BURNING FLOWERS, BURNING DREAMS

CONSEQUENCES OF SUICIDE BOMBINGS

ON CIVILIANS IN ISRAEL 2000-2005

Chapter 3 WHEN THE WORLD EXPLODES WHO HELPS?

3.1 PASSENGERS AND BY-STANDERS – HAUNTING MEMORIES | 3.2 WHAT DO PARAMEDICS SEE AND WHAT DO THEY DO? | 3.3 MAGEN DAVID ADOM – ITS ORIGINS AND ROLE | 3.4 THE COLLECTORS OF BODY PARTS – HONORING THE DEAD | 3.5 HOW FORENSIC EVIDENCE IS COLLECTED AND PROCESSED | 3.6 TYPICAL INJURIES ASSOCIATED WITH SUICIDE BOMBINGS | 3.7 FOR SURVIVORS AND VICTIM'S FAMILIES – IMMEDIATE PRACTICAL HELP

Amidst the blazing debris of a passenger bus or the wreckage of a shopping mall are strewn the bodies and body parts of the dead and wounded. What do people see? What do they hear? What do they do? What happens next? In this chapter, we outline who provides primary assistance at the scene immediately after a suicide bombing. These include fellow travelers, passers-by, ambulance crews, volunteer collectors of body parts, and the police. We look at how survivors are comforted and how relatives are helped as they search for family members both at the bombing site and later in hospitals. For some families the search can be long – ending only in the forensic institute. Some volunteers also accompany relatives as they try to find missing family members. We consider how forensic evidence is collected and processed. We look at how explosive devices of the bombers are constructed and what types of injuries they cause to civilians. We outline examples of practical assistance to survivors and families of victims.

3.1 PASSENGERS AND BY-STANDERS – HAUNTING MEMORIES

As well as bodies and body parts strewn near the bombing site, passers-by also see survivors and wounded, some of whom may be unable to extricate themselves from a devastated blazing inferno, such as a bombed bus. The savage drama is played out in front of them. There is no switch to turn off the TV or the video screen, or a chance to cover their eyes at the worst part of the movie. This is for real. It is all really happening in front of them. The following eye-witness accounts illustrate what fellow travelers and passersby observe, what haunts them, what deprives them of sleep, and what may stay with them forever.

"There was no body —just a heart still beating on the sidewalk"

Suicide bombing number 76 was aboard crowded Dan bus #4 in central Tel Aviv on 19 September 2002. As soon as the Hamas bomber boarded the bus he detonated his bomb, killing the driver and four passengers at the front, and wounding 60 other passengers, one critically. A woman who was walking nearby at the time of the bombing recalls, "The dead were dead, and those who were alive lifted themselves out of the windows of the bus. The driver, poor thing, lay slumped dead, his head on the window."

The owner of a nearby restaurant remembers, "There were arms and legs on the ground. It was a horror." When the smoke cleared from the explosion, Heyn, an 87-year-old man, saw a heart, still beating, lying on the sidewalk amidst the shattered glass. "There was no body – just a heart beating. I didn't think such a thing could happen. But I saw it and others saw it." He had been standing with his son in front of a bookstore that his family owns. He continued, "Glass shards fell on me. I was covered with smoke and dust. I looked to see what had happened to me, but I was not hurt. The bus had continued to travel a short distance (after the bomb exploded). A body was lying on the sidewalk. Later someone told me the man was dead. I saw a man walking covered with blood. Then the ambulances came. I went into the store. People there were frightened. They were hysterical and crying." One passer-by sat on the sidewalk, crying. Another passer-by entered the scorched remains of the bus. "I took off my shirt and used it as a bandage to help them," he said.

A 56-year-old woman, Yaffa, had taken a break from work when the explosion occurred. "People (still inside the bus) yelled 'Help me! Help me!' One woman was banging on the windows trying to get out. I wanted to help but I couldn't. That is what hurts me. I tried to move. I couldn't. It felt like my legs would not hold me. All of a sudden I fainted," she said. She woke up in Tel Aviv's Ichilov hospital.

Inside the bus, 24-year-old Carmit had been a passenger. She recalls, "I was getting ready to get off, so I went to the front of the bus. The bus had stopped by the light. Suddenly there was blood and glass everywhere. The bus was black and smoky. I understood there had been a terrorist attack. I was still standing. People were grasping at my arms and legs. They were wounded and didn't want to let me go. I was trying to escape but they held me back. A man outside yelled at me to get out. I said 'I can't, they won't let me go'. He helped me escape through the window." She lay on the sidewalk and someone gave her water. She called her mother on her cell phone and said she had been wounded in the attack by flying glass. In hospital, she kept beside her an inch-long thick green shard of glass. "It was still stuck in my clothing when I got here," she said.

Among those who raced to help at the scene of the bombing was Boaz, who had lost his wife and three of his sons in a terrorist attack in Itamar on the West Bank, in July 2002. He had been visiting one of his hospitalized sons in Tel Aviv when he heard of the bombing attack. He immediately jumped into his car carrying a first-aid kit and raced to the scene to help. He said, brushing aside initial concerns about going to the scene, "At the moment I heard about the attack, all I could think about was trying to save as many people as possible. Afterwards there is time for thoughts and soul searching."

