The figures may be open to debate, but the problem remains acute: members of the Ethiopian community in Israel have one of the highest suicide rates in the world. Community activists say that mistrust of the establishment leads to a reticence to ask for help. Now, with a new wave of immigration from Ethiopia imminent, the fundamental question is being asked again: Who and what needs treatment – the desperate youths or the desperately inadequate Israeli response? A Shomrim Special Report

Fatal Mistrust: Second and Third Generation Ethiopian Israelis are Most at Risk from Suicide

The figures may be open to debate, but the problem remains acute: members of the Ethiopian community in Israel have one of the highest suicide rates in the world. Community activists say that mistrust of the establishment leads to a reticence to ask for help. Now, with a new wave of immigration from Ethiopia imminent, the fundamental question is being asked again: Who and what needs treatment – the desperate youths or the desperately inadequate Israeli response? A Shomrim Special Report

The figures may be open to debate, but the problem remains acute: members of the Ethiopian community in Israel have one of the highest suicide rates in the world. Community activists say that mistrust of the establishment leads to a reticence to ask for help. Now, with a new wave of immigration from Ethiopia imminent, the fundamental question is being asked again: Who and what needs treatment – the desperate youths or the desperately inadequate Israeli response? A Shomrim Special Report

Amit Moran and Melodi Shor

Work By Artist Rachel Anyo, 2020

November 8, 2022

Summary

The driver of the private vehicle that sped northward on Route 6 on October 11 last year did not even have time to rub his eyes in astonishment when he saw an odd occurrence in front of him. “I was driving behind a taxi when I saw a soldier in uniform open the back door in the middle of the road, jump out of the vehicle, and slam into the safety barrier at the side of the road,” he told reporters at the scene. “I stopped my vehicle, called the police and an ambulance, and they took him to hospital. He was still breathing, but he wasn’t conscious.”

The harrowing and extraordinary method that the young soldier in question, Abeba Darsakh, chose to commit suicide drew the media’s attention, but beyond his and his family’s personal tragedy, the broader and familiar problem of a high suicide rate among Israelis of Ethiopian descent remains almost unaddressed. 

According to Health Ministry figures, which have been collated over several decades, young members of the Ethiopian community in Israel are in a higher risk group for suicide, and not only compared to other Israelis of their age. According to psychiatrist Prof. Gil Zalsman, the director of the Geha Mental Health Center and chairman of the National Council for Suicide Prevention, “this is one of the most suicide-prone groups of people in Israel and the world.”

Ever since Ethiopian Jews began migrating to Israel in the mid-1980s, there have consistently been high levels of suicide recorded, especially compared to the overall population – and also compared to immigrants from the former Soviet Union, who experienced immigration difficulties at around the same time. According to most estimates, in 2005, which was statistically the worst year, young people from an Ethiopian background were 13 times more likely to die by suicide than other Israelis of their age. A 2018 report entitled “Suicide in Israel,” written by the Health Ministry’s Informatics Division, found that in the years between 2010 and 2015, the suicide rate for young Ethiopians between the ages of 15 and 24 was eight times higher on average than the suicide rate among native Israelis in the same age range. Another figure published by the Health Ministry that year found that “almost half of the suicides among members of the Ethiopian community in Israel are among young people aged between 15 and 24, compared to 10 percent among immigrants who came to Israel from former members of the Soviet Union, and slightly more than 10 percent among Israeli-born youths in the same age group.”

Suicide, it’s important to stress, is not part of the cultural heritage that immigrants from Ethiopia brought with them to Israel. According to World Health Organization statistics, the suicide rate in Ethiopia is similar to that among the general population of Israel. In Russia, for comparison, the suicide rate is five times higher.

Partial Figures and Underreporting

Many studies highlight the connection between migration and suicide. The move to a new country often brings with it profound changes in the fabric of life, which could also lead to a deterioration in the social standing of those immigrants and to the unraveling total loss of their social support networks. The identity crisis suffered by the immigrant, the undermining of the familiar family structure, and having to deal with external factors, such as unemployment and xenophobia, are all defined as factors that could create psychological distress among immigrants.

