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Summary

Israel’s Ministry of Health (MOH) is generally responsible for public health crisis management.  The Minister of Health is authorized to classify specific diseases as “communicable diseases,” and to declare a public health crisis caused by such diseases.  The Minister may resort to special powers to limit and fight communicable diseases.  The Minister’s powers include the authority to order quarantine and decontamination of property.  Despite the apparent infringement on the basic rights of protection of privacy, confidentiality of medical information, human dignity, and freedom, the law permits the restriction of these rights for the purpose of eliminating public health catastrophes such as epidemics and chemical or biological attacks. 

In responding to intentional contamination, the Home Front Command (HFC) of the Israeli Defense Forces is charged with making the first response.  The HFC regularly publishes information on threats and on measures that should be taken against contamination.  Although data on the spread of communicable diseases is freely available, many aspects of counter biochemical and radiological terrorism are classified out of concern that their disclosure would endanger the public. 

Israel develops and implements special plans for preventing the spread of communicable diseases as warranted.  For example, Israel’s MOH has issued a special memorandum on preparedness for and the prevention of Ebola.  Previously, a special directive was issued by the MOH General Manager on May 4, 2009, regarding preparation for A/H1N1 2009 influenza.  In 2007 the MOH issued a report titled Pandemic Influenza Preparedness Plan for the Health System.  The Plan includes specific requirements for reporting and monitoring, as well as a means of responding to a pandemic health crisis in cooperation with the World Health Organization and its regulations.  

I.  Introduction

Israel’s systems of health crises preparedness, disease reporting and surveillance, and alert and response management are under the responsibility of the Ministry of Health (MOH).

The MOH’s jurisdiction extends to managing the medical aspects of Israel’s preparedness for, and response to, public health crises, including the operation of hospitals and clinics, identification and reporting of health crises, purchase and allocation of vaccines and medications, and distribution of information to the public.  Other aspects of addressing health crises, including activating an emergency status, ordering quarantines, maintaining public order, and determining the closing and opening of schools, are handled by the Ministry of Defense through the Homeland Security Command. 

The MOH issues new requirements on the spread, prevention, and treatment of disease periodically as needed.  Most recently, in August 2014, the MOH published special guidelines on preparedness for and prevention of the spread of the Ebola virus.[1]  In 2007 the MOH issued a detailed report titled Pandemic Influenza Preparedness Plan for the Health System.[2] 

This report describes the structure of the public health crisis management system in Israel, procedures for the determination of pandemics, and the special powers granted to public health authorities for disease and pandemic prevention.  It also discusses the impact of these powers on human rights in Israel as well as the legal requirement for transparency in the public health crisis management system.  The report includes information on special prevention programs including preparedness for chemical or biological attacks on the homeland.

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II.  Structure of Public Health Crisis Management System

Israel’s public health crisis system is regulated by law and subsidiary legislation.  The MOH is responsible for collecting information and making decisions for the protection of the public and for implementing these decisions and policies.[3]  Health services are usually dispensed through companies called health insurance establishments (HIEs) that are partially subsidized by the state.[4]  Every resident has a right to health services provided in a manner that protects human dignity, privacy, and medical confidentiality.[5]

A.  Declaring a Disease “Communicable”

The statutory framework for dealing with communicable diseases is based on Public Health Ordinance No. 40 of 1940,[6] as amended.  A “communicable disease” is defined by the Ordinance as any disease listed in the second appendix to the Ordinance, or one declared by the Head of Health Services or a designee as a communicable disease.  The declaration must be made in the official gazette and must specify the area and the period for its application.  The list appended to the Ordinance may be amended by the Minister of Health, who is authorized to add or delete diseases from the list through publication in the official gazette.[7] 

The list currently includes diseases of international importance requiring immediate notification by the treating physician to the MOH regional office or other MOH offices in accordance with the World Health Organization (WHO)’s International Health Regulations (2005), such as smallpox, Ebola virus, SARS, and yellow fever.  Other diseases listed as requiring immediate individual notification similar to that required for diseases of international importance include AIDS and HIV infection; acute hepatitis A, B, and C; West Nile virus; and malaria.[8]

The inclusion of a disease in the list of communicable diseases empowers health authorities in Israel to resort to special measures, including quarantine, to fight the spread of the disease.[9]

