How invasive rats rewire coral reef food webs creating winners and losers

Lancaster University

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A small carnivorous arc-eye hawkfish (Paracirrhites arcatus). Predators like this species appear to flourish when cryptobenthic fishes are abundant near seabird-rich islands

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Credit: Kathryn S. Christian

Invasive rats on tropical islands are creating winners and losers among the tiny underwater animals near the bottom of the food chain that inhabit surrounding coral reefs.

And scientists say the changes to these marine ecosystems can rewire food chains on the reefs.

The tiny fish and invertebrates that live at the bottom of the sea on coral reefs are known collectively as ‘cryptofauna’. These creatures are often overlooked and little studied, yet they play a vital ecological role and represent a cornerstone of energy transfer on coral reefs.

Led by researchers at Lancaster University and the University of Texas, a team of marine scientists studying these tiny critters on reefs around remote islands in the Indian Ocean have discovered that populations are very different around islands infested by invasive rats compared to reefs around islands without rats.

Reefs surrounding rat-free islands are dominated by tiny ‘cryptobenthic’ fish species, such as gobies and triplefins, whose biomass is more than five times greater than that of small invertebrates. Around rat-infested islands, however, researchers found a much higher proportion of small invertebrates, such as coral crabs, porcelain crabs, and snapping shrimps, with cryptobenthic fish and invertebrate biomass being nearly equal around these rat-infested islands.

The key to how rats are able to impact these marine creatures is found in what they are doing to seabird populations on the islands they have infested. Invasive rats, which arrived as stowaways on ships hundreds of years ago, have decimated seabird populations on the islands – eating their eggs, chicks, and sometimes even adult seabirds.

On the islands without rats, the density of seabird populations is a staggering 760 times greater. Seabirds play a vital role in recirculating nutrients from the open ocean where they feed, to the islands where they roost, breed and nest. Their droppings, known as guano, are rich in nutrients that when washed off the islands into the sea, act as a natural fertiliser for the surrounding coral reef ecosystem.

The study area in the Chagos Archipelago in the remote Indian Ocean provides a living laboratory to compare marine ecosystems around islands with and without rats.

Lancaster University researchers have conducted years of studies looking into the effects of invasive rats on marine ecosystems from how the changes in nutrient flows affect the growth of corals to the territorial behaviour of fish species.

Now this latest study is one of the first to reveal changes to benthic cryptofauna and the species that prey on them, offering surprising new insights for the study team.

“Contrary to our expectations, the low-nutrient conditions that rats create do not negatively affect all reef organisms,” said Laura-Li Jeannot, lead author of the study and PhD researcher at Lancaster University. “Nutrient-loss impacts are not uniform. There are winners and losers.

“The discovery of the role of cryptic invertebrates is interesting, as really very little is known about these critters, even less so than for cryptobenthic fishes. How they respond to disturbances or transfer energy through systems was almost entirely undocumented,” she said.

The researchers believe that fish have a number of competitive advantages when seabird nutrient flows remain intact.

“Cryptobenthic reef fishes are characterised by extraordinarily high rates of growth and reproduction,” said Laura-Li Jeannot. “As a result, they have high nutrient and energy requirements, and those can be matched in nutrient-rich environments. This allows these fish populations to flourish and expand in favourable conditions – such as seabird-fertilised reefs.”

Population expansion likely drives habitat colonisation, that would be otherwise be occupied by cryptic invertebrates.

Laura-Li Jeannot said: “Beyond chasing invertebrates away from their homes, they also outcompete them for food: our results show that cryptobenthic fish, when more abundant, likely drive invertebrates to seek alternate, less preferred resources.”

On the flip side, the researchers believe that the main reason behind invertebrates’ relative success near rat-infested islands comes from being relieved of the competitive pressure from cryptobenthic fishes, which are much less abundant in nutrient-poor reefs. Invertebrates’ lower metabolic rates could also be an advantage in lower nutrient environments as they don’t require as many nutrients to sustain a certain level of biomass.

Given the position of cryptobenthic fish and invertebrates near the bottom of the coral reef food chain, researchers expect big impacts on the rest of the food web.

“Cryptofauna are the main prey source on reefs, and will often represent the first step in transferring nutrients from primary producers to larger predatory fishes. Any change that affects them is likely to have cascading effects on their predators,” said Laura-Li Jeannot.

While very little is known about the role of cryptic invertebrates in wider reef productivity, cryptobenthic fish have been estimated to contribute up to 60% of total consumed biomass on coral reefs, so they are highly important for nutrient and energy cycling on reefs.

