How The Russian Crisis Hurts Medical Tourism In Israel

Nurses in Assuta Haifa hospital, Israel
Nurses in Assuta Haifa hospital, Israel
Diana Bahur-Nir

JERUSALEM — Three patients are sitting in the spacious waiting room at the offices of the Israeli medical tourism agency iMer. Through the large glass windows of its offices inside the Hadassah hospital in Jerusalem, they can see the scenic Ein Karem valley with the surrounding mountains and green forests.

Despite the breathtaking biblical landscape, the visitors are not in town for any exclusive spa treatment: indeed, the kerchief one of them is wearing suggests she has come for chemotherapy.

All three are Russian nationals, wealthier than the average but not particularly rich. What they all have in common is a very low degree of trust in their own country's healthcare system.

“When I was diagnosed with a brain tumor a year and a half ago in Russia, I was told I had six months to live,” says Dimitry Vassiliev, the marketing director for Audi Russia.

The 33 year-old is young and handsome and wears designer clothes. Only from a specific angle can one see an indentation in his skull, a hint of the surgery to remove the tumor he had undergone in Russia before coming for therapy in the Israeli hospital.

“They told me this is it, and there's not much that can be done to help you. But when you want to live — you would do anything,” he says. “We haven't sold a house or a car yet, but we did sell everything else we could. I also have colleagues helping, but if prices keep going up, no patients will come here anymore.”

Foreigners have been coming to Israel for medical treatment on an ad-hoc basis for the past 20 years. But only in the past decade has it turned into a full-fledged industry. iMer was founded in 2004 and targets patients from Eastern Europe, the Balkans, though mainly Russia and other former Soviet countries. Private hospitals in Israel were also quick to join the trend, and 2012 marked the peak of Israel's medical tourism business with direct income at no less than half a billion shekel ($129 million).

But a chain of events, culminating in the ongoing financial crisis in Russia, has led to a dramatic decline in Israel's medical tourism sector. What domestic public outrage, and even a harsh State Comptroller report, did not manage to do, Russia's annexation of Crimea and the ensuing collapse of the ruble did.

Dany Engel, marketing director at the Assuta Medical Centre, said 2014 was the tipping point. “It started with TV show Uvda (whose investigation showed senior surgeons asking tourists for extra cash under the table for treatment). The investigative piece quickly started circulating in Russian media, and we suffered the consequences that we're seen in a bad light abroad.”

In addition, new measures introduced by the Israeli health ministry to regulate medical tourism have hit the industry hard, says Engel, also citing last year's war in Gaza.

Perfect storm

But the major difficulties appeared on the Russian side, conspiring to bring about the inevitable collapse. “The international sanctions on Russia, following its annexation of Crimea, have meant troubles for Russian credit card owners and money transactions,” explains Engel. “Also, Putin prohibited public sector employees from receiving medical treatment abroad and then, the ruble collapsed. This was the hardest hit.”

Sheba hospital has seen its 2012 income from the industry of 120 million shekel halved by 2014, says director general Prof Zeev Rotstein. “The biggest success of the Israeli medical tourism industry in recent years was reaching beyond the oligarchs class,” he says. “But at times of economic crisis, this is the population that's hardest hit.” So practically for the average Russian, this has meant that Israeli medical treatment, priced in US dollars, has doubled.

So, where have all the foreign patients gone? Mostly to Germany, whose healthcare system's quality is comparable to Israel's and who saw a similar numbers of Russian medical tourists through the years. And now, after not only the ruble fell but also the euro has weakened, the German medical tourism business is enjoying a relative advantage.

In fact, realizing this new reality, Israeli medical tourism firms have also started referring Russian patients to Germany.

At the same time, new partnerships have started emerging inside Russia. “When people have no money they start looking for healthcare in their own country. This has led to initiatives of businessmen and doctors, from Israel and from Russia, to establish Israeli-branded clinics and hospitals in Russia,” says Jacky Ovadia, formerly the CEO of the Israeli medical tourism association and today a business development consultant. Others in the sector are now looking to establish a medical tourism industry in Cyprus that could employ Israeli doctors.

A Turkish cure

Meanwhile, Turkey is also keen to cash in on the trend, and has begun a massive investment to attract Russian patients. The Turkish government has made the medical tourism sector a national growth objective, no less than pleasure tourism. Turkey's health ministry is actively working to open clinics, rehabilitation centers and other medical facilities where 85% of the patients are supposed to be foreigners and the majority of the doctors will also be specialists from abroad.

But Israeli medical tourism advocates are not giving up just yet. While waiting for the ruble to recover, they try to find other countries from which they can attract patients for treatment in Israel.

“We are looking for a Plan B and that means we're considering offers coming from new markets, even China,” says Engel. “It has been a two decades long work. If we start building a Chinese market now, I don't know when it would take off. And unlike Russians, how can an Israeli doctor communicate with a Chinese patient?”

Sitting in iMer's waiting room, Sergey, a 50 year-old contractor and a residential building owner from a town in northern Russia, is waiting for treatment for an oncological problem. Asked why he came to Israel, he appears to be offended: “Do we need to die because our homeland doesn't have proper healthcare?” he responds.