Sources: Lazaroff, "I Saw People Jump From the Windows" and Lefkovits, "Suicide Bomber Kills Five on Tel Aviv Bus", Jerusalem Post, 20 September 2002

For some of the wounded, too seriously injured to help themselves or for paramedics to be able to reach them, survival turns quickly into horrific death. Imagine yourself so injured that you cannot extricate yourself from the post-explosion carnage, when the 'release' of death takes time in coming. Your family will go on imagining it forever.

By-standers heard the wounded screaming to be rescued from the blazing bus

At 7.15 am on 5 June 2002, a small stolen van rammed into the left side of bus #830 at the Megiddo junction near Afula. The van, packed with around 100 kilos of explosives, hit the bus so hard that the resulting explosion caused the crowded bus to overturn at least once, eventually landing on its wheels. Its fuel tank ignited, causing a secondary explosion and fire that turned the bus into a raging inferno. Bystanders heard the wounded screaming to be rescued from the blazing bus. But they were trapped within the chaos of twisted metal with flames consuming them. Debris was scattered over a wide area along with personal belongings of passengers.

Seventeen people died and 40 were wounded, at least six seriously. Those on the front right side of the bus escaped with the least serious wounds. Those toward the rear and on the side nearest the blast had little chance. The bus was burned to a shell.

A doctor from the Afula hospital, Dr Doron Koppelman, travelling to work on the Wadi Ara highway, found himself in the midst of a terror attack for the third time. He treated the wounded at the scene, then raced to the hospital to join the rest of the staff. The bomb-van is believed to have crossed from the West Bank (prior to the construction of the security fence in that area) that morning, most likely from Jenin. Islamic Jihad claimed responsibility for the bus attack. The previous Tuesday, Sheikh Nassrallah had delivered a fiery speech on Hizbullah's Manor television, urging Palestinians to continue suicide attacks.

Sources: Rudge, "Suicide Bomber Kills 17 Near Megiddo", Casualties of War, Jerusalem Post, 6 June 2002

After a suicide bombing blast, whether it is in a bus, cafe, shopping mall or market, the world itself seems to stand still in shocked silence – just for a few minutes

"The amazing and horrifying quiet — that was the quiet of ten murdered souls"

Early in the morning of 30 January 2004, bus #19 was travelling through the Jerusalem
neighbourhood of Rehavia not far from the Prime Minister's official residence and the Jerusalem
theatre. A 24-year-old Palestinian Authority policeman from Bethlehem blew himself up on the
crowded bus. Eleven people died and 50 were wounded. The dead were so badly maimed that their names were released only ten hours after the blast.

A journalist who lives nearby heard the explosion and saw scraps of metal flying upwards above the roofs of three-story houses, followed by a plume of black smoke. He describes what happened: "I dressed, went downstairs and walked down the street in the direction of the smoke. It was a beautiful morning, cloudless and warm for the season. A man and a young girl were walking towards me on the pavement opposite. The man did not appear to look anxious, and it occurred to me that what I thought was a suicide bombing might have been something else, perhaps the collapse of a construction crane, or maybe a bad car accident. The other thing I noticed was the quiet, which was unusual even in a city that has a way of going quiet. But this was not Shabbat, it was not even a high holiday, and rush hour was not yet over.

By the time I got down the block to the bus, perhaps three minutes had elapsed since the blast. Survivors lay on the pavement. One elderly man had flecks of human tissue on the back of his coat and scalp, but otherwise he seemed uninjured. Another man was bleeding from his ear, which had been sliced in half. A woman held her face in her hands, and everything was covered in blood. It was still very quiet, or at least it seemed that way to me. I don't remember any police there, although surely there must have been some. The ground was covered in glass; every window of the bus had been blasted. Inside the wreckage, I could see three very still corpses and one body that rocked back and forth convulsively. Outside the bus, another three corpses were strewn on the ground, one face up, two face down. There was a large piece of torso ripped from its body, which I guessed was the suicide bomber's.

Elsewhere, on the ground, were more chunks of human flesh, a leg, an arm, smaller bits, pools of blood. "Now the police and ambulances began to arrive in great numbers. How much time had elapsed I do not know. They began herding non-official personnel to the sidelines. My secretary called to tell me there had been a suicide bombing. I said, 'I know, I'm there.' Also, she said Independent Radio wanted to speak to me, would that be alright? Why not? I was patched through to a studio in London. It took me two or three minutes to describe the scene. 'That'll do nicely,' said a voice on the other end. 'Cheers.'

"It had become much noisier. A young policeman with a rifle and a panicky expression ordered me to move back. I retreated a bit. An older officer screamed at me to retreat a bit farther. I did so again. Crowds of onlookers had gathered behind the police lines, and TV networks were setting up their cameras. A Japanese (reporter) wanted to know whether I thought this attack justified targeted assassinations. 'Yes, and the security fence too,' I said.

"I think of that Thursday's bombing as a death event. The absolute stillness that followed the bombing, that amazing and horrifying quiet – that was the quiet of ten murdered souls. Only later, when the ambulance sirens began to wail and reporters answered the call of their beepers, did it become a news event. There is a great distance between a death event and a news event, I think. At best, a death event invites description and, even then, description can hardly capture the nature of the thing. But a news event demands speculation, analysis. Was the attack deliberately timed? Did the bomber choose to detonate himself so near the PM's home? What do I think about targeted assassinations? What about the security fence? And so on. I doubt many reporters have actually witnessed a suicide bombing up close – indeed, not many Israelis have.

