PTSD after the war with Iran —
what are you entitled to?

The war with Iran was unlike anything we had known. There was no “front line” and no area more protected than another — ballistic missiles were aimed at the centre of the country, at the north and at the south alike, and the sirens woke whole families in the middle of the night again and again. Millions of Israelis lived through weeks of running to the safe room, of waiting in a protected space without knowing what was happening outside, and of difficult news at every hour.

Now that the sirens have fallen silent, many are discovering that something inside has not gone back to how it was: difficulty falling asleep, constant hypervigilance, alarm at every sudden noise, avoiding leaving the house, difficulty functioning at work. What many people do not know is that this condition is recognised by the National Insurance Institute — and even people who were not physically injured at all may be recognised as hostile-action casualties and receive treatment, benefits and entitlements.

In this article we explain what is distinctive about this war from the point of view of recognition, what “indirect injury” means and why many people have never heard of it, which signs justify a check, and how to start the process.

Why this war created so many anxiety casualties

In “classic” hostile actions the circle of casualties was usually local — a town, a street, a defined event. The war with Iran changed that picture: barrages of ballistic missiles were aimed at populated areas across the whole country, the warning time was short, and the force of the blast and the noise were felt at great distances from the point of impact itself.

That means the circle of people exposed was far wider than usual — and accordingly, so is the number of people developing anxiety reactions and PTSD. According to National Insurance Institute figures, hundreds of civilians applied for recognition as hostile-action casualties in the early stages of the operation alone, and a substantial proportion of them were not physically injured at all.

“Indirect injury” — the category many people miss

This is perhaps the most important point in the article. Many people are convinced that if the missile did not hit them directly, they have nothing to claim. In practice, recognition also applies to injuries caused as a result of the event:

• People who fell, tripped or were hurt while running to the protected space
• People injured by glass shattered by the blast wave
• People who suffered a cardiac event or felt unwell during a siren
• People who suffered shortness of breath or an acute panic attack because of the stress
• People injured in an accident or knocked about during an emergency evacuation

All of these may count as an injury in the course of a hostile action — with all the accompanying entitlements. If any of these descriptions reminds you of something that happened to you or a family member, that is reason enough to check your eligibility.

The signs to look out for

An immediate anxiety reaction during a siren is entirely normal. What justifies a check is when the symptoms persist after the events have ended and damage your functioning:

• Difficulty falling asleep, broken sleep or recurring nightmares
• Hypervigilance and an exaggerated startle response to noises — a door slamming, a motorbike, a horn
• Recurring thoughts or “flashes” of the events
• Avoidance: not leaving the house, not going far from a protected space, not travelling
• Irritability, a short fuse, outbursts that are out of character
• Difficulty concentrating, a decline in functioning at work or in studies
• Emotional detachment, apathy or a sense of “floating” away from reality
• Physical symptoms with no medical explanation — stomach pain, chest tightness, dizziness

Why does it erupt only now?

One of the most common questions is “if I got through the war all right, why is it hard for me now?”. The answer lies in how the mind copes: during the event itself the system is mobilised for survival and functioning. Only when the pressure drops — when routine returns and there is no longer anything to “survive” — do body and mind begin to process what happened.

That is why PTSD often appears weeks or even months later, and why it is sometimes set off by an apparently small trigger. The fact that the symptoms appeared late does not rule out entitlement — but it does require medical documentation explaining the sequence of development.

Initial psychological treatment — even before recognition

A point many people are unaware of: there is no need to wait for the recognition process to finish in order to get help. The National Insurance Institute provides people suffering anxiety following a hostile action with initial psychological treatment — a course of sessions provided free of charge, so that help is available at the stage when it is most effective.

Alongside that, the health funds run mental health support lines, and there is a dedicated helpline for people with PTSD operated by the National Insurance Institute and the NATAL organisation, available around the clock. Seeking treatment is not only a positive step in itself — it also creates exactly the medical documentation the committee will need later on.

Many people put off seeking help, thinking “it will pass on its own”. Sometimes it does — but when the symptoms persist for weeks and affect sleep, work or family life, waiting longer only makes things harder. From the point of view of entitlement, every month that passes without documentation is a month that is harder to explain to the committee after the fact.

