‘And thy life shall hang in doubt before thee; and thou shalt fear day and night, and shalt have none of the assurances of thy life.’ Deuteronomy, 28, 66. SDEROT, Israel — Qassam rockets and other more powerful explosives have been raining down on this dusty city and surrounding communities for a dozen years now. At its worst, as many as 60 rockets streaked through the sky in a day and, as Shalom Ifrach can testify, they have traumatized the entire population, including a generation of children. Tired of running back and forth to bomb shelters during an alert, Ifrach one day decided to putter around his hardware store — a bad choice as it turned out. A rocket scored a direct hit on his store and by his own reckoning only a miracle from the hand of God prevented it from killing him. That was seven years ago and he has yet to recover emotionally or economically. “It destroyed my store and destroyed me,” says Ifrach, who since the attack has had chronic hearing problems and has been unable to get compensation to repair his business. “They have caused damage to our belongings, our bodies and our souls,” he says. “It doesn’t help any more to tell children not to be afraid. If a door bangs, people jump. “Everyone is on edge, especially the children, but it isn’t just the children,” he says. “And it isn’t just some, it’s everybody. The fear gets into your blood and is in your system forever. “You will,” he adds, “hear many hard things here.” Projected from Gaza, some three kilometres away, the rockets have killed a dozen or more, injured countless others and left thousands of men, women and children with post-traumatic stress disorder — a condition Col. Eyal Fruchter, the mental health chief of the Israeli Defense Forces, has seen often in troops and veterans and describes as “a long scar in the soul.” In the 40 years since the national trauma of the Yom Kippur War, when their country was nearly lost, Israel’s brightest mental health professionals and researchers have been probing the mysterious depths of post-traumatic stress disorder in an effort to find ways to understand and prevent PTSD and, more elusive, a cure. With mandatory military service for men and women and a number of full-blown wars and limited border operations in its short history, Israel is a living laboratory for any researcher interested in military trauma in which PTSD looms large. But this economically depressed city of 24,000 offers evidence enough that the risk of PTSD, or some version of it, isn’t confined to those who step on a battlefield. Sderot sits alongside small agricultural collectives — kibbutzim and moshavs — in the western Negev, where the unpredictability of the rockets whistling their way means people have 15 seconds to scramble to the shelter of “safe rooms” the government has grafted onto their homes or the ubiquitous concrete bunkers on the street. When mothers and fathers walk with their children they are ever mindful of those mere seconds, but getting them to shelter in time doesn’t protect them from the fear that has led to symptoms of PTSD in those as young as three.

Many children regress into incontinence, and find it difficult, if not impossible, to concentrate in school. In adolescence they are often withdrawn, angry and aggressive. “When the situation gets bad we can’t see what’s really happening to the kids,” says Noa Linden, a mother of two and a support worker at Sderot’s Social Rights Centre. “It’s later when it’s quiet that we start to see the effects.” Her five- and seven-year-old children are reluctant to go to school and the morning goodbyes have become a drama. “What can I tell them?” she says. “Really, I can’t do much. I hug them. I feel I can’t give them security. It’s difficult for us because we don’t feel safe ourselves. I can’t promise them it will be good, or it will be OK, because I don’t have that trust. I know the situation and I know our reality.” At nearby Kibbutz Gevim, teacher Tamar Seri says although the rocket attacks have lessened during the past 18 months, the emotional impact on children is inescapable. “When you come close to the young children you hear a lot of fear and anxiety they are not supposed to be dealing with at such young ages,” she says. The introduction of the so-called Iron Dome rocket interception system in the spring of 2011 brought a new set of rocket-related sounds to the area and created an entire learning curve in self-preservation. The defence system includes an automatically activated recorded voice warning “Tzeva Adom” or “Red Alert” across hundreds of loudspeakers throughout the region. The voice is preceded by a clicking or switch sound. Anything resembling that clicking sound is guaranteed to make almost anyone — adult or child — react in split-second panic. But it’s the kids who are the experts. “The children know all the noises,” says Seri. “You can hear them say, ‘They are shooting on us’ or ‘No, it’s our army shooting down their rockets.’ The children can understand all the sounds.” And while they may readily share that knowledge, they are less eager to talk about how the conflict makes them feel. For the younger ones, simple board games designed to extract emotional responses are among the most popular tools to help. The basic aim is to get the children to open up about their feelings and discuss how certain situations affect their moods and feeling of security. Retired teacher Shula Zukerman, a longtime resident of Kibbutz Gevim, has been working with others to tease feelings from children using animal pictures. Each animal has an emotion attached and the children can choose according to how they are feeling. “It’s a very good program,” she says. “You can hear them saying ‘I am like the turtle today because I feel sad — or like the giraffe because I feel happy — or whatever it might be. And then they can speak more about it.” Hana Tal, director of the Resilience Centre for Shaar Hanegev regional council, admits that much of their work with children and adults is experimental and while it has worked well with some, she hesitates to declare it a total success.

