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American Journal of Critical Care. 2008;17: 11
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Nursing in the Face of Constant Terrorism Threat Is More Stressful
FINANCIAL DISCLOSURES
None reported.

In describing nurses’ duties in identifying victims of Arab terrorist attacks, Liebergall et al1 mention the resulting stress on those nurses. Aside from describing the work itself, which of course is implicitly stressful, the authors modestly omit further discussion of why identifying victims of terrorism might differ from identifying patients in some other war situation.

Perhaps one reason is that the work may be more challenging. Soldiers wounded or killed in a war have dog tags that are relatively resilient to attack. The identification cards that civilians routinely carry are more commonly destroyed, along with the lives and limbs of the victims. Under these circumstances, the process of victim identification in the Liebergall et al study is surprising for its speed. Sometimes, as shown in the Israeli documentary film No. 17 Is Anonymous, the work can take months.2

Safety while on duty is a unique issue for Israeli hospitals; in fact, the authors’ very hospital has been targeted with firebombs.3,4 A plot against another hospital involved crude chemical tactics.5 It is reasonable to speculate that nursing while having to "watch your back" is more stressful than other civilian nursing situations.

A related source of potentially unusual stress is the fact that the intifada has been almost exclusively directed against civilians in and out of the health-care community. Like other Israeli civilians, nurses and allied caregivers must live with the fear that there are members of a subculture, sometimes in their own neighborhoods, who are dedicated to their murder and capable of striking at any time the Israeli security forces have their guard down. The terror campaign thus results in stress that is not only job related, but must follow caregivers and fellow citizens all the way into their homes.

Much of American mainstream opinion, fostered by media and government alike, is that the solution to this conflict is the creation of "a Palestinian state that will live side by side in peace with Israel."6 Should such a state be created, current events indicate that it is unlikely to expedite healthcare in the Arab-Israeli area. Given the pattern of Arab assaults on the Israeli healthcare system, it was perhaps inevitable that the attackers would eventually turn on their own system as well. In fact, after the terrorist group Hamas took over the Gaza Strip from its similarly inclined predecessors, it shut down its rival’s clinics.7

The authors’ hospital system was nominated for the 2005 Nobel Peace Prize, in part for its modeling of Arab-Israeli cooperation in the face of terrorism.8 That cooperation might become much easier and freer once the terrorism stops.

David A. Sherman, RN, MSN, CCRN-CMC
Needham, Massachusetts

REFERENCES

  1. Liebergall MH, Braverman N, Shapira SC, Rotem P, Soudry I, Mor-Yosef S. Role of nurses in a university hospital during mass casualty events. Am J Crit Care. 2007;16(5):480–484.[Abstract/Free Full Text]
  2. Ofek D, Rotem R, Kowarsky E, directors. No. 17 Is Anonymous [film]. Israel: Eden Productions; 2003.
  3. Jerusalem Post. March 14, 2006.
  4. Kol Yisrael [daily English broadcast]. November 6, 2006.
  5. Ha’aretz. September 24, 2002.
  6. President Bush makes remarks on Annapolis conference. http://www.whitehouse.gov/news/releases/2007/11/20071128-11.html. Accessed November 29, 2007.
  7. Barzak I. Hamas shuts Fatah-linked Gaza clinics. http://abcnews.go.com/print?id=3529406. Accessed November 29, 2007.
  8. Sheffer D. Local hospitals up for Nobel prize. http://www.ynetnews.com/Ext/Comp/ArticleLayout/CdaArticlePrintPreview/1,2506,L-3060873,00.html. Accessed October 23, 2007.




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