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A healthcare worker prepares a shot of the Pfizer-BioNtech COVID-19 vaccine at a clinic in the Negev's main Bedouin town of Rahat, on February 17, 2021. (HAZEM BADER / AFP)
A healthcare worker prepares a shot of the Pfizer-BioNtech COVID-19 vaccine at a clinic in the Negev's main Bedouin town of Rahat, on February 17, 2021. (HAZEM BADER / AFP)
ToI investigates

Remote, fearful and suspicious: Why Israel’s Negev Bedouin remain unvaccinated

Nearly 5 months into Israel’s immunization drive, only 38% of eligible Bedouins have gotten a dose despite warnings of another wave among the community; Bedouin MK: ‘I’m scared’

BIR HADAJ, southern Israel — Five months of government campaigning to vaccinate Israeli citizens against the coronavirus have left little trace in the southern Bedouin town of Bir Hadaj.

Bir Hadaj has the dismal honor of being the country’s least-vaccinated municipality. Just 2 percent of the town’s 2,000-odd residents are vaccinated; in the median Israeli city, some 56% of total residents are immunized.

“There are people here who would rather die than be vaccinated,” said Salim Denfiri, a Bir Hadaj resident.

Denfiri says he decided to get immunized. But when he tried to convince his nearly 100-year-old mother, she asked him if he was trying to “finish her off,” he said.

“People are scared of the vaccine here. They don’t listen to medical authorities, and many aren’t convinced the coronavirus is real,” said former Bir Hadaj town council member Salman ibn Hamid, who now serves as director-general for the Neve Midbar Regional Council.

Bir Hadaj is no isolated holdout. While around 85% of eligible Israelis have been immunized against coronavirus, only 38% of Arab Bedouins have gotten a shot, according to Israel’s Health Ministry.

The sun goes down in Bir Hadaj, on April 27, 2021 (Aaron Boxerman/The Times of Israel)

The crisis is deepest in the “unrecognized villages” — townships considered illegal under Israeli law. Around one-third of the Negev’s 290,000 Bedouin residents live in such communities, many of which have existed for decades without state recognition.

Mostly cut off from state-provided water and electricity, the townships have long constituted a thorny policy issue. The Israeli government, which considers such villages illegal, has sought to relocate the Bedouin to planned towns connected to utilities. But residents have long insisted on their right to remain where they are.

The result, activists, health officials, and politicians say, is deep mistrust in anything that comes from the state — including a potentially life-saving vaccine.

According to official Health Ministry figures, only around 13 percent of those eligible for the vaccine in the unrecognized villages have been vaccinated. But the true number is likely closer to 10 percent, as the Health Ministry’s population estimate lags at least 20,000 people behind that most other government agencies.

“When I got vaccinated in January in Beersheba, I was the only Arab among a thousand Jews,” said Najib Abu Bunay, a factory worker and translator who lives in Wadi al-Na’am, the Negev’s largest unrecognized village.

According to Abu Bunay, some of Wadi al-Na’am’s 15,000 residents have been vaccinated in the meantime — in part thanks to two national health maintenance organizations that brought the vaccine to the village. But many remained to be immunized, he said.

Najib Abu Bunay, a resident of the unrecognized village of Wadi al-Na’am, on April 27, 2021 (Aaron Boxerman/The Times of Israel)

The pandemic appears to have largely spared Bedouins thus far, thanks to the overwhelming youth of the population — more than half are under the age of 16, making them less susceptible to serious illness caused by the virus — and the communities’ relative isolation.

“The unrecognized villages had infections, sure, but far fewer than in the rest of the country. We live apart from everyone else. There’s little exposure the way there is in a major city,” said Atiya al-Asam, who directs an unofficial municipal council of unrecognized Bedouin townships.

The low rate of disease thus far has lulled Bedouin communities into a state of complacency, said Dr. Mazen Abu Siyam, who directs a coronavirus response center in the Rahat municipality.

“It’s apathy more than it is fear. I don’t expect the vaccination rates to rise very much, maybe four or five percent, no more than that. There’s a lot of indifference,” said Abu Siyam.

But as Israel lets down its guard from a long, bitter year of grappling with the pandemic, there is real concern for whole Bedouin communities that have yet to be vaccinated.

“There’s serious concern that we could see another coronavirus wave among Bedouin. In hospital coronavirus wards, we’re seeing almost entirely Arab patients. There’s no one left besides them,” said Dr. Ali Alhoashle, who directs medical operations in Israel’s Southern District for the country’s largest health management organization, Clalit.

