2001. But in the Israeli case, this seems to go beyond merely adapting to a changing environment of nation-state militaries, global terrorism, cyber warfare, military organizations, and advanced technologies, such as artificial intelligence. Israeli intelligence seems to be constantly looking for new paradigms.

                        In 2007, Brig. Gen. (res.) Yosef Kupperwasser, the former head of the research and analysis division in Aman, described major reforms that were conducted in the Israeli intelligence. These were fundamental changes in the process, product, and organization of intelligence: close collaboration between collectors and analysts, strong interactions between intelligence and policy, use of systemic thinking rather than merely inductive reasoning, and digital intelligence products. In 2013, David Siman-Tov and Ofer G. (a former and acting military intelligence officer writing anonymously) recommended a new paradigm for intelligence — focusing on implications of the Web 2.0 phenomena, and on better collaboration between collectors and analysts. In 2014, then Maj. Gen. Aviv Kochavi, the head of Aman (and currently lieutenant general and chief of general staff of the Israeli Defense Forces), portrayed a “permanent change in a changing reality.” He discussed fundamental changes: the new concept of “intelligence-based warfare,” a new approach to the cyber dimension, and a great emphasis on jointness inside Aman. The 2016, 2017, and 2018 journals of the Center for Research of Intelligence Methodology focused on jointness, change, and big data. Just recently, Brig. Gen. Shalom published an article describing the “multi-dimensional intelligence” — a new concept Aman has begun to implement, manifesting a rather revolutionary interaction between collection and analysis. These are all illustrations of a culture constantly seeking adaptation and revolutions, acting in a fast-changing reality, and not resting on its laurels.

                        In addition, the Israeli intelligence community seems still to be recovering from the trauma of the Yom Kippur War in 1973. The war represents the greatest intelligence failure in Israeli history, as Syria and Egypt conducted a surprise attack on Israel, thus leading to a deadly war with more than 2,700 Israeli casualties. While I was born after this war, I felt the echoes of the war every day of my quarter century of service in Israeli intelligence. The trauma of a surprise attack that threatened Israel’s existence was a haunting one and was a formative experience for Israel’s security establishment. In interviews given by acting and former Israeli intelligence officials, one can hardly find an absence of references to the Yom Kippur War.

                        During my service, I was taught to implement the lessons of being your own devil’s advocate (a new unit with such a role was formed after the war inside Aman, with similar roles to a red team) scrutinizing the analysis and decision-making of colleagues, even of higher ranks being open to different analytical judgments and methods allowing junior officers access to the highest ranks in government and military and thinking independently while remaining infused with a sense of national responsibility. This is how Aman perceives the major lessons of the 1973 failures. Many of my colleagues were educated in a similar manner. These traits have also become prominent aspects of the Israeli intelligence culture. Independence of thought, creative thinking, and showing initiative are all considered important imperatives. I believe these too were manifested when fighting COVID-19.

                        In Israeli intelligence, practice usually precedes and outweighs theory. An interesting example of this is the Israeli approach to the revolution in intelligence affairs. The revolution in intelligence affairs is a term receiving some scholarly attention in the last decade, relying on the theoretical foundations of the revolution in military affairs. It describes new concepts, organizations, and technologies that fundamentally change the way that intelligence is practiced. This is a new paradigm for intelligence, not just incremental changes. In the United States, experts have been writing about the revolution in intelligence affairs since 2005, and have currently emphasized the role of machines in this revolutionary intelligence. But in Israel, based on some media reports and articles, such a revolution is already taking place.

                        All these cultural aspects resemble the way Dima Adamsky has described Israeli strategic culture and its approach to military innovation. I believe these were also salient in the Israeli “campaign between the wars.” This campaign is an innovative concept, practiced by Israeli security services in recent years but conceptualized only in hindsight, describing active (kinetic and non-kinetic) efforts to counter Israeli adversaries’ force build-up efforts. Eliot A. Cohen, Michael Eisenstadt, and Andrew J. Bacevich have described Israeli military culture in a similar way — claiming that Israelis usually defer to innovation rather than to tradition. This is probably one of the reasons that Israel is considered a start-up nation. And adding to that, Avi Kober has claimed in the past that Israeli military thought and theory are underdeveloped, and are underestimated compared to military practice.

                        Leaning on these strategy and military cultural aspects, new challenges are often addressed by Israeli intelligence mainly through friction and engagement, which allows learning and adaptation through action and not through reflection. Interestingly enough, the current chief of Aman, Maj. Gen. Tamir Hayman, wrote an article a few years ago about learning processes in the Israel Defense Force’s general staff. Likewise, Maj. Gen. (res.) Yossi Baidatz, a former head of the research and analysis division, published a study about strategy as a learning process. In the business world, Henry Mintzberg would have probably called this “the learning school of strategy.” Such engagement through action and friction was also the case with COVID-19.

                        Israeli intelligence services leveraged their skills, which were developed for traditional national security matters, to fight COVID-19. These skills include data mining and analysis, technological monitoring, covert operations, and providing recommendations for national decision-making. Israeli intelligence also leveraged its ability to adapt, improvise, and act quickly. This combination of skill and spirit seems to be a manifestation of Israel’s national intelligence culture, and more broadly, of Israeli political, strategic, and military culture. Since the strategic and operational environment in the Middle East is so volatile, perhaps this is what it takes.