"After today, I know there is a basic difference between what one sees in the first five or ten minutes and what one sees in the next 20-30 minutes. Most of the reporters who 'covered' the bombing did not actually see the corpses on the ground. They do not know about the body convulsing in the bus. What they saw was a bus blown to smithereens, which is awful enough, while the rest was left to their imaginations. But if you haven't seen it before, you cannot imagine it.

If I learned one thing (that day), it is this: We move too quickly from death events to news events. Nobody should see the scene I witnessed this morning, while the quiet still hung in the air. Then again, maybe everyone should see it, at least everyone in the news media. They should switch off their cameras and mobile phones and close their notepads. They should observe the silence first of all by being silent. That is what I wanted to say."

Sources: Stephens, "Jerusalem, 8.45 am", Jerusalem Post, 30 January 2004

3.2 WHAT DO PARAMEDICS SEE AND WHAT DO THEY DO?

Fellow travelers and passers-by experience the immediate aftermath of a suicide bombing. Then the world stirs into frantic activity. The shocked silence is broken by a frenzy of sirens as the emergency services and the police arrive. There are motorbikes, ambulances and cars which converge on the bombing site.

A 23year-old paramedic who works with the Magen David Adom (Israeli Red Cross equivalent) raced to the scene of a bus bombing in Haifa on 5 March 2003 in which 17 people were killed and 53 wounded. He recalls what happened. In the following boxes, we hear two perspectives on one bombing, one by a paramedic at the scene, and one from a passer-by.

TWO MEMORIES OF ONE BOMBING – A PARAMEDIC AND A PASSERBY

"Inside the bus I saw three dead kids all burned, just lying there."

"I started to volunteer for Magen David Adom when I was fifteen, and my first training lasted 60 hours. There are two kinds of paramedic training in Israel, lasting one and a half or two years.

Suicide bombings happen very fast, and so do our responses to them. When a bomber blew up Egged bus #37 on Haifa's Moriah Boulevard we got to the scene in about five minutes. It was as quiet as a cemetery. The walking wounded were emerging from the debris of the burnt-out bus. Five minutes later, I saw a teenager emerging. I was shocked by how many children and teenagers there were in that bus. They had been blown out of the side and back of the bus. They were burned.

There were people around the bus trying to put out the fire. There were pieces of metal from the bus lying everywhere. For 100 metres around there were shoes, bags, parts of intestines, cell phones, all strewn across the road and sidewalk. It was still quiet. Then police with megaphones closed the area around the bus. Inside the bus I saw three dead teenagers, all burned, just lying there.

When I got off the bus, a man came up to me and said, 'Which number bus is this?' He didn't know the bus number. He was looking for his son. Later he went to all the hospitals looking, then to the forensic laboratory. The driver of that bus was a Christian Arab. I took blood to him. He had replaced the normal driver for that day. He was wounded by the blast and is deaf in one ear.

Later, when I read about that bombing in the newspaper, all my feelings came out and I just cried. I phoned the house of the man who had been looking for his son. It was too hard for me to go there. His son was dead.

What do I feel about the bombers? The main emotion is revenge. The Palestinians, the Arab world and the world outside perpetuate the suicide bombings. I think that if those who send the bombers could see the reality of what happens in a bombing – the three burned children just lying there – maybe they would not send the bombers."

Sources: Interview with A. 26 June 2003, Zichron Yaacov near Haifa

The same bus bombing was experienced by an elderly Russian-born woman who was sitting in her son's car at the traffic lights behind bus #37 when it exploded on Moriah Boulevard.

"I saw parts of the bus and parts of human bodies flying in through the broken window"

Seventy-four-year-old pensioner Frida recalls: "It was March 5, 2003, eight months ago. It was
around 2pm in the afternoon. I was in my son's car driving behind a bus on Rehov Moriah in Haifa.

We stopped at the traffic lights. Suddenly, the bus exploded. I was in shock. I saw parts of the bus and parts of human bodies flying in through the broken window of our car. I was unconscious for a few minutes. Blood was running down the right side of my face. A lot of passers-by came to help me. My son telephoned his wife, and she came to take me to the Rothschild hospital. I felt that the spirit of my dead mother had saved me from death.

In the hospital my son and daughter-in-law came to see me. I was discharged the same day. I didn't want to stay in hospital. I felt fear and had headaches and some panic attacks. My own family and relatives helped me a lot afterwards. I did not make contact with any Terror Victim or voluntary organizations. A social worker visited me at home.

Today, months later, when I go to Hadera by bus, I feel fear and remember the bombing. What do I feel about the bombers? I feel that they are something ugly and they should not exist. When I see another bombing on TV, I feel fear again and have a headache and some heart symptoms."

Sources: Interview in Russian with F. October 2003, Zichron Yaacov. (see also 6.2 – Testimonies of the Wounded)

3.3 MAGEN DAVID ADOM – ITS ORIGINS AND ROLE

A veteran MDA paramedic describes a Fatah suicide attack. He also outlines the history of MDA.

