Day of Infamy

For Dr. Oren Barzel, head of Sheba’s Orthopedic Rehabilitation Department, the horror of October 7 is encapsulated by one grim statistic: the ten to 15 amputations that took place over the course of the day.

“Someone who worked in orthopedics in the Yom Kippur War told me that over the course of the whole conflict, there were only about 60 amputations — this time around, we’ve performed 90,” he says.

The high number, Barzel explains, is due to the chaos on the front lines as Hamas struck on that terrible day. “Not only were there an enormous number of gunshot and RPG wounds, but the wounded took hours to get to the hospital. Meanwhile, the tourniquets that had been applied cut off blood circulation to those limbs, which then had to be amputated.”

That account conforms with the experience of one of Dr. Barzel’s patients, whom I’d interviewed in Sheba a year ago. Amichai Schindler’s arm was blown off below the elbow by an explosive charge attached to the door of his safe room at his home in Kerem Shalom, a kibbutz that borders the southern Gaza Strip. Due to the ongoing attack, it took ten hours for him to reach a hospital.

Like the proverbial iceberg that signals the enormous mass beneath the surface, the headline figure of amputees points to the sheer scale of the casualty list after 16 months of combat. For every soldier or civilian who has lost a limb, there are hundreds more who are scarred in ways almost as life-altering.

The healing process is helped along by the community spirit that permeates the wards. The brutal nature of the war means that waves of amputees and severely wounded soldiers continue to flow into the hospital, and the veteran patients are there to assist when newcomers enter the painful new world of rehabilitation.

On the porch outside Dr. Barzel’s ward, that process is clearly at play as soldiers from many different backgrounds sit and talk, or smoke while gazing at the grass. Aviram, an armless bus driver from Be’er Sheva, was wounded driving his D9 combat bulldozer in Rafah. He shares his story with me, while his newfound friend, an infantry soldier from an Ethiopian background, chats on the phone next to him.

There are guitars in evidence, as well as dozens of stickers memorializing fallen soldiers, their sayings, and unit insignias. “The patients who have been recovering for longer help the new ones understand that it’s going to be okay,” Dr. Barzel says of the community dynamic.

ON

the way out of the orthopedic ward, we get a reminder that the casualty rolls keep growing, often on a daily basis. Over the large Sheba campus comes the sound of clattering rotors, and above the trees, a military helicopter comes into view as it approaches the landing pad. The hospital staff confirm that another two soldiers wounded in Gaza have arrived.

If all goes well, once the new patients have cleared the ER and done their time in one of the wards, they’ll be transferred to the rehabilitation department. Prewar, that would have meant one facility. The sheer volume of cases has meant that Sheba has had to open another three wards, which are housed on the top floor of the Geriatric Department.

Dubbed “Chozrim Lechaim” — “Returning to Life” — it is home to dozens of current patients with all manner of injuries. The common denominator is that they all became casualties while fighting Hamas or Hezbollah.

Yeshivah high school teacher Hillel Ariel was a gunner with a 155mm artillery unit stationed near the northern border when he was wounded. Rushed to the front straight after October 7 as the army feared that Hezbollah was about to copy Hamas’s playbook, his unit was involved in nearly yearlong exchanges of fire that eventually led to the IDF invasion of southern Lebanon.

Like many of the soldiers here, he remembers the events surrounding his injury in granular detail, replaying them many times over the months since the battle.

“It was at the end of Succos, when we received a warning of incoming Hezbollah rockets, which gave us only 15 seconds to take shelter. My unit commander ran out to alert a soldier who was outside the howitzer’s dugout,” he remembers. “While they ran toward the shelter of the armored vehicle, the rest of us were poised by the hatch to slam it shut as soon as they made it inside. Unfortunately, a rocket fell two meters away from the hatch — the commander was killed and we were sprayed with shrapnel inside the vehicle.”

Hillel, 34, was hit in the thigh and his bone was shattered. He notes the miracles that he experienced even as he was injured. Despite the power of the 122mm Grad rocket, the explosion missed the ammunition stacked around the gun. An impact there would have caused a catastrophic detonation that would have killed all the crews in the vicinity. Beyond the narrow impact, he says the immediate presence of a combat medic — which was not the standard — saved lives. “There were many nissim,” he summarizes.