The researchers found that mixed carnivorous fish rely more on cryptobenthic fish in seabird environments, and that the productivity of fish-eating predators soars while invertivore productivity stagnates near seabirds.

Assistant Professor Dr Simon Brandl from the University of Texas and co-principal investigator of the study said: “Cryptobenthic fish are a nutrient-dense, protein-packed, highly digestible resource for predators; on the other hand, much of invertebrates’ mass is represented by a tough outer shell. In nutrient rich environments, fish are also way more abundant than invertebrates, meaning they likely require less foraging. As a result, they represent a more energetically optimal prey near seabird islands for predators looking for a quick snack.”

Laura-Li Jeannot said: “Our results show that the main mode of seabird nutrients moving up food webs is through fish, which feed both specialised fish-eating predators and more generalised carnivores. As such, when seabird nutrients are added or taken away from ecosystems, there is a rewiring of how energy travels up food webs, and a reconfiguration of larger fish communities.”

Professor Nick Graham of Lancaster University and co-principal investigator of the study said: “These findings suggest a shift in food chains from fish to invertebrate-mediated pathways near seabird-poor islands. Seabird nutrient flows do not just enhance reef productivity and health, they are also influencing trophic structure. Therefore, invasive species like rats that cut off these nutrients can drive significant changes to the food webs of the reefs.”

These results have important conservation implications: safeguarding seabirds and their nutrient subsidies is also a way to safeguard the integrity of reef food webs.

The findings are detailed in the paper ‘Contrasting cryptofaunal responses to seabird nutrient inputs illuminate coral reef productivity pathways’, which has been published by Ecology.

The authors of the study, which received funding from the Bertarelli Foundation and from the National Science Foundation, are Laura-Li Jeannot, Casey Benkwitt and Nick Graham of Lancaster University; Ruth Dunn of Lancaster University and the Centre d’Ecologie Fonctionnelle et Evolutive in France; Simon Brandl and Joyce Velos of the University of Texas; and Gareth Williams of Bangor University.

 

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Journal

Ecology

DOI

10.1002/ecy.70453 

Method of Research

Observational study

Subject of Research

Not applicable

Article Title

Contrasting cryptofaunal responses to seabird nutrient inputs illuminate coral reef productivity pathways

Article Publication Date

22-Jul-2026

 

Unraveling the mysteries of habit formation

In mice, two neural pathways in the brain determine habit-forming success and intensity

Kyoto University

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Individual differences exist in whether the frequency of habitual behavior is “maintained” or “reduced”.

Using the “two-stage training” method to shift the decision-making strategy of mice from goal-directed to habitual (left ⇒ right), a variety of changes (individual differences) were observed, ranging from individuals that maintained their frequency of behavior to those whose level decreased (top ⇔ bottom).

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Credit: KyotoU / Nozomi Asaoka

Kyoto, Japan -- Habit formation describes the repeated performance of a behavior until it becomes routine: in other words, the shift from deliberate to automatic decision-making. This concept is often invoked as a way to improve one's life by making a routine of beneficial activities that can otherwise feel tedious, such as cleaning, studying, and regular exercise.

That repeating the same behavior is essential for forming a habit has become well-established, but whether a habit develops as an exact replication of the original behavior, or if the behavior itself gradually changes as it becomes a habit, remains unclear. Because habit formation takes a long time, comparing behavioral and neural changes within the same subject before and after a habit develops has been difficult. To overcome this challenge, a team of researchers at Kyoto University developed a new training method that achieves rapid habit formation in mice, allowing them to track these transitions directly.

"Habits are one of the brain's most mysterious functions, and we often struggle to control them even though they are our own actions," says co-corresponding author Nozomi Asaoka. "By uncovering how habits work, we may eventually find ways to take control of them rather than letting them control us."

Just like how humans develop habits, the team first trained subject mice to use goal-directed strategies, followed by an additional four-days of training designed to facilitate the adoption of habitual strategies. With this two-stage training approach, the researchers were able to assess the transition from goal-directed to habitual behavior in the brains of individual mice.

The team discovered that two distinct neural circuits manage completely different aspects of habits. The first circuit, with neurons projecting from the anterior cingulate cortex to the retrosplenial cortex, determines whether a behavior becomes a habit, with its connections weakening during the transition. Crucially, the second circuit, from the lateral orbitofrontal cortex to the central striatum, controls how much the habit is executed, explaining individual differences. In this second circuit, habit-formed mice with strong neural responses maintained high behavioral execution levels, while those with weaker responses showed reduced execution. By artificially manipulating these pathways, the team was able to selectively promote habit formation or alter execution levels, proving the distinct roles of these two brain circuits.

