The spacious balcony of the "Building for the Rehabilitation of the Elderly" at Sheba Hospital creates a momentary feeling as if we are on the roof of some kind of guest house. Hammocks, benches, tables with lots of food and lively circles of friends and families.
The couple who lost a leg at a party in Re'im, are released for rehabilitation // Spokesperson Hillel Yaffe
But this is where the resort and imagination end. Because a quick glance at those present immediately reveals the grim picture: uniformed soldiers alongside their young comrades with amputations and bandages on their bodies.
Within three days, this department became a rehabilitation center for 54 war casualties. In the corridors they recently added, for the benefit of the patients, several pool and football tables, brought a PlayStation and connected a large screen in the heart of the ward. On a chair in the club sits Shimi Tavori, who came with a guitar to sing to the wounded and encourage their spirits. They say that in the evening it is impossible to find an empty chair on the roof.
We meet Staff Sergeant Ron, a medic from Golani's 13th Battalion, there. He sits on the balcony, surrounded by his family, recovering from a missile strike. His right hand was amputated, he was also hit in the right eye and hearing, and was also injured in the thigh. The bandages still hide some of the injuries. In a month, he will celebrate his 21st birthday, and was supposed to be discharged from the IDF. On the morning of October 7, he was whisked from his home in Nahariya to the area of Kibbutz Sa'ed. For six hours, he rescued wounded from the battle zones and treated them until he was wounded himself.
The most active rehabilitation department, photo: courtesy of Sheba
Eighteen of his comrades in Company B fell in battle for the Nahal Oz outpost, fighting inferiority against some 18 terrorists. He lost his hand when Hamas missiles hit the car he was riding in. "I flew out of the car. The heat of the missile burned my arteries, and that's the miracle. I was thrown in the field for two hours and I was supposed to bleed to death without a tourniquet," he recalls. "Everyone continued to the post. After half an hour, they noticed I wasn't there and reported to the rescue unit, and they located me."
After being anesthetized and ventilated at Soroka, and after further treatment in the surgical ward at Sheba, Ron is now marking his third week of rehabilitation, with at least three or four more months ahead of him. "The goal of rehabilitation is to make the left hand strong, and to know how to manage without the right hand and without help," he says.
"Every day there is physiotherapy and occupational therapy, a psychologist and personality tests of vision and hearing, as well as free time. The social part helps the process and the soul a lot. I made friends here. Everyone has a similar experience, everyone was saved by a miracle, so we share and tell, and it helps." More than 7,000 people were injured in the first month of the war. As of this week, 152 injured people are hospitalized for rehabilitation. Most of them were from the surprise attack on Black Saturday, and they are expected to be joined by others wounded in the fighting in Gaza.
Like a club, with snooker and amputees, photo: Sheba
It is too early to estimate the number of wounded who will need rehabilitation, but it is clear that the war is meeting the rehabilitation system in Israel, with a shortage of at least 300-400 beds in the wards, and a minority of specialist doctors and therapists who have left the public sector. As if that were not enough, the rehabilitation departments at Barzilai and Nahariya hospitals were closed because they operated in unprotected compounds. Only now have some of the rehabilitation activities resumed.
The rehabilitation system reports about 900 hospital beds, which should also be sufficient for "routine rehabilitation" – accident victims, people who underwent surgery, those suffering from fractures or stroke victims. In relation to the size of Israel's population, approximately 1,500 rehabilitation beds are required.
The health system is pushing for the opening of additional departments. Ichilov Hospital invested NIS 10 million to expand the system by 120 beds. Hadassah Mount Scopus is finishing construction of a rehabilitation center that will double the number of beds from 70 to 140, and Beilinson has opened a rehabilitation department with 16 beds in cooperation with Beit Levinstein.
number of rehabilitation beds in hospitals,
The rehabilitation system also suffers from a shortage of medical staff and caregivers. In 2021, 151 specialist doctors worked in physical medicine and rehabilitation until the age of 67. About a third of them will retire in the next decade. At the same time, there is a shortage of therapists in the fields of physiotherapy, occupational therapy and psychologists who prefer to work in the private sector or in the health funds.
