Lives Forever Scarred After Suicide Bombings

Motti Mizrahi groans and clenches his teeth. “Wait, wait!” he hisses to the therapist, whose expert form of torture is to push, lift and stretch Mizrahi’s mangled arm.

He lowers his lifeless limb, encased in a spiked contraption meant to hold the slowly re-fusing bones in place. He sighs, inhales and tries again.

Four months have gone by since Mizrahi was critically wounded in a Palestinian suicide bombing at a Jerusalem cafe where he was chatting with a friend. Steel nuts and bolts packed inside the bomb pierced his chest and the back of his skull. They smashed all the bones in his left forearm and upper arm. His hand was nearly sheared off, held on by pieces of flesh and ligament.

Today, three surgeries later, a nut still rests about a third of an inch from his heart. Nine nickel-size holes are gouged in his arm. Mizrahi’s recovery, if there is to be one, takes five hours of body-bending physical therapy four days a week, and X-rays every two weeks to monitor his progress.

Mizrahi is one of an estimated 2,500 Israelis--40 last week alone--who have been wounded in suicide bombings since Palestinians rose up against Israeli occupation nearly 22 months ago after the collapse of peace talks. Headlines have focused on the fatalities: About 270 people, most of them Israeli Jews, have been killed in more than 70 bombings.

But the lasting impact may best be measured in an emerging population that is permanently scathed and scarred, living reminders of the horror of the bombings. They will require years of costly and complicated physical and mental rehabilitation. In addition to paying for most of the medical care, the state must also absorb the losses to its work force.

Israeli doctors calculate that 40% of the injured will have significant permanent disability.

Israel has a long experience with suicide bombings and car bombs. What has made the current campaign more lethal--and more debilitating in the long term--is the increased use of hardware loaded into the explosive packages.

Earlier generations of bombs were packed with small ball bearings; today, heavier, deadlier metal is used. From screws and nails to scrap metal from construction sites and, in one case, blood-thinning rat poison, the additives boost the devastating nature of each explosion.

“It’s much more insidious,” said Dr. Ricardo Segal, chief neurosurgeon at the sprawling and busy Hadassah hospital in Ein Kerem, just west of Jerusalem.

“You don’t have the same energy that you have with high-velocity injuries, so many more pieces of metal go through the body and are stuck there. It may not be damage that will kill, but it creates a major dilemma: how to correct the damage without causing more damage.”

Digging into a brain to retrieve a bolt lodged there can easily harm the patient more than the original injury, Segal said. Such are the questions that the Argentine-born surgeon weighs on a regular basis. He said his earlier wartime experience of caring for bullet and regular explosive wounds only partially prepared him for what he has seen in the last months.

A year has gone by since Paulina Valis and Emma Skuleshevsky, two Israeli high school students, put on their dancing shoes, touched up their eye shadow and headed out on a Friday night for their favorite disco, the Dolphinarium on Tel Aviv’s bustling seafront boardwalk.

They were waiting outside the club in a thick queue of friends, classmates and others when a 22-year-old Palestinian, Said Hotary, detonated the nail-studded bomb strapped to his body. An impossibly bright flash of light, a rushing roar of noise, the acrid smell of blood and burning flesh, and Valis and Skuleshevsky flew through the air before crashing to the ground and blacking out. Twenty-two people were killed, more than 100 wounded.

Skuleshevsky walks around today with a nail in her head and two more in her abdomen. She and Valis have so much shrapnel in their bodies that every now and again, small pieces rise to the surface of their skin and fleck off like metallic dandruff.

“They told me to expect such surprises in my life,” Valis said.

Once a runner, dancer and aerobics enthusiast, Valis, 19, has had to learn how to walk again. A crinkly ribbon of a gash marks her right shin and calf where several inches of flesh were ripped away. She moves gingerly, taking a flight of stairs in a mall slowly. Her weak hand frequently touches her face, in hesitation.

“I had lots of plans,” said the native of Uzbekistan with curly red hair, who immigrated to Israel 12 years ago. “I wanted to go into the army, and I wanted to go to university and travel. Now I can study, but it’s going to be very hard. It’s hard for me to concentrate. I can’t travel. I can’t go into the army because the army won’t accept me. Now I depend on hospitals.”

Valis spent two months in the hospital after the blast and has had many surgeries. It took a good eight months, she said, before she could go to a sidewalk cafe or ride a public bus. She was so terrified.