People calling for help, panicked civilians, everyone wants to be the first out of hell

A few hours after a terrorist shooting attack in Kfar Saba (north of Tel Aviv) on 18 March 2000,
which left an 18-year-old woman dead and 16 other people wounded, 20-year-old veteran MDA
medic Carmi Yiftah recalled, "The first thing I think about when I enter such situations is my personal safety. I feel out the general scene to see if the terrorist is still shooting. Then I survey the scene to find the most seriously wounded; the survivors of the attacks generally lead you to the wounded."

That Sunday, the first splayed body he ran to was that of an 18-year-old woman. She lay inert on the sidewalk in a widening pool of blood. She had stopped breathing. She had no pulse, no heartbeat. He immediately sent for a team to conduct CPR and rush her first to the hospital. Hearing sounds behind him, he spun around and saw a woman who had been shot in the leg and in the mouth. She was bleeding so heavily that he could not find an entry or exit wound. "One of the worst things at those scenes is the suffering – people calling out for help, panic-stricken civilians; everyone wants to be the first out of hell. But even worse than that is the rigidness you feel; you know, we medics and paramedics become like a wall, hard, impenetrable..."

A colleague of Yivtah adds, "When I rushed to treat the wounded in a December attack, I looked at the dead and felt nothing. Their cause was lost. It was those who were living and were suffering that I ran to. Afterwards I cried because I saw ten bodies and I didn't feel anything."

On the day of the Kfar Saba attack, a beeper sounded on the MDA director general's belt. Before he could finish telling his MDA employees, they were racing towards their basement command center in readiness for action. Minutes later, in MDA's central command center, workers projected a map onto a wall-size hanging screen pinpointing the exact location of the attack and its time. Dozens of phones rang. Operators began calling out the numbers of dead and wounded. Simultaneously, reports flowed in from paramedics on the scene. A spreadsheet on the screen indicated the total number of wounded, moderately and seriously, and their current location. The screen also blinked the number of dead.

"In the initial crush, with the screaming and the blood and the feeling that there might be another terrorist about to put a bullet in your chest, it's always difficult to keep the count correct. We often double-treat people and therefore (initially may) count them twice. At that moment you try to set up the most practical use of manpower and the most logical evacuation of the wounded, despite all the mayhem around you."

When the MDA medics went to the scene of an attack on the West Bank, they had to ride in an un-armoured ambulance into a zone of continuing attack with only two bullet-proof vests and two helmets for four medics. MDA people like to tell a macabre joke: there are three types of people, they say – those who run away from a bombing, those who run towards it, and those who die in it.

Yifiah adds, "Very few of us get to pension age. This work bruises the body and the mind.
One little beeper message takes you from your home at night or calls you away from vacation."

In 2002 MDA had financial problems, with a deficit of a million dollars a year, a tenth of its annual operating budget. Between March 2000 and March 2001, MDA had answered 28% more emergency calls than in previous years. In big attacks, MDA sends 50, 60 or 80 ambulances, and 20 of the units are ultimately unused. That represents a heavy financial cost. One MDA veteran is so dedicated to his work that he rushed to the Cafe Moment attack in his pyjamas.

From March 2001 to March 2002, MDA shuttled 400,000 people to various hospitals all over the country, including terror victims. Its founders in 1930 were seven doctors in a country suffering a dearth of health professionals. By the 1936-39 Arab Riots, MDA was providing medical aid to the wounded and organizing First Aid training.

During World War Two, MDA operated within the framework of Israel's Civil Defence Organization as an arm of the Jewish Legion of the British Empire. Among MDA's legislated responsibilities are civilian emergency medical and First Aid services and temporary shelter in emergency situations. It must also maintain a blood bank for civilian use. MDA in 2002 still retained cordial ties with members of the Red Crescent operating out of the West Bank and Gaza. Until the eruption of the present violence, Palestinian paramedics trained with the MDA in Israel.

Sources: Gutman, "MDA in The Center of the Storm", Jerusalem Post, Friday, 22 March 2002

SOME VOLUNTEER PARAMEDICS ARE VERY YOUNG.

Below is the experience of a sixteen-year-old Magen David Adom volunteer in Jerusalem, 2003.

"He took out the plastic gloves he keeps in his school backpack"

A man in Jerusalem's southern Emek Refaim neighborhood heard the boom of a bomb blast at the local Cafe Hillel. At that time his sixteen-year-old son Momo, a volunteer paramedic with Magen David Adom, was crossing Emek Refaim Street, two blocks from their house. He took out the plastic gloves he keeps in his school-pack.

As he described it later, it was a scene straight out of Dante or Eli Wiesel. Victims were screaming and strewn about. A group of bystanders was attempting to put out a fire that was consuming a man. Amputated legs and arms were lying in pools of blood. A man's head was in the middle of the street. Momo acted according to the training he had received. As soon as the lead ambulance arrived, he was told whom to evacuate, and he helped carry the injured to stretchers.

Within 10 minutes it was all over, and the amazing Israeli emergency medical teams had again acted with alacrity and professionalism. Momo's mother and brother found him covered with victim's blood, and walked him home. His father recalls, "Getting home and seeing your son's clothes splattered with blood from a terror attack is a parental experience I will not forget. The relief of seeing Momo unhurt mixed with the pain, outrage and grief of an attack so close to home. Momo showered and together we watched on TV the surreal scenes of our amazing and beautiful neighborhood, hit, hurt and bleeding. Momo was curled up with his dog Lucy, hugging her and trying to regain some semblance of normalcy. A sixteen-year-old boy, having done his heroic work, and seeing things that no one should ever see, tried to return to what was left of his adolescence.

