Israel’s Qassam Generation: Unseen trauma in the shadow of the rockets

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or those Israelis who grew up in the shadow of the rockets fired from the Gaza Strip, the so-called Qassam Generation, years of military tension have left deep scars - from infancy, through childhood and adolescence, to adulthood. Subjected to years of attacks by Palestinian terror groups and suffering from endemic PTSD, they have long been furious with the government for its impotence and with politicians and the public for their indifference.

They feel unseen and unheard. Jarringly, they say, Israel has proved it can come together over a common cause - from social protests over the high cost of living and a campaign to free an Israeli backpacker from a Russian jail to, most recently, the coronavirus epidemic.

Yet even when the entire country is united in the face of an apocalyptic emergency, residents of this battered region still feel different, ignored and unimportant. After all, they are painfully familiar with emergency situations, a closed-down educational system, and the sense of perpetual threat, something that their fellow Israelis seemed blissfully unaware of until COVID-19 struck.

In 2014, Israel launched Operation Protective Edge, aimed at curtailing incessant rocket attacks from Gaza. Seven weeks of fighting and thousands of fatalities led to a period of relative calm, which lasted until March 2018. The past two years, however, have seen a spike in hostile activity, with cross-border attacks, Qassam rockets, tunnels, explosive kites and balloons - and sirens sounding at all times of day and night.

This spike, accompanied by the kind of indifference that residents have been complaining about for years, has seen the further dents in the famous ‘resilience’ of Gaza border area residents. Therapists and educators report that over the past two years, since the escalation in March 2018, they have, for the first time, been seeing cracks in the famous resilience of the Gaza border area residents, and in their ability to return to full, and even improved, functioning after a difficult event, situation, or period.

The figures speak for themselves. In 2019, the resilience centers in the Gaza border area treated 4,348 anxiety victims, almost double the number the previous year.

Talia Levanon is the director of the Israel Trauma Coalition, which operates the six resilience centers in the Gaza border area. She says that the escalation in hostilities the south since March 2018 has "totally changed the scope, the numbers, and the manifestations [of trauma]. It brought huge changes in the symptoms of trauma sufferers. We are now seeing new and more severe emotional disabilities; the number of people we refer to psychiatric treatment is increasing, and more people are taking medication."

Merav Vidal runs one of the Coalition’s resilience centers. She, too, has noticed the change over the past two years and says that there are more and more cases of chronic trauma. "Prior to 2018, despite the fact that there had been long-term exposure to terror with Operation Cast Lead, Operation Pillar of Defense, and Operation Protective Edge, those who were in therapy were being helped and their symptoms didn’t deteriorate. The number of people with chronic trauma was negligible. Now, we have more and more cases of people who need psychiatric intervention and medication and are being diagnosed as PTSD sufferers."

Life on hold

TEXT: Ron Calderon from Kibbutz Sufa has been suffering from PTSD since a Qassam rocket exploded near his kindergarten in April 2008. He was four years old at the time.

"Ron was in the playground with all the other children," says his mother, Sharon Calderon. "He didn’t see the rocket actual fall, but the whole experience has left him where his is now. He only started talking about his memories two years ago, so we don't really know what happened."

At first, Ron was diagnosed with anxiety. Later, he was found to be suffering from PTSD and was recognized by the National Insurance Institute as a victim of terrorist acts on the grounds of mental health. "Ron has had panic and anger attacks, cursing, and shouting," according to Sharon. "He withdraws into himself, cries, and shakes."

Since 2018, whenever there is an uptick in rocket attacks, Ron’s situation worsens. He suffers from shortness of breath and has fainted on several occasions. Now a 16-year-old high school student, Ron who needs an aide with him at all times.

Calderon says that she often receives a phone call from school, drops what she is doing, and drives to him. "For the past 12 years, I have put my life on hold," she says. "Once we understood the severity of PTSD, my husband and I decided that he would be the main breadwinner and I would do whatever work I could that would enable me to be there for Ron. I worked, but I couldn’t hold down a job for more than two years. It’s a problem when you sometimes need to leave work once a day for two weeks."

Tragically, Israel is fertile ground for conducting research into post-trauma. According to the Health Ministry, 10 percent of the general population suffers from security-related trauma and that "these figures are higher - up to 20 percent - in the Gaza border area, because of the chronic nature of the fighting."

According to a 2010 study, more than 13 percent of the 1,000 children who participated were diagnosed will full post-trauma and 30 percent from partial post-trauma, while another study found that 40 percent of the children in the area suffer from anxiety and PTSD symptoms.

One of the clear conclusions of these studies was the crucial impact of how mothers cope with the security situation. They found that one third of mothers in the Gaza border area suffer from PTSD symptoms and almost one third suffer from depression - a rate which is four times higher than among the general population. Some of the mothers were found to suffer from both conditions, with a total of 44 percent of mothers suffering from some kind of mental distress.

Home and unsafe

TEXT: Over the past few months, residents of the Gaza border area have been trying to drum up solidarity from people all over Israel. For example, 'Voice of Mothers' is reaching out to Israeli women and their sense of maternal solidarity. They want mothers everywhere to be aware of the conditions under which they are raising their children.

