Country: Israel
Closing date: 27 Jun 2017
TERMS OF REFERENCE
External Evaluation
Project title: Protecting and Promoting the Health and Social Rights of Groups Residing in Israel without Civil Status
Location: Israel
1) Introduction
Physicians for Human Rights (PHRI) and Hotline for Refugees and Migrants (HRM) implemented the project together, funded by the Secours Catholique-Caritas France (SCCF). The project aimed to protect and promote the rights of asylum seekers, refugees, migrant workers and other non-resident groups (hereafter "status-less" persons or groups) in Israel.
The evaluation will focus on a three-year project (July 2014-June 2017) funded by Secours Catholique-Caritas France who is requesting the evaluation, with the support of the partners. The donor wishes to evaluate those past three years to draw conclusions and lessons learned for a new phase.
Physicians for Human Rights - Israel is an Israeli human rights organization that advocates for the full and equal fulfillment of the right to health for all persons in Israel and the occupied Palestinian territory. Founded in 1988, PHRI's campaigns are informed by the principles of medical ethics, human rights, and social justice. PHRI’s campaigns seek to monitor, expose, and provide an alternative to the ways in which occupation, the structure of citizenship, privatization of the health system, growing gaps in accessibility of health services, and the denial of underlying determinants of health limit the right to health and hinder access to necessary medical services.
Hotline for Refugees and Migrants is a not-for-profit organization that defends the rights of migrants and refugees in Israel, and combats human trafficking. HRM assists vulnerable individuals, particularly those held in immigration detention, to uphold their rights. By combining advocacy with impact litigation, policy initiatives and public outreach HRM aims to achieve broad-based systematic improvements in policies and practices ensuring that the human rights of refugees and migrants in Israel are respected.
Secours Catholique-Caritas France is a recognized association of public interest and a service of the Catholic Church, a member of the Caritas Internationalis global network. The SCCF is committed to fight against poverty, exclusion and inequalities, and promote the development of each person. The SCCF is also deeply involved on migration issues in France and abroad and supports PHRI – HRM since 2013.
Available documentation
In addition to the reports listed in the table below (which were made available to the public), the evaluator will have access to internal monthly reports, databases, correspondence with the various stakeholders of the project, and any other relevant documents. Project related documents including the proposal, contract and reports submitted to SCCF will be available. Public documentation including protocols from relevant Knesset committee hearings, court hearings and judgements can also be obtained. A full list of media coverage will also be available.
Document Nr. Title Author Date Version
Immigration Detention in Israel – Annual Monitoring Report
HRM March 2017 Printed report, pdf
Caregivers from Eastern Europe
Workers’ Hotline, HRM January 2017 Printed report, pdf
Not Passive Victims
PHRI November 2016 Printed report, pdf
Forgotten in Prison: The Prolonged Detention of Migrants
HRM Dec 2016 Printed report, pdf
Reappears: New Testimonies from Sinai
HRM December 2016 Printed report, pdf
“I am alive, but dead inside” - Sinai Torture Survivors Speak | Testimonies
PHRI, HRM, ASSAF 2016 Printed report, pdf
Trafficking in Persons in Israel: Annual Monitoring Report 2015
HRM April 2016 Printed report, pdf
Immigration Detention in Israel: Annual Monitoring Report 2015
HRM Feb 2016 Printed report, pdf
The Labyrinth: Migration, Status and Human Rights
PHRI, ACRI HRM December 2015 Printed report, pdf
“Deported to the Unknown“: testimonies of asylum seekers who left Israel to a third country
HRM December 2015 Printed report, pdf
Rwanda or Saharonim
HRM July 2015 Printed report, pdf
Where There is No Free Will: Israel’s “Voluntary Return” Procedure for Asylum-Seekers
HRM, ASSAF April 2015 Printed report, pdf
No Safe Haven: Israeli Asylum Policy as Applied to Eritrean and Sudanese Citizens
HRM July 2014
The Detention Review Tribunals
HRM December 2014
“Managing the Despair” – Monitoring report: asylum seekers at the Holot facility April–September 2014
PHRI, HRM July 2014
2) Project presentation
PHRI specialize in health services and rights whilst HRM specialize in legal status, detention and deportation. The organizations’ cooperation predates this specific project, and SCCF funding started with another project in 2013-2014.