B.  Declaration of a Serious Health Danger

Public Health Ordinance No. 40 of 1940, as amended, authorizes the Minister of Health to declare the threat or existence of a serious danger to public health in Israel or in neighboring countries.  With the publication of the declaration in the official gazette, the head of health services at the MOH may issue regulations regarding any person or HIEs activities, such as house-to-house visits, the provision of medical assistance, medications, housing accommodations, ventilation, and other measures to prevent the spread of the disease.[10]

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III.  Determination of Pandemics

A.  Data Collection: Disease Reporting and Monitoring 

1.  Reporting 

Under the 1940 Public Health Ordinance, doctors treating infected patients, patients’ relatives, and possessors of property where infected patients have stayed must inform the regional government doctors of such cases either immediately or within twelve hours of learning that the patients have contracted a communicable disease.[11]

Under the 1994 National Health Law, as amended, HIEs must provide the MOH with medical data necessary for the fulfilment of the Ministry’s obligations under the Law upon the Ministry’s request.  Noncompliance with such a request may cause delay in the provision of governmental subsidies.  The Law specifies that medical information will be dispensed only to the extent necessary for the implementation of the Ministry’s obligations and for the protection of the privacy of the insured and medical confidentiality.[12] 

2.  Monitoring 

The Israel Center for Disease Control (ICDC) was established under the MOH in 1994.  The ICDC was designed to provide the Ministry with up-to-date information on health issues.  The ICDC deals with a large spectrum of health areas and cooperates closely with other departments in the MOH, the Central Bureau of Statistics, HIEs, other health care providers, as well as with research institutions and universities.[13] 

According to information posted on the website of the International Association of National Public Health Institutes,

[t]he ICDC main objectives are to identify health areas which lack essential data, establish new health-related databases, provide ongoing professional support for users of existing databases, undertake applied research in specific areas of public health, carry out national health surveys, report on the health status of the population, present policy alternatives to decision-makers in MOH, and carry out unusual morbidity surveillance. . . .

The ICDC took active part in monitoring the pandemic influenza in Israel on [sic] winter 2009-2010, including syndromic surveillance, serologic surveillance, distribution of weekly reports, regular updates of the pandemia guidelines according to the WHO and other agencies, distribution of the updated guidelines on a daily basis, and activating a hotline for medical teams.[14]

The MOH’s 2007 Pandemic Influenza Preparedness Plan for the Health System (the Plan),[15] for example, provides for a system of monitoring that relies on information received from the ICDC.  According to the Plan, the monitoring of influenza is based on a combination of both laboratory and clinical observations.  Laboratory monitoring of influenza is conducted in the MOH’s Central Laboratory for Viruses.  Samples are received from selected monitoring clinics on a weekly basis.  All influenza tests among hospitalized patients and during disease breakouts are sent to the ICDC.  The results of influenza tests conducted in two selected hospitals are also routinely delivered to the ICDC.  The 2007 Plan further calls for the preparation of additional monitoring clinics and pediatric screening during influenza season and throughout the year as needed.[16]  Clinical monitoring is conducted by the MOH Department of Epidemiology, the department for information and digitalization, and the ICDC.  The ICDC periodically collects and integrates daily data determined to be indicative of influenza.[17] 

The 2007 Plan provides for a specific monitoring program following the issuance of WHO phase 4 and 5 epidemic alerts, which correlate to both limited and significant human-to-human contagiousness.  The program calls for the operation of additional monitoring clinics, distributed geographically, and for the testing of a higher number of samples from persons meeting the disease case definition as determined by WHO.  In addition, during phases 4 and 5 of the epidemic, a comprehensive epidemiological investigation will be conducted in every case in order to identify all relevant contacts and consider treatment by medication, isolation, and quarantine, as needed.[18] 

According to the 2007 Plan, during a pandemic, when contamination is spread worldwide, there is no need for additional monitoring.  Samples will be transferred only to the ICDC, which will conduct weekly integration of all the data it receives and disseminate its report to the MOH, health clinics, hospital doctors, and the community at large.[19] 

3.  Declaration of a Crisis 

The 1940 Public Health Ordinance authorizes the Minister of Health to declare in Israel’s official gazette that public health is severely threatened by the existence of a communicable disease in Israel or in neighboring countries.  The authorization applies “if it seems that part of the country is subject to a danger of a terrible epidemic disease, local or communicable, or is infected with such a disease, such as the plague, cholera, yellow fever, smallpox, typhus, or another disease declared by the Minister of Health in publication in the official gazette, as a dangerous communicable disease.”[20]  The Ordinance does not describe the decision-making process to be followed by the Minister prior to declaring a disease communicable.

