Monday, July 27, 2026

What October 7 taught hospitals about preparing for modern warfare

The Hebrew University of Jerusalem

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

Which fish will be the next to invade the Mediterranean?

Tel-Aviv University

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Chaetodon Auriga
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Credit: Tel Aviv University

More than 120 fish species have already migrated from the Red Sea to the Mediterranean since the opening of the Suez Canal over 150 years ago. Now, researchers at Tel Aviv University have developed a statistical model capable of predicting which species are likely to be next. Based on extensive field observations in both seas, the model has identified three species with particularly high potential to invade the Mediterranean in the future (the full list is available in the published paper): the stellate pufferfish (Arothron stellatus), the cinnabar goatfish (Parupeneus heptacantha), and the yellowspotted trevally (Turrum fulvoguttatum).

The study was led by Dr. Shahar Chaikin as part of his doctoral research at Tel Aviv University, under the supervision of Prof. Jonathan Belmaker of the School of Zoology, the Wise Faculty of Life Sciences, and the Steinhardt Museum of Natural History. Additional contributors included Dr. Tal Gavriel, doctoral student Avery Deveto, and Shahar Malamud. The findings were published in the Journal of Animal Ecology.

The new model ranks Red Sea fish species according to their likelihood of becoming future migrants to the Mediterranean. The researchers explain that the model is intended not only to understand how past invasions occurred, but also to enable authorities and marine scientists to prepare in advance for future invasions, particularly in light of the warming of the Mediterranean Sea, which is accelerating the northward spread of tropical species.

According to the researchers, such watchlists could become an important tool for the early detection of invasive species, environmental monitoring, and informed decision-making aimed at protecting the marine ecosystem.

What Makes a Fish a Likely Invader?

To answer this question, the researchers deployed stereoscopic baited remote underwater video systems (stereo-BRUVs) at depths ranging from 5 to 150 meters in the Gulf of Eilat and along Israel's Mediterranean coast. Using hundreds of hours of video footage, they analyzed 179 fish populations and compared species that have already invaded the Mediterranean with those that remain confined to the Red Sea. Unlike previous studies, which focused primarily on species that had already invaded, this study also examined the source populations in the Red Sea, making it possible to distinguish between the traits that enabled the invasion and the changes that occurred afterward.

The central finding was surprising: the strongest predictor of invasion success was not whether a fish species is a "generalist," capable of living in a wide range of habitats, but rather its lack of dependence on coral reefs.

Dr. Shahar Chaikin explains: "The Suez Canal and the Mediterranean contain very few coral reefs like those found in the Red Sea. Species that depend on coral reefs are therefore unlikely to complete the journey. The fish that succeed in invading are those that do not rely on coral reefs for survival in the first place."

Once They Reach the Mediterranean, the Fish Change Their Habits

The study also revealed how fish behave after successfully establishing themselves in the Mediterranean. Contrary to expectations that they would continue using the same habitats they occupied in the Red Sea, the researchers found that they quickly shift their habitat preferences and take advantage of the habitats available in their new environment.

Moreover, contrary to the common assumption that invasive species occupy "empty ecological niches," the study found that the migrating fish use the very same habitats occupied by native species. This suggests that competition for food, shelter, and space between invasive and native fish may be much greater than previously thought.

Prof. Jonathan Belmaker concludes: "Until now, researchers have tried to understand biological invasions primarily by examining species that had already reached the Mediterranean. We took a step back and asked what characterizes these species before they begin their journey. This distinction allows us to move beyond explaining invasions that have already occurred toward predicting the next ones."

The researchers add that as the Mediterranean continues to warm, tropical species are expected to become increasingly capable of establishing themselves there. They believe that incorporating models of this kind into environmental monitoring programs could help detect new species at an early stage and improve preparedness for the ecological changes expected in the Mediterranean ecosystem.

