On October 7, 2023, southern Israel experienced its largest terror attack in history, resulting in over 1,144 deaths, 1,600 injuries, and more than 239 kidnappings to Gaza. Soroka University Medical Center (SUMC), the only tertiary medical center in the region, was at the forefront of providing medical care. The attack began with rocket fire and terrorist attacks targeting civilians, causing various injuries. SUMC's emergency response team prepared for the attack, and the first casualty arrived at 7:37 am. By 9 am, hundreds of medical staff were on hand, and by 1 pm, 281 casualties had been brought in. The number of casualties continued to rise, with 572 treated by 9 pm, 626 by midnight, and 676 in the first 24 hours. The center doubled its treatment capacity and opened additional beds and scanners to handle the influx. An information center was set up to assist families, and many patients were transferred to other hospitals. SUMC also provided support to its staff and caregivers. Key lessons from this event include early mobilization, protecting patients, increasing capacity, external staffing, and secondary patient transfer.On October 7, 2023, southern Israel experienced its largest terror attack in history, resulting in over 1,144 deaths, 1,600 injuries, and more than 239 kidnappings to Gaza. Soroka University Medical Center (SUMC), the only tertiary medical center in the region, was at the forefront of providing medical care. The attack began with rocket fire and terrorist attacks targeting civilians, causing various injuries. SUMC's emergency response team prepared for the attack, and the first casualty arrived at 7:37 am. By 9 am, hundreds of medical staff were on hand, and by 1 pm, 281 casualties had been brought in. The number of casualties continued to rise, with 572 treated by 9 pm, 626 by midnight, and 676 in the first 24 hours. The center doubled its treatment capacity and opened additional beds and scanners to handle the influx. An information center was set up to assist families, and many patients were transferred to other hospitals. SUMC also provided support to its staff and caregivers. Key lessons from this event include early mobilization, protecting patients, increasing capacity, external staffing, and secondary patient transfer.