In the Middle East, Palestinian and Israeli children have witnessed unprecedented violence for the past three years. Often overlooked is the mental trauma suffered by these children on both sides of the conflict. In the second of a two-part series, Ross Dunn in Jerusalem reports on how Israeli children have been affected.
They are hardly ideal conditions for a doctor talking patients through their experience of terror. Midway through the consultation, the clinic begins to shudder from the tremors of another suicide bombing.
Dr. Danny Brom of Israel's Center for the Treatment of Psycho-trauma, says the attacks prompted him to move his offices out of downtown Jerusalem to a safer suburb.
"Personally, it happened twice that I was sitting in session with someone who had gone through a bombing, and in the middle of it, a bomb went off, about 40-50 meters from our offices, so the whole building shook," he said. "And that is not a situation you can really help people, so we had to move out of the center of town because of this."
Dr. Brom says that most Israeli children have learned to cope with the violence around them. A small proportion of them have not.
"About five to six percent of children, suffer from full-blown post traumatic stress disorder, meaning they are preoccupied with what they have seen, heard or smelled, they are hyper-alert, they are very afraid," said Danny Brom.
Another expert in the field, Professor Charles Greenbaum of the Department of Psychology at Hebrew University, gave this outline of the condition:
"Post traumatic stress disorder is a well-defined psychiatric problem, which involves, basically, the child's inability to function either cognitively, emotionally or in terms of his behavior," said Professor Greenbaum. "It does involve children who have been involved directly with some kind of suicide bombing, or rifle attack, or something like that, at the time that it occurs, and for sometime after."
Dr. Brom says that children manifest their feelings in different ways.
Some even test their ability to defy death in deadly games of chance
"We have seen adolescents, who actually go out and cross streets, just in front of cars, so it is almost literally Russian roulette," said Dr. Brom.
Professor Greenbaum says this kind of reaction is an attempt by some children, who have been exposed to violence, to show they can cope with extreme danger.
"This is a phenomenon, in which children try to recreate and master the effect that they were exposed to, showing that they can take a risk and overcome it," he said.
More attention is being given to the problem in Israel than ever before.
Dr. Brom's center, for example, has begun a process of screening whole schools, in order to identify those in trouble. He says those in need of treatment typically start to sweat, their hearts pump faster, and finally, they break out into some form of panic attack.
Dr. Brom say he has developed a three-step program of therapy.
"First; you have to stabilize these symptoms, before you work on these traumatic memories," said Danny Brom. "Second, people have to relive, in a controlled manner, what happened to them, children by writing about it, playing whatever creative way; third, reintegrate them into their groups of friends, from whom they have withdrawn from, [and equip them] with skills to go back into environment."
Professor Greenbaum says that most children are not in need of clinical therapy. He says that the vast majority of children recover through the support of their family and friends. He says this was demonstrated in the reactions of children after Israel came under attack from Iraq during the first Gulf War.
"What we found in previous research, during and after the Gulf War, is that children are sensitive to their peers," said Charles Greenbaum. "And if they are surrounded by other children who are in the same kind of situation, with whom they can talk over what is going on, with whom they can, sometimes they can act out what is going on spontaneously in play situations. If they are people they can confide in, if they are parents with, in whom they can trust, they are really the most important factors in the recovery and the resilience of children."
While the strong bonds of family and friendship in Israel have helped children to cope with the violence, Professor Greenbaum says it may be all too easy for them to relive their experiences. He says more study is needed into the role of the media, in particular the graphic depiction of the conflict on television.
Dr. Brom agrees. He says that all too often he receives calls from former patients the day after another suicide bombing, saying their trauma has been "re-triggered" by the latest act of terror.
Like his colleagues on the Palestinian side, he says, the only real "long-term" healer for this condition is peace.