One key finding is that the habit formation process is much more complex than the traditional view that repetition simply replicates an action into a habit in its original form. In particular, the team demonstrated that even after a habit successfully forms, there are significant individual differences in the frequency and volume of that behavior.

"Our study has uncovered previously overlooked control mechanisms involved in habit formation, showing what determines how strongly a habit is carried out and helping explain why habits differ from person to person," says team leader Yasunori Hayashi.

The team plans to expand their investigations to find out what drives these individual differences in habit intensity, hoping that better understanding may help us acquire more beneficial habits and improve treatment for problematic habits linked to conditions such as obsessive-compulsive disorder.

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The paper "Dissociable roles of prefrontal plasticity in decision making strategy and execution of habitual behavior" appeared on 27 July 2026 in Nature Communications, with doi: 10.1038/s41467-026-75706-1

About Kyoto University

Kyoto University is one of Japan and Asia's premier research institutions, founded in 1897 and responsible for producing numerous Nobel laureates and winners of other prestigious international prizes. A broad curriculum across the arts and sciences at undergraduate and graduate levels complements several research centers, facilities, and offices around Japan and the world. For more information, please see: http://www.kyoto-u.ac.jp/en

 

Visual summary of the study

Credit

KyotoU / Nozomi Asaoka

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Journal

Nature Communications

DOI

10.1038/s41467-026-75706-1 

Article Title

Dissociable roles of prefrontal plasticity in decision making strategy and execution of habitual behavior

Article Publication Date

27-Jul-2026

 

When polymers meet primitive membranes: how molecular cooperation may have helped life begin

The Hebrew University of Jerusalem

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When Polymers Meet Primitive Membranes

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Credit: Zehava Cohen

Researchers have identified a simple form of molecular cooperation that may have helped life's earliest building blocks become more stable and organized. By linking fatty acids, which can form primitive cell membranes, with hydroxy acids, which can form short polymers, the team showed that short oligomers can grow directly on amphiphilic molecules, creating hybrid lipid–polymer structures that assemble more readily and resist breakdown in water.. The findings suggest that cooperation between simple molecules may have been a key step in the transition from non-living chemistry to the first living systems. The work could also inspire new approaches in green chemistry and sustainable materials.

A new study suggests that simple molecules on the early Earth may have worked together to create more stable, cell-like structures, offering fresh clues about one of science's biggest questions: how life began.

Led by Dr. Moran Frenkel-Pinter of Hebrew University and her postdoctoral researcher, Dr. Rotem Edri, the research shows that two types of simple molecules, fatty acids and hydroxy acids, can combine to create structures that are stronger and more stable than either molecule can form alone. Crucially, the study connects two areas that are often investigated separately: the formation of primitive cell-like compartments and the abiotic growth of short polymers. The findings suggest that cooperation between molecules may have been an important step on the path from simple chemistry to the first living cells.

Fatty acids are thought to be among the building blocks of the earliest cell membranes, while hydroxy acids can link together into short chains. Scientists have long studied these two types of molecules separately. This study asked a new question: what happens when they are chemically coupled, so that oligomers grow on amphiphiles that can assemble into compartments?

The answer was surprising.

When the researchers linked hydroxy acids to fatty acids under simple conditions that may have existed on the early Earth, the new molecules became much better at assembling themselves into tiny, cell-like compartments. They could form these structures at much lower concentrations than fatty acids alone, making the process more efficient. The team also observed microscopic bubble-like structures, known as vesicles, and other tiny assemblies that resemble the kinds of compartments believed to be important for the earliest forms of life.

The new molecules also proved to be more durable. Normally, chains made from hydroxy acids break apart fairly quickly in water. But when they were attached to fatty acids, they lasted much longer, making them more likely to survive in the wet environments where life is thought to have emerged. In other words, the amphiphiles helped protect the oligomers, while the oligomers improved the assembly of the amphiphiles.

"These findings point to a simple but powerful form of molecular cooperation," said Dr. Moran Frenkel-Pinter. "By linking primitive lipid-like molecules with hydroxy acid polymers, we see the emergence of properties that neither system fully displays on its own. The oligomers become more stable when attached to amphiphiles, and the amphiphiles become better at forming organized structures when modified by oligomers. This may help explain how early chemical systems became more organized, more stable, and more capable of supporting the path toward life."

