“The impacts in central Haifa are very close to the hospital. It feels like Russian roulette,” said Ahuva Tal, head nurse at Clalit Health Services’ Carmel Medical Center in Haifa, in an interview with JNS on Monday, a day before a two-week ceasefire paused 40 days of war against Iran.
Carmel Medical Center, which has a capacity of 500 beds, began evacuating some patients on Feb. 28, when Israel and the United States launched a joint attack against Iran. Some patients were transferred to Rambam Medical Center, also in Haifa, which has an underground compound, while others were moved to lower floors and protected areas within Carmel.
Hospital staff determined which patients could be discharged and which required continued hospitalization. Approximately 100 patients were transferred from Carmel to Rambam in ambulances under rocket fire on the first day of “Operation Roaring Lion.”
“One must remember that we sent them to a parking lot that needed to be converted into a field hospital. One team at Carmel sent the patients, and another team at Rambam received them,” Tal said.
The transfer began at 9 p.m. on Feb. 28 and was completed by 4 a.m., with 70 ambulances shuttling back and forth between the medical centers. Beyond the security risks, Tal noted the logistical challenges of transporting patients to a new facility and helping them adjust to being treated in an underground parking structure.
At Rambam’s underground compound, each patient is assigned a designated space corresponding to a numbered parking spot. The arrangement eliminates the need for patients to move repeatedly to protected areas during rocket alerts.
Tal noted that residents in northern Israel face two types of alerts—one providing four minutes to reach shelter and another offering only one minute. “We don’t always succeed when the missile comes from Lebanon, which is relatively close, to reach protected spaces in time,” she said.
Haifa has sustained repeated impacts. On Sunday, an Iranian missile struck a residential building, killing four people. The apartment of Professor Lena Sagi-Dain, director of the prenatal genetic service at Carmel, was destroyed in that attack. She was home at the time. A nurse at Carmel who lives in Kibbutz Shomrat, north of Haifa, lost her home to a UAV strike on Sunday.
Staff members often carry blankets in their cars in case they are unable to reach shelter and must lie on the side of the road during alerts.
“We have people on my team from Fassuta, on the border with Lebanon, and from Deir al-Asad, which is also very close to the border. They don’t have safe rooms in their homes, and they leave their families to come to work,” Tal added.
To maintain morale and support staff under sustained stress, the hospital offers treatments such as massages and counseling. Some staff members are also coping with having loved ones serving on the front lines.
“Whoever doesn’t live here can’t understand how complicated it is to maintain a routine in this chaos,” said Dr. Tamar Etzioni-Friedman, head of the Quality and Patient Safety Unit at Carmel, in an interview with JNS on Sunday.
The hospital has created a framework for staff to leave their children on-site, as schools often do not operate during wartime.
Medical centers such as Carmel aim to function with minimal personnel to reduce the risk to staff traveling under fire, though some employees still commute up to an hour and a half amid rocket and missile attacks, Etzioni-Friedman said.
Challenging situations have arisen, including cases in which patients experience acute medical emergencies as air-raid sirens sound. “Teams are stuck in protected spaces. The required team for a specific emergency may be on one floor while the patient is on another,” she said. “We created a protocol for this scenario and continuously update our wartime procedures based on field experience.”
In such cases, medical staff may be required to perform tasks outside their usual roles,” she said.
In the underground hospital ar Rambam, patients and staff rarely see daylight, with some doctors working shifts of up to 26 hours. “It’s a parking structure, with all the stress that entails, and routine tasks become much more complex,” she said.
Facilities are basic: showers resemble beach-style installations with limited privacy, separated by curtains.
Siren alerts have become background noise, even during complex medical procedures.
Etzioni-Friedman said that while Israel’s public healthcare system includes public and private institutions that may compete in routine times, such rivalries are set aside during war, with hospitals working in coordination to provide optimal care.
During wartime, medical teams prioritize emergency care, though essential treatments—including for cancer patients and women requiring Caesarean sections—continue as needed.
Carmel also implemented and continually updates mass-casualty emergency protocols, including scenarios involving missile strikes near or on the hospital, as well as chemical attacks.
Both Tal and Etzioni-Friedman emphasized that the hospital’s most critical resource is its personnel, enabling facilities such as Carmel and Rambam to maintain services under wartime conditions.
Hanan Beker, 81, a dialysis patient at Carmel, was among those transferred to Rambam.
“Dialysis is something sacred. Once it starts, it cannot be interrupted,” Beker told JNS.
“They did something very good by moving us to Rambam. Once you begin dialysis, you have to finish. Being underground gave us a significant advantage,” he said.
Describing his transfer to Rambam, Beker said he felt safe. “The ambulance driver is a paramedic with clear instructions. He knows what to do if there is an air raid siren—stop, get out, and assist patients who need help,” he said.
After completing his twice-weekly three-hour dialysis sessions, Beker is driven home by ambulance.
“This hospital truly cares for its patients, from the head nurse to the doctors on call,” he said.
