Introduction: The October 7, 2023, Hamas attack on Israel resulted in hundreds of fatalities, abductions, and hospitalizations, marking the beginning of the ongoing war. This mass casualty incident (MCI) overwhelmed the medical system and demanded unprecedented civil-military coordination in response to ongoing terrorist assaults. The World Health Organization’s Civil-Military Coordination (CIV-MIL) framework underscores the necessity of collaboration in emergency response, particularly in conflict zones. This study examines sustainable strategies for integrating military and civilian medical capabilities to improve disaster preparedness and response in war-affected areas, using the Israeli experience to inform a model applicable to similar global high-risk scenarios. Methods: The documented files of the medical cooperation plans between the Israel Defense Forces Medical Corps and three hospitals for use in a possible escalation of hostilities, written from 2020 onward, were reviewed. All documents were compared, and points of incompatibility or inaccuracy in coordination between the entities were identified. The results were presented to twelve senior officials in the IDF Medical Corps and the Israeli Health System through semi-structured interviews to obtain their opinions through open interviews regarding the strategy required to enhance disaster preparedness. Results: Document analysis revealed four critical coordination gaps: hospitals lack awareness of available military medical resources, army medical records remain undigitized, large-scale mass casualty drills are infrequent, and helicopter transport for the injured is improvised on an ad hoc basis. Interviews highlighted three predominant themes: inadequate exercise budgets, independent organizational planning that wastes resources and hinders preparedness, and staff turnover impacting emergency preparedness. Conclusion: This study is crucial as it highlights one of the most significant aspects of emergency response: the importance of routine long-term coordination and planning. In any context where there is cooperation between military and civilian entities, it is essential to consider the results of this study as the foundation for a work plan.
Arama et al. (2026) studied this question.