ISRAEL AT WAR - DAY 145

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2,005 wounded on or since Oct. 7 are permanently disabled

War caught Israeli rehab hospitals unprepared to handle number of wounded

Crucial aspect of recovery in danger if more beds are not opened and additional staff not hired to heal body and soul: ‘There is no rehabilitation without mental health’

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

President Isaac Herzog and his wife Michal Herzog (right) visit with a wounded soldier and staff at the Loewenstein Rehabilitation Hospital in Ra'anana, November 13, 2023 (Courtesy of Loewenstein Hospital)
President Isaac Herzog and his wife Michal Herzog (right) visit with a wounded soldier and staff at the Loewenstein Rehabilitation Hospital in Ra'anana, November 13, 2023 (Courtesy of Loewenstein Hospital)

Since October 7, more than 10,580 Israelis have been wounded in the war with Hamas in Gaza, attacks by Hezbollah along the Lebanon border, and terrorist attacks in the West Bank, according to the Health Ministry.

The latest figures provided by the Defense Ministry indicate that 6,125 of the wounded are IDF soldiers and members of the Israel Police and other security forces. Of these, 2,005 have already been recognized as permanently disabled.

The number of physically and emotionally injured will only grow as the war continues, and many will require intensive and long-term rehabilitation.

Health Ministry information shared with the Knesset a month into the war indicated that Israel is not prepared to handle the number of wounded soldiers and civilians, along with other patients needing rehabilitation after surgery or illness.

It is expected that many Israelis wounded in the war will require in-patient and out-patient rehabilitation for severe physical injuries in combination with post-traumatic stress disorder (PTSD).

At the war’s outbreak on October 7, Israel had 780 rehabilitation beds, but by October 18 only 150 were still available for new patients. If all bureaucratic obstacles were removed, enough staff hired, and enough equipment available, the country could offer a total of 1,225 beds.

Health authorities are making a major push to meet the demand for expanded facilities and treatment, but the question remains whether it can all be done in time.

“COVID showed us our deficiencies in internal medicine. [The war] has highlighted our deficiencies in rehabilitation and mental health treatment,” Dr. Tamar Elram, director of the Hadassah Medical Center’s Mount Scopus hospital in Jerusalem, told The Times of Israel.

Front row from left: Hadassah Medical Center board chair Dalia Itzik, Hadassah Medical Center director-general Prof. Yoram Weiss, and Dr. Isabella Schwartz, head of rehabilitation at Hadassah, at the new Hadassah rehabilitation center under construction on Mt. Scopus, Jerusalem, November 2, 2022. (Renee Ghert-Zand/TOI)

Even before the war broke out on October 7, when Hamas launched a savage attack on southern Israeli communities, killing 1,200 people amid acts of horrific brutality and taking 240 hostages to Gaza, Israel lagged behind other OECD countries in terms of spaces for patients in rehabilitation hospitals and centers.

Whereas the OECD average for rehab beds per 1,000 persons is 0.5, Israel has only 0.3 (60 percent of the average). Statistics indicate that Israel falls short of countries such as Germany (2.0), Poland (1.8) and Switzerland (0.8). It also has fewer rehab spots than Belgium and Italy.

In addition to trailing other Western countries in overall capacity, Israel has a huge disparity in terms of the number of rehab beds in the country’s central region versus the north and south. The greater Tel Aviv area has between two and three times more rehab spaces for patients than the rest of the country. The lack of beds is felt most acutely in the north and the greater Jerusalem area, which has a population of 1.2 million.

“Jerusalem is in absolute last place per capita,” said Knesset Health Committee head Yonatan Mashriki during a November 2 visit to Hadassah’s under-construction Gandel Rehabilitation Center.

Completion of the aesthetically designed, state-of-the-art center would go far in alleviating the shortage of rehabilitation beds in the capital, Israel’s largest city.

Architect’s rendering of the new rehabilitation center at Hadassah Medical Center on Mount Scopus, Jerusalem. (Spector-Amisar Architects/Courtesy of Hadassah Medical Center)

As members of the Health Committee toured the building, Hadassah board chair Dalia Itzik and Hadassah director-general Prof. Yoram Weiss emphasized that completing the construction was just a matter of money.

“We have the people ready to do the work. We can complete at least the first two floors by the end of December or early January and start getting patients in here, if we can fundraise from private donors and get the money that the government has promised us,” Weiss said.

Pleading for support from the visiting politicians, Itzik said, “You’ve got to pressure the Finance Ministry to release the budgeted NIS 35 million ($94 million).”

A war-wounded soldier undergoes rehabilitation at Bnai Zion Medical Center in Haifa in November 2023. (Nir Kopler/Bnai Zion Medical Center)

Since October 7, Hadassah’s existing rehabilitation facility has been expanded from 40 to 50 beds to accommodate patients injured in the war.

The 30,000-square-meter Gandel Center, located nearby, will ultimately accommodate 132 hospitalized patients on three floors. Some 140 more patients per day will come for outpatient treatment after they are discharged.