"There are 900-950 rehabilitation beds scattered throughout the country, most of them in the central region. We need 1,500 beds to meet the needs of the aging and growing population, with an emphasis on the periphery and rehabilitation services in the community," says Dr. Tzaki Ziv-Ner, director of the Adi Negev Rehabilitation Hospital - Nahalat Eran in the south and former director of rehabilitation at the Ministry of Health and director of the Sheba Rehabilitation Hospital. According to him, until the opening of the rehabilitation institution near Ofakim, there were no rehabilitation beds in the south. As a result of the situation, Ziv-Ner opened an additional rehabilitation department of 30 beds, in addition to 83 beds for orthopedic and neurological rehabilitation.
"So far, two people injured in the attack have come to us. When talking about rehabilitation, it makes sense to move the patient close to his place of residence, due to the proximity to the family at home. But the regulation mechanism does not work because of the lack of cooperation of hospitals. The emphasis should be on proper regulation. If, God forbid, there is a large wave of casualties in a ground offensive, it will be less simple. We'll be on edge. "You have to remember that there are other populations in need of rehabilitation, including burn victims and hip fractures. I hear about places that have released patients in order to free up beds, and we have to be careful not to neglect the routine patients."
Prof. Dudkiewicz. "There is a lack of beds", photo: Sheba
Prof. Israel Dudkevich, Director of the Division of Rehabilitation Medicine and Director of the Center for the Rehabilitation of War Victims at Sheba, wanders the corridors of his department, quickly updates on the condition of the hospitalized patients and makes decisions on issues such as changing antibiotics or continuing treatment.
"There is a shortage of beds even in routine times, and it floats up during an emergency," he explains. "The biggest problem is a shortage of medical, nursing and paramedical staff. There are very few specialists in the country, and health professionals prioritize external systems such as health funds and the private sector. We are facing a wave of patients and no doctors." Sheba absorbed doctors who had retired, and were assisted by therapists who increased the percentage of positions and even volunteers, all in order to meet the goal. At Sheba, about 100 of the wounded in rehabilitation are hospitalized across the country.
"It won't be easy. This is good for a while, but it will not be possible to keep the system stretched like this for long. The biggest problem will be the rehabilitation of routine wounded, the response for the population that needs 'regular rehabilitation' will not be good enough. We will find a place for every casualty who will come from the ground maneuver. As with the coronavirus and the current event, we are not waiting for the State of Israel to find the money, and we opened the department immediately," says Prof. Dudkevich.
Two weeks ago, at a Health Committee hearing, Dr. Yaron Sahar, head of the Health Ministry's rehabilitation division, said: "This is a huge event by any standard, hundreds of wounded civilians and soldiers will need rehabilitation over time." In a conversation with Israel Hayom, he explains that "Israel has a reserve of about 100 and a few beds available. Our reserves haven't diminished, because we're managing to open more rehabilitation beds. The system retains the ability to absorb more.
Dr. Ziv-Ner. "We need an emphasis on proper regulation", Photo: Yarin Gas
"It is difficult to know exactly what will happen in the ground maneuver, and what the time period will be until stabilization and rehabilitation are reached. We are not complacent and there are deployment scenarios. Various hospitals have gone under the stretcher and are temporarily increasing the potential of beds. We are also working on programs to strengthen the rehabilitation system, which began even before the war. If we manage to add 300-400 beds, we will have a good reserve, enough for routine and war. The restoration of routine must not be affected. Fractures due to falls and stroke must continue to receive the vital treatment amidst the madness.
"We are now working in a proactive process of contacting and locating the wounded from that terrible Shabbat, in order to make sure that as part of the mess that existed in those days, people did not fall between the chairs and were not released, those who need rehabilitation." Another important challenge that Dr. Sahar points out is the recruitment of professionals from the fields of physiotherapy, occupational therapy, speech therapy and psychology to work in public hospitals. "It's a financial challenge, and we have good partners for economic discussion," he notes.
Lieutenant Shukron. "I told the soldiers: We are entering an event we did not know, there are terrorists in the communities and our job is to protect the civilians," Photo: Arik Sultan
On the importance of rehabilitating the wounded, he says: "Rehabilitation is the tool at the end of which a person will reach maximizing his abilities and aspirations. Without rehabilitation, we didn't complete the medical treatment. I want to see all the people in the rehabilitation wards return to functioning, return to their natural environment and work as quickly as possible."
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