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"Lightly Injured"

May 9, 2009 | by Sara Yoheved Rigler

Terrorism's toll is far greater than we think.

Leah and Yitzhak Klein*, both in their mid-twenties, had just finished their pre-Shabbat shopping at Jerusalem's farmers' market. Their tote bags were laden with vegetables to prepare for chicken soup and potato kugel. Like many low-income young couples, pensioners, and Russian immigrants, the Kleins chose to shop on late Friday afternoons because the prices hit rock bottom a couple hours before the market closed for Shabbat.

Leah and Yitzhak wended their way through the crowded aisle and past the soldier guarding the entrance to the market, which, over the years, had been a periodic target of terror attacks. As they approached the bus stop on Jaffa Road, suddenly Leah heard a thunderous blast, what she would later describe as "a noise from another world." Two meters in front of them, an Arab female terrorist had blown herself up.

While Leah's burns have healed well, her psyche has not.

Leah, her face and hands burning, flew through the air. When she landed, she turned her head frantically to find her husband amidst the smoke and dust which filled the air. Yitzhak, whose hands and neck had been burned, had landed on the opposite side of the street. He ran and grabbed Leah and started to pull her toward Bikur Holim hospital, several blocks away. A taxi pulled up next to them, told them to jump in, and sped them to the hospital. There they were admitted and pronounced "lightly injured."

Although the shrapnel wounds in Leah's legs did not bleed, her clothes were soaked through to the skin with other people's blood, and were saturated with the smell of burnt flesh, which would linger even after repeated laundering.

Yitzhak, his hands partially bandaged, was discharged after two days. Leah spent ten days in the hospital, her face grotesquely swollen. When her grandmother, a Holocaust survivor, came to visit Leah, she could not recognize her own granddaughter. She approached Leah's bed and asked, "Excuse me, Miss, where is room number 7?"

Leah cried, "Look, Bubbie, it's me!"

Her grandmother, tearfully clasping Leah's bandaged hand, sobbed, "That I should survive Auschwitz and come to live in a Jewish state, only to have to see my granddaughter attacked by Jew-haters, right here, right in Jerusalem!"

After three weeks, the bandages on Leah's burned hands were removed. The doctors warned her to completely avoid the sun by staying indoors during the daylight hours for the next five months, until the end of the scorching Israeli summer. She is not permitted even to go out on her balcony to hang laundry.

While Leah's burns have healed well, her psyche has not. A cheerful, vivacious young woman, she now finds herself beset by fears. At the time of the terror attack, Leah purposely closed her eyes to avoid seeing dismembered bodies and mutilated heads and limbs, because she knew the gruesome images would give her nightmares. Her precaution did not help. Her sleep is plagued by horrific dreams of Bin Laden pursuing her. During the day, after only two or three hours of sleep, Leah is tired and weak. A high school history teacher, she has no idea when she will feel strong enough to return to work.

When Leah ventures out at night to take a walk, she panics at every passing taxi, fearful that a terrorist will jump out and try to kill her. Last week a friend invited her to a lecture on a topic which interested Leah. When they arrived at the hall, Leah surveyed what she considered to be the inadequate security arrangements, turned around, and went home.

Leah sees a private trauma therapist once a week. Despite the Kleins' strained financial situation, she pays the $80 fee herself rather than see the free psychologist, who is not an expert in trauma, which the State of Israel was willing to provide.

Leah's therapist says that a vacation outside Jerusalem would do her more good than all the tranquilizers she is taking. The irony is bitter: If the Kleins had enough money to go on vacations, they would not have been shopping for produce bargains at the outdoor market late that Friday afternoon.


The ritual in our house is mirrored in homes throughout Israel: First we hear from the radio of a terrorist attack. (If the attack is in Jerusalem, we first hear the sirens.) Someone calls out, "Pegua (terrorist attack)," and everyone in the family grabs a Book of Psalms and takes up positions in the living room. Together we fervently recite four psalms for the complete recovery of the seriously wounded victims, those who, between one radio report and the next, could move from the list of seriously wounded to the list of dead. Then we sit by the radio and listen as the reports come in: How many dead, how many seriously wounded, how many moderately wounded, and how many lightly wounded.

