Shlomo Ferera hasn't stopped shaking since he went into his shwarma restaurant opposite the army's southern command headquarters in Be'er Sheva.
Since the terror attack last February he hasn't been back to work. The thought of the officer who was shot to death, her picture brought in by her father, now framed on the wall, is too much for Ferera. He can't get used to the sight of the young female soldiers who still come to the restaurant, smiling and joking as if nothing bad will ever happen to them, ever. He couldn't go on as usual. Maybe that's why he wouldn't let them fix the bullet holes in the wall. The place was lovingly renovated just a few weeks before the attack. New ceramic tiling, a new paint job. It makes him more than sad to go in there. It reminds him of another time, when he was another person.
On February 10, a female officer and a female soldier came into the restaurant. It was, as it usually is at lunchtime, packed mostly with soldiers from the nearby base. The two soldiers sat outside, at one of the black plastic tables. The officer asked Ferera for a cold drink, he pointed to the fridge and told her to help herself. At that moment, the shots began. Ferera ran into the tiny kitchenette from his place behind the counter. The little window through which he would pass the servings was half open. Through it he saw the officer fall to the floor, dead. Her friend managed to make it to the kitchenette. She grabbed Ferera, shouting, "They're killing us, they're killing us."
The shooting went on. Ferera and the female soldier waited on the floor clinging to the walls. When he finally got up, he saw the terrorist spraying his restaurant with bullets, "like in a game," he remembers. And while his restaurant was turned into a combat zone, the soldier in the kitchen was crying, "Help me, help me."
"That's when I went wrong," he says now. "She drove me crazy. She held onto my hand tightly, her teeth chattering. I had never seen anyone who asked to die, just as long as it's fast."
TV until dawn
Ferera fell apart after the terror attack. He has been diagnosed as a shock victim. He suffers from depression, gets outpatient treatment at a psychiatric clinic and is medicated. He does not sleep at nights, worried the terrorist will reach his house and he won't be ready. He stays up until dawn watching TV. "I see that officer like in a movie, going to the refrigerator and the terrorist shooting bursts. And what did I do? Nothing." He gets nervous in crowds. He prefers not to leave home. The sight of Arabs frightens him. So do ambulance sirens.
Ferera, a tall, married father of two girls, looks at least 10 years older than his 43 years. His skin is pale, with dark circles from sleeplessness around his eyes. He says he never needed any psychiatric help before the attack. He served in the navy, on missile boats, and until recently was still doing reserve service (though not in the navy). "It's not that I don't know about danger," he says, "but I was never shot at. What could I do? Throw potatoes at the terrorist?"
That sense of helplessness in the face of the attack only sharpens the financial despair. Another owner finally reopened the restaurant, which had been closed since the attack. While Ferera tried to recover, he accumulated debts. The bailiffs came. "Be'er Sheva Municipality sent some thugs over to cut off my electricity. They don't care I was in an attack."
Ferera is having difficulty getting back on his feet, and it's not clear when, if ever, he will be back to normal. So far, his family has helped as much as it can, but since he was the sole provider, they are now teetering on the abyss of chronic poverty. The family is living temporarily with a relative. For the first time, his wife has gone to work in a shop, to help bring in some money. He doesn't like being needy and was shocked when his mother-in-law brought Shabbat food to the house. "I was used to buying a car when I wanted. My girls never wanted for anything. Now my mother-in-law is bringing us food." He still has his car, but often doesn't have money for gas.
Ferera's world has collapsed, but the aid provided by the state is minuscule. He filled in the forms at the National Insurance Institute, which is responsible for compensation to victims of war and hostilities, but they haven't even started to deal with his case. Only this month will he begin receiving a monthly payment from the NII for his illness during the months he didn't work. That check will be swallowed up by debts. "The compensation law does not provide an answer for people who become unemployed as a result of their trauma and the NII doesn't cover any of the urgent daily needs of the victims," says Avi Cohen, head of the One Family NPO, which provides charitable financial aid to terror victims. "The process is enormously bureaucratic. By the time they allow a victim to hand in a request for compensation, two or three months can go by. Meanwhile, people aren't functioning. They stop working. They don't take buses and depend on the readiness of their employer's to count them as off on sick leave." The NPO donated a one-time sum to Ferera to help him pay some of his debts.
