Gift Of United Nations (UN) For The Muslim World.

Israel is a parliamentary republic in Western Asia part of the Middle East located on the eastern shore of the Mediterranean Sea. It borders Lebanon in the north, Syria in the northeast, Jordan and the West Bank in the east, Egypt and the Gaza Strip on the southwest, and contains geographically diverse features within its relatively small area. Israel is the world's only Jewish-majority state, and is defined as "a Jewish and democratic state" by the Israeli government.

Following the 1948 Arab–Israeli War, Israel expanded its territory to the Green Line, as defined in the 1949 Armistice Agreements. Israel later annexed East Jerusalem in 1980 and the Golan Heights in 1981, although these annexations went unrecognized, and most Arabs in these areas have declined Israeli citizenship. Citizens of the State of Israel also live in Israeli settlements in the West Bank. The population, defined by the Israel Central Bureau of Statistics to include all citizens and permanent residents within Israel and in Israeli settlements was estimated in May 2010 to be 7,602,400 people, of whom 5,776,500 are Jewish Arab citizens of Israel form the country's second-largest ethnic group, which includes Muslims, Christians, Druze, and Samaritans. According to the May 2010 population estimate, including 300,000 non-citizen Arabs living in East Jerusalem and the Golan Heights, this minority numbers 1,551,400.

The modern State of Israel was declared in 1948, and traces its historical and religious roots to the Biblical Land of Israel, also known as Zion, a concept central to Judaism since ancient times. Political Zionism took shape in the late-19th century Europe under Theodor Herzl, and the Balfour Declaration of 1917 formalized British policy preferring the establishment of a national home for the Jewish people. Following World War I, the League of Nations granted Great Britain the Mandate for Palestine, which included responsibility for securing "the establishment in Palestine of a national home for the Jewish people". In November 1947, the United Nations voted in favor of the partition of Palestine, proposing the creation of a Jewish state, an Arab state, and an UN-administered Jerusalem. Partition was accepted by the Zionist leadership but rejected by Arab leaders, and a civil war began. Israel declared independence on 14 May 1948 and neighboring Arab states invaded the next day. Since then, Israel has fought a series of wars with neighboring Arab states, and has occupied territories, including the West Bank, Sinai Peninsula, Gaza Strip and the Golan Heights, beyond those delineated in the 1949 Armistice Agreements. The border between Israel and the neighboring West Bank is not formally defined by the Israeli government, as a result of a complex and unresolved political situation. Israel has signed peace treaties with Egypt and Jordan, but efforts by elements within both parties to diplomatically solve the problem have so far only met with limited success.

Israel is a developed country and a representative democracy with a parliamentary system and universal suffrage. The Prime Minister serves as head of government and the Knesset serves as Israel's legislative body. The economy, based on the nominal gross domestic product, was the 41st-largest in the world in 2008. Israel ranks highest among Middle Eastern countries on the UN Human Development Index, and it have one of the highest life expectancies in the world. Jerusalem is the country's capital, although it is not recognized internationally as such. Israel's main financial center is Tel Aviv, and its main industrial center is Haifa. In 2010, Israel joined the OECD.

Etymology

The Star of David, symbol of Judaism since the middle Ages.

In 1948, the country was formally named Medinat Yisrael, or the State of Israel, referring to the ancient Israelites of the region, after other proposed historical and religious names including Eretz Israel ("the Land of Israel"), Zion, and Judea, were considered and rejected. In the early weeks of independence, the government chose the term "Israeli" to denote a citizen of Israel, with the formal announcement made by Minister of Foreign Affairs Moshe Sharett.

The name Israel has historically been used, in common and religious usage, to refer to both the Land of Israel and the entire Jewish nation. According to the Bible, the name "Israel" was given to the patriarch Jacob; Septuagint Greek: Ἰσραήλ; "persevere with God") after he successfully wrestled with an angel of God. Jacob’s twelve sons became the ancestors of the Israelites, also known as the Twelve Tribes of Israel or Children of Israel. According to the Bible, Jacob and his sons had lived in Canaan and were forced by famine to go into Egypt for four generations until Moses, a great-great grandson of Jacob, led the Israelites back into Canaan in the Exodus. The earliest archaeological artifact to mention the word "Israel" is the Merneptah Stele of ancient Egypt (dated to the late 13th century BCE).

The area is also known as the Holy Land, being holy for all Abrahamic religions including Judaism, Christianity, Islam and the Bahá'í Faith. Prior to the 1948 Israeli Declaration of Independence, the region was known by various other names including Palestine, Southern Syria, Syria Palestina, Kingdom of Jerusalem, Iudaea Province, Coele-Syria, Retjenu and Canaan.

Zionism and the British Mandate

Further information: History of Zionism

Many Jews living in the Diaspora have long aspired to return to Zion and the Land of Israel, though the amount of human effort that should be spent towards such aim is a matter of dispute in Judaism. That hope and yearning was articulated in the Bible, and is an important theme of the Jewish belief system. After the Jews were expelled from Spain in 1492, some communities settled in Palestine. During the 16th century, communities struck roots in the Four Holy Cities—Jerusalem, Tiberias, Hebron, and Safed—and in 1697, Rabbi Yehuda Hachasid led a group of 1,500 Jews to Jerusalem. In the second half of the 18th century, Eastern European opponents of Hasidism, known as the Perushim, settled in Palestine.

Theodor Herzl, visionary of the Jewish State, in 1901

The first large wave of "modern" immigration, known as the First Aliyah, began in 1881, as Jews fled pogroms in Eastern Europe. Although the Zionist movement already existed in theory, Austro-Hungarian journalist Theodor Herzl is credited with founding political Zionism, a movement which sought to establish a Jewish state in the Land of Israel, by elevating the Jewish Question to the international plane. In 1896, Herzl published Der Judenstaat (The State of the Jews), offering his vision of a future state; the following year he presided over the first World Zionist Congress.

