PTSD, the Invisible Illness in Israeli Communities Near Gaza

The demand for tranquilizers and anti-anxiety drugs rises in tandem with every round of fighting, but local people say the authorities aren't doing enough

A fire in the Be'eri Forest near Gaza caused by an incendiary kite, June 2018.
Eliyahu Hershkovitz

Since the escalation in the south of recent months, Shimon Ganem has stopped functioning entirely. “I’ve been in bed for a month and a half now and I never get out of bed,” he said this week. “You can’t breathe, you can’t think. You’re cut off from reality, obsessed only with what will happen if another rocket hits my house. Or the neighbor’s.”

A recent escalation caught him by surprise, after he had persuaded his daughter, a new mother, to come to her parents’ home and promised that everything was fine. “All of a sudden rockets and explosions started — it makes you helpless to know that you can’t provide security for your children, your grandchildren or your wife.”

Ganem, 53, has been in treatment for nearly a decade at a Merkaz Hosen “resilience center” — a place for teaching skills to cope with stressful situations — where he receives psychological help and medical marijuana. Maybe his situation would improve if he changed his address. Where he’s living, he says, “even if you manage to reclaim 20 percent of your functioning in life, a single rocket is enough to set you back.”

He isn’t the only one. Many residents of the area, healthy people who hold down jobs, pay a high psychological price for living from one escalation to the next. They have trouble dealing with everyday tasks and take the anxiety drug Cipralex, medical marijuana and tranquilizers that let them function in the shadow of post-traumatic stress disorder.

They call it the invisible illness. They all have similar symptoms: extreme anxiety, a loss of trust in the authorities, compulsive consumption of news reports during an escalation, a sense of isolation and mood swings.

All of them say the 2014 Gaza war was an especially difficult period; some of them haven’t been themselves since. Beyond the fact that seven-week-long Operation Protective Edge was longer than its predecessors, the discovery of Hamas’ tunnels leading into Israel knocked them out. They felt that they had been lied to, and that the government and top brass were indulging in public-relations stunts at their expense while they were absorbing blow after blow.

Sharon Calderon of Kibbutz Sufa on the Gaza border often leaves the area for her mother’s place when there’s an escalation, but that’s not always possible. Three of the five members of her family have been officially recognized as suffering from PTSD; Calderon and her husband Nissan are considered 10 percent disabled.

Shimon Ganem, who lives near Gaza and has been treated for anxiety for nearly a decade, August 2018.
Eliyahu Hershkovitz

Their son has also been recognized. They were among the first sufferers to be recognized as such by the National Insurance Institute after the 2008-09 Gaza war — Operation Cast Lead — but that hasn’t been enough. “People called me crazy. They’d say to me: ‘What do you want? Your child looks normal,’” Calderon says. “It’s true, he’s normal, but he’s dealing with PTSD.”

After her psychological decline began, “life changed by 180 degrees,” she says. She and her husband couldn’t sleep at night and everything seemed to be in free fall. She says she has been affected at every level of her life: as a wife, a mother and an employee (she’s a secretary). Her son has anxiety attacks that force his mother to leave work and go to his school twice a month on average.

“We don’t know what the trigger is that sets off the anxiety attacks — over time we’ve realized that it’s not something systematic,” she says. “But we do understand that I’m his safe space and I manage to get him through the attacks. Over the past half year, ever since the escalation started, I’ve been feeling that things are harder.”

Calderon has been taking Cipralex for a decade now, and she also takes sleeping pills. Her husband Nissan is being treated with medical marijuana, and their son is also taking medication.

The use of pharmaceuticals to treat anxiety is increasing. “There’s always noise and tension here and you’re on constant alert,” the woman in charge of welfare at a kibbutz near Gaza told Haaretz. “We’re seeing a rise in both medications and psychological therapies, and I have to provide answers to the management on why this is happening.”

She declined to give specifics but said the outlays were large. “I can’t say we’ve gotten used to the situation — it’s impossible to get used to it,” she says. “You could say that we’ve learned to live with it but the more time passes, the more expensive it becomes.”

The director of the Eshkol Regional Council’s resilience center, Merav Vidal, says that her center has diagnosed problem cases and brought the issue up with the relevant authorities. “Primary-care physicians are quick to prescribe psychiatric treatment unnecessarily,” she says. Officials at the regional council realize that many local people ask their family doctor, not a psychiatrist, for Cipralex.

“We contacted the Health Ministry and asked them to deal with this via the health maintenance organizations,” Vidal says. “We did some training for the doctors to talk about the correct use of psychiatric medication in an anxiety situation. There’s still a lot that needs to be done.”