Bedouins along with other Muslims are currently observing the month-long Ramadan holiday, which often sees large gatherings. After Ramadan comes an onslaught of weddings — the same events that led to a dramatic rise in coronavirus cases among Arab Israelis last year.

“I’m scared, honestly. I’m concerned about the onset of the wedding season. The country is reopening. If we don’t continue to work on this issue, we’ll have a serious problem on our hands,” said Ra’am MK Saeed al-Harumi, a resident of the recognized Bedouin town of Shaqib al-Salam, or Segev Shalom.

‘No great response’

From the beginning of Israel’s mass vaccination campaign, Arab Israelis lagged behind. Some health officials pointed to the spread of fake news in Arab Israeli communities, while others blamed poor planning on the part of health authorities.

“When we opened our first stations in Rahat, for example, we’d see one Arab for every 100 Jews showing up — in an Arab town! People were very frightened, and the turnout was consequently very weak,” Alhoashle said.

A herd of sheep in a Bedouin village in the Negev Desert in southern Israel, January 21, 2017. (Nati Shohat/Flash90)

As the months passed, through a mixture of consciousness-raising and efforts to make the shot accessible, Arab Israelis went off to be vaccinated as well. As of Sunday, around 78% of Arab citizens over the age of 16 had received at least one dose of a COVID-19 vaccine, compared with 85% of their Jewish counterparts.

But Negev Bedouin residents never caught up with the rest of the country. Over 144,000 Bedouins have yet to be vaccinated — and in the past 10 days, just 300 got a shot, Siyam said.

“At the beginning of April, there was a slight increase in the number of those being vaccinated, but we’ve reached a kind of plateau,” said Dr. Na’im Abu Freiha, who runs a union of Negev Bedouin doctors.

The figures have sent officials to mulling over the reasons for the unvaccinated thousands. Most agree that fear and mistrust of the vaccine and lack of accessibility both play roles, although they disagree as to how much weight to give each factor.

“They say it sterilizes you. Or that it will kill you after two to three years. In general, no one believes in its effectiveness,” said Denfiri.

Bedouins rarely get vaccinated in a normal flu season, Alhouashle noted. Denfiri agreed: “This is the first time in 50 years that I got a flu shot. Every year, they’d tell us to get vaccinated and I didn’t.”

Ali Alhouashle, who directs Clalit’s Southern District (courtesy)

But the coronavirus vaccine also reached Israel’s Bedouin citizens relatively late. Israel’s vaccination campaign began in major cities, then spread to smaller towns. It reached the constellations of tiny periphery villages last.

Once the vaccine did arrive, it was not always directly accessible within the unrecognized townships: most do not have health clinics where the vaccine can be easily dispensed. The towns, after all, are illegal under Israeli law, and thus often do not enjoy basic public services.

“The vaccine, in general, is not accessible within the unrecognized villages. In order to get the vaccine, one must often leave a village to head to another area,” Abu Freiha said.

Some unrecognized villages, such as Wadi al-Na’am, are close to main thoroughfares and bus stops. But many others lack access to public transportation.

“Not only is there often no public transportation inside villages. In addition, many villages don’t have a close bus station along the length of the main highway on which they are located,” said Ella Gil, an urban planner at Sikkuy, a nonprofit that works to advance equality and partnership between Arab and Jewish citizens of Israel.

“When you add all of these factors together, access to health services is very low, and arriving can be quite complex,” Gil added. “It can be a full day’s errand. Not because the distance is far. But the time it takes to arrive makes it so.”

Health authorities say they have made efforts to make the vaccine available in the dozens of recognized and unrecognized townships across the Negev and encourage Bedouins to get immunized, despite the logistical challenges.

“The Health Ministry makes the vaccines accessible through mobile vaccine stations that come to the towns themselves,” the ministry said in response to a query by The Times of Israel.

Yet local Bedouin residents have rarely turned out even when the vaccine was brought to their doorstep. With the advent of Ramadan — when waking and sleeping hours turn upside down for many Muslims — health officials set up mobile late-night vaccine stations open from 8 p.m. to midnight.

Women wait for their turn to get vaccinated against the COVID-19 coronavirus at a clinic in the Negev’s main Bedouin town of Rahat, on February 17, 2021. (HAZEM BADER / AFP)

In the recognized community of Abu Tlul — where only 6% of the 2,000-strong town is vaccinated — only a few Bedouin trickled in to get a shot when such a station was set up last week. The site was chosen for its proximity to numerous unrecognized Bedouin townships.

