Study: One in 8 Israeli Soldiers Who Fought in Gaza Is Mentally Unfit to Return for Duty - Israel News - Haaretz.com
Some 12 percent of reserve soldiers who took part in the current Gaza war report suffering from severe symptoms of post-traumatic stress disorder that effectively render them unfit for service. The finding is part of a new Tel Aviv University study on the emotional impact of the war on young reserve soldiers and their mental readiness for renewed combat.
The study was released on Wednesday as Israel was preparing for an expansion of fighting in Gaza and a renewed call-up of reserve soldiers, many of whom have already served for long periods since the beginning of the war in October, 2023.
A team of researchers led by Prof. Yair Bar-Haim, head of the National Center for Traumatic Stress and Resilience at Tel Aviv University, studied the frequency of post-traumatic stress disorder among infantry soldiers who enlisted for regular service in March 2019. The team followed these soldiers over five years and concluded that the current Gaza war, which began after Hamas' attack in October, 2023, has deepened their mental anguish.
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In addition to the 12 percent of soldiers who reported severe symptoms rendering them unfit for service, a similar ratio of soldiers reported hardships, anguish and psychological symptoms that don't meet the clinical definition for PTSD, but nonetheless affect the soldiers' ability and motivation to resume military service, according to the study.
After over a year and a half of warfare and in light of the chasm in Israeli society, the current reserve call-up is viewed differently by the public than the call-up immediately after October 7. There is a significant deterioration in the mental resilience of reserve soldiers, some of whom have served several tours for long periods. While at the beginning of the war, there was a 100 percent response rate to military call-ups among reserve soldiers, that percentage has now dropped to 75-80 percent, according to various reports.
An Israeli tan in northern Gaza, in April.Credit: IDF Spokesperson
The reasons include the financial and occupational burden, strain on family life, loss of confidence in the leadership and anger at the inequality of the burden of military service, alongside a general decrease in motivation in light of the war dragging on and questions about its goals.
Another significant reason for the drop in turnout is an erosion in the mental resilience of soldiers who have been exposed to traumatic incidents during combat, some of whom have developed multiple PTSD symptoms.
The study, conducted with the support of the Kadar Foundation, found a significant increase in the number of soldiers suffering from multiple PTSD symptoms. Researchers followed 579 soldiers who enlisted in one of the IDF's infantry brigades in March, 2019. These soldiers, support personnel and commanders, whose average age upon enlistment was 19, are now reserve soldiers aged about 25.
Participants were asked to fill in a questionnaire for a diagnosis of PTSD symptoms at five points during the study period: upon enlistment, after 15 months of service, after 27 months of service, six months after discharge and a year and a half after discharge – that is, during the Gaza war. The findings indicate that the longer the period served, the higher the number of soldiers who reported multiple PTSD symptoms as defined by the DSM-5 (the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th Edition).
Researchers used a questionnaire developed by the U.S. Department of Veteran Affairs, considered the accepted standard for measuring PTSD symptoms by first-person reports.
The results of the questionnaire are no substitute for an official diagnosis based on a clinical interview, but they provide a broad assessment of the existence of PTSD. However, many studies from Israel and abroad indicate a strong link between the results of the personal questionnaire and the results of a clinical interview.
Prof. Yair Bar-Haim, head of the National Center for Traumatic Stress and Resilience at Tel Aviv University, is leading the research.Credit: Tomer Applebaum
An additional limitation of the study is its focus on a particularly narrow age group (mid-twentysomethings), leaving out older reserve soldiers, often family men in a different occupational and financial situation, who may have greater mental resilience and a more mature worldview.
According to the study's findings, upon enlistment, less than 0.5 percent of enlisted soldiers were suffering from PTSD. After a year and a half of conscript service (including six months' combat training and nine more months of operational activity), 2.6 percent of soldiers were suffering from post-traumatic symptoms. Toward the end of their military service, after several more operational tours of duty, this rose to 4.4 percent.
Despite the expectation that discharge from duty would alleviate the soldiers' mental hardship, half a year after their discharge, almost 8 percent of combat soldiers reported multiple post-traumatic symptoms. It should be noted that the sampling at this point was prior to October 7, and the data reflect service without any war or military operation.
Data was collected for the fifth time a couple of months after the Gaza war began, with 85 percent of participants having been called up for active reserve duty. The number of soldiers reporting significant post-traumatic symptoms rose to 12 percent.
