Hundreds of Israeli soldiers returned from war with brain injuries: 'We got a different child back'
Due to the Gaza war, the number of Israeli soldiers diagnosed with brain injuries has significantly increased over the past two years and estimates suggest the phenomenon is even more widespread. But Israel has yet to formulate a comprehensive rehabilitation policy, and the burden of care often fall
Haaretz
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Due to the Gaza war, the number of Israeli soldiers diagnosed with brain injuries has significantly increased over the past two years and estimates suggest the phenomenon is even more widespread. But Israel has yet to formulate a comprehensive rehabilitation policy, and the burden of care often falls on their families
For days, even weeks, Uri Reches did not speak at all. In fact, at the age of 20, he had to be taught everything anew. Not just how to form sentences, but also how to manage himself, how to function in his new capacity –as a person with a brain injury. This was the result of what happened to him one day in Gaza, in December 2023, when he was a combat soldier in Battalion 50 of the Nahal Brigade.
"They were clearing buildings," say his mother, Niv Alfa-Reches. "When they reached the last building, the door exploded on them, and he was the closest." Reches' condition was defined as critical. He sustained injuries throughout his body, but the most severe were to his head and face. "The entire left side of his face was completely shattered," his mother says.
From there, a long and exhausting rehabilitation process began. There have been many successes, but, in truth, it may never really end.
Reches is one of more than 400 soldiers injured in the Gaza war who have been diagnosed with brain injuries of varying severity. The number is high but it in actual fact, the number of soldiers suffering from brain injuries as a result of the war is much higher. According to studies and estimates, the total number reaches approximately 24,000, many of whom did not feel the impact of the injury initially or even seek hospital treatment. But, that does not mean they are free of symptoms.
'It's very difficult to know that you have to fight for everything, to prove that my child needs support hours or an accessible shower even though he is standing on his feet, for those with moderate or lighter injuries – it's even harder in this regard.'
Niv Alfa-Reches
Uri Reches and his father Raz.Niv Alfa-RechesDaniel Rolider
Traumatic brain injuries (TBI) usually occur in civilian life following an accident such as a fall from a height. In contrast, on the battlefield, these injuries are mostly caused by a blast or by the penetration of shrapnel or bullets. "This is a non-localized injury; the brain is shaken, moving rapidly back and forth, which causes diffuse nerve damage," explains Dr. Yaron Sachar, director of the Health Ministry's rehabilitation department.
"Even when the source of the injury is more localized, like a bullet, we see diffuse damage." According to Sachar, who formerly served as director of the head trauma rehabilitation department at Loewenstein Hospital Rehabilitation Center, "injuries of this type lead to a decline in a range of functions – the most common being concentration and memory. They can also cause sleep disorders and behavioral changes such as an impaired ability to take initiative, exercise control in social situations or make long-term plans."
But the fact that there are so many cases does not make diagnosis simpler. The battlefield is a high-risk environment, characterized by exposure to traumatic events both physically and mentally, especially during prolonged service, and this actually makes it difficult for experts to precisely diagnose each individual case. Not only that, but some of the injuries manifest with symptoms that overlap with those of PTSD.
What's more says Prof. Alon Friedman, it's not necessarily either or, "some soldiers experienced both psychological trauma and brain trauma." Friedman, research director at the Brain and Nervous System Health Division at Sheba Medical Center, Tel Hashomer, adds that for three years he and his team have been "trying to find a way to distinguish between the two conditions and diagnose them better. But it is a very complex issue because, ultimately, it is the same brain."
The spectrum of symptoms of traumatic brain injuries is broad and can vary in intensity and frequency depending on the depth of the injury, the time elapsed since it occurred, and natural or medical rehabilitation processes. At a conference in January by The Israel National Institute for Health Policy Research on head injury rehabilitation, researchers from Sheba Medical Center presented data showing that the incidence of phenomena such as sleep problems, memory difficulties, and double vision is three times higher in people with TBI's than those without.
Dr. Yaron Sachar, director of the Health Ministry's rehabilitation department.Credit: Moti Milrod.
Dr. Yaron Sachar, director of the Health Ministry's rehabilitation department.Credit: Moti Milrod.
Symptoms such as dizziness, concentration difficulties, sensitivity to noise, sensitivity to light, slow thinking, headaches, fatigue, and restlessness are twice as common in those with traumatic brain injuries.