We watched the scenes of jubilation in Gaza, with thousands of Palestinians taking to the streets in spontaneous celebration, delirious with joy at the 'quality' attacks. Yassin and others praised the 'bravery' of the suicide bombers. Yassin mentioned the 'great' Abu Shanab 'engineer' of dozens of Israeli deaths, whose own death had now been avenged. I was struck by the contrast between the two societies. Our heroes were out on Emek Refaim and at the bus stop at Tzirifim (another suicide bombing scene that same day) practicing emergency medicine, fighting to save lives and reduce casualties. Their heroes were sowing death and destruction, their engineering was the scene of terror."

Source: Medved, "Our Heroes, and Theirs", Jerusalem Post, 12 September 2003

Our heroes were practicing emergency medicine –

theirs were sowing death and destruction

HOW MDA IS TRAINING INTERNATIONAL VOLUNTEERS

In August 2003 fifty-two volunteers aged 18-52 were trained in a joint Jewish Agency-Magen David Adom Overseas Volunteer Program. Since it was established 12 years ago, the program trained over 1000 volunteers from North and South America, Europe, Africa and Australia to qualify as first responders.

In 2003, 350 volunteers participated in the program. They underwent an intensive 60-hour eight day training program at a Jerusalem youth hostel. One of the young summer volunteers from Pittsburgh in the USA said, 'Every time there is an attack it makes me stronger'. (Hazan. J 2003) "Foreign MDA Volunteers Face Terrorism First Hand" Jerusalem Post 22 August 2003.

In early 2005 "MDA instructors qualified (in a 10-day course lasting 100 hours) sixteen trainees, volunteers in the Ugandan Red Cross, as first aid and basic and advanced level resuscitation instructors. These Ugandan instructors will in future teach advanced studies to other volunteers and communities in Uganda. This project is part of the collaboration between MDA and the Uganda Red Cross Society, and is intended to increase first aid capabilities in Uganda. It will also serve as a basis for further projects to improve first aid services offered to the Ugandan population.

The Ugandan Red Cross Society and MDA have prepared a multi-annual collaboration plan which focuses on a number of principal issues: training first aid instructors in the Uganda Red Cross and setting up a training center; an (ambulance driver's course); blood donation drives; training Ugandan Red Cross volunteer youth in multi-casualty incident management... MDA was (also) able to extend aid in the form of new and advanced training equipment for the qualifying course and continuing use by the future training center. This equipment included a wide range of resuscitation (models) and birthing exercise (models), resuscitation equipment, first aid packs, backboards, head immobilizers, and an automatic external defibrillator" (Ministry of Foreign Affairs 2005.)

3.4 THE COLLECTORS OF BODY PARTS – HONORING THE DEAD

Back at the scene of a suicide bombing in Israel, the work of clearing up the carnage continues after the paramedics and ambulances have departed. Specially trained 'ZAKA' (True Righteousness) volunteers search for every piece of flesh or drop of human blood. The body parts which cannot be identified are buried all together in a 'brother's grave'. Sometimes documents found on a body help in identification, or false teeth and other dental evidence.

Within Jewish tradition life is considered precious. Every human being is considered to deserve proper burial. From the mid-nineties, when suicide bombings were underway in Israel, a movement began to honor this belief and to put it into practice, often in very difficult and dangerous conditions. A passer-by recalls what he saw after a suicide bombing in downtown Tel Aviv.

"Bits of Seared Flesh Were Heaved Hundreds of Feet"

In October 1994, a Palestinian with a briefcase of explosives detonated himself on bus number 5 on Rehov Dizengoff, a major commercial street in Tel Aviv. A man who lives not far from the bombing takes up the story.

"The explosion sounded loud in my apartment three blocks away, and shook our building. The charge ripped the roof off the bus, and the shrapnel and flames killed ten people. Storefronts within a city block were shattered. Bits of seared flesh were heaved hundreds of feet. When I passed several hours later the charred skeleton of the bus rested on the sidewalk. A knot of onlookers shuffled in the street, some quietly sobbing. A makeshift memorial of candles and flowers was already in place at the foot of a tree trunk, whose branches had been stripped off by the explosion. The wounded were in emergency rooms across the city, and the dead were already being prepared for burial.

A handful of ultra-Orthodox Jews, each holding a plastic bag, pushed through the crowd. They had come to collect the shreds of human remains from the street, trees, gutters, stores and rooftops, so that these fragments could receive a proper burial according to Jewish law. They worked for many hours, collecting lumps of flesh, later analyzing them to determine whose flesh they were. These men belonged to a loosely affiliated organization called Chesed Shel Emer (True Righteousness) also known as ZAKA.

Sources: Efron.N.J "Real Jews" in Hadassah Magazine January 2004

The wave of bombings in Israel in the mid nineties had led to the realization that an organization was needed to put into practice the sacred belief in the sanctity of human life. As well as at suicide bombings, Zaka appeared on many other occasions where human life was destroyed.

