When sirens blare, Israeli children in Sderot chant in Hebrew: “Tzeva Adom Tzeva Adom: Red color, red color. Hurry, hurry to a safe area because now it is dangerous. My heart beats boom, boom, boom. My body is shaking doom, doom, doom. We are falling down (children go under desks) and now it is okay. Now we stand up and shake, shake, shake our legs. Breathe in deep, breathe out far, and now we can laugh. It is all gone, and now I feel better.” The children pose like Hercules and continue to chant: “But I am overcoming because I am different. And now it is okay.” Hands are clapped and everyone gives a sigh of relief, “Yes!”
Israeli youngsters are taught this song as soon as they can talk to reduce the anxiety created by sirens signaling rocket attacks. For 12 long years, this has been the reality for Israeli children in southern Israel near the Gazan border. Some of them have never known a life sans sirens.
Children exposed to war and violence are at high risk for post-traumatic consequences that may negatively impact their personal, relational, and academic futures. This is true for preschoolers, toddlers, and infants, as well as older children. Old theories about young children being immune to war- and violence-exposure are upended by more recent assessments and research. Experts in the field of psychotraumatology found that safety begets expectations of further safety, and danger begets expectations of more danger. The children’s fight-or-flight response is not a one-time event—it puts children into permanent “survival mode.” Staying “on guard” replaces spontaneity and exploration. For children living in Israel and Gaza, basic assumptions about the safety of the world they know, while at home, at school, or at play, are overwritten by sirens and/or bombs.
For those who can find safe shelter, protective routines can be created. A degree of psychic protection can build upon literal protection, as in the songs and routinized behaviors Israeli children are taught through shelter-drills and real-life attacks. For those without available turns-to-safety, such psychic protection (partial at best) is not available.
Professor Danny Brom, director of the Herzog Israel Center for the Treatment of Psychotrauma, has been leading mother–child groups to strengthen children’s emotional regulation for the last nine years. During this war, crisis intervention is the priority over traditional therapy. Resilience workbooks have been distributed to young children in the south. There is a 24-hour hotline to help parents cope: A mother wants to know what to do when her 7-year-old vomits and collapses every time he hears a siren.
Says Brom: “The real work with trauma victims starts when the war is over. Restoration and recovery will take a long time. Those who have severe symptoms Post-Traumatic Stress Disorder (PTSD)—10-15%—have not had the opportunity to recover because children and adults are in and out of stress all the time.”
Brom believes PTSD is just one of the effects of massive psychic trauma. The majority of victims are not necessarily suffering from PTSD. Children in Sderot and in southern Israel have not had a respite since the first rockets fell in 2002, and now more powerful missiles are aimed at them. Children under 14 have lived under threat of annihilation their entire life. How will these children feel about living in Israel when they grow up? What kind of faith will they have in God? How will this sense of insecurity influence their intimate relations and ability to commit to a relationship and having a family? What kind of a world view will they develop? How will their aggression manifest itself when they become adults? How will they be able to regulate their emotions?
Children growing up in contexts of protracted and recurring warfare and terrorism, experiencing their days interspersed with preparations, protective maneuvers, and their aftermath accrue massive strains and stresses. Add direct exposure to bloodshed and/or the anguish of loss or personal injury, and children directly learn of the limitations of adult capacities to safeguard them. They develop psychological armor that may be adaptive in the moment, but maladaptive in the long-run. Waiting for PTSD to emerge before offering intervention is imprudent, as accumulated violence underscores the benefits of “prevention.” This includes offering facilitated play where the child creates a more coherent narrative through “pretending.” Helping parents and caregivers appreciate children’s symbolization in play, especially when they are highly stressed themselves (which itself diminishes symbolic activities) becomes a key element in such prevention, exemplified by the Namal Program implemented in Sderot (developed by Esther Cohen, and expanded and applied by the Israeli Center for the Treatment of Psychotrauma).
Operating efficiently in group therapy focusing on caregiver-child relations, the program highlights themes of attachment, self-reliance, playfulness, and the importance of make-believe, a positive view of the child, child-expressivity of emotions, self-care for the adult caregivers, the use of soothing interactions, and an increased appreciation for the complexity of child-thought. This is all designed to help the child feel that his or her inner experiences are understood. Countering feelings of helplessness and associated anxiety, active construction in play promotes a developmental ability for the child to distinguish what is real and what is imagined, to differentiate one’s own perspective from what is another’s, and resilience itself.