The difficulty lies in the fact that many of these symptoms also characterize PTSD. "Does this fundamentally change the treatment? On the face of it, in today's medicine – no," Friedman says. "Nevertheless, these are two different injuries, and their correct and precise diagnosis is important from a research perspective, for developing treatments and conducting clinical trials."
Accurate diagnosis becomes even more complicated when the cause of injury is a blast, which unlike a bullet or shrapnel, is not visible to the eye. And brain injuries caused by blasts are particularly common, as data from the Sheba researchers reveals. It turns out that 94% of brain injuries in soldiers evacuated to hospital were caused by blasts.
The data also shows the difficulty in diagnosing brain injuries within this group. It found that seven out of ten combatants whose head CT scans appeared "normal" actually had brain injuries.
But this phenomena wasn't just found among soldiers who were evacuated and treated in hospitals. According to data from a collaboration between Sheba and Ono Academic College, two out of ten combatants who returned to their studies at the institution suffered from brain injuries Sometimes they were mild injuries which resolved on their own thanks to the human brain's capacity to repair itself, especially in young people. But when it comes to brain injuries, human intervention is often required, says Sachar.
"People with head injuries who go to rehabilitation centers overwhelmingly improve," he clarifies. "The vast majority improve significantly." However, they are not necessarily exactly as they were before: "They still have functional difficulties that require long-term responses, whether it's social support, academic assistance, or mobility. Ultimately, individuals injured in war are young people who will suffer the consequences for decades to come."
Prof. Alon Friedman, research director at the Brain and Nervous System Health Division at Sheba Medical Center.Credit: Joy CohenProf. Alon Friedman, research director at the Brain and Nervous System Health Division at Sheba Medical Center.Credit: Joy Cohen
Indeed, "one of the difficulties characterizing head injuries is that people can change as a result," says Dr. Gili Givati, chief physician of the Defense Ministry's rehabilitation department.
Her description almost exactly matches the case of Oz Ocampo, a soldier in the Kfir Brigade, who was severely wounded in Khan Yunis in March 2024. He underwent a long rehabilitation process and in many respects returned to himself; in others, less so.
"To receive a son with a brain injury is to receive a different son than the one you sent off," his mother, Smadar, tells Haaretz. "It changes the entire family dynamic. He went from being the eldest son to the small child at home – he needs someone to come with him everywhere, he goes to the grocery store with his sister." Particularly prominent, according to his mother, are attention and concentration problems, and short-term memory difficulties: "When he leaves a treatment session, we ask him what happened, and he doesn't remember."
In November 2024, Ocampo, along with other parents, established "Laetet BaRosh" (loosely translated as "to defeat") and today it unites 367 families of soldiers with brain injuries sustained in the Gaza war who advocate for improved rehabilitation processes for their children. They are motivated by the sense that these young people are falling through the cracks. Indeed, despite the scale of the phenomenon and the unique characteristics of war-related brain injuries, Israel has yet to formulate a uniform national rehabilitation policy.
"The experience accumulated over the past two years," says Givati, "constitutes an important opportunity to advance knowledge at the national level and formulate a rehabilitation policy to best utilize the window of opportunity for rehabilitation."
'It changes the entire family dynamic. He went from being the eldest son to the small child at home – he needs someone to come with him everywhere, he goes to the grocery store with his sister.'
Smadar Ocampo
Smadar Ocampo.Oz and Smadar OcampoFadi Amun
According to Givati, despite the challenges, there are also achievements. She says that hundreds of individuals with brain injuries have already reintegrated into academic studies and employment, through adapted programs. But she warns that "it is precisely the success stories which highlight how insufficient the existing policy is.
"When rehabilitation is provided early, continuously, and tailored to the relevant needs, many young people succeed in returning to independent lives. But in the absence of a uniform and clear rehabilitation policy, the outcome often depends on chance, the place of hospitalization, and the availability of services. The reality created by the war necessitates a shift from a piecemeal response to a structured, coordinated, and long-term national policy that will allow for maximizing the rehabilitation chances of hundreds of young people injured early in their lives."
