Israel Middle East Politics & Diplomacy
MENASource February 17, 2023

Hospitals under fire: how Europe can learn resilience from the Israeli experience

By Yoel Har-Even

This piece originally appeared on Sheba Global.

When Russian forces invaded Ukraine in February 2022, hospitals in the affected regions faced a daunting challenge: how to provide essential care to their communities while under attack. As the conflict escalated, hospitals even became targets, with some facilities coming under direct missile fire. This led to the complete destruction of medical centers in high-conflict zones like the northern coastal city of Mariupol.

Still, despite the many perilous obstacles, most Ukrainian hospitals managed to maintain operations and provide vital care to those in need. In some cases, hospitals were forced to evacuate patients or relocate to safer areas. Other hospitals were able to continue operating despite being caught in the crossfire, with staff working tirelessly to ensure that patients received treatment.

For years, Europe has been relatively insulated from the threat of war and has grown accustomed to addressing specific, targeted attacks. Today, much of Ukraine is an active war zone because of ground fighting and aerial attacks that strike apartment buildings, hospitals, and other civilian sites. Hospitals in eastern Europe could get drawn in by strikes that go astray or a possible Russian escalation.

In addition to physical threats, Europe’s hospitals also face increasing risk of cyberattacks, whether for profit or as part of Russia’s ongoing hybrid warfare campaign against European support for Ukraine. These attacks can compromise patient data, disrupt medical equipment, and hinder internal communication and coordination. They also pose a significant threat to the delivery of medical care and the overall resilience of hospitals.

To ensure they can provide care in the face of these adversities, European hospitals are learning to prioritize hospital resilience, which can be defined as the ability to withstand and quickly recover from attacks. One country with extensive experience in this area is Israel, which has successfully navigated a range of threats from full-scale war to aerial attacks and cyberattacks.

To improve resilience, Israeli hospitals have implemented and fine-tuned a range of measures to better prepare and withstand times of crisis. As part of Israel’s home front protection strategy, hospitals have developed a critical role in bolstering preparedness and resilience during war or large-scale operations. This doctrine includes a comprehensive action plan that ensures the active participation of hospitals in protecting the home front. Ukraine has already begun to benefit from the Israeli experience, based on the various medical and logistical teams Israel has sent and continues to send into the war-torn country in order to deal with the harrowing realities.

Ukrainian and other European hospitals can learn from these six key areas:

  1. Reducing vulnerabilities: To safeguard against physical attacks, hospitals in Israel have fortified their structures with reinforced concrete and other materials that are resistant to explosions. Efforts to improve protection have focused on securing essential infrastructure, specifically surgery and intensive care units. To reduce vulnerabilities to cyber threats, hospitals have implemented secure networks and systems and provided training to staff on how to recognize and prevent these types of attacks.
  2. Prioritizing staff resilience: Israeli hospitals have implemented various measures to ensure the ability of staff to withstand crises, manage personal danger, and maintain a sense of social cohesion. This includes regularly conducting simulation exercises and providing emergency support for the families of staff, such as on-site kindergartens and educational resources that can be quickly activated in times of need. Additionally, Israeli hospitals have implemented employee counseling services, stress management programs, and mental health support for staff to help them cope with the emotional and psychological stress of working under constant threat.
  3. Establishing emergency protocols: Israeli hospitals have established clear protocols for responding to small and large-scale emergencies. These protocols outline emergency roles and responsibilities and specify the steps that need to be taken to ensure the safety of patients and the continuity of care. For example, detailed plans outline procedures for evacuating patients, activating emergency backup systems, managing an influx of patients during mass casualty events, and providing care at alternative sites, such as field hospitals.
  4. Ongoing training and drills: Hospitals across Israel regularly conduct training and drills to ensure that all personnel are prepared to respond to emergencies. These drills help staff to familiarize themselves with emergency protocols and practice the skills and procedures needed to respond effectively in a crisis. Drills may include simulated missile attacks, cyberattacks, or other emergency scenarios, and are often conducted in collaboration with local emergency responders.
  5. Collaborating with other healthcare providers: To ensure that Israeli hospitals can provide mutual support in the event of an attack, they have formed collaborative networks with other healthcare providers, as well as local and national authorities. These partnerships—sometimes between would-be competitors—involve sharing resources, expertise, and coordinating patient transfers between hospitals when necessary. Through collaboration, these facilities can ensure that patients receive the care they need, even if one hospital is unable to operate.
  6. Managing field hospitals: Israeli field hospitals, such as the “Shining Star” mission to Ukraine that I had the privilege of leading last year, provide practical examples of hospital resilience in action. These facilities have implemented contingency plans for procuring and distributing crucial medical supplies to ensure patients are treated even when supply chains are disrupted. Distinct protocols for triage and treatment of mass casualty events have also been established to ensure patients receive timely and efficient care. In addition, Israeli-run field hospitals have benefited from telemedicine and remote monitoring technologies, which enable treatment even when a patient or expert physician cannot be there physically.

By adopting these strategies and more, European hospitals can continue to improve their resilience and provide essential care in the face of a range of attacks. Whether responding to a cyberattack or a missile strike, hospital resilience is crucial for maintaining the health and well-being of communities served by local medical centers.

These techniques, which would benefit all European Union nations, could also have practical applications in collaboration with countries under the burgeoning Abraham Accords, where Israel can offer its expertise in managing ongoing security challenges, including missile threats in the region.

Ensuring this sort of support for patients, families, and staff is not an optional add-on, but an integral part of the comprehensive care that hospitals must provide in today’s unpredictable world. By taking inspiration from the resilient spirit of the Israeli healthcare system and implementing proactive measures to minimize vulnerabilities, European and other global hospitals can be better prepared to weather any storm, creating a healthier and safer world for all.

Yoel Har-Even is director of the International Division and Resource Development, Sheba Global, at Sheba Medical Center in Israel.

Further reading

Image: Ukraine, Vyjnytsia, 2023-02-02. Vyjnystia local hospital. French volunteers come to Vyjnytsia to identify the needs and provide humanitarian aid. Photograph by Geoffrey Bire / Hans Lucas.