Moran BenDov, a resident and social worker in Sderot works with Hosen, a center for trauma treatment. She is with traumatized children and their parents 24/7. The schools in Sderot are now day camps, yet each afternoon, 200-300 children are in shelters with 50 to 70 volunteers from Sderot and elsewhere. The children are entertained with clowns, music, and movement among other activities. There is a psychologist in every shelter; parents are taught to care for their children and understand their behavior during this traumatic time. BenDov’s center teaches parents to be aware of children’s symptoms like excessive clinginess, wanting to sleep in the parents’ bed nightly, bed-wetting, and nightmares. Parents are encouraged not to allow their children to watch news, to explain the truth but in age-appropriate ways, and not to expand on details. Children learn to cope from their parents, so parents need to stay calm in front of the children. But of course, this is not always possible.
Parents and caregivers in war-torn environments are challenged to provide infants and young children with the basic ingredients of pleasure, security, safety, and trust, and the tools that children need to manage emotions in their lives, especially negative emotions. This is true even when the child is not directly hurt and has not witnessed death or injury to others, though such experiences exacerbate reactions. Young children, even infants and toddlers, are remarkably skilled at reading the emotions of those around them. The nonverbal communications are every bit as powerful as the verbal ones. Hence the adult who is terrified lends a feeling of terror to the child via body tension, a slightly opened mouth, raised brows, and opened eyes locked in narrowed attention. Perhaps later the caregiver is angry or highly distracted. Young children tend to personalize such behavior, attributing it to something they did. Children at different levels of cognitive maturity, based upon age and distinct trajectories, may come to different conclusions, but the caregiver’s ability to attend to the child’s experience and meaning-making is invariably crucial. But that becomes difficult when the parent is stressed and is not reading the child’s cues as sensitively as he or she would in a safer context.
BenDov went to a home of a woman who had a panic attack when a Kassam fell near her house. The 37-year-old had difficulty breathing, heart palpitations, noises in her ears, and heaviness in her legs. BenDov showed the mother a few breathing exercises while her 7-year-old daughter watched. After a few exercises, the daughter tried to get the mother to continue and told BenDov she wants to be a doctor when she grows up, showing amazing strength. In situations of life and death, children sometimes exhibit more resilience than the parents. Roles are reversed and children end up taking on greater responsibility. Sderot has many single mothers from the former Soviet Union who don’t speak Hebrew very well. They rely on their young children to let them know what is going on in the outside world.
The discovery of the tunnels has created new fears. Therapists are creating new ways to help people cope with this new threat of annihilation. Children are moved to safer areas for brief periods, sing the “Red Color” song, and play rocket games.
All traumatic stressors, including natural disasters, trigger concerns regarding injury or death to oneself or loved ones. Human brains are pre-wired to respond to such threat by entering a survival mode. Fear-arousal is a biological response that is given psychological meaning in context. One of the major factors in war and terrorism is that people are behind it. Children know that the danger comes from people with malevolent intent. Thus, mistrust and hatred are fueled by their trauma. Even very young children remember these traumas in meaningful ways. Enough knowledge has accumulated from Holocaust child studies and trauma research to recognize that there are long-term consequences to trauma-exposure during the earliest days of life. In fact, the fetus absorbs stress (e.g., through higher cortisol levels), proving that war-exposure has negative pre-natal consequences.
Danny Brom strongly believes that during war, children and adults don’t need traditional psychological care as much as they need human connection and to feel as part of a community. But pre-war psychologically-informed prevention is necessary to lessen the disruptive and frightening impact of the recurring threat. Later, psychological intervention will be needed for those with symptoms. Moran BenDov says creating a sense of community with those on the “outside” is vital. “We need to feel that Jews all over the world are giving us a big hug.”
Drs. Eva Fogelman and Mark Sossin are officers and therapists for the International Study of the Organized Persecution of Children/Child Development Research, which works with child survivors of the Holocaust since the 1970s. They apply the knowledge gained from Holocaust survivors to help children everywhere from suffering from the trauma of war. www.holocaustchildren.org
EvaFogelman, Ph.D. andMarkSossin, Ph.D. (exclusivetoJLBCfrom TheInternationalStudy of Organized Persecution of Children)
