Israel Defense Forces Research Articles

Long-Term Outcomes of Cricothyroidotomy Versus Endotracheal Intubation in Military Personnel: A Retrospective Comparative Analysis Cohort Study

IntroductionEmergency airway management is critical in trauma care. Cricothyroidotomy (CRIC) is a salvage procedure commonly used in failed endotracheal intubation (ETI) or difficult airway cases. However, more data is needed regarding the short and long-term complications associated with CRIC. This study aimed to evaluate the Israel Defense Forces experience with CRIC over the past 2 decades and compare the short-term and long-term sequelae of prehospital CRIC and ETI. MethodsData on patients undergoing either CRIC or ETI in the prehospital setting between 1997 and 2021 were extracted from the Israel Defense Forces trauma registry. Patient data was then cross-referenced with the Israel national trauma registry, documenting in-hospital care, and the Israel Ministry of Defense rehabilitation department registry, containing long-term disability files of military personnel. ResultsOf the 122 patients with short-term follow-up through initial hospitalization, 81% underwent prehospital ETI, while 19% underwent CRIC. There was a higher prevalence of military-related and explosion injuries among the CRIC patients (96% versus 65%, P = 0.02). Patients who underwent CRIC more frequently exhibited oxygen saturations below 90% (52% versus 29%, P = 0.002). Injury Severity Score was comparable between groups.No significant difference was found in intensive care unit length of stay and need for tracheostomy. Regarding long-term complications, with a median follow-up time of 15 y, CRIC patients had more upper airway impairment, with most suffering from hoarseness alone. One patient in the CRIC group suffered from esophageal stricture. ConclusionsThis retrospective comparative analysis did not reveal significant short or long-term sequelae among military personnel who underwent prehospital CRIC. The long-term follow-up did not indicate severe aerodigestive impairments, thus suggesting that this technique is safe. Along with the high success rates attributed to this procedure, we recommend that CRIC remains in the armamentarium of trauma care providers. The findings of this study could provide valuable insights into managing difficult airway in trauma care and inform clinical decision-making in emergency settings.

Role and importance of Egypt in regional geopolitics

The article analyzes the role and significance of the Arab Republic of Egypt in regional geopolitics at the present stage. The author pays special attention to the specific role of its armed forces, which not only perform tasks to protect the state from external threats and combat terrorism,but also take an active part in the internal political and economic life of the country. The peaceful nature of Egypt's foreign policy is emphasized, Cairo's desire to take part in the work of the UN, Arab League, AU, OIC, BRICS, EU, other international and regional organizations, and to maintain mutually beneficial relations with leading world powers, Israel, Arab, African and Asian countries on a bilateral basis. Diversifi cation of Egypt's foreign policy and foreign economic relations with foreign countries, maintaining a balance of interests of all countries interested in Egypt ensure stability and progressive development of the state in all areas. The author also points out the continuing objective diffi culties and even crisis phenomena in the Egyptian economy: infl ation, devaluation of the national currency, large external borrowings, youth unemployment, loss of income from the operation of the Suez Canal, the tourism industry, etc. The next serious test for the country was the tragic events in the Gaza Strip, when the Israel Defense Forces launched a large-scale military operation against the militants of the radical Islamist groups Hamas and Islamic Jihad (the latter is recognized as terrorist and is banned in Russia). The threat of an uncontrolled exodus of hundreds of thousands of refugees from this Palestinian exclave to the Sinai Peninsula requires vigilance and preventive measures from Egypt's security forces. Along with this, Egypt remains one of the leaders in the Middle East, Africa, and among Muslim countries. Cairo's emphatically independent foreign policy and neutrality in regional conflicts allows it to maintain strategic partnerships with the United States while simultaneously developing relations with Russia and China in all areas.

