'Stressed and stretched almost above their capabilities'

Israel’s health system showing ‘impressive’ resilience during war, report finds

But Taub Center researchers say that with workforce shortage, budget cuts, and 15,000 soldiers who now suffer from stress-induced trauma, the system faces serious challenges

Reporter at The Times of Israel

An illustrative photo of health workers. (istock photo/ nanostockk)
An illustrative photo of health workers. (istock photo/ nanostockk)

Although the health system demonstrated “impressive” resilience and an exceptional ability to respond to the country’s needs since the war began on October 7, 2023, it faces great challenges in the future, according to a report by the Taub Center for Social Policy Studies.

Prof. Nadav Davidovitch, who heads Ben-Gurion University of the Negev’s School of Public Health, and Natan Lev, a Taub Center researcher and Ben-Gurion University PhD student, led the study.

When the war started with Hamas’s onslaught — when thousands of terrorists stormed into Israel, killed 1,200 people, and kidnapped 251 people into Gaza — the researchers said, the health system had already been operating “with a diminished budget and a severe shortage of personnel and resources.”

With the aftereffects of the war, the mental health and rehabilitation fields that had been neglected, “unfortunately, for many years, are now stressed and stretched almost above their capabilities,” Davidovitch told The Times of Israel by telephone.

“Long-term strategic planning to invest in the public healthcare system is needed,” he said, “and that should include strengthening mental health and rehabilitation services.”

Trauma across the nation

Screen capture from video of Nadav Davidovitch, head of the School of Public Health at Ben-Gurion University. (YouTube)

As of October 2024, one year after the war began, over 70,000 individuals have been recognized as victims of hostile acts, and nearly 13,000 have filed for permanent disability benefits, the vast majority due to psychological issues.

“This has come at a heavy economic cost,” the study said.

More than NIS 370 million ($100 million) was paid to individuals with a recognized disability. Over NIS 250 million ($68 million) was spent on rehabilitation, and more than NIS 1.2 billion ($326 million) was spent on medical care.

In addition, people living in conflict areas in the country also suffered significant harm.

A Maccabi Healthcare Services study of members revealed that approximately 80 percent of relatives of hostages reported a worsening self-perception of their health status, with significant weight loss and increased use of antidepressants and sleeping medications.

Israeli girls evacuated from Kiryat Shmona play in a room in a hotel in Tiberias, March 4, 2024. (AP Photo/Ariel Schalit)

Evacuees from war zones also reported deteriorating health conditions, with about 30% of evacuated women reporting poor physical health and 60% reporting psychological harm, compared to 20% and 50% in the general population, respectively.

A Clalit health maintenance organization study of its members reported a 200% increase in the use of anti-anxiety medications among residents of the Gaza border region, compared to a 50% increase in the general population.

Additionally, approximately 15,000 soldiers were classified as suffering from stress-induced trauma, 18% of whom were removed from combat.

Since the start of the war, some 1,000 new patients have been admitted each month to the Defense Ministry’s Rehabilitation Department, most of them reservists.

A former IDF soldier and post-traumatic stress disorder sufferer expresses his anger and frustration about the lack of sufficient appropriate mental health services at an emergency meeting at the Knesset, Jerusalem, August 8, 2023. (Oren Ben Hakoon/Flash90)

“We ended 2024 with some promising plans,” Davidovitch said, referring to Health Minister Uriel Buso’s plan to upgrade the mental health system and to double the budget for mental health treatment.

“But he must continue to follow through,” Davidovitch said.

A decline in national expenditure on healthcare

In 2023, Israel’s per capita current health expenditure, in terms of purchasing power parity, was lower than that of most OECD countries.

This expenditure decreased by 0.9% in the past two years.

Only South Korea, Portugal, Greece, Chile, and Mexico rank lower in health spending.

A doctor with a syringe in his hands against the background of an Israeli flag (Niyazz via iStock by Getty Images)

Healthcare workers needed

The number of active physicians and nurses per 1,000 population — standing at 3.47 and 5.04, respectively — remains below the OECD average.

According to projections, the shortage of physicians is expected to worsen further. By 2035, the number of physicians per 1,000 population is projected to decline to 3.02, despite the anticipated increase in the number of physician assistants and nurse practitioners entering the field.

Medical clowns from Dream Doctors, an Israeli nonprofit that was observed in new peer-reviewed research on medical clowning (courtesy of Dream Doctors)

Although Israel is low on the OECD ranking, Davidovitch said, healthcare professionals “give so much of themselves and they are probably the main reason why we still see the quality, the enthusiasm, and the commitment.”

However, he stressed, “this is something that cannot continue for the long term because of a lot of secondary trauma being reported by healthcare professionals, “and that’s something that must be taken care of.”

Waiting times for specialists

In critical fields like neurology and endocrinology, the study found a long waiting time to see a specialist. However, the research shows that between 2023 and 2024, there was a slight decrease in waiting times for most specialties, especially orthopedics and gynecology.

Exercising — and smoking — more

The study found that young adults aged 20 and over are exercising more, but between 2019 and 2022, their rates of smoking also increased by 1.6%.

An ultra-Orthodox Jewish man seen smoking an electric cigarette. September 23, 2012. (Nati Shohat/Flash90)

Among men, the primary increase was observed in the lowest socioeconomic tier. Among women, the highest smoking rates were found in the middle-to-upper socioeconomic tier.

Decrease in vaccines and increase in infectious diseases

The war has had a significant impact on public health, including a decline in vaccination rates and an increase in outbreaks of infectious diseases.

A notable emergency is the outbreak of the polio virus in the Gaza Strip, following the war’s negative effect on hygiene conditions and vaccine accessibility in the area.

Beyond the immediate risk to Gaza residents, the outbreak poses a threat to Israelis and necessitates strengthening regional cooperation for vaccination campaigns and clinical and epidemiological monitoring, the report said.

A young girl receives a dose of the COVID-19 vaccine in Jerusalem on December 30, 2021. (Olivier Fitoussi/Flash90)

The state of the health system

Davidovitch said the results of the study paint a “mixed picture” of Israel’s healthcare system.

In some ways, he said, he compared the current crisis in the healthcare system to an Eastern European folk tale of a workhorse.

“The owner is happy the horse works so hard so he gradually reduces the horse’s food, and then he’s so happy that the horse continues to work,” Davidovitch said. “Until, finally, the horse is dead.”

He said it’s promising that the Health Ministry is “finally investing in some areas of healthcare, but it’s not enough.”

Debbie Cohen, right, head nurse of Nursery Department A, and Amira Morad, staff nurse, check on newborn babies at Galilee Medical Center on December 22, 2024. (Diana Bletter/Times of Israel)

One thing Israelis agree on

However, one aspect of the Israeli healthcare system that is promising, Davidovitch said, is that unlike in the United States, for example, “health insurance and public health insurance is not perceived as polarizing.”

He noted that the National Health Insurance Law of 1995 was voted in by both “Likud and the Labor party, the right and the left.”

The health system within Israel also represents people “coming from all segments of society, including a relatively high percentage of Arab healthcare workers,” Davidovitch said.

“Although there were problems this year, there is a sense of solidarity,” he said. “I don’t think we can count on it to remain forever if there aren’t going to be any reforms in terms of the budget, for example, but still, there is a lot of solidarity, and that’s crucial.”

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