State Comptroller Finds Critical Communication Failures Between IDF and Magen David Adom on October 7 Hampered Casualty Evacuations

The State Comptroller's report on the events of October 7 reveals severe communication breakdowns between the Israel Defense Forces (IDF) and Magen David Adom (MDA) that critically delayed the evacuation and treatment of thousands of injured civilians during the Hamas attack. On that day, the MDA emergency line received 24,000 calls reporting injuries, with 22% from the Gaza envelope area. However, IDF's closure of the area and lack of coordination delayed the transfer of casualties to MDA ambulances by eight hours, forcing many civilians to self-evacuate under dangerous conditions. Approximately half of the injured were evacuated by security forces or other civilian groups, with MDA ambulances reaching fewer casualties than needed, potentially costing lives and increasing disabilities.

The report highlights that the IDF's Southern Command was unprepared for the scale of the attack, with no relevant evacuation plan for civilians. The IDF prioritized neutralizing attackers over organized casualty evacuation, resulting in chaotic and inefficient medical response. Communication gaps also existed between MDA and other emergency organizations like United Hatzalah, exacerbated by competition and lack of coordination. MDA had only 24 bulletproof ambulances available, far fewer than the recommended 50, with only one assigned to the Gaza envelope. The report recommends expanding armored ambulance fleets and integrating all emergency ambulances into a centralized national system.

Beyond the immediate crisis, the report criticizes Israel's long-standing deficiencies in rehabilitation services, which were severely strained by the influx of around 1,660 war casualties hospitalized between October 2023 and July 2025. Chronic shortages of rehabilitation professionals and inadequate infrastructure, especially at Sheba Medical Center, led to reduced treatment quality and difficulties for families. The report also notes unauthorized repurposing of geriatric wards for war casualties, negatively impacting elderly patients. It calls for systemic improvements in rehabilitation planning, information systems, and patient rights enforcement.

The Comptroller sharply criticizes the IDF for failing to conduct a comprehensive investigation into the evacuation failures, despite the critical nature of the issue. The Ministry of Health acknowledged the unprecedented complexity of the events and accepted the report's criticism, noting that many gaps have since been addressed. It also outlined ongoing investments exceeding 250 million shekels to expand rehabilitation capacity, workforce training, and infrastructure, including new rehabilitation centers and enhanced information systems.

Responses from Sheba Medical Center emphasized their rapid expansion of rehabilitation services during the crisis, while the Ministry of Health stressed improved coordination with the IDF and continuous efforts to balance patient needs with system capacity. The report underscores the need for better emergency preparedness, inter-agency cooperation, and long-term healthcare system strengthening to manage future mass casualty events effectively.