Another official partnership between HRM and PHRI took place in the framework of a three-year EU-funded project on Sinai torture victims (2014-2016.)
PHRI and HRM work together in the following fields:
- Individual case-work such as patients with summons to Holot; clients with health problems; clients in detention with health problems; suspected torture victims; suspected trafficking victims
- Lobbying work in the Knesset – especially with regards to Sinai victims, trafficking victims
- Petitions to the High Court and exclusion of Sinai torture victims from Holot
- Promoting rehabilitation and identification mechanisms for Sinai victims – advocacy and lobbying meeting with policy makers
Over the course of this project, PHRI and HRM have employed individual counseling and advocacy, legal action, government lobbying, provision of medical and legal services, and public outreach, to both provide for the immediate health and other needs of the target groups, and promote long-term policy change to secure public health care services and access to basic human rights for all persons living in Israel, regardless of legal status.
PHRI and HRM’s clinics’ activities are detailed below:
The Open Clinic (PHRI):
- Receives patients five days a week, approximately five hours per day (medical care, depending on demand) and an additional seven hours per day (referral and counselling services), providing medical counselling, medication and rights information to patients;
- Provides primary and secondary healthcare as well as para-medical treatment for people without medical insurance under Israeli law and arranges for discounted referrals for secondary and tertiary care;
- Oversees treatment and follow up of chronically ill (high blood pressure and diabetes) patients not currently accepted to the Ministry of Health program for status-less persons;
- Is operated by volunteer medical, support and administrative staff, a salaried manager, one caseworker (100%), one part-time medical secretary and a Tigrinya translator.
- Collects data about the situation of Refugees and Asylum Seekers in Israel and provides support for PHRI to advocate for the right to health of this population.
The Crisis Center (HRM):
The HRM operates a Crisis Intervention Center in their offices in South Tel Aviv, open for consultation for 18 hours a week from Sunday-Thursday. HRM also operate a telephone hotline 40 hours a week and conducts regular visits to immigration detention and to Holot. HRM staff aim to provide personal assistance and, where the need arises, para-legal representation to all their clients. Forms of assistance include information and explanations, interventions with the authorities, assistance with filling out forms, accompaniment to appointments with the authorities, and referrals to other organizations. Inside detention paralegal representation also includes representation in front of the detention review tribunal, who has the authority for judicial review over the detention of migrants who are not detained under the Anti Infiltration Law. Some cases - especially where there is potential to set precedents with broad implications for the whole refugee community - are referred to the HRM's Legal Department for legal representation in the court. (see below – litigation on principle issues)
Examples of interventions:
Requests for release from detention on humanitarian grounds
Requests for release because asylum requests were not answered
Requests for preparation periods before deportation
Request to state's legal aid and recognition as trafficking victims
Assistance with asylum procedures
Complaints about immigration official's behavior towards our clients
Requests for recognition of family units
HRM intervene on behalf of their clients with the Ministry of the Interior, the Justice Ministry, the Prison Authority and the Immigration and Population Authority.
Background
The State of Israel continues to lack an immigration and naturalization process for its non-Jewish inhabitants. Over 217,000 non-Jewish migrants live without civil status, on which social rights like health and welfare services are conditioned.
Without health rights, status-less persons are either forced to rely on the very limited private insurance policies or go without health care completely, except in cases of medical emergency. Although Israeli employers who employ migrant workers or asylum seekers are required by law to purchase private insurance for their employees, many do not comply. Status-less individuals can also lose their insurance coverage, or lose continuity between policies, if they change employers, or when they are determined too sick to work. Status-less individuals without health insurance go without care. Sometimes they are able to seek care in hospital emergency rooms, which are bound by law to treat them regardless of their status or ability to pay. Sometimes status-less persons refuse emergency treatment for fear they will be turned into security authorities, or fear that they will not be treated due to prior debts.
The lack of health rights for status-less persons living in Israel is inextricably related to Israel's current political climate, which is deliberately hostile to non-Jewish, status-less residents. The very leaders appointed to draft policies that safeguard the rights of asylum seekers and refugees as well as foreign workers have been the source of incitement and intolerance against status-less groups, exposing the Israeli public to unprecedented levels of xenophobia.