“We are doing big research to try and answer that question,” she says. Tal and psychologist Ornit Rozenblat are on the front lines of treating the 7,500 people who live outside Sderot city limits on more remote kibbutzim and moshavs. Since it opened in 2008, the centre has treated 700 people — 60 per cent of them children — but there are many more who won’t come forward. (More than 2,000 have been treated by a similar organization in Sderot). “In the United States they had 9/11,” says Tal. “It was once. The tsunami in Thailand was once. Here we have had it since 2001 — again, again and again. Sometimes the rocket falls and traumatized people come for treatment. Then it happens again near their house, when they’re going to school — or something happens to a friend. “It’s a prolonged trauma and for some people it’s chronic.” It can also be crippling. Many have allowed themselves to become so consumed by their fear that they have forgotten how to play with their children, says Rozenblat. “People are afraid to be in their own houses,” she says, “and they have no safe place inside themselves. Some say they won’t even celebrate birthdays because of the rockets.” A major focus of the centre’s treatment is community and individual resilience — teaching people to find their inner strengths and encouraging them to not let fear limit them. “We understand it’s not a normal life,” says Rozenblat, “but we have to think about resilience and about the future. We have to learn how to talk about life going on.” What they’ve learned, says Tal, is that the ability to cope is down to each person’s inner resources. “You might believe in God or believe about the ideology of living on the Israeli border,” she says. “Our mayor, for example, is always telling us how important it is for us to sit here on the border and defend Israel. It gives some people strength. It’s not for everyone, but we try to teach people to find their own resources. “Life is going on,” she says, “and people have their family, friends and community in which to find strength.” It wasn’t always this way. Until the rockets began to fly, Palestinians and Israelis in the Gaza-Sderot region interacted regularly and after decades of living besides each other had established many personal and business relationships. Avi Besser, a psychology professor at Sderot’s Sapir College and chairman of its Center for Research in Personality, Life Transitions, and Stressful Life Events, says there is sympathy for Gaza residents among the Israeli population and a recognition that the situation is just as bad among civilians on the other side of the conflict. “The Israeli population understands that you can’t generalize about the populations in Gaza,” says Besser, who has seen the impact of trauma on many of his students. “Israelis know there are human beings who suffer as we do from the situation and there is a minority of fundamentalists who are controlling the destiny of the people.

“We have fundamentalist people in Israel who say that all Arabs should be dead, as well as people on the other side who say that all Jews should be thrown into the sea. But it doesn’t represent the majority. We need to find a bridge.” A short distance from the college is a new high school complex, built with reinforced walls thick enough to withstand rocket blasts. The government built it to halt the constant interruption of classes and to ease the emotional strain on students and staff who were constantly on alert and rushing for shelter. They no longer need to move. It’s all familiar emotional territory for psychologist Dr. Mooli Lahad, one of the world’s leading experts on post-traumatic stress in both military and civilian populations. Most of the mental health interventions in Sderot and the surrounding communities are based on his work at the Community Stress Prevention Center in the small northern Israeli city of Kiryat Shmona, which is close to the Lebanese border and has a long history of rocket attacks, border wars and terrorist infiltrators. Since its opening in 1979, Lahad has become an internationally recognized innovator in the treatment of PTSD and other trauma. He has worked with traumatized communities and individuals in the aftermath of the 9/11 attacks on New York’s World Trade Center and the 1999 earthquake in Turkey. He was in Sri Lanka after the tsunami in 2004 and in New Orleans after Hurricane Katrina. Most recently, he went to Japan where he was asked to help communities displaced by the crippling of the Fukushima nuclear power plant. Though to some it’s a distinction without a difference, Lahad says many civilians on both sides of the conflict — he has treated many from Lebanese border communities — suffer crippling effects from trauma but don’t have full-blown PTSD. “PTSD means that they can’t function,” he says. “Civilians usually do function but they have a lot of pain in their hearts and a lot of trouble with daily behaviours. They have been exposed to tremendously terrible things. They have felt horror and terror in their hearts and minds and know what it is to be emotionally paralyzed.” Lahad’s centre conducted a major study among toddlers in Sderot and surrounding areas and discovered that almost a third of them had PTSD, something they didn’t even think was possible 10 years ago. “It was very disturbing,” he says, “but whenever we found a child with post-trauma at least one of their parents had PTSD. We never found a child with PTSD without a parent with PTSD but we did find parents with PTSD whose children did not develop the symptoms. Why? What is the physical and mental makeup of those children? We still don’t know. We need more study.” Following the brutal Israeli-Hezbollah war in Lebanon, northern Israel and the Golan Heights in 1986, Lahad saw a massive influx from both the Israeli and Lebanese border communities seeking help for themselves and their children. Lahad says the experience inspired him to explore new avenues of treatment and study the “power of community” in the healing process.