Ferera feels humiliated, which only adds to the depression. Thinking about where to get money for the family next month is torture. "Things can change in a second. I was a happy man. Now everything is dark. I never needed a thing. I paid all my bills, NII, taxes, everything. Now I have to beg from clerks." Since the attack he's been going to synagogue. Faith helps him - a little, he says. Thirty years ago he met the woman who would become his wife and she said she doesn't drive on Shabbat. He decided to abide by her wishes and they married. Over time he became religious. Now he wears a black skull cap, and his daughters go to the religious girls' school, Beit Ya'acov, but he says he doesn't belong to any organized group. He smiles as he remembers how pretty his wife was when they married. Their wedding was dubbed "wedding of the year" by a woman's magazine, which gave them an oven. He leaves the room for a minute and comes back with a large picture from the wedding - a beaming couple in a wooden frame. For a second he seems to forget himself, awash in memories. But then his face dims again. "Another woman would have left me," he says. "My poor daughters; Fanny has become sad. She has her matriculation exams. She shouldn't have to think about her father. I feel like a scapegoat for the entire country."
The invisible victims
There are dozens of people like Ferera, who have been in a terror attack and come out of it physically whole but emotionally damaged. Some will bear the scars for the rest of their lives. Unlike the hundreds who go through a terror attack and manage to get on with their lives, despite the horror, there are those like Ferera who find it difficult, and sometimes impossible, to go back to normal life.
Israeli society ignores these traumatized victims. The state institutions are suspicious of them. Sigal Haimov, head of Natal, the center for emotional aid in times of national stress and trauma, says that society's attitude toward victims like Ferera is derived in large part by the victims' own retreat into their corners. They don't ask for help and isolate themselves from their surroundings.
What was once known as shell shock, is now a medical term: Post Traumatic Stress Disorder (PTSD). Israel became aware of it in the wake of the Yom Kippur War and in the last decade, as the home front has become, in a sense, the front line, Israel has become a country-sized laboratory for investigating the phenomenon. Israeli researchers are considered among the leaders and pioneers in the field - but they are far from providing all the answers. Shock victims are the last to be evacuated by Magen David Adom from the scene of a terror attack, they are transported after all the physically traumatized victims have been sent to the emergency rooms of hospitals in the area. They are scared, they respond anxiously and replay the scenes of horror over and over again in their minds. They also develop some physiological symptoms: high blood pressure, accelerated pulse, disassociation, a desire to flee, and uncontrollable tears, all part of the body's escape mechanism.
"When the event is more powerful than the system's ability to accept, the brain begins reorganizing itself," says Dr. Ilan Kotz, head of psychiatrics at Meir Hospital in Kfar Sava. "The first reflex passes through the brain's less rational areas. The brain orders adrenalin to be released. Only then do the brain's rational thinking centers begin to work. That's the stage of perspective, relaxation."
Most Israeli researchers distinguish between the acute symptoms that trauma victims experience immediately after the event (Acute Stress Disorder) and chronic post-traumatic disorder, which is considered a disease that can only be diagnosed about four months after the actual incident. Prof. Aryeh Shalev, head of trauma at Hadassah Hospital, ran MRI brain scans on people exposed to traumatic events one week after the incident and then six months later. In the first month, things appeared normal. But as time progressed he found there was more activity in the brain's centers. He says the memories slowly have an impact on the chronic patients. They become socially regressive in their behavior, anger easily, are nervous, and lose interest in their surroundings. PTSD victims can break out in a sweat at the slightest noise, or even the beeping of the hourly radio news broadcast. They respond the same way to any sudden sound, even if they hear it repeatedly. The brain does not get used to sounds. The body releases adrenalin in classic defensive action.
Researchers appear to be reaching the understanding that the first period after a trauma is a window of opportunity. The system is still open and sensitive to changes, and the damage is reversible. Therefore, psychological treatment is critical at that stage. Without treatment during the first three or four months, says Shalev, acute phenomenon can become permanent and chronic.