By 1997 Zaka was also the only civilian force trained to respond to chemical or biological warfare. It developed a rapid response capability by using motor-cycles which could manoeuver in Israel's many narrow streets, where it was harder for ambulances to manoeuvre. Volunteers need to reach their destination in four minutes.

In 2001, Zaka (80% of whose volunteers are religious) was formally initiated, with funding of one million dollars. By 2002, it was an official arm of the police force, in the same way as the Civil Guard. By 2003, Zaka had 100 motorcycles and was assisting with 35 cases a week of what they term 'unnatural deaths'. A new project, the First Aid Station program, trains volunteers in first aid and in handling equipment such as that needed to administer oxygen.

Zaka volunteers are trained to 'enter the scene', to collect every small piece of flesh and, if possible, 'every drop of human blood', so deeply do they revere human life. They regard it as a religious duty. One Zaka volunteer was seriously injured by the suicide bombing in Ben Yehuda pedestrian mall in December 2001. In that bombing, a second car bomb was detonated, designed to target those who came to help the wounded.

Bombers killed 16 & wounded 361 people over 4 years

in Jerusalem's Ben Yehuda pedestrian mall

Often Zaka volunteers are the first on the scene. Under fire, they assist the wounded and treat survivors suffering from shock. But then the grim part of their task begins. They recover corpses and body parts to ensure that all victims are accorded a proper Jewish burial. What motivates these volunteers?

The Zaka fund-raising leaflet explains: "The belief that every Jewish life is precious. That every human being deserves a proper burial. Every victim's family should have at least a grave to visit." Zaka attends to everyone, without consideration of ethnic origin, whether it is the body of a bombing victim – or the bomber who detonated the bomb. They even responded to a call for help in Ramallah when a building collapsed early in the Intifada. A few people were rescued alive. Afterwards, the late Yasser Arafat presented the Zaka rescuers with two camels.

In Israeli society, Zaka has engendered respect among secular and sometimes anti-religious Israelis. They see people who are religious doing one of the hardest jobs. An Israeli television appeal for volunteers to join Zaka resulted in 4000 applications. Some volunteers were Israeli Arabs. Volunteers work from ambulances and some from their own cars. Some training of Zaka volunteers is carried out by Magen David Adom. A 120-hour training course includes watching hours of videos of mutilated bodies in order to de-sensitize volunteers, and exercises using practice dummies.

Zaka is funded largely by voluntary contributions, with minimal funding from the government. The equipment it needs to carry out its work includes: megaphones, collapsible stretchers, first aid equipment, bandages, manual suction equipment, portable lighting sets, oxygen masks, chemical toxic masks, bullet-proof vests and ambulances, rescue axes, pneumatic break-in equipment, lifting cushions, basic radio transmitters and beepers, neck braces, deodorizing spray, body bags, identification bracelets and stickers.

In 2001 ZAKA was named the United Nations Volunteer Organization of the Year. Originally a grassroots organization, by 2003 it had 800 members who worked closely with police, military and emergency medical personnel to provide First Aid and to recover and identify victims of terror attacks.

The horrors of death also take their toll on Zaka volunteers. Although they regularly receive psychological counseling, many have had to take leaves of absence. "They can no longer eat or sleep or function normally without visions of death and despair torturing their minds. Fortunately, there are others who willingly take their place, wanting to do something, anything, to help the dozens of innocent people who have been killed and injured." (ZAKA 2003)

Zaka volunteers find it hard when they return home because they cannot tell family and friends of all that they have witnessed and experienced. For six months after psychological counseling was offered, no-one came for therapy. There seemed to be a reluctance to admit the need for help. Then the workshops began. After the workshops some volunteers felt a heavy weight had been lifted, but after the next suicide bombing, some of their symptoms returned. The challenge was how volunteers could cope and continue to be professional in their particularly demanding work. The sounds and sights of the bombings continue to run through the mind. One volunteer reported that a dead baby with body parts missing reminded him of his own baby.

What about the survivors and families of victims? What really happens to them when they have to spend hours, even days, trying to locate their loved ones. Some drive themselves, or are taken, to hospitals to see if their relatives and friends have been taken there. Sometimes they are 'fortunate' and find them alive but wounded. Sometimes they are taken by social workers to the morgue to identify dead relatives and friends. Sometimes they have to travel to the forensic institute to identify what is left of their loved ones. How is forensic evidence collected? What do survivors and families of victims have to endure?

3.5 HOW FORENSIC EVIDENCE IS COLLECTED AND PROCESSED

When a suicide bombing takes place, police seal the area to impede access by unauthorized civilians and press. Bomb squad units of police sweep the area for possible un-detonated explosive devices. The explosives laboratory collects all relevant data on the exploded bomb before any other technical personnel are authorized into the area.

The Israel National Police, the Israel Defence Forces and the L. Greenberg Institute of Forensic Medicine's experts examined 171 victims who died in 21 incidents of suicidal terrorism between 1993 and 1997. An article in 2000 reported, "Once the (bomb) area is cleared, medical teams direct the wounded to pre-selected trauma centers. Scenes of crime officers (SOCOs) videotape and photograph the exact positions of all bodies and body parts and collect relevant trace evidence. The human remains are numbered sequentially and placed into plastic body bags. Bodies and body parts are gathered and transported to a nearby medical center or funeral facility and from there to the National Institute of Forensic Medicine located in Tel Aviv.