In the case of H1N1 influenza, several cases have been identified in Israel.  The declaration concerning H1N1 influenza,[21] however, followed alert announcements by the WHO.  Such a declaration forms the basis of the extensive powers granted to the Minister of Health and the Ministry’s designees.[22] 

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IV.  Powers of Public Health Authorities 

A.  General Powers 

The Head of Medical Services of the MOH, and a government doctor or a supervisor appointed by the Minister of Health or the Minister of the Environment, whichever is relevant, are provided the authority to

  • inspect and decontaminate areas suspected of being contaminated with communicable diseases;
  • examine persons found in suspected contaminated areas; and
  • quarantine or transfer infected persons to a hospital.[23] 

Specific powers are provided to the Head of Medical Services and to government doctors to order

  • the decontamination, reconstruction, repair, or closure of all home water supplies;
  • the purification or protection of all private or public water supplies; and
  • the removal and destruction of all garbage from private or public premises.[24]

Additional powers include the vaccination of residents of an area suspected of being contaminated in order to stop the spread of the disease.[25] 

Any person under an obligation to report communicable diseases, including relatives who stay with the infected person, building managers, and treating physicians, is authorized to carry out temporary quarantine actions ordered by the government doctor.[26] 

B.  Quarantine Powers 

Under the Quarantine Ordinance (New Version) 5741-1981 the General Manager of the MOH is authorized to order a “quarantine service to prevent the penetration of diseases into Israel via land, sea or air, and their transfer from Israel to other countries.”[27]

In accordance with the Quarantine Regulations,[28] the MOH is authorized to require a medical examination of every vessel in Israel’s waters, to prohibit its contact with the shore or any other vessel, and to impose quarantine and sanitary measures to be followed upon arrival.[29]  Vessels suspected of being infected may port only in the ports of Haifa and Tel-Aviv, while those confirmed infected, only in the Haifa port.[30] 

The Quarantine Regulations specify the procedures to be taken when a vessel arrives at an Israeli port, including the requirement that a health certificate filled out by the vessel’s doctor be submitted.  The health certificate must include information on events that occurred during travel that are related to public health.  The health certificate should specify the health status of the ship’s country of origin and all the ports it visited, especially if these places were infected with the diseases listed in the Regulations.[31]  Vessels arriving without a health certificate or with an inappropriate health certificate will be subjected to quarantine.[32]  Goods and passenger luggage may be subjected to decontamination and possible elimination by burning.[33]  Passengers in vessels confirmed as infected will be subjected to quarantine.[34] 

Although the Regulations specifically deal with vessels, it is reasonable that similar procedures are applicable to other modes of transportation, such as airplanes, under the general authorization by the Quarantine Ordinance (New Version) 5741-1981.

C.  Forced Hospitalization and Seclusion 

The 1940 Public Health Ordinance authorizes the head of the MOH or a government physician to force the hospitalization or seclusion of every person who is infected with a communicable disease.  This may be done when the conditions of the residence are not suitable for prevention of the spread of the disease.  Every person who was in contact with the infected person during the disease’s incubation period may also be subjected to forced hospitalization.[35] 

D.  Powers During Periods of Emergency 

As discussed above, the Minister of Health is authorized to publish a declaration that recognizes a dangerous communicable disease as existing or threatening public health.  Once such a declaration has been published, the Head of Medical Services is authorized to order, by decrees, directives, or other means, any measures found necessary for preventing or containing the disease, including home visits; the provision of medical help; the distribution of medication; and the provision of clean, ventilated, and decontaminated places of residence.[36]  The authorization encompasses the entire country, or designated parts, and applies to all vessels within the territorial waters of Israel.[37] 

The Head of Medical Services is further authorized, following the publication of a declaration, to remove or arrest infected persons and subject them to supervision, medical examination, or treatment.  Persons in touch with the infected person may also be subjected to this authority.  Similarly, the Head of Medical Services is also authorized to perform all acts required to obtain samples from such persons for laboratory exam, such as

