Coping with the situation

Trauma

People call it ha'matzav [the situation]."We are living in denial," comments the Canadian-born wife of a Magen David Adom (MDA) paramedic, and a mother-to-be. It is a term that many people use. Others speak of feeling terrified.

The Israel Trauma Centre for Victims of Terror and War known by its Hebrew acronym, NATAL, has received thousands of calls on its telephone hotline since it was ?rst set up in 1998. Its aim is to provide emotional and psychological support to trauma victims. Since the start of the present intifada, in September 2000, the number of calls per month has increased to around 300.

Callers express a vast range of emotions, from fear of leaving the house, to sleep problems and a revulsion at the smell of roasting meat. Some are suffering latent reactions to attacks they witnessed years ago, memories of which have been triggered by the current violence. "If you have been traumatized once, it doesn't take much to bring it back," remarks Dr Ilan Kutz, a Tel Aviv psychiatrist and expert in the treatment of trauma.

The NATAL hotline is manned by volunteers who undergo six months of training. "A person has to know himself before he can help others," explains Hannah, who joined NATAL just after the intifada started. "You must look inside yourself. It is not easy to be exposed to all these things."

The hotline's uniqueness lies in its policy of maintaining regular contact with callers, thereby building up a support mechanism based on trust and on concern for each individual's problem. "Finding the energy to call for the first time is not always easy," Hannah explains,"but for people afraid to leave home, or concerned about the stigma of seeking psychological support through public agencies, the hotline may be their only source of support."

There is a growing recognition among many counsellors and therapists that it is not only the direct victims of terror attacks who may succumb to a condition known as post-traumatic stress disorder (PTSD). Rescuers are also at risk, as are policemen, ?re-fighters and bystanders, as well as those not even directly involved in response, such as street sweepers and window cleaners. Children are especially vulnerable. Dr Rony Berger, director of NATAL's community services, runs an outreach programme that aims to help prevent PTSD among people regularly confronted with scenes of horror. It includes workshops, lectures and seminars that use the participants' experience of exposure to stress to strengthen their existing coping mechanisms and to teach them new ones.

Rushing to the spot

At the forefront of any rescue effort are the MDA first responders. MDA, a National Society with observer status within the Red Cross Red Crescent Movement, is mandated by the Israeli government to run the nation's blood bank and emergency medical services. The ICRC is currently providing US$ 80,000 to MDA to help meet the increased demand for blood bags.

The first responder unit was set up two-and-a-half years ago, and comprises 1,600 volunteers stationed all over the country, including 500 in Jerusalem. They remain on permanent call, equipped with everything necessary to save lives and ready to respond instantly when their "beeper" alarm sounds.

The men and women who volunteer for this "elite rescue unit", as its Jerusalem coordinator, 27- year-old Dovie Meisel, calls it, come from all walks of life. "Whenever their pagers go off the responders who are closest to the incident rush to the spot, often arriving before the ambulances." "Theirs is a vital, life-saving role when seconds count," says Gilad Bock, a lawyer and first responder who has been with MDA since his teens.

"In the aftermath of an attack, a rescuer's training gives him a mantle of protection which ordinary citizens lack," comments Dr Ilan Kutz. But even hardened professionals are sometimes overwhelmed, especially when the dead and injured are known to them, or when children are involved.

Gathering the dead is sometimes harder to cope with than caring for the living, especially in the event of a suicide bombing when the victims' bodies are often torn to pieces. Marti Goldstein is a business manager and medic. He is also a member of Zaka, the ultra-orthodox Jewish group that gathers body parts following suicide bombings or other incidents where people are killed. "The first priority is to care for the injured, and then for those in shock," he says. After that, Zaka mobile units are deployed to recover all the limbs, blood, tissue and other remnants. "You have to work fast, and in a safe, good way," he explains, "so as to get all the pieces and put them in the right order for burial." This ensures that the directives of the Jewish religion, which require that all human remains be buried, are observed.

For Marti, his belief that it is important to help people gives him strength to do his job. Team spirit is also crucial. "We understand each other and talk together afterwards. You also have to know how to put things aside," he says.

After the attack at the Hebrew University, Daniel Farahan recalled discussing with some friends what they should do. "We agreed that being here is like being on the front line of the world, but you have to get on with your life. We all decided we would not leave."

Some days later Danny was asked to pay a tribute during a memorial service for the victims. "I talked of the need to be strong and not give in," he said, "because we want peace between the Palestinians and ourselves."