Beneficiaries
- Refugees and Asylum Seekers
Between 2006 and 2012, numbers of asylum seekers in Israel rose steadily. Since 2012 numbers of new arrivals have declined almost to a stop due to a number of factors including the Israeli government building a fence on the Israel/Egypt border. Publicly, the government’s stance is that these people who enter via the Sinai border are not asylum-seekers, but rather are illegal labor migrants who are officially referred to as ‘infiltrators". However, at the same time and in contradiction, these Sudanese and Eritreans so-called “infiltrators” receive ‘group protection’ meaning they cannot be deported. Therefore, they remain in Israel, subject to harsh, inconsistent and unclear policies, with many people spending long periods in detention and constant uncertainty about their future.
Israel maintains a policy of “temporary protection” or “delay of removal” for Sudanese and Eritrean nationals, so as to be in compliance with the non-refoulement principle. The principle, the heart of the Refugee Convention, forbids states to deport people to a place where their lives or liberty is likely to be endangered. However, asylum-seekers from those countries were not eligible to file asylum requests until late 2013. As of February 2017, only eight Eritrean nationals and two Sudanese nationals were recognized as refugees in Israel, eliciting criticism from the High Court of Justice and international bodies alike.
Israel grants asylum-seekers a visa that only gives them the right not to be deported from Israel until their deportation is possible. On these visas, a Ministry of Interior stamp reads: “This permit is not a work permit”, but because the State made an obligation to the High Court of Justice, employers of asylum seekers are not fined. This confusing policy, in which asylum seekers do not have the 'right' to work, but indeed can (and have to) work, makes them vulnerable to abusive work conditions. Israel also bars them from access to medical and welfare services because it believes that the “infiltrators” come to Israel to work and harming their ability to live in dignity in Israel will deter more of them from coming and would encourage those who are already in Israel to leave.
Asylum-seekers in Israel live mostly in areas where the cost of living is comparatively low. The vast majority live in the neighborhoods of southern Tel Aviv; others have moved to impoverished neighborhoods in Jerusalem, Eilat, Arad and Ashkelon. Asylum-seekers often live in very crowded apartments in those areas due to their low wages and because apartment owners exploit the fact that many landlords are unwilling to rent apartments to Africans and raise the prices. One can find apartments where ten asylum-seekers live in just one room. The crowdedness that characterizes the living conditions of asylum-seekers increases the burden on the already-poor infrastructure of the impoverished areas where refugees live, increasing the anguish of the Israeli residents of those neighborhoods.
In addition to depriving asylum-seekers of social and economic rights, Israeli officials, even at the highest levels, are waging an incitement campaign that is designed to justify the State’s treatment of them. Asylum-seekers are presented as “infiltrators” who came to Israel to work, and not as humans who were persecuted and whose lives will be in danger if they are deported from Israel. Government officials struggle to explain why these people, who according to them are illegal work migrants, are not deported from the country as Israel routinely does with undocumented migrants. In addition, ministers and elected politicians present refugees as criminals and spreaders of disease based on racial stereotypes. The asylum-seekers, who make up about 0.5% of Israel’s population, are also presented as a demographic and a security threat.
Out of the roughly 40,000 African asylum seekers currently living in Israel, there are an estimated 4,000 men, women, and a few children who have survived torture in Sinai en route to Israel, or in their home countries. Mostly Eritreans and some Sudanese, they suffered some of the most heinous abuse imaginable, and bear both physical and emotional scars. They are often left in complex psycho-social situations, suffer severe trauma, and are in dire need of medical care, welfare services as well as other forms of support. However, as all asylum seekers in Israel, survivors of torture have no legal status and therefore have very limited access to the public health and welfare services. Moreover, to date Israel has no mechanism in place to identify victims of torture amongst asylum seekers, and the government does not provide tailored medical and psychological treatment specifically suited for the rehabilitation of torture victims.
2) Migrant Workers:
The majority of the 95,000 migrant workers come from Asia, particularly Thailand, the Philippines, India, and China, and most of them are women. Ever since the introduction of migrant labor in Israel in the 1990s their employment has been fraught with problems and rights violations are rampant. The most frequent abuses are underpayment, excessive working hours, neglecting to pay for medical insurance and inappropriate living conditions. According to Israeli law, Israeli employers are required to purchase private health insurance for their non-Israeli employees, but these policies are limited, and subject to the profit motive of private companies.
