Dr. Evgenia Cherniavsky, head of the medical imaging department at Barzilai University Medical Center in Ashkelon, was on vacation in France when Hamas launched its brutal attack on October 7. In a race against time, she and her husband – the director of the interventional radiology department at Shamir Medical Center – managed to get a flight back to Israel the very next day. “We woke up that Saturday morning to messages in the family WhatsApp group and we felt utterly helpless,” she recalls. “Our children were alone in Ashkelon and they couldn’t even go to each other’s apartments because there were terrorists roaming the streets. The hospitals were full of wounded people and we’re both physicians – but we weren’t there to help. El Al helped us find a flight and even held up departure so that we would make it on time since my husband’s position is important to the army. We ran to the airport and the ground crew asked us, ‘Are you doctors? Get on board’.”

On October 8th you landed straight into the insanity

“The first week was the toughest on us emotionally. I have never seen injuries like those. Point-blank gunshot wounds, bombs going off close to people. One technician told me, ‘I have seen every organ I know in the human anatomy outside of the human body today.’ We were also not prepared to receive so many wounded at one time. None of the drills that were held simulated such a flood of injured people and, because it was hard to get back from home for the next shift, we slept on mattresses in the hospital. We were worried that if we left, we wouldn’t be able to get back again. We spent 10 consecutive days here – a team of three radiologists and a few technicians. I also brought my 15-year-old son here to sleep on the sofa in my office as my husband had been called up for reserve duty at Soroka Medical Center and my daughter was also in the reserves. I didn’t want him to stay there alone.”

Meaning, you were living at your work the entire time?

“When I left home to go to work during the first week, I didn’t believe I would return home again. I took important documents with me because I didn’t know if the house would be there when I got home. I thought it would be bombed because other houses in Ashkelon had been hit by missiles. We felt that anything could happen. The floor of the hospital where the imaging department is located is reinforced against bombs, so at least we felt we were in a safe place.”

Did people who were not there 24/7 manage to return?

“Some people panicked; some were called into the reserves. We needed backup from other hospitals but people were afraid to drive all that way under missile fire and helped us by analyzing scans remotely. We fought to make sure that our technicians weren’t called up by the army. The service that they provided soldiers here was just as important as being on the front line.

“We also suffered a personal tragedy in our unit. The husband of our chief X-ray technician, Dorit, was killed that same week in Kissufim by a missile when he went there to look after the cattle. We found out before Dorit had officially been informed. It was so hard to work right next to her during the shift and not being able to say anything. The army only informed her when she got home. We are more like a family than a team. We waited close to her house so that we could be there as soon as she got the news to support her.”

Have you had any contact with the families of wounded people?

“Not much, but the intensive care unit is located right next to our unit and we could hear the anguished cries and screams of the soldiers’ relatives when they are told that there’s been a deterioration in his condition or that there was nothing they could do.”

How do you feel in such situations?

“Usually, we manage to hold ourselves together and not display any emotions, so as not to lose concentration. Afterwards, we went into our offices and cried. I am a very strong woman. I grew up in the Soviet Union in very tough circumstances. I have been in this profession for 24 years and I almost never cry. But now we cry and talk and hold each other. Admittedly, I share a little less than the younger doctors because we need someone who can carry it all, keep calm and not fall apart.”

Is there psychological help available to team members? Even a couple of meetings can help.

“The Israel Medical Association and the hospital itself offer us counseling all the time. Some people think that because the team offering psychological help is also collapsing because of the high demand, we’ll hold off for now and deal with it later. We can see for ourselves who is really in a state of distress and whose mood can be changed with a conversation between us. But there are people who go. For example, the team members who were evacuated from the Gaza-border area. They really did experience some horrible things.”

How are you now?

“We’re working. I don’t know when it will all come bursting out in the future. We’re running out of energy and the exhaustion is cumulative. In the end, we process everything through the heart.”