  • entering any private or public premises;
  • establishing sanitary supervision;
  • seizing, decontaminating, or destroying articles subjected to contamination;
  • burying or disposing of the dead;
  • taking possession of buildings or land (subject to compensation) to establish temporary hospitals; and
  • taking possession of transportation vehicles (subject to compensation) needed to prevent the spread of the disease.[38] 

The Head of Medical Services or a government doctor may also order the destruction of any building or shelter used by humans or animals that may provide a center for disseminating disease because of poor sanitary conditions.  The owner may be reimbursed, depending on the owner’s liability for the unsanitary conditions.[39]  In the case of a disease outbreak in a limited area, an order may be made not to allow any person to exit the place.  The police may be called upon to assist in enforcing such an order.[40] 

E.  Enforcement 

All legal instruments regulating the handling of a public health crisis provide authorized persons with the power to sanction violations of law and violations of their orders.  For example, the failure to inform the government regional doctor of an infected person may result in a one-month term of imprisonment or a fine.  Any person under obligation to provide critical information must also carry out the temporary quarantine orders imposed by the regional government doctor.[41] 

Certain expenses related to quarantine and decontamination of an infected vessel will be paid by its captain.[42]  In addition, penalties are imposed under the Public Health Ordinance on anyone infected with a communicable disease who knowingly exposes himself in a manner that endangers public health or sells or loans clothes and sheets.  Persons who transport an infected person without decontaminating the transport vehicle afterward are likewise subject to penalties.  Similarly, the parents of a child or a dependent infected with a communicable disease specifically listed in the third appendix of the Ordinance who knowingly or negligently allow the child to visit his school without a medical certificate permitting such a visit are subject to a criminal penalty and a fine.  A teacher who knowingly permits such a child to attend school is also subject to penalties.  Fines are also imposed on infected persons for engaging in any occupation related to food supply or any other occupation without taking the proper precautions against spreading the disease.[43] 

F.  Impact on the Protection of Human Rights 

The powers exercised by authorities in public health crises appear to conflict with patients’ rights guaranteed by the Protection of Patients’ Rights Law, 5756-1996,[44] as well as those prescribed by Basic Law: Human Dignity and Freedom.[45]  For example, the delivery of information on infected patients contradicts the rights of patients to medical confidentiality.  The Protection of Patients’ Rights Law, 5756-1996, however, provides that caretakers or medical institutions may provide medical information to others if they are under a legal obligation to do so.46  The provision of medical information in cases involving communicable diseases is mandatory under the 1940 Public Health Ordinance and, therefore, not in violation of the Protection of Patients’ Rights Law. 

Removal of persons, forced decontamination, and other measures taken to prevent the spread of disease appear to be in violation of the principle of protecting the life, body, and dignity of a person, guaranteed by Basic Law: Human Dignity and Freedom.  Such infringement, however, may be legal under the conditions enumerated in section 8—namely, relevancy and proportionality.  The law states that “[t]here shall be no violation of rights under this Basic Law except by a law befitting the values of the State of Israel, enacted for a proper purpose, and to an extent no greater than is required.”[47] 

It is reasonable to assume that the authority bestowed upon the Health Minister and his designees, specifically those permitting forced entry and quarantine, is one that can be viewed as an authority that is provided “for a proper purpose” in fighting the spread of infectious diseases.  Accordingly, orders for forced entry and quarantine that are limited in duration may be considered to meet the requirement that any violation of rights be “to an extent no greater than is required.”

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V.  Actions for Preparedness and Prevention of Pandemics

The MOH issues instructions on preparedness for and the prevention of pandemic diseases as necessary.  The following sections provide examples of actions taken by the MOH regarding preparedness for and the prevention of Ebola and pandemic influenza.

