Ringworm affair

The ringworm affair refers to circumstances involving at least 20,000 Israeli individuals, particularly children, who were treated between 1948 and 1960 for tinea capitis (ringworm) with ionizing radiation to the head area. This population was composed mostly of newly arrived immigrants from North Africa and the Middle East. An estimated 200,000 children worldwide received X-ray treatment for tinea capitis in accordance with the standard Adamson-Kienbock procedure between 1910 and 1959, until griseofulvin, the first effective antifungal agent for ringworm, was introduced. X-ray treatment for ringworm were demonstrated as early as 1903.

Subject of documentaries

The affair has been the subject of a film documentary screened in Israel.

The Ringworm Children directed by David Belhassen and Asher Hemias. The documentary won the award for "Best Documentary" at the Haifa International Film Festival and was featured as a documentary at the Israel Film Festival in Los Angeles in 2007. It is claimed in the documentary that the X-ray radiation used on the children was thousands of times beyond the maximum recommended dose and it is suggested that the program was funded by the United States in order to test the effects of large radiation doses on humans. In fact, the treatment in Israel was the same that was used elsewhere in the world. The documented dosages given to the Israeli children were similar to (if not less than) that administered to children treated for ringworm at New York University Hospital between 1940 and 1959. A study from the early 1950s found X-ray treatment effective in almost all cases of ringworm. The documentary alleges that 100,000 children were irradiated, and that 6,000 of them died shortly after receiving treatment. Many of the 'ringworm children' later developed cancer, and in 1994 the Knesset passed a law mandating the Israeli government to provide them with compensation.

Historical background- Ringworm in Israel and Jewish Communities

The scalp ringworm, also known as tinea capitis, mycosis, thrichophytia, and favus was one of the most common fungal diseases in children in the Jewish communities in Israel and abroad since 19th century.

At the beginning of the 20th Century, Hadassah Medical Center in Jerusalem treated ringworm disease among the religious Jewish community in Jerusalem using irradiation and the disease almost disappeared.

With mass immigration in the 1940s and 1950s, many new cases of ringworm surfaced, primarily among immigrant children from Asia and North Africa due to crowded living condition and deficient hygienic conditions. As at the outset of the 20th Century, again in the 1950s ringworm was treated with irradiation, under the supervision of Hadassah Medical Center in Jerusalem (Prof. Dostrovsky and Prof. Drukman).

The treatment regime caused cancer and noncancerous growths (meningiomas) on the brain membrane years later among a portion of the patients. A number of research groups in Israel and the world have followed patients who were irradiated as children, to examine tendencies to develop various cancerous growths. In Israel this study was led by Professor Baruch Modan who published an article in the prestigious medical journal The Lancet in 1974 in which Modan determined irrefutably a causal linkage between irradiation of ringworm patients and the appearance of growths on the head and neck.

In light of Professor Modan's findings, legislation was passed in 1994 in Israel to provide compensation for damage to health resulting from exposure to such ringworm treatment; the law provided compensation for the patient (or their next-of-kin)for those diagnosed with the diseases stipulated in the law and treated for ringworm between January 1, 1946 and December 31, 1960 . The legislation, however, placed the burden of proof on the claimant to submit factual evidence substantiating that they had received treatment – a proviso that generated public criticism.

The Ringworm Affair

A documentary film in Hebrew entitled "The Ringworm Children" (Yaldei Hagazezet), produced by the Dimona Communications Center and directed by Asher Nachmias and David Balchasan was released in 2003; the film received the Best Documentary Film Award at the Haifa International Film Festival. The documentary harshly attacked Israel's medical Establishment in the 1950s, branding the episode "the ringworm children's holocaust (shoat yaldei hagazezet). It also harshly criticized the compensation law and the politicians involved in its passage. Later in 2007, the film makers Asher Nachmias and David Balchasan expressed second thoughts and regrets, disassociating themselves from the film's conclusions (an unequivocal statement to this effect can be found (in Hebrew) at www.marocmoreshet.com/index.php?showtopic=2551/ . At an April 2007 academic gathering in Jerusalem on ringworm casualties (see the Hebrew itinerary at http://www.nakim.org/israel-forums/viewtopic.php?p=3679) David Balachsan declared: "If I had the power, I would erase this film." (Testimony to this effect can be found in the response of a listener who was a ringworm irradiation casualty, present in the room – Eli Philo (see his comments in Hebrew, in a talkback posted on January 5, 2010 at http://www.notes.co.il/eshed/66373.asp?p=0 .)

Treatment of ringworm patients is viewed by Mizrachi activists in Israel as the most salient example of injustices immigrants encountered in the 1950s as a result of shortcomings, negligence, paternalism or irresponsibility on the part of Israeli authorities in their reception and absorption in Israeli society as new immigrants.

Many of the accusations surrounding ringworm treatment in Israel were the product of an incomplete narrative that skewed reality: Both the Mizrachi community and the medical community were unaware of two key factors:

1. . The broader international context of the Israeli eradication program : at the time, this form of treatment was an accepted treatment method, considered safe (as was x-raying children's feet in shoe stores at the time) and was employed elsewhere in the world – from Syria and Yugoslavia, to New York/California, Portugal and Sweden. In fact, irradiation was the recommended protocol at the time and was partially underwritten by UNICEF.
2. . The broader Jewish context: this form of mass treatment with irradiation had previously been used elsewhere in the Jewish world, in mass treatment of Ashkenazi children in Eastern Europe on a much larger scale, and among Jewish (and gentile) immigrants to the United States.