                        However, such an intelligence culture also has its downsides. For example, surprisingly for a country that gives such importance to intelligence and to higher education, the academic status of intelligence studies in Israel is low compared to other Western countries. I see this as an example of Israeli aversion towards theory and academia. In Hebrew, “academic” oftentimes means “non-practical.” However, without proper theory and academic research, I believe that an adaptive culture of practice might not be sufficient for future challenges.

                        There is also a potential for ethical pitfalls. There are already signs, for example, of criticism in Israel about military intelligence reports discussing medical issues. Israelis, and especially former intelligence officers like myself, are not used to seeing officers in uniforms discussing the financial aspects of easing the lockdown in the Israeli education system. It is potentially awkward to see intelligence officers providing recommendations pertaining to controversial issues in Israeli society, such as lockdowns with dramatic financial repercussions, or limitations on prayers in synagogues. It is more natural, or even more ethically appropriate, to see them discuss Iran and the Palestinian Authority.

                        To sum it up, Israeli intelligence played and still plays an active and public role in fighting COVID-19. This can be seen as a manifestation of the Israeli national intelligence culture that usually favors practice over theory, friction over reflection, initiative over protocol, and adaptation over stagnation. American and British intelligence communities have different intelligence cultures, and indeed acted differently in the wake of the pandemic. I believe they also act differently when it comes to traditional national security matters.

                        As the pandemic continues, Israeli intelligence might face more ethical and professional challenges. But I believe that the adaptive and proactive nature of Israeli intelligence culture will meet the challenge head on. When facing new threats, Israeli intelligence tends to act first, then take time for reflection later. But action in the Israeli way inherently creates opportunities for learning and adaptation. Theory will be developed later on.

                        “In Israel, you’re 60 times more likely to have a COVID vaccine than in Palestine”

                        As a medic, I am shocked. The internationally-acclaimed COVID-19 vaccination success of Israel has a dark side, the consequences of which are being felt cruelly in the West Bank territory of Palestine where I work, and in the blockaded Gaza Strip where my Médecins Sans Frontières (MSF) colleagues work.

                        Israel has managed to vaccinate nearly 4.2 million people with a first dose – that’s around 50 per cent of the population – and 2.8 million people with the full two doses – that’s more than 30 per cent of the population.

                        Meanwhile, only several thousand doses are available in the Palestinian West Bank, and a delivery of 20,000 reported to have arrived last weekend in Gaza scarcely scratches at the surface of the needs. At a generous maximum, assuming that the 35,000 reported Sputnik and Moderna vaccines are all available, that would be around 0.8 percent of the Palestinian population.

                        To make that clearer, you are over 60 times more likely to have a vaccination in Israel than in Palestine. Israel has a responsibility as an occupying power to ensure the medical supplies of the occupied people, including “adoption and application of the prophylactic and preventative measures necessary to combat the spread of contagious diseases and epidemics” to “the fullest extent of the means available to it.” Fourth Geneva Convention

                        I came to Hebron with an MSF team specifically to help with the COVID-19 response. In December last year, when the second wave hit the West Bank, the Dura hospital where we are supporting medical assistance was full of COVID-19 patients. We had mostly elderly people, many with underlying conditions such as diabetes or other chronic diseases. Patients died. Sick COVID-19 patients have died in hospitals around the world, but these patients died on my watch, and that pains me.

                        In eight of the 11 West Bank governorates, COVID-19 case numbers are on the rise again. In Hebron, this increase has been slow and steady for the past four weeks. I do not want to see any more patients dying of hypoxia. A medical condition where the body, or parts of the body, are deprived of sufficient levels of oxygen at the tissue level. The vaccine is my hope to avoid this. It is also a source of despair.

                        A few kilometres away in Israel, all the vulnerable groups have been vaccinated and they are planning to move onto vaccinating healthy adults and youths, who are less vulnerable, especially to severe complications.

                        Here in the West Bank, there are around 10,000 doses, which is enough for 5,000 people to be vaccinated. In the hospital where I work, staff have been offered the vaccine, but the available doses do not come close to covering the healthcare workers, let alone the elderly and people with medical conditions that make them susceptible to dying of COVID-19.

                        If asked why vulnerable people cannot be vaccinated in Palestine, I do not know how to answer. It is inexplicable and unbelievable. Worse than that – it is unjust and cruel.

                        We hear information about additional vaccines coming to Palestine from various donation mechanisms, but they are not here now. And a half-hour drive away, Israel has piles of vaccines and is moving onto vaccinating non-vulnerable groups.

                        I am outraged, but my colleagues in Gaza are even more so. It has not always been easy, but the Dura hospital in Hebron where I have been working was able to get most of the supplies needed for COVID-19. The MSF team was able to provide on-the-job coaching and training to boost the capacity of the staff to manage severely and critically ill patients, all of them needing oxygen.

                        But in Gaza they have much more severe shortages of medical supplies and pharmaceuticals because the blockade is so strict. Their capacity for COVID-19 treatment is lower, so their need for the vaccine is all the higher. And the recent delivery of 20,000 vaccines will not be enough to protect both the healthcare workers and the people most vulnerable to needing critical COVID-19 medical care.

                        Israel is an occupying power and has millions of vaccines. Palestine is the occupied territory and has barely a few thousand vaccines. As a medic, I don’t really care who sorts this out. As a medic, I do care deeply that the most vulnerable are prioritised. I am left with this shameful thought echoing in my mind – 60 times more likely to be vaccinated in Israel than in Palestine, with the most vulnerable in Palestine still left unprotected.

                        Matthias Kennes is a registered nurse, and medical adviser for the Médecins Sans Frontières (MSF) COVID-19 response in Hebron, West Bank, Palestine.