The Second Aliyah (1904–1914), began after the Kishinev pogrom; some 40,000 Jews settled in Palestine, but nearly half of them left. Both the first and second waves of migrants were mainly Orthodox Jews, but those in the Second Aliyah included socialist pioneers who established the kibbutz movement. During World War I, British Foreign Secretary Arthur Balfour issued what became known as the Balfour Declaration, which "view[ed] with favour the establishment in Palestine of a national home for the Jewish people". At the request of Edwin Samuel Montagu and Lord Curzon, a line was also inserted stating "it being clearly understood that nothing shall be done which may prejudice the civil and religious rights of existing non-Jewish communities in Palestine, or the rights and political status enjoyed by Jews in any other country".

The Jewish Legion, a group of battalions composed primarily of Zionist volunteers, assisted in the British conquest of Palestine. Arab opposition to the plan led to the 1920 Palestine riots and the formation of the Jewish organization known as the Haganah (meaning "The Defense" in Hebrew), from which the Irgun and Lehi paramilitary groups split off. In 1922, the League of Nations granted the United Kingdom a mandate over Palestine under terms similar to the Balfour Declaration. The population of the area at that time was predominantly Arab and Muslim, with Jews accounting for about 11% of the population.

The Third (1919–1923) and Fourth Aliyahs (1924–1929) brought an additional 100,000 Jews to Palestine. Finally, the rise of Nazism in the 1930s led to the Fifth Aliyah, with an influx of a quarter of a million Jews. This caused the Arab revolt of 1936–1939 and led the British to cap immigration with the White Paper of 1939. With countries around the world turning away Jewish refugees fleeing the Holocaust, a clandestine movement known as Aliyah Bet was organized to bring Jews to Palestine. By the end of World War II, the Jewish population of Palestine had increased to 33% of the total population.

Independence and first years

After 1945, Britain found itself in fierce conflict with the Jewish community, as the Haganah joined Irgun and Lehi in armed struggle against British rule. At the same time, thousands of Jewish refugees from Europe sought shelter in Palestine and were turned away or rounded up and placed in detention camps by the British. In 1947, the British government withdrew from the Mandate of Palestine, stating it was unable to arrive at a solution acceptable to both Arabs and Jews. The newly created United Nations approved the Partition Plan for Palestine (United Nations General Assembly Resolution 181) on November 29, 1947, which sought to divide the country into two states—one Arab and one Jewish. Jerusalem was to be designated an international city—a corpus separatum—administered by the UN.

The Jewish community accepted the plan, but the Arab League and Arab Higher Committee rejected it. On December 1, 1947, the Arab Higher Committee proclaimed a three-day strike, and Arab bands began attacking Jewish targets. Jews were initially on the defensive as civil war broke out, but they gradually moved onto the offensive. The Palestinian Arab economy collapsed and 250,000 Palestinian-Arabs fled or were expelled.

David Ben-Gurion proclaiming Israeli independence on May 14, 1948, below a portrait of Theodor Herzl

On May 14, 1948, the day before the expiration of the British Mandate, the Jewish Agency proclaimed independence, naming the country Israel. The following day, the armies of four Arab countries—Egypt, Syria, Lebanon and Iraq—attacked Israel, launching the 1948 Arab–Israeli War; Saudi Arabia sent a military contingent to operate under Egyptian command; Yemen declared war but did not take military action. After a year of fighting, a ceasefire was declared and temporary borders, known as the Green Line, were established. Jordan annexed what became known as the West Bank and East Jerusalem, and Egypt took control of the Gaza Strip. About 700,000 Palestinian refugees were expelled or fled the country during the conflict.

Israel was accepted as a member of the United Nations by majority vote on May 11, 1949.

In the early years of the state, the Labor Zionist movement led by Prime Minister David Ben-Gurion dominated Israeli politics. These years were marked by an influx of Holocaust survivors and Jews from Arab lands, many of whom faced persecution in and expulsion from their original countries. Consequently, the population of Israel rose from 800,000 to two million between 1948 and 1958. Some arrived as refugees with no possessions and were housed in temporary camps known as ma'abarot; by 1952, over 200,000 immigrants were living in these tent cities. The need to solve the crisis led Ben-Gurion to sign a reparations agreement with West Germany that triggered mass protests by Jews angered at the idea of Israel accepting financial compensation from Germany for the Holocaust.

In the 1950s, Israel was frequently attacked by Palestinian fedayeen, mainly from the Egyptian-occupied Gaza Strip. In 1956, Israel joined a secret alliance with Great Britain and France aimed at regaining control of the Suez Canal, which the Egyptians had nationalized (see the Suez Crisis). Israel captured the Sinai Peninsula but was pressured to withdraw by the United States and the Soviet Union in return for guarantees of Israeli shipping rights in the Red Sea and the Canal.

In the early 1960s, Israel captured Nazi war criminal Adolf Eichmann, an architect of the Final Solution, in Argentina and brought him to trial. The trial had a major impact on public awareness of the Holocaust, and Eichmann remains the only person ever to be executed by order of an Israeli court.

Conflicts and peace treaties

Further information: Arab–Israeli conflict, Israeli–Palestinian conflict, and Positions on Jerusalem

See also: List of United Nations resolutions concerning Israel

Arab nationalists led by Egyptian President Gamal Abdel Nasser refused to recognize Israel, calling for its destruction. By 1966, Israeli-Arab relations had deteriorated to the point of actual battles taking place between official Israeli and Arab forces. In 1967, Egypt expelled UN peacekeepers, stationed in the Sinai Peninsula since 1957, and announced a partial blockade of Israel's access to the Red Sea. Israel saw these actions as a casus belli for a pre-emptive strike that launched a Six-Day War, in which Israel was able to occupy the West Bank, Gaza Strip, Sinai Peninsula and Golan Heights. Jerusalem's boundaries were enlarged, incorporating East Jerusalem, and the 1949 Green Line became the administrative boundary between Israel and the occupied territories.