Dr. Evgenia Cherniavsky: "I have been in this profession for 24 years and I almost never cry. But now we cry and talk and hold each other. Admittedly, I share a little less than the younger doctors because we need someone who can carry it all, keep calm and not fall apart.”

‘You Can’t Afford to Be Weak’

On October 7, Barzilai University Medical Center in Ashkelon was faced with a disaster on an unprecedented scale. In the first 24 hours, 370 wounded people were rushed to the hospital (more than 4,000 have now been treated there since the start of the Israeli ground operation), barrages of rockets were fired at the city and the medical staff, who are used to dealing with injured soldiers from military operations, were forced to handle situations that were incredibly complex from a professional and psychological perspective. In Barzilai, however, like in the other hospitals that are bearing the brunt of this war, the medical teams appear to be in no rush to ask for psychological counseling. Management encourages employees to use the hospital’s psychological team and the various relaxation workshops they offer, but the physicians, especially the more veteran among them, have rejected the offer and prefer to deal with their traumatic experiences alone.

Their testimonies are heartbreaking precisely because of their restraint. “You’re looking for the emotional side but, when it comes to treating a wounded person, the last thing they need to see is your tears,” says Dr. Olga Meizler, head of the hospital’s vascular surgery unit. “The patient needs you in order to survive, so you can’t afford to show any weakness – because the staff are looking at you, the parents are looking and want to see a rosy future for their child. They don’t want to see you crying on the side, they want to see that they are in safe hands and safe hands can’t be drenched in tears. So, on the outside, you have to be oh-so-strong,” she says, drawing out each syllable.

Do you allow yourself to let it out when you get home?

“My daughter is serving in the Border Police in the West Bank. She has seen so much and she also has a friend who is a hostage. I can’t add to her woes with my stories and my tears. But, yes, when I get home and put my slippers on, it’s easier.”

In the end, the tension will find a way out.

“Fine, some time after the war. Barzilai offers counseling all the time and we have a hotline but I don’t think that this is the right time. Right now, everyone needs to find inner strength, to stay strong and sane.”

How do you look after yourself?

“The most frightening thing is recognizing an injured person just in case emotions get in the way of treatment if I know someone from normal life. So, I do not do the triage. I don’t want to see names and faces. That’s my self-defense mechanism. I wait in the operating theater. Ready and alert. Once we have dealt with any life-threatening injuries, it’s a different story.”

Were the injuries you saw on October 7 particularly bad?

“Yes. We’re not talking about shrapnel and bullet wounds that we’re used to seeing in combat zones. The start of this war was shocking, very untypical of what we saw in previous wars. Both in terms of the kind of injury and the large number of civilians. I don’t know if we would have been able to deal with another day like that. Now, too, it’s been going on and on; this is the first time we’ve been in a war with casualties every day. I have seen nurses burst into tears in the operating room when they realized that the patient wouldn’t survive their injuries. One of the medical team tries to get them out as quickly as possible. We tell them, ‘Wait, not now. Pull yourself together.’ We all live here in the South; we all have children. They could have been our kids. And these injured kids are like our own children. When they read out the names of the fallen soldiers on television and there are names that we recognize from our work – it’s incredibly painful.”

Maybe crying actually helps to alleviate the distress?

“Maybe. On the other hand, there are patients waiting. There’s a lot of work to be done and you can’t fall apart. One day, we will all fall apart. But now isn’t the time.”

It must give you strength when you manage to stabilize a patient’s condition.

“It’s hugely gratifying when they regain consciousness and when we move them to the rehabilitation ward. It’s not just rehabilitation – it’s a victory.”

The start of this war was shocking, very untypical of what we saw in previous wars. Both in terms of the kind of injury and the large number of civilians. I don’t know if we would have been able to deal with another day like that".

‘We Walked between the Bodies to Identify People’

The emotional burden can sometimes make the treatment rather mechanical. Dr. Ben-Zion Joshua, head of the Department of Otolaryngology-Head and Neck Surgery at Barzilai, says that on that fateful Saturday, he had to remind medical staff that, even though they wanted to treat as many patients as possible, the human touch was also vital. “What stunned us at first,” he recalls, “was mainly the mass. You went down from the operating room to the ER and you saw countless people with injuries. At first glance, it’s enfeebling. Anyone who saw that sight was in shock.”

