HomeJanuary 2013Treating Trauma in Sderot

Treating Trauma in Sderot

Despite the regular sounding of the Color Red siren earlier this month and the subsequent booms as Kassam rockets struck their town, the residents of Sderot seem, at least on the surface, to be leading normal lives.

On Thursday, the second day of the army’s Operation Pillar of Defense against terrorist targets in the Hamas-controlled Gaza Strip, life appeared to continue with little or no change in day-to-day activities.  Cars drove down the streets, and shoppers frequented local businesses.  A gardener was pruning branches outside a house on a quiet residential street, and several youths rode past on bicycles.  Outside a convenience store, several men sat and smoked cigarettes, appearing blasé and unmoved by the occasional rocket.

Such is everyday life for the residents of one of the nearest Israeli cities to Gaza — less than a kilometer from the border.

However, not everything is as placid as it appears, says a psychiatrist, Dr. Adrianna Katz, who heads the Sderot Mental Health Center — a clinic, affiliated with Ashkelon’s Barzilai Medical Center, that services the residents of Sderot and the surrounding moshavim.

Speaking to Metro that Thursday in her makeshift office in the city’s downtown police station — she had moved her base of operations to be more readily accessible to those in need of emergency services — Katz said that following 12 years of regular rocket attacks, many of Sderot’s residents were showing symptoms of mental disorders, most notably post-traumatic stress disorder (PTSD).

Several seconds into the interview, she nonchalantly rose and strolled to the bomb shelter as a loudspeaker began blaring.  In the shelter, which was equipped with stretchers and medical supplies, the 63-year-old psychiatrist from Ashkelon began heatedly to debate issues of supply and logistics with members of her team until it was deemed safe to emerge.

Continuing the conversation as if nothing had happened, she asserted that despite repeated promises from the government, specifically the Health Ministry, she had been operating on a shoestring budget for years.

Barzilai Medical Center, she said, did not have the budget to expand her operation.

Although her clinic “takes care of several thousand” residents, she explained that in terms of personnel and funding, it had “almost nothing.”

“In total, at the moment, our team consists of a secretary and three mental health professionals,” she lamented, saying that each member of her team treated many more patients than {he or she} could handle.  “There have been times when I have been here alone with 50 people seeking treatment.”

Katz claimed that despite occasional reports in the media, there had been no budget increases or staff expansions, even as the burden on her team increased.

“There are many who want [to help,] but we still haven’t gotten anything.  I don’t know [why, but] the money isn’t being given to us,” the psychiatrist said.

Asked why she thought that was the case, she gestured to a Health Ministry representative sitting next to her.

“Speak with the Health Ministry,” she replied.

The representative, who had been sent down to the South to coordinate with Katz’s team during the latest emergency, leaned back and refused to comment, saying that all inquiries must go through the ministry’s spokeswoman.

However, when Metro contacted ministry spokeswoman Einav Greenbaum the same day, she said she did not know about Katz or the Sderot Mental Health Center.

Katz asserted that over two years ago Deputy Health Minister Ya’acov Litzman had promised her a budget for one additional social worker and half the salary of another psychiatrist.

However, she continued, “two and a half years later, only now have I received the budget.”

Moreover, she said she had not yet received any additional staff or funding to deal with the influx of victims sure to arrive at her doorstep during and after Operation Pillar of Defense.

While the makeshift center remained empty during the interview, they psychiatrist said that “any second, a Kassam rocket can fall on a house inside the city, as just happened, and [even if] nobody is hurt physically, you may have seven people suddenly arriving here in trauma, suffering from shock.”

She added that this did not apply only to the most recent IDF operation.

“We don’t know when the end of the operation will be.  We have been in the midst of an ‘operation’ for 12 years.  It is just that sometimes it is more serious than other times.”

Meanwhile, a short distance away, a young girl stood outside her house only meters from the impact crater of a Kassam rocket, with a look of dread and shock on her face — a visual reminder of the mental health issues Katz was discussing.

Asked how she felt, the girl began to reply, but her sister quickly instructed her not to speak with the press and she turned away toward her house — which at that moment had a policewoman in body armor stationed in front of it to prevent entry.

Around her, a crowd of people milled, uncertain what to do with themselves and rubbernecking at the scene of the impact.  Some were neighbors and some passersby, and they continued to push against the tape demarcating a closed police zone in the yard until an officer stood on a low wall and bellowed for everybody to leave.

“Do you want to get hurt standing out in the open?” he called out in an authoritative voice.

While other residents of the street stood on their porches, staring blankly at the dispersing crowd, a man who said his brother lived in one of the houses on the street mused that it must have been a “miracle” that the gas tank in the yard where the rocket fell had not ruptured and exploded, causing casualties.

He seemed, understandably, to be stressed.

Stress is a big part of daily life in Sderot and has had a deleterious effect on many residents, says local resident Yael Shpanglat.

Shpanglat is a computer programmer and a mother of five whose husband was called up for reserve duty during operation Pillar of Defense.  According to her, people do not “play the hero” in Sderot, and if they need psychological help for any of their children, they immediately go to the local resilience center.

Discussing how the sustained trauma of living with regular rocket attacks can affect families, she recalls an incident that occurred earlier this month during the flare-up in the South.

“My older children already know what Color Red is, and they have experienced periods of [Color Red sirens] in the past and have run to the shelters,” she says.  “They are well trained in what to do when they hear the alert, but the youngest child, Binyamin, is only two and a half years old, and he has never experienced an alert.  He has lived through it a few times since he was born, but never really experienced a Color Red.”

She recounts that at the beginning of the IDF operation, he and his sister were playing in the backyard, “but she came home and he stayed outside.  The exact minute he was outside alone, there was a Color Red, and… I ran outside to pick him up and take him home, but then there was the launching of the Iron Dome and it made a lot of noise and a huge explosion.  Ever since, he has not stopped talking about the lion and dog he thinks live in our backyard.  Now, he talks about the Color Red and the lion all the time.”

