Israeli trauma expert on refugee wave: You must help people find their inner strength
Taking in over 300,000 war refugees in the space of several weeks is an unprecedented challenge for the Czech Republic logistics-wise and in terms of psychological support. A team of experts from the Israel Trauma Coalition, which trains government organizations, NGOs, healthcare workers, teachers and counsellors how to get communities back on their feet following a disaster, visited the Czech Republic this week to share their know-how. I spoke to Gili Nir from ITC about their mission.
“Basically, the ITC is an organization in Israel that helps the population to deal with the whole Israeli situation. We do resilience building, trauma therapy and prepare individuals, families, communities to deal with crisis situations. We try to share our hard-learned lessons of the Israeli situation with the rest of the world. Of course, since the war broke out we have been working very hard on this refugee situation.”
The Czech Republic has taken in over 300,000 refugees from Ukraine, manly women and children. What problems should we be looking out for?
“First of all, I want to tell you that I was amazed and even in awe to how the Czech Republic is accepting this situation as a nation, as a state and even as private people. I have met some absolutely amazing Czech private people who are doing amazing initiatives to help the refugees. I also saw how you as a state, as a city are being organized to accept these people. I have also been to Poland and Germany and other places and every state has its own way how to deal with the situation but here in Prague, in the Czech Republic, I saw something different. I saw people really opening their homes, their hearts and saying “we are with you in this bad situation”. So I really was inspired to see and to feel your reaction to this situation.”
Of course, in the first phase, these people are greeted, welcomed, given food and a bed to sleep in – but what problems may emerge later on?
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“When we deal with an emergency we have to divide it into sections. In the first stage of the emergency you have an acute stress reaction –which requires quick solutions. Then you have the medium stage; none of us know where this war is going –maybe it will end, maybe it will last for a long time. So you always have to think long-term – the first stage, the medium stage and helping them return to a normal life. The first stage you have pretty much organized, now you need to think about what to do to give them something resembling a normal life –helping them find a semblance of normality in an abnormal situation. They need to settle down here and not feel too much like foreigners.”
So in practical terms –what does that mean? They need a job, they need family and friends….
“When dealing with trauma victims you have to understand that the first phase is a phase of action – finding food, a place to live etc. Once the emergency is over then the emotions hit. Sometimes you see people crossing the border and when you offer to help they say “ No, I’m OK, just give me something to eat” but when the emergency is over, emotions will come up and you have to give them some kind of system to process their experience, their trauma. And you have to understand something about trauma –the faster you intervene, the bigger your chance of preventing PTST –post-traumatic stress disorder. It is exceptionally important to intervene as quickly as you can. Because if you don’t, you could have hundreds or thousands of people walking around with PTST and that is a very difficult mental state.”
And what does that intervention involve – talking to them about what happened, or not doing so? People are never quite sure what to do in such situations…
“In Israel we have something called a resilience centre or rather a network of resilience centres –this is what my organization runs. A resilience centre helps people who have been exposed to a calamity or a situation such as we have in Israel. It does three things : it gives the community and the municipality the knowledge how to be prepared for any kind of extreme emergency, it gives direct psycho-therapy (so if you feel that you have a problem returning to a normal life and have symptoms you can come to us and get therapy) and thirdly it gives resilience building –it teaches people and communities how to strengthen their resilience to future calamities. Such a centre helps to prevent serious problems developing.”
Now we are talking about specialists at work, but what about normal people, people who are hosting war refugees in their homes. What do you do to help them?
“You have to keep in mind the Maslow ladder -Maslow's hierarchy of needs -starting with the basic need of food and drink. The second need is security – being secure from bombs, but also feeling mentally secure, knowing that they are in a safe place. After that we come to social connections –if a person or family are disconnected they feel like they have no idea where they are and what’s happening –so you need to construct some kind of community.”
But their minds are back home in Ukraine -with their husbands, brothers, fathers –with their men fighting. Will they want to socialize and meet new people here? Because once they have food and a bed to sleep in they will just want to be on the phone to the family and friends they left behind or maybe talk to other Ukrainians here. Should one try to give them a “social life” at a time like this?
“That is a big problem. Almost in every place I worked in since the war broke out that was a big problem. Because we try to tell people “OK, so you escaped from the war, now you have to try to live as normal a life as possible”. And they tell me “ I don’t want to live a normal life, because my husband is in there, I don’t want to be happy, I don’t even want to relax.” That makes sense. But in such a case we always have a simple trick – we say “ You have kids, you have a mother and a grandmother with you – they need you. If you want them to survive, you must survive.” You know how on the plane, when they give you the security brief they always tell you have to put the oxygen mask or vest on you first and only then on your children. That is a psychological thing you have to absorb. Only when you are safe, happy and energetic will you be able to help others. It is a little trick that we use, but it works.”
And with the children? Is it easier for them to start recovering as soon as they are safe?