Architectures of Terror

International Relations theory, in spite of having undergone several epistemic iterations, continues to analyze urban warfare via outdated perspectives. This is exemplified in the state-centric analyses that dominate the literature on the history of Israel-Palestine. There is an overwhelming concentration on policy and belligerent behaviors and little to no consideration of anthropocentric perspectives. This results in a near-total exclusion of human suffering from discussions of the conflict and its impacts on everyday civilian life, which in turn heavily alters the socio-political foundations. The academic domains of critical theory and human geography have, however, made good progress in capturing the severity of these discourses, enabling a nuanced understanding of the manner in which conflict management takes place. This paper aims to unify these perspectives and in so doing, expand the grammar of realpolitik – identifying it as a competent domain of IR that primarily focuses on conflict and its modalities. Making use of diffractive reading and analysis, this paper showcases the impact of realpolitik from the perspective of those affected. The aim is to inject empathy into contemporary mainstream discussions that deal with complex geopolitical situations such as Israel-Palestine. To that end, post-structuralist perspectives from continental philosophy, human and critical geography and affect theory are employed. Additionally, the philosophy of realism is theorized to be the epistemic foundation of realpolitik, and is subsequently dissected. The paper concludes by arguing for interdisciplinary approaches into the existing subject matter of realpolitik, a re-evaluation of the epistemic foundations and reflections on practical novelties. Note that this paper in no way aims to suggest political solutions, legal interventions or strategic shifts, but rather interprets the methods of urban warfare used by the Israeli Defense Forces, which defies traditional operational logic.

The Israel-Hamas conflict: ‘You might not be interested in attrition, but attrition is interested in you’

ABSTRACT This article discusses the Israel-Hamas conflict, focusing on the ‘survive-win’ cycle and the concept of attrition in armed conflict. It highlights how power differentials between combatants – like Hamas and the Israeli Defense Force – lead to strategies like positional warfare and Fabian tactics, ultimately resulting in wars of attrition. Further, research illustrates that attrition is a fundamental aspect of conflict, challenging the idea that Western militaries should avoid the approach. Moreover, precision munitions in urban areas, such as Gaza City, still lead to significant casualties and collateral damage, urging a realistic acknowledgment of attrition in warfare.

‘Profiles in intelligence’: an interview with 8th Mossad chief Danny Yatom

ABSTRACT This article is based on an interview conducted in July 2023 with Danny Yatom, the eighth Mossad chief. He had a distinguished career in the Israeli Defense Force, joining the Mossad in 1996 after his military service. Yatom’s contributions were pivotal during the 1980s and 1990s, particularly in diplomatic engagements and peace negotiations between Israel and Jordan. With experience spanning elite military units, intelligence agencies, Prime Minister’s offices, and the Israeli Parliament, his insights offer a comprehensive understanding of intricate matters, making it the primary reason for my decision to interview Yatom. Among other topics, Yatom provided nuanced perspectives on Israel’s involvement in the Nagorno-Karabakh conflict, its relations with Azerbaijan, the special ties between Israel and Germany, and the 1979 Islamic revolution. I also inquired about the impact of emotions on decision-making in national security, the historical trajectory of the Mossad, and Israel’s approach to Official Public Intelligence Disclosure.

The 7 October Hamas Attack

On 7 October 2023, Palestinian militants led by Hamas launched a complex coordinated attack on Israel from the Gaza Strip, triggering an Israeli ground invasion combined with an aerial bombing campaign. The Hamas fighters killed around 1,200 people and took more than 250 hostages, while the death toll from Israeli military operations in the Gaza Strip exceeded 31,600 in mid-March 2024. The Hamas attack not only shocked the whole world but also caught most people by surprise. Probably only a few could have imagined that the Palestinian organisation that controls the Gaza Strip could carry out such an attack on Israel. Following 7 October, several questions arose. Why Israeli intelligence could not predict the attack, and why did security and defence forces not react in time? The Israeli Government promised a full investigation once the Gaza ground offensive launched in response to the attack was over. But even without knowing more details of the events, we might still be able to provide a preliminary assessment of the surrounding Israeli intelligence failures based on the reports and accounts made public in the international media. Three months after the attack, the publicly available information showed that the Israel Defense Forces were unprepared and there was no battle plan in place in case Hamas militants broke out of the Gaza Strip with large forces. Clarifying what happened will be crucial not only to learn from the mistakes, but also because other actors or adversaries can learn from Hamas and copy its tactics.

