Sadly, there are only approximately 152,000 Israeli Holocaust Survivors alive today – and the number is due to drop to an estimated 140,000 in 2020, 92,600 in 2025 and 26,000 a decade later. On average, one Holocaust survivor dies in Israel every 45 minutes – or more than 1,000 per month.

They all carry with them, especially as they get older, bitter memories of their indescribably tragic losses of loved ones, friends, homes and surroundings and the pain of immigrating to a new, unfamiliar place.

According to the official definition, a Holocaust survivor is someone who lived in one of the countries occupied by or under the direct influence of the Nazi regime between 1933 and 1945 and/or refugees who were forced to leave their homes due to the Nazi regime.

The average age of those who live among us, some of them in extreme poverty, is 85 years of age. And all of them suffer from chronic diseases.

A new Israeli study shows that Holocaust survivors here had higher rates of chronic conditions but lower rates of death than a comparison group of individuals insured by Maccabi Health Services, the second-largest (of four) health maintenance organizations in Israel. Maccabi provides health insurance to two million of the nearly nine million residents of Israel.

Biological and psychosocial reasons may help to explain the findings, but the researchers suggest that unique characteristics of resilience among Holocaust survivors and better health literacy may be among the possibilities. said Dr. Gideon Koren of Maccabi. His co-researchers were Na’ama Fund, Prof. Nachman Ash, Prof. Avi Porath and Prof. Varda Shalev.

 The observational study, just published in the Journal of the American Medical Association (JAMA), included more than 38,000 Israeli Holocaust survivors who were born between 1911 and 1945 in Europe and nearly 35,000 people of the same ages in a control group who were born in Israel during that 34-year period.

With groups insured by Maccabi Healthcare Services, the study used data collected from 1998 through 2017 and looked at heart disease, chronic kidney disease, chronic obstructive pulmonary disease, osteoporosis, diabetes, hypertension, cancer and death.

Repeated studies have suggested that Holocaust survivors may experience chronic diseases, usually several at a time. These include hypertension, heart diseases, osteoporosis, metabolic syndrome and cancers, compared with the general population. These health problems could be explained by psychosocial trauma and post-traumatic injury, poor hygienic conditions, prolonged malnutrition and sub-optimal preventive means in Europe during the Nazi era.

Previous studies have suggested that Holocaust survivors may experience different chronic illnesses more often than the general population, but few researchers have looked into the overall survival and age at death among Holocaust survivors.

The researchers aimed at examining the death rate among Holocaust Survivors, compared with Israelis who did not go through the Holocaust but were treated by the same health maintenance organization. They also compared rates of chronic diseases between Holocaust Survivors and the control group.

In this case-control study, the Israeli researchers found significantly higher rates of chronic diseases in the Holocaust Survivor group than in the control group. But surprisingly, the overall death rate was lower among Holocaust Survivors (25.3%) compared with the control group (41.1%). They collected data over two decades, from January 1, 1998, through December 31, 2017.

The researchers took into account their gender, socioeconomic status, and body mass index (whether they were underweight, had normal weight or were overweight).  The 38,597 Holocaust Survivors included 22,627 women (58.6%) and had a mean age of 81.7 years, and the 34,931 individuals in the control group included 18,615 women (53.3%) with a mean age of 77.7 years.

But the overall death rate was lower among Holocaust Survivors (25.3%) compared with the control group (41.1%). Taking all factors into account, the average age at death was significantly older in the Survivor group compared with the control group.

The researchers looked not only at the diseases with which they had been diagnosed, but also hospitalizations, emergency department visits, physician visits, outpatient specialist visits, the purchase of medications, laboratory test results and radiologic imaging results.

Each individual – both Holocaust Survivors and the control group – gave their consent to being included in the study.

Experts agree that surviving genocide sustained for five years would have serious consequences on the psychological and physical well-being of individuals because of psychosocial trauma, post-traumatic injury, poor hygiene, prolonged malnutrition, and suboptimal preventive means, they wrote.

But higher rates of reported and diagnosed symptoms may theoretically reflect a bias, that Holocaust Survivors may be more fearful about and sensitive to their health and more likely to see a physician than Israeli-born elderly in a control group.

In addition, Holocaust Survivors may be more likely to seek financial compensation and other types of privileges available to them. But the researchers said their analysis revealed higher rates of chronic diseases that were unlikely to be subject to bias.

A possible reason for their lower death rate may be associated with their concentration camp experience, they continued. Although millions of Jews died in death camps, “those who survived may have had higher resilience from more favorable genetic, physical, and emotional characteristics.” They concluded that “more research is needed to explore the biologic and psychosocial basis for this resilience.”