The new facility will have the newest and most advanced rehabilitation treatments and equipment for physical, occupational, respiratory, and speech therapies, as well as neurological and orthopedic rehabilitation. The center will house two large hydrotherapy pools, and the staff will include a variety of specialists trained to address the psychological recovery of soldiers and war victims.

“Psychological treatment and addressing PTSD is integral to rehabilitation. There is no rehabilitation without mental health,” Elram said.

Other hospitals pivot to rehabilitation

Other hospitals have also been updating or expanding their rehab facilities in response to the ongoing war.

President Isaac Herzog (left) and Michal Herzog join Tel Aviv Sourasky Medical Center-Ichilov Hospital CEO Prof. Ronni Gamzu in visiting a soldier at the hospital’s new rehabilitation center, November 8, 2023. (Jenny Yerushalmi/Ichilov Hospital)

Ichilov Hospital in Tel Aviv has transformed its rehab division into a standalone hospital on its campus with 120 beds and 100 outpatient stations. Additional geriatric rehab beds will be situated in the main hospital.

The rehab hospital, called Bishvilam (“for them” in Hebrew), is operating according to the latest philosophy in the field, which involves beginning the rehabilitative process as soon as the patient exits surgery. The patient has a dedicated nurse who coordinates a smooth transition from the acute hospitalization phase to the later stages of inpatient and outpatient rehab.

Loewenstein Rehabilitation Hospital in Ra’anana, the country’s largest rehab facility, has been treating dozens of war injured — civilians, soldiers, and members of the security forces. With the expectation that the war will continue for some time, Loewenstein has partnered with Beilinson Medical Center in Petah Tikvah to open a new rehab center at Beilinson.

President Isaac Herzog comforts a young person wounded in the war at Loewenstein Rehabilitation Center in Ra’anana, November 13, 2023. (Courtesy)

Loewenstein will provide all the staff and equipment for patients’ physical and psycho-social rehabilitation at the new 14-bed center at Beilinson, which did not previously offer rehab services.

Sheba’s name precedes it

As the new rehabilitation center at Beilinson opened in November, some questioned the unequal distribution of patients among facilities around the country. A report in the Israeli newspaper Haaretz stated that 80% of the war wounded requiring rehabilitation were ending up at Sheba Medical Center outside Tel Aviv. At the same time, many beds stood empty at the other 20 or so rehab hospitals and departments around the country.

Prof. Israel Dudkiewicz, chair of the rehabilitation division at Sheba Medical Center, at the entrance to the newly created rehabilitation department for IDF soldiers and war-wounded civilians, November 7, 2023. (Renee Ghert-Zand/TOI)

Sheba has the second-largest number of rehabilitation beds in Israel and has been well-known for decades for its program. With patients able to choose where to go, many are attracted by Sheba’s reputation.

On a visit to Sheba on November 7, The Times of Israel learned from rehab department chair Prof. Israel Dudkiewicz that his hospital also had to expand its capacity in response to the war. It quickly added 86 beds to its existing 140.

The key part of the effort was a three-day renovation of a floor of Sheba’s geriatric rehab building, making it suitable for the rehabilitation of war wounded — mostly young soldiers and civilians.

“The geriatric patients from the floor had already been moved to a fortified area of the building at the beginning of the war, so we quickly brought in a team to convert the evacuated space into a welcoming one for young people,” Dudkiewicz said.

Since the speedy renovation, dozens of soldiers have filled the beds in the ward. The atmosphere is upbeat, with staff engaging in warm conversation and visiting friends and IDF comrades joking with patients. The inviting dining area, comfortable lounge spaces, and large outdoor patio encourage patients to leave their rooms and socialize.

A view of the lounge created for IDF soldiers undergoing rehabilitation at Sheba Medical Center, November 7, 2023. (Renee Ghert-Zand/TOI)

The new rehabilitation department is for patients who are relatively ambulatory and can move on their own or with minimal help to a fortified space in case of a missile siren. Those with head and spine injuries, amputees, and those with respiratory issues are cared for in Sheba’s main rehab center.

As pleased as he is with how Sheba speedily pivoted to address unforeseen needs since October 7, Dudkiewicz admitted that Israel has a significant way to go in getting to where it should be in ensuring that everyone who needs high-quality rehabilitation gets it.

A soldier does exercises to rehabilitate nerves and muscles in his arm after a bullet wound, Sheba Medical Center, November 7, 2023. (Renee Ghert-Zand/TOI)

“There is no question that we have a problem in terms of both in-patient beds and in our day programs. There are several reasons for this. First, our population has grown very fast and rehabilitation capacity has just not kept up. Also, medicine has improved, leading to higher survival rates, which in turn requires more rehabilitation,” Dudkiewicz said.

In addition, there simply aren’t enough rehab physicians and other rehab professionals in hospitals. Private practice is more rewarding for many.

“We need to attract good people, and it takes time to educate and train them,” Dudkiewicz said.

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