Representation of women in combat roles

Women represent 35% of the IDF6 but only account for 10.8% of the UK Regular Armed Forces.7 The IDF is considered a ‘People’s Army’, with military service compulsory for most Israelis (some exceptions exist on religious grounds); women have a mandatory military service requirement of 2 years from the age of 18 years.5 In contrast, military service in the UK Armed Forces is entirely voluntary, which might explain the contrast in female representation between the two Forces, and potential differences in population physiological and psychological characteristics.

Although women have been employed in combat roles in the IDF since 1995, only 85% of military positions are actually open to women; GCC roles with a high probability of engagement and extreme physical requirements do not permit female employment.4 5 Women in the IDF are permitted to serve in 14 combat positions, including the Border Defense Force and field intelligence units, but are currently excluded from armoured cavalry and elite infantry units with primarily offensive roles.5 The integrated combat roles open to women do not deploy offensively outside of Israel, and while highly respected by Israeli female conscripts, are less well-regarded by their male peers.4 In contrast, the UK permits women to serve and deploy overseas in all GCC roles, without exception and irrespective of the physical demands.8 9

Military service is mandatory for most Israeli women, but employment in a combat role is voluntary and requires an extension of military service from 2 to 3 years, which aligns with the male mandatory service requirement.4 Personnel statistics suggest that combat roles available to women are less popular than other roles in the IDF: women account for only 9% of combat soldiers compared with 43% of Intelligence soldiers.6 These proportional statistics align with the reported interest among UK servicewomen to fulfil GCC roles, and the number of UK female applicants that were anticipated for those roles.3 While UK servicewomen choosing GCC roles are expected to be highly motivated, like their Israeli counterparts, further direct comparisons might be confounded by the differences between employment models in the two Forces.

Physical employment standards

PES define the minimum physical requirements to successfully perform an occupational role.2 Recruits in the IDF are ranked in order of suitability for military roles, but because military service is compulsory, there is no entry PES. Before induction, IDF conscripts undergo psychotechnical skills assessments and are assessed for their medical suitability for combat roles, but there is no specific entry physical fitness requirement for any role.4 Men who perform best on the psychotechnical skills assessments (and satisfy the medical requirements) are streamed to elite male-only combat units; the integrated combat roles available to volunteer women are, therefore, less highly regarded by men.10 In contrast, the UK Armed Forces have defined GCC PES, using an internationally recognised methodology which combined scientific technical job task analysis and military judgement.11

Injury and attrition rates

The IDF report an increased risk of musculoskeletal injury for women compared with men,12 which has historically been similar for the British Army.13 The lower physical fitness of women, on average, than men, rather than sex itself may partly explain this increased injury risk in women.13 14 It is expected that women who meet UK Armed Forces GCC PES will be both highly motivated and potentially physically elite in comparison to female population norms,2 which may mitigate against the anticipated higher injury risk for UK servicewomen in GCC roles.1

Female IDF combat soldiers are at an increased risk of overuse injury compared with men when employed over 36 months4 12 and seek more medical attention than women in non-combat roles.10 The sex difference in injury risk is attributed to anatomical and physiological differences between men and women and is used to justify the continued IDF policy to restrict certain combat roles to women in the IDF, in order to maintain military readiness.12 However, no overall difference was observed in the actual medical attrition rate between women and men in the same IDF combat unit, except the attrition rate for psychological issues at 18 months of service was higher in men; 76% of women were still serving compared with only 68% of men.4 This finding possibly reflects the highly motivated cohort of IDF female combat soldiers,4 which may prove comparable to British servicewomen selecting GCC roles. As UK Armed Forces servicewomen in GCC roles must pass a rigorous series of validated PES and women in IDF combat roles do not, direct comparisons between militaries with regards to physical performance, musculoskeletal injury epidemiology and prevention strategies, and medical attrition may be not be as helpful as initially anticipated.

Integration of women into combat roles

The IDF respects Jewish religious law, which mandates that men and women cannot be accommodated together; this law has implications for training and deployments. As recruits spend most nights sleeping under canvas during training, the IDF train in single-gender squads. This single-gender approach is then continued throughout career, when trained soldiers deploy on active duty. The IDF Border Defense Force regiments are, therefore, mixed-gender, but the squads within them are single-gender. However, societal expectations in Britain and Israel are different, and segregation of British servicewomen from their male peers is perceived to negatively impact on cohesion.15 The UK Armed Forces, therefore, fully integrates men and women from initial training and throughout their career. While in barracks sleeping accommodation remains segregated by room, with the rooms typically within mixed accommodation blocks.

Women, on average, have lower aerobic fitness and strength compared with men.16 17 This difference has been used to partly justify why small female-only teams cannot be deployed in the most physically demanding IDF combat roles. A recent IDF pilot study reviewed the feasibility of employing women in tank crews, but because of the intimate operating conditions would not consider mixed-gender crews. It was anticipated that loading the weapons-system would be too physically demanding for women. However, the pilot illustrated that women found, and adopted, alternative approaches to men to overcome the physical challenges and complete the task.6 Women may not need to adopt alternative strategies to overcome physical challenges within mixed-gender British GCC teams, and the effect of mixing men and women on team strategy and efficiency when completing physically-demanding tasks is unknown.

The UK Armed Forces adopted a broad-front approach, which allows women to serve with any combat unit of choice, acknowledging numbers selecting each individual unit might be low.3 Low numbers of women may contribute to perceived social isolation, which is avoided in the IDF because of the limited number of combat units open to women and the higher numbers of women pooled within specific units. These different approaches may confound comparisons in attrition rates between the IDF and UK Armed Forces.

The IDF approach to employing men and women in single-gender teams should result in similar training loads between sexes18–20 and minimise overuse injuries.21 However, the IDF trains men and women to different physical standards, confounding sex comparisons. The IDF also assumes very low initial fitness standards, due to its lack of entry PES, and has, therefore, developed bespoke training approaches to mitigate injury risks. Although men and women in the IDF cannot train for their job-role together, they are grouped by aerobic ability for physical training (ie, running) and the physically elite women in the IDF compete with men. This physical training approach aligns with evidence identifying that physical fitness, not sex, is the principal predictor of injury risk.13 14

In contrast, the UK Armed Forces train men and women together, to the same physical training output standards. Female GCC recruits in the UK Armed Forces must meet an initial gender-agnostic and age-agnostic entry PES and then undertake a common military training syllabus alongside their male counterparts. Physical training is also often streamed according to aerobic fitness and strength, but individuals do not formally receive bespoke training programmes to enable them to meet the same training output standards. Direct comparisons between the IDF and UK Armed Forces outcomes, therefore, risk being confounded by these different training approaches, as well as the other approaches to selection and employment (Table 1).

The women entering UK Armed Forces GCC roles, and other international GCC roles, are likely to be limited to a small number of physically elite women. Collaborative international research effort between militaries will, therefore, facilitate a better understanding of the health risk to servicewomen in GCC roles. Multicentre international research trials, and data and research protocol sharing, are potential ways in which this outcome may be achieved. Differences in approaches to selection, training and employment between militaries must, however, be considered in this approach (Table 1).