In some cases, mental and physical abuses also occur as well as sexual violence. The inherent vulnerabilities of being foreign, unfamiliar with local laws and avenues for assistance, and living away from family and in unfamiliar surroundings are compounded by inadequate enforcement of labor laws and an employment system that increases employers' power over their workers. Migrant workers have been subject to discriminatory law that bind a caregiver to his or her employee and make her undocumented if she leaves this employer (even if the reason is abuse). The government of Israel has also moved to deport children of migrant workers born in Israel, and their families.
Partners and stakeholders
Partners, donors: UNHCR (funding PHRI's Open Clinic and HRM's Crisis Intervention Centre and playing a coordination role between the various organisations working on asylum seekers’ issues,). The Samuel Sebba Charitable Trust, Medico Switzerland, BGS Fund, the Moriah Fund, the UN voluntary fund for victims of torture as well as the EU. The Secours Catholique-Caritas France is also funding the project and is supporting its evaluation. All the latter play only a “donor role” and are not involved with the beneficiaries and have no connections between themselves that PHRI-HRM are aware of.
Non-funding stakeholders include other refugee rights organisations such as ASSAF (Aid Organization for Asylum Seekers in Israel), ARDC (African Refugee Development Centre) and Kav LaOved (Worker's Rights organisation.) There have been three levels of involvement of these actors: Individual casework, esp. with ASSAF on patients with complex psycho-social situations, and Kav Laoved surrounding migrant health insurance and occupational doctors' visits; Advocacy: with ASSAF on health and welfare for asylum seekers, on vulnerable groups among them such as people with disabilities and Sinai victims; with Kav Laoved on the problems in migrant health insurance, esp. when applied to asylum seekers; Informational leaflets on insurance with kav Laoved; a joint petition with Kav laoved about caregivers' right to health; Lobby in the Knesset: with ASSAF especially regarding Sinai victims and health and welfare rights for asylum seekers.
Government stakeholders include the Ministry of Interior, Ministry of Health and Ministry of Justice. In particular, the Ministry of Justice's taskforce on combatting trafficking, which has been the main government contact regarding our advocacy work on behalf of victims of torture.
The most important stakeholders are our clients and patients – people residing in Israel without civil status. Across the project period, approximately 4,800 clients benefited from services and/or case work by HRM, while PHRI patient visits amounted to about 5,000 a year, in addition to 2,800 yearly referrals, and about 120 individuals per year whose issues were addressed through casework. However, the policy changes we achieved influenced the entire target populations - approximately 140,000 people if we include migrant workers and asylum seekers (numbers did fluctuate throughout the project period).
Objectives, activities, results
Overall objective:
Advancing the Health and Social Rights of Groups Residing in Israel without Civil Status
Specific objectives:
- Provide individual paralegal and legal assistance to status-less individuals whose health rights and other basic human rights are denied, including those in or facing immigration detention.
- Secure policy reforms and change official guidelines to remove the barriers facing status-less persons
- Contribute to a more informed public debate and provide tools for addressing discrimination against status-less groups – in particular for the health community
Activities:
I MEDICAL CARE
1.1 Providing medical care in the Open Clinic
1.2 Referring patients to off-site hospitals, clinics, private practices, labs, etc
1.3 Collecting data about the situation of status-less people in Israel
II CASEWORK
2.1 Assisting individuals that require more complicated health services than the Clinic is able to provide, advocating on their behalf to the Health Ministry, finding individual and collective solutions
2.2 Mediating on Behalf of status-less persons vis-à-vis private insurance agencies and representing individuals at the Ministry of Interior (Preventing Deportation of Sick Status-less Persons, assisting status-less spouses of Israelis.)
