The IDF’s failure to defend Gaza border communities on October 7 was also at the root of failures in evacuation from combat zones, State Comptroller Matanyahu Englman found, in an audit published on Tuesday.
Englman added that the evacuation system lacked an orderly IDF response, clear command-and-control arrangements with Magen David Adom, and timely coordination of handover points.
Some 1,340 wounded people reached hospitals that day. About 70% arrived at three southern hospitals: Soroka Medical Center in Beersheba, Barzilai Medical Center in Ashkelon, and Assuta Ashdod Hospital.
That day, MDA received roughly 24,000 calls and opened about 7,400 incidents, with around 1,640 from the Gaza border area. But the Gaza Division’s formal instruction to MDA to evacuate casualties through designated handover points reached the organization only at 2:23 p.m., nearly eight hours after the Hamas assault began.
Evacuations from those points began at 2:37 p.m. Until then, civilians, security forces, volunteers, and other rescue organizations carried much of the burden. Of the approximately 930 wounded who arrived at the southern hospitals, about 460 came independently.
The comptroller noted that those improvised evacuations saved lives, but said they also reflected the collapse of the planned system.
MDA had installed a digital medical command platform at the IDF’s Gaza Division in 2022, which showed emergency calls, casualty locations, and ambulance deployments in real time. Military medical officials did not use the system on October 7, according to the audit, meaning information that could have assisted forces in reaching civilian casualties did not reach units operating in the fighting.
The IDF acknowledged in its response that it had failed to defend the communities, and that forces evacuated wounded people amid heavy fighting, blocked routes, shifting priorities, and an urgent need to repel terrorists and regain operational control.
It added that Southern Command maintained continuous contact and situation assessments with MDA, opened a command medical operations room shortly after the attack began, and assigned ground and air evacuation forces. The IDF said MDA control tools are now displayed in military medical command rooms as part of lessons learned.
The Health Ministry noted that the October 7 attack was unprecedented in scope and complexity, and unfolded without warning or a complete operational picture. It said the active combat zones, blocked roads, and uncertainty on the ground made it impossible for the IDF to carry out an orderly evacuation from some areas for hours.
Still, it said, the health system’s response was life-saving, and accepted the criticism, saying that most of the gaps identified had already been addressed during the war, including through closer coordination with the IDF.
The audit also found shortcomings in the distribution of casualties between hospitals.
Barzilai asked to begin transferring patients elsewhere at 8:45 a.m., while Soroka asked at 10 a.m. not to receive further helicopter evacuations.
The Higher Hospitalization Authority, chaired by the Health Ministry director-general and including the IDF chief medical officer and Clalit’s director-general, is responsible for setting policy on casualty distribution and medical resources in emergencies. It first convened that day at 2 p.m. By then, 501 wounded people had already reached Soroka and Barzilai.
The IDF said determining destinations and distribution of patients was the responsibility of the Health Ministry and Higher Hospitalization Authority, while Home Front Command could assist at the ministry’s request.
Rehabilitation system faced its own gaps
A separate audit examined the treatment of soldiers, security personnel, and civilians after their arrival in the rehabilitation system.
Englman recused himself from the rehabilitation audit because his son was wounded during the war. The review was handled by Comptroller’s Office director-general Brig.-Gen. (res.) Yishai Vaknin.
By September 2025, about 20,000 soldiers and security personnel had been wounded in the war, the report stated. Between October 7, 2023, and July 2025, approximately 1,660 war wounded - soldiers, security personnel, and civilians - were treated in hospital rehabilitation departments.
Of those requiring inpatient rehabilitation, 783, or 47%, were hospitalized at Sheba.
The report found that the growing number of patients at Sheba reduced the average number of daily treatments available to them. By mid-January 2024, the average had fallen below 2.2 treatments per patient per day.
It also found that patients living farther away were disproportionately treated there: 64% of those living more than an hour from Sheba were hospitalized at the hospital, compared with 49% of those who lived within a half-hour drive.
Hospitals, the IDF, and the Defense Ministry did not have procedures requiring them to explain all available rehabilitation options to wounded people, including facilities closer to home, according to the audit.
About 80% of respondents had low or moderate familiarity with their rights
A June 2024 Rehabilitation Department survey found that about 80% of respondents had low or moderate familiarity with their rights.
“The dedication of the teams in the field is no substitute for orderly policy,” Vaknin said, calling on the Health and Defense Ministries to “act immediately to correct the deficiencies.”
The Defense Ministry said it had received more than 25,000 wounded people from the war and expected the number treated by its Rehabilitation Department to reach 100,000 by 2028.
It said its “rehabilitation before bureaucracy” policy allowed wounded people to receive medical, psychological, and financial assistance before appearing before medical boards. According to the ministry, 70% of wartime recognition applicants were recognized within 48 hours.
The audit credited the Rehabilitation Department for adapting quickly to the influx of wounded people. But as of May 2025, about 7,000 recognition requests had not received a final status, including approximately 2,200 that had been pending for more than a year.
The IDF said authorized Defense Ministry officials can access relevant military medical records, but military medical personnel do not have direct access to rehabilitation-treatment information. It supported the comptroller’s recommendation for a reciprocal interface between the systems.
The report called for clearer coordination between the IDF, MDA, and the Health Ministry during mass-casualty events, including real-time information-sharing and dedicated operational reviews. It also urged the Health and Defense ministries to ensure that wounded people receive accessible information about their rehabilitation options and rights.