When the Sirens Stop, the Body Still Remembers

For survivors of sexual violence, prolonged war does not begin on an empty page. It can make an earlier danger feel present again, as though the body has lost control and nowhere is truly safe.

During the war, Israel’s sexual assault crisis centers reported increased demand for support, especially through anonymous online chats. Survivors who had not sought help for years reached out again, while others described worsening post-traumatic symptoms.

For some, the war stripped away the everyday anchors that had helped them feel safe: sleeping in their own bed, controlling who enters their space, having a trusted person nearby. When partners were called up for reserve duty, some survivors lost an important source of support. Evacuation placed families in crowded temporary housing, while repeated stays in shelters meant confinement, proximity to strangers, and little control over personal space. Reports of sexual harassment in shelters further undermined the very meaning of a “protected space.”

A medical encounter often requires precisely what trauma can make difficult: entering an unfamiliar environment, removing clothing, being examined or touched, and temporarily placing one’s body in another person’s hands. Even a routine examination can trigger freezing, dissociation, or an overwhelming urge to escape. Patients may postpone appointments, avoid essential examinations, or leave before treatment is completed.

This is not only emotional distress. It is a barrier to healthcare.

This week, Israel’s Ministry of Health brought together healthcare leaders, clinicians, and patient representatives to advance a national vision for a healthcare system grounded in compassion and trauma-informed care.

After years of prolonged threat, the question is no longer whether the healthcare system can function during a crisis, but whether it can respond to the lasting human consequences.

Trauma-informed healthcare is sometimes treated as a specialized approach relevant mainly to mental health or sexual assault services. In practice, it is a basic standard of safe and effective medicine.

It does not require clinicians to know every patient’s history. It begins with the recognition that they may never know that history, yet still need to account for how it may affect a patient’s ability to receive medical care. In practical terms, this means explaining before acting, asking permission before touching, reducing unnecessary exposure, offering choices where possible, and allowing the patient to pause. It also means understanding that silence or withdrawal may reflect fear rather than unwillingness to cooperate.

At the Briah Foundation, we have spent years listening to patients describe the gap between what medical teams intend and what patients sometimes experience. A clinician may see a necessary examination; a survivor may experience a sudden loss of control. The Purple Card was developed to help bridge that gap.

Created by the Briah Foundation together with the Israeli Society for Sexual Trauma Treatment and Prevention, the Purple Card is a discreet communication tool, available free of charge, that allows patients to signal their need for trauma-informed care without having to share details of the assault they experienced. It translates broad principles into a simple set of clinical requests: explain before acting, ask before touching, protect privacy, and allow the patient to pause.

The Ministry of Health’s adoption of the Purple Card, supported by Director General Moshe Bar Siman Tov, is significant because it establishes trauma-informed communication as a system-wide responsibility, rather than merely an individual practice. Many clinicians already respond with care when a patient presents the card, even without formal training; the challenge now is to make that response consistent across healthcare settings.

This week’s gathering represents the next stage of that work: embedding trauma-informed practice in professional education, clinical protocols, and healthcare environments. Its success will ultimately be measured not at a conference, but in the examination room, when a frightened patient asks a clinician to stop and is heard.

Although the Purple Card was developed in response to the needs of sexual assault survivors, its principles also matter for people living with combat-related trauma, domestic violence, childhood abuse, medical trauma, bereavement or displacement.

The issue is not whether every medical encounter can be made comfortable. Many cannot be. But healthcare professionals can avoid adding unnecessary fear or helplessness to an already vulnerable moment.

A resilient healthcare system does more than continue to function under fire. It learns what prolonged threat does to people and changes the way it cares for them.

The sirens may fade. The body may still remember. It is our responsibility to ensure that trauma never becomes a barrier to medical care.