As the Arab states lost in the 1967 war against Israel, Arab non-state actors came to have a more central role in the conflict. Most important among them is the Palestinian Liberation Organization (PLO), established in 1964, which initially committed itself to "armed struggle as the only way to liberate the homeland". In the late 1960s and early 1970s, Palestinian groups launched a wave of attacks against Israeli targets around the world, including a massacre of Israeli athletes at the 1972 Summer Olympics in Munich.

On October 6, 1973, as Jews were observing Yom Kippur, the Egyptian and Syrian armies launched a surprise attack against Israel. The war ended on October 26 with Israel successfully repelling Egyptian and Syrian forces but suffering massive losses. An internal inquiry exonerated the government of responsibility for failures before and during the war, but public anger forced Prime Minister Golda Meir to resign.

The 1977 Knesset elections marked a major turning point in Israeli political history as Menachem Begin's Likud party took control from the Labor Party. Later that year, Egyptian President Anwar El Sadat made a trip to Israel and spoke before the Knesset in what was the first recognition of Israel by an Arab head of state. In the two years that followed, Sadat and Menachem Begin signed the Camp David Accords and the Israel-Egypt Peace Treaty. Israel withdrew from the Sinai Peninsula and agreed to enter negotiations over autonomy for Palestinians in the West Bank and the Gaza Strip. Begin's government encouraged Israelis to settle in the West Bank, leading to friction with the Palestinians in that area.

Israeli artillery at the Golan front, during the Yom Kippur War, 1973

The Jerusalem Law, passed in 1980, was widely believed to have reaffirmed Israel's annexation of Jerusalem and reignited international controversy over the status of the city. However, there has never been an official act that has declared expanded East Jerusalem as having been annexed by the State of Israel. The position of the majority of UN member states is reflected in numerous resolutions declaring that actions taken by Israel to impose its laws, jurisdiction and administration on the whole of Jerusalem are illegal and has no validity.

In 1982, Israel intervened in the Lebanese Civil War to destroy the bases from which the PLO launched attacks and missiles at northern Israel; that move developed into the First Lebanon War. Israel withdrew from most of Lebanon in 1986, but maintained a borderland buffer zone until 2000. The First Intifada, a Palestinian uprising against Israeli rule, broke out in 1987 with waves of violence occurring in the occupied territories. Over the following six years, more than a thousand people were killed in the ensuing violence, much of which was internal Palestinian violence. During the 1991 Gulf War, the PLO and many Palestinians supported Saddam Hussein and Iraqi missile attacks against Israel, though Israel did not participate in that war.

In 1992, Yitzhak Rabin became Prime Minister following an election in which his party promoted compromise with Israel's neighbors. The following year, Shimon Peres and Mahmoud Abbas, on behalf of Israel and the PLO, signed the Oslo Accords, which gave the Palestinian National Authority the right to self-govern parts of the West Bank and the Gaza Strip. The PLO also recognized Israel's right to exist and pledged an end to terrorism. In 1994, the Israel-Jordan Treaty of Peace was signed, making Jordan the second Arab country to normalize relations with Israel. Arab public support for the Accords was damaged by the continuation of Israeli settlements and checkpoints, and the deterioration of economic conditions. Israeli public support for the Accords waned as Israel was struck by Palestinian suicide attacks. Finally, while leaving a peace rally in November 1995, Yitzhak Rabin was assassinated by a far-right-wing Jew who opposed the Accords.

Yitzhak Rabin and Yasser Arafat shake hands at the signing of the Oslo Accords, with Bill Clinton behind them, 1993

At the end of the 1990s, Israel, under the leadership of Benjamin Netanyahu, withdrew from Hebron, and signed the Wye River Memorandum, giving greater control to the Palestinian National Authority. Ehud Barak, elected Prime Minister in 1999, began the new millennium by withdrawing forces from Southern Lebanon and conducting negotiations with Palestinian Authority Chairman Yasser Arafat and U.S. President Bill Clinton at the 2000 Camp David Summit. During the summit, Barak offered a plan for the establishment of a Palestinian state, but Yasser Arafat rejected it. After the collapse of the talks and a controversial visit by Likud leader Ariel Sharon to the Temple Mount, the Second Intifada began. Sharon became prime minister in a 2001 special election. During his tenure, Sharon carried out his plan to unilaterally withdraw from the Gaza Strip and also spearheaded the construction of the Israeli West Bank barrier.

In July 2006, a Hezbollah artillery assault on Israel's northern border communities and a cross-border abduction of two Israeli soldiers sparked the month-long Second Lebanon War. Two years later, in May 2008, Israel confirmed it had been discussing a peace treaty with Syria for a year, with Turkey as a go-between. However, at the end of the year, Israel entered another conflict as a ceasefire between Hamas and Israel collapsed. The Gaza War lasted three weeks and ended after Israel announced a unilateral ceasefire. Hamas announced its own ceasefire, with its own conditions of complete withdrawal and opening of border crossings. Despite neither the rocket launchings nor Israeli retaliatory strikes having completely stopped, the fragile ceasefire remained in order.

Administrative divisions

Main article: Districts of Israel

The State of Israel is divided into six main administrative districts, known as mehozot (מחוזות; singular: mahoz) – Center, Haifa, Jerusalem, North, Southern, and Tel Aviv Districts. Districts are further divided into fifteen sub-districts known as nafot (נפות; singular: nafa), which are themselves partitioned into fifty natural regions.