One of the biggest mysteries in origins-of-life research is how the first molecules became organized enough to eventually form living cells. Modern cells depend on membranes that create protected spaces and on large molecules, such as proteins and DNA, that carry out life's essential functions. This study suggests that long before those complex molecules existed, simple molecules may already have been helping one another, creating more stable chemical systems that could evolve over time. By coupling oligomer formation to self-assembling amphiphiles, the work offers a model for how primitive compartments and primitive polymers could have influenced each other’s evolution from the very beginning.

The researchers found that this cooperative effect was not unique to one pair of molecules. Similar results were seen with several different fatty acids and hydroxy acids, suggesting that this type of molecular teamwork may have been common on the early Earth.

Beyond helping explain life's origins, the work could also inspire new environmentally friendly materials. Because the molecules are made using simple, solvent-free reactions and are biodegradable, they could have future applications in green chemistry and sustainable materials.

The study provides new evidence that cooperation—not just competition—may have played an important role at the very beginning of life, allowing simple molecules to develop new abilities together that they could not achieve on their own. Rather than treating early compartments and early polymers as separate problems, the findings suggest that their emergence may have been chemically linked.

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Journal

Nature Communications

DOI

10.1038/s41467-026-75192-5 

Method of Research

Experimental study

Subject of Research

Not applicable

Article Title

Hydroxy acid conjugation to lipids increases structural and hydrolytic stability

Article Publication Date

27-Jul-2026

 

New research turns the Dunning-Kruger effect on its head: Rethinking the confident incompetent

Study reverses one of psychology’s most famous findings to show confidence follows competence

University of Bath

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Researchers at the University of Bath and The London School of Economics and Political Science (LSE) suggest that the celebrated Dunning-Kruger effect, often taken to mean the least competent people are the most overconfident, may actually be the wrong way round. 

For decades, the Dunning-Kruger effect has been understood to mean that people with low ability, those who know the least, are the most overconfident, while high performers are more realistic. Hundreds of studies have replicated the classic finding, illustrating that people who do well on multiple-choice tests overpredict their performance by less than those who do badly.

Backed by this mountain of evidence, the Dunning-Kruger effect has become the internet’s ultimate shorthand for calling out clueless confidence—explaining everything from bad bosses to Twitter trolls with a simple ‘truth’: low performers are ‘unskilled and unaware of it.’

However, this new study, published in Psychological Review, reveals how the Dunning-Kruger effect is an artefact of flawed statistical analysis rather than human nature.

When this flawed statistical analysis is corrected, the researchers found that high-ability people tend to be the most overconfident – reversing the Dunning-Kruger claim, widely understood as “stupid people don’t know they’re stupid”. 

Professor Chris Dawson, from the University of Bath’s School of Management, said: “Our research demonstrates that the original methodology fell victim to a statistical illusion. The popular image of the incompetent person brimming with confidence tells us less about human psychology than it does about the hidden traps in statistical analysis.

"When we clear away the statistical problems, the apparent pattern disappears. Instead, we see that overconfidence is a universal human trait, but it is the most capable among us who exhibit it the most." 

Professor David de Meza from LSE’s Department of Management, said: “Test performance is naturally volatile- impacted by factors such as luck or bad question phrasing-and sorting participants purely by their test scores mathematically distorts the data to manufacture a false psychological phenomenon.

“When a test score is exceptionally low, it’s often because the person just got unlucky with the questions—meaning their estimated performance naturally ends up looking way too high. The exact opposite happens to top performers, who benefit from a lucky break.” 

To address it, the researchers applied improved statistical techniques to data from thousands of participants across massive replication datasets. This approach manages to handle randomness in both people’s test scores and their predictions about those scores. Once a statistical model respects this reality, the classic story flips. It now turns out that the more able tend to be the most overconfident, the opposite of Dunning-Kruger. 

It is plausible that poor performers may sometimes lack the cognitive ability to recognise their own incompetence. There are, though, other reasons why overconfidence arises. The researchers go on to show that it can result from attempts to signal otherwise hidden ability, a mechanism that high-ability individuals have the most incentive to engage in. 

Talking the Talk, Not Walking the Walk: Coevolution of Overconfidence and Loss Aversion is published in Psychological Review at: https://doi.org/10.1037/rev0000644. 

