All of the nearly 1,000 beds in Israel’s rehabilitation centers were occupied on Oct. 6. Even then, the well-known lack of rehabilitation facilities was a source of serious concern and regular discussion within the country’s medical system. 

And then the Oct. 7 mass terror attacks happened, sending a staggering influx of patients to Israeli hospitals for physical and emotional rehabilitation. In the first two days of the war alone, hospitals were facing 4,400 incoming wounded, and those numbers continue to increase on a daily basis as the war goes on, according to directors of Israel’s leading rehabilitation centers.

“We needed thousands of rehabilitation beds for those injured people,” Shauli Hercyk, CEO of the Medical Care rehabilitation hospital in Bat Yam, just outside of Tel Aviv, told eJewishPhilanthropy. “The fact that Israel was not ready for such an event in terms of rehabilitation infrastructure was all over the news.”

Since the outbreak of the war there has been a concerted effort to create more rehabilitation locations for civilians and security forces who have been — and will be — injured during the conflict, Hercyk said. He stressed that psychological and emotional rehabilitation must go hand-in-hand for any physical rehabilitation treatment to be successful.

There are currently about 7,000 people in rehabilitation programs in Israeli hospitals — half of them soldiers and half civilians, according to Nadav Davidovitch, chairman of the Health Policy Program for the Taub Center for Social Policy Studies in Israel and director of the School of Public Health at Ben-Gurion University of the Negev. Whether the Israeli government and society has the capacity to meet the future rehabilitation needs for the wounded depends on how long the war continues and the economic situation of the country, he said.

The Rehabilitation Division of Israel’s Defense Ministry, which is responsible for providing rehabilitative care to Israeli soldiers injured in the line of duty, has seen a massive rise in the number of wounded service members that it is providing care for. Before Oct. 7, the division had treated a total of 62,000 people over the course of its 76 years. Since Oct. 7, that number has grown by 8,504 — a 13.7% jump in eight months — and it is expected to continue rising as the war progresses, representatives of the Defense Ministry told the Knesset earlier this week.

“There are [existing rehabilitation] programs, but if the war continues like this, I think there will be another cutting of the government’s budget and usually these [services] suffer the most,” said Davidovitch, adding that while the budgets may be reduced, the number of people needing rehabilitation will likely grow. “That is not a good combination.”

According to a recently published report by Israel’s Health Ministry, the country has 60% of the average number of rehabilitation hospitalization beds in countries in the Organization for Economic Cooperation and Development (OECD). At the end of 2022, Israel had 0.3 rehabilitation beds per 1,000 people, compared to the OECD average of 0.5 beds per 1,000 people. (Israel ranked higher than Holland, the United States and Canada, which all have 0.1 beds per 1000 people.)

The war has put a spotlight back on the lack of sufficient beds in rehabilitation facilities and rehabilitation services in general, which have long been inadequate, Davidovitch said. It has also emphasized the existing inequalities, especially the existing gap in available treatments between the center of the country and the geographic periphery. 

Some strides have been made over the years to improve the situation, including the opening of a 20-inpatient-bed rehabilitation department Beersheva’s Soroka Medical Center in 2016, and the creation of the Hallenberg Center for Rehabilitation in Ashkelon’s Barzilai Hospital in July 2019. A month after the war began, a new rehabilitation ward with 25 inpatient beds opened at Soroka’s Legacy Heritage Oncology Center. But still more needs to be done, Davidovitch said, especially in training of health professionals such as physical and occupational therapists.

“There is a lack of physicians, but the [situation with other] health professions is even worse,” he said, referring to occupational therapy and other rehabilitation-related fields.

Dr. Shilo Kramer, director of the orthopedic rehabilitation and residency program at ADI Negev-Nahalat Eran Rehabilitation Hospital, noted that hospitals are scrambling to keep up with the rehabilitation needs by closing other wards, such as geriatric wards, and sending patients to other facilities or to home care.

“That’s not good,” he said, estimating that currently in the Negev region there are 120 rehabilitation beds. “You have a limited amount of human resources and now you’re just shifting it from taking care of the geriatric patients to take care of rehab patients, which means that a lot of these patients who are getting rehabilitation are being seen by a geriatrician who doesn’t know anything about the world of rehabilitation. They’ll find physical therapists and occupational therapists to take care of [the rehabilitation patients], but they’re not being overseen by a… rehabilitation physician or rehabilitation team, which is a problem.”

While thousands of injured disabled and trauma victims are waiting for placement in appropriate rehabilitation centers, several centers, including ADI Negev, are in the midst of trying to fast-track work on upgraded facilities, which had already been in the works prior to Oct. 7 but whose need is even more acute now.

