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By Daphna Arditi – a delegation from the Shelva Mental Health Center 10.22.23

The Occupational Therapy meeting with evacuees

INTRODUCTION: My aunt, Daphna, is an Occupational Therapist in Ra’anana, a small city outside Tel Aviv. Her youngest daughter, after having finished her military service just a few months ago, was recalled to service on the northern front Lebanon border. Daphna was part of a group of therapists that went to access the mental health needs of the displaced survivors of the October 7th massacre. They traveled to Eilat, the southernmost city in Israel on the Mediterranean Sea, where the survivors were relocated for the time being. This is her account of what she heard, and what the survivors, their families, and the entire State of Israel will need for the foreseeable future. All the while Hamas fires rockets toward them and many other civilian cities all around Israel. – Osi Rosenberg

“I wasn’t injured, I wasn’t killed, my family is fine… do I deserve treatment?” So asked a mother of 3 children, a Pilates teacher in her spare time, as she explains how her three children, aged 4-12, sharpen knives to prepare go outside as they move to another house because the power cut from their current shelter making it unsafe.

I’m sorry I didn’t have a gun because then I would have gone outside. I know Sderot City very well, and I would have known how to hit the terrorists. I sat for hours with a knife by the door, and imagined what I was going to do to whoever came in. I said goodbye to life, I knew I had to take care of my mother and my three sisters.” – 17-year-old boy.

My boyfriend and I work here in a hotel in Eilat, that’s why we weren’t at the Nova party. We almost finished saving money to fly to New Zealand in a month. Five members of our group were killed, we moved from funeral to funeral, from family to family, all from the nearby villages, we grew up together. After two weeks we decided to try to get out of the mourning and go back to work in Eilat, but when we got to the hotel, we broke up….” A 26-year-old couple with dreams for the future are referred by the manager of the staff who refers them to therapy and shows understanding for their dysfunction. I encounter an abysmal, almost existential sadness, motor restlessness, inability to function or maintain an agenda, little sleep, a feeling of insecurity in one’s place, difficulty with the present and the future and at the same time an exciting and supportive concern for each other.

Don’t look at me like that, I’m always the strongest. I’m a pedagogic lecturer, everything was ready for the school year. I’ve been through a lot in life, I’m a sister who died since Yom Kippur, one of the grandchildren passed away and…. on Black Shabbat there was supposed to be an event in memory of my brother after 50 years as a legacy for the family, 80 people were supposed to come. No event compares to what happened. I was always the one who raised the family, who functioned, who continued… and now I’m afraid to go home…” A 65-year-old couple who finance their stay at the hotel, sitting all the time holding each other with great love and compassion, missing home but afraid to return.

Today I started showering alone but he has to be in the room (partner), I hear noises from everywhere, I hardly sleep and I wake up from nightmares, sweating, checking that the baby is okay, I can’t get up to get him a bottle, I don’t stay alone in the room… .” 20-year-old in a hotel room with a baby and her partner, (19) “I can’t do anything, she doesn’t calm down, I have to be with her all the time, she needs something to calm her down…”

For several days I was in the evacuee hotels in Eilat. My heart was with them. In our therapeutic sessions, I met a population that charmed me, exciting marital relationships, parental relationships, stories of heroism, and miracle moments. Now when it is time to start healing and rehabilitating, you realize that first you need to digest and process the experiences they went through. The hard work is to help the victims to process it in a way that will not leave chronic pathology.

OBSERVATIONS:

When I arrived at the hotel, I realized that beyond the horrors and survival on that “Dark Day”, there is a daily struggle for survival in the present and the future. A young couple from Sderot, who got married in February, describes the financial expenses that continues to weigh on them, student loans, mortgage, car loans. They had good jobs but now there is no income, but the debts do not stop. They don’t know what they will do, they just decided that they are not coming back to Sderot. They will never go home.

Personal security, home life, personal habits, the need for permanence, order, and thoughts for the future are omitted from the conversations. For a large part, the community, social, and family ties are damaged and for some their careers and future prospects are irreparably ruined. Mess, disorganization, flooding emotions, and day to day unpredictability take center stage until they can find a more stable location whether in the hotel or back at home. The recovery process takes time, and finding a stable place to call home is in its early stages.

Currently, they live in difficult conditions. Some are in small hotel rooms or in extended family’s homes. Some have rooms and homes are too small for the many children. Some have special living needs or with increased sensitivity and dynamics that existed even before but now the need is heightened. There are women with children alone whose men go back to work or army. Parents and adults who must keep their grandchildren busy. People with special needs require extra care, and there are people who have nothing to do. There are teenagers, some of whom get help from their peers in youth movements and volunteers. There are communities that are initially organized, and there are people who do not belong to the community. There are tensions arising from discrepancies in the benefits that the State grants depending on the area of residence and not the reality of life. These are just some of the ever growing complexities.

I notice that the place has a sensory overload flood of incessant noise, smells, and a lot of movement of people The same hotel we used to choose in Eilat for a family vacation turns into a “nightmare” and “the epitome of chaos”.

The lack of routine is especially noticeable. As mentioned, the children began to organize activities that allow the parents to breathe, except for cases where the child does not separate from the parent or vice versa.

The busy meals, as is customary in hotels, are an anchor in times but a difficulty in dietary habits.

Building an agenda is limited due to emotional and financial reasons. There is an avoidance of financial expenses due to the economic situation, the size of the families, and the unknown length of stay.

Emotionally, many feel guilty and that there is no right to enjoy this period even in the pool available at the hotel. In addition, fears and anxieties prevent many from leaving the hotel, the room or separately from the children.

So where is Occupational Therapy?

From a general point of view, it seems that in this period, in the field of mental health, therapists touch/complement each other. There is great generosity in the disclosure and sharing of information from leading professionals and experts. The interventions after trauma point to working with understanding, inclusion, and non-judgment. Normalizing physical and emotional reactions, such as feelings of guilt.

At the current stage, prevention and control of emotional flooding is prevalent. There were sessions of working with grief, anxiety, and parental guidance. Use of cognitive elements that allow emotional balance such as thinking sheets, games, etc. were utilized. There is discussion about building a routine and building habits, finding concrete and creative solutions to life situations without routine, solutions for employment, volunteering, social connection, using apps for leisure and sports, and sometimes buying a guitar or, when there is no money, finding hobby items through donations.

We conducted exercises to acquiring knowledge in the use of relaxation and mindfulness tools for personal independent application and building hope and recovery for the future. Use of sensory regulation tools is encouraged like pressure balls, soap bubbles, gravity blankets, Korean rings, etc.

It is important to identify health needs in order to refer to appropriate professional factors and continue mental health care if necessary.

Personal insight:

The meeting with the evacuees in Eilat was mainly a human meeting, from a humble and mutually enriching place. I started with a strong desire to be significant in this period and at the same time with a fear of exposure to the contents. I found myself dealing with “excessive” exposure to information that led to restlessness and damage to professional security. I ended up feeling satisfied with both the tools and the ability to be significantly involved in the meetings.

The return to routine required time and effort, but the main insight is a sense of reward and peace that I received from the ability to be with the people, deal with the content, and contribute professionally from the knowledge of mental health and occupational therapy.

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