Violence Traumatizes Hardened Israeli Rescuers

For an army of Israeli professionals and volunteers who deal with the aftermath of terrorist attacks, 2001 will be remembered as a numbing blur of mass-casualty bombings etched in scenes of horror.

Since June, a string of deadly attacks by Palestinian militants that has killed more than 70 people and injured hundreds has strained the coping abilities of even veteran rescuers in this battle-hardened nation.

Emergency room doctors and nurses, disaster volunteers, police officers, soldiers and forensic pathologists say their resilience has been undermined by the sheer volume of victims, the sustained nature of the attacks and the sense that there is no end in sight to the bloodshed.

Government agencies report increases in sick days emergency workers and police have taken this year, and in the number of times stress or burnout are cited as the reason for taking a day off.

Responding to an upsurge in demand from officers, Israel’s police force is establishing a clinical psychology department to offer therapy for those suffering from post-traumatic stress disorder.

“In the last year, we have reached a breaking point in the level of stress and burnout for police,” said Col. Raffi Lev, commander of the national police force’s behavioral science department. The current wave of violence has been worse than in years past, Lev said, “because this has been high stress for a long time. It feels like an endless war.”

Members of the 26,000-strong national police force have been working 12-hour shifts six days a week for more than a year now, much of it in a state of high alert, said Maj. Gen. Moshe Karady, head of manpower for the force. They are exhausted and often frightened, he said.

“Policemen usually approach a suspect as though he were a man,” Karady said. “Now they approach him as if he is a bomb and they are a sapper [bomb expert].” Knowing that a suspect might blow himself up during routine questioning, Karady said laconically, “causes anxiety.”

Bomb disposal units, forensic squads and traffic police--often the first ones on the scene of a mass-casualty attack--have been hit particularly hard. The department has sent hundreds of these personnel to counseling workshops or on group vacations in an effort to ease their stress.

Still, Karady said, he worries about how the force will cope if the conflict with the Palestinians, which erupted in September 2000, wears on for another year.

Yossy Landau agrees that this year has tested rescue workers in Israel like no other year he can remember. Landau is a volunteer with Hesed shel Emet, an ultra-Orthodox organization that sends teams of men to recover and bury human remains collected from the scene of attacks.

A 33-year-old businessman who has worked with the group for five years, Landau said he once felt armored against psychological trauma by his conviction that he was performing a religious duty. No more.

Memories of the Aug. 9 suicide bombing of the Sbarro pizzeria in downtown Jerusalem still haunt Landau. Sixteen people died when the bomber detonated explosives packed on his body in a restaurant filled with families at lunchtime.

Among the dead was 2-year-old Hemda Schijueshuurder, who was cradled in her father’s arms as he stood waiting for the family’s pizza.

“We could find nothing left of the little girl,” recalled Landau, the father of seven. “We sent a special team of 15 men back to search for five hours, trying to find something,” he said, tears welling in his eyes. “At last we found her pacifier, and there was a tiny piece of flesh on it. DNA testing showed that it was her. That is what the family buried.”

Landau spoke to a reporter during a break at a two-day seminar Hesed shel Emet organized this month at Kibbutz Hafetz Hayim for 100 of its volunteers. Amid warnings that future bombers might pack their explosives with nerve gas or other toxins, the group was trained to deal with collecting the bodies of victims of a biological, chemical or nuclear assault.

Also jarring to the volunteers is the knowledge that synchronized attacks can put rescuers at risk. In December, workers converged on the scene of a downtown Jerusalem pedestrian mall, where two suicide bombers blew themselves up and killed 11 others. Minutes later, a car bomb went off near where the Hesed shel Emet volunteers had gathered to begin their work, and one was injured by flying shrapnel.

“We had to pull two of our guys in to desk jobs after that,” Landau said. “They were on the verge of nervous breakdowns.”

Recently, Hesed shel Emet asked Israel’s Health Ministry to provide psychological counseling for its volunteers.

“We are getting lots of phone calls from the wives of our volunteers,” said Rabbi Yehuda Meshi-Zahav, the group’s director. “They ask us to release their husbands from this work because they say there are consequences for their home lives.”

Perhaps no group of Israelis has had more direct or devastating exposure to the results of attacks than the six forensic pathologists at Abu Kabir, Israel’s only forensic institute. By law, the remains of anyone who dies in questionable circumstances in Israel are brought to the institute in Jaffa.

This year, Abu Kabir was a chamber of horrors. Again and again, the pathologists counseled distraught families, breaking the news that their loved ones were dead, guiding them through the identification process and, in some cases, explaining that there was little left to identify.

A rabbi and social worker are usually on hand to deal with the families, but doctors recently asked that a psychologist also be present.

“This month we had 25 victims plus four terrorists,” said Dr. Jehuda Hiss, who has directed the clinic for 27 years. “My generation of doctors never felt that we needed psychological help, but the new generation feel that they need it, now that we have so many victims.”

Years ago, Hiss said, the doctors at the institute usually knew little about the victims they examined and virtually nothing about their families. Now, he said, “once we leave the clinic after identifying the victims and meeting with the families, we go home and see all the stories of these victims and their families on television. Suddenly, you feel that you are a part of the whole story.”

The youthfulness of many of the victims has also affected the doctors, Hiss said, “because many of us have children the same age as, say, those who died at the Dolphinarium.” Twenty-one mostly young people died at the popular Tel Aviv disco in a June 1 suicide bombing.

It was after that attack, Hiss said, that he and his staff began spending more time counseling families who arrive to identify victims.

“When you have to meet with the families, it is terrible,” said Dr. Ricardo Nachman, another Abu Kabir pathologist. “When I am with the bodies, I am OK, this is my profession. But when I meet with the family, this is the point of psychological break for me.”

Because Jewish law requires the dead to be buried as quickly as possible--preferably before sundown on the day they die--the pathologists at Abu Kabir have worked as long as 48 hours straight in the past year. After such marathon sessions, “I cannot sleep,” said Nachman, 33. “I go home, turn on the TV, and I see the families cry, and I cry with them.”

Dr. Maya Furman-Reznic, 29, a resident in forensic pathology at the institute, began work there just five months ago. She already feels the stress of the job, and sometimes sees dismembered bodies in her dreams.

“We are all taking this pretty well from the outside, but we don’t know what effect it has in the long term or how it will break out in other aspects of our lives,” said Furman-Reznic. “That is why we said we need someone here to help us ventilate our feelings.”

Emergency room nurses have also needed extra counseling, said professor Arieh Shalev, head of the department of psychiatry at Jerusalem’s Hadassah Ein Kerem Hospital.

“Who is more professional than nurses?” he asked. “They are just there to help, and they are able to be very active, to work well in a group, to feel that they are making a difference. And still, from time to time, you get one or two nurses who break down, particularly when young people are brought in.”

For professionals dealing with wave after wave of violence, “you need to recruit a level of distancing and then you carry your distancing shield back home,” Shalev said. “You remain numb and emotionally unresponsive.”

Shalev said experts are still searching for the most effective way of helping professionals and volunteers remain emotionally responsive, yet capable of dealing with trauma that simply does not end.