“We felt that we must open the center soon,” said Amir Bar Chaim, vice president of the Israeli disability nonprofit Alim Beit Noam, about the organization’s new Ilanot National Rehabilitation Center, which is nestled on 10 acres of land within the Ilanot Forest in Israel’s central Sharon Region. 

The project began four years ago with the intent of providing additional services to their regular clients, who are living with severe physical, mental, intellectual and sensory disabilities. Alin Beit Noam quickly pivoted the focus of the $50 million Ilanot National Rehabilitation Center to the pressing physical and psychological rehabilitation needs of the Oct. 7 victims and injured soldiers. With $43 million already invested, they are missing the last $6 million which would allow them to complete the project in six months, said Bar Chaim.

The center is intended to be a transitional space for those needing physical and also psychological rehabilitation between leaving the hospital and going back into their communities, he said, including for approximately 1,000 injured people from the Nova music festival, with whom they have already begun working with in their current facility. 

“People who are in hospitals don’t want to go out of the hospital,” he said. “They are afraid. They don’t know how to continue with ‘normal life’ after they were injured in the war. So our place is like a mediator, because our center is in nature. The new idea is to bring people who need time to recover here for two, three, four months… not just from the army, but also (internally displaced) people from the north and the south.”   

The Ilanot center includes advanced sports facilities tailored to therapeutic use by wheelchair users, including a half-sized Olympic swimming pool, hydrotherapy pool, sports hall, gym and Pilates and yoga studios, and adapted bike routes in the forest as well as psychological treatments.

ADI Negev’s Kramer noted that, in 2022, the organization opened the Harvey and Gloria Kaylie Rehabilitation Medical Center with two wings, the first rehabilitation hospital in southern Israel, as part of the 40-acre ADI Negev-Nahalat Eran Rehabilitation Village. In addition to specialized physiotherapy treatments and psychological support, patients of the facility have access to ADI Negev’s farm, hydrotherapy and sports therapy complexes, as well as therapeutic horse stable and petting zoo. The medical center now has 83 impatient beds, and a third ward now under construction scheduled to open in March 2025, will add 40 more beds, he said.

With support from the Jewish Federations of North America, the Jewish Agency for Israel, UIA Canada, UIA Keren Hayesod Holland, C4I, and supporters throughout the world, the Kaylie Rehabilitation Medical Center was able to purchase necessary equipment needed to accept the extra patients at the outbreak of the war including beds, hoists, monitors, an EKG machine and physiotherapy equipment.

The Israeli government paid for 55 percent of the cost of the $40 million first two wards of the new hospital, while JNF-USA, which supports the rehabilitation village, raised another 25% of the initial costs. Now ADI Negev has raised $13 million of the remaining $15 million needed to complete the project and is in the process of raising funds for the remaining $2 million, Kramer added.

Representatives of tens of organizations, including JNF-USA, the Israeli Trauma Coalition, ADI Negev, JNF-KKL, the Jewish Agency and Karen Hayesod, participated in a conference last month at ADI Negev to discuss a cohesive plan for post trauma and rehabilitation treatment in the Western Negev region. ADI Negev was chosen as the epicenter point that will give the services to the entire Negev region, said Kramer.

“This will give us the ability to give high quality rehabilitation care to all the citizens of Israel,” said Kramer. “They should be able to receive rehabilitation close to home and not have to schlep all the way to the center of Israel.”

In Bat Yam, Medical Care Rehabilitation Hospital received building permits for three more previously-planned rehabilitation wards for a total of 110 new beds in September before the war broke out, according to Hercyk. The first ward was opened just before Israel’s Independence Day, with the second scheduled to open this month and the third by the end of the summer, he said.

Some funds for the project have been donated by supporters toward the approximately $4 million needed for rehabilitation equipment including equipment for the wards, medical equipment, physiotherapy equipment, for the therapeutic floor, and therapeutic pool, but more is still needed to complete the project, Hercyk said.

Israel has never before had to care for so many people from a war. Beyond the lack of physical infrastructure for rehabilitation, the country is also struggling to provide the psychological support that is needed for all those who have been injured and will continue to be injured by the conflict, Hercyk asserted. 

“We are introducing a rehabilitation protocol that deals both with the physical problem but with the same emphasis on the trauma and on the emotional side with a lot of trauma treatments,” he said. “So everybody [coming for] our hospitalization service or day care unit gets a combined program… dealing with the physical situation and also with the [psychological] trauma situation.”