Number	District	Main City	Provinces	Number of Residents
1	North	Nazareth	Kinneret, Safed, Acre, Golan, Jezreel Valley	1,242,100
2	Haifa	Haifa	Haifa, Hadera	880,000
3	Center	Ramla	Rishon Lezion, Sharon (Netanya), Petah Tikva, Ramla, Rehovot	1,770,200
4	Tel Aviv	Tel Aviv	Tel Aviv	1,227,000
5	Jerusalem	Jerusalem	Jerusalem	910,300
6	South	Beersheba	Ashkelon, Beersheba	1,053,600
B	Judea and Samaria	Modi'in Illit (Largest "settlement"/city)	"B" is the West Bank, not part of Israel.	304,569

For statistical purposes, the country is divided into three metropolitan areas: Tel Aviv metropolitan area (population 3,206,400), Haifa metropolitan area (population 1,021,000), and Beer Sheva metropolitan area (population 559,700). Israel's largest municipality, both in population and area, is Jerusalem with 773,800 residents in an area of 126 square kilometers (49 sq mi) (in 2009).

Israeli government statistics on Jerusalem include the population and area of East Jerusalem, which is widely recognized as part of the Palestinian territories under Israeli occupation. Tel Aviv, Haifa, and Rishon LeZion rank as Israel's next most populous cities, with populations of 393,900, 265,600, and 227,600 respectively.

Occupied territories

Main article: Israeli-occupied territories

In 1967, as a result of the Six-Day War, Israel gained control of the West Bank (Judaea and Samaria), East Jerusalem, the Gaza strip and the Golan Heights. Israel also took control of the Sinai Peninsula, but returned it to Egypt as part of the 1979 Israel-Egypt Peace Treaty.

Map of Israel showing the West Bank, the Gaza Strip, and the Golan Heights

Following Israel's capture of these territories, settlements consisting of Israeli citizens were established within each of them. Israel has applied civilian law to the Golan Heights and East Jerusalem, incorporating them into its territory and offering their inhabitants permanent residency status and the possibility to become full citizen if they asked it. In contrast, the West Bank has remained under military occupation, and it and the Gaza Strip are seen by the Palestinians and most of the international community as the site of a future Palestinian state. The UN Security Council has declared the incorporation of the Golan Heights and East Jerusalem to be "null and void" and continues to view the territories as occupied. The International Court of Justice, principal judicial organ of the United Nations, asserted, in its 2004 advisory opinion on the legality of the construction of the Israeli West Bank barrier, that the lands captured by Israel in the Six-Day War, including East Jerusalem, are occupied territory.

The status of East Jerusalem in any future peace settlement has at times been a difficult hurdle in negotiations between Israeli governments and representatives of the Palestinians. Most negotiations relating to the territories have been on the basis of United Nations Security Council Resolution 242, which emphasises "the inadmissibility of the acquisition of territory by war", and calls on Israel to withdraw from occupied territories in return for normalization of relations with Arab states, a principle known as "Land for peace".

The West Bank was annexed by Jordan in 1948, following the Arab rejection of the UN decision to create two states in Palestine. Only Britain recognized this annexation and Jordan has since ceded its claim to the territory to the PLO. The West Bank was occupied by Israel in 1967. The population is mainly Arab Palestinians, including refugees of the 1948 Arab-Israeli War. From their occupation in 1967 until 1993, the Palestinians living in these territories were under Israeli military administration. Since the Israel-PLO letters of recognition, most of the Palestinian population and cities have been under the internal jurisdiction of the Palestinian Authority, and only partial Israeli military control, although Israel has on several occasions redeployed its troops and reinstated full military administration during periods of unrest. In response to increasing attacks as part of the Second Intifada, the Israeli government started to construct the Israeli West Bank barrier. When completed, approximately 13 % of the Barrier will be constructed on the Green Line or in Israel with 87 % inside the West Bank.

The Gaza Strip was occupied by Egypt from 1948 to 1967 and then by Israel after 1967. In 2005, as part of Israel's unilateral disengagement plan, Israel removed all of its settlers and forces from the territory. Israel does not consider the Gaza Strip to be occupied territory and declared it a "foreign territory". That view has been disputed by numerous international humanitarian organizations and various bodies of the United Nations. Following June 2007, when Hamas assumed power in the Gaza Strip, Israel tightened its control of the Gaza crossings along its border, as well as by sea and air, and prevented persons from entering and exiting the area except for isolated cases it deemed humanitarian. Gaza has a border with Egypt and an agreement between Israel, the EU, the PA and Egypt governed how border crossing would take place (it was monitored by European observers), until June 2006, following the abduction of the soldier Gilad Shalit, when the crossing agreement ceased to exist. As of 2010 the Rafah border crossing was controlled by Egypt. Internal control of Gaza is in the hands of Hamas.

Military

Main articles: Israel Defense Forces, Israeli security forces, and military operations conducted by the Israel Defense Forces

The Israel Defense Forces consists of the Israeli Army, Israeli Air Force and Israeli Navy. It was founded during the 1948 Arab-Israeli War by consolidating paramilitary organizations—chiefly the Haganah—that preceded the establishment of the state. The IDF also draws upon the resources of the Military Intelligence Directorate (Aman), which works with the Mossad and Shabak. The Israel Defense Forces have been involved in several major wars and border conflicts in its short history, making it one of the most battle-trained armed forces in the world.

The majority of Israelis are drafted into the military at the age of eighteen. Men serve three years and women serve two to three years. Following compulsory service, Israeli men join the reserve forces and do several weeks of reserve duty every year until their forties. Most women are exempt from reserve duty. Arab citizens of Israel (except the Druze) and those engaged in full-time religious studies are exempt from military service, although the exemption of yeshiva students has been a source of contention in Israeli society for many years. An alternative for those who receive exemptions on various grounds is Sherut Leumi, or national service, which involves a program of service in hospitals, schools and other social welfare frameworks. As a result of its conscription program, the IDF maintains approximately 168,000 active troops and an additional 408,000 reservists.

