Herzog Medical Center

Hospital History & Evolution

• Founded: 130 years ago as the first psychiatric hospital in the Middle East, initially named Ezrat Nashim (“women’s aid”), established by a group of women.
• Early Focus: Primarily treated women, especially those with postpartum depression, at a time when mental illness was stigmatized and not seen as a medical issue.
• Growth: Moved outside Jerusalem’s Old City due to expansion; original funding came mainly from Eastern Europe and Russia, with early American support from California.
• Under British Mandate: Modernized, received first doctors, and focused on mental health.
• Post-1948: Remained independent after the establishment of Israel; Jerusalem’s hospitals (Hadassah, Shaare Zedek, Herzog) do not receive direct government funding due to the city’s intended international status.

Funding & Operations

• Funding Model: Receives per diem payments from HMOs (not the government), which do not cover all costs; Herzog relies heavily on charitable donations (mainly from North America and Europe) for capital investments, equipment, and research.
• Negotiation Challenges: Smaller hospitals like Herzog have less bargaining power with HMOs compared to large or government hospitals.
• Staff & Patients: Diverse, with significant representation from Jewish, Muslim, and Arab communities across Israel.

Clinical Focus & Facilities

• Transition Over Time: Shifted from mental health to include geriatrics and rehabilitation as psychiatric care became more ambulatory.
• Current Structure:
  
  • 20–25% mental health inpatients; large outpatient mental health services.
  • Major clinics: Youth at Risk (18–25, mainly women, often with histories of abuse), soldiers/veterans, PTSD, and general psychiatry.
  • Geriatric and general rehabilitation (120+ patients, many war-related).
  • Largest respiratory care center in Israel (250+ ventilated patients, ages 0–104).
  • Inclusivity: About 50% of pediatric patients and significant staff are Arab; patients and staff come from across Israel.
  • Education & Therapy: Onsite school and sensory stimulation for ventilated children.

Infrastructure & Innovation

• Underground Hospital: Built for war contingencies; used extensively during COVID-19 as Israel’s largest COVID center (160 patients at peak, 3,000+ treated overall).
• Features: Blast doors, airlocks, gas/biological protection, independent oxygen production (250 m³/hr), backup generators (96 hours autonomy), Wi-Fi for patient-family contact.
• Psychological Support: Measures such as enabling patient-family communication and providing ice cream for nutrition improved COVID survival rates.
• Recent Expansion: New underground inpatient facility built under the outpatient mental health building; dual-purpose for emergencies and peacetime use.
• Future Plans: Major expansion for mental health and extended care centers, aiming for 1,200 patients.

Unique Features & Anecdotes

• Archaeological site on hospital grounds includes a protected Hasmonean-period building (continuously inhabited from 250 BCE–400 CE).
• Main civilian helipad for Jerusalem, used by medical, commercial, and military flights.
• New construction emphasizes green building principles: natural lighting, energy efficiency, and bomb-resistant windows.

Culture & Environment

• Participants described the atmosphere as familial, inclusive, and non-hierarchical, contrasting with more rigid American hospital culture.
• Staff morale remains high despite ongoing conflict and emergencies; trauma is considered routine.

Notable Challenges

• Financial: Constant fundraising required due to lack of government support.
• Logistics: Maintaining and expanding underground facilities during war and emergencies.
• Patient Care: Managing long-term ventilator dependence, integrating multicultural staff and patients, and supporting at-risk populations.

Conclusion

Herzog Medical Center exemplifies adaptability, inclusivity, and innovation in the face of historical, political, and medical challenges. Its unique funding, diverse community, and advanced infrastructure make it a vital institution in Jerusalem and beyond.

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Bio

Dr. Yehezkel Caine is President of Herzog Medical Center after serving as its CEO for over two decades. London-born, he graduated in medicine from Hebrew University and then specialized in general and trauma surgery and aerospace medicine. He served as a colonel and flight surgeon in the Israel Air Force, is a fellow in the American Aerospace Medical Association, and a member and former president of the Israel Aeromedicine Society and the International Academy of Aviation and Space Medicine.