What October 7 taught hospitals about preparing for modern warfare

The Hebrew University of Jerusalem

LinkedIn
Message

A new study of an Israeli hospital's response to the October 7 attacks shows that while years of disaster training enabled staff to continue treating patients under rocket fire, real wartime conditions exposed critical gaps in communication, staffing, logistics, and casualty distribution. The findings offer practical lessons that could help hospitals worldwide prepare for prolonged armed conflicts and other large-scale emergencies.

When the first rockets began falling over southern Israel on the morning of October 7, 2023, staff at Assuta Ashdod Hospital activated a plan they had rehearsed for years. Within hours, the emergency department was treating waves of patients suffering from gunshot wounds, blast injuries and burns—all while the hospital itself remained under rocket fire.

A new study led by Maximilian Nerlander, a Ph.D. candidate at Linköping University in Sweden and a visiting scholar at the Hebrew University of Jerusalem's School of Public Health, offers one of the most detailed accounts yet of how a modern civilian hospital functioned during an unprecedented wartime emergency. The research was conducted together with Prof. Adam Rose, from Hebrew University of Jerusalem's School of Public Health, and Dr. Debra West of the Department of Emergency Medicine at Assuta Ashdod Medical Center. Based on in-depth interviews with 19 staff members, from the emergency department, as well as the head of trauma and disaster management, who worked during the October 7 attacks, the study provides practical lessons for hospitals around the world as many countries strengthen their preparedness for large-scale armed conflict.

Unlike previous terrorist attacks in cities such as London, Paris or Boston, the October 7 assault unfolded over many hours, across multiple communities, while large parts of the surrounding region remained under active attack. Ambulances struggled to reach casualties, communications broke down, and hospital staff often had little understanding of the rapidly evolving situation beyond what they could piece together from patients, soldiers and social media.

Yet despite the chaos, the hospital continued to operate.

Researchers found that one of the greatest strengths was not sophisticated technology, but preparation. Years of frequent mass casualty drills meant doctors, nurses and support staff instinctively understood their roles, allowing them to focus on solving unexpected problems rather than basic procedures. The hospital’s reinforced, missile-protected emergency department also enabled teams to continue caring for patients without needing to seek shelter, preserving both workflow and morale.

The Interviews also revealed weaknesses that only became apparent under real wartime conditions.

Many employees faced an impossible choice after being called simultaneously by both the military reserve system and the hospital. Others hesitated to leave home because their own families were in danger. Administrative personnel responsible for registering patients were unable to report to work, creating unexpected bottlenecks. Plans to relocate less critical patients out of the emergency department proved unworkable because other hospital areas were not protected against incoming rockets.

Perhaps most striking was the lack of reliable information. Emergency department staff often knew little about the broader situation outside the hospital, forcing them to rely on fragmented updates from military personnel, emergency responders, patients and even social media videos to anticipate what might arrive next.

The study also uncovered an unexpected consequence of the day's events. While some hospitals became overwhelmed with casualties, Assuta Ashdod's emergency department believed it could have safely treated many more patients. The finding suggests that future emergency planning should place greater emphasis on distributing casualties efficiently among hospitals during large-scale crises rather than allowing some facilities to become overloaded while others retain available capacity.

The findings arrive at a time when governments across Europe and North America are reevaluating civilian preparedness amid rising geopolitical tensions. Hospitals have traditionally planned for isolated mass casualty incidents such as terrorist attacks or natural disasters. The experience of October 7 demonstrated that prolonged warfare presents a different challenge altogether—one in which hospitals must continue operating while transportation, communications and emergency response systems are simultaneously under strain.

“The lessons from October 7 extend well beyond Israel” said Prof. Adam Rose from the School of Public Health at Hebrew University of Jerusalem. “Our findings show that hospitals preparing for future conflicts need plans that account not only for treating casualties, but also for protecting staff, maintaining communication in rapidly changing situations, and adapting operational plans when reality departs from even the best rehearsed scenarios.”