Israeli soldiers training alongside the 26th Marine Expeditionary Unit on the USS Kearsarge

The nation's military relies heavily on high-tech weapons systems designed and manufactured in Israel as well as some foreign imports. The United States is a particularly notable foreign contributor; military aid to Israel is expected to increase by 6 billion over the next decade. US is expected to provide the country with $3.15 billion per year from 2013-2018. The Israeli- and U.S.-designed Arrow missile is one of the world's only operational anti-ballistic missile systems.

Since the Yom Kippur War, Israel has developed a network of reconnaissance satellites. The success of the Ofeq program has made Israel one of seven countries capable of launching such satellites. The country has also developed its own main battle tank, the Merkava. Since its establishment, Israel has spent a significant portion of its gross domestic product on defense. In 1984, for example, the country spent 24% of its GDP on defense. Today, that figure has dropped to 7.3%.

The IDF Namer (Heavy IFV), introduced from 2008

IDF Caterpillar D9 armored bulldozer - used for combat engineering and counter-terrorism missions.

Israel is widely believed to possess nuclear weapons. Israel has not signed the Nuclear Non-Proliferation Treaty ^{[citation needed]} and maintains a policy of deliberate ambiguity toward its nuclear capabilities. Israel's policy of nuclear ambiguity may have played an important role in subduing Israel's enemies.

After the Gulf War in 1991, when Israel was attacked by Iraqi Scud missiles, a law was passed requiring all apartments and homes in Israel to have a mamad, a reinforced security room impermeable to chemical and biological substances.

The IDF has also been deployed on humanitarian missions. After the 2004 Indian Ocean earthquake, Israel mobilized a team of 150 IDF doctors and rescue and relief teams, which were to set up a field hospital in Sri Lanka. After the Sri Lankan government rejected this offer, Israel instead flew in 82 tones of humanitarian aid along with a small number of IDF personnel. Israel also sent in rescue workers and medical personnel to other countries, along with relief workers and body identifiers from ZAKA and the Israel Police. Israel also donated USD 100,000 to each affected country.

After the 2010 Haiti earthquake, a rescue team was dispatched to Haiti, which consisted of 40 doctors, 20 nurses and rescue workers, and two rescue planes loaded with medical equipment and a field hospital with X-rays, intensive care units, and operating rooms. The Israel Defense Forces set up a satellite communications room with phone and wireless internet access and video conference systems so that surgeons could consult medical experts in Israel. A Magen David Adom delegation arrived on January 17 to establish field clinics in cooperation with local rescue services. The Israeli rescue team remained in Haiti until January 28. Following a request from the United States and United Nations, Israel sent 100 police officers as peacekeepers to Haiti. A group of police forensics investigators to assist in the identification of victims was also sent, along with 220 Home Front Command search and rescue teams and Israeli Medical Corps personnel.

Autism

Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old.^[1] Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organize; how this occurs is not well understood.^[2] It is one of three recognized disorders in the autism spectrum (ASDs), the other two being Asperger syndrome, which lacks delays in cognitive development and language, and Pervasive Developmental Disorder-Not Otherwise Specified (commonly abbreviated as PDD-NOS), which is diagnosed when the full set of criteria for autism or Asperger syndrome are not met.^[3]

Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear whether ASD is explained more by rare mutations, or by rare combinations of common genetic variants.^[4] In rare cases, autism is strongly associated with agents that cause birth defects.^[5] Controversies surround other proposed environmental causes, such as heavy metals, pesticides or childhood vaccines;^[6] the vaccine hypotheses are biologically implausible and lack convincing scientific evidence.^[7] The prevalence of autism is about 1–2 per 1,000 people; the prevalence of ASD is about 6 per 1,000, with about four times as many males as females. The number of people diagnosed with autism has increased dramatically since the 1980s, partly due to changes in diagnostic practice; the question of whether actual prevalence has increased is unresolved.^[8]

Parents usually notice signs in the first two years of their child's life.^[9] The signs usually develop gradually, but some autistic children first develop more normally and then regress.^[10] Although early behavioral or cognitive intervention can help autistic children gain self-care, social, and communication skills, there is no known cure.^[9] Not many children with autism live independently after reaching adulthood, though some become successful.^[11] An autistic culture has developed, with some individuals seeking a cure and others believing autism should be accepted as a difference and not treated as a disorder.^[12] 
Characteristics

Autism is a highly variable neurodevelopmental disorder^[13] that first appears during infancy or childhood, and generally follows a steady course without remission.^[14] Overt symptoms gradually begin after the age of six months, become established by age two or three years,^[15] and tend to continue through adulthood, although often in more muted form.^[16] It is distinguished not by a single symptom, but by a characteristic triad of symptoms: impairments in social interaction; impairments in communication; and restricted interests and repetitive behavior. Other aspects, such as atypical eating, are also common but are not essential for diagnosis.^[17] Autism's individual symptoms occur in the general population and appear not to associate highly, without a sharp line separating pathologically severe from common traits.^[18] 
Social development
Social deficits distinguish autism and the related autism spectrum disorders (ASD; see Classification) from other developmental disorders.^[16] People with autism have social impairments and often lack the intuition about others that many people take for granted. Noted autistic Temple Grandin described her inability to understand the social communication of neurotypicals, or people with normal neural development, as leaving her feeling "like an anthropologist on Mars".^[19]

Unusual social development becomes apparent early in childhood. Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name. Autistic toddlers differ more strikingly from social norms; for example, they have less eye contact and turn taking, and are more likely to communicate by manipulating another person's hand.^[20] Three- to five-year-old autistic children are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate nonverbally, and take turns with others. However, they do form attachments to their primary caregivers.^[21] Most autistic children display moderately less attachment security than non-autistic children, although this difference disappears in children with higher mental development or less severe ASD.^[22] Older children and adults with ASD perform worse on tests of face and emotion recognition.^[23]