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Journal

Psychological Review

DOI

10.1037/rev0000644 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Talking the Talk, Not Walking the Walk: The Coevolution of Overconfidence and Loss Aversion

 

Gender gap in predicted grades raises questions over their use in university admissions

A study of more than 350,000 students in England has found that teachers predict higher A-Level grades for girls than boys who go on to achieve the same exam results.

University of Cambridge

The research, by academics at the Universities of Cambridge and Bristol, found a consistent “pro-girl” gap in teacher predictions across 10 A-Level subjects. Depending on the subject, girls were between 3% and 11% likelier than boys to have their grades overpredicted, and between 15% and 41% less likely to have them underpredicted.

This does not mean that teachers deliberately favour girls. Instead, the researchers suggest that because girls typically have stronger all-round academic records, teachers may pick up on characteristics like motivation, diligence and classroom engagement when forming expectations about their future performance.

This could create a “halo effect”, where positive impressions about these students spill over into predictions about their academic potential.

Indeed, when the researchers compared students who not only achieved the same A-Level results, but also had similar records of prior academic performance, the picture changed. Within these groupings, boys received higher predicted grades in scientific STEM subjects, while girls retained a smaller advantage in non-STEM subjects, such as English Literature.

The findings, published in the Economics of Education Review, have implications for the UK’s university admissions system. Although university places are ultimately awarded based on students’ final A-Level results, initial offers are made months earlier and rely heavily on predicted grades.

Organisations including the educational charity The Sutton Trust have called for reforms to the system. In 2020, the Government consulted on moving towards Post-Qualification Admissions, where university decisions would be made after students received their final grades – but ultimately decided against the change.

Dr Konstantina Maragkou, from the University of Cambridge’s Faculty of Education and the study’s lead author, said the debate around predicted grades should be revisited.

“It is very unlikely that teachers deliberately predict better results for girls, but they may be relying on an impression of student characteristics which can lead to gendered predictions,” she said. “We need to think carefully about how fair that is for young people when the stakes are so high.”

The study used data from three university application cycles between 2017 and 2019. By comparing boys and girls with the same A-Level outcomes, the researchers identified a substantial gender gap in predicted grades.

On average, girls received predictions between one tenth and one fifth of a grade higher than boys. For example, girls were predicted, on average, around 0.17 of a grade higher in Physics and 0.13 higher in Sociology. “Differences of this size may appear small, but they can be enough to move a student across a grade boundary – for example, from a B to an A, or an A to an A*,” Maragkou said.

The researchers tested whether the findings could be explained by other differences between boys and girls and accounted for a wide range of other possible factors, including socioeconomic background, ethnicity, class size and school attended. The results remained unchanged in each case.

The researchers then explored what might explain this gender gap. One possibility is that teachers’ predictions are influenced by a conscious or unconscious perception of girls’ abilities compared with boys. Another is that their predictions incorporate broader information about the students. Previous studies have suggested that teachers could be influenced by observable characteristics such as a student’s work ethic, diligence, engagement, or everyday conduct at school.

To investigate this, the researchers used earlier Key Stage 2 and GCSE results to measure students’ broader academic profiles. Crucially, they looked beyond performance in the subjects they later chose at A-Level, capturing what they describe as “cross-disciplinary competence”. For example, they examined the earlier English performance of students who went on to take STEM A-Levels, and the earlier maths performance of students who chose non-STEM subjects.

This substantially changed the results. When comparing boys and girls with both identical A-Level outcomes and comparable prior academic records, the prediction advantage for girls fell by about 70% in non-STEM subjects and reversed in STEM subjects in favour of boys. “Accounting for prior academic record did not eliminate the gender gap; it just changed it,” Maragkou said.

The researchers also found that the gender gap was particularly pronounced among lower-achieving students, possibly because predictions are more difficult when performance is less certain.

The authors stress that their explanation for the gender differences requires further research. However, they note that official guidance states that “predicted grades should be independent of student behaviour or background.”

The findings may also have implications for other countries where teacher assessments form part of student evaluations, although the UK remains unusual in using predictions in university admission decisions.

Maragkou said that any attempt at reform should involve teachers, policymakers and researchers. “Teachers are not supposed to base predicted grades on students’ character, but they are probably not doing so consciously,” she said. “We also need to ask whether it is always wrong, conceptually, to consider broader qualities that affect academic success. These are difficult questions and they deserve careful consideration.”

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Journal

Economics of Education Review

DOI

10.1016/j.econedurev.2026.102814 

Article Title

Tracing the origins of teacher gender bias

 

What October 7 taught hospitals about preparing for modern warfare

The Hebrew University of Jerusalem

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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.

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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