Dr Debra West, who was ED Director at Assuta on October 7, added that “Unlike a conventional mass casualty event, a mass casualty event under fire disrupts every aspect of hospital operations, from patient flow and emergency department evacuation to staffing and the ability of personnel to work while their families are under threat. These experiences offer lessons beyond clinical care for hospitals preparing for disasters in which the healthcare system itself becomes part of the crisis.”

“The Russian full-scale invasion of Ukraine and October 7 were historical inflection points,” notes Maximilian Nerlander, the lead author. “It is becoming increasingly evident that at some point in the future, other parts of the world will face the same type of high-intensity asymmetric warfare as Israel did on October 7. My hope with this study is that the tragedy of that day can be converted into knowledge that can save lives and avert suffering in the future, wherever it occurs.”

The researchers conclude that future preparedness should include more realistic disaster drills that test complex logistical challenges, stronger coordination between civilian healthcare systems and military authorities, secure transportation options for healthcare workers during active conflict, and better mechanisms for sharing operational information among hospitals and emergency agencies.

Although born out of one of Israel's darkest days, the study offers a practical blueprint for strengthening hospital preparedness in an increasingly uncertain world. As conflicts become more complex and civilian infrastructure is drawn into modern warfare, the experiences of frontline healthcare workers at Assuta Ashdod may help hospitals elsewhere prepare for crises they hope never to face.

---

Journal

Disaster Medicine and Public Health Preparedness

DOI

10.1017/dmp.2026.10407 

Method of Research

Observational study

Subject of Research

People

Article Title

Wartime Mass Casualty Incident Plan Operation: Staff Experiences from a Civilian Hospital in Southern Israel on October 7, 2023

Article Publication Date

21-Jul-2026

 

Venezuela’s twin earthquakes: the toll one month later

Copyright Copyright 2026 The Associated Press. All rights reserved

By Jesús Maturana

Published on 25/07/2026 - EURONEWS

One month after twin earthquakes struck Venezuela, the official death toll has surpassed 5,500, with 16,700 injured. Damage is estimated at $19.6 billion, while thousands remain homeless and the number of missing people has not been updated since late June.

Thirty days have passed since the two earthquakes measuring 7.2 and 7.5 in magnitudestruck northern Venezuela just 39 seconds apart on the night of 24 June. What was described at the time as a rare seismic phenomenon**,** a seismic doublet, has turned into one of the worst natural disasters the country has experienced in more than a century.

A month on, the figures continue to evolve, although at a much slower pace than in the first few days, and there are still gaps the government has yet to fill. The most recent official toll, released last Friday by the president of the National Assembly, Jorge Rodríguez, puts the death toll at 5,546 and the number of injured at 16,740.

The figure has remained largely unchanged for weeks, which suggests medical teams are no longer receiving new serious cases, while the death toll continues to rise as debris removal work progresses and forensic teams continue identifying bodies, many of them buried unidentified in mass graves in cemeteries in La Guaira.

The most sensitive figure, however, is the one the Venezuelan government has stopped updating. Since 25 June, the day after the seismic doublet, the authorities have not provided a new official figure for the missing, which at that point stood at 157 people. In that vacuum, a citizens’ initiative has emerged, Desaparecidos del Terremoto de Venezuela, which centralises reports from relatives and keeps a register containing reports on nearly 29,500 people whose whereabouts have been reported as unknown. That gap between what the state acknowledges and what citizens themselves are documenting is one of the most questioned aspects of the way the emergency has been handled.

Material damage and displacement

Beyond the lives lost, the earthquake has left a significant economic scar. A World Bank report published last week estimates direct physical damage at around 19.6 billion dollars.

Of that amount, 9.3 billion correspond to homes destroyed or severely damaged, 5.2 billion to public infrastructure, including hospitals, schools and other essential facilities, and nearly 5 billion to commercial and industrial buildings.

On the ground, the latest official count records:

• 856 buildings affected, 190 of which collapsed completely
• The number of families left without housing stands at 17,907, while 23,122 people remain in 107 temporary locations set up in Caracas and La Guaira
• 128,324 families have received some form of assistance from the authorities since the start of the emergency

Since the main shock, 1,405 aftershocks have also been recorded, some strong enough to complicate work on structures that had already been weakened.