However, while Shpanglat believes that many residents make use of the resilience centers for dealing with more immediate issues, some of the issues of long-term trauma that the staff of the Sderot Mental Health Center address are going untreated, says Danny Dahan, chairman of the city’s chamber of commerce.

“There are many who require extra help,” he says.  However, because “this is a small place and everybody knows everyone else, people are embarrassed to go to a mental health professional.”

Aside from the issue of staffing shortfalls, he says, there is a stigma attached to seeing a psychiatric professional.

“It is uncomfortable afterward that [people] speak about you and look at you,” he explains, adding that although fellow residents know there have been years of traumatic events, they often suspect that “maybe there is another problem.”

“Not everyone goes for counseling just because of the war. There is the suspicion [when someone goes] for counseling that perhaps he isn’t going due to the war.  People are embarrassed by this and want a little more discretion,” he says.

Dahan believes that if there were “psychologists who could make house calls and give personal service,” it would greatly help the local residents.

“There is a very big need for that,” he asserts, but says such service would only be possible if the mental health center added more psychiatric professionals to its staff.

Several days after Metro’s initial request for comment, the Health Ministry’s Greenbaum did reply regarding the Sderot Mental Health Center’s lack of personnel.  In response to a query by journalist David Bedein, Greenbaum sent a letter to Katz, stating that the ministry was allocating a budget for another therapist and that the “staffing process” was being handled.

Asked about the letter, Katz said last week that she wasn’t aware of any new developments and that the ministry’s reply must be in reference to the budget for hiring a new social worker, which had been in the works for two years and had finally come through during the latest crisis.

While she still has not brought another person down to serve in the center, at least the budget is now there, she said.

Bedein noted in his letter to the ministry that it should “allocate funds from your special [Jewish Federations of North America] campaign for the Victims of the South” and that the “Sderot Mental Health Center should not be confused with the resiliency centers, which… receive help from the Jewish Agency system.”

One social worker familiar with the situation in Sderot, who prefers to remain anonymous, describes the resiliency centers as a “Band-Aid operation.”

They are run by “good people who do very good work,” he says, “but that’s not what’s needed here.  What is needed here is the augmentation of the mental health center, which deals with people who are on the verge of breakdowns.”

The resiliency centers’ specialty, he continues, is “taking phone calls from people who can’t sleep or need immediate advice on dealing with the immediate situation or about dealing with their children.”

However, the Sderot Mental Health Center “needs at least 10 to 12 professionals on the psychiatric level, because the center is now dealing with 3,000 active files for people suffering mental breakdowns,” the social worker says.

He contends that the center has been requesting funding from the Jewish Agency and Jewish Federations for six years and, “having not received anything,” has “given up.”

Tikva Schein, Israeli spokeswoman for the Jewish Federations of North America, notes that while her organization does not directly fund the resilience centers, it has “funded some of their direct services, which are provided under the auspices of the centers.”

Especially during the latest conflict, she says, the Jewish Federations “assessed and dealt with” many of the needs of residents of the South.

“We have been in touch with {people from} the Israel Trauma Coalition, and they have been telling us what they need in terms of funds, and we’ve been responding by fund-raising and allocating funds,” she says.

Asked about the Sderot Mental Health Clinic’s claim that it has requested funding on several occasions, she replies that “there are no plans as yet to fund them” and that she does not think there is “any particular reason” they have not received any disbursements.

According to Schein, the resilience centers — which she agrees are “very different” from the Sderot Mental Health Center — “deal with counseling and meeting together with families.

It’s first aid in the sense that they have phone lines that they run d u r i n g traumatic circumstances, and they sent people, as kind of first [responders], to individuals at the time of need.”

However, first aid may not be enough, says Noam Bedein, David’s son and the director of the Sderot Media Center.

Noam has been working in Sderot for the past six years.  The media center, a small office in a ramshackle house on a residential street, has become a prominent place for visiting dignitaries to get a quick look at the remains of rockets and to speak with survivors of Hamas barrages.

Noam sees his job as educating the world about the suffering of the people of Sderot, and he frequently confers with his father on strategies to reach the international media.

“The thing is,” he says, “no matter how much treatment you can actually get… it can be quiet for two weeks and then one thing happens, you have one siren go off, and people go back to that first-day experience of rockets exploding nearby.  And that is the entire difference.

You have to explain to people that no matter how much you go through, you always have sirens going off here and there and explosions, and there really is no post-trauma — it’s still very much traumatic.”

He says that a cease-fire notwithstanding, there is no peace for local residents.

“What does [a cease-fire] mean?” he asks.  “That we should be expecting on a daily basis rockets like we had during the previous cease-fires. It’s as simple as that.”

He stresses that “there will be more and more anxiety victims needing treatment for shock…. We have had an entire region coping for years with psychological warfare, and people should be aware of that.”

This echoes a statement that Barzilai Medical Center spokeswoman Leah Melloul made several months ago during the last escalation in the South, when she said that “the rockets are actually more of a psychological weapon.”

Referring to PTSD and its prevalence in the South, she said she believed Israelis were “actually building up a new generation of children that have no future because nobody can understand what this means that you have to run for shelter sometimes up to 50 or 60 times a day.  When I travel in New York… when I hear the sound of an ambulance, I have a split second that I say to myself, ‘Where am I going to look for cover?’”  Noam says the solution to a psychological weapon is a psychological cure, and he agrees that there is a shortage of psychiatric workers available in Sderot to bring about such a cure.  Not only are the residents of his city suffering from PTSD, he says, but the “entire staff of the clinic are anxiety victims themselves.”

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