This message was also reinforced by Prof. Nachman Ash, chairman of the board of directors of The Israel National Institute for Health Policy Research. "Treating head injuries among young people injured in the Gaza war is a significant and long-term medical challenge," he says. "In the absence of a coordinated and clear framework, a significant portion of the treatment and bureaucratic burden falls on the shoulders of parents and families." Ash's words echo some of the main complaints of those closest to brain injury patients.
"From a medical perspective, we do everything," says Alfa-Reches. "We coordinate with eight different medical disciplines. And it's very complex." This has been the case since the first days of the injury, she says. "We moved near Tel Hashomer; he was in a state where he couldn't understand or make decisions. None of us has returned to full-time work since."
Alfa-Reches says that despite the good intentions of the medical staff, there was a noticeable lack of both a centralized framework to coordinate the rehabilitation process and neuro-cognitive professionals with the necessary backgrounds to provide full guidance. "As parents, we are forced to manage super-complex cases," Alfa-Rekhes says. "Although we have support from Sabar Health (contracted by the Defense Ministry to manage the case), complex issues like choosing specialists are not within their purview. After all, they are a private company, not a public entity."
Dr. Gili Givati, chief physician of the Defense Ministry's rehabilitation department.Credit: Ilan AssayagDr. Gili Givati, chief physician of the Defense Ministry's rehabilitation department.Credit: Ilan Assayag
The bottom line, she says, is that her son was sent to fulfill his duty to the state and in some respects was abandoned. "It's very difficult to know that you have to fight for everything… to prove that my child needs support hours or an accessible shower even though he is standing on his feet," she explains, adding that "for those with moderate or lighter injuries – it's even harder in this regard."
Part of the difficulty in navigating the medical bureaucracy, Ocampo says, stems from the lack of communication between the Defense Ministry and the health maintenance organizations.
"When I go to Oz's family doctor – he has no idea what's wrong with my son, because his medical file at the HMO has only been updated until his enlistment in the army," she says. "The doctor lacks the necessary information to make a decision based on the significant injury he sustained."
Moreover, he cannot even issue a prescription – this area is managed by the case manager, Sabar Health. Givati is well aware of the problem. "For our significantly injured individuals, there are home care packages, and they receive services, a therapeutic framework, and a case manager. But on the other hand, there is no one to follow up with them daily near their home, and that's unfortunate."
Since the start of the war with Iran and in Lebanon, there are additional difficulties. Many rehabilitation frameworks, especially in the north of the country, are not operating, or are only operating on Zoom.
There are other problems too. Ocampo says that many parents feel that they are left alone to decide what treatments are best for their children.
"One mother says: 'I found this physiotherapist,' another says 'I brought a speech therapist,' or a vocal development teacher who helps her son speak."
Prof. Nachman Ash, chairman of the board of The Israel National Institute for Health Policy Research.Credit: Ohad ZwigenbergProf. Nachman Ash, chairman of the board of The Israel National Institute for Health Policy Research.Credit: Ohad Zwigenberg
And there are also problems one might not think about when it comes to managing someone with a brain injury, she notes. For example, financial extravagance. "Oz could spend 15,000 shekels a month on things he ordered online – all sorts of military products, patches and tags, weapon stocks, stickers of fallen comrades," she says.
She also talks about the difficulties faced by these young men whose sense of mission and purpose was suddenly cut short. "If you ask them all what they would want to do – it's to return to the army. They were all combatants, and one day it was cut short. They feel that in one moment they are told: You are not wanted. You have a problem and I cannot accept you. They feel they have been pushed aside, and they want to complete what they started."
Another overlooked factor in this equation is the families – they too need support. "There are parents who 'live' at Sheba and Loewenstein Center," Ocampo says. She calls on decision-makers to "Take the families, create groups, teach them how to deal with memory problems, how to accept a child with a brain injury."
Among the hundreds of individuals diagnosed with brain injuries, there is a group of several dozen young people who suffer from severe and irreversible injury.
In some cases, a home-based therapeutic framework can be created for them, and in other cases, they require permanent hospitalization. According to the families, due to the scarcity of frameworks suitable for young people in this situation, they are hospitalized in institutions for the elderly. "The issue is complicated and requires a flexible approach," says Sachar. "Since we are talking about several dozen cases scattered throughout the country, even if you open, say, a department in Tel Aviv, it will not be sufficient (for someone whose family lives far away) because you want the person close to their family. Family support is essential and we need to see how to improve things."