“I have to say that we saw some very severe symptoms in kids – kids who stopped talking, started stuttering or screaming for no reason, bed-wetting, and many, many symptoms. So we always tell parents – be alert, but do not be scared, because these may be normal symptoms in response to an abnormal situation. Given what they have been through, this may be normal. If you look at it this way, you will have the tools to help them. You must help them to feel safe, give them a routine and the tools to help them relax. We demonstrate how to relax and how to process what you have gone through. But we must prevent them being flooded, overwhelmed by the memories.”
So normal activities, children can draw pictures, for instance?
“Yes, they can draw pictures, we teach them breathing techniques and how to find their inner strength. If I sit with a kid and I have half an hour with him it will not necessarily be the right thing for me to say – tell me everything you saw and everything you have been through. That could make a mountain of problems and not help at all. The right thing to do would be to give him a sense of his inner powers.
“When he mentions something bad that he experienced you can ask – how did you cope with that? What helped you cope? You can say – OK, I will give you three or four channels of coping and you will tell me what helps you. For example, if you have something stressful coming up –like waiting for the results of a medical examination – what would you do in the meantime to feel more relaxed? You may say – I will run, someone else may tell me they will swim and someone else may meditate. Or – religion – would you pray – would you talk to your priest? So I guide them to find the things that will build their inner strength, things that work specifically for them. Because when you deal with extreme trauma, you do not have time for deep therapy. You have ten minutes, or thirty minutes and you have to help them to reflect on their strengths and guide them to the things that will help them to cope.”
So processing this experience will probably take months and years ….
“Yes. If someone just processed everything right away and then fell apart – how would that help – it is not the time, he is still in emergency mode.”
Is it important for the adults to hang onto the belief that they will go back – to rebuild their homes, cities, their country? Because that is what most of them are saying now, that they want to go back. Is it important for them to hang onto this?
“They have to hang onto hope. But hope has to be realistic and I guess none of us knows what’s going to happen. So usually we say hang onto what you have right now. Because we don’t want them to hang onto something that may happen, but might not. So we say – what do you have? “I have my mother, she’s always with me.” OK, so hug her. We encourage them to strengthen what they have. Not to focus on what they lost. This is not the time.”
So, learn Czech, make friends and make the best of your life here for the time being?
“Yes, and make it as positive as you can.”
As you said, the wave of solidarity has been enormous, but experts say that people may tire in time and the solidarity may be replaced by hostility. Is there any chance to influence that to some extent at least?
“I want to tell you a story about that. I worked in many places, doing humanitarian work. I worked in the Philippines after a typhoon struck –they have them two or three times a year and sometimes it’s devastating – and I noticed that two or three days after the disaster they were eagerly helping one another and then they would say, “You know, we are all hurt. I don’t have the energy and time and money to help someone else. I need to focus on myself”. That is natural. So we did something very interesting – we took a few people – we called them the “core team” – and put a core team in every barangay –or every district in the city. And the core team said- we are the emergency team of the barangay. We will harvest the energy of people helping in the first days, help them do whatever they can and after that we take responsibility for the other needs. So we gave the spontaneous assistance some sort of system. We harvested the goodwill and plugged it into a system. Here you have some very good people that are doing amazing things but you have to somehow institutionalize it so that people do not get worn out. I can tell you that a few streets from here we visited an information centre and they are doing amazing work, but they are really worn out. Most of them are volunteering. So we had a conversation with them and told them that they really needed to recharge their batteries and bring in new people.”
That’s very true. But I was not thinking about volunteers. I was thinking about the mood in society. Czechs thinking “We have so many problems. We can only do so much”. There are disinformation campaigns and the solidarity may be replaced by hostility. How can you prevent that?
“What you can do is to try to reverse the situation and show how it may be beneficial, how the refugees or migrants may benefit the country.”
In Israel this is something that you work with continuously. Because it seems that people continuously live with this fear of war, of conflict, of bombs dropping. Can you live with that long-term? Is it possible to actually accept this as part of your life and get on with your life?
“You know I have four kids – the oldest is 15 and the youngest still a baby – and it is very interesting for me to see how they grew up and accepted the situation in our country as something normal. The baby doesn’t know anything about bombs, but it is normal for our 15- year- old daughter. So it is amazing to see how human beings are such adaptive creatures. A few years ago we were sitting in the house and the sirens went off and we looked at each other, wondering -is this real? Are we being bombed? And my girl was looking at me, saying “Daddy, is this real?” There was a moment of disbelief, trying to understand what was happening and then we just grabbed each other and ran to the shelter. Two days later, the same thing happened. And everyone just grabbed their stuff and ran. It was mind-blowing to see how quickly this became normal. The first day it was an absolute shock, and two days later - it was normal. It is sad to say how quickly we get used to crazy things. People firing rockets at my family is something I will never accept, but very sadly that is something normal in my life. We have accepted it, but it does have consequences and I see it on my kids.”