How do you recover?

“During treatment, you disconnect yourself – especially when the pressure is intense and there are so many anonymous patients who need treatment. So, the most important thing is to remind the staff that we’re treating human beings. It’s sort of obvious to everyone but it was important to remind them that professional-technical treatment is not the only important thing. It was a disaster that led to a lot of wounded people who looked lost and were unaccompanied. A lot of foreign workers arrived alone. We had to make everyone feel like we saw them.”

Were there also people who flocked to the hospital looking for relatives?

“Lots. Members of our team were sent photographs by people they knew of loved ones from the city or from the communities closer to Gaza, asking for help identifying them. When three trucks full of bodies arrived at the hospital, our people walked between them, checking the photographs they’d been sent.”

That’s not something that happens regularly

“No. We helped give treatment wherever we could. Doctors helped out as surgeons, giving infusions. It was difficult to even get to Barzilai in those first few days. One intern drove here with a helmet on his head just in case there was a missile attack. Anything to get here. Another doctor on my team, originally from East Jerusalem, lives with his family in Ashkelon. The family left for Jerusalem because they didn’t have a bomb shelter in their apartment. He never left the hospital during that first week. Not only did he work round the clock, but he also had to listen to whispers in the corridors about what Israel should do with all the Arabs. When I saw that he was on the verge of breaking down, I told him that he needed to take a breather, to go visit his family. The problem was that when he wanted to come back from East Jerusalem, it took us two days to get him a permit.”

How did the Arab physicians deal with it all emotionally?

“They felt attacked. It’s hard to work when people are talking about you like that. To Barzilai’s credit, the hospital had a zero-tolerance policy toward discrimination and racism. Prof. Hezi Levi, the director of Barzilai, sent out a letter making it clear that such behavior would be unacceptable and that we all have to work together – then things calmed down. The Arab workers were mainly worried about what would happen outside the hospital. Arab physicians left the hospital wearing their scrubs so that it would be obvious they were doctors. They were afraid of being shot by a civilian when identified as Arab. They were also afraid to travel by bus and they would drive each other home.”

How can you, as a department director, make sure your team doesn’t fall apart?

“I made sure that our morning meetings were not just dry, professional reports but also included a personal element. I asked how people were doing and what was going on at home. Interns were afraid to stay in the department alone overnight in case there was a major incident and they wouldn’t be able to handle it alone. So, during the first month, two interns and two senior physicians stayed overnight. And because all of the ambulatory services were suspended – like outpatient clinics – I managed to add some teaching, which helped to distract them from treating patients.”

Did you get psychological assistance?

“They offered us all. I told myself, forget about it, you don’t need it. My conversations with my colleagues and family were enough for me.”

“What stunned us at first was mainly the mass. You went down from the operating room to the ER and you saw countless people with injuries. At first glance, it’s enfeebling. Anyone who saw that sight was in shock.”

‘What Kind of Professional am I If I Have Nightmares Every Night?’

The phenomenon of physicians rejecting mental-health services is something that Dr. Shiri Ben-David – the head of Rehabilitation Psychology at the Hadassah Medical Organization – knows all about. “They really are a hard-to-treat population. Anyone who survives in that profession believes that they have an elevated level of ability to withstand traumatic situations. The problem is that we all reach the end of our capabilities at some stage and they do not always recognize that moment in themselves. During the coronavirus pandemic, for example, it took many months before they started to contact us and by then they had already reached a worse point than the nurses. The nursing staff take advantage of the emotional support that we offer far more often.”

Why is that? Physicians aren’t unaware of the issue, are they?