Link to the article:

https://besjournals.onlinelibrary.wiley.com/doi/full/10.1111/1365-2656.70293

DOI

10.1111/1365-2656.70293

Coris Aygula

Credit

Tel Aviv University

Future perspectives: Pathways out of inequality

University of Konstanz

Future Perspectives. In_equality magazin No. 9. — image:
The latest issue of the freely available *In_equality magazine.*
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Credit: Annalena Kampermann, Cluster of Excellence "The Politics of Inequality"

Inequality often has a self-reinforcing dynamic. This is one of the key research findings from the first seven years of the Cluster of Excellence "The Politics of Inequality" at the University of Konstanz. Underestimating inequality can weaken political support for corrective measures, low levels of education can reduce political participation and political decisions may further entrench existing inequalities. In the second funding phase, the cluster concentrates more on dynamics that reduce inequality: When is inequality perceived as unfair? When does this perception lead to political mobilization against existing inequalities? And under what circumstances do policymakers respond with measures that actually reduce structural inequalities?

"The reduction of inequality is not an automatic process but depends on specific political conditions", says Marius R. Busemeyer, speaker of the Cluster of Excellence, in the latest issue of the In_equality magazine: Future Perspectives. The central research question of the second funding phase addresses precisely this challenge: Under what conditions can the cycle of self-reinforcing inequality be broken and transformed into a dynamic of decreasing inequality?

The current issue of the In_equality magazine showcases new projects and explores current research questions: In the "Rectification for International Historical Injustice (ReJust)" project, for example, Aurélia Bardon investigates which forms of state redress for historical injustices – such as colonialism, genocide or looted cultural property – are politically and morally appropriate. In the "WorkDNAge" project, Florian Kunze’s team examines how occupation, workload and social inequality influence biological ageing processes, and what lessons can be drawn from these findings for staff, businesses and policymakers in an ageing society. Using the example of dual-career couples, Vera Schweitzer shows how inequality in relationships can be perpetuated or prevented not only by structural factors, but also by day-to-day household decisions.

Other topics in In_equality magazine No. 9: Future Perspectives

The Long Shadow of Violence. A conversation with Anke Hoeffler on conflict and inequality.
The Better Researcher? Opportunities and Risks of AI in Social Science Research.
Building Bridges Between North and South. Research Infrastructure Collaboration with Sri Lanka and Pakistan.
The Politics of the Shopping List: On the Power of Consumer Choices.
In_equality Research Award: An interview with Steffen Mau.

Key facts

Original publication: Future Perspectives. In_equality magazin No. 9. Cluster of Excellence "The Politics of Inequality", University of Konstanz.
In_equality magazine is the research magazine of the Cluster of Excellence. The texts can be reprinted after consulting with the editorial team.
The Cluster of Excellence "The Politics of Inequality" at the University of Konstanz investigates the political causes and consequences of inequality from an interdisciplinary perspective. The research is dedicated to some of the most pressing issues of our time: Access to and distribution of (economic) resources, the global rise of populists, climate change and unfairly distributed educational opportunities.

Societies around the world have buried their dead at home. Anthropologists want to understand why the practice started, and why it has largely disappeared

Field Museum
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image:
The slab-stone roof of a subterranean tomb on residential Terrace 925 at El Palmillo, Santiago Matatlán, Oaxaca, Mexico (ca. 700–850 CE). The image foreground is the surface of a domestic patio with small remnants of white plaster, while the tomb was situated under a room of the house (positioned on the terrace). Note the small carved stone, which was part of the patio banquette in front of the tomb. When in use, the tomb was entered from the patio.

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Credit: Photo credit: Linda M. Nicholas, Field Museum.