One month on, life is trying to resume

As the weeks go by, the search-and-rescue phase has given way to debris clearance and reconstruction, a process which the authorities themselves acknowledge will take months, if not years.

Some basic services, such as electricity in certain parts of La Guaira, were restored about two weeks after the quake, but normality remains partial. Organisations such as Médecins Sans Frontières are keeping mobile clinics operating in the worst-hit areas to meet healthcare needs that the public system, already weakened before the earthquake, is unable to cover fully.

The tragedy also struck at a politically sensitive moment for Venezuela, which is undergoing a transition following the arrest of former president Nicolás Maduro at the beginning of the year, with Delcy Rodríguez heading an interim government that has yet to set a date for elections.

The way international aid is being managed, including cooperation from countries such as Israel and efforts to unblock Venezuelan assets with United States support, is emerging as one of the factors that will determine the pace of reconstruction in the coming months.

The Strait of Hormuz Closure Is Already Hitting Supermarket Prices

By Haley Zaremba - Jul 24, 2026

• Crop prices just hit a three-year high as Black Sea attacks and heat waves squeeze the global grain supply.
• 
  
• The Strait of Hormuz closure has blockaded 3.9 million tonnes of Middle East urea exports, about 30 percent of the region's annual fertilizer trade.
• 
  
• A new UN report warns that conflict-driven energy and fertilizer costs could push 9 to 18 million more people into hunger worldwide.
• 
  

Crop prices just hit a three-year high, indicating major downstream pain soon to come at the supermarket. There are two major factors leading to high crop prices and a potential global food crisis: heat waves and intensifying conflict in the Black Sea threatening to disrupt global grain trades, and volatility in fertilizer markets stemming from the war in Iran and the closure of the Strait of Hormuz.

The International Food Policy Research Institute (IFPRI) is referring to the unfolding situation in fertilizer supply chains as an “input crisis” that could soon develop into a full-blown food crisis, especially in poor countries. Synthetic fertilizer is a petroleum product, and markets for fertilizers and fertilizer components like urea and phosphate are therefore extremely sensitive to oil shocks and supply disruptions. About one-third of the world's urea imports come from the Middle East. Since the Strait of Hormuz closed to shipping traffic earlier this year, 3.9 million tonnes of urea exports, or about 30 percent of the region's annual fertilizer exports, have been effectively blockaded.

Fertilizer prices spiked in the months after the Strait initially closed at the end of February, but had since stabilized. However, prolonged conflict in the region threatens to create sustained volatility in the market as factories cut back on fertilizer production and stockpiles threaten to spoil. “Most production facilities in the region continue to operate at reduced rates to prevent excessive stockpiling,” IFPRI reports. “While urea can generally be stored for several months, high temperatures and moisture can damage its quality. The risk of substantial fertilizer supply shortages is rising as the conflict prolongs and the Strait of Hormuz stays closed.”

In addition to the supply chain disruptions in the Middle East, Ukrainian ports in the Black Sea are now the site of renewed conflict, causing major supply chain disruptions for staple grains. Moreover, Ukraine's exports of corn, barley, wheat, and meslin already remained far lower than their 2020 levels, before Russia's invasion. This deficit has also had a considerable and ongoing impact on global food security, as Ukraine is a major agricultural exporter.

A new United Nations report warns that the effects of rising energy and fertilizer prices, driven by global conflict including the United States and Israel's war in Iran as well as Russia's ongoing war in Ukraine, could result in an additional 9 to 18 million people going hungry around the world. The report found that, on a global level, the average cost of a healthy diet increased by nearly 25 percent between 2021 and now, from 3.44 purchasing power parity (PPP) dollars per person per day to 4.28 PPP. Latin America and the Caribbean face the highest average costs, at a painful 4.91 PPP.