“What most upsets me,” he adds, “is that my Israeli oncologist studied in Russia. Your doctors acquired their knowledge in our country, the best ones came here and we were left with nothing. I don't know what's the problem with our healthcare system, why there is such a lack of trust, but something in the system is built wrong and it's not a matter of resources.”

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How Thailand's Lèse-Majesté Law Is Used To Stifle All Protest

Once meant to protect the royal family, the century-old law has become a tool for the military-led government in Bangkok to stamp out all dissent. A new report outlines the abuses.

Pro-Democracy protest at The Criminal Court in Bangkok, Thailand

Laura Valentina Cortés Sierra

"We need to reform the institution of the monarchy in Thailand. It is the root of the problem." Those words, from Thai student activist Juthatip Sirikan, are a clear expression of the growing youth-led movement that is challenging the legitimacy of the government and demanding deep political changes in the Southeast Asian nation. Yet those very same words could also send Sirikan to jail.

Thailand's Criminal Code 'Lèse-Majesté' Article 112 imposes jail terms for defaming, insulting, or threatening the monarchy, with sentences of three to 15 years. This law has been present in Thai politics since 1908, though applied sparingly, only when direct verbal or written attacks against members of the royal family.

But after the May 2014 military coup d'état, Thailand experienced the first wave of lèse-majesté arrests, prosecutions, and detentions of at least 127 individuals arrested in a much wider interpretation of the law.

The recent report 'Second Wave: The Return of Lèse-Majesté in Thailand', documents how the Thai government has "used and abused Article 112 of the Criminal Code to target pro-democracy activists and protesters in relation to their online political expression and participation in peaceful pro-democracy demonstrations."

Criticism of any 'royal project'

The investigation shows 124 individuals, including at least eight minors, have been charged with lèse-majesté between November 2020 and August 2021. Nineteen of them served jail time. The new wave of charges is cited as a response to the rising pro-democracy protests across Thailand over the past year.

Juthatip Sirikan explains that the law is now being applied in such a broad way that people are not allowed to question government budgets and expenditure if they have any relationship with the royal family, which stifles criticism of the most basic government decision-making since there are an estimated 5,000 ongoing "royal" projects. "Article 112 of lèse-majesté could be the key (factor) in Thailand's political problems" the young activist argues.

In 2020 the Move Forward opposition party questioned royal spending paid by government departments, including nearly 3 billion baht (89,874,174 USD) from the Defense Ministry and Thai police for royal security, and 7 billion baht budgeted for royal development projects, as well as 38 planes and helicopters for the monarchy. Previously, on June 16, 2018, it was revealed that Thailand's Crown Property Bureau transferred its entire portfolio to the new King Maha Vajiralongkorn.

photo of graffiti of 112 crossed out on sidewalk

Protestors In Bangkok Call For Political Prisoner Release

Peerapon Boonyakiat/SOPA Images via ZUMA Wire

Freedom of speech at stake

"Article 112 shuts down all freedom of speech in this country", says Sirikan. "Even the political parties fear to touch the subject, so it blocks most things. This country cannot move anywhere if we still have this law."

The student activist herself was charged with lèse-majesté in September 2020, after simply citing a list of public documents that refer to royal family expenditure. Sirikan comes from a family that has faced the consequences of decades of political repression. Her grandfather, Tiang Sirikhan was a journalist and politician who openly protested against Thailand's involvement in World War II. He was accused of being a Communist and abducted in 1952. According to Sirikhan's family, he was killed by the state.

The new report was conducted by The International Federation for Human Rights (FIDH), Thai Lawyer for Human Rights (TLHR), and Internet Law Reform Dialogue (iLaw). It accuses Thai authorities of an increasingly broad interpretation of Article 112, to the point of "absurdity," including charges against people for criticizing the government's COVID-19 vaccine management, wearing crop tops, insulting the previous monarch, or quoting a United Nations statement about Article 112.

Juthatip Sirikan speaks in front of democracy monument.

Shift to social media

While in the past the Article was only used against people who spoke about the royals, it's now being used as an alibi for more general political repression — which has also spurred more open campaigning to abolish it. Sirikan recounts recent cases of police charging people for spreading paint near the picture of the king during a protest, or even just for having a picture of the king as phone wallpaper.

The more than a century-old law is now largely playing out online, where much of today's protest takes place in Thailand. Sirikan says people are willing to go further on social media to expose information such as how the king intervenes in politics and the monarchy's accumulation of wealth, information the mainstream media rarely reports on them.

Not surprisingly, however, social media is heavily monitored and the military is involved in Intelligence operations and cyber attacks against human rights defenders and critics of any kind. In October 2020, Twitter took down 926 accounts, linked to the army and the government, which promoted themselves and attacked political opposition, and this June, Google removed two Maps with pictures, names, and addresses, of more than 400 people who were accused of insulting the Thai monarchy. "They are trying to control the internet as well," Sirikan says. "They are trying to censor every content that they find a threat".

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