Children with high-functioning autism suffer from more intense and frequent loneliness compared to non-autistic peers, despite the common belief that children with autism prefer to be alone. Making and maintaining friendships often proves to be difficult for those with autism. For them, the quality of friendships, not the number of friends, predicts how lonely they feel. Functional friendships, such as those resulting in invitations to parties, may affect the quality of life more deeply.^[24]

There are many anecdotal reports, but few systematic studies, of aggression and violence in individuals with ASD. The limited data suggest that, in children with mental retardation, autism is associated with aggression, destruction of property, and tantrums. A 2007 study interviewed parents of 67 children with ASD and reported that about two-thirds of the children had periods of severe tantrums and about one-third had a history of aggression, with tantrums significantly more common than in non-autistic children with language impairments.^[25] A 2008 Swedish study found that, of individuals aged 15 or older discharged from hospital with a diagnosis of ASD, those who committed violent crimes were significantly more likely to have other psychopathological conditions such as psychosis.^[26] 
Communication
About a third to a half of individuals with autism do not develop enough natural speech to meet their daily communication needs.^[27] Differences in communication may be present from the first year of life, and may include delayed onset of babbling, unusual gestures, diminished responsiveness, and vocal patterns that are not synchronized with the caregiver. In the second and third years, autistic children have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Autistic children are less likely to make requests or share experiences, and are more likely to simply repeat others' words (echolalia)^[28][29] or reverse pronouns.^[30] Joint attention seems to be necessary for functional speech, and deficits in joint attention seem to distinguish infants with ASD:^[3] for example, they may look at a pointing hand instead of the pointed-at object,^[20][29] and they consistently fail to point at objects in order to comment on or share an experience.^[3] Autistic children may have difficulty with imaginative play and with developing symbols into language.^[28][29]

In a pair of studies, high-functioning autistic children aged 8–15 performed equally well as, and adults better than, individually matched controls at basic language tasks involving vocabulary and spelling. Both autistic groups performed worse than controls at complex language tasks such as figurative language, comprehension and inference. As people are often sized up initially from their basic language skills, these studies suggest that people speaking to autistic individuals are more likely to overestimate what their audience comprehends. 
Repetitive behavior

Autistic individuals display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R)^[32] categorizes as follows.

 A young boy with autism, and the

precise line of toys he made

• Stereotypy is repetitive movement, such as hand flapping, making sounds, head rolling, or body rocking.
• Compulsive behavior is intended and appears to follow rules, such as arranging objects in stacks or lines.
• Sameness is resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.
• Ritualistic behavior involves an unvarying pattern of daily activities, such as an unchanging menu or a dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors.^[32]
• Restricted behavior is limited in focus, interest, or activity, such as preoccupation with a single television program, toy, or game.
• Self-injury includes movements that injure or can injure the person, such as eye poking, skin picking, hand biting, and head banging.^[3] A 2007 study reported that self-injury at some point affected about 30% of children with ASD.^[25]

No single repetitive or self-injurious behavior seems to be specific to autism, but only autism appears to have an elevated pattern of occurrence and severity of these behaviors.^[33] 
Other symptoms
Autistic individuals may have symptoms that are independent of the diagnosis, but that can affect the individual or the family.^[17] An estimated 0.5% to 10% of individuals with ASD show unusual abilities, ranging from splinter skills such as the memorization of trivia to the extraordinarily rare talents of prodigious autistic savants.^[34] Many individuals with ASD show superior skills in perception and attention, relative to the general population.^[35] Sensory abnormalities are found in over 90% of those with autism, and are considered core features by some,^[36] although there is no good evidence that sensory symptoms differentiate autism from other developmental disorders.^[37] Differences are greater for under-responsivity (for example, walking into things) than for over-responsivity (for example, distress from loud noises) or for sensation seeking (for example, rhythmic movements).^[38] An estimated 60%–80% of autistic people have motor signs that include poor muscle tone, poor motor planning, and toe walking;^[36] deficits in motor coordination are pervasive across ASD and are greater in autism proper.^[39]

Unusual eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur;^[25] this does not appear to result in malnutrition. Although some children with autism also have gastrointestinal (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual;^[40] studies report conflicting results, and the relationship between GI problems and ASD is unclear.^[41]

Parents of children with ASD have higher levels of stress.^[42] Siblings of children with ASD report greater admiration of and less conflict with the affected sibling than siblings of unaffected children or those with Down syndrome; siblings of individuals with ASD have greater risk of negative well-being and poorer sibling relationships as adults.^[43] 
Classification
Autism is one of the five pervasive developmental disorders (PDD), which are characterized by widespread abnormalities of social interactions and communication, and severely restricted interests and highly repetitive behavior.^[14] These symptoms do not imply sickness, fragility, or emotional disturbance.^[16]

Of the five PDD forms, Asperger syndrome is closest to autism in signs and likely causes; Rett syndrome and childhood disintegrative disorder share several signs with autism, but may have unrelated causes; PDD not otherwise specified (PDD-NOS; also called atypical autism) is diagnosed when the criteria are not met for a more specific disorder.^[44] Unlike with autism, people with Asperger syndrome have no substantial delay in language development.^[1] The terminology of autism can be bewildering, with autism, Asperger syndrome and PDD-NOS often called the autism spectrum disorders (ASD)^[9] or sometimes the autistic disorders,^[45] whereas autism itself is often called autistic disorder, childhood autism, or infantile autism. In this article, autism refers to the classic autistic disorder; in clinical practice, though, autism, ASD, and PDD are often used interchangeably.^[46] ASD, in turn, is a subset of the broader autism phenotype, which describes individuals who may not have ASD but do have autistic-like traits, such as avoiding eye contact.^[47]