The most recent oil and fertilizer shock emanating out of the Strait of Hormuz hit markets at a vulnerable time, when they are still contending with the fallout of Russia's war in Ukraine and facing mounting pressure from climate change. “We are in a current era where we have the highest number of conflicts and are still increasing,” International Fund for Agricultural Development (IFAD) President Alvaro Lario told the Associated Press earlier this month, adding that “Whenever there is a conflict, also hunger, displacement and refugees increase.”

Solving the problem will require sustained efforts in a time of unprecedented global uncertainty and insecurity. “Ending hunger and making healthy diets affordable requires political commitment, sustained investment and enabling policies,” QU Dongyu, the Director-General of the United Nations Food and Agriculture Organization, was quoted by EuroNews. “Recent crises – from natural disasters like the COVID-19 pandemic to man-made disaster like hotspots of conflicts, the war in Ukraine, the Gaza crisis, and the recent Strait of Hormuz disruption - have demonstrated both the resilience of agrifood systems and the need to strengthen them further to better serve the world's most vulnerable people, farmers and consumers,” Dongyu went on to say.

By Haley Zaremba for Oilprice.com

Hormuz Tanker Crossings Sink to Lowest Level Since May as War Risk Spikes

By Tsvetana Paraskova - Jul 24, 2026

Only one oil tanker transited the Strait of Hormuz on Thursday, the lowest number of crossings since May 7, as war risks spiked this week to hike crude oil prices above $100 per barrel again.

Three tankers transited the Strait of Hormuz on Wednesday, but this number crumbled to just one on Thursday, according to Kpler’s vessel-tracking data cited by Reuters on Friday.

The New Giant, a supertanker loaded with about 2 million barrels of Basrah crude from Iraq, exited the Strait of Hormuz on Thursday, with China’s Rizhao port expected to welcome it in the middle of August, the data showed.

At the same time, no tanker made an inbound transit through the Strait into the Persian Gulf on Thursday.

Traffic at the Bab el-Mandeb Strait in the Red Sea held relatively high despite the Houthi attacks on vessels and threats of blockade at Saudi Arabia’s key export valve in the absence of Hormuz traffic.

However, some tankers were observed to have turned north in the Red Sea, toward the Suez Canal, to avoid being targeted by the Houthis, the Iran-aligned group in Yemen which emerged as the new threat to oil supply from the Middle East.

Voyages from the Red Sea through the Suez Canal, the Mediterranean, and around the southern tip of Africa make the delivery time of energy commodities to Asia three times longer than through the Bab el-Mandeb Strait.

Aramco, the Saudi oil giant that had managed to re-route most of its shipments away from Hormuz via Bab el-Mandeb, has begun offering crude loadings at Sidi Kerir, the Egyptian port on the Mediterranean, Reuters reports.

“Further escalation in the Persian Gulf and fears of a widening conflict are putting a significant amount of oil supply at risk,” ING commodity analysts said in a note on Friday, pointing out the Houthis’ attacks on Saudi tankers in the Bab el-Mandeb Strait and President Trump’s fresh threats against Iran.

By Tsvetana Paraskova for Oilprice.com

The Hormuz Crisis Is Driving a Geopolitical Shift Across Asia

By RFE/RL staff - Jul 22, 2026

• Rising tensions around the Strait of Hormuz are making energy security a central strategic concern for Southeast Asian governments.
• 
  
• Analysts argue that dependence on Middle Eastern oil could push ASEAN members toward greater energy cooperation with Russia while creating diplomatic opportunities for China.
• 
  
• The crisis highlights how economic security and national security have become increasingly intertwined across the Indo-Pacific.
• 
  

For years, policymakers in Washington have viewed Asia primarily through the lens of Taiwan, the South China Sea, and China's military rise. Russia's full-scale invasion of Ukraine has only reinforced that perspective, cementing Europe and East Asia as the principal arenas of geopolitical competition.

But security experts in Southeast Asia increasingly argue that another crisis thousands of kilometers away in the Middle East may ultimately reshape the regional balance of power far more profoundly than either Ukraine or Taiwan.

The strategic importance of the Strait of Hormuz, through which roughly a fifth of the world's oil passes, has become impossible for governments across Southeast Asia to ignore.