We cry for the dead, we pray tearfully for the seriously and moderately wounded, and we experience a macabre sense of relief that most of the victims are "only" lightly wounded. The numbers in last week's suicide bombing outside an ice cream parlor in Petach Tikvah represent the usual proportion: Two dead (an 18-month-old baby and her grandmother), 4 seriously injured, 8 moderately injured, and 40 lightly injured.

But what does "lightly injured" mean? According to Professor Shmuel Shapira, Deputy Director General of Hadassah University Hospitals, "lightly injured" is slang rather than a scientific definition. It generally means that there is no danger to life or to any organ of the patient's body. Thus, a terror victim who suffers fractured limbs and/or shrapnel injuries that do not bleed all over the legs, arms, and face would be categorized as "lightly injured."

The term "lightly injured" is a misnomer.

Prof. Shapira points out that the term is a misnomer because the effects on the patient's life can be far from light. The physical wounds may require weeks of hospitalization, repeated surgeries, months of rehabilitation, and frequent visits to the outpatient clinic for a year or longer. The psychological trauma may be even more devastating, leading in the worst cases to chronic unemployment, divorce, and sometimes suicide. "His family life may be ruined altogether," observes Prof. Shapira, "and he may be mentally handicapped for life."

The symptoms of acute stress disorder experienced by terror victims include: trouble concentrating, recurrent and obtrusive thoughts (which may adversely affect professional productivity), nightmares, re-experiencing of the traumatic event, insomnia, headaches, loss of appetite, numbing, social problems, dizziness, stomach aches, heart palpitations, depression, survivor guilt, and hyper-vigilance.

According to Dr. Batya Ludman, an Israeli psychologist specializing in trauma, people suffering from Post Traumatic Stress never totally recover, but they move on. "It's like a death in the family," Dr. Ludman explains. "In both cases, you're dealing with loss. A terror victim has lost the ability to casually walk into a mall or café. Like a death, we incorporate that loss, and we move on."

Dr. Ludman, who treated trauma victims in Nova Scotia after the Swiss Air crash there, says that people associated with a one-time terror attack cope by re-experiencing the incident and memorializing it, a process in which Jews are expert. The problem she observes in Israel presently is that people do not have time to recover from one terror attack when the next one hits.

"Look at the September 11 terrorist attack on America," Dr. Ludman declares. "Many Americans who have begun to move on are re-traumatized every time there is an official announcement of a terror alert."


Since September, 2000, the beginning of what many in Israel call "The Oslo War," the two branches of Hadassah Hospital, Jerusalem's largest medical facility, have treated 1,700 terror victims. Most of these were "lightly injured," including those suffering shock who were sent home after a few hours.

Yeshara Gold, Founder and International Director of Kids for Kids, an organization dedicated to the recovery of young victims of terrorism, believes that the problem of Post Traumatic Stress is far more widespread than the numbers of those actually injured in terrorist attacks. Kids for Kids services what they call "the kids who fall between the stretchers." These include the child who lives next door to the child who was killed, the teenager who daily rides on the bus line which was targeted by a terrorist attack, the kid who witnessed a suicide bombing, the classmates of terror victims, etc.

Although the National Insurance Institute provides free psychological counseling for the immediate relatives of anyone murdered in a terrorist attack, it assumes no responsibility for other relatives or close friends. For example, Koby Rubinstein*, a young man killed a year ago in a terrorist attack, had a sister who is the single mother of a seven-year-old boy named Motty. Koby used to visit his sister and Motty every morning before school and every evening. After Koby was killed, the National Insurance Institute offered psychotherapy to his sister, but not to his nephew Motty. The boy suffered an acute case of trauma, including nightmares, acting out in school, and constant fears. Fortunately, Kids for Kids was able to help Motty with a recovery support team trained in play therapy, therapeutic art work, and trauma counseling.

In another case, Malka*, age 13, whose aunt and cousins were killed in a terrorist attack, stopped going to school, dropped out of her youth group, developed eating problems, and totally shut down. While Malka received help from Kids for Kids, Yeshara Gold asserts that Malka's friends played a pivotal role in her healing: "They kept calling every day, no matter how many times she refused to talk to them. They wouldn't take 'no' for an answer. Such peer support can make all the difference in trauma cases."