Thus, the campaign among North African immigrants to Israel – prior to or following their arrival was only part of a regrettable international phenomenon whose scope is still being uncovered.

Scientific findings

Research in the first decade of the 21st Century casts the Israeli ringworm narrative in an entirely new context. It was the product of research conducted by medical historian Professor Shifra Shvarts;

Shvarts followed a handful of parenthetical references in Israeli primary documents to international organizations, uncovering a wealth of archival material (a Pandora's box) in Hadassah archives, at United Nations archives and subsequently in the archives a growing list of countries that reveal mass treatment of ringworm in Israel was founded on treatment protocols designed and administered decades earlier: Between the years 1921–1938, there was a campaign among Jews in Eastern Europe (e.g. among Ashkenazi Jews) in the course of which some 27,000 East European children were irradiated in an identical fashion – in part to allow their families to emigrate, since ringworm was grounds for exclusion in the United States and elsewhere.

The campaign carried out on Mizrachi children from the Mediterranean region was based on this European campaign. The organizers were convinced that the European campaign had been crowned with success in treating ringworm and therefore they sought to enable the Jews of Morocco to benefit from the same. Since most of the Jewish children who had been irradiated in Eastern Europe perished in the Holocaust, there was no way of knowing the ramifications of such treatment

A key figure in formulation and organization of the ringworm campaign among the Jewish community in North Africa was Professor Moshe Prywes who would later become president of Ben-Gurion University and the founding dean of BGU's Medical School. Prywes traveled to North Africa in 1947 and following his findings there, formulated a comprehensive program for eradicating contagious diseases among those planning to immigrate to Israel. The program was called T.T.T., for the three leading diseases the program would address: Tinea (Ringworm), Trachoma and Tuberculosis.

Parallel to irradiation for ringworm carried out during the 1950s in the State of Israel, irradiation for ringworm was also carried out among thousands of Yugoslavian children (some 50,000), in Portugal (30,000) and Syria (7,000).

The primary agent behind these ringworm eradication operations was UNICEF, which even assisted in the purchase of x-ray machines for this purpose. It even supplied the two x-ray machines that operated in the immigrant intake and processing facility for immigrants in Israel – Shaar Haaliyah south of Haifa. With the discovery of the drug griseofulvin for treating ringworm, UNICEF, as part of its policy devoted to eradicating contagious diseases among mothers and children, began funding the supply of the drug to all countries with a high incidence of ringworm.

There is a question of how many children of Moroccan origin actually suffered health issues as a result of ringworm treatment in childhood. One encounters wild estimates (for example, in the aforementioned 'documentary' film) claiming there were a hundred thousand persons or more. Others go even farther: A non-profit organization, established in 1999 to organize former patients and to ensure their compensation (http://www.gazezet.org.il), goes so far as to put the number of Mizrachi children irradiated at 200,000. In fact, a more accurate assessment can be extrapolated from reliable statistical data in the historic record. In Dr. Yaron Tzur's work on Moroccan Jewry between the years 1940–1954 – Kihilah K'ruah (A Community Torn-Asunder), demographic data found by the author regarding the Moroccan Jewish population shows the numbers must have been much more modest. A 1947 Moroccan census, even after adjustments, show there were at most 240,000 Jews in Morocco at the time. The work is a comprehensive study, filled with archival material, correspondence of key figures, reports of Israel emissaries and a rich bibliography that includes a list of all points of settlement in which Jews resided in Morocco, down to those with just a few families. Up until 1956, data shows 80,000 Jews emigrated from Morocco. Therefore, the maximum number of child immigrants within the age range that ringworm attacks could not exceed 20,000 to 25,000. If one assumes that not all the children in that age group had ringworm, there is no logical statistic basis for assuming that more than 10,000 to 15,000 underwent irradiation. The Israel Ministry of Health has files of 10,000 individuals; they are, apparently the total number of individuals irradiated of all ethnic origins (see www.health.gov.il/pages/default.asp?maincat(PageId=4136&catId=768&=78 )

From reports submitted to UNICEF by the Israeli Ministry of Health and which were even published in the medical news, it was stated that the number of children treated with irradiation in Israel between 1948–1959 was approximately 15,000. Testimony exists that shows, without question, that children of Eastern European origin who were suspected of having ringworm were also irradiated. It is hard to know their numbers but they most likely numbered a few thousand. According to Giora Leshem, who was Professor Modan's statistical partner in his 1974 study (based on the Cancer Registry), it seems that the number of Moroccans who were irradiated was in the vicinity of 15,000 children.

See also

• First government of Israel
• Jewish exodus from Arab lands
• Ma'abarot
• Chaim Sheba

External links

• The Ringworm Children
• "Israel compensates for ringworm treatment". BMJ 310 (6976): 350. 1995-02-11. http://www.bmj.com/content/310/6976/350.2.full. 
• The Ringworm Children on Google Video