A.  Preparedness for and Prevention of Ebola

No Ebola cases had been identified in Israel at the time this report was prepared.  On August 7, 2014, however, the MOH, issued a recommendation to avoid visiting infected countries to the extent possible.  Travelers visiting Guinea, Liberia, and Sierra Leone are required to refrain from having contact with Ebola patients, their excreta, and their personal items.  Among other things, they are advised to refrain from visiting health institutions or obtaining medical care in those countries to the extent possible.[48]  According to guidelines issued by the Ministry, a patient who develops a temperature of 100.4°F (38°C) within twenty-one days of returning to Israel from any of these three countries must immediately inform hospital authorities prior to their arrival at the hospital in order to receive proper protection instructions.[49]

A memorandum titled The Ebola Outbreak in West Africa issued by the MOH on August 7, 2014, provides information on the virus’s epidemiologic and microbiologic origin, clinical symptoms, and incubation period and treatment.[50]  The Memorandum outlines procedures for the prevention of the spread of Ebola by requiring health care institutions to increase awareness of the potential spread of the virus, identify suspicious cases, and give advance notice to emergency and other health personnel regarding admission and treatment of Ebola patients.  Additional requirements on health care institutions introduced by the Memorandum include the duties of issuing emergency alerts for health care personnel,[51] issuing instructions regarding patients’ admission, and following the memorandum’s guidelines regarding case reporting management and the treatment of patients.[52]

At a minimum, the Memorandum requires the implementation of transmission-based precautions—specifically, regarding contact, droplet, and airborne protections.[53]  The following is a summary of relevant procedures and instructions that were issued on the basis of the Memorandum at an exercise conducted in October 2014 at the Tel-Aviv’s Ben-Gurion airport.

1.  Identification

a.  Ebola Patients Arriving at the Airport

According to instructions given at the exercise, a person returning to Israel from the infected countries should be screened.  The screening is to include a medical interview and taking the person’s temperature.  Anyone found to have temperature above 100.4°F is to be immediately transferred to isolation in a hospital.  During the transfer to a protected ambulance, the patient is to be placed on a protected stretcher.[54]

b.  Patients’ Arrival at Health Facility Following Advance Notice

According to the Memorandum issued by the MOH, every hospital must assign a physician on every shift to answer telephone calls concerning suspicion of Ebola infection.  Any patient who has visited a country where the Ebola virus has spread and reports a high fever upon return is to be instructed to appear for an examination at the Emergency Room.  The patient must be instructed to minimize risk to others while on route by adopting such measures as covering his/her face, refraining from using public transportation, meeting a health team member who is wearing protective gear, and arriving directly at a secluded area in the admissions department designated ahead of time for this purpose.[55]

c.  Patients’ Arrival at Health Facility with No Advance Notice

The Memorandum requires the posting of signs at admissions areas instructing patients who have stayed in an Ebola-infected country twenty-one days prior to admission and developed a high fever to immediately report these facts to the receptionist.  The receptionist must instruct these patients and people accompanying them to wear protective masks and wait in an isolated area.[56]

The admissions office must immediately report any such cases to the medical team assigned to conduct a brief interview of the patient to determine if it is required that he/she be isolated.  While conducting the interview the team will wear an N-95 protective mask, face/eyes protector, a robe, and gloves.[57]

When a patient, who is already being treated either at the ER or at another hospital unit is diagnosed with Ebola, he/she must immediately be transferred to a suitable isolation room.  The patient and the treatment team providing care to the patient must wear a surgical mask, and the team must wear protective gear.[58]

2.  Treatment Management of Suspicious Cases

The Memorandum requires that the physician and the nurse responsible for managing a suspected case of Ebola will appoint a treatment team that will treat the patient exclusively.  Team members must wear full protective gear.[59]  Upon admission the patient must be transferred to an isolation room that will be under full supervision to ensure that entry and exit from the room is in accordance with guidelines.  The Memorandum requires the filling out of a special form documenting all persons who were in either direct or indirect contact with the patient prior to the patient’s entry into the room.[60]

The Memorandum limits the number of visitors that can be in touch with the patient and requires that they use the same protective gear required of the treatment team.[61]  It further provides that after complying with all required measures for preventing contamination, the patient must be diagnosed and treated for any additional dangerous diseases he/she might have, particularly those “common among travelers returning from Africa”—diseases whose symptoms may be similar to those of Ebola, including malaria, typhoid, and hepatitis A.[62]

The Memorandum requires preventing the contamination of materials and equipment as appropriate, by full isolation or by sterilization and fumigation.[63]  It also provides specific guidelines for handling and transferring blood and other bodily fluids, for conducting activities that may create aerosols, for procedures involving the use of contained centrifuges, and for the transfer of samples for diagnosing contamination from a patient suspected of having Ebola.[64]