Dr. Ludman corroborates that a decisive factor in a positive prognosis for trauma victims is a strong, understanding support system. In this sense, however, the "lightly injured" may suffer the most. While the nation is mobilized to help seriously injured terror victims and their families, those who suffer minimal or no physical injury may be ignored.


"The whole country is suffering some level of Post Traumatic Stress."

"I believe the whole country is suffering some level of Post Traumatic Stress," asserts Dr. Ludman. "In addition to those injured or present at a terrorist attack, there is a whole subset of people who 'should have been there,' such as the person who planned to have lunch at S'barro's but got held up in traffic, or the person who works in that shopping center but by some quirk wasn't there when the bomb exploded, or the person who was in that shoe store a couple hours before the attack. These people feel they had a narrow escape, and they may suffer many of the symptoms of acute trauma."

"In addition," Dr. Ludman continues, "we personalize." After a terror attack on an outdoor café, those who tend to go to outdoor cafes may feel panic. If an eight-year-old child is killed, parents of eight-year-old children feel effected. After a suicide bombing in Rishon LeTzion, people all over the country think, "I know someone in Rishon LeTzion." They feel personally bereft.

This is, after all, the goal of terrorism: to make the entire population feel terrorized, vulnerable, unsafe in their restaurants, basketball courts, Bat Mitzvah halls, malls, bus stops, and, in the case of small communities, even in their own homes.


While coping with normal cases of Post Traumatic Stress after, for example, a car accident or a singular terror attack in Kansas City, requires "moving on," the frequency of terror attacks in Israel during the last year and a half makes recovery impossible. We are on what Dr. Ludman calls, "a terror roller-coaster. We live our lives between terror attacks."

The most debilitating result of terror is that it snatches from people their sense of predictability.

The most debilitating result of terror is that it snatches from people their sense of predictability. In psychological jargon, their entire "assumptive world" changes. They used to assume that they can run an errand in downtown Jerusalem and be home before dinner, but now they wonder if they will return home at all. They used to say "l'hitraot, (see you later)" to classmates or co-workers at the end of the day and expect to see them the next morning, but they may see them next in a hospital bed. They used to consider taking their grandchild to the local shopping mall as an innocent excursion, but now they are not so sure.

According to Dr. Ludman, the entire Israeli population should be aware that symptoms such as headaches, stomach aches, irritability, or insomnia are perfectly normal reactions to our current situation. No one should feel that he is weak or she is losing her mind when experiencing these and other symptoms of Post Traumatic Stress. "We are all normal people responding normally to an abnormal situation," Dr. Ludman emphasizes.

Rebecca Weinberger, Spokesperson for Public Awareness for Kids for Kids, maintains "The Israeli attitude of 'Yiheyeh b'seder (It'll be okay),' which got them through five wars, no longer works. The Israeli citizenry needs a license to know that after a string of terror attacks, it isn't going to be okay, and they should seek help for whatever level of trauma they are experiencing." She suggests establishing "islands of coping," such as taking a bubble bath, engaging in daily exercise, or visiting "safe places," with only one, guarded entrance, such as a museum or the zoo.

Another effective coping mechanism is the development of what Dr. Ludman calls, "superstitious behaviors." For example, many Jerusalemites refuse to take a bus on Sunday mornings or go downtown on Thursday afternoons, due to the incidence of terror attacks at those times and places. "In this way, we establish our own safety zones, our own sense of control."

Establishing a sense of control is vital to warding off the effects of trauma. In fact, the greatest single indicator of recovery from trauma is a sense that one is not helpless, that one can do something to effect the situation. Becoming active -- spiritually, politically, or societally -- all confer a feeling of empowerment which neutralizes terrorism's scourge of vulnerability.

Those who believe that prayer, undertaking new mitzvot or performing acts of kindness can ameliorate our situation are right on two counts: spiritually, what God decrees for us will change when we change; psychologically, acts of spiritual empowerment counteract the effects of trauma. As Dr. Ludman attests: "Groups who get together to recite Psalms make themselves stronger even as they ward off terror."

In addition to whatever we as a nation do militarily or politically, spiritual activism is a vital response to our collective trauma. Visit a hospital, support victims of terror, learn Torah. While we may be vulnerable, we are not helpless.

*All names of terror victims in this article have been changed in order to protect their privacy.

For another perspective on victims of terror, read "Creating Diamonds".

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