The manifestations of autism cover a wide spectrum, ranging from individuals with severe impairments—who may be silent, mentally disabled, and locked into hand flapping and rocking—to high functioning individuals who may have active but distinctly odd social approaches, narrowly focused interests, and verbose, pedantic communication.^[48] Because the behavior spectrum is continuous, boundaries between diagnostic categories are necessarily somewhat arbitrary.^[36] Sometimes the syndrome is divided into low-, medium- or high-functioning autism (LFA, MFA, and HFA), based on IQ thresholds,^[49] or on how much support the individual requires in daily life; these subdivisions are not standardized and are controversial. Autism can also be divided into syndromal and non-syndromal autism; the syndromal autism is associated with severe or profound mental retardation or a congenital syndrome with physical symptoms, such as tuberous sclerosis.^[50] Although individuals with Asperger syndrome tend to perform better cognitively than those with autism, the extent of the overlap between Asperger syndrome, HFA, and non-syndromal autism is unclear.^[51]

Some studies have reported diagnoses of autism in children due to a loss of language or social skills, as opposed to a failure to make progress, typically from 15 to 30 months of age. The validity of this distinction remains controversial; it is possible that regressive autism is a specific subtype,^{[10][20][28][52]} or that there is a continuum of behaviors between autism with and without regression.^[53]

Research into causes has been hampered by the inability to identify biologically meaningful subpopulations^[54] and by the traditional boundaries between the disciplines of psychiatry, psychology, neurology and pediatrics.^[55] Newer technologies such as fMRI and diffusion tensor imaging can help identify biologically relevant phenotypes (observable traits) that can be viewed on brain scans, to help further neurogenetic studies of autism;^[56] one example is lowered activity in the fusiform face area of the brain, which is associated with impaired perception of people versus objects.^[2] It has been proposed to classify autism using genetics as well as behavior.^[57] 
Causes
Main article: Causes of autism

It has long been presumed that there is a common cause at the genetic, cognitive, and neural levels for autism's characteristic triad of symptoms.^[58] However, there is increasing suspicion that autism is instead a complex disorder whose core aspects have distinct causes that often co-occur.^[58][59]

Deletion (1), duplication (2) and inversion (3) are all chromosome abnormalities that have been implicated in autism.^[60]

Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear whether ASD is explained more by rare mutations with major effects, or by rare multigene interactions of common genetic variants.^[4][61] Complexity arises due to interactions among multiple genes, the environment, and epigenetic factors which do not change DNA but are heritable and influence gene expression.^[16] Studies of twins suggest that heritability is 0.7 for autism and as high as 0.9 for ASD, and siblings of those with autism are about 25 times more likely to be autistic than the general population.^[36] However, most of the mutations that increase autism risk have not been identified. Typically, autism cannot be traced to a Mendelian (single-gene) mutation or to a single chromosome abnormality like fragile X syndrome, and none of the genetic syndromes associated with ASDs has been shown to selectively cause ASD.^[4] Numerous candidate genes have been located, with only small effects attributable to any particular gene.^[4] The large number of autistic individuals with unaffected family members may result from copy number variations—spontaneous deletions or duplications in genetic material during meiosis.^[62] Hence, a substantial fraction of autism cases may be traceable to genetic causes that are highly heritable but not inherited: that is, the mutation that causes the autism is not present in the parental genome.^[60]

Several lines of evidence point to synaptic dysfunction as a cause of autism.^[2] Some rare mutations may lead to autism by disrupting some synaptic pathways, such as those involved with cell adhesion.^[63] Gene replacement studies in mice suggest that autistic symptoms are closely related to later developmental steps that depend on activity in synapses and on activity-dependent changes.^[64] All known teratogens (agents that cause birth defects) related to the risk of autism appear to act during the first eight weeks from conception, and though this does not exclude the possibility that autism can be initiated or affected later, it is strong evidence that autism arises very early in development.^[5] Although evidence for other environmental causes is anecdotal and has not been confirmed by reliable studies,^[6] extensive searches are underway.^[65] Environmental factors that have been claimed to contribute to or exacerbate autism, or may be important in future research, include certain foods, infectious disease, heavy metals, solvents, diesel exhaust, PCBs, phthalates and phenols used in plastic products, pesticides, brominated flame retardants, alcohol, smoking, illicit drugs, vaccines^[8], and prenatal stress^[66], although no links have been found, and some have been completely dis-proven. Parents may first become aware of autistic symptoms in their child around the time of a routine vaccination, and this has given rise to theories that vaccines or their preservatives cause autism, which was fueled by a scientific study which has since been proven to have been falsified. Although these theories lack convincing scientific evidence and are biologically implausible, parental concern about autism has led to lower rates of childhood immunizations and higher likelihood of measles outbreaks in some areas. 
Mechanism

Autism's symptoms result from maturation-related changes in various systems of the brain. How autism occurs is not well understood. Its mechanism can be divided into two areas: the pathophysiology of brain structures and processes associated with autism, and the neuropsychological linkages between brain structures and behaviors.^[67] The behaviors appear to have multiple pathophysiologies.^[18] 
Diagnosis

Diagnosis is based on behavior, not cause or mechanism.^[18][108] Autism is defined in the DSM-IV-TR as exhibiting at least six symptoms total, including at least two symptoms of qualitative impairment in social interaction, at least one symptom of qualitative impairment in communication, and at least one symptom of restricted and repetitive behavior. Sample symptoms include lack of social or emotional reciprocity, stereotyped and repetitive use of language or idiosyncratic language, and persistent preoccupation with parts of objects. Onset must be prior to age three years, with delays or abnormal functioning in either social interaction, language as used in social communication, or symbolic or imaginative play. The disturbance must not be better accounted for by Rett syndrome or childhood disintegrative disorder.^[1] ICD-10 uses essentially the same definition.^[14]

Several diagnostic instruments are available. Two are commonly used in autism research: the Autism Diagnostic Interview-Revised (ADI-R) is a semistructured parent interview, and the Autism Diagnostic Observation Schedule (ADOS) uses observation and interaction with the child. The Childhood Autism Rating Scale (CARS) is used widely in clinical environments to assess severity of autism based on observation of children.^[20]

