Tens of thousands of Israelis evacuated from their homes in southern and northern Israel experienced short-term disruption in preventive care and, in some cases, sharp spikes in mental health–related medication use.
Yet despite the upheaval, Israel’s health fund system enabled “rapid restoration of many services and supported continuity not only in chronic disease management but also in ongoing evaluation of preventive care patterns even during a national crisis.”
Those findings come from a study published last month by researchers from Maccabi Health Fund and the Hebrew University of Jerusalem, which is currently undergoing peer review.
The report, “Health Impacts of the Iron Swords War on Evacuees Displaced from Their Homes in Israel,” was led by Carmil Azran of the School of Pharmacy at the Hebrew University. She said the goal was to give insights to strengthen preparedness and response strategies within the health funds. At the same time, the research calls attention to the value of Israel’s integrated and coordinated primary health care system, especially during times of crisis such as large-scale civilian displacement.
The study found that in the first six months after the Hamas massacre, when residents were evacuated, there was a marked decline in preventive screenings, including for diabetes, hypertension, and cancer. In the six months that followed, however, partial and, in some cases, full recovery was recorded.
Both the people and the health system managed more than expected
“Both the people and the health system managed more than expected,” Azran told The Media Line.
At the same time, the mental health toll remained significant. Even a year after the start of the war, there was up to a 90% annual increase in the use of antidepressant and anxiolytic medications among southern evacuees compared to prewar levels.
During the war, Israel’s health care system was tasked with providing services not only to citizens who were living in unprecedentedly difficult times, but also to unique populations who were directly impacted by the Hamas massacre and Hezbollah rockets and, therefore, were relocated from their homes. Evacuees from southern Israel were directly exposed to extreme trauma and violence, and evacuees from the north faced prolonged relocation due to ongoing security risks.
The two groups were also evacuated differently. Southern residents were moved immediately and were generally resettled as communities. In contrast, relocating residents from the north took longer, and many were dispersed to hotels or cities in small groups or on their own rather than being moved collectively with their neighbors. These differences created an organic framework for comparing health service utilization and preventive care patterns.
The retrospective study used anonymous electronic health record data from Maccabi. It examined adults aged 21 and older who had been enrolled in the fund before the war. Evacuees from northern and southern regions were compared with non-evacuated district residents and with the broader Maccabi population across two postwar periods and their corresponding prewar periods.
The postwar periods were November 1, 2023, to April 30, 2024, and May 1, 2024, to October 30, 2024. These were compared with October 1, 2022, to March 30, 2023, and April 1, 2023, to September 30, 2023.
As of October 7, 2023, a total of 1,761,354 individuals aged 21 and older were enrolled in the fund, of whom 1,673,543 had been continuously enrolled for at least one year before the outbreak of the war. Among them, 6,220 individuals resided in evacuated villages in the southern region, and 5,613 in those in the northern region.
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A closer look at the data shows how differently the two evacuated populations fared.
When researchers examined annual diabetes screening rates, they found an overall dip during the first six months after the war began. Southern evacuees rebounded. By the end of the second six-month period, their screening rates had returned to levels comparable to before the war. In the north, the recovery was weaker. Annual screening rates fell from 60.8% before the war to 54.3% afterward, an 11% decline.
A similar pattern appeared in hypertension screening. Southern evacuees not only caught up but, in some cases, exceeded earlier levels in the second postwar period. Northern evacuees showed a more modest recovery.
Cancer screening told a more troubling story.
For colorectal cancer, annual screening rates among northern evacuees dropped sharply, from 27.4% in the year before the war to 18.3% in the year after.
Breast cancer screening also fell significantly in both regions during the initial months after October 7. Although screening activity increased in the later postwar period, the year-over-year numbers remained substantially lower. In the south, annual rates fell from 44.1% to 28.9%. In the north, they declined from 42.0% to 22.6%.
