Welcome to our November email update.

Dome of the Rock in Jerusalem

This is a very special Newsletter, as I am beginning to write this on El Al flight 271 returning from Tel Aviv. Gail and I are returning from a 10 day visit to Israel that had a very special purpose. It was also a trip that really opened our eyes to the reality of the Middle East conflict in a number of ways that we could not understand before. I’m sure it will be a while before I finish this, since we will be quite busy at the Center on my return.

First of all, the purpose of the trip: a year ago, I enrolled in a program designated “Western Galilee ERG.” The letters ERG stand for Emergency Response Group. A group of doctors, nurses and healthcare workers have agreed that if the State of Israel is forced into war, we will serve as back up health care providers to replace the personnel called to the front lines. Of course, we hope that this will never take place but if the need arises we have agreed to come to Israel within seventy-two hours to serve.

This trip served as our orientation and training, and what an experience it was! Our group met in Jerusalem on Friday. That evening we walked to the Old City. With the onset of the Jewish Sabbath, we joined hundreds who prayed at the Western Wall, a site that had long been forbidden to Jews before the establishment of the secure borders of Israel determined by a series of attacks upon the Jewish State and resulting victories over crushing odds. The following day, a guided tour impressed upon us the importance of Jerusalem to the Christian and Moslem faiths as well.

Saturday night, we continued our journey to Nahariya and the Western Galilee Hospital. Here we began a full week of lectures and training which also included an opportunity to work with colleagues in related specialties.

At the Lebanese border during a military briefing.

Israel is a country under constant siege by enemies who are determined to see the destruction of this Jewish State. In addition to never ending suicide bombing attacks, the nation has been subjected to countless rocket and sniper attacks by the Hezbollah terrorists across the Lebanese border. The net result of all this was the development by Israel of the most advanced techniques of rapid emergency response in the world. By the end of the week we came away with an understanding and appreciation for the skills and determination of this young nation to assure its survival.

Key to their success is the tight knit coordination between the medical staff, the military, police and fire departments. Each plays an important role and each is well integrated into a comprehensive total plan of rapid response, triage and care. Even the press has a vital role in providing rapid communication.

Gail at the border.

In the Western Galilee, the threat has been primarily from rocket and sniper attacks across the northern border, but they also have developed and implemented plans and procedures to deal with suicide bombers as well as conventional and non-conventional warfare. Of course, knowledge is always a two way street, and many of the techniques and procedures developed and implemented in Israel are being brought back to the U.S. by individuals like ourselves. The sad truth is that in spite of 9/11 our country remains poorly prepared to deal with mass casualty. Through graphic documentary videotapes, we saw first hand the savagery of the suicide bombers, with attacks on civilian adults and children alike, all the while realizing that this could also happen in America.

The preparation that has been made to deal with these threats is so extensive it would take pages to describe. Perhaps an example will give you an idea. The hospital in Nahariya consists of 600 beds. Beneath the hospital is another 600 bed facility that exists only to provide for the possibility of a massive attack. Although it has never been used, it is in full readiness with its own power, lighting, ventilation – all built to withstand a bomb or chemical attack. Drills are carried out and procedures are in place so that if needed, the facility could be activated to replace or supplement the existing hospital.

Drills are carried out on a regular basis and a well formulated system of communications assures that necessary staff is always readily available. Whether the attacks should be conventional in the form of a bombing or sniper attack or non conventional such as a gas or chemical attack, the staff is trained and equipped to manage mass casualties rapidly and efficiently.

Briefing on emergency casualty treatment by Israeli Druze
medical officer.

Perhaps the question we are asked the most is whether we felt threatened in Israel. The answer is an emphatic “No!” Certainly Israelis live under the constant threat of terrorists. While there were no attacks during our stay, two or three years ago a suicide bomber attacked a bus in Nahariya resulting in several deaths and multiple injuries. In fact we saw a shocking videotape of that attack during our training. Indeed, armed guards are seen everywhere and many citizens are armed. Yet in some ways the country seems safer than our own. Here in Texas, even those who live in affluent suburbs are afraid to allow their children to walk to school alone. No such fear seemed to exist in Nahariya. Children are seen walking and playing unattended and while everyone seems to be in constant contact with cell phones, there is not the anxiety about kidnapping or predators that seems to exist in our society. In a country where so many people are armed, personal violent crime is rare. Citizens recognize that guns are needed for defense. Since all Israelis serve in the armed forces, all are trained in the use of weapons. It all seems to lend poof to the theory that the violence in America is not the result of guns but simply a manifestation that we are a more violent society.

A word about Israel’s security fence is in order. During the 34 months from the beginning of the violence in September 2000 until the construction of the first continuous segment of the anti-terrorist fence at the end of July 2003, terrorists carried out 73 atrocities (suicide bombings, shootings, car bombings) within Israel (including Jerusalem) in which 293 Israelis were killed and 1950 wounded.

On the Golan Heights in a discarded tank left after the 1967 war.

In contrast, during the 11 months between the erection of the first segment of the fence at the beginning of August 2003 and the end of June 2004, terrorist groups have succeeded in carrying out only three atrocities within Israel. All three occurred in the first half of 2003, in areas where the fence was not yet completed.

An equally important part of our trip was the opportunity to work with and visit with Israeli doctors. Of course Israeli medicine is highly advanced and we were all impressed with the overall level of care as well as the sophistication of the equipment available.

Following our week of training, we had two days to tour Northern Israel. It was remarkable to see how the Israelis had changed a desert into a garden. Everywhere we saw orchards, vineyards and fields of vegetables. In spite of the fact that the Turks, years ago, had cut down all the trees for use in constructing the railroad, new forests were seen all over.

It was a wonderful trip-all too brief, but enough to give us a taste sweet enough to insure that we shall return.


Howard A. Tobin, M.D., F. A. C. S.

For general information: askdena@newlook.org or n41gt@newlook.org