On high alert since October 7, hospitals were already prepared to deal with Iran attack

Administrators say IDF Home Front Command and Health Ministry have not instructed healthcare system to adjust readiness for possible widening of conflict

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

Soldiers help prepare the Sammy Ofer Fortified Underground Emergency Hospital at Rambam Medical Center in Haifa following the outbreak of war, October 11, 2023. (Courtesy of Rambam)
Soldiers help prepare the Sammy Ofer Fortified Underground Emergency Hospital at Rambam Medical Center in Haifa following the outbreak of war, October 11, 2023. (Courtesy of Rambam)

When Iran fired hundreds of missiles and drones at Israel overnight Saturday-Sunday, there was no need for Israeli hospitals to go onto emergency footing; they have been on high alert since the beginning of the war with Hamas in Gaza six months ago, employing an extensive range of strategies to be ready for any eventuality.

This heightened emergency preparedness, along with risk calculations of the IDF Home Front Command, meant hospitals were not required to take additional precautions during the unprecedented attack from Iran.

Although the hospitals are prepared to handle mass casualties, such an event was averted when the 350 missiles and drones launched by Iran were nearly entirely intercepted by Israel and its allies’ air defenses.

The lone injured Israeli was a 7-year-old girl severely wounded in the head by shrapnel from an intercepted ballistic missile that fell on her home in a Bedouin community in the south. Such communities, most of them unrecognized by the state, typically have no rocket shelters.

The girl was rushed to Soroka Medical Center in Beersheba, where she underwent surgery and is now in the pediatric intensive care unit.

Even in peaceful times, Israeli hospitals are required by the IDF Home Front Command to annually carry out full-scale emergency drills. A three-year cycle has hospitals rotating among earthquake, mass casualty, and toxic chemical leak or attack scenarios.

Aerial view of Sheba Medical Center, outside of Tel Aviv, on May 31, 2023. (Omer Fichman/FLASH90)

Yoel Har-Even, vice president of global affairs at Sheba Medical Center, told The Times of Israel that his hospital, Israel’s largest, also does regular single-department drills and practices emergency scenarios with partners such as the fire department and police force. New staff are routinely trained on safety procedures.

However, since October 7, emergency preparedness has been kicked up a notch at Sheba and all other hospitals.

“It’s fundamentally about always being mentally alert that we are in a different situation. It is wartime and we are in a war zone. It doesn’t matter if the missiles are coming from Gaza, Hezbollah, or from further to the east, or from the south,” Har-Even said.

“It’s about saving lives — our own and those who we are responsible for at the hospital. This situation has never changed, but sometimes the alert level is sharpened,” he said.

Prof. Michael Halbertal, director-general of Rambam Medical Center in Haifa, said that his hospital remains on high alert and has maintained the underground hospital it opened early in the war.

Medical personnel working in a department transferred to the underground parking garage at Rambam Hospital in the northern Israeli city of Haifa, January 11, 2024. (Leo Correa/AP)

Almost immediately after the war’s outbreak, Rambam set up its underground hospital in 36 hours. This fortified hospital, with its 2,000-bed capacity, is the largest such facility in the world.

As the north’s only tertiary care hospital and level-one trauma center, Rambam must be ready for any situation, including an escalation of the direct confrontation between Israel and Iran or a full-scale war with Hezbollah in Lebanon.

“As we have continued to deliver regular medical care to patients, we have left one level of the underground hospital in place so that we can mobilize and transfer everyone down on short notice. It takes us eight hours to move all patients and staff,” Halbertal said.

“We have room for almost 1,200 patients on that level of the underground hospital. We also have room for another 200 patients in above-ground fortified areas. If necessary, we would send non-critical patients home to make room for the incoming wounded,” he said.

Sheba does not have underground hospital space for all patients. However, early in the war, it transferred some patients to underground facilities, where they have been cared for since. These patients include babies and young children, geriatric patients, and people requiring mobility aids.

“Otherwise, all our staff knows where the closest above-ground fortified space is to quickly take patients, regardless of the warning time given us,” Har-Even said.

In a video message distributed to health reporters, Dr. Noy Cohen, deputy director-general at Assuta Medical Center in Ashdod, said that his hospital and all others in the country were ready for the Iranian attack.

The entrance to Samson Assuta Ashdod University Hospital, in the southern Israeli city of Ashdod, on January 26, 2022. (Yossi Aloni/Flash90)

“All our systems are operational and inventories are full in terms of medications, equipment, and diesel fuel [for generators]. In terms of manpower, we are prepared for any eventuality,” Cohen said.

Cohen emphasized that the Health Ministry and hospitals are only second to the IDF and security services in terms of preparedness for dealing with what could come.

The Magen David Adom emergency response service also announced that it was on high alert. In addition, it launched a pre-Passover blood drive appeal to shore up the supply of blood and blood products during the holiday and in case of an escalation of the war.

For months, there have been warnings of possible electricity shortages or full blackouts in the event of full-scale war breaking out in the north.

“Our underground hospital can operate as an isolated island without outside help for three days. We can be self-sufficient for three to four days in terms of power, also,” Rambam’s Halbertal said.

He believes this would give the Israel Electric Corporation time to bring the outside power back online.

“One of the priorities for the electrical company is to provide a solution to hospitals and other critical services,” Halbertal said.

According to Har-Even, all medical equipment at Sheba that runs on electricity and is connected to a patient must be backed up automatically by generator systems should the regular power supply fail.

Example of a portable power station available through Yad Sarah for use with electricity-dependent home medical equipment in the event of a power system outage. (Courtesy of Yad Sarah)

In what Har-Even referred to as a belt-and-suspenders system, the equipment is also backed up by an uninterruptible power supply (UPS), which is a sort of large battery that keeps the equipment running until the generators automatically kick in.

“The UPS can keep computers going for hours and heavy-duty equipment for around 20 minutes,” Har-Even said.

While Har-Even declined to share specifics about how much emergency fuel Sheba stores, he did say that the medical center has enough reserves of all kinds to keep it operating for a few weeks to a few months.

Concern about power failures extends to homes where individuals rely on electrically supported medical equipment.

Yad Sarah, the largest volunteer-staffed organization in Israel providing health aid equipment and home care services, is making portable power stations available. Vital oxygen and other medical equipment can be plugged into these 23-kilogram (50-pound) devices, whose battery power can keep equipment going between four hours to two days, depending on usage.

“So far, dozens of people have reached out to us and received these power stations,” said Yad Sarah CEO Moshe Cohen. “Following Sunday morning’s events, we expect more people to ask for it in the coming days.”

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