There is an Information Center (IC) staffed by local police investigators, rabbis, social workers and psychologists in a governmental area adjacent to the Institute of Forensic Medicine. The main task of the IC is to obtain and catalogue ante-mortem data from individuals searching for missing persons, and to exchange information with the forensic teams and trauma medical centers. In the interim, the bereaved are provided with psychological assistance by municipal health services. The human remains are numbered with impermeable identification tags. A member of the forensic team (the 'tracker') is in charge of recording the incoming bodies, matching the numbers given at the scene with the Institute's enumeration and trafficking of information between the IC and the Institute, thus completing the postmortem examination steps described below:

a) External examination in which the body is photographed and clothing and personal belongings removed after proper documentation and transferred to the Information Center. Tissues and body fluids are sampled, labeled and delivered to the forensic biology laboratory. Forensic odontologists and anthropologists prepare dental charts and take Polaroid photographs (of the deceased) (Hiss & Kahana 2000).

Fingerprints of the dead are taken. Dental and whole body radiographs are taken. External injuries are documented. All foreign bodies are extracted and sent to the police explosives laboratory for identification of the explosive device. Complete autopsy is performed upon consent of next of kin or court order.

"Reassociation of body parts is performed after all complete or partially complete bodies have been processed. Anatomical reconstruction of the fragmented bodies is accomplished through physical matching of the torn parts. Communication with the various trauma centers treating the wounded is of paramount importance. All admitted amputees have to be reported to the information center by trauma centers to avoid overestimation of fatalities based on body fragments at the institute.

Once the post-mortem is completed, the body is sent to the storage area. The information collected is relayed to the IC to make comparisons for possible identification. When possible, facial tissues are cleaned and restored to spare the feelings of family members during the viewing of the body. Positive identification is established through at least one of the commonly recognized techniques, e.g., fingerprints, dental records, radiographic, medical, biological extraction of DNA from tissue samples, or by visual recognition. Once the cadaver has been identified, the staff of the IC requests the next-of-kin to consent to complete autopsy of the victim (of 171 victims who died in 21 incidents of suicidal terrorism, consent was granted in 42% of cases).

Court orders for autopsy are requested only for perpetrators (bombers). In 34 cases (20%), visual identification was the only means available to the forensic team. Identification of the (bodies) was accomplished within 24 hours of the incident in 89% of the cases (delay in identification is mainly due to the body being that of a bomber – or a tourist). In 20% of cases the investigating team had to rely solely on visual recognition because of time constraints and strong opposition to autopsies being performed stemming from religious beliefs (Hiss & Kahana 2000).

The Israel National Police, the Israel Defence Forces and the L. Greenberg Institute of Forensic Medicine's experts examined 171 victims who died in 21 incidents of suicidal terrorism between 1993 and 1997, suicide bombings carried out in Israel by terrorists detonating explosive devices carried either on their own bodies or in close proximity to them. The explosions took place either within confined spaces or in crowded open areas. The trauma sustained by the victims and perpetrators of suicidal bombings included complete body disruption, flying missile and blast injuries. Fifty-five victims died in open-space bombings and 91 inside buses (the others inside closed spaces, presumably).

During the Second Intifada, many suicide bombing explosions again took place in confined or crowded areas. 'The purpose of the forensic investigation of mass casualty incidents is manifold: establishing the minimal number of individuals involved, identifying the victims and perpetrators, collecting material evidence and determining the modus operandi. The postmortem examination includes external description of the bodies and their injuries, photo-documentation and sampling of tissues, radiography, and ten-print card (fingerprints) of each cadaver.

The present Intifada attacks differ somewhat from previous terrorism waves and include more road shootings and vehicular terrorism. In addition three suicide bombers who detonated explosives devices within crowded areas were young women and the age of the perpetrators increased from up to 35 years to up to 47 years. Virological and biologic tests have been introduced to examine the tissues of suicide bombers since they are possible sources of contagion to wounded victims" (Hiss et al. 2002).

In order to understand better how such disruption is caused to the human body, the next paragraph describes briefly four patterns of construction of explosive charges used by suicide bombers.

EXPLOSIVE DEVICES – HOW THEY ARE CONSTRUCTED

Main patterns of construction were detected in an analysis in 1991 (Potter 1991). One method was to strap the device to the bomber's body (strapped human bomb – SHE) so that it could be detonated inside a bus or in an open space. Or, explosives were transported by car and detonated by the driver, a vehicular human bomb (VHB), so that it could be detonated near a bus, or in an open area.

The quantities of explosives used in the bombs at that time varied from 50 kg (VHB) to 700 kg (SHE) and they were of both commercial and homemade types. The device was either encased in a pipe (pipe bomb) or affixed to a domestic medium-sized gas tank (gas bomb). In Israel, re-emergence of religious fanaticism has created an unpredictable type of urban terrorism. The common conception that perpetrators wish to inflict massive fatalities while escaping unharmed has been proved wrong. Human bombs could not be blocked by conventional security measures, therefore a different approach had to be considered, one based primarily on preventive intelligence.

