Medics seek to minimise impact of trauma on shelled residents

Despite a mass movement south away from the Hizbollah shells, some Israelis living in the North have refused to leave their homes. Health professionals are acting to pre-empt widespread trauma among these residents. Dr Itsick Vorgaft is a psychologist working in the emergency room at Sieff Hospital in the small northern town of Safad, close to the Lebanese border. The majority of families with children have left, so most of Dr Vorgaft’s patients are adults. But part of the emergency room caters specifically for children, many of whom have seen buildings destroyed, neighbours wounded or dead bodies. Of particular concern are cases of trauma in infants because, according to Dr Vorgaft, the symptoms are often very hard to see. “Parents do not always identify these symptoms, which are that the infant may become irritable, doesn’t want to eat, can’t sleep and won’t stop crying,” explains the doctor. “Or they may go to the other extreme, playing less and becoming quiet. Part of our job is to educate parents about these symptoms. We try to convince people that, although this situation is not normal, their reactions are. We try to normalise things, but telling a parent that everything is okay while their child is screaming is very difficult.” The same is true for the adults, says Dr Vorgraft. “We say: ‘It’s okay if you cry. It’s okay if you don’t sleep.’ But the problem with a lot of these people is that they are over-normalising by ignoring the fact that something might be wrong. Others are too busy just trying to stay alive, and many more are afraid to come to the hospital. They prefer to stay in safety in their shelter.” Because of this reaction, many are missing out on treatment. Dr Vorgraft is keen to emphasise the importance of treating the symptoms of trauma at an early stage. Although it is difficult to treat the acute distress initially, it is vital to do so in order to prevent debilitating post-traumatic stress disorder at a later stage. This, says the doctor, is a very real threat. “When we eventually get a moment of quiet, people’s defences will collapse,” he says. Since Hizbullah began shelling the north of Israel two weeks ago, 52 Israelis have been killed and an estimated 500 injured, according to the Israeli Defense Forces. Alan Cohen oversees the Community Stress Prevention Centre in Kiryat Shmona, just three kilometres from the border with Lebanon. The centre’s 10 staff man hotlines offering 24-hour counselling to residents, and work in conjunction with Magen David Adom, Israel’s national emergency medical service, providing emotional support to emergency teams operating in the region. His team has also been visiting homes and shelters all over the northern region. “The anxiety we are seeing manifests itself as nervousness, sweating, dizzy spells and, most noticeably, as disproportionate fear,” explains Cohen. Sometimes, aside from the shelling, it is the shelters themselves that have become part of the problem. When people spend several days in a small room they become reliant on its safety. “It is possible for someone to leave a shelter briefly to have a shower,” says Cohen, “but some people just won’t. Some really are incapacitated by fear.” Already Cohen is making plans for a post-conflict response, when his team will work with teachers to educate them on the signs of child trauma so that cases can be referred to medical professionals. But, for now, Cohen agrees with Dr Vorgaft that immediate and thorough outreach to the community will minimise repercussions later. “We are at the fire extinguishing phase,” says Cohen. “Right now we are dealing with reactions. Later we will have to locate those showing signs of trauma.” BB/ED