State Comptroller Reveals Medical Evacuation Failures During October 7 Terror Attack in Southern Israel

A State Comptroller report released on June 27, 2024, exposes severe failures in medical evacuation and coordination during the October 7, 2023 terror attack in southern Israel, the deadliest since the state's founding. The report highlights a dramatic breakdown in information management between the Israel Defense Forces (IDF) and Magen David Adom (MDA), Israel's emergency medical service, which critically delayed treatment and evacuation of approximately 1,340 wounded civilians.

According to Comptroller Matanyahu Englman, about 70% of the wounded, around 930 patients, were admitted to Soroka and Barzilai hospitals in serious condition. The medical evacuation system of the Southern Command and Gaza Division collapsed due to lack of organized response, command, and control, resulting in hours-long delays during crucial life-saving moments. Englman attributes the root cause to the IDF's failure to protect southern communities on October 7, which was compounded by significant shortcomings in casualty evacuation.

The report reveals that MDA had deployed a digital medical command system in the Gaza Division to track wounded civilians and ambulance locations in real time. However, military medical personnel refused to use this system, preventing vital information from reaching forces on the ground. Despite three major situation assessments by Southern Command on the day of the attack, no evacuation issues were reported, and senior officials ignored MDA teams' inability to enter affected communities due to ongoing fire.

Due to ambulance access restrictions, about 525 of the wounded had to self-evacuate or be moved by local security forces or civilians, often under fire. Before the attack, only 24 bulletproof ambulances were available nationwide, with just one operating in the Gaza border area. The IDF had not conducted a comprehensive investigation into the evacuation failures by the time of the report, except for a limited Air Force inquiry.

The IDF responded by acknowledging the failure to protect western Negev communities and the complexity of evacuations amid active combat. It stated that evacuation efforts were prioritized alongside fighting terrorists and that continuous communication with MDA occurred throughout the day. The IDF also noted that MDA's command system was not practiced with military personnel, limiting its use during the attack. Following the report, the IDF has integrated MDA control systems into military medical command centers and is conducting extensive reviews and cooperation with external bodies to improve future responses.

The report calls for immediate changes in command and control concepts, full adoption of computerized MDA systems by the military, and pre-planned establishment of safe casualty transfer points to prevent similar failures in future extreme events.