According to him, the answer requires, among other things, the creation of a strategic plan to strengthen the resilience and ability among the public to deal with the unexpected challenges yet to come. “We had an epidemic, we had a revolution, we had a war, and I don’t know what the next M is. We need to produce a strategic plan right now that will train more personnel, that will give tools to the public and that will maintain the infrastructures to provide a better answer for the future.”
Prof. Nachman Ash, chairman of the National Institute for Health Policy Research, and who served as the Director General of the Ministry of Health, emphasizes the importance of urgent treatment regarding mental health. “The immediate danger is the mental state of the Israelis. These problems are already emerging and on a large scale.” Prof. Ash points out that there is a severe shortage of therapists in the system, and even though the state has allocated budgets to deal with the issue, it is a long process until they are actually realized. “It is impossible to solve the shortage overnight, there is a big challenge here.”
Prof. Haim Bitterman, the scientific director of the National Institute for Health Policy Research, adds that the tremendous need to provide mental health services comes against the background of a system that even before the war had room for improvement, “with terrible queues and poor access to treatment options.” According to him, she will not be able to keep up with the required pace.
“In times of stress and fear, people place less emphasis on health and preventive medicine”
The eyes of the experts are on the future, for the next months and the next years, when according to them it will be possible to identify the consequences of the war on the health of the Israelis. Prof. Bitterman explains that the patients with chronic diseases, especially the citizens of the country evacuated from their homes whose routine care is compromised, are at high risk. “I am very worried about the evacuees, what kind of care they receive, especially the chronic patients who need follow-up, and are now cut off from their family doctor and the medical system they know. About 9 percent of the population suffers from diabetes, in some sectors it even reaches 20 percent. An imbalance of diabetes may cause complications within a few months, as well as an imbalance in hypertension, which can manifest itself in an increase in the rate of cerebral or cardiac events.”
According to Prof. Nachman Ash, the evacuee population is at risk in the long term, also due to their lifestyles that have changed for the worse in recent months. “When you eat in a hotel, the diet is not the same as the food you prepare at home. Maintaining physical activity is also more difficult when you are far from home. Together with the stress and anxiety that already exist in these populations, and the fear of livelihood after so many months away from home, it can be assumed that there will be Effects on their mental and physical health that we will see in the future.” According to him, the effect of the evacuation and leaving the framework also affects the children. “Child obesity is something that worries us. In the last two years, the rate of childhood obesity has increased, and we fear that the war will contribute to this trend.”
Indeed, in a recent survey conducted by the Maccabi Health Services Health Insurance Fund among the evacuees in both the north and the south, disturbing findings were discovered – about a third of the evacuees reported a change for the worse in their health condition, and among the parents, a third stated that there had been a change for the worse in the children’s eating habits. The survey also revealed that about 50 percent of the evacuees who performed regular physical activity before the war had to reduce their activity, and about 20 percent testified that they stopped completely. Even among smokers, or ex-smokers, the situation is not alarming. 43 percent reported that following the war they started smoking or increased the frequency of smoking.
The head of public health services at the Ministry of Health, Dr. Sharon ElRai Price, testifies that even in the findings recently collected by the ministry, they identify the deterioration and neglect of health in the evacuees, but also in the general population, in issues such as the quality of the diet, and in certain situations even in the amount of food and nutritional security, and a return to habits which are not healthy. “We are not surprised. I think that in times of stress, burden and fears, people put less emphasis on everything related to maintaining health and preventive medicine. We understand that mental health affects physical health.”
“The war may shorten life expectancy by several years”
The evacuee population is just one “vulnerable circle” among many that exist in the Israeli public, explains Prof. Hagai Levin. From the abductees and their families, through the bereaved families to the Israelis who experienced secondary exposure to the atrocities through the media and social networks. According to the professor, the trauma of October 7 may be an intergenerational trauma, and the epigenetic changes (“above the genes”) among the Israeli population must be monitored, and an answer must be tried to reduce the impact. “The analogy is to the studies done on Holocaust survivors here at the School of Public Health at the Hebrew University. We know that in the case of Holocaust survivors, both on the epigenetic level and on the cultural and mental level, the effects were intergenerational.”