“It stems from a combination of contradictory messages. The war is still not behind us, so I’ll use the the coronavirus pandemic as an example. On the one hand, the management gave wall-to-wall support for these interventions and even told people explicitly that they should ask for help. That’s important. And they also provided the funding needed to give this help. On the other hand, there’s a message between the lines that you are a member of the hospital’s emergency team and you’re supposed to be able to deal with things and to continue to function fully. People who did go for treatment asked the therapist not to tell their supervisor – even though it was the supervisors who sent people to therapy.”

Were they afraid that they would be classified as unfit for work?

“A lot of people asked what it says about them, about their professional self-image, if they are unable to deal with the things they have seen or the trauma they have experienced. What kind of professional am I if I wake up at night with nightmares? These are people who functioned fine professionally – but the very fact of having to ask for help raised doubt about their own professional capabilities.”

Maybe they were worried that work-place treatment might not be discreet enough. It would go down in the personnel file and then suddenly they could find themselves being moved to a different position or even put on unpaid leave.

“We have stated very clearly that personnel files are also confidential within the hospital and that it will not affect their employment in any way. Sometimes, exactly the opposite is true and treatment is what gets some of them back to being fully functioning, whereas someone who is put on leave or moved to a different position will go without treatment and finds themselves unable to function. And there are still those who prefer not to be treated by hospital staff, maybe simply because they don’t like the idea of bumping into their therapist in the dining room. We try to find a subsidized alternative for these people outside the hospital.”

What gives them a sense of legitimacy?

“Normalization of an experience and presenting data that shows how collective it is. I found myself saying many times, ‘I have heard the sentence you just said from so many staff members,’ or ‘That is a normal reaction to an abnormal situation. What you are telling me is supposed to shock you. There would be something wrong with you if you acted as normal.’ A dentist who spent two months at the Shura base identifying people by dental records should not think that such an experience will not leave a mark. That person has come close to the very limit of human experience and it’s important to process that.”

What about people who are afraid that opening the wounds now, when everything is still so fresh, will crush them and leave them unable to function at all.

“This is a familiar response and we respect it. Six months after the coronavirus pandemic, when it was all over, we saw people coming to us and asking to discuss traumatic experiences, like when they tried to revive someone and failed. The same will probably happen after this war, too. We aren’t going anywhere and we hope that everyone will get treatment one day’.

“In one unit, which is experiencing high levels of stress because of the ongoing war, the team asked to meet with a psychologist who could provide them with tools to deal with the pressure. They said in advance that they don’t want to talk about emotions because they were worried it would overwhelm them. At the meeting, during the first exercise, one of the participant shared something he had experienced, which the technique reminded him of, and there an important conversation erupted about the accumulation of experiences and how that affects home life.”

"A dentist who spent two months at the Shura base identifying people by dental records should not think that such an experience will not leave a mark. That person has come close to the very limit of human experience and it’s important to process that.”

Flashbacks, Nightmares and Extreme Physical Reactions

High tension levels are also part of the routine for staff at the National Institute of Forensic Medicine in the Tel Aviv neighborhood of Abu Kabir. In their case, however, even the most hardened professional cannot process the horrors they saw on October 7. Two weeks after the attack, employees of the institute started reporting nervousness, anxiety and nightmares. The institute’s social workers organized a visit by staff from Ichilov Hospital’s mental health unit, who gave workers emotional first aid.

“The social worker called me and said that she had never seen their employees in such a bad state and that they were going through something terrible,” says Barak Tor, the head social worker in Ichilov’s psychiatric unit, who coordinated treatment for the institute. “In the first few weeks, everyone was full of motivation, they worked extra hard and were highly functioning. When the pressure dropped a little, there were signs of problems, an extraordinarily tense atmosphere.”

Did they open up to you easily?

“At first, it was very strange for them that we came to listen to them. We set up improvised treatment rooms and the social worker went from room to room, encouraging them to come – but very quickly there was a line of people waiting. We allowed anyone who was in the compound to come for a conversation and there were people from Zaka and volunteers from the United States who were helping the pathologists.”

What came up in the conversations?