Analyzing the Capacity of the Healthcare System in Gaza to Address Gaza Residents Needs

The present humanitarian crisis in Gaza has resulted in the devastation of medical facilities and health infrastructure. As of January 2024, the World Health Organization reports that 78% of primary care clinics funded by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA, 2024) have ceased operations, and hospitals’ bed capacity throughout Gaza has decreased by more than 59% (World Health Organization, 2024). Direct military attacks on medical facilities as well as the blockade of medical supplies and humanitarian aid pose the largest obstacles to greater healthcare attainment in Gaza (IRC, 2024). Over the course of the conflict, there has been a surge in the number of people suffering from war injuries, which now totals 71,377 (Shurafa, 2024). The rise in the number of patients who require access to medical services in combination with the limited hospital functionality in the Gaza Strip is putting a massive strain on their already limited healthcare system; before the over 6 month long duration of direct military attacks by the Israeli Defence Forces (IDF) on hospitals in Gaza, data indicated a maximum ratio of 1.55 hospital beds per 1000 individuals across the entire region of the Gaza Strip, while the ratio in the US is around 2.35 hospital beds per 1000 individuals (Taylor, 2024). The already poor living conditions of the demographic–most of whom are housed in temporary structures in severe weather conditions with a lack of access to food and water for sustenance or hygiene–signify a need for a more robust healthcare system. However, triage conditions prioritize treatment of the most severe war injuries, which has forced hospitals to abandon previously established vaccination projects and disease surveillance programs, leaving the remaining population to suffer from preventable diseases such as chickenpox, upper respiratory infections, scabies, and Hepatitis A (Soni, 2024). Individuals who do receive medical care face higher levels of infection due to a lack of adequate sanitation, waste management measures, and basic hygiene supplies (The Economist, 2024).

"Caught in the crossfire" - women veterans' testimonies regarding excessively violent acts committed in combat zones.

As women in the Israeli Defense Forces (IDF) are increasingly placed in supportive and combat roles in active war zones, they routinely encounter and participate in violent acts. This study focusses on the centrality of gendered inequality and oppression as a factor that shapes not only women's experience in the military but also their responses in cases of excessive violence. The goal of this study was to explore the ways women veterans of combat or combat-support units conceptualize their stance regarding violent acts which they either committed or witnessed in war zones. Using a qualitative approach, we analyzed the retrospective testimonies of 58 Israeli women veterans from the archives of an NGO that documents veteran combatants exposure to excessive violence. Most women explained their violent acts as inherent to the military system and culture, which in our analysis was categorized as examples of either internalized gender oppression or as identification with the aggressor. A smaller number of women described their attempts to protest, as they took a moral stance rooted in a feminine perspective. The three explanations revealed through the analysis of the testimonies reflect the inner tension experienced by many women in the military, as they navigate between two extreme positions, either as victims of male dominance, or as aggressors that are part of a powerful military system. In this study, gendered inequality provides a framework for analyzing the data. Thus, this study contributes to the theoretical knowledge and methodological approaches concerning violent situations in combat areas, focusing on the various ways in which women veterans subjectively and retroactively conceptualize their participation in and responses to violent acts.

SISTEM PERTAHANAN ISRAEL DALAM MENGHADAPI PERKEMBANGAN KEAMANAN NASIONAL

Israel was founded on May 14, 1948, with a declaration made by David Ben-Gurion. Since its founding, Israel has often faced external threats from other countries, such as Egypt and Jordan. As time goes by, Israel manages to reach peace agreements with its neighboring countries. It turns out that the external threats does not stop. Now, Israel needs to face threats from non-state actors such as Hamas and Hezbollah. Apart from that, developments in international relations have impacted the strategies for achieving national security. This research employs two theories: National Security with three key concepts and Civil-Military Relations with three key concepts. The research utilizes a qualitative method, including literature studies and internet-based research for data collection. This research aims to identify Israel's civil-military relations in facing non-traditional threats to ensure its national security. The results indicate that civil-military relations in Israel, integrated into the democratic system model, have successfully adapted to developments in national security. However, based on the findings of this research, there is no Israeli document in the form of a Defense White Paper serving as a basic constitution for dialogue between the government and the Israel Defense Force (IDF).