3.  Notice Requirement

The Memorandum imposes on the MOH regional physician the duty of immediately reporting by phone every suspicious case of Ebola.  The regional physician must immediately transmit the information to the heads of the Ministry’s departments of epidemiology and public health services.  The Memorandum requires that all announcements be made exclusively via the Ministry’s Press Release office.[65]

4.  Determination of Treatment Location

Patients must be treated only at hospitals that provide suitable isolation conditions and whose personnel possess the required training and abilities.  The MOH management may decide to transfer a patient to another hospital as needed.  Such a transfer will be conducted in accordance with the protocol on “Encountering an Unusual Biological Event—the First Hours.” [66]

5.  Epidemiological Investigation and Follow-Up of Patients and Their Contacts

An epidemiological questionnaire must be filled out for every case where Ebola is suspected.  The questionnaire, a copy of which is appended to the Memorandum, includes information identifying the patient and his/her residence address, insurance, treating physician and hospital, clinical symptoms, laboratory results, history of travel, and meetings with any person who returned from a foreign country in the twenty-one days before the onset of symptoms (including meetings to medically treat such a person).[67]

B.  Preparedness for and Prevention of Pandemic Influenza

As indicated above, in 2007 Israel’s MOH issued its Pandemic Influenza Preparedness Plan for the Health System.[68]  The Plan provides a list of measures to be employed by HIEs and local and district medical facilities.  The Plan also provides special instructions for the Magen David Adom, Israel’s national emergency medical, disaster, ambulance and blood bank service.[69] 

The Plan lists the following actions to be taken in the community to prevent the spread of disease: 

1.  Public Health Guidelines 

Guidelines regarding the cleanliness of surfaces, personal and respiratory hygiene, and other relevant information related to disease transmission and prevention must be easily accessible to the public via the MOH’s website and influenza pandemic site, and through leaflets titled Hygiene Rules.[70] 

2.  Restrictions on Social Gathering 

Restrictions on social gathering may be imposed, depending on the scope and duration of the contamination and the conditions of the area where it occurs (open or closed).  Schools, day-care centers, and nursery schools may be closed; restrictions may be imposed on the use of public transportation; employees may be encouraged to work from home by phone, fax, computer, etc.; cultural and sports events may be cancelled; and patients may be voluntarily secluded.[71] 

3.  Limitations on Freedom of Movement 

Recommendations to avoid unnecessary travel and restrictions on local and international travel may be issued.  In the event of pandemic influenza occurrences involving transmission from human to human, the recommendations of the WHO and the Centers for Disease Control and Prevention in the United States should be followed.  The Plan also provides for preparing control measures for closed or semiclosed facilities, including elderly homes, military facilities, and prisons.  To reduce the spread of disease in medical facilities through contact between medical teams, the Plan, among other measures, authorizes the organization of labor teams that work in shifts without meeting each other.  The Plan requires the adoption of personal hygiene measures, such as the use of face masks by patients, medical teams, and the public at large.[72] 

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VI.  Transparency of Public Health Crisis Management System 

The Department of Epidemiology of the MOH prepares a weekly report based on data received on communicable diseases in the country.  The reports have been available to the public in paper or digital form since the year 2000.[73]  Israel cooperates with the WHO and provides the organization with data on contagious diseases.  Israel protects freedom of the press, and the public may obtain information through any means of communication.

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VII.  Response to Threats of Chemical and Biological Attacks 

Preparing for chemical, biological or radiological attacks is the responsibility of both the Ministry of Defense Home Front Command and the MOH.  These Ministries have prepared working procedures; stockpiled vaccines, antibiotics, and other medications; and trained health providers for crisis events.  Specific information on such attacks and instructions on how to protect against chemical, biological, and radiological attacks are provided on the website of the Home Front Command.[74]

Information on the state’s preparedness for chemical, biological, and radiological attacks is not easily accessible.  A 2002 report prepared by the Knesset Information and Research Center in anticipation of the 2003 Iraq War states that the reluctance of the Israeli defense system and its MOH to disclose information on the state’s preparedness stems from the concern that this will expose the extent of the state’s vulnerability to such attacks.[75]  The following is a summary of relevant portions of the report. 

