Photo by Negative Space, Stocksnap.io

During my ethnographic research in Milan between 2018-2019, from interviews with patients and doctors, consulting regional, national and EU reports, and participation in hospital meetings, I learnt about the development of digital health in the city of Milan, the region of Lombardy, and across Italy. Digital or mobile health (mHealth) has been developing in and across Italy in recent years[i]. Since 2016, a few regions such as Lombardy, Emilia-Romagna, and Tuscany have been particularly active in this field, and Lombardy’s activity in digital healthcare is above the national average.[ii] Developments in this area have since been impacted by the coronavirus pandemic during 2020, in Italy, and in Lombardy in particular, which saw the highest number of cases in Italy in early 2020. Digital technologies have played a significant role during the pandemic in a number of core areas relating to health from regional and national healthcare access communication and delivery and nascent public-private partnerships, to the everyday experience of lockdown. Amid the pandemic, the country has witnessed an increase in state engagement with the digital, including a range of public-private partnerships that, for example, offer ‘digital solidarity’ packages to citizens[iii] and seek to warn against ‘fake news’ about the virus that has been shared across social media. In March 2020, the Italian Ministry of Health published a warning list of ten particularly pertinent ‘fake news’ items about the coronavirus that were circulating across the Italian social web, urging the public to be vigilant about this issue.[iv]

During my broader ethnographic research studying ageing, care, and smartphones in Milan, I found that formal and informal policies and practices exist within a nexus of an emerging digital health scene ‘from above’, and a diverse adoption of digital practices by people of different ages and backgrounds ‘from below’. Amongst research participants who were smartphone users, googling for information about health and using WhatsApp to communicate with and care for others, for example, could be popular activities not wholly distinct from broader uses of smartphones for care and communication. Concurrently, these practices could also go hand in hand with the spread of mis/disinformation[v].

As such, although Milan and Lombardy are leading sites within Italy for healthcare and digital innovation, a range of factors continue to affect the equity of healthcare access, delivery and uptake, online and offline; such as income, socio-economic factors, regional location, and language; and these factors all play a role in the differentiated experience of living and ageing with smartphones in Milan that I explored during my research in Italy, and which are core themes in my forthcoming book as part of the ASSA book series with UCL Press, Ageing with Smartphones in Urban Italy: Care and Community in Milan and Beyond (2021).

References

[i] The uptake of mHealth in Italy has been reported as steady while slower than in other European countries such as Estonia and Denmark. Kostera, Thomas. 2019. ‘Digital health – Europe is moving at different speeds’. The Digital Patient (blog), 25 April. https://blog.der-digitale-patient.de/en/digital-healtheurope/. Accessed 23 November 2020.

[ii] See Postelnicu, Leontina. 2019. ‘Q&A: How Italy is working to digitise healthcare’. Healthcare IT News, 23 October. https://www.healthcareitnews.com/news/europe/qa-how-italy-working-digitise-healthcare. Accessed 23 November 2020.

[iii] In Italy during the Covid-19 pandemic in 2020, ‘digital solidarity’ packages were offered to bridge some of the socio-economic and digital gaps highlighted and perpetuated by the virus, at a time when digital practices of care and communications had taken on heightened significance. See Agenzia per l’Italia Digitale. 2020. ‘Solidarietà Digitale al servizio di studenti e commercianti’. Solidarietà Digitale. https://solidarietadigitale.agid.gov.it/#/. Accessed 21 November 2020.

[iv] See Ministero della Salute 2020 Salute (Ministry of Health). ‘Covid-19, occhio alle bufale’. http://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=dalministero&id=4380. Accessed 23 November 2020.

[v]The distinction between misinformation and disinformation has been defined in terms of intentionality. The former describes the sharing of information regardless of intention, while the latter involves the intention to mislead, misinform and/or manipulate. See: https://www.dictionary.com/e/misinformation-vs-disinformation-get-informed-on-the-difference/ and https://en.unesco.org/fightfakenews

Laila Abed Rabho & Maya de Vries

While Israel is now in the middle of a third full lockdown due to the Covid-19 pandemic, there are many who still question if the pandemic is real, or whether it is a worldwide conspiracy run by governments. Israel’s population is divided into several sectors: Religious Jews, Secular Jews, Palestinians, and other minorities. Those who are still indifferent about the Covid-19 pandemic and the actual existence of this virus are more likely to be found among the Arab and Orthodox Jewish communities. The latter is a rather ‘disconnected’ community when it comes to the ‘information society’ (Castells, 2003), with the use of the Internet and smartphones not being fully approved by their leading authorities – Rabbis (for more information about Internet use in the Ultra-Orthodox society see this report). The Arab community in Israel, as well as in al-Quds, which is under Israeli control, is not limited in terms of using the Internet or smartphones, however, it does suffer from a ‘digital divide’ due to lower rates of ownership of PCs, poor knowledge of Hebrew, especially among older women and al-Quds residents, a lack of trust in the Israeli authorities and intensive use of social media through which they receive news and other information (see the full report here in Hebrew). Obtaining news primarily through social media can be problematic since plenty of the ‘news’ is actually ‘fake news’. It is also important to mention here the fact that a lot of official information about the virus is first distributed in Hebrew, and only afterwards translated into Arabic, which leaves a gap that enables ‘fake news’ to be distributed in Arabic easily and rapidly.