Damage caused by rocket in Sderot, August 2018.
Eliyahu Hershkovitz

Horror scenarios

Ilana (not her real name) also suffers when the fighting escalates. “Outwardly, you won’t show it. I wake up in the morning, manage 30 people, keep on functioning,” she says, adding that she functions with the help of medication she began taking shortly after the 2008-09 Gaza war.

“After an incident my body wouldn’t stop shaking for two hours,” she says, adding that horror scenarios often play out in her mind in which terrorists emerge from tunnels and riddle the kibbutz houses with bullets. “I could be an amazing film director. These are movies I have in my mind constantly. I don’t even stop to think about them.”

Evident in a conversation with her is her loss of faith in the authorities after the 2014 Gaza war. “They said there weren’t any tunnels. They said there was a cease-fire. A little boy gets killed at Nahal Oz. Two friends of mine get killed. It’s like, okay, stop playing games with us. I’m a human being, I’m raising my children here. You can’t treat me with such disdain.”

The recent talk about an “arrangement” with Hamas in Gaza hasn’t added to the trust.

“After Protective Edge I functioned, but it was difficult. You get home, then somehow you pull yourself together to give the children the warmth and love they need,” Ilana says.

“You’re dying for them to get out of your sight so you can just be yourself for a second. You sit in the living room, staring at nothing for two hours and then you go to bed,” she adds.

“That operation was very long. We held on, held on, held on — two weeks before the end we realized, my husband and I, that we’d reached our limit, that was it, we didn’t have any strength left, not even for each other. It took us many months to recover. It’s as if you got run over by a tank and then they tell you. ‘Okay, now it’s over.’”

The medications improve her ability to cope. “The problem with the children is that they aren’t taking Cipralex,” she says with a thin smile. “That’s kind of unfair.” She says that the children, too, are suffering. “My 10-year-old daughter is a very sensitive child. She cried all day, and I think her fragility has to do with the security situation.”

Her middle child, she says, seems okay, but questions he asked during a recent escalation suggested that for him too the coping hasn’t been easy. Her eldest, a girl of 16, has been meeting with a psychologist for two years now because of the security situation.

Sharon Calderon of Kibbutz Sufa on the Gaza border, August 2018. She often leaves the area for her mother’s place when there’s an escalation.
Eliyahu Hershkovitz

Burden of proof

Bureaucracy is a stumbling block everyone encounters at the National Insurance Institute and at hospitals. The law is clear: Someone considered more than 20 percent disabled receives a monthly stipend, treatments and other benefits. Someone considered less disabled is entitled to a grant and additional treatments and benefits, but less.

Sherry's (not her real name) psychological state worsened during the 2014 war. Ever since a Qassam rocket landed on her car just before she and her children were about to get in, she has experienced extreme mood swings and a feeling that everything around her is disintegrating.

“Ever since that moment when the Qassam landed, everything has fallen apart for me,” she says. “There have been entire days when I felt I was disguising myself in order to get out of bed and my physical appearance changed.”

For the sake of her children she doesn’t want to reveal her identity, but she believes that at some point she will “come out of the closet,” as she puts it, and become the face of the PTSD sufferers. She says the authorities are treating them disgracefully.

“By now I’d rather lose a leg — that’s something they can see, so it's easier to diagnose,” she says. “You have to understand that just as no one expects a handicapped person to run a marathon, I have a wounded psyche that prevents me from doing certain things and makes me unpredictable, not always comprehensible.”

At a certain point she applied to the National Insurance Institute and began receiving medication and psychological treatment. Her condition improved but it was a bumpy road.

She says a medical-board review at the NII is “a cynical event at which you try to prove that you’re screwed up to people who are joking around with each other. You feel small and like a liar. This made me feel like I had to apologize for wanting to live.”

At first, her disability was pegged at 15 percent, which entitled her to a grant that she calls hush money. Later it was dropped to 10 percent, a difference of tens of thousands of shekels in the grant. “I felt like they were laughing at me,” she says. She appealed the decision and got the 15 percent restored.

For its part, the National Insurance Institute says that it “places special emphasis on cases of people with anxiety disorder to ensure that they receive swift, sensitive and readily accessed treatment.” The NII funds the psychological treatments at five resilience centers in the area, at hospitals and mental health clinics, and “the sufferers are not required to fill out forms or submit documents to the National Insurance Institute in order to receive treatments.”

The NII adds that “we are in close communication and are working  cooperatively with the Health Ministry and the resilience centers to give personal and sensitive service to this community …. To improve the treatment and help the inhabitants of the south, we have expanded the number of treatments and are funding family therapy and group therapy.”

The NII also says that it has modified procedures recently, “realizing that sometimes it is not possible to put a finger on a specific incident that has caused the anxiety. The claim form has also been amended so that it is possible to describe the difficulties due to the security situation without specifying any particular incident.”