That drop stands in contrast to the broader Maccabi population, where annual breast cancer screening rates rose from 29.3% to 34.1%.
“We started to see the graph go back again after evacuees were settled in their new homes,” Azran explained. “Once they found their new providers and the place they would go to get screened. At the beginning, I think they were more focused on survival and just getting their families ready, so maybe thinking about mammography or colonoscopy was not the first thing they wanted to do.”
She added that after the first six months, there was a “really big push and focus” by the health funds to ensure evacuees received care. That effort included direct outreach, which may have helped boost screening rates later on.
Azran also noted a roughly 3% overall increase in screening among southern women who were not evacuated. That, she suggested, may have been because “there was more time and people were not really going to work” at the beginning of the war.
One reassuring finding from the Maccabi study was that there were no significant changes in the incidence rates of diabetes, atherosclerotic cardiovascular disease, or cancer one year after the outbreak of the war.
However, other experts caution that it may simply be too soon to draw firm conclusions.
A separate study published last year by the NATAL Israel Trauma and Resiliency Center, a nongovernmental organization, found a link between trauma and physical illness, including chronic and life-threatening conditions.
Chronic disease, you can usually find two years after the trauma. So, only now, we are noticing more diabetes and heart attacks, and we are not yet counting the number of cancers or other diseases. The numbers will likely be way higher than the numbers we based our calculations on.
“Chronic disease, you can usually find two years after the trauma,” Dr. Yifat Reuveni, who helped lead that study, told The Media Line. “So, only now, we are noticing more diabetes and heart attacks, and we are not yet counting the number of cancers or other diseases. The numbers will likely be way higher than the numbers we based our calculations on.”
NATAL reported a 35% increase in severe heart attacks between October and December 2023 compared with the same period in 2022. Among civilians in southern Israel living close to combat zones, there was an eightfold increase in cardiac events. The report also documented a 20% rise in strokes linked to psychological stress from the war.
If preventive care tells one part of the story, mental health medication use tells another.
Azran said the sharp rise in prescriptions reflects the depth of trauma experienced by evacuees, particularly those from the south.
“The ones that were evacuated from the south, a lot of them obviously were there on October 7 and either they had close people hurt, or they were hurt, or they knew hostages,” she said. “The northern evacuees had a different kind of trauma, of being evacuated and the rockets, but they didn’t really see what the southern evacuees saw.”
The numbers highlight that difference.
Among southern evacuees, the proportion using anti-anxiety and antidepressant medications jumped by 90% in the year after the outbreak of the war compared to the year before. By contrast, among other residents of the southern district who were not evacuated, the increase was just 8%.
In the north, the pattern was far more moderate. The use of anti-anxiety and antidepressant medications rose by about 5% among evacuees and by roughly the same amount among residents who remained in their homes.
Sleep medications followed a similar, though less dramatic, trajectory. Among southern evacuees, purchases for sleep disorders increased by 40% in the year after the war compared to the previous year. Among other southern residents, the increase was 9%. In the north, the rise was again more modest, about 5% among evacuees and 7% among other residents.
Azran said the study’s results show that Israel’s health funds were better prepared for an emergency than other sectors of the country. She noted that this was likely partially due to the COVID-19 pandemic, which improved Israel’s ability to work with remote patients via telemedicine and other services.
She said the lesson should be one of preparation.
“We know it can happen again, and we need to have systems in place,” Azran added.
We know it can happen again, and we need to have systems in place
Her colleague, Naama Shamir-Stein of the Department of Health Evaluation and Research at Maccabi, shared a similar message.
“The findings illustrate the heavy health price paid by residents who were forced to leave their homes for an extended period,” Shamir-Stein said. “The decline in preventive screenings and the rise in medication use point to the need for systemic intervention to ensure continuity of care even under emergency conditions. As a health care provider, we see tremendous importance in proactive monitoring and the rapid identification of gaps to prevent deterioration in the health status of evacuees.”