A search of social media networks reveals a plethora of mothers telling their stories of life in the region. One mother wrote: "To be a mother in the Gaza border area is to be on alert at all times. It is to sleep fully dressed as if you were on call in the army. It is constantly to live with the conflict of whether to stay or to flee. It is to go crazy with worry until your heart explodes. It is to be at home and not feel safe."

Hadas Tzalach is married and lives in Ashkelon with her 8-year-old daughter and twin 6-year-old boys. When her daughter was working on a school project on feelings and emotions, "She cut out the letters peh, het, and dalet [which form the word 'fear' in Hebrew], stuck them on a piece of black paper, and brought it home. In infancy, there isn’t any awareness; then, slowly but surely, when my daughter understood the meaning, the anxiety began. We would go to the emergency room when she complained of chest pains and said she couldn't breathe. At first, we did not realize that these were panic attacks."

On days when there is a missile siren, Tzalach says, he daughter is incapable of attending school the next day. "When there is a chance that the siren may sound, she prefers to sleep in the safe room because she is frightened. If I take her out for pizza in Tel Aviv and she hears the sound of a motorbike, she jumps from fear. This would not happen to a girl who lives in Tel Aviv."

Tzalach is a balloon artist. For years she has taught children what fun it is to twist balloons into interesting shapes and not to be afraid if the balloon bursts. Things have changed - in addition to rockets, terrorists in Gaza are floating balloons with explosive devices attached to them over the border - and now she repeatedly warns them not to go near balloons when they are out.

"In my house, they all grew up with balloons. How has such a happy item become such a dangerous object that you mustn’t go near? They took all the good, the joy and innocence of the children, and simply destroyed it."

I asked Tali Levanon of the Israel Trauma Coalition what kind of adults the children living in the Gaza border area will become as a result of growing up in these circumstances.

"We have to be very cautious because, while we are talking about trauma, we also have to remember that Israel is characterized by a high degree of resilience," she says. "Growing up in this country, Israelis internalize that there is hardship as a result of the security situation. This becomes part of their DNA and they develop coping mechanisms on both an individual and a societal level. However, I believe that some of these children will grow up to be adults with one hand tied behind their back. In other words, they will have difficulty in some areas concerning quality of life. This is not only measured in terms of trauma, but also in the ability to live life to its fullest. This situation affects a person’s ability to forge interpersonal relationships, to love oneself, and to cope with day-to-day challenges."

Yizhar Sha’ar has been the director of the Eshkol Region Educational Psychological Service for the past 18 years. He lives on Kibbutz Nirim and has three children.

"We're talking about an entire generation that has been exposed to the reality of war," he says. "They join the IDF and develop PTSD - especially those serving in combat units. Everything they've seen and endured comes to the surface. Overexposure to situations that simulate war during basic training, for example. Some of them cope and this may boost their sense of self-esteem. But for others, it can break them."

Dalya Yosef, director of a dedicated helpline, is unequivocal. "This is a ticking time bomb," she warns. "History books will tell the story of the children who lived in the shadow of the Qassams. To be born and grow up feeling that there is no safe place in the world is not normal and exacts a heavy price."

Ongoing trauma

TEXT: Along with the figures that show the rates of PTSD among residents of the south, another fundamental issue needs to be addressed: the inner turmoil experienced by residents of the Gaza border area does not always fit the dry criteria defined in the academic literature on PTSD. The situation is, therefore, even more complex - so too are the ramifications.

"The term post-trauma is problematic when referring to the people in the south because the current situation is not ‘post’ - it is a constant, ongoing situation and the threat is ever present," says Levanon.

Moran-Hila Madmoni lives in Sderot. Her 9-year-old son, Yisrael Meir, has been stuttering ever since 2014's Operation Protective Edge. "Stuttering is not considered post-trauma, but it is an ongoing trauma," she says. "As far as I am concerned, we are fully-fledged victims of terror just like anyone else. A balloon with explosives attached to it is just like a missile. It kills. Children are traumatized by them and mental-health victims are no less victims than those who are physically injured. People don’t understand that we are constantly on high alert."

The Health Ministry's estimates for last year are that only 3 percent of the residents of the Gaza border area apply to the National Insurance Institute to be recognized as victims of terror attacks as a result of their emotional trauma. While the ministry publishes data on the number of civilian terror victims suffering from PTSD or other mental problems (excluding IDF victims who are recognized by the Ministry of Defense), it says that it is unable to provide that data specifically for residents of the south.

One way or the other, there is no doubt that the figures represent only a partial picture of what is actually happening in the south. For example, in 2019, 16 people were recognized as trauma victims and five as victims of emotional injury. In 2018, 62 people were recognized as trauma victims and five as victims of emotional injury. In 2014, the year of Operation Protective Edge, there was a spike in numbers, with 260 people recognized as trauma victims and 58 as victims of emotional injuries.

I asked Levanon whether the National Insurance Institute is now more aware and sensitive to the needs of the population after two turbulent years in the Gaza border area.

"Unfortunately," she says, "we have not seen any greater understanding in terms of recognizing them as victims of terror. In 2008, regulations were introduced to make it easier to get recognized as trauma. Until then, if you didn’t go to hospital on the actual day of the incident, you would be given the runaround for months. The new regulations state that anyone who was involved in a security incident is eligible for up to 12 therapy sessions, and even more if necessary. Nonetheless, with more and more people being recognized as trauma victims, which necessitates continuous therapy, we are still facing a challenge."