The Lubrani Connection: Revisiting Israeli-Druze Relations in Lebanon’s 1983 War of the Mountain

ABSTRACT This article ponders Israeli-Druze relations during Lebanon’s 1983 War of the Mountain in light of derestricted sources pertaining to the Robert C. McFarlane mission in Lebanon. After the assassination of the Lebanese President-elect Bashir Gemayel in September 1982 and the rise to the presidency of his brother Amine, Israel’s relations with Lebanon’s Christians soured. By contrast, Israel’s connections with the Lebanese Druze intensified, and the Israeli Prime Minister Menachem Begin threatened to establish a “Druze Canton/Israeli Protectorate” in the Shuf-Aley region. Ostensibly, Walid Jumblatt, the leader of the Druze community, allied himself during the Lebanese Civil War with the Palestine Liberation Organization (PLO) and Syria. Untapped diplomatic documents show, however, that Jumblatt also courted Israel and developed ties with the Menachem Begin administration. Uri Lubrani, an Israeli official who recruited members of Israel’s Druze community to serve in the Israeli Defense Forces (IDF) in the 1950s, played an important role in developing Israel’s ties with Jumblatt. In this paper, I flesh out the dynamics of Israel’s discrete relations with Lebanon’s Druze community and their implications on the trajectory of the Lebanese conflict.

Damage to medical complexes in the Gaza Strip during the Israel–Hamas war: a geospatial analysis

IntroductionMedical facilities are civilian objects specially protected during armed conflict by international humanitarian law (IHL). These protections are customarily applied regardless of the conflict, parties or contexts involved. Attacks on...

Hemorrhagic Shock in Isolated and Non-Isolated Pelvic Fractures: A Registries-Based Study

Background Pelvic fractures resulting from high-energy trauma can frequently present with life-threatening hemodynamic instability that is associated with high mortality rates. The role of pelvic exsanguination in causing hemorrhagic shock is unclear, as associated injuries frequently accompany pelvic fractures. This study aims to compare the incidence of hemorrhagic shock and in-hospital outcomes in patients with isolated and non-isolated pelvic fractures. Methods Registries-based study of trauma patients hospitalized following pelvic fractures. Data from 1997 to 2021 were cross-referenced between the Israel Defense Forces Trauma Registry (IDF-TR), documenting prehospital care, and Israel National Trauma Registry (INTR) recording hospitalization data. Patients with isolated pelvic fractures were defined as having an Abbreviated Injury Scale (AIS) <3 in other anatomical regions, and compared with patients sustaining pelvic fracture and at least one associated injury (AIS ≥ 3). Signs of profound shock upon emergency department (ED) arrival were defined as either a systolic blood pressure <90 mmHg and/or a heart rate >130 beats per min. Results Overall, 244 hospitalized trauma patients with pelvic fractures were included, most of whom were males (84.4%) with a median age of 21 years. The most common injury mechanisms were motor vehicle collisions (64.8%), falls from height (13.1%) and gunshot wounds (11.5%). Of these, 68 (27.9%) patients sustained isolated pelvic fractures. In patients with non-isolated fractures, the most common regions with a severe associated injury were the thorax and abdomen. Signs of shock were recorded for 50 (20.5%) patients upon ED arrival, but only four of these had isolated pelvic fractures. In-hospital mortality occurred among 18 (7.4%) patients, all with non-isolated fractures. Conclusion In young patients with pelvic fractures, severe associated injuries were common, but isolated pelvic fractures rarely presented with profound shock upon arrival. Prehospital management protocols for pelvic fractures should prioritize prompt evacuation and resuscitative measures aimed at addressing associated injuries.