There are almost no precise figures available in Israel about the extent of suicide. According to reports from the Central Bureau of Statistics, there are some 400 cases of suicide in Israel every year and around 7,000 attempted suicides, but most estimates say this is an extremely incomplete picture. There are several reasons why the phenomenon is so undercounted in Israel, such as Jewish law, which defines suicide as a grave sin, the social stigma accompanying suicide, and inadequate data collection. A report published some two years ago by the Israel Center for Disease Control, which is part of the Health Ministry, found that only 28 percent of the deaths by suicide that were examined were recorded as such in the death certificate. Moreover, the report found that one-fifth of the confirmed cases of death by suicide were not recorded as such in CBS reports. A State Comptroller’s Report on the issue, also published some two years ago, estimated that the phenomenon in Israel is at least a third more widespread than the official figures would have us believe.

It is even harder to obtain accurate figures for the extent of the phenomenon of suicide among young members of the Ethiopian community. A report published by the Health Ministry some three years ago, which examined reports of attempted suicides, found that this sub-category among members of the Ethiopian community was three times higher than the national average. The report also found that, since the figures usually only mentioned the place of birth of the person who died by suicide, deaths by suicide among members of the Ethiopian community who were born in Israel – but who most certainly suffered first-hand the same immigration difficulties as their parents – are not counted as part of the community’s suicide statistics.

“Suddenly, the penny dropped,”  said Pnina Tamano-Shata, Israel’s Minister of Immigration and Integration‎‎, at a Knesset hearing in late 2021. “When I was a Knesset member in 2018, there was a discussion, and the question was asked how many members of the Ethiopian community died by suicide. They only counted those people born in Ethiopia, but we know that the problems of members of the Ethiopian community, whether they were born here or there, are similar problems.” Today, it is important to point out that most young members of the Ethiopian community were born in Israel.

Pnina Tamano-Shata, Israel’s Minister of Immigration and Integration‎‎. Photo: Reuters
According to most estimates, in 2005, which was statistically the worst year, young people from an Ethiopian background were 13 times more likely to die by suicide than other Israelis of their age.

Figures released by the Israel Defense Forces from 2021 also show that the problem is far from disappearing. A summary of the most up-to-date casualty figures issued by the Personnel Directorate shows that three of the 11 deaths by suicide in the IDF last year were soldiers from the Ethiopian community. This is an especially troubling figure given that members of the Ethiopian community make up no more than 1.5 percent of the general population.

One senior member of the IDF’s Medical Division casts doubt on the statistical value of that figure, given the very small sample size, but, in the same breath, admits that “over the course of the past decade or two, the rate of deaths by suicide among soldiers from the Ethiopian community has remained steady at around 10 percent of all cases, which is an overrepresentation given the proportion of members of the Ethiopian community serving in the army.”

A study from 2020, which examined the commonalities between those soldiers from the Ethiopian community who died by suicide during their service, found that they all suffered from extreme environmental pressures, such as financial problems and/or a death in the family. In this context, the senior officer also said that “the proportion of young members of the Ethiopian community who serve in combat units is a lot higher than their numbers in the general population. In many cases, this presents a financial question of whether to continue supporting the family, which is one of the challenges the army faces with this community.”

In addition, the officer admits that the Israeli military has a hard time understanding the unique problems faced by the community. “The distress faced by an Ethiopian soldier is not put into words, and it is not diagnosed in psychological terms. In some cases, culturally speaking, the second generation will behave differently from Israeli-born soldiers when it comes to talking about their problems. While there are some soldiers who come to us to ask for help, we see that the phenomenon still exists whereby they try to keep their distress inside and deal with it in all kinds of other ways. Sometimes, they will approach medical staff and try to present their problems in a way that sounds like physical pain.”

In order to deal with the problem, the IDF established a committee headed by a retired brigadier general “to examine how to provide members of the Ethiopian community with more attractive posting and how we can help them when they find themselves in a crisis, whether that’s financially or within the family,” explains the senior officer. “In the end, the program will have a positive effect on the suicide rate,” he hopes.

