A new study examining the performance of Assuta Ashdod Medical Center during the first day of the October 7, 2023, attack found that years of emergency preparedness drills enabled staff to treat casualties under missile fire, while also exposing critical shortcomings in communication, personnel management, and the coordination of casualty distribution among hospitals.

The study, conducted by researchers from the Hebrew University of Jerusalem, Linköping University in Sweden, and Assuta Medical Center, is based on in-depth interviews with 19 medical and administrative staff members. It offers practical recommendations to help hospitals worldwide prepare for prolonged armed conflicts and large-scale emergency situations.

Unlike the isolated terrorist attacks that many healthcare systems around the world have become accustomed to handling in recent years, the October 7 attack unfolded over many hours and across multiple locations, while the area surrounding the hospital remained under active rocket fire. Ambulances struggled to reach the wounded, communications systems collapsed, and medical teams lacked reliable information about events unfolding outside the hospital, forcing them to rely on fragmented reports from wounded civilians, soldiers, and social media.

Despite the chaos, the hospital’s fortified emergency department enabled medical treatment to continue without relocating to alternate protected areas. The researchers found that the primary factor preventing the hospital from becoming overwhelmed was not advanced technology but years of frequent emergency drills, which enabled physicians, nurses, and administrative staff to respond instinctively and focus on solving operational challenges in real time.

At the same time, the real-world conditions exposed significant vulnerabilities. Many staff members found themselves torn between reporting for military reserve duty and fulfilling their responsibilities at the hospital, while others hesitated to leave home because their families were in danger. Administrative personnel responsible for registering patients were unable to reach work, and plans to discharge hospitalized patients to free additional emergency beds proved unworkable because other parts of the hospital were not protected against missile attacks.

Another major finding was the lack of operational information. Medical teams struggled to assess the scale of the attack outside the hospital and later learned that Assuta Ashdod’s emergency department had the capacity to receive and treat many more casualties, while hospitals elsewhere in the country were overwhelmed. The researchers said this demonstrates the need for more effective coordination and distribution of patients among hospitals during national emergencies.

The study’s authors said their findings are increasingly relevant for countries across Europe and North America, which are reassessing civilian emergency preparedness in light of growing geopolitical tensions and the wars in Ukraine and the Middle East. Their recommendations include conducting more realistic emergency drills that simulate complex logistical challenges, strengthening coordination between civilian healthcare systems and security agencies, developing secure transportation solutions for medical personnel, and creating advanced real-time information-sharing mechanisms among medical institutions.

“The investment of time and effort in advanced preparedness over many years saved the lives of soldiers and civilians,” said Maximilian Nerländer, the study’s lead author, whose research was published by the University of Cambridge.

“I think we can safely say that a strong culture of preparedness, reinforced through regular training and well-established procedures that everyone understood, clearly contributed to saving lives on October 7 when the crisis unfolded,” he said.

The study noted that the hospital conducted mass-casualty exercises every three months. Nerländer added, “The strong culture of preparedness we observed at Assuta and throughout Israel can certainly serve as an inspiration for policymakers and healthcare professionals in the United Kingdom and elsewhere to adopt a culture of preparedness that could save lives in the future.”

The researchers noted that while many hospitals around the world have treated mass-casualty incidents—including the 2005 London bombings, the 2015 Paris attacks, the 2016 Orlando nightclub shooting, and the 2017 Las Vegas shooting—none of those events directly threatened the hospitals themselves.

Assuta Ashdod, along with hospitals even closer to Gaza, such as Barzilai Medical Center in Ashkelon, remained operational but faced the constant threat of missile strikes throughout the day.

“It is becoming increasingly clear that, at some point in the future, other parts of the world will face the same kind of high-intensity asymmetric warfare that Israel experienced on October 7,” Nerländer said. “My hope is that the tragedy of that day can be transformed into knowledge that saves lives and prevents suffering wherever such events may occur.”

(YWN Israel Desk—Jerusalem)