Israel Unprepared to Treat Large Number of Wartime Casualties, Officials Warn

Defense and medical officials say the army would have difficulties evacuating the wounded in a multi-front war and would face a serious shortage of doctors

Evacuating the wounded following a grenade explosion in 2016.
Rami Shlllush

Senior Israeli defense and medical officials warn that they are not prepared to cope with the potential casualty toll of a multi-front war.

A senior defense official said the Israeli army has yet to come up with a solution that would address anticipated complications of a scope greater than in the past, in evacuating wounded soldiers from the battlefield in war, as a result of more advanced weapons used by Israel's enemies.

There is a 30 percent shortage in military ambulances that would be needed should a war break out and about 20 percent of army physician positions remain unstaffed, the official added.

Concerns have also been expressed about war preparedness in the civilian sector. A senior health care official has told Haaretz that the country’s packed emergency rooms would not be capable of receiving the anticipated number of casualties. In addition, the Magen David Adom medical emergency service would be expected to face significant staff shortages since about half its staff would likely be called up for reserve duty.

“There will be a problem with evacuations, and this is well known,” said the senior defense official, who attended a series of recent discussions on the issue. “It’s clear to everyone that nobody will let women and children wait underneath the rubble of their homes because the army wants to supply emergency vehicles to soldiers at the front. We will get to a point where those responsible will have to choose one over the other, and I wouldn’t want to be one of those decision-makers when that moment comes.” He added that “this issue keeps coming up for discussion, but nobody is taking it seriously and nobody is dealing with it to the core.”

The difficulty in evacuating the wounded from the battlefield was brought up by outgoing State Comptroller Joseph Shapira in March of this year. He warned that the army’s helicopter fleet would have difficulty evacuating wounded soldiers from the front lines due to regional threats.

Joint exercise

At the beginning of the week, the Israel Air Force held a joint exercise with ground forces, in which they practiced such an evacuation, but defense officials warn that the army is far from being adequately prepared in this regard. A defense source said the army is now examining the possible use of drones or unmanned vehicles to evacuate wounded from the field, but such means are far from operational and in any event would not be suitable to handle the large number of casualties that could be expected in a multi-front war.

The shortage of military doctors is also a cause for concern among defense officials. The army is placing an emphasis on the need for first aid treatment in the field in light of the fact that 83 percent of those wounded in Israel’s wars who succumbed to their wounds died from blood loss during the first hour after being injured.

But the army is having difficulty recruiting doctors. And in his last report, issued in June 2018, the outgoing army ombudsman, Maj. Gen. (res.) Yitzhak Brik, wrote that in addition to the problem of filling positions, there has been an increase in the number of doctors seeking to leave the service. “The army has imposed an impossible load on the medical personnel, which has caused fatigue and clear harm to the treatment provided. We are currently facing one of the most difficult crises the medical corps has ever known,” he wrote.

With the strain on the hospitals, the healthcare system is preparing for the option of discharging patients whose lives are not in danger to make room for the seriously wounded during wartime. It is expected that entire wards would be emptied out to make room for an emergency room to treat casualties from the front and civilians.

“The plan is to take one large hospital and make it a triage center,” a knowledgeable source said. “From there we would move the wounded depending on the urgency and nature of their injuries to other hospitals that would specialize in treating their injuries.”

Despite the increased supply of military ambulances in the past two years, the army is still short dozens of ambulances to meet the standards set by national emergency agencies. A military source added that some of the available ambulances are rather old and according to assessments would not meet the needs during fighting. “We would like to meet 100 percent of the standard that was set, but there are priorities,” he said.

Comptroller’s report

The comptroller’s report issued in March said the ambulance shortage would not only affect soldiers on the front lines, but also the evacuations of civilian casualties on the home front. “Due to a shortage of ambulances at the Home Front Command and Magen David Adom, as well as medical staff, it wouldn’t be possible to ensure a swift and efficient evacuation of casualties from areas of destruction,” Shapira wrote.

The Medical platoons' field headquarters informed the comptroller’s staff that the means at the disposal of the Home Front Command to carry out evacuations are low “and some of the ambulances wouldn’t necessarily be appropriate for evacuating the wounded and providing medical assistance.”

The army released a statement, saying that “[The IDF] deals with readiness for various battle scenarios and is constantly improving its capabilities in the air, at sea, on the ground as well as its technology. All of this is being done in addition to advancing battlefield medicine and rescue under fire that are already at the forefront of Western armies.

“Recently agrrements have been made with Magen David Adom that responsibility for evacuations from sites of destruction would be carried out by Magen David Adom. The army will gradually receive 160 new ambulances by the year 2020 and has also purchased additional ambulances from Magen David Adom,” the statement read.

Touching on the difficulty in filling the positions of military doctors, the army added "that more than 85 percent of the positions are manned, while doctor staffing in operational units is 100 percent manned. In addition the Medical Corps has doubled the number of doctors and paramedics for emergency and has expanded the paramedics’ authority to give the soldiers the most rapid and best care. In addition, the process of introducing nurses to combat units has recently begun.”

But defense officials warn that relying on Magen David Adom for evacuation of the wounded on the home front is not in line with the situation that can be anticipated during wartime. According to figures issued by the comptroller, a maximum of 500 of the 1,050 ambulances at Magen David Adom’s disposal, would be staffed during wartime due to the large number of personnel that could be expected to be called up for reserve duty.

A defense source involved in the matter said the data shows that the defense and healthcare systems are having difficulty drawing conclusions following the criticism they elicited from the comptroller and the army ombudsman. “Although everyone knows that the next war will be an event unlike what the army and the home front have ever faced, the preparations are all based on what was in the past, and that’s the mistake.

“The army won't be able to allocate the resources to the home front during an emergency, and officials at the political level will have to make decisions in real time on where to direct these resources.”