"When I can't afford the medicine, I'll cut down on my inhalation treatment. Instead of four times a day like I'm supposed to, I'll do it three times a day." The consequence are humiliating. "I'm embarrassed to say this, but when I have an asthma attack, I pee in my pants." He starts to cry. "One day I'll cut my throat."

Theoretically, Rosen has a Holon municipal social worker assigned to him, but, as social workers have hundreds or even thousands of cases each to handle, Rosen has had only one home visit during his old age.

"My teeth hurt," he says, taking out his dentures and saying he can't afford to fix or replace them. He's got eyeglasses only because a German woman who read about his plight sent him money to buy a pair. The Keren (Foundation for the Benefit of Holocaust Victims in Israel), which pays part of his caregiver's salary, had to turn him down for a grant for the glasses, because it doesn't have nearly enough money to meet all the basic needs of financially-strapped survivors.

Noting that his old-age pension comes out of taxes he himself paid during his working years, and that his reparations money comes from Germany, Rosen raises his good right hand and says bitterly, "With one hand I worked over 50 years, and what do I get from the government?"

Referring to all the Holocaust survivors who came to Israel in the years after World War II, he says with outraged pride, "We helped build this country!"

THE FIGURE 70,000 impoverished Holocaust survivors in Israel is a conservative estimate, the one used by the Keren. Of these, some 20,000 are Europeans; the remaining 50,000 immigrated from the former Soviet Union (FSU) since 1990.

In general, the Europeans suffered much worse under the Nazis. The great majority (although not all) of the survivors from the FSU escaped Hitler's invasion, or were relocated by their government toward Siberia, where they were safe from the Germans but had to endure extreme cold and hunger.

"They weren't in concentration camps, they don't have numbers on their arms, so are they Holocaust survivors? Well, they were on the run from the Nazis. They suffered terribly. Many of those from Ukraine were in Nazi camps and witnessed members of their family being murdered. So yes, they are Holocaust survivors," says Dr. Natan Kellermann, a top official of the organization Amcha, which provides social and therapeutic services to about 9,500 survivors, and which, like the Keren, would have many more clients if it had the money to help them.

Compared to European survivors, however, those from the FSU tend to be considerably poorer - partly because they basically started over from zero in this country at an advanced age, partly because they usually do not get the regular German reparation payments or monthly Israeli survivor's pension that many of the European survivors get. With few exceptions, the only compensation FSU survivors of the Holocaust ever got was a one-time payment from Germany, typically of 5,000 DM, which would be about NIS 14,000 today.

Among Holocaust survivors who can be found eating in soup kitchens and wearing charity-store clothes, the overwhelming majority, probably over 90%, are from the FSU.

In a study two years ago by Jenny Brodsky, an expert on aging at JDC-Brookdale, and Hebrew University demographer Sergio Della Pergola, it was found that 35% of Holocaust survivors in Israel require economic aid, such as free blankets or heaters, to get through the winter cold; 25% have to choose between spending money on food or on other basic needs like medicines and utilities; 16% can't afford regular phone calls and visits to their children living in this country; and 13% suffer "food insecurity," meaning they can't afford to eat nutritiously on a dependable basis.

The economic pressure on poor Holocaust survivors is made worse by their unusually high health care expenses. Most everyone understands that Holocaust survivors suffer psychological trauma, and that it never completely goes away. What may be less widely known is that they also tend to suffer much more than normal from physical illness. This is especially true of those who lived some of their childhood or adolescence under Nazi persecution. And as the years have passed, of course, these "child survivors" have become a steadily larger part of the Holocaust survivor population. Today they are a majority or close to it.

"These people were malnourished during their youth, so now they have an extremely high incidence of osteoporosis [weakening of the bones], which means hip replacements and such. They have much more than their share of cancer, high blood pressure, tooth and gum diseases, and blindness," says Dubby Arbel, general manager of the Keren.