Various reasons can be suggested as underlying the steep rise in morbidity in Israel in EWII. The natural course of the disease; fast release of WI lockdown; lack of government response to the subsequent rise in morbidity; unclear government instructions after WI lockdown; breaches of the regulations by senior public figures, including the state’s President, Prime Minister, Ministers and senior military officers; breaches of the regulations by ‘rank and file’ Israelis due to economic, social and religious pressures; lack of state assistance to people in various forms of need; large public gatherings, mostly for religious rituals, especially during the holidays, attended by both Jewish and Muslim Israelis; ongoing government overlooking of these various breaches.Footnote 6,Footnote 7 Notwithstanding these factors, the gap between WI and EWII morbidity was exceptional in Israel. First, the ‘remission’ between the two waves was shorter than in other countries, spanning roughly along the month of May 2020, vs. 3–4 months in Germany, or in badly hit Italy and other European countries.Footnote 8 Second, the increase in the severity in EWII was momentous. Whereas the tenfold rise in confirmed cases can be attributed to intensified testing, the soaring percentage of confirmed cases,Footnote 9 the trebled death tollFootnote 10 and the death rate, which quadrupled from 32 per million in WI to 133 in EWII, all attest to the swift and stark increase in the severity of the pandemic during the summer of 2020.
These figures gain additional weight when compared with those of other countries. To this end, we explored the situation in the period of February to September 2020 in several pandemic stricken European countries of relatively similar population scale: Norway, Austria, Sweden and Ireland. Compared to these countries, in Israel, the gap between the severity of WI and that of EWII was wider than in any of the observed countries (Case Proportion, EWII/ WI was 8.6 in Israel vs. 1.2–2.2 in the other countries), as was the rise in the proportion of death rates (Death Proportion, EWII/ WI was 3.7 in Israel vs. 1.1–1.3 in the other countries). Given Israel’s exceptionally young population, its island-like situation (i.e., its single international airport), its hot summer months that might have slowed down the virus spread, the deterioration is especially alarming, raising questions regarding the factors that might have underlain it.
Several structural factors seem to have obviously facilitated the disease spread. Israel’s population density is extremely high, exceeding those of all OECD country, but the Netherlands and South Korea.Footnote 11 High fertility rates of over three children per woman, result in large families that often live in small apartments, sometimes, in multigenerational families, and are therefore more likely to suffer from domestic contagion. Some sectors lead traditional lives that entail large social gatherings for family and religious events. In such communities, breaches of government pandemic dictates were routine. Indeed, reluctance towards government restrictions has widened as the pandemic progressed and gradually included also diffused public criticism and countrywide demonstrations.Footnote 12
What was the government’s response to these dynamics? As mentioned, the government’s strategy has changed dramatically over the scrutinized period. Starting out from tight lockdown, early on in WI, it moved on to withdrawal of social restrictions and reluctant enforcement in EWII. According to the Oxford Government Response Stringency Index (GRSI), based on 18 indicators,Footnote 13 the response of Israel’s government to WI was swift and stringent, followed by a gradual relaxation of restrictions. Interestingly, the government continued to reduce the stringency of its response throughout the summer of 2020, when the morbidity was steeply resurging, with daily confirmed cases rising from several dozen in early June to over 6000 in mid-September. From mid-August, Israel’s government sustained its exceptionally low level of 34 on the GRSI, while Covid-19 morbidity and mortality were soaring.Footnote 14
Notably, between June 29 and August 17, when the number of daily confirmed cases climbed from 800 to 2071, Israel’s government kept lowering the stringency of its response from 75 to 34. In the subsequent month, from August 16 to September 17, Israel’s government retained its response at a stringency level of 34, lower than that of Sweden, while the number of newly diagnosed cases trebled from a 7-day average of 1383 to 4247 and the number of severely ill Israelis climbed by roughly 50%, from 382 to 573.
Under these epidemiological and political circumstances, how did the pandemic spread impact various local subpopulations? As revealed by the preceding analysis, dense, poor, young communities were especially infected. Prominent in this category were UO communities, followed by Arab ones. In UO communities, both the density and poverty have been largely shaped by the communities’ own preference of exceptional fertility rates and low male participation in the labor market, due to prioritization of Judaic studies over gainful employment. In the Arab sector, the crowdedness and poverty were primarily imposed from the outside by decades of discriminatory state policies that marginalized Arab Israelis in education and the labor market. During the pandemic, Arab communities, that were less intensively supported by state allowances and foreign charities (compared to UO communities), were economically injured more pervasively by the lockdowns (Reznikovski, unpublished).
