When missiles rained down on northern Israel from Lebanon six years ago, surgeons at Rambam Hospital in Haifa worked, terrified, on the building’s eighth floor.
Earlier that summer, missiles had struck just 20 yards away, endangering the staff and patients of the area’s largest hospital and the central facility for treating soldiers injured in the fighting.
“There wasn’t even a bomb shelter because we thought they’d never bomb a hospital,” said David Ratner, Rambam’s spokesman. “We weren’t ready. The message we got was that we needed to become a hospital that could treat people under attack.”
The experience has pushed Rambam’s wartime operating room a dozen stories down, to the third level of an underground parking garage that will become, should bombs fall again, one of the world’s largest emergency hospitals. At 645,000 square feet, the three stories will house 2,000 medical stations — enough to care not only for those wounded physically or psychologically from the war zone, but also for the most critically ill inpatients and outpatients needing regular treatments like dialysis.
“This changes us from a laid-back hospital to a machine,” said Ratner. “People aren’t going to stop having babies” during a war.
As tensions between Iran and Israel heat up, and amid fears that Syria’s civil war could spill over into Israel, Israeli cities and institutions like Rambam are planning for a potential repeat of the missile fire seen during Israel’s 2006 war with Hezbollah.
Any war with Iran is expected to prompt retaliatory strikes by Hezbollah, the Iranian proxy militia in Lebanon, and possibly by Hamas, which controls Gaza and has received funding and weaponry from the Islamic Republic.
In 2006, northern Israel was caught largely unprepared for war. The region had enjoyed relative quiet since Israel’s 2000 withdrawal from southern Lebanon. But more than 4,000 missiles were fired at Israel during the 34-day war, prompting massive numbers of residents to flee their homes and leaving 163 Israeli soldiers and civilians dead. On the Lebanese side, there were more than 1,000 dead.
In the six years of quiet that have followed, area residents say they have remained on guard.
Nahariyah, a northern city less than 10 miles from the Lebanese border, suffered hundreds of rockets and two deaths in the 2006 war. Since then, the city has improved its emergency services by renovating its bomb shelters and implementing its part of a national attack alert system. Nahariyah’s hospital, like Rambam, has an emergency underground wing.
Security officials in the north credit Israel’s streamlined Home Front Defense Ministry, part of the Defense Ministry, for spearheading improvements, including the national alert system, drills to prepare for crises, and improved oversight and evaluation of emergency preparedness.
In mid-September, the Israel Defense Forces conducted a surprise drill in the Golan Heights simulating a response to an attack there. And on Oct. 21, the National Emergency Authority, a division of the Home Front ministry, ran a national disaster simulation drill that included the interruptions in communication and mobilization of forces that would take place during actual hostilities.
American Jewish communities have supported the emergency body’s efforts through the Jewish Federations of North America. Since 2006, U.S. Jewish federations have raised $350 million for the north, much of it used to renovate bomb shelters: for air conditioning, light fixtures, water coolers, toilets and television sets in the underground spaces. The funding also has provided for social, economic and educational programs.
Some Israeli politicians still worry the country is unprepared for war, and they’ve been critical of Prime Minister Benjamin Netanyahu for seeming to move the country closer to an attack while Israeli cities are left exposed. Bomb shelters in northern Israel can hold only 60 percent of the local population, and almost half of Israelis do not own gas masks.
“Israel has failed to learn from the Second Lebanon War,” said Ze’ev Bielski, chairman of the Knesset’s Subcommittee for the Examination of Home Front Readiness, according to the Times of Israel. “The bomb shelter situation is still dire for millions of Israelis.”
But Meir Elran, director of the Homeland Security Program at Israel’s Institute for National Security Studies, said that while the number of bomb shelters is not ideal, the situation is manageable because people will be safe as long as they remain inside a building. Building bomb shelters for every citizen would cost too much money and take too much time, he said.
Sometimes, Elran suggested, the best defense is a good offense.
“The shorter the war is and the more severely the other side will be hurt,” he said, “the better it will be for Israel.”