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The explosion sounded like it was far off. Twenty-two-year-old Meli Katzav, who was sitting in the Sbarro restaurant in Jerusalem with a friend from work, thought to herself: "There has been a terrorist attack." She didn't have an inkling that she had been involved.

The bomber detonated his explosives on the ground floor of the restaurant at midday on August 10, a year ago. Katzav and her colleague, Carla Levanon, were sitting in front of their pasta and pizza one floor up. For a moment, silence reigned and only the plaster from the ceiling could be heard spluttering down around their heads.

Then suddenly Katzav became aware of the screams and the smoke below. Levanon grabbed her hand and began pulling her down the staircase. Dense smoke filled the restaurant. They groped for the exit, tramping on bodies on the way. They ran across the road and found a safe spot in one of the shops. Only then did it hit Katzav. She began shaking all over - a tremor which didn't let up even the next day. The two girls were taken to hospital and Katzav, who suffers from juvenile diabetes, was kept for observation overnight.

"The first month, the weeks after that, were the most terrible," she says, alternately blushing and turning pale. Nevertheless her life went on as usual. A month after the terrorist attack, she started studying speech therapy at the Hadassah College in Jerusalem as planned, worked when her studies permitted as a telephone operator in the post office, and even met a new boyfriend. But her self-confidence had been undermined. Getting to her studies and her job in the center of the city is a daily battle for her. She feels as if she is a sitting duck. She is afraid, she says, "of being hit again and experiencing what I went through, once more."

Katzav is careful not to go to places that are connected with "her" terror attack, and often has to take a circuitous route to reach her destination. She stays away from cafes and restaurants completely. "The suspense of expecting another tragedy to happen makes me totally exhausted, both physically and mentally," she says. She hangs on to her studies and work like a lifesaver. "I have to keep busy every minute in order not to think," she says. "The horror will never leave me."

Like most terror victims, Katzav applied to the National Insurance Institute (NII) to be recognized as a victim of a hostile act. Her appeal was rejected outright. The State of Israel does not recognize her emotional trauma. The term "terror victim" was defined by law in 1971 and defines the position and rights of people who are casualties of terror attacks. In order for Katzav to be recognized, and to receive compensation from the NII, she has to be approved by a special authority in the Defense Ministry, which has the sole right to decide whether her problem was caused not only at the place and time of the terror attack but also as a result of it. The authority is manned by a small team of three lawyers, headed by Ruth Bar, and they are responsible for sifting out false claims, particularly those of people who were not physically hurt.

According to the official terror victims' organization, which is in touch with many of the casualties, those who are suffering from shock are generally eliminated at the start of the process and do not succeed in getting the desired recognition as terror victims. The NII statistics bear this out. Dr Haya Catan, who heads the NII's medical department, confirms that there is only a small number of shock sufferers among those getting help from the NII. This is a surprising fact, since research has shown for more than a decade that 10 percent of the shock victims will become chronic sufferers.

According to NII statistics, 2,900 people have asked to be recognized as terror victims since October 2000 and 500 have been turned down. This does not include claims currently being investigated and it is possible that the number of rejections will be even higher. Since the number of shock sufferers receiving NII assistance is so low, it is reasonable to assume that they are the vast majority of those who are turned down.

Over the past two years, as the number of terror attacks and the number of shock victims reaching the hospitals has increased, the health system began to notice them and to count them. The NII and the Defense Ministry are lagging behind the health system and tend to ignore the psychological problems - only when there is both a physical and an emotional problem does the NII show readiness to recognize chronic emotional trauma. Catan says that since the establishment of the state until 2001, 5,554 people have been hurt in terror attacks and 1,550 cases are still being handled by the NII. Of the latter, some 650 people have both physical injuries and emotional problems - 444 have minor emotional disturbances and the remainder are moderately or seriously impaired psychologically. She says the number of people suffering serious emotional damage is small.

`No injury'

Meli Katzav is not interested in a disability allowance. She wants her injury to be recognized. She would like to know that, if her problem worsens, she will be entitled to treatment. Meanwhile, as a special gesture, the NII paid for her to have six months of psychological counseling. Following that, she received assistance from a private organization, One Family, which helped her to get further treatment.

Last December, Katzav received a laconic letter from the Defense Ministry authority stating that, "since there is no injury, the claimant cannot be recognized as a victim of a hostile act." Katzav was amazed, went to the terror victims' organization and recently decided to appeal to the district court. The case is due to come up next month.

"I was on the second floor of the restaurant. I'm not trying to pull a fast one on anyone," says Katzav. What makes her feel that the decision was arbitrary is the fact that her friend, Clara Levanon, was recognized as a terror victim. Contrary to Katzav, Levanon was not hospitalized and did not need psychological counseling. Katzav is determined to use legal means to get recognition, particularly since she knows that shell shock can become chronic many years after the trauma.

The NII puts the blame for the rejections squarely on the shoulders of the Defense Ministry, but the NII has an important part to play in the process. It is the body that presents the evidence - the release form from the hospital emergency ward and the medical documents relating to the case. According to the law, if there is circumstantial evidence that the victim was injured in a hostile act, s/he must be recognized as such unless it is proved otherwise. While this is relatively easy in the case of physical injury, it leads to suspicion and lack of trust when it comes to emotional injury.