"The data from the study reflects one draft for one infantry brigade – such as the paratroopers, Golani or Givati – that enlisted in 2019 and was discharged in 2022," explains Prof. Bar-Haim, who headed the study, which was presented at Tel Aviv University's annual conference. "During the conscript service of these soldiers, Israel did not go to war or on any special military operation, so this data reflects post-trauma symptoms among Israel Defense Forces combat soldiers in regular activity."
Most of the soldiers in the study did much of their regular military service in the West Bank. While the increase in post-trauma symptoms during regular service was relatively mild, the study indicates a sharp rise in significant post-trauma symptoms following the soldiers' discharge. "The reason for this is unknown, but perhaps the military environment during conscript service provides support and a sense of belonging that wane after discharge," says Bar-Haim.
The study's findings should not come as a surprise to mental health professionals, he adds. "These are the numbers we see in studies around the world. Ten to 20 percent of people exposed to the battlefield suffer from multiple post-trauma symptoms – whether they are combat soldiers or support personnel. This is true for the Vietnam War, the Yom Kippur War, the first Lebanon war and also for people who took part in the wars in Iraq and Afghanistan." He says the study's findings also correspond with the large number of discharged soldiers who request help from and recognition by the Ministry of Defense's rehabilitation division.
Irit Aloni, head of NATAL's clinical unit, says that the current reserve call-up also triggered a wave of calls to the organization's hotline.Credit: Ran Yehezkeli
Post-traumatic stress disorder comprises four groups of symptoms: The first involves re-experiencing the traumatic event in a tangible way, such as jolting memories, flashbacks and nightmares. The second is over-excitability, hyper-alertness and sleep disorders. The third is typified by a tendency toward avoidance.
"A person's wish to minimize situations of being overwhelmed by tough experiences and feelings leads to avoidance. Many people begin to minimize interactions with their surroundings, to the point of shutting themselves in the house or in a room. This avoidance is both physical and social, in an attempt to quell the trauma or to avoid thinking about it – and it does not really help," he notes.
The fourth group of symptoms is characterized by cognitive and emotional changes. "These are changes in attitude toward myself and toward the world, which is perceived as a dangerous place. In many cases, depression is involved," he adds.
The National Center for Traumatic Stress and Resilience at Tel Aviv University, headed by Bar-Haim, currently treats several hundred reserve soldiers who served in the war. "They begin treatment and are then called up [for reserve duty] again after one month. In the best-case scenario, they realize they cannot go back and must take care of themselves. But in the worst-case scenario, soldiers and commanders who feel committed to the platoon and their friends show up for reserve duty, bringing with them all their symptoms. This is both operationally dangerous as well as a mental risk for themselves. It's like a blow to the wound," says Bar-Haim.
NATAL, the Israel trauma and resiliency center, has treated some 6,000 reserve soldiers since the start of the war and is currently treating some 2,500. On the week of Memorial Day for Fallen Soldiers there was an increase of several hundred percent in the number of calls seeking emotional help from the organization's hotline, with 60 percent of those calls by discharged conscript and reserve soldiers.
Irit Aloni, head of NATAL's clinical unit, says that the current reserve call-up also triggered a wave of calls to the organization's hotline.
"There is tremendous rage among those who are being called up these days – and caregivers are also frustrated," she says. "One patient told me: 'Ever since October 7, we have been on a crazy ride. I now feel like the ride has gone off the rails and I am crashing.' When I asked him why is he going back to reserve duty, he replied, 'Not to save anybody and not for the country. I am going back for my team and my friends. I do not believe in this war.' We have been hearing this a lot these days."
Aloni says that many soldiers undergoing psychological treatment don't have enough time to recuperate from the previous stint of reserve duty before they are called up for a new one. "One patient was called up on Memorial Day, while he was at the cemetery, next to the graves of two of his friends," she says.
"Reserve soldiers are only just beginning to process what they have been through in service, and are already required to go back," she continues. "When you go back, you cannot process the experiences, the hard images, the loss, the danger to life. Now everything comes up and everything becomes a trigger. People report recurring symptoms such as hyper-alertness. Our hotline has been getting a lot of calls from people with anxiety attacks. Some call, report that they are heading off for reserve duty and ask us to save a place for them."