'Ecology of healing': Israel's October 7 trauma victims say the system is failing them

Israel’s system for victims of hostile acts remains centered on proving the extent of a person’s disability rather than helping them rebuild their lives, survivors, mental-health experts and political representatives warned at a Tel Aviv conference on Sunday.

The conference took place at Riverside in Tel Aviv, and was sponsored pro bono by Rafi Pomrock, the CEO of the Dynamo Group and a member of 121’s public council. It was hosted by journalist Rina Matzliach.

Founded in 2017, 121 describes itself as a nonpartisan social-policy organization that works with civil-society groups and professionals to advance legislation and government policy.

At the conference, 121 presented interim findings from a survey it conducted among 145 victims of hostile acts. Only 27% had returned to the same scope of employment they held before their injury, while 35% were not working at all, and 34% had returned only partially.

Nearly two-thirds of respondents - 61.8% - said their financial situation had deteriorated even after receiving allowances and compensation, while 35.2% said a first-degree relative had been forced to reduce their workload because of the respondent’s condition.

Two-thirds said they had not received continuous and consistent guidance from the state, and respondents gave the assistance they received in navigating their rights an average score of 2.5 out of 5.

Taken together, the findings underscored how the consequences of an injury can extend beyond the person formally recognized by the state, affecting the employment and finances of entire families and placing additional burdens on relatives providing care.

Roni Katz, whose son Arad survived the Supernova music festival massacre, said in a video presented at the conference that she had been forced to stop working to care for him around the clock.

“My son Arad returned from Nova in a severe psychological condition, and since then I have been caring for him constantly,” she said. “I lost my source of income, but I received no response from the state - no financial assistance, no guidance, and no treatments that could have helped me cope.”

Ron Segev, another Nova survivor, said he had previously worked 12-hour days as a salesman but could no longer function as he had before October 7. Segev said he was currently recognized as having a temporary disability through the end of 2026, with a permanent determination expected only in 2027.

“Instead of a system that focuses on disability percentages, I need a personal rehabilitation track that determines what I need in order to return to functioning and to life,” he said.

Recognition as a victim of hostile acts and the determination of a disability rating are two separate stages of the process.

A person seeking recognition submits a claim to the National Insurance Institute (NII). The claim is then transferred to the certifying authority in the Defense Ministry, which determines whether the incident meets the legal definition of a hostile act and whether the person should be recognized as a victim.

Once recognized, a person seeking disability compensation must file a separate claim and appear before a medical committee, which determines whether the recognized injury created a temporary or permanent disability and assigns a percentage to it. The committee may assess only injuries connected to the hostile act for which the claimant was recognized.

A disability rating below 10% does not entitle the victim to disability compensation. Ratings between 10% and 19% generally lead to a one-time grant, while those rated at 20% or above receive a monthly disability payment.

Recognition can fund medical treatment connected to the recognized injury even without a 20% disability rating, but many of the broader rehabilitation, treatment, and family benefits depend on crossing higher thresholds.

The “One Soul” reform, for example, applies to victims receiving monthly compensation with a disability rating of at least 20% for post-traumatic stress disorder, another mental injury, or a head injury.

Given the unprecedented number of people who entered the system in the past three years, the distinction is significant.

Approximately 82,000 civilians were recognized as victims of hostile acts between 2023 and 2025, excluding those killed, according to NII data presented in a recent Knesset Research and Information Center report.

By April 2026, approximately 38,000 had applied for a disability determination. Of those, around 88% were determined to have a mental disability, along with approximately 6% with a physical disability and another 6% with combined physical and psychological injuries. Among those with psychological disabilities, the largest group received ratings between 20% and 34%.

Religious Zionist Party MK Michal Woldiger said on Sunday that the committees intended to determine those ratings had themselves become an obstacle to recovery.

“The vast majority of medical committees today are anti-rehabilitative,” she said. “They focus on the question of how injured a person is, instead of asking what that person needs to return to functioning.”

Woldiger said the committees should not necessarily be abolished, but their purpose and methods should be changed to support individualized rehabilitation.

Similar criticism was raised at a June 9 meeting of the Knesset Labor and Welfare Committee on medical committees for disabled IDF veterans and victims of hostile acts. One participant told the committee that a psychiatrist had reduced her disability rating by 20 percentage points after asking whether she had begun studying - an example of the fear that signs of recovery can be interpreted as evidence that assistance is no longer required.

Yashar Party candidate Inbar Yehezkeli Blilious argued that the legal criteria themselves must be reconsidered as the nature of exposure to terrorism changes.

“Terror has changed, and the law must also change,” she said.

People may sustain severe psychological harm despite not being physically present at an attack, she said, including through watching events unfold in real time on their phones or through videos. Where serious harm can be demonstrated, the state should consider expanding recognition to include them, she said.

Yehezkeli Blilious also called for earlier intervention through the health funds and for support to be extended to siblings and other family members affected by a survivor’s condition.

Some victims may return to work while continuing to require long-term support, she noted, meaning employment alone should not be treated as proof that rehabilitation is complete.

Prof. Mooli Lahad, founder and president of the Community Stress Prevention Center, warned against treating every prolonged response to the war as PTSD. Some people are experiencing other forms of unresolved distress, including what he described as “ambiguous loss,” requiring a broader therapeutic vocabulary and response.

Individual treatment remains important, Lahad said, but cannot succeed fully when a person returns to a family, workplace, or community that lacks the ability to support them.

“Real healing comes in an ecology of healing,” he said.

After years of continuing war and repeated attempts to recover, people are also experiencing what he described as “healing fatigue.” Strengthening communities would allow them to provide a protective structure around individuals and families, he said.

“The more we heal communities, the more they will wrap around the individuals themselves,” Lahad said, adding that resilience should be understood as a muscle that must be continually strengthened.

The pressure on those communities is already visible throughout the public mental-health system.

A State Comptroller’s survey conducted in April 2024 found that 35% of adults reported moderate or severe post-traumatic stress symptoms, 32% reported symptoms of depression, and 21% reported anxiety.

In the first six months after the attack, health funds and resilience centers provided psychotherapy to approximately 58,000 adults and children. By the spring of 2024, the average period between requesting care and beginning treatment, including the diagnostic process, was around six-and-a-half months.

The state comptroller warned that delayed treatment could cause symptoms to become entrenched and lead to long-term damage to victims’ employment, family lives, and social functioning.

The local welfare system expected to form part of the community response is also struggling. A June State Comptroller’s Report found that only 18% of the additional municipal social-work positions allocated in response to the war were filled in 2023, rising to 32% in 2024 before falling to 28% in 2025.

In a nonrepresentative survey conducted for the report, 54% of municipal social workers said they had experienced high or very high burnout since the war began. The principal difficulties they identified were workload, staffing shortages, and the growing number of cases.

Together Party representative Liran Avisar Ben Horin called for a shift from responding to crises only after they become severe to actively identifying people in distress.

Just as workplaces are required to appoint officials responsible for preventing sexual harassment, they should consider appointing a mental-health officer able to recognize signs of distress and connect employees with treatment, she said.

The conference’s proposals varied, but they shared a central premise: Israel cannot treat psychological rehabilitation as a temporary emergency project or reduce recovery to the percentage written beside a person’s name.

“The war created a new reality that the State of Israel has still not adequately addressed,” Liat Eilam, executive director of 121, said.

Israel must redesign the rehabilitation process around a person’s return to functioning, extend support to families carrying the burden of care, and build a national mental-health and resilience system rooted in local communities, she said.