Samer,1 34, lives in Beit Safafa, a Palestinian neighborhood in south Jerusalem. Palestinian Jerusalemites generally hold permanent-resident status in Israel rather than Israeli citizenship (see Precarious Status). Under this status, in order to receive the social benefits administered by Israel’s National Insurance Institute (NII) (Bituach Leumi) to which they are entitled, they are required to pay taxes and contribute to social security. Beyond that, they must meet the eligibility criteria.

Samer, a laborer, has worked continuously since the age of 16 to support his family. He later married Suzana and together, they went on to have three children. Samer is the family breadwinner; his wife manages the home and the children.

Six months ago, Samer suffered a work-related back injury. Following a medical examination, his doctor diagnosed him with a herniated disc and ordered him to stop working immediately. On the same day, Samer submitted an application for disability benefits to the NII, the Israeli government agency responsible for administering social security programs including disability, unemployment, retirement pensions, and other welfare benefits (see Health and Health Care).

The assessment process for disability benefits can take several months and requires applicants to undergo medical evaluations and demonstrate that their disability significantly limits their ability to work. During this application period, if the applicant is found to be working, the NII can reject the disability claim.

As a result, many applicants like Samer, who are the sole or main providers in their families, face an excruciating dilemma: in order to remain eligible to receive their disability benefits during this waiting period, they cannot work, but this means they are left without any way to support themselves and their families.

Samer is the sole provider for five people. They have always lived paycheck to paycheck. He cannot afford to remain without income for months while waiting for his claim to be processed. Consequently, he has been left with no recourse but to work in the informal economy, despite his doctor’s instructions to rest and avoid work. This exposes him to further physical injury while also placing his disability claim at risk, as disclosure of his under-the-table work could lead the NII to deny his benefits. The stress of knowing that he is risking everything also takes a further steep toll on his health, which ricochets out to his family as well.

Samer’s experience illustrates the tension between Israel’s social protection policies designed to verify eligibility and the economic realities faced by many Palestinian residents of East Jerusalem: either lose your income to protect your health, or work in secret and risk losing the benefits to which you are legally entitled.