Palestinians, Israelis suffer trauma

By Ramit Plushnick-Masti

JERUSALEM (Reuters): Hours after Hila Vahaba saw a Palestinian suicide bomber blow himself up in a crowd of Israelis, the bloody images kept running through her mind like a never-ending movie.

For Palestinians, rocked by retaliatory Israeli air strikes, the horror of death and destruction is no less vivid.

Vahaba, a 24-year-old Israeli, emerged physically unscathed from a bus stop bombing. But like more than 30 of the 39 people wounded in the attack on April 22 in the central Israeli city of Kfar Saba, she suffered acute stress disorder or trauma.

"I saw everything that happened, the whole attack, all of the dead and wounded. The entire terrible scene," Vahaba said, clenching and unclenching her shaking hands.

"All the windows (of the bus) shattered, people fell on one another, screams and shouts. I saw two bodies. There was smoke ... blood, flesh on the ground ... a body was even stuck to the windshield of the bus," she recalled.

Nearly eight months into a Palestinian uprising, Palestinian and Israeli doctors are becoming adept at dealing with the disorder, which psychologists define as a normal human response to an abnormal situation.

There is no end in sight. A suicide bombing that killed five Israelis at a shopping mall on May 18 was followed within hours by air strikes by F-16 warplanes and helicopters on Palestinian security posts in which at least 12 Palestinian policemen died.

Palestinian psychologist Iyad al-Sarraj, who is based in the Gaza Strip, said repeated Israeli air raids and the constant echo of gunfire means no one in the area is unaffected.

"I think everyone in the Gaza Strip is traumatized in one way or another," Sarraj said. "A state of tension and apprehension doesn't pass anyone by."

Sarraj said the symptoms include panic -- especially among children whose parents are frightened -- a certain detachment from reality and in some people hyperactivity, a need to care for others in order to deal with their own anxiety.

Ilan Katz, an Israeli psychiatrist at Meir Hospital in Kfar Saba, said immediate treatment was paramount.

"If they don't get initial diagnosis and treatment they may move from an acute disorder to chronic Post-Traumatic Stress Disorder (PTSD), which is more difficult to eradicate," Katz said, referring to a disorder common among war veterans.

Sarraj said he treats acute trauma by allowing people to talk and through role-playing. He treats children by letting them paint and draw what they are feeling.

"We try to just be a mirror that reflects back to them their own feelings. Children are very responsive to treatment, much more than adults," Sarraj said.

Katz said those with a more intense response who cannot rid their minds of the harrowing images after group therapy can be treated with an eye movement procedure.

An American psychiatrist discovered that for unknown reasons when a person moves their eyes back and forth repeatedly after undergoing a traumatic experience, the images recede, Katz said.

In the most severe cases, hypnosis is used and treatment is followed up.

"For most people these effects fade anyway even without treatment. But for a certain percentage, between five to 20 percent, there could be residual effects resulting in Post Traumatic Stress Disorder," Katz added.

Will Matthews, an international psycho-social delegate with the American Red Cross in Washington, said most people easily overcome acute trauma caused by a single incident.

For example, Matthews said he recently treated a group of American children who were in a serious bus accident while on a trip to Canada. Several children were killed or injured.

"The children went through serious trauma but their prognosis is good because they will return to a stable, nurturing, non- threatening environment," Matthews said.

Katz said that until recently most patients were not treated for acute trauma. Months later they would return with PTSD symptoms: depression, nightmares and personality disorders.

Since treatment for acute trauma has begun, Katz said there has been a drastic drop in those who seek follow-up treatment.

But Sarraj said he has seen an increase in the number of people with symptoms of PTSD, a chronic disorder. He said those suffering from it need intensive one-on-one therapy and often require medication to treat depression and flashbacks.

Matthews said the bigger problem for Israelis and Palestinians is that they have been living for nearly eight months in a situation of constant threat. Anxiety is much more difficult to overcome than trauma, he added.

The constant anxiety often results in eating disorders, sleeping problems and feeling constantly drained, which results in an inability to cope, Matthews said.

Children become clinging and insecure, especially when their routines are disrupted and they cannot play or go to school as they were accustomed to, he added.

Sarraj said he often sees these symptoms among children in the Gaza Strip, many of whom have become bed-wetters and refuse to go to sleep without their mothers.

Matthews said there is a positive side to the situation. In Kosovo, he treated people who had lived through the war and NATO's air raids. He found that once a stable environment was restored, people recovered quickly.

"We saw, especially with the children, a great resilience. Very few had severe psychological damage," Matthews said. "People do recover, but the insecurity ... and the threats of danger, of violence ... certainly perpetuate the problem."

Adults tend not to recover as quickly because they hold on to their anger and feelings of oppression, Matthews said.

Americans who fought in the Vietnam War in the 1960s and 1970s often suffered PTSD when they returned because they did not have a defined enemy or know what they were fighting for, Matthews said.

When they returned from the war, society did not support them and severe psychological problems resulted, he added.

Israelis and Palestinians have a defined enemy that is supported by society, allowing them to deal with what would seem to be almost impossible situations, Matthews said.

Because the region has often been locked in conflict, Israelis and Palestinians may actually suffer less from anxiety disorders, he said.

"If you live in an environment where pretty much your whole life you've been exposed to the threat of violence ... it's the norm for you. People adapt to that."