Gaza “Envelope”: 3 Years of Neglect

I am an adult and child psychiatrist in Beer Sheba now 43 years. I evaluate and try to treat the victims of the savage events of October 7, 2023.

I am stymied at every turn by a government whose neglect of the mental health needs of these citizens is almost as great as its neglect of their security that led to the massacre.

The score is abysmal.

It begins with the infamous letter of October18 – 11 days after the onslaught- in which the Ministry of Health composed a circular stating that there won’t be significant PTSD and certainly medical cannabis should be avoided at all costs.

The only thing positive I can say is that the government’s approach has been consistent with this shameful document.

The neglect continues in the astounding fact that in three years there is no central treatment facility offering all modalities of treatment for the population. The HOSHEN centers are swamped, not adequately staffed, and not responding by adjusting the treatment modalities to the enormity of the trauma. Few residents I have met have found the well-meaning “treatment” of value.

It gets worse. Medical cannabis has been a recognized treatment in Israel since 2009 for adults with PTSD. Founded rather informally, it became “reformed” in 2014 with the personal  appointment by the PM, with no tender (i.e. illegally) of one Yuval Landschaft, a pharmacist whose peculiar appointment for  5 years lasted 10. He was replaced -I kid you not – with a lawyer specializing in regulation. Did I say “Medical” – well, in name only. Landschaft produced a series of limitations of prescribing cannabis for PTSD, all completely without any evidential basis – including that you had to be ill for 3 years before you could apply. (I am still not kidding but I can see why you might think I am). The Sick Funds had no part in cannabis for PTSD so it was left to private psychiatrists, not  a great many, to manage requests that were made to the central organization. I have documented elsewhere just how badly this was managed.

But the new “reform” implemented after 7/10 washed away 10 years of experience by placing the management exclusively in the hands of the Sick Funds whose physicians had no experience. (Yes. I said “reform” – in Israel its comes with a strange cynical twist,  just take “improvement” out of the semntic range.) The new directors of the new programs of the Sick Funds, at least in most of the Funds are public health types who haven’t treated a patient in decades and know nothing about cannabis let alone PTSD. They follow the now decade old and never studied restrictions to a T (for trauma) including a new one that a recommendation cannot be made until a psychiatrist has been treating the person for a year. Of course, you had to prove also what everyone knows – that you took Prozac and its cousins for a year and got no assistance, but you still had to prove that you b o u g h t the stuff. (Does BigPharma influence these “restrictions”? No Comment) Oh, and you have to start at 20 grams a months even if you need 40, and the new one is that you have to start with oils, not smoking, and only with low concentrations. And for dessert, the Sick Funds were justifying this based on two articles which they quoted which actually had nothing to say about this (probably just anothe AI glitch, I know – but after I pointed it out, the papers continued to be quoted. SO if October 7 left you sleepless, unable to be calm or concentrate, the likelihood that this new “reform” will let you chill with cannabis is small, and if you get it, it will be too weak to be effective based on bogus literature.

For adults a “new” and highly effective treatment showed up 6 months before October 7. It is called Stellate Ganglion Block (SGB) and is a fifteen minute procedure  and has been around since 1925 (when doctors started using cocaine and its derivative local anesthetics just about everywhere.) It first treated upper extremity sympathetic nervous system damage which some of the GIs returnning from Afganistan and Iraq suffered. But surprisingly those treated returned and told one anesthesiologist who actually listened to them that their PTSD symptoms were unexpectedly relieved. Dr. Lipoff was impressed and created literature and experience in the US. When an Autralian who made aliya and served in special forces saw all his mates with PTSD, he thought to do something that hadn’t occured to the erstwhile trauma experts in Israel, then called “Google.” He found Lipoff and after he could not get the Israeli authorities to wake up, set up a Stella branch in Israel six months before October 7. There is no medical or scientific reason to doubt that SGB can and should be an important improvement in PTSD treatment, sometimes with astounding results. Do the Sick Funds provide it? No. Stella actually had to seek – and receive – donations from USA Jews to subsidize the tretament for October 7 survivors! And have trauma “experts” and psychiatrists become aware of this now practically harmless and often -up to 80% – effective treatment? Sorry but you guessed right. Nada.

Want to try another guess? You know how people with anxiety and sleep troubles go around the corner to the CBD store and buy what they need? Not in Israel. CBD was actually a Schedule 1 drug in Israel until 4 years ago when it was completely descheduled and therefore completely legal (Did you gues right that was during that  o t h e r government?) People started to import and  market freely. The DAY that this government that we have now showed up, customs impounded all shipments. Step 2, they would impound for 6 months, so no business could survive. Step 3 just a few months agao, customs impounds CBD shipments and tells the frustrated customer to go get permission from the Health Ministry. The Helath Ministry answers your inquiry (if you are naive enough to pursue the matter) with NO SUCH THING. SO the PM and his folks have succeeded in at least one important (to them) goal, to make the State of Israel CBD-FREE. But it so happens that the only thing that helps children with PTSD is  CBD. In the experience I have with people who managed to attain CBD , it often helps children to turn a corner, be able to sleep better, be less irritable and more attentive. I have seen hundreds of children from the Envelope. Not a child that I know of in Sderot or her neighbors has had a reasonable night’s sleep for three years. One would think that the State has an interest in assisting these children in every way possible. But the current government has no interest in what are the State’s or the people’s needs. Instead many children as misdiagnosed as ADHD (leak of attention is part of the symptoms of the hyperarousal state in PTSD) and given Ritalin. In most cases, you guessed right that Ritalin, a stimulant, increases hyperarounsal and worsens sleep. You also probably guessed who profits from these prescriptions.

And now we come to Bituah Leumi (Social Security). BL almost immediately recognized the severity of PTSD with double digit disability compensation for many of the victims. But instead of adjusting rules to reality and giving say 4 or 5 years of temporary disability, it was temprary the was a broken leg is, for a year or 6 months at a time. Then you have to scramble for find a psychiatrist or child psychiatrist to document what should be obvious – that this doesn’t just go away, But – remember the October 18th letter? Now of course there is a greivous lack of mental health profesisnals in the South, and they are mostly in the Sick Funds which refuse to provide these exams. So you get a letter from BL giving you 2 weeks or maybe a month to go get a document from nonextistent professionals or you lose your disability. I personally became swamped with hundreds of desperate people under totally unrealistic time pressure. To boot, often some functionary in BL would deny what I recommended without any professional justification, often an adult psychiatrist denied what I had written for children and then a new exam for an appeal, often with a lawyer, was needed. I admit that my health at 76 couldn’t tolerate the pressue and I had to stop providing this service – reluctantly and sadly. You probably have guessed that this goverment did not allocate personell to BL so the officials were also under terrible pressure and I am told that many left their positions.

So I apologize for having trained your guesses is such a cynical direction. You can delete this information from your brain if it makes you unhappy – that’s what the government does.