State Comptroller Reveals Severe Failures in Israel’s War Injury Rehabilitation System

The State Comptroller's report released on Tuesday exposes significant shortcomings in the rehabilitation system for casualties of Operation Iron Swords, despite the dedication of medical teams. The system entered the conflict with outdated staffing standards from 2003 and shortages in critical health professions such as physiotherapy, speech therapy, and occupational therapy. Sheba Medical Center treated about 47% of the approximately 1,660 rehabilitating patients by July 2025, but the average daily treatments per patient dropped below 2.2 due to excessive workload. Sheba also converted internal geriatric wards into rehabilitation units without Ministry of Health approval, negatively impacting elderly patients.

The Ministry of Health managed ward occupancy manually using Excel files, lacking computerized systems and essential data on wait times. The Ministry of Defense’s Rehabilitation Division also faced serious operational issues. Although the "rehabilitation first" policy aimed to provide rapid medical care and financial advances by postponing medical committee evaluations, delays caused uncertainty and postponed benefits. As of May 2025, around 2,200 applications for recognition as disabled IDF veterans awaited processing for over a year, triple the division’s maximum timeframe. Many injured soldiers reported limited awareness of their rights, and significant delays occurred in payments to disabled veterans and service providers. There was also no oversight of personal escort services, which cost approximately 309 million shekels in 2024.

The Comptroller urged the Ministry of Health to urgently update staffing standards and develop a centralized computerized system for managing ward loads. Hospitals, the IDF, and the Ministry of Defense were advised to provide injured soldiers with clear, written information about rehabilitation options to enable informed decisions. The Rehabilitation Division was instructed to promptly summon injured soldiers for medical committees, implement active rights enforcement, reduce disability recognition wait times, and set measurable service quality goals.

The report also reviewed emergency medical services on October 7, 2023, revealing major failures in evacuation coordination and communication between Magen David Adom (MDA) and the IDF. There was a critical shortage of armored ambulances and evacuation helicopters, with only one armored ambulance available in the Gaza border area at the attack’s start. Nearly half of the wounded were evacuated independently by civilians or security forces. The national hospitalization authority convened only at 2 p.m., after hundreds of casualties had already arrived at southern hospitals. Coordination systems were inadequate, and MDA’s digital command center was unknown to IDF medical officers. The Ministry of Health had not finalized the regulation of rescue helicopters before the war, only doing so in February 2025 following a Supreme Court ruling.

The Comptroller criticized the national command center’s management and the lack of post-event reviews by the Ministry of Health, IDF, and MDA. These issues had been previously highlighted in reports from 2007, 2014, and 2019. The IDF stated it values its wounded soldiers and supports recommendations to establish interoperable medical information systems to improve treatment continuity and patient care.