As tensions involving Iran threaten one of the world's most important energy chokepoints, analysts say the consequences are already altering regional calculations about security, diplomacy, and alliances.

"We're already seeing ASEAN (the Association of Southeast Asian Nations) moving toward Russia, not in security but in energy reliance," Lester Joseph Buitizon, a Manila-based threat intelligence analyst with Aldebaran Threat Consultants whose work focuses on international security and politics in the Middle East and North Africa (MENA), told RFE/RL.

Military operations between the United States and Iran in recent days have renewed attention on the Strait of Hormuz.

Iran is claiming control of the strategic transit route, while the United States says it has been launching air strikes aimed at targets in southern Iran "to further degrade Iranian military capabilities used to attack commercial shipping in the Strait of Hormuz."

Despite a significant US military presence, shipping companies remain reluctant to transit the strait, highlighting a reality that extends beyond naval power: The greatest challenge may be restoring confidence among commercial operators.

Oil transit in the Strait of Hormuz is of critical importance to Southeast Asia because it remains deeply dependent on Middle Eastern energy.

The Philippines, for example, imports more than 90 percent of its oil from the Middle East, making disruptions in flow an immediate economic and political concern rather than a distant foreign policy issue.

Although Manila remains one of Washington's closest treaty allies and public opinion continues to favor the United States over China, the Marcos administration has sought to increase Russian crude access and expanded discussions over long-term energy cooperation.

For Buitizon, the message is simple. If even America's closest regional ally is forced to engage Moscow to safeguard energy supplies, countries with more neutral foreign policies such as Indonesia and Malaysia are likely to do so even more readily.

"If Russia successfully reorients its economy eastward," he argues, "Western sanctions become structurally less effective."

While Russia may gain economically, China may see diplomatic gains amid the same situation.

There was a time, according to Vincent Kyle Parada, a defense research analyst with the Philippine Navy's Office of Naval Strategic Studies and Strategy Management, when ASEAN could successfully hedge East and West: China provided economic growth, while the United States guaranteed regional security.

Today, Parada said, that distinction is becoming increasingly blurred. He pointed to the Iran crisis as evidence that economic security and national security have become inseparable.

"The overlap between economics and security has become much greater than it was 10 or 20 years ago," Parada told RFE/RL.

He added that recent US policy decisions, including reductions in regional development assistance, trade tensions, and intervention in Iran have weakened Washington's foothold across Southeast Asia while creating opportunities for China to expand its economic influence.

"China doesn't really need to do anything but wait," he said.

By RFE/RL

The New Monarchs: Catastrophe as Opportunity

Graham Peebles

 July 24, 2026

FacebookTwitterRedditBlueskyEmail

In our deluded world one of the perks of huge wealth is power, political and corporate — and the two are bedmates. Piles of money also ~~seems~~ [seem] to rot the brain, eroding any semblance of rational thinking and common sense as the fingers of narcissism and megalomania engulf the mind and poison the soul.

I recently watched a BBC documentary entitled ‘The Tech Billionaire Takeover’. It featured a series of extremely rich, completely whacky, and very dangerous characters: playing a central role is Justin Sun, CEO of Tron, a blockchain platform where crypto can be bought and sold. Sun is in business with World Liberty Financial, the Trump family crypto business, although they seem to have fallen out and he is now suing them, and, true to form, the Trumps are suing him. And while the world burns and the people cry out, the pantomime of money goes on, and on.

Another leading figure in the documentary is Tim Draper — “The Risk Master of Silicon Valley”. A venture capitalist, he heads up Draper University — “Building the Next Generation of Superheroes”. A weird place where the ‘gods of money and success’ form the altarpiece, offering “an intensive immersive five-weeks pre-accelerator program” in Hero Training — whatever that is.

Curtis Yarvin, a key figure in shaping the ideology shared by Draper, Sun, Trump, Vance and others, was also featured.

