More than two years after the worst terrorist attack in its history, Israel is still fighting a different kind of war, one that is unfolding quietly in homes, clinics, and classrooms across the country.
The trauma of October 7 and the months of fighting that followed have left deep emotional scars, and the systems meant to treat them are straining under the weight. According to Professor Eyal Fruchter, co-founder and head of medical and scientific affairs at the ICAR (Israel’s Collective Action for Resilience) Collective, the State of Israel has entered a situation it “does not really know how to handle.”
On Sunday, Fruchter addressed a room of several hundred people at ICAR’s annual summit, laying out the scope of the crisis. He reviewed the impact of the war on Israeli society based on a variety of surveys and studies, including the more than 2,000 people killed in the fighting and the over 165,000 displaced from their homes. More than 30,000 people have already filed claims for support from the National Insurance Institute, 24,000 of them for psychological conditions.
“These are numbers the State of Israel has never experienced before,” Fruchter said.
Fruchter presented data from several national surveys conducted over the past two years, including surveys of people from across the country and of all ages. One in five respondents reported experiencing significant emotional distress that continues to affect them today.
Between 19% and 25% of respondents reported suffering from depression, anxiety, post-traumatic stress, or a combination of these, depending on the survey. The Health Ministry reports that 435,000 people have sought treatment within the public mental health system.
“Three and a half million treatment sessions have taken place,” Fruchter stressed. “That represents an increase of more than 40% compared to 2022. And these numbers refer only to the public sector. They do not include nonprofits or private providers.”
Three and a half million treatment sessions have taken place. That represents an increase of more than 40% compared to 2022. And these numbers refer only to the public sector. They do not include nonprofits or private providers.
He said some organizations have had to more than double their treatment hours. Yet as many as 20% of people report severe distress and have not sought treatment. In general, he said, 38% of those who need care have not sought it, in part because of long waiting times.
The waiting time in the public system from intake to treatment is now 6.5 months, according to Fruchter.
“This is not theoretical,” Fruchter said. “It is happening on the ground. The strain is visible in the exhaustion of therapists.”
The therapist workforce itself is aging and limited. There are about 1,120 psychiatrists in Israel, 63% of them over age 55. Only about 300 specialize in child and adolescent psychiatry.
One area where the crisis has become particularly acute is within the defense establishment, as soldiers, police officers, and security personnel seek help in high numbers. In addition to the 13,000 already recognized as disabled by the Defense Ministry since the start of the war, another 9,000 cases are pending. The ministry’s Rehabilitation Department expects up to 100,000 recognized disabled veterans by the end of 2027, about half of them with mental health conditions.
“Before the war, about 4,000 new disability claims were submitted each year,” Fruchter said. Today, around the same number of claims are reported per month.
The impact spreads beyond those who served. Fifty-two percent of families of reservists report a decline in their children’s emotional stability. About one-third of couples with a reservist spouse are speaking concretely about divorce.
“When trauma is not treated early, we expect secondary damage,” Fruchter continued, noting that addictions and trauma commonly reinforce each other.
When trauma is not treated early, we expect secondary damage
The country has seen a 70% increase in opioid use, and one in four Israelis reports increased substance use, including 30% of young adults aged 18 to 24 who report ongoing substance misuse. Fruchter said that among individuals with post-traumatic stress disorder (PTSD), more than half (54%) report substance abuse.
There are physical consequences as well.
“We are already seeing about a 20% increase in certain stress-related conditions and additional increases in cardiac events in the south,” Fruchter said. “There are also psychosomatic illnesses, allergies, fibromyalgia, irritable bowel syndrome, and immune system disorders. Over time, weakened immune systems can increase the risk of cancer. These effects may become clearer in four to five years.”
Suicide rates may rise by 20% to 30% after the fighting ends, Fruchter added, noting that research from the United States after 9/11 showed that symptoms peak about nine years later.
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“So, what we see today is only the beginning,” he said. “This is a long-term challenge, not a short crisis.”
This is a long-term challenge, not a short crisis
Dr. Gilad Bodenheimer, director of the Health Ministry’s mental health division, said it remains unclear which phase of healing or recovery Israel is in.
“The answer is very complex, because we have been through more than two years of stress,” he told the room. “There are people for whom the main trauma passed after a few days. I think that is a minority, but there are some. There are people for whom the trauma passed over these two years in different stages, with peaks. And there are people for whom the trauma passed only with the return of Ran Gvili, or others for whom the trauma has not passed yet.”
Ran Gvili was the last hostage to return home after being murdered by Hamas.
Bodenheimer said Israelis are coping with injuries and bereavement in many forms. At the same time, studies tracking symptoms of depression, anxiety, and trauma across Israeli society show that for most of the public, there has been a significant decrease in symptoms in recent months.
“This is not meant to calm us. It is meant to say that large parts of the public in Israel have already begun even post-traumatic growth,” Bodenheimer said.