A.  General Preparedness 

The general health system has been reportedly prepared, potential threats identified, and operating procedures formalized for hospitals, health clinics, and localities, including procedures for cooperation among the different bodies.  An intensive instruction of thousands of doctors and nurses began at the time the report was issued.[76] 

B.  Anthrax Preparedness 

A health system plan for the treatment of anthrax victims has been prepared.  While most of the treatment would be provided by the HIEs, the health system plan includes immunizations and preventive antibiotic treatments for affected persons.  The report stated that the authorities had a sufficient supply of antibiotic medications for the treatment of anthrax.  The report further recommended not vaccinating the entire population against anthrax because of possible serious side effects.[77] 

C.  Smallpox Preparedness 

It was decided at the time not to vaccinate the entire public against smallpox.  Instead, fifteen thousand medical and security personnel were to be vaccinated, some of whom would be among the first teams to come in contact with future patients.  Approximately six thousand five hundred persons had been vaccinated by October 2002.  These teams would also serve as first reactors from whom antibodies would be extracted to enable countering complications and side effects of the disease.[78] 

The report concluded that there was enough vaccine for the country’s population.  The vaccines and antibiotics are not available at the HIEs, but are kept by the Homeland Command and the MOH.  There were several plans for vaccinating the population that were expected to be implemented on the basis of government decisions or the consequences of an event.[79]

At the time of the report, the MOH had requested the Ministry of Education to prepare three hundred schools around the country to serve as smallpox vaccination centers if the need arose.[80] 

Prepared by Ruth Levush
Foreign Law Specialist
February 2015


[1] State of Israel Ministry of Health [MOH], Memorandum No. 13/14 by Head of Public Health Services (Aug. 7, 2014), http://www.health.gov.il/ hozer/BZ13_2014.pdf (in Hebrew).

[2] MOH, Pandemic Influenza Preparedness Plan for the Health System(updated to June 7, 2007), http://www. health.gov.il/Subjects/emergency/preparation/DocLib/tora/BIO_TORA_PANDEMIC_FLU.pdf.

[3] For information about the Ministry’s vision and activities, see About the Ministry, MOH, http://www.health. gov.il/English/About/Pages/default.aspx (last visited Oct. 14, 2014).

[4] National Health Insurance Law, 5754-1994, Sefer HaHukim [SH] [Book of Laws] (official gazette) No. 1469 p. 156 (5754-1994).

[5] Id. § 3.

[6] Public Health Ordinance No. 40 of 1940, Iton Rishmi [IR] (official gazette during the tenure of the Provisional Council of State) 1st Supp. 191 (1940).

[7] Id. §§ 11–11(A).

[8] Public Health Ordinance (Change of List of Communicable Diseases) Decree (5771-2010), Kovetz Hatakanot (Subsidiary Legislation) 5771 No. 6951 pp. 262–72.

[9] Public Health Ordinance No. 40 of 1940, §§ 13–19.

[10] Id. § 20.  For a discussion of powers provided to public health authorities following the declaration of a serious health danger, see Part IV, infra.

[11] Public Health Ordinance No. 40 of 1940, § 12. 

[12]National Health Insurance Law §§ 40–41. 

[14] Israel Center for Disease Control, The International Association of National Public Health Institutes, http://www.ianphi.org/membercountries/memberinformation/israel.html (last visited Oct. 20, 2014).

[15] Pandemic Influenza Preparedness Plan for the Health System, supra note 2.

[16] Id. at 19–28.

[17] Id

[18] Id. at 25. 

[19] Id. at 26. 

[20] Public Health Ordinance No. 40 of 1940, § 20 (in Hebrew; translation by author, R.L.).

[21] Declaration of a Dangerous Communicable Disease, Yalkut Hapirsumim (Notices – Official Gazette) No. 5945 p. 3536 (2009); for procedures to be followed by health teams, see MOH,General Memorandum by the General Manager Regarding Preparedness for 2009 A/H1N1 Influenza(July 1, 2009), http://www.health. gov.il/hozer/mk30_2009b.pdf.

[22] For a discussion of these powers, see Part IV, infra.

[23] Public Health Ordinance No. 40 of 1940,§§ 13–16. 

[24] Id

[25] Id. § 19.

[26] Id. § 13. 

[27] Quarantine Ordinance (New Version) 5741-1981, §1, 35 Dinei Medinat Yisrael (Nusach Chadash) (the revised, updated, and binding Hebrew text of legislation enacted before the establishment of the State of Israel) p. 747 (translated by author, R.L.).

