Why did Israel’s Netanyahu conceal his heart condition?

JERUSALEM — The urgent procedure to fit Prime Minister Benjamin Netanyahu, 74, with a pacemaker early Sunday morning unveiled the state of his health, which had been shrouded in fog for years. 

A report on his medical condition was last issued in 2016, giving him a clean bill of health. Unlike the standard practice by US presidents and some other Western leaders, the Israeli public had no idea what medication the prime minister was taking and whether there had been any deterioration of his health over the last seven years. Official reports were only issued the few times he underwent a procedure under sedation to remove intestinal polyps, which were found to be benign.

For his detractors and opponents, what appeared to be deliberate concealment of the state of his health provided further proof of their argument that Netanyahu was behaving more like a dictator than a democratic leader. Netanyahu, for his part, regularly posted video clips on social media, showing him walking vigorously along a beach or a street, or energetically navigating the corridors of the Knesset. 

Netanyahu has always sought to maintain the image of strength and vitality. In 1988, at the outset of his political career, his physical strength was his hallmark, as reflected in his pride at serving as an officer in an elite commando unit that had seen anti-militant action. The young Netanyahu was branded to the public as a fresh force showing up and outpacing the old guard. 

That was also his trump card in 2006. When Prime Minister Ariel Sharon suddenly collapsed at 78 due to a stroke at the height of that year’s election campaign, Netanyahu, then the 57-year-old opposition leader, issued his medical file. Apart from minor hypertension and several other minor findings, his doctors reported that he was in good health. The public report was clearly intended to contrast this vigorous political opponent with a comatose, ageing leader.

Since he took office in 2009, Netanyahu’s office had issued periodic summaries describing his good health, but these stopped in 2016. 

His physical fitness was questioned in October 2022 when the premier fell ill during Yom Kippur and was rushed to hospital. His office said at the time that his weakness had been brought on by the 24-hour fast undertaken by observant Jews on Yom Kippur, adding that all the test results were normal. 

Ten days ago, on July 15, Netanyahu was rushed to Sheba Medical Center in Tel HaShomer. The sudden hospitalization, and the delay in issuing an official statement, prompted special live broadcasts on major TV stations. Several hours elapsed before the facts emerged. Netanyahu had apparently fainted at home and was taken to hospital by his security guards on the advice of his doctor. The official statement that followed attributed his fainting to dehydration, brought on by a cruise on the Sea of Galilee the day before in scorching heat. 

Question of replacement

His sudden hospitalization also brought up the question of his replacement in case he was incapacitated. Netanyahu has deliberately avoided appointing an official stand-in in order to prevent any indication that he was designating a successor. By law, the replacement for an incapacitated premier is decided by the government. 

Given the tumultuous pro-democracy protests that continued even as he was taken to hospital, and the political upheavals roiling the country, Netanyahu was determined to project an image of strength and good health. In a video clip from his hospital room, he explained that he had suffered from the effects of dehydration after spending time in the sun "without a hat and without water." Official photos showed him bareheaded on the boat.

Although his office initially said all the tests had shown he was fine, a few hours later his office announced that the regular Sunday morning Cabinet meeting had been postponed because Netanyahu would spend the night in the hospital and was seen by leading cardiologists. He may have indeed been dehydrated, but the puzzling mention of cardiologists revved up the rumor mill. It turned out that Netanyahu was fitted with an implantable loop recorder that records heart rhythms.

Several days later, the monitor indicated an episode of irregular heart rhythms. A top cardiologist arrived at Netanyahu’s office and told him he needed a pacemaker and that the procedure should not be put off. Following the procedure under light sedation three days later, Netanyahu issued another video clip from the hospital, in which he was seen heavily made up and saying he feels great.

Netanyahu was released from hospital on Monday morning and said he would show up for the decisive vote on the judicial overhaul scheduled for later in the day, although standard practice after pacemaker implants calls for rest. On the other hand, his office said that two visits abroad, scheduled for later this week — to Cyprus and to Turkey — were both postponed, with no new date announced. 

Meanwhile, news reports citing medical sources said Netanyahu had in fact been suffering from arrhythmia in recent years. His office denied the claims, but this lack of transparency in order to convey the image of a timeless leader has severely damaged Netanyahu’s credibility, which is already at an all-time low.