Refusal to serve in the Israel Defense Forces reserves in an era of anti-democratic judicial reform

ABSTRACT In Israel, most citizens are obligated to serve in the military for a mandatory period and subsequently in the reserve forces for about 21–45 days per year up to the age of 44. Many veterans continue to serve in the reserves for even longer periods. However, uncharacteristically, during 2023, reservists were linked to the social protest in Israel. The ever-widening public protest in Israel was unprecedented. Every Saturday night, from January 2023 until the War of October 7th began, 5–10% of the Israeli population headed out to demonstrate in the streets of various cities and regions against the anti-democratic legislation that was under consideration or had been passed. Among the protesters were many citizens serving in the reserve forces. These opponents of government policy voiced their protest, saying loud and clear that if the legislation continued, they would not serve, unless a war would erupt; indeed, many of them had already quit the reserves only to rejoin when the October War started. And thus, without intending to do so, the army has become a political player in the political struggle currently taking place in Israel. The wide-ranging protest in Israel and the massive number of reservists who had voiced a decision not to show up for reserve duty are indications of an unprecedented social phenomenon that is worthy of scholarly attention. How do we, as critical scholars, put an identity on the military? How do we interpret situations in which the military is more democratic than the government?

Associations Between Prematurity, Birthweight, and Adolescence Blood Pressure in a Nationwide Cohort

Prematurity is associated with incomplete nephrogenesis and an increased incidence of acute kidney injury, that may increase the risk of future kidney disease, including hypertension, proteinuria and reduced glomerular filtration rate. The aim of this study was to evaluate the risk of hypertension or proteinuria in adolescents born prematurely or small for gestational age, in a nationwide cohort. The study cohort included potential recruits examined in the Israel Defense Forces (IDF) medical facilities, between November 2005 and October 2018. Clinical and anthropometric data, including blood pressure (BP) measurement, were retrieved from the IDF medical files. Adolescents born between January 1993 and December 2000 had additional data on gestational age at birth, retrieved from the Israeli Ministry of Health database. The study cohort included 513,802 participants, aged 17.3 ± 0.9 years, of whom 48,994 had gestational age data. Adolescents born as very preterm, as extremely preterm infants, those born with very low birthweight (VLBW), or with extremely low birthweight (ELBW) had higher incidence of hypertensive-range BP (55%, 47%, 19% and 12%, respectively). No significant association between birthweight (BW) adjusted to gestational age and hypertension was observed. Within the overweight and obese adolescents, those born with VLBW and ELBW, had further increased hypertensive-range BP rate. Proteinuria was diagnosed in 0.33% of the study cohort, with no significant difference between BW or gestational age categories. Adolescents born with VLBW or as significant preterm were associated with high BP and should be monitored for hypertension development and its potential complications.

Military AI, sacred violence, and war in the Middle East

Israel’s commitment to a policy of collective punishment, disproportionate response, outright assassination and ethnic cleansing are the culmination of a long process. It has its origins in the expropriations organized by colonial powers, as does the state of Israel itself, but the proximate causes are the recent turn in politics to Biblical Jewish fundamentalism and an irrational enthusiasm for new military technologies, especially AI. These have led to important changes in official Israeli Defense Forces (IDF) policies, including a fundamental degradation of their ethical code.

The Role of Social Systems in Absorption of Immigrants in Israel

Immigrants from the Former Soviet Union (FSU) are the largest ethnic unit to have arrived in Israel and, as such, have had a major impact on Israeli society in cultural, social and demographic terms. The manner in which the immigrants were absorbed in social institutions influenced the adaptation strategies they adopted, which changed over time.&#x0D; The research is aimed at examining the extent to which the immigrants have, according to their perception, adapted to the social frameworks, based on their experiences in connecting with the local population through the educational system and the Israel Defense Forces (IDF). The research is a qualitative one, in the framework of which interviews were conducted with 28 immigrants who had immigrated to Israel as children and adolescents.&#x0D; The immigrants developed adaptation strategies which changed as they transitioned from the educational system to the military framework, and subsequently settled into civilian life.

Deploying whole blood to the battlefield-The Israel Defense Forces Medical Corps initial experience during the 2023 war.

