Not Heaven of Coexistence– Israel’s Healthcare System Holds a Mirror to Society
Israel’s healthcare system is often portrayed as a model of successful coexistence — a space where Jews and Arabs work side by side treating patients and are guided by professionalism that rises above political or national divisions.
Statistics seem to reinforce this image: roughly 40% of all healthcare workers in Israel are Arab, including 27% of doctors and nurses and half of all pharmacists. Today, about 50% of new medical graduates receiving their licenses are from the Arab community.
But beneath the surface, reality is far less idyllic. A significant health gap persists: Jewish citizens live, on average, four years longer than Arab citizens. Disparity within professional leadership with Arabs severely underrepresented in senior management — in the Ministry of Health, hospitals, and HMOs. The result is a paradox: broad Arab participation at the professional level but very limited influence over policy and decision-making.
In other words, Israel’s healthcare system is diverse but not equal. It is multicultural in structure but not necessarily inclusive in leadership or governance. Years of working side by side have created a routine of professional coexistence but not necessarily of ethical partnership, and certainly not one free from tension.
The horrific Hamas massacre of October 7 and the war that followed tore through the thin layer of normalcy that had long masked deep identity tensions. Doctors, nurses, and caregivers — Jews and Arabs — suddenly found themselves at the heart of an emotional, social, and political storm.
In dozens of in-depth interviews conducted with medical staff in hospitals across Israel, a disturbing pattern emerged of shock, alienation, and mutual suspicion. Friendships frayed; colleagues avoided eye contact. Jewish staff members sometimes demanded that their Arab peers “prove their loyalty” or publicly condemn Hamas. Arab staff members described fear of speaking Arabic in hallways, a sense of insecurity, and thoughts of leaving Israel altogether.
Hospital administrators responded quickly, issuing statements calling for “unity” and “restraint.” These messages prevented open clashes and helped maintain day-to-day functioning — but they rarely addressed the deeper roots of mistrust. Beneath the calm surface, suspicion, fear, and moral injury continued to fester.
What we are witnessing is not only a professional rupture but also a moral and narrative one. For many Arab employees, institutions that had long claimed to be neutral and “apolitical” seemed to abandon them precisely when they most needed protection. Their sense of mission — the ethical foundation of their professional identity — was shaken. This is what we at the Abraham Initiatives describe as Organizational Trauma: a deep disappointment in one’s institution when it fails to live up to its declared values of equality and compassion.
In organizational terms, this represents the unraveling of a shared story — the narrative that once united Jewish and Arab medical teams as symbols of human partnership. In moments of crisis, that shared professional identity was replaced by polarized national identities. The boundary between “us” and “them” hardened, threatening not only social cohesion but the very functioning of institutions that depend on trust and teamwork.
Israel’s healthcare system cannot afford to ignore these unaddressed tensions. If we want it to continue providing equal, professional care in times of crisis, we need a deep cultural and policy shift.
First, there must be open acknowledgment of the healthcare system’s binational reality among both staff and patients. Arab healthcare professionals are not a “silent minority.” They are an essential part of the system, and deserve a safe and respectful work environment.
Second, institutions must establish mechanisms for dialogue, protection, and mediation, such as permanent Jewish–Arab forums, rapid-response channels for discrimination or harassment, and leadership training for conflict management.
Third, moral and courageous leadership is required — not one that merely seeks to “quiet things down,” but one that sees the current crisis as an opportunity to strengthen trust, equality, and shared purpose among staff.
And finally, these efforts must begin before the outbreak of violence and war. Only organizations that nurture trust and solidarity during routine times can withstand the pressures of a national crisis.
Israel’s healthcare system, whose proper functioning is literally a matter of life and death, reflects the deeper tensions of Israeli society. It is not immune to them — nor should we pretend it is. Instead of maintaining the comforting illusion of a coexistence heaven, we must confront the pain and fragility of the system with honesty and courage. Because in truth, our hospitals and clinics are not an island distinct from society but a mirror of its flaws.
The time has come for the Ministry of Health, hospital directors, and medical schools to act decisively, and develop a national framework for partnership and equality in healthcare, backed by clear goals, funding, and accountability. Such a framework should ensure Arab representation in senior management across the system, train managers and staff in cultural competence and conflict navigate, establish an independent mechanism for reporting discrimination and bias, and incorporate shared-society education into medical training.
Israel must ensure that its renowned health systems remain healthy. Courageously addressing the challenges arising from its binational characteristic is a necessity, not an option.
