Challenges in societal integration

The difficulties encountered by Ethiopian-Israeli citizens are indicative of challenges faced by immigrants, refugees and communities that have undergone a dramatic shift in their geographical and cultural context.1

The change in lifestyle from Ethiopia to Israeli absorption centres and cities led to culture shock and social upheaval in the community.11 The extended family support structure that existed in Ethiopia shifted into the nuclear family model, cultural rifts emerged between younger and older generations of Ethiopian Israelis and traditional physical and dietary habits eroded. Ethiopian men, who historically performed agricultural work in Ethiopia and were considered the head of the family in the traditional Ethiopian patriarchal system, became unemployed or worked in low-income jobs.10 The absorption centres, coordinated by the Israeli government, sought to orient Ethiopians to Israeli society and address health concerns such as infectious diseases.6 Ethiopian Jews were sent to these centres on arrival in Israel.

Efforts were made to further integrate Ethiopian Jews into Israeli society, with variable success.5 The Israeli government promoted settlement into apartments and permanent living facilities following a period in the absorption centres. In order to prevent clustering and ghettoisation of Ethiopian Israelis in specific locations, and in the hopes to better integrate the Ethiopian community within the broader Israeli society, the government encouraged settlement in various cities and provided grant and lone incentives. However, likely due to the Ethiopian population's strong family and community structure, extended families tended to settle together in the same location. This highlights the issue of governmental integration efforts in conflict with immigrant community structure and psychosocial health. On one hand, the distribution of Ethiopian Israelis among non-Ethiopian Israelis may promote and hasten immersion into Israeli society, with increased interaction with presiding Israelis and greater familiarisation of cultural nuances. On the other hand, disruption of the traditional Ethiopian community structure, undoubtedly a protective factor in mental health (which can influence the success of integration), may aggravate the psychosocial distress that accompanies immigration. Mitigating between these two factors in opposition may lead to more optimal conditions for successful and healthy integration.

Children of secondary-school age were required to attend state religious schools for at least the first year of their education. In some cases, this presented challenges for local school systems in absorbing high numbers of new students and tending to the unique educational needs of these children, whose academic background varied from that of native Israelis. Additionally, some Ethiopian-Israeli children needed to travel great distances to attend the required state religious schools.

In cases where the Hebrew competency of Ethiopian children surpassed that of their elders, transformation of traditional family roles occurred, as children acted as the Hebrew-speaking representatives of the family. A preparatory programme was established for Ethiopian Israelis interested in pursuing higher education. This governmental initiative demonstrated the young Ethiopian population's motivation for higher education and ability to succeed academically. The promotion of army service through youth programming heightened draft rates among the Ethiopian community as well as male recruitment into combat units. Vocational training provided tools for successful independence in Israeli society and heightened Ethiopian employment rates.

The Ethiopian community's Jewish identity was questioned when Israel's religious ruling body sought to coordinate ritual conversion of community members to Judaism.2 Although the Israeli Rabbinate ruled that the Ethiopian-Jewish community was eligible for immigration under the Law of Return, the emphasis on conversion was an attempt to fully embrace the community as Israeli Jews, as the Israeli orthodox religious sect specifically perceives Jewish identity.2 ,5 Tension soared when the public discovered that from 1984 to 1996, blood donations from Ethiopian Israelis were being eradicated by the Magen David Adom (MDA) Israeli blood bank. According to MDA, the goal was to protect donation recipients from infectious bloodborne diseases that were prevalent in Ethiopia. Many in the Ethiopian community felt as though they were perceived as second-class citizens that posed a danger to Israeli society. Efforts to conceal the practice of blood donation rejection added insult to injury. Initiatives to successfully integrate Ethiopian Israelis into all levels of Israeli society while encouraging the maintenance of Ethiopian heritage and identity are crucial.

Despite successes with efforts to integrate Ethiopian Jews into Israeli society, socioeconomic gaps still exist.12 Statistical data were collected by the Joint Distribution Committee and presented in a 2012 report on the status of Ethiopian Israelis. Discrepancies in economic, educational, employment and family status between Ethiopian Israelis and the greater Israeli population were prevalent. This leaves room to strengthen pre-existing initiatives and create novel programmes that address these issues.

Determinants of health of the Ethiopian community in Israel

Cross-cultural misunderstanding

A 1999 study by Marian Reiff, Havah Zakit and Michael Weingarten examined the perceptions of treatment by Israeli doctors and Ethiopian-Israeli patients.1 This study illuminated differences in perception and satisfaction of the care between both groups. The cultural manifestation of stress in illness, as an example, was understood differently between Ethiopian-Israeli patients and their physicians. This prompted different views of the quality of care. The study highlights the importance of cross-cultural understanding and recognising various beliefs and presentations of illness. In addition to the use of qualified translators, the degree of care between immigrant patients and physicians may be improved by cross-cultural education and communication workshops for both parties. The difference in belief systems of new immigrant populations, and the way in which western biomedical practitioners approach these beliefs, may greatly affect care.

Diabetes and chronic disease

On arrival to Israel, the lifestyle habits of the Ethiopian community diverged from common practices in Ethiopia.11 With the new use of public transportation around the country, walking became less of a necessity and less commonplace than it was in Ethiopia. The diet of the Ethiopian community formerly consisted of fresh, healthy, independently grown food, and it was considered an essential component of Ethiopian culture and pride.11 ,17 With the presence of high carbohydrate and fatty options, and the availability of food at local stores, the diet of the community changed. The quality and prevalence of dining on traditional dishes changed following immigration to Israel due to the high cost of this food.10 Diabetes in the Ethiopian-Israeli community increased to a significant degree following the waves of immigration.10 ,11 The prevalence of type 2 diabetes expanded from 0.4% to 8.9% from 1985 to 1987.10 ,23

Tene Briut, a community-based project that ‘promotes culturally appropriate prevention, detection and management activities’, was developed to improve the health of the Ethiopian-Israeli community. The project was created in 1998 and has focused on health education programming. Tene Briut has used Ethiopian community members, knowledge of cultural practices and beliefs and a culture-specific approach in their activities. Tene Briut's train-the-trainer approach used 15 Ethiopian nurses with specialised training during the programme's inception, garnering participation from within the Ethiopian community. Community support has persisted throughout the creation, maintenance and outcomes of the programme. A diabetes education initiative compared insulin's relationship to the body with water's relationship to the cultivated greens found in Ethiopia.11 Type II diabetes and other lifestyle-directed chronic diseases were unfamiliar concepts in the immigrant Ethiopian community's understanding of health.10 The emphasis on elements that are essential to life and the Ethiopian community's strong connection to agriculture make this an excellent demonstration of conveying a western biomedical concept through a culture-specific understanding of health and the world. Tene Briut notes its successes in creating awareness of chronic disease in the Ethiopian-Israeli community, empowering community members to take leadership positions in the organisation and developing methods for community-specific health intervention. Tene Briut can serve as a model for further outreach in the Ethiopian-Israeli community, in other Israeli immigrant and refugee populations, and throughout the world.