How recognition and entitlement are determined

After the claim is filed, recognition as a hostile-action casualty is assessed, and after that the psychological disability percentages are set by a medical committee — under the psychological impairment sections, according to the severity of the disorder and its effect on functioning. The structure of entitlement on the hostile-action casualty route:

• 0%–9% — no entitlement to payment (and it can be appealed)
• 10%–19% — a one-off grant
• 20% and above — a fixed monthly benefit

Beyond the benefit itself, recognition opens a package of entitlements: funding for psychological treatment and medication, reimbursement of medical expenses, vocational rehabilitation for people whose career path was disrupted, and further entitlements for family members in certain cases.

It is worth knowing in advance: PTSD claims are considered complex, and they take longer to process than a claim for a simple physical injury — sometimes several months, and sometimes involving more than one committee. That does not indicate a problem with your file; it is simply the nature of the process.

Documentation — what decides the outcome

With a physical injury there is an image or a visible finding. With a psychological injury, the documents are everything, because the committee cannot “see” the anxiety. What matters to collect:

• A professional psychiatric or psychological assessment documenting the disorder and its connection to the events of the war
• Treatment summaries and continuity of treatment over time — not a single visit
• Prescriptions and documentation of drug treatment, where given
• Documentation of your first approach for help — an emergency line, the health fund, an emergency room
• Sick notes or documentation of absence from work
• A detailed description of the effect on functioning: at work, in the family, in the daily routine

If you live in an area that was attacked, or from which you were evacuated, it is also worth keeping documentation tying you to the place and time: evacuation confirmations, hotel documents, a letter from the local authority.

Who else may be entitled

• Evacuees — people forced to leave their homes, including children who experienced prolonged displacement
• Family members — of casualties, in certain cases
• Eyewitnesses — people present at the scene of an incident or who saw its aftermath
• Rescue services and volunteers — who were exposed to difficult scenes
• People who were abroad — Israelis injured by a hostile action outside the country as well

Common mistakes that come at a cost

• “I am fine, others suffered more” — comparing yourself with people who were hurt more badly stops people applying. Entitlement is assessed on your situation, not on someone else’s.
• Waiting for it to pass by itself — the earlier treatment starts, the better the chances of recovery, and the better the documentation is built.
• Playing it down at the committee — many people “pull themselves together” in front of the doctor out of pride. Describe the difficult day, not the good one.
• Describing symptoms without functioning — not “I have anxiety” but “I cannot sleep more than two hours, I have stopped driving to work”.
• Giving up after a refusal — every decision carries a right of appeal, and in many cases that is exactly where the outcome changes.

What to do now — step by step

If you recognise yourself in the descriptions above, this is the logical order:

• 1. Seek treatment. Your family doctor, your health fund or a mental health support line. This is the most important step — both for recovery and as the basis for documentation.
• 2. Ask for a professional assessment. A psychiatrist or psychologist who will document the diagnosis and its connection to the events of the war.
• 3. Gather the material. Every medical document from the period of the war onwards, sick notes, evacuation documentation.
• 4. File a claim for recognition as a hostile-action casualty on the appropriate route.
• 5. Prepare for the committee. Know in advance what you will be asked, what to present and how to describe the effect on your functioning.
• 6. And if you are refused — consider an appeal within the deadline given in the decision letter.

At every one of these stages you can be supported by someone who knows the system — so that the bureaucracy does not land on you during a period that is already hard.

You do not need shrapnel to be injured. What you are experiencing after the war is real, it is recognised in law — and there are rights that go with it.

In summary

The war with Iran exposed millions of people to an experience that left its mark — and even those who came out of it without a scratch may be carrying a real psychological injury. PTSD and anxiety are recognised by the National Insurance Institute as a disability in every sense, and they entitle you to treatment, benefits and accompanying rights. The injury does not have to be direct, does not have to appear immediately, and does not require you to prove that you suffered more than anyone else.

If you recognise yourself in the descriptions in this article, the first step is to see a professional, both for your recovery and for the documentation. And from there, it is worth checking exactly what you are entitled to.