[28] Quarantine Regulations, 3 Huke Eretz Israel [HEI] [Laws of Palestine] 2170, as amended

[29] Id. § 5. 

[30] Id. § 6.

[31] Id. § 8.

[32] Id. § 9.

[33] Id. §§ 17–19.

[34] Id. § 12.

[35] Public Health Ordinance No. 40 of 1940,§ 15. 

[36] Id. § 20.

[37] Id. § 23.  An extension to airplanes could be interpreted as applying to territorial air space as well.   

[38] Id. § 20(2).

[39] Id. § 20(4)(a).

[40] Id. § 20(4)(b).

[41] Id. § 12(2). 

[42] See Quarantine Regulations, supra note 28, § 14. 

[43] Public Health Ordinance No. 40 of 1940,§ 22.

[44] Protection of Patients’ Rights Law, 5756-1996, SH 327 (5756-1996). 

[45] Basic Law: Human Dignity and Freedom, SH 1391 (9752-1992). 

[46] Protection of Patients’ Rights Law § 20(a)(2).

[47] Basic Law: Human Dignity and Freedom § 8, SH 5752 No. 1391 p. 150.

[48] Press Release, MOH, Guidelines and Preparedness of the Health System Following the Outbreak of the Ebola Virus in West Africa (Aug. 7, 2014), http://www.health.gov.il/NewsAndEvents/SpokemanMesseges/Pages/ 07082014_2.aspx.

[49] Id.

[50] Memorandum No. 13/14 by Head of Public Health Services, supra note 1.

[51] Id. § 1.

[52] Id. at  4–9.

[53] Id. § 1.

[54] Itai Gal, First Publication: This Is How Ebola Patients Will Be Treated in Israel, YNET (Oct. 20, 2014), http://www.ynet.co.il/articles/0,7340,L-4581372,00.html.

[55] Memorandum No. 13/14 by Head of Public Health Services, supra note 1, § 2.1.

[56] Id. § 2.2.1.1.

[57] Id. § 2.2.1.2.

[58] Id. § 2.2.2.

[59] A detailed description of the gear requirements is provided.  Id. § 3.3.1.

[60] Id. § 3.3.2.

[61] Id. § 3.3.3.

62 Id. § 3.3.6.

[63] Id. § 3.10.

[64] Id. § 5.

[65] Id. § 6.

[66] Id. § 7; MOH Emergency Unit, Encountering an Unusual Biological Event – The First Hours (Aug. 2008), http://www.health.gov.il/Subjects/emergency/preparation/DocLib/tora/BIO_TORA_BIO_EVENT_HOURS. pdf (in Hebrew).

[67] Memorandum No. 13/14 by Head of Public Health Services, supra note 1, § 10.

[68] Pandemic Influenza Preparedness Plan for the Health System, supra note 2.

[69] Id. ch. C(6).   

[70] Id. ch. C(7)(a)(1).  

[71] Id. ch. C(7)(a)(2).   

[72] Id. ch. C(7)(a)(3)–(6).   

[73] Infectious Disease Unit, MOH, http://www.health.gov.il/UnitsOffice/ICDC/Units/Infectious_Diseases/Pages/ default.aspx (in Hebrew; last visited Oct. 23, 2014); for weekly influenza status reports, see Weekly Influenza Reports, MOH, http://www.health.gov.il/UnitsOffice/ICDC/Infectious_diseases/Flu/Pages/FWR.aspx (in Hebrew; last visited Oct. 23, 2014).

[74] Chemical Weapons, Home Front Command, http://www.oref.org.il/10648-en/Pakar.aspx (last visited Oct. 23, 2014); Biological Weapons, Home Front Command, http://www.oref.org.il/10649-en/Pakar.aspx (last visited Oct. 23, 2014); Radiological Terror, Home Front Command, http://www.oref.org.il/10654-en/Pakar.aspx (last visited Oct. 23, 2014).

[75] Y. Shai, Immunizations Against Chicken Pox and Anthrax 2, Knesset Information and Research Center (Oct. 20, 2002), http://www.knesset.gov.il/mmm/data/pdf/m00465.pdf (in Hebrew).

[76] Id. § 4(B).

[77] Id. § 4(C).

[78] Id. § 4(D)(1).

[79] Id. § 4(D)(2).

[80] Id. § 4(D)(3).

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Last Updated: 06/09/2015