A pediatrician commonly performs a preliminary investigation by taking developmental history and physically examining the child. If warranted, diagnosis and evaluations are conducted with help from ASD specialists, observing and assessing cognitive, communication, family, and other factors using standardized tools, and taking into account any associated medical conditions.^[109] A pediatric neuropsychologist is often asked to assess behavior and cognitive skills, both to aid diagnosis and to help recommend educational interventions.^[110] A differential diagnosis for ASD at this stage might also consider mental retardation, hearing impairment, and a specific language impairment^[109] such as Landau–Kleffner syndrome.^[111] The presence of autism can make it harder to diagnose coexisting psychiatric disorders such as depression.^[112]

Clinical genetics evaluations are often done once ASD is diagnosed, particularly when other symptoms already suggest a genetic cause.^[46] Although genetic technology allows clinical geneticists to link an estimated 40% of cases to genetic causes,^[113] consensus guidelines in the U.S. and UK are limited to high-resolution chromosome and fragile X testing.^[46] A genotype-first model of diagnosis has been proposed, which would routinely assess the genome's copy number variations.^[114] As new genetic tests are developed several ethical, legal, and social issues will emerge. Commercial availability of tests may precede adequate understanding of how to use test results, given the complexity of autism's genetics.^[115] Metabolic and neuroimaging tests are sometimes helpful, but are not routine.^[46]

ASD can sometimes be diagnosed by age 14 months, although diagnosis becomes increasingly stable over the first three years of life: for example, a one-year-old who meets diagnostic criteria for ASD is less likely than a three-year-old to continue to do so a few years later.^[52] In the UK the National Autism Plan for Children recommends at most 30 weeks from first concern to completed diagnosis and assessment, though few cases are handled that quickly in practice.^[109] A 2009 U.S. study found the average age of formal ASD diagnosis was 5.7 years, far above recommendations, and that 27% of children remained undiagnosed at age 8 years.^[116] Although the symptoms of autism and ASD begin early in childhood, they are sometimes missed; years later, adults may seek diagnoses to help them or their friends and family understand themselves, to help their employers make adjustments, or in some locations to claim disability living allowances or other benefits.^[117]

Underdiagnosis and overdiagnosis are problems in marginal cases, and much of the recent increase in the number of reported ASD cases is likely due to changes in diagnostic practices. The increasing popularity of drug treatment options and the expansion of benefits has given providers incentives to diagnose ASD, resulting in some overdiagnosis of children with uncertain symptoms. Conversely, the cost of screening and diagnosis and the challenge of obtaining payment can inhibit or delay diagnosis.^[118] It is particularly hard to diagnose autism among the visually impaired, partly because some of its diagnostic criteria depend on vision, and partly because autistic symptoms overlap with those of common blindness syndromes or blindisms.

History

A few examples of autistic symptoms and treatments were described long before autism was named. The Table Talk of Martin Luther contains the story of a 12-year-old boy who may have been severely autistic.^[162] According to Luther's notetaker Mathesius, Luther thought the boy was a soulless mass of flesh possessed by the devil, and suggested that he be suffocated.^[163] The earliest well-documented case of autism is that of Hugh Blair of Borgue, as detailed in a 1747 court case in which his brother successfully petitioned to annul Blair's marriage to gain Blair's inheritance.^[164] The Wild Boy of Aveyron, a feral child caught in 1798, showed several signs of autism; the medical student Jean Itard treated him with a behavioral program designed to help him form social attachments and to induce speech via imitation.^[165]

The New Latin word autismus (English translation autism) was coined by the Swiss psychiatrist Eugen Bleuler in 1910 as he was defining symptoms of schizophrenia. He derived it from the Greek word autós (αὐτός, meaning self), and used it to mean morbid self-admiration, referring to "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance".^[166]

Leo Kanner introduced the label early infantile autism in 1943.

The word autism first took its modern sense in 1938 when Hans Asperger of the Vienna University Hospital adopted Bleuler's terminology autistic psychopaths in a lecture in German about child psychology.^[167] Asperger was investigating an ASD now known as Asperger syndrome, though for various reasons it was not widely recognized as a separate diagnosis until 1981.^[165] Leo Kanner of the Johns Hopkins Hospital first used autism in its modern sense in English when he introduced the label early infantile autism in a 1943 report of 11 children with striking behavioral similarities.^[30] Almost all the characteristics described in Kanner's first paper on the subject, notably "autistic aloneness" and "insistence on sameness", are still regarded as typical of the autistic spectrum of disorders.^[59] It is not known whether Kanner derived the term independently of Asperger.^[168]

Kanner's reuse of autism led to decades of confused terminology like infantile schizophrenia, and child psychiatry's focus on maternal deprivation led to misconceptions of autism as an infant's response to "refrigerator mothers". Starting in the late 1960s autism was established as a separate syndrome by demonstrating that it is lifelong, distinguishing it from mental retardation and schizophrenia and from other developmental disorders, and demonstrating the benefits of involving parents in active programs of therapy.^[169] As late as the mid-1970s there was little evidence of a genetic role in autism; now it is thought to be one of the most heritable of all psychiatric conditions.^[170] Although the rise of parent organizations and the destigmatization of childhood ASD have deeply affected how we view ASD,^[165] parents continue to feel social stigma in situations where their autistic children's behaviors are perceived negatively by others,^[171] and many primary care physicians and medical specialists still express some beliefs consistent with outdated autism research.^[172]

The Internet has helped autistic individuals bypass nonverbal cues and emotional sharing that they find so hard to deal with, and has given them a way to form online communities and work remotely.^[173] Sociological and cultural aspects of autism have developed: some in the community seek a cure, while others believe that autism is simply another way of being.