In the past month, Israel, in a very impressive operation, started to vaccinate everyone over 60, followed by other age groups over 40. These last few weeks have been like a race between the pace of infection and the rate of vaccination. One of the reasons Israel has started so early is that the vaccination operation exploits the specific way in which the healthcare system has been constructed  Local clinics are managing the entire process under the supervision of the Ministry of Health. The fact that these local health clinics, which are divided into four state-mandated health service organisations (Clalit, Macabi, Leumit and Mehudedt) have medical records and personal information dating back thirty years (on average) on each patient gives Israel an advantage, as it will be able to provide the drug companies (Pfizer, Moderna and others) with detailed medical information about side effects such as allergies and other responses observed in those who received the vaccine. This is viewed by the companies as vital data that can be used for further research, but we will leave this to another discussion about the value of medical data and the issue of privacy.

The number of people who received the vaccine in al-Quds as of the 7^th of January can be seen in the table below (though it is important to note that the data keeps being updated as the vaccination operation continues, and other age groups are starting to receive it now).

Figure 1. Data taken from Ynet (January 7th, 2021).

This information has not been broken down into the different ethnic groups that composed the population of Al-Quds. Although we looked for specific information about vaccination rates among Palestinians in Al-Quds, this was difficult to find.  We did receive some data through private email correspondence with the manager of the Clalit clinic in Dar al-Hawa, who said that that a quarter of the Palestinians over 60 had received the vaccine al-Quds. However, when comparing this rate to the rate of vaccination seen among the secular Jewish society in the city, this is a relatively low number. The general fear of the new vaccine is understandable. However, there is also the possibility that the fear is being combined with rumours based on ‘fake news’ items currently circulated on social media and WhatsApp groups, which can potentially put people in physical danger due to non-vaccination (see also Haaretz’s article Fake News during Covid-19 in al-Quds).

In Dar al-Hawa and al-Quds more generally, rumours and fake news about the virus and the vaccine have crossed gender, race, and religious differences.

Currently, it can be said that a significant number of people still do not follow the instructions given by the Ministry of Health and choose not to wear a face mask and to keep social distancing, while some are still holding wedding parties with many guests, though in private yards, since most halls are closed. There are also many cases of people still visiting bereaved families in person to give their condolences, although, in the first lockdown, this had stopped almost completely. Low levels of compliance with safety measures may have led to a significant increase in the number of positive COVID-19 cases in Israel as well as in Al-Quds.

Some of these rumours, which circulate on Facebook and WhatsApp, continue to this very day and a serious effort is needed in order to weaken them. Among these rumours, there are a few narratives that keep getting circulated:

1. One narrative says that this artificial virus was created by China in order to eliminate Muslims in cooperation with other major countries.
2. Another says that the virus was created in order to get rid of the elderly in order to alleviate the global population crisis.
3. There is also a rumour that says that this virus is part of a greater conspiracy led by the World Health Organization (WHO) in order to market and sell medicines.

These narratives have been circulated over Facebook and WhatsApp in the past few months and still today, despite the death toll and the increasing number of hospitalised people, they clearly have taken hold in parts of al-Quds. One of the ways both the military and the Palestinian social and political leaders in al-Quds have tried to fight these problematic rumours has been through circulating postings intended that oppose these positions through social media channels, intended to refute these rumours.  Two Facebook pages served as the main platforms for distributing reliable information about Covid-19. One is the Arabic-language official Facebook page of the Jerusalem municipality, and there is also a new Facebook page that was established at the beginning of the crisis (if less active at present), created by prominent Palestinian individuals and organisations working in al-Quds under the name The coalition of Jerusalem.

These Facebook pages are quite popular in terms of their number of followers, but when judged in terms of success, their impact seems limited as evident in the degree to which people still celebrate weddings and may not wear masks.

Figure 2 Example of a post from the Jerusalem municipality’s Arabic-language Facebook page, auto-google-translated here.

While rumours about the Covid-19 continued to circulate online, there are now additional fake messages about the expected vaccine which have also started to spread around. The message below repeats the often-heard point that the vaccine includes a chip that assists global superpowers in tracking individuals around the world (including obtaining their bank account details and giving them the ability to kill an individual).

Figure 3: Inaccurate message about the vaccine on the FATA Facebook page (https://www.facebook.com/Fatabyyano/)

In Dar Al-Hawa (our fieldsite), it is not easy to convince local residents to take the vaccine – and the rumours around it are not helping. In the current political situation of constant contestation in al-Quds, Covid-19 reveals how existing socio-economic gaps have a direct impact on the digital divide, itself related to infrastructure and education as well as poor access to the information originally published in Hebrew. The space created in these divides is quickly occupied by alternative and highly problematic rumours, which, if believed, can prove to be a matter of life and death. More than that, the circulation of false news items which then take the place of real news deepens the digital divide, increasing the divergence between hegemonic groups and non-hegemonic groups and extending the latter’s distance from mainstream and official information.