MEDICAL PREPAREDNESSWhat October 7 Taught Hospitals About Preparing for Modern Warfare
A new study of an Israeli hospital’s response to the October 7 attacks shows that while years of disaster training enabled staff to continue treating patients under rocket fire, real wartime conditions exposed critical gaps in communication, staffing, logistics, and casualty distribution. The findings offer practical lessons that could help hospitals worldwide prepare for prolonged armed conflicts and other large-scale emergencies.
When the first rockets began falling over southern Israel on the morning of October 7, 2023, staff at Assuta Ashdod Hospital activated a plan they had rehearsed for years. Within hours, the emergency department was treating waves of patients suffering from gunshot wounds, blast injuries and burns—all while the hospital itself remained under rocket fire.
A new study led by Maximilian Nerlander, a Ph.D. candidate at Linköping University in Sweden and a visiting scholar at the Hebrew University of Jerusalem’s School of Public Health, offers one of the most detailed accounts yet of how a modern civilian hospital functioned during an unprecedented wartime emergency. The research was conducted together with Prof. Adam Rose, from Hebrew University of Jerusalem’s School of Public Health, and Dr. Debra West of the Department of Emergency Medicine at Assuta Ashdod Medical Center. Based on in-depth interviews with 19 staff members, from the emergency department, as well as the head of trauma and disaster management, who worked during the October 7 attacks, the study provides practical lessons for hospitals around the world as many countries strengthen their preparedness for large-scale armed conflict.
Unlike previous terrorist attacks in cities such as London, Paris or Boston, the October 7 assault unfolded over many hours, across multiple communities, while large parts of the surrounding region remained under active attack. Ambulances struggled to reach casualties, communications broke down, and hospital staff often had little understanding of the rapidly evolving situation beyond what they could piece together from patients, soldiers and social media.
Yet despite the chaos, the hospital continued to operate.
Researchers found that one of the greatest strengths was not sophisticated technology, but preparation. Years of frequent mass casualty drills meant doctors, nurses and support staff instinctively understood their roles, allowing them to focus on solving unexpected problems rather than basic procedures. The hospital’s reinforced, missile-protected emergency department also enabled teams to continue caring for patients without needing to seek shelter, preserving both workflow and morale.
The Interviews also revealed weaknesses that only became apparent under real wartime conditions.
Many employees faced an impossible choice after being called simultaneously by both the military reserve system and the hospital. Others hesitated to leave home because their own families were in danger. Administrative personnel responsible for registering patients were unable to report to work, creating unexpected bottlenecks. Plans to relocate less critical patients out of the emergency department proved unworkable because other hospital areas were not protected against incoming rockets.
