The long-term consequences of 35 years of terror attacks against civilians in Israel: Medical and nonmedical costs, disability


  • Eytan Ellenberg, MD, MPH, PhD
  • Zvia Bar-On, MD, MHA
  • Danielle Luft-Afik, MHA
  • Mark Taragin, MD, MPH
  • Ishay Ostfeld, MD, MA, MHA



disability, Israel terrorism, costs insurance, rehabilitation



Background: Terrorism is a major threat, which requires operative preparedness, principally for the emergency structures. Similarly, its rising impact on the healthcare system should interest the researchers in health affairs and policy. The number and the nature of disabilities due to terror is insufficiently addressed in the civilian population. In this article, we described the type and number of disabilities in Israel due to war and terror attacks since 1980.

Methods: Descriptive analyses of the National Insurance Institute of Israel (NII) Civilian Victim of Terror database which embraces medical and social information including the number and severity of disabilities and their nonmedical costs (disability pensions) since 1980; the related medical costs (based on hospital and ambulatory invoices) and their principal International Classification of Diseases (ICD 9) diagnoses and comparison to the data coming from the START database (National Consortium for the Study of Terrorism and Responses to Terrorism)

Results: There was a surge in the number of disabilities following the years of the second Intifada 2000-2006. Although the number of wounded decreased after the end of the Second Intifada, the number of disabled stayed high due to their ongoing care. The costs of disability pensions grew in parallel to the number of disabled and approached 140 M US$ for 2016.

Conclusions: The different waves of terror attacks have an awful legacy as 4,000 disabled whom are supported today by the State of Israel. Because of the unique way Israel is tracking and following the victims, including the number of disabled and their attendant social and medical costs we can assess the broad impact of terrorism in Israel. It is interesting to note that when a country supports the victims of terror with an efficient system and dedicated means and resources, the social (nonmedical) costs are far more significant than the medical costs.

Author Biographies

Eytan Ellenberg, MD, MPH, PhD

Research and Policy Analyst, Office of Medical Affairs, National Insurance Institute of Israel (NII), Jerusalem, Israel

Zvia Bar-On, MD, MHA

Office of Medical Affairs, National Insurance Institute of Israel (NII), Jerusalem, Israel

Danielle Luft-Afik, MHA

Medintec-NII’s Contractor for Medical Claims & Bills AI Processing, EMR, Case Management and Reporting, Petach-Tikva, Israel

Mark Taragin, MD, MPH

Office of Medical Affairs, National Insurance Institute of Israel (NII), Jerusalem, Israel

Ishay Ostfeld, MD, MA, MHA

Office of Medical Affairs, National Insurance Institute of Israel (NII), Jerusalem, Israel


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How to Cite

Ellenberg, MD, MPH, PhD, E., Z. Bar-On, MD, MHA, D. Luft-Afik, MHA, M. Taragin, MD, MPH, and I. Ostfeld, MD, MA, MHA. “The Long-Term Consequences of 35 Years of Terror Attacks Against Civilians in Israel: Medical and Nonmedical Costs, Disability”. American Journal of Disaster Medicine, vol. 14, no. 3, Aug. 2019, pp. 167-73, doi:10.5055/ajdm.2019.0328.




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