There are countless different cultures and societies around the world, spanning thousands of years. One thing that they all have in common is that no matter what, death is a part of everybody’s life. Examining how different societies commemorate their dead can give archaeologists and anthropologists insights into how those societies work and what matters to them. In a new paper published in the journal American Antiquity, a team of researchers explored the practice of burying the dead in or near their family’s houses.
“In the deep past, settlements were places where both the living and the dead coexisted and felt at home,” says Sabina Cveček, an archaeologist and Marie Skłodowska-Curie Global Postdoctoral Fellow at the Field Museum in Chicago.
Residential burials, in which people are buried inside of or very close to their houses, are no longer common, especially in the West. But over the past few centuries, cultural anthropologists have documented several societies all around the world that have residential burials. Why some societies began burying their dead at home, and why so many of them later stopped, has remained a mystery. “Until now, nobody had tried to find a way to predict whether or not a society would practice residential burial,” says Cveček, the new paper’s lead author.
“One theory about why some societies started to practice residential burials has to do with where people lived, and how long they lived there,” says Cveček. “Some researchers theorized that once people started settling down, they might have buried their dead by their houses to mark their territory.”
To investigate this theory, Cveček examined a database of cultural records, or ethnographies, dating back several centuries. She built a dataset of 60 different societies from around the world and found that 12% of the ones in her sample practiced residential burials. That number seemed low to Cveček and her colleagues.
“I went over the data with Carol Ember, an anthropologist at Human Relations Area Files at Yale, and we agreed, we weren’t seeing that many residential burials in these records. We wanted to know, what’s going on?” says Cveček. Cveček, Ember, and their colleague Tim Earle, an archaeologist at Northwestern University, reached out to fellow archaeologists at the Field Museum, who were familiar with the seemingly more frequent occurrence of residential burials in ancient sites.
The researchers consulted another database and built another dataset based on archaeological records. Unlike the ethnographies, which were written by anthropologists about societies that they observed in real life in the past few centuries, the archaeological data included information about societies from thousands of years ago. “Ethnographies are about as old as the practice of cultural anthropology, so they only date back a couple hundred years, but archaeology can tell us about societies from way longer ago,” says Cveček.
The research team examined burial records from 49 different archaeological sites from around the world. They found a lot more evidence of residential burials than they had in the ethnographies of more recent societies. “It was incredible to see, about 33% of the communities we looked at had at least some family members buried within or around their homes,” says Cveček.
The team wanted to know why residential burials were so much more common in the earlier societies than in the more recent ones. While some anthropologists and archaeologists have hypothesized that residential burials were associated with people living in more permanent residences, the data didn’t support this idea.
“We found that there wasn’t a strong link between how transient or permanent a society was, and how likely they would be to practice residential burial,” says Cveček. But the databases did yield a potential reason why the more recent ethnographies contained so few descriptions of residential burials in comparison to the older archaeological findings.
“In the ethnographies I read, in many cases, anthropologists would say that the society being described used to practice residential burials, but that they stopped when major organized religions and colonization arrived in those places. For instance, they’d say that a society used to bury their dead at home, but now they use Christian cemeteries outside the settlement, or that a society used to bury their dead at home, but with the spread of Hinduism, they adopted cremation,” says Cveček. “It seems like colonization really impacted burial practices on a global scale for the past four centuries and beyond, and that’s part of why residential burials are much less common in the ethnographic record.”
Gary Feinman, a co-author of the study and the MacArthur Curator of Mesoamerican and Central American Anthropology at the Field Museum’s Negaunee Integrative Research Center, notes that colonization doesn’t explain all of the changes in burial practices that the team observed, but that change over time is common in cultural practices overall. “A key finding of this paper is that even a practice as sensitive and important to most people as how and where we inter our dead can shift in specific cultural contexts over time. Human cultural behaviors are dynamic, not static, and for some of the cases studied here, the changes in burial practices even shifted well before the Colonial era,” says Feinman.
Overall, the findings offer anthropologists a deeper understanding of humanity. “The choices people make about burying their loved ones provide insights for archaeologists into how their societies were organized,” says William A. Parkinson, Curator & Associate Director of Anthropology at the Field Museum and the paper’s senior author.
While questions remain about what makes a society more likely to practice residential burials, Cveček says that the underlying story of the practice can help us forge connections to our fellow humans around the world. “I think the most beautiful message from this study is that there are so many different practices of mourning the dead. But residential burial, keeping the dead close to you at home, was a practice present around the globe throughout human history,” says Cveček.
This study was contributed to by Sabina Cveček (Field Museum), Timothy Earle (Northwestern University), Carol Ember (Yale University), Gary Feinman (Field Museum), and William A. Parkinson (Field Museum).

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Dr. Sabina Cveček visiting the site of Lepenski Vir in the Danube Gorge in Serbia.

The Lepenski Vir (6300–6000 BC) architectural phase, characterized by trapezoidal buildings in which numerous infant burials were placed close to the house walls.

Credit