Mental distress and care disruption in crises: Israeli regional disparities in the Israel–Hamas war

Background

Armed conflicts disrupt healthcare and affect population health. During the Israel–Hamas war, residents of southern and northern Israel were more exposed to hostilities, potentially increasing mental distress and disrupting access to care. Evidence on regional disparities, key to health system preparedness and resilience, is limited.

Methods

Secondary analysis of a nationally representative 2024 survey conducted during the war among Israeli adults aged 22 + (N=2,448). Respondents were classified into three groups of residents: of frontline communities in southern/northern Israel (within 40 km of the Gaza Strip/11 km of the Lebanese border), of other southern/northern communities, and of the rest of Israel. Outcomes included war-related mental distress, assistance from Health Maintenance Organizations (HMOs), proactive staff inquiry, cancelled or postponed medical appointments, and satisfaction and trust in the health system. Logistic regression adjusted for sociodemographic factors.

Results

War-related mental distress was more likely in frontline (OR≈2) and other southern/northern communities (OR≈1.4), compared with the rest of Israel, yet help-seeking from HMOs was similar across regions. Proactive healthcare staff inquiry about distress was slightly higher in southern/northern regions, both within and outside frontline communities (16–17%) than elsewhere in Israel (12%), but not statistically significant after adjustment. Cancellation or postponement of medical appointments was also more likely in frontline (OR≈2) and other southern/northern communities (OR≈1.4), compared with the rest of Israel. Satisfaction and trust were similar across regions.

Conclusions

Greater proximity to hostilities was associated with higher mental distress and care disruption, while help-seeking and proactive detection did not differ. Strengthening proactive detection and care continuity during crises is recommended to enhance health system resilience and population health.

Key messages

• Armed conflicts increase mental distress and disrupt healthcare. Strengthening proactive detection and care continuity during crises is recommended to enhance system resilience and population health.

• Greater proximity to hostilities is associated with higher mental distress, but not with increased help-seeking or proactive detection, highlighting gaps in the health system’s response.