Health Impacts of the ‘Iron Swords’ War on Evacuees Displaced from Their Homes in Israel

Background: Armed conflicts and large-scale population displacement pose major challenges to healthcare systems, even in high-income countries with universal health coverage. On October 7, 2023, the “Iron Swords” war led to the internal displacement of tens of thousands of civilians in Israel, creating a unique opportunity to examine continuity of preventive and chronic care during a prolonged national emergency. Objectives: To assess changes in preventive healthcare utilization, mental health medication use, and chronic disease management among populations evacuated from their homes during the Iron Swords war, and to compare trends between evacuees and non-evacuated district residents. Methods: This retrospective population-based study used de-identified electronic health record data from Maccabi Healthcare Services, Israel’s second-largest health maintenance organization. Adults aged ≥ 21 years with continuous enrollment prior to October 7, 2023, were included. Evacuees from northern and southern regions were compared with non-evacuated district residents across two post-war periods and corresponding pre-war periods. Outcomes included screening tests, incidence of chronic diseases, monitoring of chronic conditions, and dispensation of medications for mental health and sleep disorders. Results: Following the outbreak of war, evacuees experienced a marked decline in preventive screening, including diabetes, hypertension, and cancer screening, particularly during the first six months. Partial or full compensation occurred in some measures during later periods, but annual rates remained lower for breast and colorectal cancer screening. Use of antidepressant and anxiolytic medications increased substantially, especially among southern evacuees, with up to a 90% annual increase compared with pre-war levels. Modest worsening in glycemic and blood pressure control was observed in certain subgroups, while the incidence of major chronic diseases remained largely unchanged. Conclusions: Internal displacement during the ‘Iron Swords’ war was associated with substantial disruptions in preventive care and increased mental-health–related medication use among evacuees. Despite these challenges, Israel’s strong, integrated health system enabled rapid restoration of many services and supported continuity not only in chronic disease management but also in ongoing evaluation of preventive care patterns even during a national crisis. This capacity provides important insights for strengthening preparedness and response strategies and underscores the value of robust health information systems and coordinated primary care in managing large-scale civilian displacement.