Analysis
How the IDF is using lessons from Gaza to teach the US how to minimise casualties
The CFR (case fatality rate) is down to 6.5 per cent from 15 per cent in the Second Lebanon War in 2006
July 10, 2024 08:56
4 min read
The CFR (case fatality rate) is down to 6.5 per cent from 15 per cent in the Second Lebanon War in 2006
July 10, 2024 08:56One of the few sections of Israel’s security establishment that can say it was properly prepared for the war which began on October 7, and which has operated well in the nine months that have passed since, is the IDF’s Medical Corps.
This wasn’t through any special intelligence regarding the Hamas attack but rather the years spent preparing for just this sort of emergency – and the Covid pandemic, during which the corps had beefed up its personnel and organisational infrastructure when it looked for a while that it would need to set up a network of field hospitals as a backup for civilian hospitals which were on the verge of collapse. Ultimately that didn’t happen, but “the capabilities and readiness we built up were there on October 7, when they were needed,” says the IDF Surgeon-General, Brigadier-General Professor Elon Glassberg, who this week ended a four-year term, encompassing a war and a pandemic, after a military career of 34 years which began as a medical student and officer cadet.
In a war in which so many of the casualty numbers of civilians and Hamas fighters are deeply contested, Glassberg’s numbers are exact to the decimal point. His doctors and paramedics, 650 of them (nearly a quarter women) who served inside the combat zone in Gaza, are measured by one metric – CFR (case fatality rate) which in combat means the percentage of wounded soldiers evacuated from the battlefield who they have failed to save.
In the Second Lebanon War in 2006 the CFR stood at 15 per cent. In the Gaza War the CFR was down to 6.5 per cent. Glassberg says there are three main reasons for this. “We were much more aggressive in deploying doctors and paramedics in the field. Most militaries usually have a senior medical figure at battalion level. In Gaza we deployed them also at company level, which meant that within minutes of a soldier being wounded they were being treated by a serious professional in the field. Then we streamlined the evacuation process, changing centuries of military medical practice by eliminating the battalion aid station as the hub of treatment, and instead putting more focus on the initial treatment followed by immediate evacuation by helicopter or armoured vehicles to the border and then helicopters home. Third, we developed both powdered plasma and ‘whole blood’ transfusions which can be used in the field and have been proven to save lives.”
Now he’s leaving with “mixed feelings” as his staff are preparing for a possible war in Lebanon. “If war does break out in the north, achieving the same level of CFR will be a challenge as we’ll be operating in a much larger area where Hezblollah has the tools to contest our air superiority and make it harder for helicopters to evacuate. But we’ve had these past nine months to get ready for a bigger war.”
Meanwhile, Glassberg is off to Washington to work with the American military medicine experts on sharing the IDF’s experience from this war. In his office there’s a framed copy of an article he published in the Lancet in 2017 on Israel’s field hospital for refugees from the Syrian war, which he ran on the Golan Heights. “I’m not sure I’ll be able to write another piece for the Lancet about our experience in this war,” he smiles. “They’ve become too political and we need to keep this about the medicine.”
End of term
July always has an end of term atmosphere in the Knesset, but this year, as the war enters its tenth month, it’s even more surreal than usual. On Monday different – and opposing – groups of relatives of hostages and soldiers killed in Gaza milled around in the corridors, trying to lobby the lawmakers to either support or oppose the hostage release and ceasefire agreement being mediated simultaneously in Cairo and Doha.
Knesset ushers had set up tables for them near a canteen, but as the day progressed they increasingly found it difficult to draw the MKs’ attention. Instead, everyone was focused on a filibuster organised by Shas, which was trying yet again to pass its controversial law allowing it to appoint local rabbis.
By this point few were talking about the details of the law itself but rather about how Jewish Power leader Itamar Ben-Gvir had decided to challenge both the prime minister Benjamin Netanyahu and Shas leader Aryeh Deri by refusing to allow his members to support the law – because he has not been allowed to join the war cabinet despite being National Security Minister. Ben-Gvir had got it into his head that Deri, who he accused of being an “eternal partner of the left,” was the one blocking his path to the internal forum directing the war in Gaza.
“Ben-Gvir is half-right,” said a cabinet insider. “Netanyahu doesn’t want him in the war cabinet, but it’s Deri who is making sure that Bibi sticks to his position. And with Ben-Gvir using as his hostage the law that Deri wants so much, it is only convincing him even more to keep Bibi steadfast.” As Shas and Jewish Power traded insults in public, other members of the coalition began making dark predictions of the government’s ultimate demise.
Just as the MKs began preparing for a session long into the night, the news came shortly after 8pm that the coalition had pulled the law from the agenda. There were still three other votes on government legislation scheduled for that evening but then Shas announced that their eleven MKs had left the plenum in protest over their law being pulled. The coalition removed the rest of the legislation and there was a stampede for the car park.
“I’m getting that vertigo feeling you get when governments are on their last legs and can’t pass anything,” said one Likud MK. “Until now we expected that the coalition would break up either over the far-right’s opposition to a hostage deal with Hamas or to the Charedi parties leaving over yeshivah students’ exemption from military service. Now it looks like it may be over internal rivalries and general dysfunction.”
"There’s just over two weeks until the summer session ends and the recess,” said one opposition MK. “You can’t topple the government in recess and if the coalition manages to drag things out, Netanyahu will be secure until the winter session begins at the end of October. Chances are he’ll last it out, but it just shows once again that Israel at wartime doesn’t have a functioning government.”