A soldier at the Western Wall in Jerusalem. Photo: Shutterstock
A summary of the most up-to-date casualty figures issued by the Personnel Directorate shows that three of the 11 deaths by suicide in the IDF last year were soldiers from the Ethiopian community. This is an especially troubling figure given that members of the Ethiopian community make up no more than 1.5 percent of the general population.

‘Depression’ isn’t in the dictionary

Over the years, there have been several studies into the reasons for suicide among members of the Ethiopian community. Some researchers insist that the profound cultural differences between the indigenous population and the immigrants make it impossible to identify mental distress, which leads to undertreatment. 

According to Prof. Zalsman, “the mental health services at the time did not understand the Amharic and Tigrinya languages and were incapable of providing a response to the signs of distress among the adult community. For example, because those languages lack a word for ‘depression,’ there were those who said that they were hearing voices or described physical symptoms such as a burning in the stomach or Zār [the Amharic term for a demon or spirit] that possesses them.”

Another study, conducted by the chair of the MA Clinical Psychology Program at the Ruppin Academic Center, Dr. Rafael Youngmann, examined the mental health care afforded to immigrants from Ethiopia in Israel and found that veteran Israeli therapists sometimes found it hard to understand what these immigrants were complaining of. The inability to understand the cultural images they used to express their distress meant that, at a later stage, there were difficulties providing accurate referrals, psychiatric diagnoses, and finding the correct medicinal course of treatment.

Studies that examined the phenomenon of suicide among young people in general indicate that their inability to express their feelings is the main risk factor. According to a number of researchers, the problem becomes even more acute among members of the Ethiopian community in Israel. For example, some community members express their feelings through idioms, such as “The stomach keeps everything, absorbs it all.” Relatives of Abeba Darsakh also said that he rarely shared his difficulties and problems with them.

“They don’t talk about their feelings; anyone who does is perceived as weak. [Young members of the Ethiopian community] cannot go to their fathers and say, ‘Dad, I’m not feeling well today… I had a bad day.’ A lot of young people tell me that they experience things and keep it all inside,” says Uri Endgaw, CEO of Endgaw House, who has first-hand experience of working with young people from the Ethiopian community.

Prof. Zalsman (left), Uri Endgaw and Dr. Youngmann. Photos: Avital Zimet, Anat Youngmann
Prof. Gil Zalsman, the director of the Geha Mental Health Center and chairman of the National Council for Suicide Prevention, “this is one of the most suicide-prone groups of people in Israel and the world.”

Teenagers borrowing money from loan sharks

“In my opinion, and in the opinion of the professional literature, suicides are like accidents. There is no single cause – you need a combination of causes,” argues Dr. Youngman, who specializes in the connection between psychiatry and culture. “After the first wave of immigration from Ethiopia, in Operation Moses and Operation Solomon, the highest rates of death by suicide among the immigrants were among adults and the older population, who were unable to adapt. This is a phenomenon that characterizes communities in states of migration, but, over time, the highest risk group became younger.” Youngmann also argues that “the years in which there were the most incidents of death by suicide, at the start of this century, were the result of economic issues and the slashing of welfare funding at the time, which mainly affected the most vulnerable sectors of society.”

Today, too, most members of the Ethiopian community are in the weakest economic segments. The Diversity Index, published in May 2022 by the Ministry of Economy and Industry’s Equal Opportunities at Work Unit, found that “the average wage and the wage ceiling of members of the Ethiopian community are among the lowest in Israeli society.” The index also found that while members of the Ethiopian community make up 1.3% of the total working-age population, they make up only 0.5% of the academic workforce. Even in the computer programming sector, which has increased the proportion of members of the Ethiopian community it employs, the wage gaps that existed at the time that the first Diversity Index was published five years ago still exist.