Beyond the ongoing physical pain, it’s clear that Hillel struggles with the emotional impact of the event. Yet, in a sentiment expressed by some of the other religious soldiers on the ward — their numbers evidence of the very high volunteerism rates among the national-religious community — faith gives him perspective.

“It’s not easy. My close friend was killed, and this type of injury puts one’s life on hold. If I would just focus on my own position, then I would be depressed. But if you look at the wider story of the Jewish people now, it’s clear that we’re part of a very big event. It’s a period during which our nation needs to prove itself.”

“In Every Generation”

Even in a ward of wounded soldiers, Sagi Azar, a 22-year-old Ashdod native, is noticeable for his injuries, because one of his eyes is covered with a black patch. It’s the result of a close-quarters firefight in Lebanon on October 25, a date seared into his memory. A soldier in the Nachal Brigade, he served a six-month tour of duty in Gaza, and after being discharged from the standing army, he was immediately sent as a reservist to the north. A few days into the IDF’s thrust into Lebanon, his unit suffered heavy casualties in a fierce battle with Hezbollah. Eleven soldiers were wounded, and two were trapped in a burning house. Sagi was sent in as part of a rescue force.

“We thought all the terrorists were dead,” he recalls. “But one was hiding. He threw a grenade that landed near me and I got shrapnel in my left eye and throughout my body. My vision held out for a few moments after the blast and I was able to drag myself behind a wall where a friend applied a tourniquet to my leg.”

Sagi is stoic about his injuries: It’s part of the price that Israelis must pay in every generation in order to protect their country. “My father served, and so did my grandfather. In every war people are wounded, and we’ll do it again when we need to,” he says. “I told myself after I was wounded that I have two choices: if I don’t want to cry all the time, then I have to laugh.”

But after a few minutes’ conversation, the philosophical attitude crumbles and he speaks of the constant flashbacks and trauma that accompany life-threatening injury. “I’ve learned not to think beyond today. On the day that I was wounded, I was planning my upcoming vacation in Thailand — a few hours later, I was fighting to stay alive while being airlifted to the hospital.”

“What’s the use of thinking too much about the future? We have no idea what’s around the next corner.”

Long Road

A short distance away from the one-eyed veteran is a soldier from a very different background. Even against the diverse backgrounds of the other patients, Chaim Treitel stands out. A 20-year-old Nadvorna chassid from Bnei Brak, Treitel

is a chareidi soldier currently serving in the Givati brigade. His peyos and black yarmulke would fit into the army’s chareidi units, but in this infantry brigade, he stands out.

On October 7, he wasn’t serving with the front line troops. Having contracted an infection, he’d been invalidated for combat and sent to be a “jobnik” or service soldier — not what he’d dreamed of when signing up. Chaim fought hard to requalify for combat status, and around Succos time, he was finally sent into Gaza. His unit was conducting a large anti-terror sweep in Jabalia, in the northern Gaza Strip. But on his fourth day in action, he was shot.

“We climbed out of the Namer personnel carriers, and almost immediately, I was shot by a sniper from behind. The bullet entered and exited my leg. I felt a sharp pain, looked down and saw the blood and understood what had happened.”

As the platoon’s combat medic, he had a tourniquet at hand, and crawling back into the armored vehicle, he was whisked away from the gunfire. It took just 32 minutes from when he was shot until he made it to Soroka Hospital in Be’er Sheva, where he underwent surgery.

“It was a miracle that the bullet missed an artery,” he says. “But what crossed my mind when it happened was the thought, ‘Why did this have to happen on my first deployment?’ ”

Unlike others on the ward, the chareidi soldier’s wounds are light enough that he can be treated as an outpatient. But that doesn’t mean that the future is any clearer. “When you get wounded, life stops,” he says. “I don’t know how I’ll recover, and I don’t know what the future holds.”