“Three things were tough and powerful, even for people like them, whose daily work involves dead bodies: the quantity, the dismemberment and the large number of children. One volunteer from the United States, who had worked identifying bodies after 9/11, said that what she saw here was far worse and far more upsetting. She said that she broke down when she had to deal with the body of a terrorist, because it was a lot cleaner and a lot less mangled than the Israeli victims. The contrast broke her.”

What kind of things were they reporting?

“They were very anxious. They spoke about a lot of tension and anxiety, which they took home with them. There were also extreme physical reactions, like trembling, dizziness and vomiting. They kept on coming to work. It didn’t make them stop – and that’s one of the symptoms of post-trauma. But they did experience flashbacks, nightmares, insomnia and even a sense of guilt over the fact that they were breaking down or that they could be working instead of wasting time talking to us.”

What do you tell them?

“We tell them that therapy will help them function better, that it’s normal for them to feel that way and that it shows they care and are sensitive.”

Were some people worried that talking about the subject might lead to a breakdown and to loss of control?

“Some people said, ‘This isn’t the time. We’re still at war.’ But there were enough people who did want to talk, so we never felt underemployed. We held three sessions and there was demand for more, but it didn’t work out because we’re so busy. We offered them group therapy but they said it’s hard to get everyone together on a given day. I think it’s also hard for them to expose themselves like that in front of colleagues.”

"One volunteer from the United States, who had worked identifying bodies after 9/11, said that what she saw here was far worse and far more upsetting. She said that she broke down when she had to deal with the body of a terrorist, because it was a lot cleaner and a lot less mangled than the Israeli victims. The contrast broke her.”

‘People Knew What Their Red Lines Were’

At Ichilov, too, management’s calls for the medical staff to get emotional help are not always answered. “We heard responses like ‘We’ll get by until it’s over’,” says Tor. “As counselors, we of course get group therapy once a week and one-on-one help. I brought in experts to give lectures about how to deal with all the evil and the flood of emotions that a therapist experiences during a session. They can feel like their eyes hurt, they suffer from dizziness, a sense of emptiness, a desire to sleep or to disconnect, as part of dealing with the content they have been exposed to. Even for experienced therapists it has not been easy to digest what they heard from survivors of the rave and from the Gaza border communities. We had one therapist who couldn’t sleep at night after hearing testimony from one Nova survivor.”

Were there any concerns about treating survivors of such a massacre? They expect you to contain the horrors – but you’re human, too.

“There was a lot of tension before these sessions. The coordinator assigned two patients to each therapist. People knew what their red lines were and there were some who asked not to be given a patient with a story that they would find hard to contain, like violence or sexual abuse. One therapist said, ‘I don’t have a problem talking about anything, no matter how hard it is. I just ask not to have to see things with my own eyes.’ When we went to the Forensic Institute, he asked not to be shown photographs.”

As therapists, how do you treat people from the Forensic Institute?

“I dreamt about scorched bodies. Another therapist had stomach aches the whole week. There were four therapists and we gathered for a group chat at the end of every day. When you’re dealing with trauma so large, it’s important that the therapists have a support group – otherwise they could end up suffering from secondary trauma. And I genuinely felt that I was not alone in all of it when I spoke to them.”

How is it possible to crack the medical teams’ reticence? Maybe people aren’t coming to therapy because it’s at the expense of their free time?

“Even during work hours, some people are reticent. When people believe that something will help them, they’ll find a few hours for it – when it’s a physical ailment. Emotional therapy is still treated with suspicion, especially among people aged 50 or over. I have been asked, Who can guarantee it will help me? There is not enough understanding of the price that emotional distress can cause. It can exact a physical cost, too.”

Ben-David concurs. “Younger doctors seek therapy more readily,” she says. “The younger generation of physicians is more skilled at emotional discourse. Unlike in the past, medical schools encourage students to talk about tough experiences. After their first autopsy, for example, they work through their emotions with a psychologist. People have to understand that asking for help does not mean that there’s any psychopathology. Waking up at night with nightmares doesn't mean that you have PTSD. Much of this range of responses – especially in the first few weeks – is very normative. And many of them will pass without therapy. But they could pass better and faster with therapy – and without leaving scars.”