2.3 Providing free legal advice, consultation and para-legal representation to refugees and migrants through the Crisis Intervention Centre
III PRINCIPLED ADVOCACY
3.1 Conducting advocacy with Ministries, Knesset members, committees and all other relevant national and international stakeholders
3.2 Litigating to advance policy change
IV PUBLIC AWARENESS
4.1 Engaging the medical community in hospital settings and medical schools
4.2 Conducting lectures targeting the medical community.
4.3 Exposing issues facing asylum seekers in the media
Expected Results and annual outputs:
Result 1: Direct medical assistance provided to status-less individuals (about 5,000 patient visits a year, 2800 referrals to offsite medical care – PHRI
Result 2: Status-less individuals’ needs, rights’ denial addressed through casework; roughly 200 cases a year, 150-200 hours of legal consultations a year and 10 legal procedures (PHRI) - Consultation and advice provided during office hours and by phone to approx. 1,500 clients a year; 2 visits per week to immigration detention centers, 2 visits per month to Holot, 200 interventions in writing per month (HRM)
Result 3: Policy reforms secured, and/or official guidelines changed, removing barriers facing status-less persons (10-12 principle litigation cases per year (HRM), Participation in at least 4 relevant Knesset Committee hearings per year (PHRI+HRM) 40 meetings per year with local decision makers, at least one position paper published, 12 briefings per year to international stakeholders (PHRI+HRM)
Result 4: Increased public awareness of discrimination against status-less group – 20 lectures and public events per year to raise awareness amongst the medical community (PHRI); At least 10 press releases on issues related to Holot and/or the Anti-Infiltration Law, 35 articles published in local and international media per year (PHRI+HRM)
3) Objectives of the evaluation
The partners wish to receive a global appreciation of the work accomplished based on DAC criteria, answering the following questions:
Relevance:
• To what extent are the objectives of the programme still valid?
• Are the activities and outputs of the programme consistent with the overall goal and the attainment of its objectives?
• Are the activities and outputs of the programme consistent with the intended impacts and effects?
• How did the project adapt to the changes in the legal and political context between 2014-2017?
Effectiveness:
• To what extent were the objectives achieved?
• What were the major factors influencing the achievement or non-achievement of the objectives?
• How was the coordination and task-sharing between PHRI and HRM? What added value did it bring to the project? Is there any room for improvement and if so, on what aspect(s)?
• Does the management of the project allow to fulfill the requirements towards the donors?
• Did the project encourage the empowerment of migrants? If not, what were the limits of the means employed and how can they be improved?
Efficiency:
• Were activities cost-efficient?
• Were objectives achieved?
• Was the programme or project implemented in the most efficient way compared to alternatives?
• Are the human resources adequate for the project?
Impact:
• What has happened as a result of the project? What concrete differences has the activity made to the beneficiaries? For example in terms of receiving treatment; ensuring insurance continuation; empowerment though raised awareness of their rights and information; promotion of policies.
• How many people have been affected?
• From the point of view of migrants and asylum seekers, how do they perceive the actions of PHRI/HRM, in terms of health services (consultation), legal and administrative support, etc?
• How relevant is an advocacy strategy regarding asylum seekers in such a hostile environment?
• Are there any unexpected or unexplained consequences to this project?
• About the work with volunteers: what added value does it bring to the project, and what challenges? In particular in terms of the spreading of the organisations’ message and change of mentalities?
• What about the impact of public awareness on the change of mentalities? How can we perceive the change of mentalities on the public, the media, the medical staff and the public sector?
Sustainability:
• To what extent will the benefits of the project continue after it has ended?
• What were the major factors which influenced the achievement or non-achievement of sustainability of the programme or project?
• What benefits would stop, in case activities carried out by PHRI and HRM were to stop after contract’s end? What strategy could be implemented to better secure the sustainability of these benefits?
• Were the donors, stakeholders, beneficiaries and partners involved in the preparation of the strategy?
• Do the various project stakeholders have a good capacity to adapt and support the intended changes for the next project?
Operational considerations: what should be done next?
The current strategy employed by PHRI has been to work with the administrative levels of the Ministries, advocating for a more comprehensive solution granting health insurance to all asylum seekers, based on the principle that one’s human rights should not depend on his or her status. This strategy has proved itself as we have made great progress on some fronts despite many hurdles along the way. Currently, the organisation is pursuing a strategy that best reflects its ideology. An evaluation would help us assess and explore other avenues, would the current direction chosen by the organisation appear less relevant in the near future due to external factors. The evaluation should also help us build some qualitative indicators for the next multi-year project (currently the main outputs are quantitative in nature.)Strategic considerations: what lessons should be learned from this experience in order to improve the intervention strategy?
The partners are highly interested in drawing lessons learned from the project and evaluating best practices.