Young members of the Ethiopian community who find themselves in financial difficulty will look for external sources of income. In Israel, it is legal to borrow money from loan sharks. Zamir Jegnawo, an economist and business consultant, is a member of the Ethiopian community. He lectures on the dangers of loan sharks in the hope of deterring youngsters from taking loans at exorbitant interest rates. “I studied the issue in part because of my profession. Financial institutions like banks and credit companies won’t give a line of credit to someone with no financial history. We hear about many young people who go to loan sharks, as young as 13 or 14.”

From that moment on, their situation gets complicated. Interest on the gray market is significantly higher than mainstream financial institutions, and the total amount repaid can often be several times higher than the original loan. Endgaw, who specializes in addiction treatment and coordinates treatment and rehabilitation for prisoners, also helps young people who have run afoul of loan sharks. “I know of at least a handful of cases of youngsters, between the ages of 16 and 24, who have died by suicide because of this kind of problem,” he says.

In addition to these efforts to explain why youths from the Ethiopian community are considered to be such a high-risk suicide group compared both to other immigrants of second-generation immigrants in Israel, it is impossible not to speak about the elephant in the room – the color of their skin, which makes them an easy target for racism of various kinds and represents an obstacle in their path to becoming integrated into the mainstream of Israeli society.

A demonstration in Tel Aviv in the past. Those photographed have nothing to do with the article. Photo: Reuters
Most members of the Ethiopian community are in the weakest economic segments. The Diversity Index, published in May 2022 by the Ministry of Economy and Industry’s Equal Opportunities at Work Unit, found that “the average wage and the wage ceiling of members of the Ethiopian community are among the lowest in Israeli society.”

‘Connecting Suicide to Culture is a Crime’

Not all experts agree with the explanations offered above. “The figures are just baseless. Total nonsense” insists anthropologist Prof. Esther Hertzog. “Linking suicide to culture is a crime. Simply a crime.”

Hertzog describes the conclusions of the studies presented above as “complete and utter nonsense” and warns that the only goal of these studies is “to ascribe to the Ethiopian community the characteristics of a marginalized, problematic and needy population. This is exactly the way to continue to tarnish them with an unfounded stigma.”

Hertzog rejects any effort to compare death by suicide rates based exclusively on the person’s ethnic background and adds that “there is a bias here toward those who control the data, toward those who hold power.” In the 1980s, Hertzog was a member of a research team that looked into the bureaucratic encounters with Israeli authorities experienced by immigrants from Ethiopia. “Studies about suicides have, in a certain sense, sex appeal,” she explains. “Organizations had a vested interest, which still exists today, I believe. There are very generous funds available in this field. I remember how busloads of American tourists would come to the integration‎‎ centers, and we would show them how we deal with these immigrants.”

Prof. Hertzog rejects any effort to compare death by suicide rates based exclusively on the person’s ethnic background and adds that “there is a bias here toward those who control the data, toward those who hold power.”

Prof. Hertzog. Personal Photo

Hertzog believes this kind of framing causes great harm, even if it leads to treatment funding. For example, she points to the town of Yeruham in the Negev. “There was a project there called ‘Clean up Yeruham.’ There was a stigma that Yeruham was dirty and neglected. So they got funding – and what did they do? That funding certainly helped the officials, but city hall itself didn’t get anything from it. On the contrary – it lost out because it was tainted by the stigma.”

When one examines the statistics, Hertzog says, one has to ask what one is comparing them to. “Let’s say that 30 young people recently died by suicide, so there’s a problem here. But did they compare that to the total number of young people, according to various definitions? Let’s say you people who come from families in which the parents are divorced? There are various elements that can provide a partial explanation for a greater rate of death by suicide. So, with which group does one make the comparison?”

Yafit Tedla, a clinical psychologist, also takes issue with the description of deaths by suicide among members of the Ethiopian community as ‘a phenomenon.’

“It is a very diverse community,” she says, “and you cannot make sweeping generalizations about it. “Within the community, there are generational gaps and differences in economic status. Some members of the Ethiopian community have become more integrated into Israeli society, and some have maintained the gaps of language and culture.”