During the second Intifada, explosives were again strapped to the body of male or female
bombers, or transported by car and detonated by the driver(s). In addition, they were often packed with metal nails, screws and ball bearings in order to cause the maximum casualties and wounding. Sometimes these items were first dipped in rat poison, which prevented the later clotting of the victim's blood.

3.6 TYPICAL INJURIES ASSOCIATED WITH SUICIDE BOMBINGS

Of the 171 cases documented in the Hiss and Kahana article in 2000, four major types of lethal injuries were detected:

(1) Total disruption of the body due to its close proximity to the epicenter of the explosion (17%) affecting mostly perpetrators;
(2) Explosive injuries characterized by gaping lacerations of the skin and internal organs, with traumatic amputation of auricles (52%);
(3) Flying missile injuries caused by nails, screws, or by debris from the surroundings accelerated by the blast (12%), which perforate internal organs and major blood vessels; and
(4) Blast injuries caused by extensive pulmonary and hollow-viscous tears and hemorrhages caused by the waves from the blast (9%).

(The next chapter provides some more recent information on lethal injuries sustained from suicide bombings from 2000-2004.)

3.7 FOR SURVIVORS AND VICTIM'S FAMILIES – IMMEDIATE PRACTICAL HELP

What else happens when the world explodes and survivors and families of victims are immediately projected into a different world? It is a traumatic world of shock, pain, and often grievous wounding. The physical, emotional, psychological and socio-economic realities have changed, sometimes permanently. What practical and financial help is available ?

The Department of Rehabilitation of the National Insurance Institute is the main body responsible for providing services to all residents of Israel, including victims of terrorist actions and their families . The Ministry of Immigrant Absorption is also available and willing to help where they can, and to provide referrals to appropriate sources of help. In 1970 there was a Compensation Law passed for Victims of Enemy Actions. It covers citizens and residents of Israel and foreign citizens working for an Israeli employer, injured on Israeli territory, the West Bank or overseas (if the injured party is not compensated by that government). It covers tourists visiting Israel in accordance with the law, who are injured in Israel or the West Bank. This law does not cover those who join or support a terrorist organization.

According to the law, all victims of terror attacks, and their families, are entitled to a number of benefits, including financial compensation. The Disability Law of 1959 defines the levels of financial assistance granted to victims of enemy actions.

WHAT TYPES OF ASSISTANCE ARE OFFERED?

The National Insurance Institute covers medical expenses related to a victim's injuries, including initial medical care, hospitalization in any hospital recognized by the Ministry of Health (excluding private hospitals), ongoing care, and rehabilitation. Refunds are also given on the purchases of medications and medical equipment, and costs of transporting the injured person to and from treatment. A person who is classified as 'lightly injured' can go to the nearest branch of the National Insurance Institute with a letter of referral from the health fund or hospital where they were first treated. If the injured person did not arrive in an ambulance they also need a letter of verification from the police.

For the 'seriously injured' the Institute sends a social worker to assist patients and family to make initial arrangements, filing a claim (within one year) , and providing information. If the level of injury is likely to result in partial or total loss of ability to work, the patient is referred to the Medical Committee of the Institute which determines whether the extent of the injury is temporary or permanent. Once the disability level is assessed, the individual will be eligible for a monthly or one-time payment according to disability.

In most cases, a person who is classified with a disability of 10%-19% can receive a one-time payment, while a person with a disability classified as 20% or higher generally receives a monthly allowance according to the type of disability. A person receiving a disability allowance may further be eligible for a number of other benefits, such as, assistance in purchasing an apartment, partial payment of telephone expenses, assistance towards school fees, household expenses, purchasing air conditioner, clothing, convalescence allowance, exemption from television fees, discount of rates payment, chronic care services, annual grant for home heating (if disabled 50%) and vocational rehabilitation and training.

WHERE FAMILIES STAY AT THE BEDSIDE OF WOUNDED RELATIVES

Families of victims can receive payment towards travel expenses, board and lodging expenses in cases where victims are hospitalized in moderate, serious or critical condition. Most hospitals have sleeping facilities for the use of family members. Where these do not exist, families can claim costs of lodgings such as a hotel. Compensation is paid for lost workdays and child care until the patient's condition no longer necessitates the continuous presence of family members at the bedside. The Institute has rehabilitation workers, and publishes information about terror victim support groups.

As well as the Institute there are public bodies which offer assistance to terror victims, including psychological counseling and practical help, and in various languages. Included are the Israel Crisis Management Center in Tel Aviv, which offers immediate practical support as well as longer term assistance such as support groups. There is a mental health hotline. If property was damaged during enemy action, it is also possible to apply for compensation. Immediate assistance and action for survivors and families of victims of suicide bombings is available with options to assist them in coping with their losses and disabilities. (Bituach Leumi 2002)

RIPPLE EFFECTS OF A SUICIDE BOMBING

The suicide bomber explodes like an evil stone dropping into a living pool of unarmed civilians. After the eerie silence there is a desperate burst of activity to save survivors and to cope with the dead. The ripples of pain and loss spread outwards. For those bereaved and maimed the longer-term ripple effects of the bombings continue, often for a lifetime.

The next chapter outlines some of the terror-taught medical innovations which have had to be discovered, especially from the new types of wounds wrought on Israeli civilians by the bombers and their senders.

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