Are there high-tension departments where such therapy is routine?

“In the oncology and surgical departments, for sure. There’s also one internal medicine department in our hospital that does it. We have seen the impact. These people are more resilient. Not in the sense that they don’t need treatment, but in the sense that they knew when to ask for it.”

“For the first time in my life – and I consider myself a strong person – I spoke in December with the department’s psychologist about the possibility of joining the hospital’s resilience group. In the end, I decided not to because at the moment the pressure dropped, I no longer felt that way.”

‘There Were Cases That Made the Medical Teams Fall to Pieces’

One place that does not experience heightened levels of tension as a matter of routine is the sperm bank. “Our department generates life, we deal less often with death,” says Dr. Shimi Barda, director of the sperm bank laboratory at Ichilov. However, the high number of young fatalities and the massive increase in the number of families seeking to retrieve sperm from their slain loved one has forced the urologists and their teams to confront cases that, until now, were reserved mainly for pathologists.

At a hearing a few weeks ago of the Knesset’s Health Committee, Lt.-Col. Natalie Barda from the IDF unit that handles wounded and fallen soldiers said that since the start of the war, sperm had been retrieved from more than 100 soldiers and civilians. In professional terms, this is known as rescue, given that there is a very narrow window of opportunity to retrieve the sperm. Although sperm can be retrieved up to 72 hours after death, the optimal time is in the first 24 hours. The emotional cost of the procedure is paid by the medical teams.

“I insisted that the top half of the body be covered up while we were working so that we couldn’t see the face – but the covering was not always as ordered as it could have been and we saw some traumatic things".

“Working with the bodies – especially in the first stage – was extremely tough – and I say that as a physician with plenty of trauma experience and as a frontline officer who has seen some horrific things,” says Prof. Gil Raviv, director of the Andrology Unit at the Sheba Medical Center in Tel Hashomer. “A body arrives in a black bag; then the nurses have to open it and get the body ready for the procedure. No one can prepare them for what they will see when they open the body bag. There were cases of corpses with traumatic head wounds or deep wounds to the torso, which made the medical team fall to pieces. Some bodies were brought to us straight from the battlefield, still wearing their uniforms and boots with sand and infusions. The nurses who prepare the bodies for the procedure are not pathologists. They never thought that they would have to deal with bodies in that kind of condition. One nurse who works with me still has nightmares. There was one intern who puked his guts up.”

How do you deal with that kind of thing?

“I insisted that the top half of the body be covered up while we were working so that we couldn’t see the face – but the covering was not always as ordered as it could have been and we saw some traumatic things. There were some doctors who were not willing to do it, but there were enough who were. In one case, a fatality arrived in a wooden casket and we retrieved the sperm while he was in the coffin. These are things that you would never even imagine seeing as a urologist or a nurse. I am not ashamed to say, it was hard. We’re just lucky that our brains know how to forget.”

Dr. Barda, who is the contact person between Ichilov and the IDF for everything related to sperm retrieval, says that he experienced something similar. “It’s impossible not to take it to a personal place. You try to disconnect from the situation, to open the body bag at the end where the feet are and not expose any part of the body that does not have to be exposed. We found it hard to get the horrific sight out of our minds the one time we saw a face.”

Have you sought therapy?

“For the first time in my life – and I consider myself a strong person – I spoke in December with the department’s psychologist about the possibility of joining the hospital’s resilience group. In the end, I decided not to because at the moment the pressure dropped, I no longer felt that way.”

Is the trauma from the horrific things you saw or from the quantity of cases?

“Both of them together is exhausting. The most difficult thing is the extra workload on top of the regular amount. We usually perform retrievals at night and during the day we see people being treated for fertility issues at the sperm bank. They expect to keep getting normal service – and they're quite right.”