Post-traumatic growth refers to a positive psychological transformation that can occur after a crisis, when a person finds new meaning in life and seeks to move forward. PTSD and post-traumatic growth can often coexist.
Still, some populations are suffering more than others.
According to Bodenheimer, there are the “obvious” populations, meaning those who were most directly harmed. These include people who were injured, people who experienced captivity, residents of the Gaza border area, and those evacuated from their homes.
There are also specific groups facing acute challenges, including Arab citizens of Israel.
“I will mention that Arab society in Israel is also experiencing very severe violence in the streets, and it is hard to separate the effects of the trauma of the Swords of Iron war from the effects of street violence,” Bodenheimer said.
“And there are other populations we must not forget: people who already lived with mental health conditions, who suffered even before the war, and the war intensified their ability to cope. Now they have to fight for an appointment with a psychiatrist, alongside many more people who also need care,” he continued.
Children are also at particular risk, according to Professor Amir Krivoy, CEO of the Geha Mental Health Center, who also spoke on Sunday.
He raised a pressing question: What will happen to the children who have been exposed to such a confusing world?
Certain school-aged cohorts were the first to enter lockdown during the COVID-19 pandemic and the last to return to classrooms. When they did return, they faced teacher strikes, missed grades, and canceled school trips. Then the war arrived, which again kept many of them at home. Many teachers were called up for reserve duty, leaving schools staffed by substitutes.
“One number, I believe from the National Council for the Child, is that around 20,000 children were exposed directly or indirectly, through a parent or grandparent, to a significant mental health event,” Krivoy said.
The overwhelming majority [of children] will, through the systems we are building and will build and through their support circles, return to normal life and recovery
But he emphasized that there is still hope.
“The overwhelming majority [of children] will, through the systems we are building and will build and through their support circles, return to normal life and recovery,” he said.
However, he stressed that these systems must be strengthened. Children exposed to considerable stress in childhood are at increased risk of developing mental illness.
“But it is not a foregone conclusion,” Krivoy added. “It is something you can come out of. This is exactly where action is needed.”
Dr. Sagit Arbel-Alon, director of the health services division of the Welfare and Social Affairs Ministry, expressed similar sentiments. She said the role of Israel’s welfare system today is to create continuity with other ministries so that patients get consistent care and do not fall between systems.
Arbel-Alon said the state was not prepared for the level of collaborative planning required, as ministries continue to operate under different laws and budgets. She noted that more than once, including before the war and after COVID, the Education, Welfare, and Health ministries sat together to design a comprehensive, holistic program that included community care and hospitalization.
The state still was not ready. … I think it is past time to stop working in fragmentation and create an overall, comprehensive view.
“The state still was not ready,” she said. “The state, as a state, was not yet mature enough to see this joint work, and even today it still does not really work … I think it is past time to stop working in fragmentation and create an overall, comprehensive view.”
Arbel-Alon also called for the establishment of a municipal health department.
“In my view, this component is critical,” she said. “To begin seeing people at the local level and to connect the dots, we need it. In the end, ministries are regulators, not local operators. The Welfare Ministry has a hand in the municipality, as does the Education Ministry. What is missing is one very dramatic component: a municipal health officer.”
The urgency for collaboration was a central theme on the first day of the ICAR Collective Summit, which ran February 15 and 16 in Tel Aviv. ICAR executive director, Gila Tolub, said that while Israel’s mental health system offers hotlines, resilience centers, health funds, NGOs, and even enjoys substantial funding, those who move through the system experience it as fragmented.
“Some pieces are strong, some pieces are fragile, some are very crowded, and some are barely used,” Tolub said. “And all of them mean well, but even good pieces don’t help much when they’re not connected.”
She warned that the longer people wait for appropriate mental health care, the more their conditions can worsen.
ICAR’s goal, she explained, is to build bridges between the various mental health supports in Israel and the people who run and work within them, so they can coordinate better and share resources.
“When organizations work alone, we only see what happens inside each piece, inside one program, inside one population, inside one intervention,” Tolub said. “But when pieces share information, we start to see patterns. We learn what actually works, for whom, and at what moment. And this is how real innovation happens, not in isolation, but through shared learning.”
She said the aim is to compare approaches, adapt more quickly, and stop repeating mistakes. So much is at risk in Israeli society, and statistically, even in communities that did not directly experience the October 7 massacre or the war, the impact is still felt.
Without a system, there is no way to learn at scale. We build together, no new organizations, just new connections.
“Without a system, there is no way to learn at scale,” Tolub said. “We build together, no new organizations, just new connections.”
This report is part of Traumatech, a series developed and created by Maayan Hoffman and debuting on The Media Line. The series explores how Israel is building and exporting breakthrough mental health technologies that can transform life at home and bring hope to communities worldwide.