“We’d hoped to vaccinate around 150 people, but only around 23 got a shot,” said deputy coronavirus czar Ayman Seif, who coordinates the government fight against the virus among Arab Israelis. “Again, we’re not seeing a great response.”

Health officials have become more hesitant to send out vaccine stations, worried that the fragile doses will simply go to waste. Unlike most other vaccines, batches of coronavirus doses expire quickly once unsealed.

“Take Bir Hadaj — we opened a vaccine center there for five days. But only one or two people showed up. You can’t keep bringing vaccines that you then end up having to throw away three or four days later,” Alhouashle lamented.

With most Israelis now vaccinated in any case, health care providers have also begun shuttering the emergency clinics and mass vaccination sites that brought the doses to nearly every corner of the country. But the result may be the Bedouins have, in a sense, missed their shot.

“There was a period when we’d fixed the accessibility problem. But as infections dropped across the country, many of the places that used to vaccinate people closed. They say, ‘we can’t put our medical teams to work for hours and see maybe 5, 6, 10 people arrive to get vaccinated,’” said Seif.

‘It’s all a matter of trust’

Bedouin have lived in the Negev desert for generations. Many have traditionally herded flocks of sheep and goats for a living, eschewing fixed settlement in favor of a nomadic lifestyle.

Since Israel’s establishment in 1948, authorities have sought to relocate the Bedouin to recognized towns. The planned Bedouin living areas feature public utilities such as water and electricity, which the government does not provide to unauthorized settlements.

But many residents oppose moving to the planned cities, demanding the right to remain in their homes. They ask for recognition on the spot or, occasionally, refuse to recognize the state altogether.

As a result, tens of thousands of Bedouin live in villages that, according to Israeli law, do not exist. While Israel rarely conducts mass expulsions, the government regularly demolishes illegal homes and other structures in the villages, contending that they are enforcing the law against squatters.

The ongoing struggle has sown deep mistrust between Bedouin in the unrecognized villages and the state — even over a potentially life-saving vaccine, residents, policymakers, and health officials said.

“All of this is a matter of trust,” Ra’am MK al-Harumi contended, referring to the willingness to take the COVID-19 shot. “And the demolitions destroyed the trust between the Bedouin and the state.”

In the early days of the coronavirus pandemic, Health Ministry vehicles came to some of the unrecognized villages to distribute flyers warning about the dangers of the rapidly spreading virus. As soon as they saw the cars, residents would flee — fearing the flyers were home demolition orders, al-Harumi said.

A view of the Bedouin town of Hura in the Negev Desert, south of Beersheba, (Hadas Parush/Flash90)

“People doubt everything that comes from the government. The harsh circumstances in which people live have created a rift between the state and citizens. They don’t believe that the Health Ministry is their ministry, a government body that ought to serve them too,” said al-Harumi.

The demolitions continued apace throughout the coronavirus pandemic. Some 1,600 structures were bulldozed or confiscated by Israeli authorities in the unrecognized villages in 2020, al-Asam said.

Health officials say they conduct intensive efforts to raise public awareness, seeking to draft local leaders, activists and religious authorities into the fight.

“For a while, we even had doctors go down a list of numbers to call people and personally implore them to take the vaccine,” said Alhouashle, the Clalit official.

Wadi al-Na’am resident Abu Bunay dismissed the campaign as insufficient.

“These were mostly social media campaigns, and people aren’t active on Facebook. When local doctors here in Wadi al-Na’am worked to reach people at home — not on the phone; at home — that changed things. And people got vaccinated. But the campaign didn’t last,” Abu Bunay said.

In recent months, another campaign — the race for the 24th Knesset — took over the airwaves. Public figures threw themselves into the battle for votes. The fight against coronavirus, meanwhile, took a backseat.

MK Said al-Harumi. (courtesy)

“Rather than focus on the coronavirus problem, we spent our time campaigning,” al-Harumi admitted. “The elections set everything back somewhat.”

Abu Banay expressed optimism that a renewed push to knock on doors in Bedouin communities could finally get their residents vaccinated.

“The campaigns so far haven’t reached the unrecognized villages. But when you reach people at home — that has an enormous impact. We could see the scene totally transform in a few weeks,” Abu Bunay said.

But Naim Abu Freiha, the veteran Bedouin physician, held out little hope for success. Fear and apathy are simply too entrenched in some communities, while the vaccine is not fully available in others, Abu Freiha argued.

“I used to be much more optimistic,” Abu Freiha said with a sigh. “But after a year of fighting on this issue, and seeing even the educated refuse to be vaccinated — I’ve had to become more realistic.”

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