A far-right political blogger and software engineer, in 2008, under his pen name Mencius Moldbug, Yarvin posted an online pamphlet entitled ‘Patchwork: A Political System for the 21st Century’. The basic idea of ‘Patchwork’, according to Moldbug/Yarvin, is the replacement of governments by “a global spiderweb of tens, even hundreds, of thousands of sovereign mini-countries, each governed by its own joint-stock corporation without regard to the residents’ opinions.” Micro-nations, like Liberland, which was featured in the BBC programme.

These small island territories, independently governed backwaters, exist outside international law, with no democratic structures, and are funded not through taxation — nobody pays tax in such bubbles — but through corporate donors. Democracy is jettisoned in favour of a corporate monarchy administered through blockchain, a hidden world of pulsing dashes and dots — where Sun and Co. envision elections taking place within years, not decades, or not never.

On top of their hatred of democracy and social justice, these blinded visionaries hold a dismissive approach towards the environmental emergency.

On this issue too there is broad agreement among the techno-colonialist circle — a symbiotic delusion that might be summed up by Yarvin, who regards the environmental crisis as “basically insignificant” compared to violence, which he considers the only truly significant problem facing humanity. They do not simply ignore the climate crisis; they see it as an opportunity — ‘Catastrophe as an Opportunity’.

Rising sea levels, unbearable heat, drought, floods and so on, are not regarded as disasters but rather the chance to “start society afresh” along ideological lines drawn by the new Monarchs. Non-democratic societies built by the mega-rich from the wreckage of a world ravaged by climate change and ecological collapse — caused by the very ideology of greed that such men champion.

Though not featured, Elon Musk also sits comfortably within the paradigm of extremism that was on display. He has routinely spread misinformation about climate change, including dismissing farming’s impact on the climate. His false and incendiary statements often align with fringe viewpoints that fuel division and downplay the urgency of the climate crisis, leading many to label him a climate denier.

Disbelief

All of this madness was new to me, and I spent most of the time shaking my head in disbelief. To begin with I thought I’d stumbled on a drama series, so horrific and far-fetched was the content.

I had never heard of micronations; I was aware of crypto and blockchain, but, like most people, I had no idea what they really are or how they work. I suspect I am not alone in my ignorance or confusion. Do those investing in crypto, or regulating it — is it even properly regulated? — understand it any better? I doubt it. That, I suspect, is precisely the point.

The digital despots sitting behind such systems profit from collective ignorance. The more obscure the technology, the more power they hold. They speak in jargon, promise utopia, and nobody questions them – because nobody wants to admit they do not understand, and anyway, we all have lives to live.

Where, in such a disturbing dark paradigm, do we find ‘the people’? Where is the accountability, the democratic processes, the aspirational ideals like equality, freedom and social justice?

Wealth, power, inequality, exploitation: entwined social poisons that destroy democracy, make social justice impossible, and fuel division and conflict — constitute the very foundations of the world they want to build.

Clearly these would-be monarchs are not concerned with equality, freedom or social justice — woke ideals, they may call them. On the contrary, they are open about their plans to dismantle democracy, establish private kingdoms and install dictators, oh, and replace money with crypto currencies.

All of this led me to ask myself: what kind of world is it that listens to men like these, and allows them to wield so much power?

It is a world in crisis, without doubt. By ‘world’ we mean society, and by society is meant people. There is no society separate from people; society is not an abstraction existing outside the men and women who populate it.

‘The world’ cannot be changed because it does not exist as an independent form. Rather, it is people who must change — and in changing, accept complete responsibility, both for the chaos that is all around us, and for the new world that, if we are to prosper — indeed, if we are to survive — must be built.

Only then, when we all accept total responsibility for ourselves, for our neighbour and by extension, for society, and in doing so act for the common good, the welfare of our neighbour and the natural world, only then can people like Sun, Draper and ‘The Trumps’ — divisive, cruel men — be consigned to the margins. Their ludicrous, dangerous vision of society seen clearly for what it is, and consigned to irrelevance.

Graham Peebles is a British freelance writer and charity worker. He set up The Create Trust in 2005 and has run education projects in Sri Lanka, Ethiopia and India.  E: grahampeebles@icloud.com  W: www.grahampeebles.org