Throughout the pandemic, these two sectors were repeatedly condemned for conducting large scale social and religious gatherings. Several points need to be noted in this context. First, Covid campaigns in ArabFootnote 15 and UOFootnote 16 communities were substantially deficient in the pandemic early days, as compared to campaigns conducted in other communities, resulting in belated and more partial response to the pandemic outbreak. Second, the majority of the communities in both sectors abided by the regulations and significant breaching was observed only in few particular communities. In this respect, the public discourse, which often lumped together ‘the UO’ or ‘the Arabs’ as monolithic entities, was did not do justice to these communities of humble means.
More generally, both the UO and the Arab sectors have been socially and politically marginalized in Israel’s public arena for years. The communities’ members live in their own segregated towns, mostly working in sectorial work places and marrying internally. Even linguistically, in the Arab sector and in substantial portions of the UO sector, the spoken languages – Arabic and Yiddish, respectively – are not the country’s official language (which is Hebrew). Politically, too, despite their dramatically different positions in the state’s power structure, both these sectors have been alienated from Israel’s hegemonic Zionist ethos, from the country’s symbolic center and its national narrative and are have been represented by their own sectoral parties since the founding of the State of Israel. Materially, this alienation manifests also in exclusion from the state’s security bodies. Whereas one can dispute the merits of serving in these bodies, participation in any of them is a source of ample material and social benefits, of which both these sectors are excluded. This separateness has probably contributed to the communities’ approach that underlay pervasive non-adherence to government guidelines during EWII.
What were the internal circumstances of the pandemic in these sectors? In UO communities, numerous families regularly depend on various types of allowances, most of which have remained intact. These allowances, alongside the highly organized community charities that operate regularly in the UO sector, have protected many UO families. However, the closure of the educational system has brought home many teenage children, who normally attend boarding schools, and rendered the small apartments even denser than they routinely are. The congestion of large families in small spaces increased the risk of contagion. In some cases, it also flared up domestic violence. Though family problems are extremely under-reported in UO communities, preliminary accounts estimated that UO domestic violence calls have quadrupled during the pandemic.Footnote 17 The lack of internet access, due to ideological rejection, impacted UO children, who were cut off from their peers and teachers even more than their non-UO peers. Telephone based distant studies were established but worked rather poorly.
In the Arab sector, families and communities sustained over 30% of unemployment and unpaid leave from the early days of the Covid-19 outbreak in Israel. Following this financial decline, 42% of Arab families sunk below the poverty line. Loan applications were, however, mostly declined by banks and other official lenders, thereby forcing people in need to withdraw money from pension savings or else issue grey market loans. Soon thereafter, people who were unable to repay their loans and the high interests they incurred, faced lenders’ violent reactions, which were part of a broader, steep rise in rates of local violent crime. In line with this state of affairs, 30% of Israel’s Arab citizens – twice the percent of Jewish Israelis – have reported, during the pandemic, feelings of insecurity, stress, anxiety and depression and described their psychological state as negative.Footnote 18 Children in Arab families, who had insufficient internet access, could not fully participate in online schooling. Domestic violence has also soared. In the first 7 months of 2020, 50 Arab Israelis were killed due to violence. Eight of the victims were women. Insufficient police presence and distrust in its service greatly contributed to the deterioration.Footnote 19
Problems and strain of various types abounded, however, also beyond these two sectors. The novelty and volunteering that dominated WI gave way to growing routinization, spreading social, psychological and economic distress, especially in disempowered settings. Economic difficulties and concerns also deepened. In order to assess the scope of the impact, we need to look at the Israeli landscape before the pandemic outbreak.
Israel’s cost of living has been extremely high for years, ranked seventh in the world.Footnote 20 The mounting prices affected even the most basic products like food and electricity and contributed to growing inequality and class polarization.Footnote 21 Of all Israeli workers, just over one quarter (27%) are unionized [5, 6], leaving the rest largely unprotected. Small business owners and employees are especially exposed to market fluctuations and have been defenseless in the face of the pandemic-induced commercial slowdown. The first wave broke out when less than 200,000 Israelis were unemployed. The second wave evolved with nearly 900,000 people on unpaid leave or unemployment benefits. The economic impact was colossal.
