Damning critique was prepared before coronavirus struck

Comptroller report: Israel’s healthcare system cannot cope with a pandemic

Officials in newly appointed comptroller’s office blast him for delayed publication, saying report was ready months ago, failure to name those at fault means criticism is toothless

Jacob Magid is The Times of Israel's US correspondent based in New York

Israeli firefighter wearing protective clothes disinfects the entrance of the emergency of Hadassah Ein Karem hospital in Jerusalem on March 22, 2020. (Olivier Fitoussi/Flash90)
Israeli firefighter wearing protective clothes disinfects the entrance of the emergency of Hadassah Ein Karem hospital in Jerusalem on March 22, 2020. (Olivier Fitoussi/Flash90)

Israel’s healthcare system is not prepared for the outbreak of a pandemic, the state’s comptroller warned in a report published Monday. Prepared before the coronavirus crisis struck, it offers a chilling warning of the damage the pandemic can wreak, given the lack of strategic planning, funding, equipment and general readiness of the Israeli health service.

“The Health Ministry, the healthcare service providers and the hospital system are not fully prepared for a pandemic flu outbreak,” the report warns, highlighting a lack of hospital beds, isolation rooms, ill-equipped intensive care units and a lack of cooperation between the Health and Defense Ministries.

The audit had been largely completed, according to Hebrew media, in November — months before the coronavirus began raging through China and eventually the rest of the entire world.

State Comptroller Matanyahu Englman’s office had been holding off on its publication until a government was formed, but decided that it was best not to wait any longer, given the current COVID-19 outbreak, according to reports.

State Comptroller Matanyahu Englman holds the 2020 State Comptroller’s Report in his office on March 23, 2020. (Tadmeet)

Based on an audit of various ministries that was conducted between February and October 2019, the report, titled “The health system’s readiness to deal with pandemics,” deals with the possibility of a COVID-19-like outbreak, but also reviews the government’s preparedness for other outbreaks that have happened more recently such as measles or Leishmania.

The report revealed that the Health Ministry does not have a plan to stock its hospitals with enough beds and staff to be prepared for such scenarios.

The report also determined that the telephone services of healthcare providers are not prepared to provide responses to thousands of citizens who would be in need if a pandemic were to break out.

Regarding cooperation between the various government offices, the report cited a drill that was conducted by the Defense and Health Ministries in December 2018 that exposed significant gaps in their preparedness to work together in a time of an outbreak.

The Dan Hotel in Jerusalem that was converted to receive coronavirus patients, March 17, 2020. (Olivier Fitoussi/Flash90)

“The [ministries] must formulate a plan to reduce the gaps that have arisen in the drill, including the need to regulate the issue of authority and responsibility of the various bodies, the lack of prescription drugs and vaccines and how they are to be distributed,” the report said.

Those gaps have surfaced in the real world in recent days, as tensions between the ministries over the proper way to handle the crisis have blown into the open.

Defense Minister Naftali Bennett has demanded his office take charge of the state’s virus response team while officials in the Health Ministry have accused the Yamina chairman of seeking to capitalize off the outbreak for political gain, according to reports in Hebrew-language media.

Moreover, the audit highlighted an insufficient stock of anti-viral medications, which currently is only able to supply 16% of the public when the doomsday scenario practiced for expects 25% of the public needing them. The report also revealed that many of the drugs currently in stock are past their expiration dates.

The state comptroller also urged the Health Ministry to test the ventilators to ensure that they will all work in a time of an outbreak.

Englman acknowledged in the report that the state is in the process of creating a vaccination laboratory, but added that “there is an urgent need to complete the project in order to address the need for vaccines when pandemic influenza breaks out.”

The report also expresses alarm over the steady decline in Israelis receiving vaccinations for the common flu, calling on the Health Ministry to take a more active role in encouraging the public to vaccinate.

Magen David Adom workers at a drive-through site to collect samples for coronavirus testing, Tel Aviv, March 20, 2020. (Tomer Neuberg/Flash90)

The report is based on a World Bank prediction that in the next 15 years, there is a high chance of a pandemic outbreak that would could result in the deaths of millions and economic losses in the trillions.

Preparing for such a doomsday scenario, the Health Ministry drafted a comprehensive martial law plan for a deadly flu pandemic in 2005. The government office then updated it in 2018 based on recent conclusions from the US Centers for Disease Control.

The updated scenario sees 25% of Israel’s population — 2,250,000 people — contracting the virus over an eight week period of time, with the peak being between the third and fifth week.

According to the scenario, 150,000 would require hospitalization, with 25,000 requiring ICU treatment and 12,000 needing to be hooked up to ventilators.

Timing is everything

Speaking to The Marker business daily on the condition of anonymity, an official in the comptroller’s office criticized the decision to wait on publishing the report until weeks after the coronavirus outbreak began spreading through Israel, saying an earlier warning could have helped serve as a wake-up call.

“The report could have been published as early as January, after the last of those audited had sent their responses. There were officials in the office who had requested for it to have been published weeks ago, but for some reason [Englman] chose to release it now, after the pandemic is already at its peak.

Another source in Englman’s office blasted the comptroller’s refusal to name specific officials, companies and offices who were responsible for the faults plaguing the healthcare system.

“Who is the ‘Health Ministry?’ Who are healthcare service providers,” the official said, lamenting Englman’s failure to be more specific.

Matanyahu Englman (R) shakes hands with Prime Minister Benjamin Netanyahu at the Prime Minister’s Office in Jerusalem shortly after being nominated for state comptroller on June 3, 2019. (PMO/Twitter)

“When you don’t name names — the criticism doesn’t reach anyone,” he added.

The criticism expressed by Englman’s own staff is nothing new. Since entering the position last June, the ombudsman tapped by Prime Minister Benjamin Netanyahu has been hit with allegations from officials in the comptroller’s office that he is seeking to neuter its authority.


Responding to the report, the Health Ministry said that it will study the findings of the report and draw the necessary conclusions, while hoping that it won’t be used for unnecessary criticism. that it is struggling to reach the medication benchmarks due to a lack of funds.

It added that it is struggling to reach the medication benchmarks due to a lack of funds.

“The outbreak of the new coronavirus is unique in its power and creates a challenge for all of the world’s health systems,” the ministry said.

Workers inside a building at Tel HaShomer Hospital which was converted to receive Israelis who were under quarantine on the cruise ship Diamond Princess in Japan due to the spread of the coronavirus, February 20, 2020. (Avshalom Sassoni/Flash90)

“The Israeli healthcare system has been readily responding to the outbreak since mid-January, already then purchasing protective and respiratory equipment, and testing kits. Hospitals have been open and ready [to treat patients] with designated departments as have been healthcare service providers.”

“Israel was one of the first countries to understand the severity of the epidemic, and drastic measures were taken to close the country’s borders, led by the National Security Council and the Health Ministry, which were subsequently implemented in almost all countries of the world,” the Health Ministry concluded.

Prime Minister Benjamin Netanyahu issued his own response, which similar to that of the Health Ministry, appeared to refrain from taking responsibility for the faults highlighted by the report.

“No country in the world was prepared for the coronavirus pandemic, the likes of which the world hasn’t seen in 100 years,” Netanyahu said in a statement.

“Thanks to the decisions we made, which preceded those of the rest of the world, Israel is currently better off than many developed countries,” he added.

Netanyahu went on to boast that the Bloomberg index ranked Israel’s healthcare system within the top 10 in the entire world, adding that he had overseen the doubling in the healthcare system’s budget over the past decade.

“However, there is always room for improvement, so I have asked [my office] to study the details of the report as soon as possible,” he said.

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