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Prologue Foreign Exchange Small-Town Dreams In Sderot, the rockets have been coming for years. What has that meant for the health of its residents? In a small room in a small clinic in a small Middle Eastern town, a small woman speaks to a small group of visitors. The thoughts she expresses, in small, clipped bursts of Hebrew, aren’t small. They are large and weighty, and translated into English, they hold her listeners—tough, seasoned veterans of American emergency services—rapt. She’s talking about fear. The fear of missiles crashing through roofs and into streets. The fear of fathers who can’t protect their families. The fear of children who dare not play outside. A fear so constant and conditioning, for some it can ultimately trigger incontinence when the sirens come. Of a community so battered by fear and death and war—the grotesque asym- metrical kind that fi nds children legitimate targets—that acute stress reactions can be triggered, at last, by something as mundane as the call of a strolling street vendor. The Americans have seen a lot. They haven’t seen this. Rocket City They call Sderot Rocket City. It’s a small town in central Israel, less than a mile from the Gaza Strip. That’s where the rockets have been coming from, now, for more than a decade. From 2001–09, according to the Sderot Media Center, which works to publicize the town’s plight, more than 10,000 rockets were launched from Gaza toward Sderot and the western Negev Desert. Primarily Qassams, simple steel artillery rockets developed by Hamas, the U.S.- and E.U.-designated terrorist organization that governs Gaza, they grew over the decade in range and payload. By 2009 they’d killed 28 people, nine in Sderot, including three children, and injured hundreds more. Israel cracked down after that, but even in the “quiet days” since Operation The entrance and interior of the 2,000- square-meter covered indoor playground for the children of Sderot. The former textile factory was converted via donations from an American group, the Jewish National Fund. Dr. Adriana Katz speaks to U.S. delegation members (from left) Bernard Heilicser, Gary Wingrove and John Hick at her clinic in Sderot. Katz says she’s assisted roughly a quarter of the town’s residents—half of those for acute stress reactions. Cast Lead, Sderot has taken, by the estimate of one town elder, around 700 rockets. The woman is a psychiatrist. Originally from Europe, Dr. Adriana Katz is now the lone mental health professional on this weary front line of long, intractable confl ict. She says she’s assisted roughly a quarter of Sderot’s resi- dents in her time here—around half of those for stress and anxiety problems. It’s not PTSD, Katz is careful to distinguish, because “there is no post-.” Sderot is just one stop on a full itinerary for the Americans, but for nearly all of them it’s the most memorable. These Americans alleviate suffering—they are doctors, nurses, paramedics, leaders of emergency care systems. They’ve come to Israel as guests of its government to exchange ideas on mass-casualty incidents and nonconventional threats. If a rocket were to land in Sderot that day, they’d know how to treat the injuries. Against the emotional wreckage wrought by years of random shelling of civilians, their skills seem less useful. 4 JULY 2011 EMS WORLD