What is certain is that for the foreseeable future, his life will consist of a daily routine of therapy, exercise, and medical assessments.

How effective a given patient’s regimen is, says Caroline Barmatz, director of hydrotherapy at the hospital, can often come down to motivation. “Early in the war, we’d see young soldiers pacing up and down outside at six a.m., getting through their exercise routines — they wanted to get back to their units.”

Just off the main area where Ariel, Sagi, and Chaim are chatting with visitors is a physio room featuring parallel bars where injured patients can practice walking again. Next door is occupational therapy, where the basic movements of everyday life are practiced through normal activities such as sorting objects.

Eytan, a 19-year-old from Kiryat Gat, is patiently waiting for his session to start. He shows me his wound, a jagged scar near the shoulder. “There was a terrorist hiding inside the door of a house that we raided,” he repeats a familiar story. “He fired at me and the bullet missed the bone and an artery, thankfully, but it hit the nerves.”

The results are obvious when looking at his right hand, which is both flaccid and swollen, a result of Eytan’s inability to move his arm properly.

While comparatively minor compared to the mutilation that some others in the rehabilitation wards have suffered, Eytan’s case somehow emphasizes just how devastating the war has been. Despite the limited nature of his injuries, this man’s life has been utterly changed — and there are many thousands of others like him.

AS

both a physiotherapist and the mother of a seriously wounded reservist, Devora Segal has an unusual insider’s view of the rehabilitation process. Her son Eli, a 34-year-old lawyer and father of three, was wounded at the beginning of August this past summer. His unit had gone in to clear some buildings in Khan Younis when an explosive charge was detonated by Hamas terrorists remotely as the Israeli unit prepared to enter the building. Six soldiers — including the unit commander — were wounded by the blast.

Eli was riddled by shrapnel that penetrated his diaphragm and liver; his left elbow was shattered, and the nerves in that arm were damaged.

“The soldiers saw many miracles in the evacuation, which took place despite the fact that Hamas terrorists were filming the incident, and clearly had the zone in their sights,” Eli’s mother recalls. “Afterward, the paramedic who treated the squad said that if he’d dealt with Eli first, then two other more seriously injured soldiers would have died. As it was, they all survived.”

That type of blow-by-blow analysis is typical of many patients recovering from incidents that nearly ended their lives, but in the case of Eli Segal’s squad, it’s aided by the fact that four of the six were hospitalized and recuperated together by the commander’s request.

From the beginning of the process, it was obvious that today’s IDF has a sophisticated approach to trauma, and the way it impacts soldiers’ families. That manifested itself on the initial phone call informing them of the injury, which came from Eli himself.

“The army has a policy that if the soldier can speak, then he should make the phone call himself,” says Devora Segal. “It’s a much easier way than to hear from an anonymous officer that your son has been wounded. Even though he had been taken into surgery by the time his wife and I arrived at the hospital, the phone call alone told us that the worst had been avoided, and that his head was untouched.”

In her son’s case, the rehab process took longer to begin because he first needed time for the internal injuries to heal. But once it began, the full schedule of physical and occupational therapies — in Eli’s case multiple times a day — ensured steady progress. It’s a sophisticated system, Devora says — one that signals the army’s commitment to look after its own. “Both his wife and I are physiotherapists, and I was impressed by the fact that the hospital’s PT was open to our contributions.”

The atmosphere in the hospital is something like a boot camp for rehab — hyper-focused and well-resourced across a range of disciplines. Just walking the corridors gives some idea of what options are out there to encourage movement of all kinds. Sandwiched in the corridor between two clinics is a ping-pong table at which a game is ongoing. It pits a young boy against one of the patients — an electric-wheelchair-bound man in his 20s with one arm in a cast, and two stumps in place of legs.

What the future holds for Eli Segal after leaving the supportive environment of the rehabilitation ward is now unclear. Despite his good medical outlook, he can’t type on a computer at the moment, and it’s unclear at what stage that barrier will be crossed — or indeed, whether his severe internal injuries will create complications down the line.