During the pandemic first months, state support to businesses was minimal and applied only to particular categories.Footnote 22 Bureaucratic hurdles made it hard for beneficiaries to receive these allowances even when they were entitled to.Footnote 23 For many small-scale entrepreneurs, who had taken loans in order to survive the first lockdown and subsequent business decline, the scarce state support and then the second lockdown, were fatal. Numerous small businesses were forced to close down, at first, temporarily and then permanently [7]. A senior economist estimated that some 80,000 businesses, representing a fifth of the country’s businesses, were facing financial collapse, and predicted that hundreds of thousands of workers on unpaid leave, will not manage to go back to work.Footnote 24 The scope of the expected economic crisis has been so momentous that the police has developed plans for tackling the potential tide of crime. As part of this forecast, a steep rise was expected also in the number of new prisoners as well as women who would be forced to turn to sex work.Footnote 25 At that very time, a policy modification allowed company owners to distribute exceptional benefits they had been ‘caging in’ for years, at greatly reduced taxes.Footnote 26
Social crises also proliferated. Women, in general, have been overrepresented among the pandemic various victims. In September 2020, women comprised 62.7% of unemployed Israelis or those on unpaid leave, roughly twice as men.Footnote 27 In the private sphere, women in abusive relationships were under greater threat. During the month of September, domestic violence reports trebled as compared to the previous year.Footnote 28 In specific time intervals, the proportion increased fiveFootnote 29- to tenfold.Footnote 30 Between March and mid-October 2020, 17 women were killed, most of them, by their partners.Footnote 31 This figure represents a 50% annual increase vis-à-vis the previous decade’s average.Footnote 32
Adolescents and young people have also been vulnerable to the tide of morbidity. The number of calls to a domestic violence hotline for youths aged 18–20 increased by 500% vs. 2019.Footnote 33 Tens of thousands of calls from pupils reported psychological distress to Israel’s Ministry of Education hotline. An official report assessed that roughly a quarter of Israeli school students experienced stress, loneliness, anxiety, domestic violence and risk behaviors in EWII.Footnote 34 With two thirds of the children reporting inability to participate effectively in online learning, damage was also accumulating in the educational sphere. A similar proportion of school pupils said they were spending most of the time on their own.Footnote 35 Children with special needs have been at an even higher risk for various forms of deterioration and harm.Footnote 36
As elsewhere, elderly people were especially hit by the pandemic also in Israel. As of October, the average age of the dead was 79.5 and the median age was 82. Female victims were slightly older (81.9) than the male (77.6).Footnote 37 As common in Israel, many of the people in this age group were accustomed to routine frequent gatherings with family and friends. The pandemic has brought an end to these gathering and exacerbated anxiety and loneliness among many elderly Israelis. In a recent report, half the participating elderly people said they were feeling lonely.Footnote 38 The number of lone elderly people who have died in the pandemic months have risen by 47% as compared to the previous year (ibid).
People who were subjected to social exclusion before the pandemic were particularly harmed by its spread. Prisoners had their home and prison visits cancelled and suffered restricted access to healthcare. Given that roughly 40% of prisoners are diagnosed with chronic illnesses and 73% have had previous psychiatric referrals, and given the growing portion of elderly prisoners, the health implications of the limitations on care services were especially grave in this population.Footnote 39 People living in Israel as undocumented or stateless residents, e.g., foreign workers, asylum seekers or Palestinians and tourists who have overstayed their visas, remained completely vulnerable. Many of these people have lost their jobs and were not entitled to any financial or logistic support from the state. Among asylum seekers, about 80% have become unemployed. Requests for food, especially babies’ food, have doubled, primarily on the part of single mothers.Footnote 40 Due to the fear of contagion, the state has decided to provide pandemic-related medical treatment to these individuals and communities, who are normally prevented from obtaining medical insurance. This support was, however, minimal and in many cases, ineffective as it had not been planned to match the needs of the population at hand.Footnote 41 In a recent letter to the heads of state, community activists described how they had managed to survive the first pandemic wave, with the aid of volunteers and NGOs. However, in EWII, “the economic and psychological situation of our community is catastrophic. The community is in a state of complete uncertainty and helplessness.”Footnote 42
A pandemic is, evidently, a major social, economic and political crisis. As such, it is reflective and formative of its social context. In Israel, years of underfunding of the health and education systems, growing social fragmentation and economic polarization have preceded the pandemic. Already before the pandemic, 18% of Israeli families and 30% of Israeli children lived beneath the poverty line. Among Arab Israelis, 45% of families were below the poverty line. Poverty among women is 21% higher than among men. Gini coefficient index is roughly 10% higher in Israel than in developed countries.Footnote 43 These gaps have all surfaced and intensified when the state has withdrawn from disease containment following WI lockdown and allowed the pandemic to further spread.
Evidently, the prolonged duration of the pandemic has in itself had its impact. Some of the difficulties depicted above piled up in many communities, well beyond Israel. And yet, the striking differences between the government’s policy in the pandemic’s first wave and the early second wave suggest that grater government involvement and support, as well as stricter enforcement might better protect vulnerable populations, including minority, poor and elderly women and men. The very emergence of the second wave and its exceptional enormity, may possibly be related to the belated, undecided government response to the soaring morbidity that placed Israel far below other island countries that managed to contain the pandemic.
Israelis were this badly hit by the covid-19 pandemic. At the time of this writing, nearly 5500 Israelis have died of the disease, representing 600 deaths per million. People suffering all forms of disadvantage have been especially implicated, paying the price of what appeared to be a politicized, reluctant government policy that let the pandemic take its natural, lethal course.