Tedla is most interested in finding out whom the statistics serve. “Suicide is an endpoint, and the media preoccupation with it usually results in extreme responses. Every side takes the statistics and the attention and uses it for its own interests. The focus needs to be elsewhere, on the problems that preceded that endpoint, in managing the crises that people experience in life. People in every sector of society suffer from distress, so it’s impossible to talk about a high-risk group without comparing it to other risk groups. The alignment of social forces, racism, and cultural and language differences make other risk groups stand out – but statistics about their suicide rate are not discussed.”

All of this, she says, invalidated any comparison between the tragedies and the distress of young immigrants to those suffered by third-generation immigrants, who are situated in the middle classes – if its only frame of reference is the shared ethnic origin of the subjects. Hertzog stresses that “talking about a phenomenon without clear statistics creates a stigma that could do more harm than good. Figures about a certain ethnic group in society can provide another element in analyzing a social phenomenon but cannot be its main point of departure.”

“Instead of creating dangerous stigmas, we need to promote treatment with a multicultural approach, to recognize the needs of various high-risk groups, to make the solution available to them and suitable for them, across various systems,” Tedla summarizes.

A demonstration in Tel Aviv in the past. Those photographed have nothing to do with the article. Photo: Reuters
Yafit Tedla, a clinical psychologist, also takes issue with the description of deaths by suicide among members of the Ethiopian community as ‘a phenomenon.’ “It is a very diverse community,” she says, “and you cannot make sweeping generalizations about it.“

People who die by suicide have lost all hope

In December 2012, the Israeli government announced the launch of a national project aimed at preventing suicide under the leadership of the Health Ministry. Ostensibly, it seems that the project has been a success. According to a Health Ministry statement issued in November 2021, the suicide rate among members of the Ethiopian community fell from 41.9 per 100,000 in 2005 to 17.1 in 2019. Between 2001 and 2019, there was a 40 percent drop in the number of deaths by suicide among members of the Ethiopian community between the ages of 15 and 24. Among girls and young women, the statistics are slightly less encouraging – with a drop of just 18 percent being recorded.

It is worth remembering that while these figures represent a positive trend, there is some argument over their validity since they do not necessarily include second and third-generation immigrants. Many people believe that, over the years, the phenomenon has changed shape but is far from disappearing. “Our youngsters do not have anyone who can guide them where to study or what position to take in the army, says economist and businessman Zamir Jegnawo. “Parents from the Ethiopian community do not have the information that Israeli-born parents have, they do not have the wherewithal to advice the youth. In our community, young people have to choose by themselves, and they have no way of knowing what’s right. Members of the third generation were born here, and when they see how their neighbors and friends are living, they tell themselves, ‘I deserve this, too, I also want to live like that.’ It certainly has an effect when they find out that it’s a lot harder for them than for native Israelis.”

“People who commit suicide have lost all hope,” adds Youngmann. “You could say that they lost hope because of internal depression, but the reality also causes them to lose hope. The stimulus could be that they did not get accepted to a certain job or that they are alone, they don’t talk about it, they are alienated from their families and do not want to be a burden on their parents. They are in a cloud of desperation, so they do something from which there is no return. You have to remember that they were born in Israel and are Israelis, with all the ambition that comes with that. Afterward, they discover a very different reality, as we saw in the demonstrations, in which not every opportunity is available to them. In one of the studies we conducted, we interviewed a soldier in a combat unit. He has good friends in the army, but when he goes home, and his [non-Ethiopian] friends go to their homes, it is impossible to deny the inequality that exists between them. There is a large gap between the expectations that members of the Ethiopian community have of Israeli society and the reality that they encounter, in which there are only limited opportunities available to them.”

“We were a very open community, and we embraced the authorities in this country,” says Tedla. “We came to Israel with a sense of a homecoming, returning to our brothers and sisters, but, over the years, there were various events and incidents that created a lack of trust toward the state, whether it’s the blood scandal [when it became apparent that the state had secretly dumped blood donated by members of the Ethiopian community because of fear that it was contaminated with the AIDS virus], the shooting to death of 18-year-old Solomon Teka by an Israeli police officer in Haifa or other cases of discrimination against citizens from the Ethiopian community. It’s important to understand that all of these issues created a rift that did not previously exist.”

