Adding insult to injury
By Relly Sa’ar

Despite the 51 years that have passed, Albert Asayag, a 55-year-old resident of Dimona, clearly remembers the traumatic moment when he was strapped to a chair and his head was irradiated to treat tinea capitis, ringworm of the scalp.

When he was 4 years old, he immigrated with his parents and his four siblings from Morocco to Israel. That was in 1955, during one of the waves of mass immigration from North Africa. A few months later, after his family had settled in Kfar Shamai in northern Israel, authorities came and took Asayag and his siblings to the Sha’ar Ha’aliya immigrant transit camp, near Haifa.

“I remember I cried a lot. I didn’t want to sit in the chair, and they forced me. I remember that they spread hot stuff, like tar, on my head, and pulled out all my hair,” he recalls.

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Asayag was one of tens of thousands of immigrant children from Middle Eastern and North African nations who were exposed to high levels of radiation as part of a project by Israel’s medical establishment to eradicate ringworm. This initiative ran from the late 1940s through the 1960s. The fungi that cause scalp ringworm – Microsporum canis and Tricophyton verrucosum – are particularly contagious among children, and may produce an itchy, scaly, red rash that can cause permanent hair loss.

Tinea capitis is now treated with fungicidal creams and occasionally antibiotics. But during the mid-20th century, fears of an epidemic motivated health care personnel to “treat” immigrant children by exposing them to radiation at levels equivalent to 500 standard X-rays. Asayag remembers spending two months in the Sha’ar Ha’aliya transit camp in order to receive this radiation.

Twelve years ago, Israel recognized its responsibility for the destructive results of this unwarranted irradiation, including scarring of the scalp, baldness, premature tooth loss, and benign and malignant tumors. The Israel Tinea Capitis Compensation Law states that those who can prove to a Health Ministry committee of experts that they were irradiated as children are entitled to compensation in accordance with the damage to their health.

Torturous interrogation

But victims must go to great lengths to receive the compensation to which they are entitled under the Tinea Capitis Law.

Attorney Zvi Regev, who says he has represented about 1,000 individuals in front of the committee, attests to this. “Someone applying for government compensation for the great suffering caused to him undergoes tortuous interrogation. Committee members try to trip him up with trick questions, ignoring the fact that dozens of years have passed since the event. For example, if he testifies that he experienced pain during the radiation, his appeal will probably be rejected. Because, to be precise, it wasn’t radiation – which is painless – but the pulling of the remaining hair from his scalp that caused the pain,” he says.

Asayag says he described to the committee the color of the flowers growing next to the radiation room at Sha’ar Ha’aliya. “They asked me how I remembered. I responded that I couldn’t forget because my head has been hurting since that moment,” he says.

The committee’s rigid policy has proved to be an efficient and thrifty means of saving public money. Health Ministry statistics show that through the middle of last month, 34,500 individuals sued the state for compensation under the 1994 Tinea Capitis Law. Forty-seven percent of these suits were rejected. Only 16,908 individuals successfully bore the burden of proof and presented evidence the committee could not undermine.

In spite of that, the treasury is still trying to cut the cost of the Tinea Capitis Law. Last week the Knesset passed the 2007 budget in its first reading, with a 68-MK majority. The budget includes an amendment to the Tinea Capitis Law that the Finance Ministry initiated in accordance with the Economics Arrangements Bill, which passed two months ago: An individual may appeal for compensation “up to four years from the day of the event that entitles him to compensation.”

In addition, the second clause of the amendment states, “The protocols of the expert committee’s deliberations and decisions regarding eligibility for compensation under the Tinea Capitis Law may not be given to any party.”

Attorney Avri Rav-Hon is the legal adviser of the non-profit organization that assists victims in obtaining compensation under the Tinea Capitis Law. He says he has represented thousands of radiation victims.

“Despite its moral obligation, the number of individuals whom the State of Israel has recognized and compensated is infinitesimal. According to testimony and archives, 150,000 to 200,000 children under age 15 were exposed to radiation over 14 years, in Israel and in European transit camps,” he says.

Because compensation under the Tinea Capitis Law is granted based on the extent to which an individual is ill, someone like Asayag, who has not yet developed malignant tumors and suffers “only” from bald patches and constant head pain, is entitled to 5 to 39 disability percentage points. This grants him a single payment of NIS 1,218 per point.

“The committee compensated me a year ago. Despite the fact that it’s small change given how much I suffered, I am not willing to undergo extensive examinations. I am really scared they might find other things. The family tells me it’s dangerous, but I’m not willing to listen. I told the committee, ‘If I discover I have the disease [cancer], I won’t be able to stand it.'”

Anyone who falls ill with “the disease” – including leukemia, and skin, thyroid and throat cancer – is legally entitled to maximum compensation. Individuals who with 75-100 disability points are entitled to a single grant of NIS 150,000 and monthly benefits of NIS 1,400 to 1,800. After the committee accepts an individual’s claim that he was exposed to radiation as a child, a National Insurance Institute committee determines the level of compensation, and retroactive payments are granted from the day the law was enacted in 1994.

According to NII data, Israel pays monthly disability benefits to tinea capitis radiotherapy victims with 40 points or more. Through the end of last year, NII had paid out NIS 790 million; 3,150 people receive monthly disability benefits.

‘Moral catastrophe’

Regev says the treasury’s four-year statute of limitations “is a moral catastrophe. This means that if an individual discovered he had cancer five years ago and did not connect the disease to the radiation, and as a result he did not file for compensation and disability, his claim has expired and he is not entitled to monetary compensation, despite the fact that the state is responsible for his illness.”

The Finance Ministry says the large expense of the Tinea Capitis Law justifies the amendment. “When the law was enacted, it was estimated that NIS 100-150 million would be required to implement it. The NII has paid a total of NIS 850 million so far [NIS 60 million more than NII reported to Haaretz]. In its present format, the law will cost more than a billion shekels.”

Anyone unfamiliar with the inner workings of Health Ministry committees may not understand how the amendment’s second clause, which closes committee protocols, might save public funds. Regev says the clause’s objective is to make it even harder for appellants and their legal representatives to handle the committee’s questions.

“Currently the appellant and his attorney are entitled to receive only partial protocols in order to keep the committee’s questions and the appellant’s answers secret. If someone is asked whether he or she sat or lied down during radiation, and the appellant errs in answering, and the state’s representative comments to this effect, that protocol might help another appellant answer questions correctly to entitle him to compensation.”

Now that the budget has passed its first reading, the Tinea Capitis Law amendment is subject to standard legislative proceedings. It will apparently be transferred to the Labor, Health and Welfare Committee to be prepared for a second reading. Only later will the bill be passed to the Knesset for approval.

Rav-Hon says he hopes that “the treasury’s unjust proposal will be thwarted by MKs. The treasury is gambling with the weakest sectors. Tinea capitis victims don’t live in [upscale] Mevasseret Zion, Haifa’s Denia neighborhood or North Tel Aviv. They are residents of Be’er Sheva, Dimona, Sderot and Ofakim – poor, downtrodden people with limited education whom the state severely wounded during their childhood. Now, the treasury comes along and tries to deny them rights granted by legislature. Why is it necessary to hurt them twice?”

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