But Eli’s reentry into normal life will be eased by the sheer prevalence of combat injuries — even very visible ones. The war has normalized the sight of amputees, to the extent that major Israeli companies are now using amputees in their advertisements. Strauss, a leading dairy producer, recently advertised a new cream cheese with a man who opens the container and spreads the cheese using his bionic arm.

Such a campaign is clearly both an enlightened bid to help the process of normalization, and a recognition of how common injury in today’s Israel actually is.

Making It Home

On the wall of Anat Ben Dor’s office in Sheba is a picture, taken at a recent wedding. Nine people in their 20s to 40s beam at the camera. Some are soldiers, some are civilians, and they’re all survivors of the Nova festival, Kibbutz Be’eri, or the war that followed.

It’s not immediately obvious, but all have one thing in common: they’re missing a leg.

Over the course of 35 years at Sheba’s orthopedic rehabilitation unit, the head nurse had seen it all — or so she thought. “I was here during the 2014 Gaza war, and we only saw two amputees,” she says, reaching for the most obvious measure of a war’s intensity. “But look at this picture — this tells the story of the whole war.”

One of the group’s more recognizable figures is Avida Becher, a resident of Kibbutz Be’eri who has become a leading voice for survivors in general, and for reconciliation between the warring tribes of Israeli society.

While sheltering in his safe room on October 7 as killers swarmed over the kibbutz, Becher lost his wife and son, along with one leg. When I first visited the rehabilitation ward in Sheba a year ago, Avida was sitting in his bed, with his son’s surfboard next to him, a picture of grief. But a year on, he has is a paragon of strength that continues to inspire all Israelis, and survivors in particular.

His words in an interview two weeks ago echo in the room, quoted by Anat. “It’s a mazel that the attack took place in Be’eri and not Gush Etzion,” he told an interviewer. “Because if it would have happened there, I would have said, ‘They deserved it — it’s because they were living there.’ I paid a high price, but I’ve learned a lesson.”

On the medical front lines of the October 7 response, Anat understood early on the horror that her patients had endured. She spoke to a Nova survivor, who shared an account of the Hamas atrocities in which he’d lost friends and a limb.

She saw the way that severe injury shook wider circles of family. “One mother who lost a son in a previous war told me: ‘I’ve encountered death, but in a way, this is worse, because when I lost a son, I knew that he wasn’t in pain — only I was. But with a wounded child, both of us are in pain, and that pain is greater.’”

Rehabilitation toward a normal life, says Anat Ben Dor, is a lifelong process that is never truly over. Ongoing therapy is provided at facilities in the hospital funded by the Ministry of Defense and at a network of centers for soldiers across the country recently refurbished by the Friends of the IDF organization — sometimes years after an injury.

But the first stage is breaking out of the pocket of warmth at the hospital, where an injured state is standard. “Here, everyone is wounded, so they have each other,” says rehabilitation department head Dr. Oren Barzel. “But the downside is that they can find it very hard to leave this cocoon.”

Beyond the mental reentry, returning to normal life necessitates learning how to do basic daily tasks, with workarounds if necessary. Everything from answering the phone to opening a door can be challenging, and it’s here that tech can be used to simulate real-life situations.

Sheba’s Immersion Room is equipped with projectors that beam backdrops of different scenarios onto the wall, with sensors to detect motion. One projection is of a house with a couch, and a table next to it with a phone charging. Tapping on objects in the house simulates the motion needed, say, to reach the phone. In another scenario, a London double-decker bus is beamed onto the walls, and a user needs to navigate the layout.

Multiple users can compete against each other simulating these everyday tasks or going through gym-like exercises by following avatars projected onto the walls.

Once rehabilitation can go no further, clever engineering solutions can sometimes fill the gap. Sheba’s Milbat center, which specializes in technological solutions for those of limited mobility, made news with a device to help an amputee put on tefillin. It solved a problem that has affected numerous observant soldiers who have lost part of their arm: how to correctly position the tefillin shel yad, and then wind the retzuos.

