Impact of prolonged armed conflict on the patterns of emergency department visits.

backgroundArmed conflicts disrupt health services in nearby regions. While the impact of short-terms wars on hospital activities has been studied, long-term effects of wars on Emergency Department (ED) patterns remain unclear. This study assessed the effect of conflict, followed by organizational changes within the hospital and population evacuation on the profile of ED visits near a war zone.

methodsA time-series analysis was conducted at Galilee Medical Center (GMC), 10-kilometers from Israel’s northern border. Since the onset of Israeli-Hamas war on October 7th, 2023, GMC has operated under missile attacks. Organizational changes were implemented to prepare for mass casualty incidents (MSI) and protect patients and staff. Conflict period (7/10/2023-26/11/2024) was compared with preceding year. Post-ceasefire interval (27/11/2024-6/2/2025) was compared to corresponding pre-conflict period to assess return-to-routine trends. ED data for adult (≥ 18) and pediatric (0–17 years) were extracted from hospital records. Wilcoxon-Mann-Whitney, Poisson, Chi-square tests, with relative-risk confidence intervals were calculated; significance was set at p < 0.05.

resultsDuring conflict period adult ED visits dropped by 13.5% compared to pre-conflict period. Children visits showed sharper decline of 19.5%. ED visits of both adults and children showed partial recovery during post-ceasefire period. The proportion of patients from evacuated localities decreased during the conflict. Among children, urgent visits (triage level 1–3) increased by 80% (RR 1.8 [95% CI, 1.72–1.89; p < 0.0001]), whereas non-urgent visits (triage level 5) decreased by 36% (RR 0.64 [95% CI, 0.63–0.66; p < 0.0001]). ED and Pediatric ED performance metrics improved during the conflict period, though changes weren’t clinically meaningful. Adults’ admission rates decreased by 36% (RR 0.64 [95% CI, 0.63–0.65; p < 0.0001]), and by 35% among children (RR 0.65 [95% CI, 0.62–0.68; p < 0.0001)]. The proportion of in-hospital adult mortality increased during the conflict (RR 1.4 [95% CI, 1.38–1.43; p < 0.0001]).

conclusionsED utilization declined, especially among children, with greater reductions during uncertainty than actual threat. ED performance metrics sustained organizational adaptations, while reduced hospitalization rates were caused by underground operations and preparedness for MSI. The rise in pediatric urgent cases during the conflict, warrants further investigation to better understand underlying causes and plan intervention for future crisis.