Wars keep two sets of books. The first counts the dead, and it is kept loudly. On 7 October 2023, about 1,200 people were killed in the Hamas-led attacks on villages and army outposts in southern Israel. In the three years since, Israel’s assault on Gaza has killed more than 74,000 Palestinians and left the territory almost uninhabitable, in a campaign of destruction that a UN commission of inquiry has concluded amounts to genocide. That first ledger has been written out at length.

The second set of books is quieter. It sits in health-fund databases and parliamentary tables, and it records what war does to the people who live through it without being killed. As Israel marked the third anniversary, Caolán Magee, writing for Al Jazeera, put that ledger in front of psychiatrists. Their verdict: Israeli society goes on functioning, but beneath the surface the attacks, the war and the missile strikes have piled strain upon strain. More children with PTSD. More adults who cannot manage ordinary life. More soldiers taking their own lives.

The children

The plainest figure comes from Clalit Health Services, Israel’s largest health fund. Its report, released on 4 October, examined the records of about five million members from October 2023 through September 2026 and set them against the two years before the war. Among adults, psychiatric emergency visits barely moved. Among children and teenagers, according to The Times of Israel, they rose 78.3% in the second year of the war and 121.3% in the third.

More than double. And the curve was still climbing in year three, long after the first shock.

The surrounding numbers point the same way. Pediatricians’ referrals to mental health services rose by 52.1%, and anxiety diagnoses among children rose by 40 to 70%, Ynetnews reported. Among children evacuated from the south, prescriptions for bed-wetting medication rose by 47.8%. One caution belongs here: as i24NEWS noted, the report counts visits, not individual patients, so it cannot say how many young people came, how many came back, or with what.

One reading, offered only as reflection: adults can hold themselves together for a time, sometimes because they must. Children have no such discipline, and they spend what the adults are saving.

The adults

The adults are not doing well either. The National Mental Health Barometer, produced by Clalit’s Research Institute and the Myers-JDC-Brookdale Institute, found that one Israeli in five reports severe difficulty getting through the day because of mental health. A third felt they needed treatment. Half said the war had affected their leisure, and 35% reported trouble forming or keeping close relationships. In the war’s first year, Clalit recorded a 45.5% rise in new anxiety diagnoses and a doubling of new PTSD diagnoses. Among evacuees from the south, PTSD cases ran eighteen times the prewar level in the first year, eleven times in the second and six times in the third.

Prof. Amir Krivoy, director of Clalit’s Geha Mental Health Center, put it without euphemism: “The psychological consequences of the war and the events of Oct. 7 are not a temporary, isolated event, but a deep and ongoing crisis.”

Eric Vermetten, a psychiatry professor at Leiden University Medical Center, explained the mechanism. Repeated attacks and sirens turn the smallest daily decision into a question of safety. “Maintaining that vigilance is exhausting,” he told Al Jazeera.

The soldiers

Israeli parliamentary data record 279 suicide attempts among serving soldiers between January 2024 and July 2025. In 2024, combat soldiers accounted for 78% of military suicide deaths. Veterans are not included in these figures, so the true count is incomplete by design.

Vermetten pointed to reservists who move back and forth between the front and the kitchen table, with little time in between to absorb loss, guilt or shame. He warned against treating suicide as inevitable, but said “conflict, loss and isolation can increase vulnerability.” Edgar Jones, a professor at King’s College London’s Institute of Psychiatry, Psychology and Neuroscience, said some people adapt while those who lose homes or relatives may develop PTSD or depression. “Everyone has a breaking point,” he said. Soldiers, he added, can suffer “moral injury”, which arises “when their actions challenge their view of themselves.”

That is a phrase worth reading twice. Governments decide what armies do. The injury of having done it is carried by the men and women who did.

A bus driver from the south

Behind the percentages there are names. At a Clalit webinar, Irit Ben Arye spoke about her husband, Haim, a 52-year-old bus driver who helped evacuate survivors from Kibbutz Be’eri. He came home crying. About two weeks later he died by suicide. They had been married for 30 years and had eight children.

What she asks of her children now is simple:

Cry, ask, break something. Make yourself noticed, make us notice that you are in pain.

Across the lines

The same arithmetic runs beyond Israel’s borders, at a far larger scale. According to UNICEF, more than a million children in Gaza need mental health and psychosocial support, despite the so-called ceasefire of last October, in a territory that now measures its life in percentages of what was lost. In Lebanon, the agency counts 770,000 children who have experienced psychological distress, and nearly two-thirds of households report anxious or nervous children.

In February, Jonathan Crickx, UNICEF’s chief of communication in the State of Palestine, said: “Children know trauma does not end when the bombing stops.”