Tedla stresses that the lack of trust is not cultural. “It was created here over the years, thanks to countless examples of young members of the Ethiopian community encountering the discriminatory and racist side of the establishment. People are afraid that control will be wrested away from them, along with their ability to choose what’s right for them.”

“This distrust was created by years of unequitable and distorted activity by the very authorities that were supposed to provide a solution,” adds social activist Avi Yalew. “The language was not understood, the hardships were different from those that the therapists were familiar with. People were misdiagnosed, and it’s the easiest thing in the world to shove some pills at them. I remember how, when I was a child, we would see people from our neighborhood who were sent for treatment and came back drugged up with pills. That created the impression that if you show any sign of weakness or express distress, you’ll be disappeared, and you’ll come back as disconnected as a zombie. For years, there was a belief that you wouldn’t get the correct treatment.”

Hertzog adds that if even the establishment were to try to rectify the situation by throwing money at it, “it would be a process that entrenches the stereotype. Even if members of the Ethiopian community were to get the money, that money would once again bolster the stereotype. Suppose they keep wasting funding on one kind of weakness or another and do not improve services like education or employment. In that case, there is no chance of improving the situation, just perpetuating the inadequacies.”

What, then, can be done to help a community with special characteristics? Prof. Zalsman participated in a study conducted by Columbia University into methods of reducing the suicide rate among Hispanic youths in Harlem. One of the conclusions was that, in order to provide optimal treatment, those providing the service must be familiar with and understand the culture and language of those receiving the service.

“First of all, the psychologists needed to learn Spanish. In addition, we all learned how to interview someone from a Hispanic background with suicidal thoughts, how to explain things to them, and how to talk about the subject. We learned with whom it is acceptable to talk about the issue of suicide, whether it’s the father or the mother, whether the initial conversation should be in the presence of the parents, whether it is acceptable to report such tendencies. We were taught all of this because there was cultural sensitivity. We have been dealing with this for many years, but Israel is not there yet.”

Zalsman’s comments are reinforced by comments made by the ERAN Association, which provides psychological counseling by phone. A statement from ERAN confirmed that the organization’s Amharic hotline is no longer operational. The reason stated for the closure was the small number of calls made to it – which stems in part from the fact that there is limited awareness of the service at all.

Zamir Jegnawo (left) and Avi Yalew. Photos: Yohans Palten, Gideon Agaze
“This distrust was created by years of unequitable and distorted activity by the very authorities that were supposed to provide a solution,” adds social activist Avi Yalew. “The language was not understood, the hardships were different from those that the therapists were familiar with."

Epilog

In June this year, the State of Israel relaunched Operation Tzur Israel, which aimed to bring here some 3,000 first-degree relatives of members of the Ethiopian community. The operation was first announced some two years ago but was put on hold for over a year because of the coronavirus pandemic. Now that the world has returned to routine and given the dire famine afflicting the Horn of Africa, the state redoubled its efforts.

The imminent arrival in Israel of thousands more members of the Ethiopian community provides an opportunity for a profound discussion of the difficulties facing them and the way to reduce the number who die by suicide. The Israeli state is more than capable of giving people who immigrate here a sense that they have returned home, but the real test will arrive when these new immigrants turn from honored guests to citizens with responsibilities and discover how low on the Israeli socio-economic ladder they are.

And so, when culture shock, economic hardship, and many other factors marginalize many of them, it’s worth remembering the impressive way that Israel rallies round to save Jewish lives that are in danger in various disasters across the world – and ensuring that this does not end once they cross the border into Israel. Whether or not it is a phenomenon, the state’s efforts to reduce the death by suicide rate among members of the Ethiopian community is – quite literally – a matter of life or death.

The writing of this article was mentored by Shay Fogelman, a journalist, and a teacher at the Department of Communication at Haifa University.

This is a summary of shomrim's story published in Hebrew.
To read the full story click here.