Clalit Health Services, Israel’s largest health organization, released on Sunday the results of a comprehensive assessment of the health costs of war over the past three years. Its data set was its 5 million members.
The report found that the most pronounced impact was on mental health.
The war’s first year saw a 45.5% rise in new anxiety diagnoses and a 100% increase in new PTSD (post-traumatic stress disorder) diagnoses, a trend that did not subside throughout the three years of war.
“The data show that the psychological consequences of the war and the events of Oct. 7 are not an isolated, passing event, but a deep and ongoing crisis that presents a national challenge to Israel’s mental health system,” said professor Amir Krivoy, director of Clalit-Geha Mental Health Center and director of Clalit’s Center for Resilience and Mental Health Research.
“The fact that even in the third year, the rate of PTSD diagnoses among populations exposed to high levels of stress remains between two and six times higher than before the war requires a broad systemic response,” he added.
Evacuees—north and south
Referrals and visits to community mental health services rose about 20% to 28% during the three-year period covered. The numbers were higher among residents evacuated from southern Israel and communities neighboring the Gaza Strip.
Among southern evacuees, PTSD cases increased 18-fold in the first year vs. the year before the war. In the second year, cases remained 11 times higher, and in the third year six times higher than before the war.
Anxiety diagnoses among southern evacuees rose 10-fold the first year. Referrals and visits to mental health services increased between two and 4.5 times. Sleep disorders spiked by 358% during the first year among southern evacuees.
Data show the impact on evacuee populations is not limited to mental health. A significant and persistent deterioration was observed in blood pressure control, from 30% to 53.7% compared with the prewar baseline. There was also a deterioration in diabetes control.
In new diagnoses of high cholesterol and blood lipid disorders, the general population saw a 20% increase, whereas among northern evacuees the increase reached approximately 60%.
Avital Margalit, Clalit’s director of the Galilee administration in the northern district, said the changes may be explained by the fact that most evacuees spent months in hotels with access to large meals and reduced physical activity. This would impact the management of chronic diseases.
Assi Cicurel, director of family medicine of the Southern District of Clalit, and physician at the Nir Oz Clinic, said, “We are concerned that people experiencing stress are doing less to maintain their general health and promote healthy behaviors, as the data indeed show.”
Children and adolescents
Among adults in psychiatric emergency department visits no substantial change was noted. But among children and adolescents data show a significant trend upwards.
Psychiatric emergency visits among Clalit children and adolescents increased by 78.3% in the second year of war. In the third year, the increase reached 121.3%, more than twice the prewar baseline.
Referrals by pediatricians to mental health services increased by 52.1%, while anxiety diagnoses among children across Israel increased by 40% to 70%.
Jordan Lewinski, director of mental health services at Clalit, “We see that emotional distress does not remain only in the treatment room. It is also directly reflected in medication use in the community.”
“Among children, and particularly among southern evacuees, anxiety and trauma are also expressed in direct physiological ways, with a 47.8% increase in the use of Minirin for bedwetting,” he said. “These findings show that we are dealing with ongoing psychological and physical consequences that require treatment and continuity of medical care in the community in the years ahead.”
Preventive medicine & remote care
While screening rates across Israel remained relatively stable, among female evacuees from northern Israel there was a continuing decline of up to 7.5% in mammography screening.
Screening for colorectal cancer declined by 2.5% to 3.5% among evacuees from the south and north.
Among southern evacuees, the use of smoking cessation medication increased by 104%, compared with 37% across Israel and 26.7% among northern evacuees.
Despite the war, the overall number of primary care encounters across the general population remained relatively stable. But the way Israelis accessed healthcare changed, with face-to-face visits declining by about 13%.
Phone consultations rose about 36%. Among evacuees from the north and south, phone consultations rose by approximately 50%.
Data show the role remote medicine plays in maintaining continuity of care during periods when routine, place of residence and physical access to healthcare services are disrupted.
What stayed the same
Health indicators that remained stable include the incidence of stroke across the general population.
“Despite three difficult years of war that create stress and challenges for patients and the healthcare system, the data on cardiovascular disease are encouraging,” said Limor Ilan Bushari, director of cardiology services at Clalit-HaEmek Medical Center.
Anda Eilam, director of the neurology department at Clalit-Kaplan Medical Center, said it is possible that the problems may not manifest themselves right away. “It is important to emphasize that psychological stress by itself has not been proven to be a direct factor that increases the risk of stroke. However, prolonged war may affect the overall set of stroke risk factors, including chronic disease management and lifestyle, and such effects do not necessarily manifest immediately as a stroke.”
Mapping future challenges
Clalit’s comprehensive report, covering three years and containing data on a large part of the population, including residents evacuated from southern and northern Israel, provides for the first time a long-term view of the effects of the war.
It also maps out the challenges that will form the basis for planning the national medical and rehabilitation response in the years ahead, Clalit said.
Gil Lavie, head of planning and strategy at Clalit, said, “The report data point to a society that has managed to maintain stability across a significant number of health indicators even during three years of war, while at the same time clear areas of vulnerability have emerged that require long term attention.
“At the top of our agenda are mental health, children and adolescents, populations in the south and north affected by the war and evacuation, the return to preventive medicine and early detection screening, and monitoring and treatment of chronic diseases in which deterioration has occurred.
“Our challenge as a healthcare system in the years ahead will be to identify these trends in time, reduce the gaps that have emerged and prevent the health cost of the years of war from becoming a long-term burden on an entire generation.”
