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In Bat Yam, on Israel’s Mediterranean coast, a veteran female soldier who developed post-traumatic stress disorder (PTSD) after her military base was overrun during the October 7, 2023 Hamas attack walks into the sea holding a surfboard.

She is taking part in a surfing therapy program run by the non-profit organiZation “Hagal Sheli,” alongside other men and women coping with PTSD following military service.

Recalling the moments during the attack, the woman, who asked not to be identified due to privacy concerns, said she feared she wouldn't survive at that time. Symptoms of PTSD, including insomnia, nightmares and mood swings, appeared almost immediately after, she said.

Israel is grappling with a dramatic increase in PTSD and suicide among its troops, a challenge weighing on the Middle East's most powerful military as fighting persists in Gaza and Lebanon and as tensions flare with Iran.

The military's mental health crisis, detailed in recent reports by the defense ministry and by health providers, was set off after the October 7, 2023, Hamas attack on southern Israel that precipitated Israel's two-year assault on Gaza.

The Gaza war quickly expanded with cross-border fire between Israel and Lebanon's Hezbollah, and saw hundreds of thousands of soldiers and reservists deployed across both fronts in some of the heaviest fighting in the country's history.

Israeli forces have killed more than 71,000 Palestinians in Gaza and 4,400 in southern Lebanon, according to health officials, and Israel says more than 1,100 service members have been killed since October 7, 2023. With much of Gaza destroyed, its 2 million people overwhelmingly lack proper shelter, food or access to medical and health services.

The fighting has also exacted a heavy toll on the mental health of soldiers carrying out their country's stated war aims of eliminating Hamas in Gaza, retrieving hostages there and disarming Hezbollah.

Israel's Defense Ministry says it has recorded a nearly 40% increase in PTSD cases amongst its soldiers since September 2023, and predicts the figure will increase by 180% by 2028. Of the 22,300 troops or personnel being treated for war wounds, 60% suffer from post-trauma, the ministry says.

The country's second largest healthcare provider, Maccabi, said in its 2025 annual report that 39% of Israeli military personnel under its treatment had sought mental health support while 26% had voiced concerns about depression.

Several Israeli organizations like NGO HaGal Sheli, which uses surfing as a therapy technique, have taken on hundreds of soldiers and reservists suffering from PTSD. Some former soldiers have therapy dogs.

Ronen Sidi, the director of the Combat Veterans Psychedelic Research Clinic at Emek Medical Center in northern Israel, said soldiers were generally grappling with two different sources of trauma.

One source was related to "deep experiences of fear" and "being afraid to die" while deployed in Gaza and Lebanon and even while at home in Israel. Many witnessed the Hamas assault on southern Israel - in which the militants also took more than 250 hostages back into Gaza - and its aftermath first hand.

Sidi said the second source is from moral injury, or the damage done to a person's conscience or moral compass from something they did.

"A lot of (soldiers') split second decisions are good decisions," which they take under fire, "but some of them are not, and then women and children are injured and killed by accident, and living with the feeling that you have killed innocent people... is a very difficult feeling and you can't correct what you have done."

Israeli influencer and reality TV star Idan Gelfer, 31, who served in the army reserves on October 7, 2023 and during the Gaza war, took to Instagram in July after reports of a spike in suicides among combat soldiers.

“You don’t understand what it means to be a fighter inside Gaza... You don’t know what it’s like to look your entire team in the eyes, say the Traveler’s Prayer (prayer asking for divine protection, guidance, and safe passage during journeys), and enter the war knowing that some of us won’t return," Gelfer said to the camera in a clip that went viral, was aired across media platforms and has now been translated into seven languages and shared widely.

Since his post, Gelfer who served more than 400 days of reserve duty, says he received thousands of messages from reservists and their family members telling him he expressed what they were afraid to say.

A soldier desiring increased trauma resources must appear before a defence ministry assessment committee which determines the severity of their case. That process can take months and can deter soldiers from seeking help, some trauma professionals say.

Israel's defense ministry says it immediately starts providing some resources to soldiers once they start the evaluation process.

An Israeli parliamentary committee found in October that 279 soldiers had attempted suicide in the period from January 2024-July 2025, a sharp increase from previous years. The report found that combat soldiers comprised 78% of all suicide cases in Israel in 2024.

The risk of suicide or self-harm increases if trauma is untreated, said Sidi, the clinical psychologist.

"After October 7 and the war, the mental health institutions in Israel are overwhelmed completely, and a lot of people either can't get therapy or don't even understand the distress that they are feeling has to do with what they have experienced."

Israel's military remains deployed in over half of Gaza and fighting has persisted there despite a U.S.-backed truce in October, with more than 440 Palestinians and three Israeli soldiers killed.

Its troops still occupy parts of southern Lebanon, as the Lebanese army presses on with disarming Hezbollah under a separate U.S.-brokered deal. In Syria, Israeli troops have occupied an expanded section of the country's south since the ouster of former leader Bashar al-Assad.

As tensions flare with Iran and the U.S. threatens to intervene in the country on behalf of anti-Iran protesters, Israel, which fought a 12-day-war with Iran in June, could find itself again in a violent confrontation with its arch foe.

Production: Rami Amichay, Emily Rose, Rami Ayyub, Dedi Hayun, Lee Marzel/Reuters