From Conflict to Care - Telemedicine Utilization During Wartime: A Retrospective Cohort Study.

Background: Armed conflict poses severe challenges to healthcare delivery, requiring rapid adaptation. This study evaluates how telemedicine enabled continuity of care during the October 7, 2023, war in Israel, and assess regional and service-specific utilization patterns in relation to conflict intensity.

Methods: A retrospective cohort study of 7.19 million healthcare interactions from an Israeli HMO covering one-third of Israel's population. The study compared three periods: (T0) the first month of the war, (T1) the month before, and (T2) the same period last year. Interactions included visits and inquiries in primary care, secondary care, mental health, and allied health services. Data were categorized by service type and geographic conflict zones. Chi-square tests and effect sizes assessed trends.

Results: Telemedicine utilization increased significantly during the war, especially in primary conflict zones (13-20%, p < 0.01). Remote consultations in mental health tripled (10-30%, p < 0.01), and nutrition services reached the highest telemedicine adoption (27-52%, p < 0.01). Family medicine, pediatrics, and gynecology also showed significant increases. Digital inquiries surged in family medicine but declined in pediatrics.

Conclusion: This study offers timely insights into telemedicine's role in maintaining access during armed conflict within a digitally advanced system. By examining service utilization across medical domains and conflict zones, it highlights how remote care supports system adaptability in crises. Notably, patient satisfaction remained high, suggesting telemedicine preserved access and perceived care quality. Findings may inform digital health planning to strengthen continuity, equity, and resilience in future emergencies.