Regarding the relationship between SCCF on one side and PHRI/HRM on the other side: what does the relationship with SCCF bring to PHRI and HRM, and vice-versa? How could this partnership evolve, in a way that would increase mutual benefits? What are the expectations of PHRI/HRM (networking, experience sharing, systematization)?
4) Detailed expectations
See questions in 4) 1. above.
PHRI is interested in having the work of its Open Clinic and Status-Less Department evaluated, in particular regarding the communication between the two and what could be done to improve it. How can the clinic be turned into a better resource for advocacy work?
HRM would be interested in having its strategy to advance the distinct rights of torture victims evaluated. In addition, the organization would like to know if its work influenced detention conditions, considering that there was an improvement over the project period. Moreover, HRM would be interested in assessing its partnership / cooperation with the other NGOs.
Criteria and indicators
See question 3) above.
Recommendations
PHRI wishes to get advice on how to fine-tune its strategy: which practices, activities have been effective? How could we improve them and fine-tune or strengthen our strategy? Are there more practices that could help towards the same end-result? What has stopped being effective, has been worn out? Have some strategies run their course?
Methodology
The available sources of information are the following: monthly reports, appeals to the Ministry of Health, database of appeals, paralegal work, letters sent to various Ministries, correspondence, referrals within and out the clinic, patients’ database, etc.
Key people to talk to: Knesset members, Ministry civil servants, the Unit for the Battle Against Human Trafficking (part of Ministry of Justice), Israel Prison Authority, the Refugee Status Determination Unit in the Ministry of Interior, the Detention Review Tribunal, UNHCR, SCCF, Mesila, Gesher Clinic, Terem Clinic well as hospital staff and management including social workers. Internally at PHRI, volunteers would have a different perspective on how the clinic runs, and what they think needs to be done to improve the work. Staff should also be interviewed. If possible, it would be relevant to interview some patients and clients.
The partners recommend a qualitative evaluation.
A participative approach is favored, whereby the abovementioned stakeholders are interviewed on the activities in which they are involved. From patients and clients, it would be interesting to understand what were their expectations vs. what the partners can or want to provide. Form hospitals, to get their perception of our individual casework, of treatment of asylum seekers and aftercare, and understand if our methods are successful in recruiting them towards supporting our objective of a systematic healthcare solution for all asylum seekers. From ministries, understanding if our advocacy does manage to bring about policy change and if our methods are adequate. From Knesset members: are we able to push them to exert pressure on ministries to enact policy change? Other NGOs are our partners in individual casework and policy change efforts – getting their perspective on our methods, objectives would be important; the Gesher clinic for mental health is a partner in individual casework; the Unit for the Battle Against Human Trafficking can explain how we work with them on human trafficking and torture.
5) Evaluation team
The evaluation can be carried by one person or a team. It is helpful for the evaluator (or at least one of the team’s members) to be a native Hebrew speaker, familiar with Israel’s political environment, and with the way things work – i.e. the formal and non-formal way by which information flows and agreements are reached. The evaluator must be familiar with the topics at hand, i.e. policies towards refugees and asylum seekers in Israel. The evaluator(s) should have relevant experience in evaluation and some expertise on the field of migration and advocacy.
6) Timeframe of the evaluation mission
The evaluation should take place somewhere between June 15 and August, 15, 2017.
Detailed timetable
Call for evaluators: 26/05
Deadline for submission of the applications: 16/06 (extended: 27 June 2017)
Shortlisting from SCCF side: 20/06
Feedback from PHRI – HRM: 25/06
Selection: 26/06
Contract signature: 30/06
Field visit: between the 01/07 and 30/07.
Submission of first draft: 16/08
Comments and feedback: 30/08 (roughly two weeks after)
Submission of final report: 15/09 (roughly two weeks after).
7) Expected documentation
One final evaluation report due at the end of the consulting period, followed by a presentation of the results to all interested parties. The report, which must include recommendations, must be written in English.
How to apply:
8) Application process
Application should include:
- Letter of interest
- Detailed technical proposal including the work plan, methodology, and timetable.
- Detailed Budget - with breakdown of cost per unit inclusive (includes transportation, communication, and overheads).
- Curriculum vitae
All proposals should be submitted on 16.06.2017 (extended: 27 June 2017) at the latest to: missioncourteduree@secours-catholique.org
We will only respond to complete and relevant applications.