Nahariya, the seaside town hit by hundreds of Katyusha missiles over the past month, is home to a hospital whose adjustment to crisis and treatment for "shock" has become a paradigm for preparedness for the next war.
“When we were notified by the army last month that we should expect missiles and the possibility of mass casualties, we prepared to go underground,” says Dr. Moshe Daniel, Deputy Director of the Western Galilee Hospital in Nahariya.
“We already had 450 beds underground and when we received the advance warning, we moved 180 people from the top floor of the hospital and the entire northern building to the shelters,” Dr. Daniel says. The hospital now has 650 beds and eight operating rooms that are fully protected from not only missiles, but the threat of chemical and biological attack as well.
Along the hospital’s southern perimeter, chemical showers were set up in the later weeks of the Re-Engagement War. “Haifa’s chemical facilities were very nearly hit,” a representative of the Ministry of Health said, "though it was not reported, but we made all the preparations for a mass casualty chemical incident.”
One of the main issues that the hospital had to deal with was the sheer number of people who were brought in suffering from shock following a missile attack. “That first day when Nahariya was struck, we treated five people brought in with wounds, and 100 people for shock,” Dr. Daniel explains. “It was a serious problem. We could not properly treat the wounded with the shock victims around, and so we opened a separate emergency room specifically for those suffering from shock.”
Shock, according to Dr. Carlos Giloni, who heads the hospital’s psychiatry department, is a normal reaction to an abnormal situation. “The main aspects of treatment," he said, "are assuring people that the reaction is normal, diffusing the intense fear they have of their own fear, and showing people that they are already able to take care of themselves and take control of their situation.”
To that end, in designing the special section of the hospital for treatment of shock victims, Dr. Giloni ensured that victims would have to walk to the emergency room and not be rolled in on a gurney. “If you put them in a bed, they get the sense that they need more treatment,” he says. “They see themselves as hospitalized and feel like they need medication to regain control. It is therefore critical that the patient be made aware that he or she is able to take control of their situation.”
The shock victims room does not look like a hospital room, but more like a lecture hall. It is staffed by social workers, and with a doctor and nurse on hand to ascertain whether there are victims who need medical attention.
“After a barrage of Katyushas falls, anywhere from 50-90 people come in – victims together with families or neighbors,” Dr. Giloni says. “They sit down together with a social worker and address the situation directly. Eventually the patients themselves begin talking and supporting each other – driving home the point that this is a normal reaction and providing an environment much more conducive to self-empowerment than the blood and wounds in the regular emergency room.”
The model created by the hospital has been replicated, with the help of volunteer social workers and the IDF Home Front Command, throughout northern Israel. In Carmiel, an Ethiopian banquet hall has been turned into a clinic geared specifically to victims of shock. “One of the benefits of treating shock victims in community centers like this is that they don’t have a chance to feel hospitalized,” says Josla, a South African immigrant who staffed the center as a social worker from the start of the war. “The essence of it is really resiliency. People have the power within them to heal themselves from shock and trauma.”
Child psychologist Jo Ishai works alongside Josla, dealing with children who come into the treatment center. “Once parents are calmed down,” she says, “the children do a lot better. We are seeing a lot of regression in the children, and that is normal. Parents must realize that it is a normal response to this truly abnormal situation.”
Ishai says most of the children just need to be talked to, hugged and held close. She has a collection of drawings that children have created to express themselves following rocket attacks. One shows an incoming missile with fire enveloping the ground. Another shows a house with holes drawn all over it. “One of the children was highly expressive. She drew a wedding scene and carefully cut it apart into pieces – expressing that life had been shattered by the rockets,” she says. Another picture simply shows a ring of multi-colored hearts. “Some kids express what they need – a lot of love,” she says.
Tzvi, a Lieutenant Colonel in the reserves and a psychiatrist in civilian life, oversees mental health care in the IDF northern command. He is proud of the combination of military and civilian services at the community centers. “The model works very well,” he says. “[It is a] core of professionals with military decision-making supported by a civilian staff and backed up by volunteers.”
With the ceasefire, Josla has begun to follow up, calling those who have been treated to find out how they have been doing.
Meanwhile, in Nahariya’s Hospital, staff are preparing to repair a section of the hospital that was struck by a Katyusha missile, holding courses and conferences for medical staff from Israel and around the world, and expanding their capabilities to cope with mass casualty biological and chemical attacks.
(Photos: Ezra HaLevi)