To a large extent, the duration and dimension of the threat to life and worldview, determine the intensity of the traumatic response. "The more surprising the event, and the less conceivable, the worse the trauma," says Kotz. "It will be difficult for people who watched bodies leaping from the Twin Towers."
The threat of death experienced by anyone on the scene of an attack is the heart of the traumatic event. But no less critical are the scenes they see. "Our contract with life says we don't see such horrors as heads without bodies," says Kotz. The more catastrophic the event, the more likely there will be people who are emotionally wounded. Sometimes, it's not the victims who were on the scene at the time of the attack who suffer most, but those who come to their aid.
People with PTSD replay their memories over and over again. They have difficulty sleeping and are afraid of the dark. During the day they are on edge and every slightest bit of noise disturbs them. Sometimes they just stare, disassociated from their surroundings. Over time they find it possible to go back to normal life, but are irritable and intolerant at both home and in public. Then there are those who seem to circumvent the experience by repressing it. But sooner or later it bursts out of them.
Previous traumas come back
Why do two people who experience the same violent event respond so differently. "It depends on sensitivity, on biological vulnerability, and on previous traumas the victim brings to the scene," says Kotz. "People with previous traumas are much more susceptible, and there are quite a few of those in Israel."
Most people need only a few hours to get back to themselves. For some, a day or two suffices. But then there are those for whom it is much more difficult. There is a connection between the intensity of the initial reaction and the duration of the symptoms, to the developments later on. "If there is a trend toward improvement, the chances of recovery are great," says Kotz. "But if the symptoms remain, there is a danger of it becoming chronic."
Prof. Shalev found that people with high blood pressure that does not decline over the first hours and days, are the highest risk sample for chronic PTSD. Most of the research shows that when the person is disassociated - staring into space, not responding - they are in the high-risk zone for the disorder. They are "stuck in the experience" and do not recover. Researchers are trying to determine how many people who are exposed to severely traumatic incidents will bear the psychological damage to the end of their lives. According to Shalev's observations among victims of car accidents, 30 percent will initially experience symptoms of PTSD. After four months, 17 percent remain with the symptoms, and only 10 percent report the symptoms a year later, and are considered chronic victims. A New York Times survey after September 11 found that 25 percent of the people exposed to the event reported symptoms of PTSD. The number of PTSD victims is not known, but there's no question there has been an increase. Natal says that between 1998 and 2001, they dealt with 800 requests for help. There were 600 calls between January and April of this year.
The lack of official data is evidence of the state's indifference to the phenomenon. While terror survivors in shock flow into the emergency rooms, they are generally included in the category of "lightly wounded." Only two years ago, with the outbreak of the intifada and the dramatic increase in the number of terror incidents and trauma victims, did the Health Ministry begin considering the unique problems of PTSD victims and establishing some rules for treating them. News reports now number shock victims separately from the "lightly wounded."
A Health Ministry report from January to May shows that, in addition to 940 lightly wounded people in terror attacks, 229 people showed up at emergency rooms as psychologically traumatized. Shalev says 60 percent of the 2,000 people wounded in terror attacks and treated at Hadassah's two hospitals, were suffering from shock. Judging by his own statistics, 10 percent of those 1,200 have chronic PTSD. According to Shmuel Pintzi, head of rehabilitation at the NII, more than 3,500 people over the past two years have received or are receiving psychiatric help through his NII department. But that also includes physically damaged people. Until the waves of terror, there were only 1,200-1,300 getting care through the NII. Pintzi says that not all were specifically at a terror incident. He says there has been a general increase in anxiety in Israeli society. "Something has happened to the people of Israel, they scare more easily and they respond emotionally. There's less strength." It happened to Shlomo Ferera in February. He is afraid he will be forgotten. He wants people to know about the problem, to do something. "Something bigger than me happened. I'm done for. Why should I have to beg for the state to compensate me for what has happened to me? I'm embarrassed to say it, but it would have been better if I got a bullet in my leg."
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