Another point raised by the experts is the Israelis’ neglect of the routine tests – the survey tests. “Our medical routine is made up of supervision, follow-up and prevention. For example, screening tests, mammography for early detection of breast cancer, colonoscopy to check the colon, etc., all of these are included under preventive medicine, and people’s referrals to this have gone very wrong during this period,” says Prof. Haim Bitterman.
Prof. Ash believes that if we do less screening tests, we will find out less, but “it may erupt in later stages. It may be that due to the decrease in compliance with these tests, we will see a trend of late stage detection of diseases.” The professor also points out that the health system must mobilize even more than usual during this period in order to encourage the citizens to get tested. “We cannot allow gaps to arise in the treatment of chronic diseases or screening tests, especially not in view of the security situation and the fear of opening another front in the north, so it will not be possible to handle the issue in the same way.”
And could the impact of the war meet us even in decades? In the opinion of Prof. Hagai Levin, the prolonged state of war may also harm life expectancy in the State of Israel. “We know that stress and trauma are associated with shortening life expectancy, literally, war can shorten life expectancy by several years.” According to him, there are populations that are at greater risk, such as the abductees who were released from Hamas captivity. “I assume that in the future we will detect more diseases in them, a poorer quality of life and a shorter life expectancy.” In a similar way, adds the professor, the families of the abductees are also at risk. “There is a difference between bereavement and the pressure felt by the families of the abductees. The ongoing uncertainty regarding their loved ones is heartbreaking and difficult. I remind you that Herzl, Oron Shaul’s father, died at a very young age, when he was only 53 years old. Although we have seen few studies, we have seen enough. It is clear to us We will see the life expectancy shorten in these families.” He further adds that the damage will be even more serious if the abductees, who are still held captive by Hamas, are not released and the families do not get closure. “If we manage to free them and bring the dead to a proper burial, there will be an opportunity for rehabilitation.”
Prof. Nachman Ash agrees with the claim that the consequences of the war on the health of Israelis also depend on its results and the good national feeling among the public, if it ends successfully and the abductees are returned. He also adds that there is also weight for the duration of the fighting. “There is no law of the Six Day War like the law of this war. The longer the war continues, and of course if there are significant flare-ups such as another arena in the north, then surely the damages will be more serious and significant.”
“There are decisions that are in our hands”
So what can be done to deal with the negative effects of the war on public health, and reduce the damage as much as possible? The Ministry of Health says that these days headquarters work is being done to formulate a new plan for the health of the body and mind, which is being drawn up in cooperation with the Mental Health Division of the Ministry of Health, the Strategic Planning Administration and the Prime Minister’s Office. “It is very clear to us that mental state affects physical state and physical state affects resilience, and we want to produce a holistic program,” explains Dr. Sharon Elrai Price. According to her, the program will be carried out through the local authorities, through a coordinator who will help integrate the tortured and develop tools to build resilience in the community , to improve the nutrition of the population and to encourage physical activity and smoking prevention.
Prof. Hagai Levin points out the need to get out of the box of the health care system. “People receive the same basket of services for everyone, entitlement to a fixed number of treatments. But what if someone needs more treatments? Or treatments of a different type? The health system is a conservative and bureaucratic system, and it is important that the rehabilitation is done according to the needs of each person and each community.” He also adds that there is a need to invest in other treatments, such as art, sports and nature therapy.
According to Prof. Nachman Ash, there should also be reference from the education and welfare system, and the local authorities. “The health system is not the only one that should be involved in the various solutions. The solution is multi-channel.”
Dr. Sharon Elrai Price wants to emphasize to the public that besides the systemic solutions, there are also things that are in our hands. “When there is a short military operation, then we put aside the concern for health, for a week or ten days. This time, the continuation of the war requires us to return and take care of ourselves despite the situation, and there are things that are in our hands. So, for example, decide to do physical activity, or cut back on smoking cigarettes. We are aware of the difficulty, but we don’t have to make big decisions, even small steps will suffice as a start.”