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Analysis

Professor Danny Brom on the psychological impact of rocket fire on Israeli civilians

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Rockets fired by armed groups in the Gaza strip now reach the whole of Israel but it is the south of Israel which is still absorbing the bulk of the fire. The areas closest to the Gaza Strip have been enduring fire for more than ten years. To discuss the psychological impact of the situation on Israeli civilians, BICOM Director of Research Toby Greene interviewed Professor Danny Brom, founding director of the Israel Center for the Treatment of Psychotrauma at the Herzog Hospital in Jerusalem. You can listen to this interview as a podcast here.

What kind of impact does sustained rocket fire have on communities in the south of Israel?

There is a wide area of impact. It is not new, so people are used to rocket attacks, but there is a lot more now. One of the impacts is when you know a rocket attack is happening and you have 15 seconds to get to a safe place then people go into a survival mode. This is built into our system and makes us very efficient and we know then exactly what to do to stay safe. The problem is that when you are in and out of survival mode all the time, people tend to stay in survival mode, and that is when it can become problematic. It means that the only thing you are doing at that moment is looking where the danger is.

When you do that, a lot of other things fall out of your sight. Parents with small children, when they are in survival mode, are only concerned with their children; which is natural and good, but when they continue to be in survival mode they forget about other needs of their children, like playing, or being in a safe contact with their parents, rather than focusing on safety and danger. So that has an impact on children, especially young children.

How wide-spread are these effects?

These effects are quite wide-spread. In some areas we are talking about almost 14 years of daily rocket attacks, so we now have 14 year old kids who were born into this situation. So the whole area around Sderot is an area where children and parents are very jumpy, because anything could mean danger.  You have 15 seconds to get to a safe place, but what if you are 20 seconds away, or 30 seconds away from your child who is playing outside, what do you do then?

Are other sectors of the community particularly vulnerable, for example children or old people?

We see that in children, about 30-35 per cent of children stay in this survival mode, and if you let it go on it means that they will get into a post-traumatic stress disorder which is a severe situation where it really influences functioning. People have difficulties concentrating and it affects the normal development of children. When you see the world as a place where you have to think about safety all the time, it influences the way you see enemies and friends because you will be inclined to intuitively categorize people within these two categories. Then you also have people who can very quickly go into violent expressions, either in words or in deeds. That can be a long term effect that needs to be taken care of.

Adolescents who live for a long time in this situation tend to engage in risk-taking behaviour, like more smoking, more drinking, as if to take control of the hyper arousal they are feeling. They try to regulate themselves and get rid of that through drugs and drinking. Alternatively, they are attracted to dangerous places. This is especially so with adolescents who have post-traumatic symptoms; they cannot differentiate between what is dangerous and what is safe and they are attracted to wherever the adrenalin is.

You mentioned symptoms of PTSD, what kind of symptoms are there?

It is a conglomerate of symptoms that people can develop. In general it is not more than 10-15 per cent of people who go through severe trauma and it consists of the inclination to re-experience what has happened. People have nightmares, frequent associations; they need to talk about it all the time. On the other hand, they get so overwhelmed by these memories that they tend to avoid them. Through this oscillation between re-experiencing and avoiding, the experience doesn’t get processed, so it stays in active memory and small triggers can provoke a strong reaction of fear.

How prevalent are these PTSD symptoms for those who have experienced rocket fire?

With prolonged exposure, like in Sderot, we have conducted research among young mothers which shows that 35-40 per cent are now showing these symptoms. But you can really only know if this is PTSD once the situation is over. Because then you can see who stays in this constant arousal state and who is able to relax and regain balance.

One thing you hear in all of Israel, because of the sirens, is that everyone seems to be jumpy; when you hear a motorcycle passing people jump. These kinds of symptoms tend to pass once the situation is over in a couple of weeks or a few months.

Does the fact that there is a protective system, with an iron dome and bomb shelters, help reduce the psychological harm?

If people do what the Home Front Command says and go to a safe place then they don’t get hurt. That is something that people understand and do. That is helpful in psychological sense, as you can feel a sort of control. At the same time the fear that suddenly the siren might go off while walking outside or being in a car is still there.

What kind of impact would you expect in parts of the country experiencing this for the first time, for example Tel Aviv, which has come under daily attack during this conflict?

One of the things we see is that the whole country seems to come together; which sometimes is not a feeling that is present in this country. A part of survival mode is that people pull together.

With respect to the experience of people in Tel Aviv, it depends how old you are. In the first Gulf War, in 1991, there were lots of missiles on Tel Aviv so that is not really new. In a way this helps because people say, ‘Okay, we just have to get through this and it will disappear.’ But sometimes people feel that their reactions are even stronger because it reminds them of the past. It is not only that siren now, but also that siren that is still in your memory. But all in all people are coping with it in a very adaptive and good way.

What do you think the prospects of recovery are for those who are suffering from psychological effects if rocket fire stops?

Looking at long-term consequences, we have to think of several domains. One is fear and PTSD and people who need treatment, which we expect to be quite a lot. Even if it is, say five per cent, we are still talking about tens of thousands of people. We also have to look at what such a war does to the way people think about the conflict, how they see the possibility of change, how they see Arabs within Israel, or the Palestinian community outside of Israel, and how it influences the way people view their world. It is a myth that you only have to look at PTSD; you have to look at the very broad and long term consequences of such a conflict.

Another group we have to look at is soldiers. What does it do to a soldier seeing a friend being killed next to him? Or what does it do to a soldier to fire his gun to kill someone? All these things can have long-term effects and that is a field that Israel has not developed much. After three years soldiers get out of the army and there is no transition program from combat service to civilian life. One of the things the Trauma Centre in Jerusalem has been doing in the past few years is trying to develop such a transition program, as otherwise a lot of unprocessed trauma will stay in our culture. If you know Israel and the way people even drive and speak to each other very often, it reminds you of unprocessed trauma. There is an attempt now to look at how to help people to get out of survival mode, even if you have been a soldier and might be called up again.

A new threat that has emerged in this conflict are tunnels underneath the Gaza-Israel border bringing terrorists that emerge close to small Israeli communities on the Israeli side of the border. Do you anticipate psychological problems caused by this new threat?

The tunnels are a very frightening thing for the whole country, because suddenly someone can pop-up from underground and you don’t know what to expect. One of the main questions for the Israeli people now is ‘Didn’t the army know? And if it knew why didn’t they do something about it?’ The main issue now is that the army and the government take responsibility for knowing and doing something about it, and that will quiet down the fears that there are.