Military and prehospital medical organizations invest significant resources to advance the treatment of trauma patients aiming to reduce preventable deaths. Focus is on hemorrhage control and volume resuscitation with blood products, with adoption of Remote Damage Control Resuscitation (RDCR) guidelines. The Israel Defense Forces Medical Corps (IDF-MC) has been using tranexamic acid and freeze-dried plasma (FDP) as part of its RDCR protocol for more than a decade. In recent years, low-titer group O whole blood (LTOWB) has been integrated, on IDF evacuation helicopters and expanded to mobile ambulances, complementing FDP use in treating trauma patients in state of profound shock. During the war that erupted in October 2023, the IDF-MC made a decision to bring LTOWB forward, and to equip every combat brigade level mobile intensive care units with LTOWB, onboard armored vehicles. The goal was to make whole blood available as close as possible to the point of injury and within minutes from time of injury. We describe the IDF-MCs' efforts to bring LTOWB to the front lines and present four cases in which LTOWB was administered. All patients were young male, with significant blood loss following penetrating injuries. One patient died in the operating room, following hospital arrival and emergency thoracotomy. The others survived. Our initial experience with bringing LTOWB as close as possible to the point of injury during high intensity fighting is encouraging, showing patient benefit along with logistic feasibility. After action reports and data collection will continue.

"In the army I'm no longer typecast as the son of migrant workers": modalities of inclusion and belonging among children of migrant workers in the military in Israel.

This article explores how non-citizen minorities experience military service, focusing on children of international labor migrants who served in the Israel Defense Forces. During the 1990's, Israel witnessed an influx of migrant workers, primarily from the Philippines, Latin America and Africa. However, due to Israeli immigration policies, neither they nor their Israeli-born children were eligible for citizenship. Consequently, upon reaching the age of 18, unlike their Israeli peers, these children were not recruited into the army. Furthermore, they lived under constant threat of deportation. Due to advocacy by civil society organizations, in 2006 and 2010 the government granted civic status (permanent residency) to approximately 1,500 children. This made them eligible for military service, a somewhat unique situation globally. Upon completion of their first year of military service, they were eligible for Israeli citizenship and their immediate family members were eligible for permanent residency. Through qualitative and quantitative research, we examine inclusion and belonging amongst children of migrant workers who served in the military. Our findings suggest that military service enabled them to overcome the exclusionary boundaries they experienced as children in three ways. Firstly, they achieved formal belonging by receiving citizenship. Secondly, they achieved informal belonging through the cultural and social capital this service accrued within Israeli society. Finally, for some, military service deepened their knowledge of Judaism and, in certain cases, led to conversion, thus fostering religious belonging. These three aspects facilitated inclusion and a sense of belonging for these formerly marginalized children while also enhancing their legitimacy within Israeli society. This unique case study contributes to ongoing global debates about the experiences of minority groups in the military.

Suspending Voluntary Reserve Service: New Questions in Israeli Military Ethics

Military activities with the framework of the IDF [Israel Defense Force] is carried out by citizens in a variety of positions. In addition to the ordinary positions of career officers and NCOs, the IDF consists of conscripted men and women as well as reservists. Some of the latter serve under an ordinary command to serve for a certain relatively short period. Other reservists, including pilots and special forces officers have served since they volunteered to serve. Facing the political clash between the government, who have been viewed as trying to change the democratic nature of the state, and the popular opposition, who have tried to protect the judiciary and other elements of democracy, many officers who belong to the latter reservist group have suspended their voluntary service or even retired. Their decision has raised the obvious issue of whether such decisions can be justified, morally, ethically, and democratically. This is the topic of the present paper.

From Plan Gideon to Plan Tnufa: Israeli defense strategy and the buildup of the Israeli Defense Forces in the wider context of the Middle East after the Arab Spring

Based on the content analysis method, this study analyzes the first ever published security strategy of the Israel Defense Forces, which was published in 2015. The main objective of the paper is not only to present the circumstances of its creation and discuss the main objectives of this strategic security document, but also to outline the broader geopolitical context from which it emerged. The authors argue that the document primarily emphasized two areas - the use of force and capacity building of the Israeli military. Among other things, the publication of the strategy was intended to have a deterrent effect. In the conclusion, the authors compare the Gideon Plan and its follow-up, the Tnufa Plan, and point to the considerable importance that consensus among political and military elites has in the implementation of such a document and reflect on what lessons and inspiration can be drawn from this case in our geographic space in the process of formulating or reformulating strategic security documents.