The device — which looks like a cross between a woodworking clamp and a tefillin box — emerged from a collaborative effort of product engineers and occupational therapists. “The challenge here was twofold,” says Einat Carmeli, director of Milbat. “On the one hand, to find customized solutions that allow people with physical limitations to deal with a motion that demands fine motor skills, at the same time, maintaining complete fidelity to halachah.”

“We felt a sense of mission, not only developing technological solutions, but also giving people back some of their ability to be themselves.”

A Lifetime of Struggle

Over the course of a morning with Israel’s wounded warriors, I’m reminded of an encounter on a hilltop near Beit Shemesh a number of years ago with a scarred veteran of a previous war. The man, in his 70s, limped heavily over to me and struck up conversation. Unprompted, he supplied the details of his injury. He’d lost a leg in one of the savage battles of the Yom Kippur War, and the event had clearly gone on to define his life, the ongoing pain spurring his reflections about what it all meant to him.

Gesturing at my children, he said movingly, “I would do it all again, because it enabled us to have a future here.”

Like the Yom Kippur amputee generations before, the knowledge that people recognize their sacrifice provides a measure of comfort for his fellow soldiers, says wounded soldier Sagi Mazar. “When we see how we are enveloped in love here, by the staff and regular people who just come in to thank us or share a doughnut, we see what it was all for.”

It’s perhaps only natural that in a facility that serves so many veterans, military jargon abounds, but when both staff and patients refer to the recovery process as a “war,” the term feels appropriate.

As the country as a whole learns to live with its longest war, for Israel’s wounded generation, life stretches ahead of them like a battlefield. It’s one shaped by a paradox: The advances in combat medicine ensure that soldiers once too badly injured to survive now make it to the rehabilitation wards — and a lifetime of struggle.

Having downed their rifles and removed their helmets, their own personal war is just beginning.

“This is my life’s war,” says Sagi Mazar. “I won’t return to the front any more, but instead, every day is a personal battle.”

Painful Decisions

UP

to the beginning of the war, Sheba’s experience with amputation lay mostly with treatment of diabetics, which made the surgery semi-elective, performed under optimum conditions. But the volume of wartime surgeries has made local doctors as expert as their counterparts in America and Britain, who became familiar with blast wounds after years of combat in Afghanistan and Iraq.

Sheba’s surgeons learned that it was often necessary to reopen and clean fresh wounds every three days and that amputations are an ongoing process, sometimes requiring repeated revisions. That learning process took place even as the department suffered staff depletion, with up to half of doctors drafted into the reserves at the beginning of the war.

Perhaps the most shocking thing about the amputees who dot Sheba’s corridors is that in some cases, the loss of limb is not always a case of last resort. When it comes to a damaged leg, it’s sometimes preferable to remove a semi-functional limb in favor of a high-performance prosthesis. “We’ll operate for hours to reattach an arm, but won’t do the same for a leg,” says Dr. Barzel. “That’s because a leg needs to do more for functionality. It has to bear weight, and a stump covered by a skin graft can’t do that.”

Although these decisions need to be made quickly in the case of battlefield injuries, that’s not something that doctors can decide on their own. Sometimes, an injured soldier will elect to go through the grueling process of rehabilitating the leg, only to discover a year later that the constant pain and lack of functionality makes amputation the best option after all.

There’s also no hard-and-fast formula to determine the correct treatment in cases that require a trade-off. A case in point is a recent Syme amputation, which is performed through the ankle joint. The foot is removed but the heel pad is saved so the patient can put weight on the leg without a prosthesis.

The advantage of such an amputation is that a patient then has some form of balance even when not wearing a prosthetic; the downside is that he can’t wear the most advanced false limbs that enable advanced movements, such as running.

The multiple injuries suffered by many of the soldiers who are hit by grenade or shrapnel explain the length of time that some of them remain at Sheba, where each injury is a medical saga of its own.

Given the complexity of their injuries, a soldier’s recovery can take far longer than in a standard amputation case, says Dr. Barzel. “The stump takes time to heal, and then they wait six weeks until receiving their first prosthesis, because the scar has to be strong enough to walk on. But if there are other injuries, such as fractures, then the healing time can be double.”

(Originally featured in Mishpacha, Issue 1044)