Between regular visits to orthopedists, neurologists, plastic surgeons, physical therapists and a counselor, Valis has managed to finish her senior year of high school. But she has lots of questions.

“My main question is, why?” she said. “God decided I should stay alive, but I don’t think I should thank him for that because he took a lot of my friends. There are no answers.”

Skuleshevsky, 18, has managed to recover most of her ability to walk and dance, but she tires easily and has to do everything in moderation. She has narrowed her circle of friends--few people can really understand what she’s been through--and limited her education to correspondence courses with a local university.

Mizrahi, the man with the injured arm, also had a lot of plans.

An athletic 31-year-old computer software engineer who heads the information technology department for the Israeli city of Modiin, Mizrahi has been sidelined from work since the attack. He tries to maintain telephone contact with his staff, but it’s not the same. Meanwhile, the municipality’s soccer team, where he was a star forward, has sunk from second to fifth place in his absence.

The pain, he said, is still constant, months after the injuries. He is reluctant to continue taking the morphine and other painkillers that the doctors prescribe because they impair normal activity and he worries about addiction.

“I want to believe that I will recover my life and do the same things I did before,” he said. “But I know it will be hard and it will take a long time.”

For him and others, it’s an open question whether recovery will ever be complete.

Adi Hudja, who just turned 15, will never fully recover. She was strolling with friends through the Ben Yehuda pedestrian mall in Jerusalem late on the night of Dec. 1 as they tried to decide where to go and what to eat. Two bombers standing a few feet apart blew themselves up that night, killing 11 people and wounding 100.

About 40 steel nuts bored their way into Adi’s body--two in her rib cage, six in the pelvic region and most of the rest in her legs. Both tibiae and femurs were fractured. Photographs from that night show her legs looking like bloody Swiss cheese.

One of the bombers used rat poison in his explosive device, according to Dr. Avi Rivkind, head of emergency care at the Hadassah hospital. The poison works as a blood thinner and causes those exposed to bleed profusely and die more quickly.

Adi “bled like hell,” Rivkind said. He finally staunched the flow with a drug used for hemophilia patients.

Adi spent weeks in intensive care, underwent 15 surgeries, numerous bone grafts and only narrowly averted amputation of a leg. She faces additional surgery to improve the alignment of her legs.

“It feels like it’s been a year in and out of the hospital,” Adi said the other day, lying in a hospital bed with the latest cast enveloping her leg, punctuated by a discolored and misshapen foot poking out of the end. “It’s not so bad. I’m walking now, but just with one leg.”

Adi’s worried mother, Malka, a police officer, sat at her side. “We don’t know how long [recuperation] will be,” she said.

Dr. Meir Liebergall, who heads the hospital’s orthopedics department, said his patient will always have, at the minimum, a limp and numerous scars.

“If she can walk, even with a cane or a walker, then we will consider that a tremendous success,” he said.

Sharon Maman, 22, also was at the Ben Yehuda mall that night. The bolt in his brain has left him severely disabled. A fun-loving youth who had just finished his military duty as an air force mechanic, Maman now lies limp in a hospital ward, unable to speak. He cries and moans a lot.

“He hurts physically, but I think even more spiritually,” said his sister, Fanni Romberg, at his side along with their mother.

In six months, he has learned to shave and feed himself, his therapists said.

In Israel’s crowded emergency rooms after each bombing, the motto is “life, then limbs.” Triage and urgent surgery save the lives, and decisions are made later about whether limbs are amputated or reattached.

“The first 24 hours are a struggle for life,” Liebergall said. “Then the struggle is for the quality of life.”

The question of whether people can function independently again has a far-reaching impact on society. Will the victims return to the work force, or will they rely forever on state care? Unlike the Palestinians, whose numbers of wounded in the conflict surpass those of Israelis by an enormous margin, Israelis can count on a social services system in which medical and psychological care are paid for by the government.

Still, many of the wounded say they feel forgotten, overlooked in the outcry over the dead and in the numbing succession of attacks. They are little more than a statistic, usually referred to in local parlance as the “lightly injured”--meaning they survived.

“The thing I learned is, it never really ends--the trauma goes on, the nightmare, the fear of vulnerability,” said Sara Levinsky Rigler, a writer who volunteers with a Jewish Orthodox organization to assist victims and their families.

“We think, ‘lightly injured.’ ‘They got off lucky.’ ‘They’ll be OK.’ They’ll never be OK. It’s a misnomer. Lives are ruined.”