Letisha D’souza, is always alert, like anyone living in Israel amidst war. The noise of a siren indicating a bomb shelling makes her run towards a bunker to secure life. For Letisha, 53, from Mangalore, working in Jerusalem, the bomb shelling is not new. But since October 7, things have changed, witnessing attacks, killing, and trauma during war. According to experts, many war survivors are bound to suffer from post-traumatic stress disorder, depending on the reaction to the situation they live in.
While many households have bunkers beneath their houses, some depend on the public bunkers. Nights are scary as in case of alarm Letisha has to rush to a public bunker. “I am not afraid of bombs,” says Letisha, who has her confidence in Israel’s iron dome defence system, which destroys enemy rockets through missile. What scares her most is videos of Hamas militants knocking at the doors and gunning down people. “Militants have entered the country, and it is not safe for anyone. While traveling in public transport, how do we know who is who? That’s my biggest fear,” says Letisha. The situation is no different for those facing the war in Palestine.
Trauma during war: How responses vary
Dr Sanjeev Kumar Manikappa, associate professor, Department of Psychosocial Support in Disaster Management, NIMHANS, Bangalore says that when people are under great deal of stress, trauma during war, there can be two responses: fight or flight. “Those in the war zone are in flight mode, they can’t do anything. They are currently helpless. When a situation is within our control, we may be able to fight back,” he adds.
In a situation like war, there are some who accept the situation, move on and wait for the consequences to improve. But there are others who suffer from disturbed sleep, nightmares, and become hyper vigilant. “The reactions depend upon both the situation and the individual. Personalities differ. Responses vary depending upon someone’s experience and knowledge. If such anxiety and stress continues for a month or more, they become vulnerable to psychiatric disorders like Post Traumatic stress disorder (PTSD),” he adds.
What is post-traumatic stress disorder in connection to war?
Dr Rohit Garg, director and senior consultant psychiatrist, Mind Vriksha, Delhi who has been seeing multiple cases of PTSD in terror-struck Afghanistan, says that in order to diagnose the condition PTSD, the symptoms have to be persistent for a minimum of one month. “PTSD develops within the six months of the trauma. PTSD can persist for years and years. It can persist for a longer per,” says Dr Garg.
Any traumatic event which could be life threatening to oneself or near and dear ones, or the person being exposed to the event through media, can act as trauma, says Dr Garg. He explains that, in PTSD, a person will usually have:
- flashback memories of the event
- dreams or nightmares of similar theme
- immense change in behavior, becoming extremely anxious.
- strong avoidance of anything that could remind a person of a similar situation
PTSD and psychosomatic disorder
Dr Garg further adds that most of the PTSD is represented in the form of psychosomatic complaints, where a psychological issue is presented with physical symptoms, without clinical explanation.
“Those with PTSD, complain about pain. Headache is one of the most common complaints. When tests done do not reveal the cause of pain, they get directed towards psychiatric evaluation to check if it is stress induced mental illness rather than a physical illness,” said Dr Garg
Besides, PTSD is also challenging to treat as it involves the memory regions of the brain, adds Dr Garg. “The memories are not stored in the right way. There is no delete button in the brain and you will have to de-sensitize a person and also reduce the somatic response to the memory. PTSD is a difficult situation to treat or deal with. A young child that has gone through a sexual assault, may face issues in an intimate relationship, may develop fear of having a baby,” says Dr Garg, talking about kinds of trauma seen during war.
Psychological first aid-need of the hour:
A recent WHO media release issued on October 24, mentions the visits of WHO Special Representative in Israel, Dr Michel Thieren who has been reviewing the health response on multiple fronts through his visits to the war hit area. The release mentions that among the sites Dr Thieren visited is a hospital in the coastal city of Ashkelon that is treating many of the injured. “What is so striking is that almost all the people I spoke to, the vast majority of them with severe injuries from gunshots, shrapnel and burns, did not want to talk about themselves at all but about the people they had seen die in front of them,” Dr Thieren has been quoted.
“Almost every one of those survivors had seen someone else die before they themselves were injured. They are absolutely haunted by this. It is dominant in their thoughts. So many need urgent mental health support,” stated WHO media release quoting Dr Thieren reads.
The need of the hour in the war hit regions of Israel-Palestine is early intervention and providing psycho-social first aid at the earliest, so as to reduce the possibilities of PTSD. “The exercise of identifying the vulnerable must begin. The most vulnerable include those who experienced trauma, apart from those who witnessed it, says Dr Sanjeev. Pregnant women, children, elderly persons are the most vulnerable, he adds.
Dr Sanjeev adds that children, if displaced, must be reunited with their families and they must be given a sense of security. “Volunteers, community workers can champion the cause by identifying the vulnerable and offer them psychological first aid to deal with trauma during war,” says Dr Sanjeev, stressing the need of psychiatric help.
The need of hour in the war hit regions of Israel-Palestine is early intervention and providing psycho-social first aid at the earliest, so as to reduce the possibilities of Post traumatic stress disorder. Addressing trauma during war, health concerns, uniting families and restoring peace must be given importance.