The hospital release form is most vital. Shula Tal, who deals with terror victims at the NII, admits that, if the victim was not in hospital, "it is hard to prove injury." But those suffering from shell shock do not always go to the emergency ward and because of the nature of the trauma, it is hard for them to get there on their own. For the same reasons, many of them have difficulty later pressing claims and they give up in the face of the bureaucracy.

It took Galina Vishbein more than a week to realize she had been injured emotionally during the Seder night bomb attack at the Park Hotel in Netanya. The NII demanded confirmation from the hotel that she had been working that night. "I started to cry," Vishbein says. "I asked her: `How do you expect me to take a bus and go there when I was hurt in a terrorist attack there?'" Since Vishbein has no one to help her, she has not filled out the forms.

Irena Michaelov, whose son was shot and seriously wounded in front of her, at a bat mitzvah celebration in Hadera in January 2002, left the emergency ward without a letter of release in order to be with her son. A month later, she began suffering fear symptoms and went to the emergency ward once again. The release form says she was suffering from post-traumatic syndrome. The ministerial authority rejected her claim, saying "there was no evidence of damage." The letter adds that fear is natural in such a case and that there is no evidence of permanent damage.

Advocate Leah Dekel, legal counsel to the terror victims' organization, says the number of rejections has increased recently. "As the number of terror attacks increases, the burden of proof appears to fall on the victims, contrary to the spirit of the law," she says. In a letter to the attorney-general, Dekel writes, "The medical discussion is held without the injured party being present, on the basis of documents alone and on the basis of the opinion of the National Insurance Institute's doctor (without an examination)." She points out that it is essential for the victim of emotional trauma to have a talk with a psychiatrist or psychologist and not merely for the decision to be based on documents.

"For me it is as if they said: `You were not there'," says Katzav. "They should at least have sent me for an examination; but no one checked me and no one saw me. It's not clear how they can decide, like that, that I was not injured."

The NII has no system of examinations and no medical team at this early stage of a claim. Catan says that when there are insufficient medical documents, the claimant is referred to a doctor or psychiatrist but says the documentation is "generally sufficient."

The Defense Ministry spokesman, Rachel Nidak-Ashkenazy, denied the decisions were arbitrary. "The opposite is true. Every request is examined individually and given deep and serious thought," she said, noting that it was possible to appeal to the District Court. She added that the decisions in the specific cases mentioned were supported by outside experts in the field, including psychiatrists.

Falling between the cracks

This was not the case with Orly Lili, a medical secretary from Jerusalem who was injured in a terror attack in the center of the city on January 27 this year. Lili fell on a dead body and suffered shock injuries. She says she began screaming in a way she had never realized she was capable of. She was taken to hospital. Lili, who like Katzav suffers from juvenile diabetes, says her condition has worsened as a result of the trauma. She says she has frequent panic attacks. If she sees someone who looks suspicious, she gets off the bus immediately, covered in cold sweat and with palpitations. The tension and fear upset her sugar balance and she suffers from weakness and dizziness. She has to inject herself with insulin about seven times a day now, double what she needed before the bomb. Since the attack, she has remained inside her one-room apartment, like in a bubble, struggling with the daily task of keeping her sugar balanced. Like Katzav, she wants official recognition, particularly for fear of the future.

The NII did not send her to an expert doctor or to a psychiatrist for diagnosis either. Her claim was rejected. The NII explained that there was no causative connection between the bombing and the worsening of her medical condition. While her claim was being examined, the NII agreed to pay for three tests requested by the hospital but further important tests were not covered once her claim was rejected. Her health maintenance organization is refusing to pay for the treatments, saying that if she was injured in a terror attack, she is covered by the NII. Dekel says: "Until the claimants are recognized, they simply fall between the cracks."

What makes matters worse, Dekel says, is that the claims can be appealed only in Tel Aviv District Court. She would like to see the matter brought before the NII's medical committees instead. "The damage caused to the state by having to pay for a few extra medical tests is minimal compared to the damage caused to the injured who are not getting treatment," she says. The attorney-general does not agree with her view: Dekel is considering appealing to the High Court of Justice.

In the case of Yolanda Srur, the matter has been taken ad absurdum. She was moderately wounded in a terror attack in 1986 while traveling on a bus from Bnei Brak to Tel Aviv. She received a disability pension. This year, as she was on a bus at the Azrieli junction, shots were fired. The driver pulled up and told the passengers to get off. The 70-year-old Srur fainted. Since then, her life has been a misery. "I can't get the terror attack out of my head," she says. "I'm confused and can't concentrate. But the worst is the fear. I didn't have it earlier. If I get on a bus, I think there must be eight terrorists, not just one. I keep looking over my shoulder and feeling the terrorist behind my back. I'm not young and I don't care if I die but I'm terrified of staying in one place, like a statue, and being carved up to bits." She requested that her NIS 1,800 pension be increased, saying that she has suffered additional injury. The authorities responded that she is not recognized as a terror victim.

Advocate Omer Yavetz, who became disabled in the IDF and wrote a book on terror victims' rights, says the Defense Ministry is much more lenient and considerate about IDF shell-shock victims than the NII, even though there is also a lot of red tape involved. The terror victims' organization, which realizes this, is therefore trying to get the same conditions for those who have been emotionally impaired as a result of terror.