Israeli combat doctors digest war

KIBBUTZ SNIR, Israel, Aug. 17 (JTA) — Dr. Yaki Samet and two medics crouched low to the ground as Hezbollah fighters opened fire around them. Then they made a run for a nearby ditch and — surrounded by rocky earth — began a makeshift triage, treating wounded Israeli paratroopers. One soldier had a crushed arm, others had limbs riddled with shrapnel. One arrived breathing his last after a rocket-propelled grenade ripped through his helmet and into his head. “Getting to that ditch was very dangerous and it might sound strange, but when I found myself in it I felt better, more protected,” said Samet, 37, a captain in the Israeli medical combat reserves who has a day job is as a general surgeon in a Jerusalem hospital. Samet tried his best to ignore the bullets and rockets whizzing overhead to focus on the wounded. He and his medical team then waited 20 hours until the wounded could be safely evacuated from their position in the southern Lebanese village of Ayta al-Shaab. Now that the cease-fire has set in, Samet and most of his medical unit of six doctors and one commanding officer are back in Israel. They have time to sit in the shade of pink flowering trees on a northern kibbutz as they digest their last three weeks as combat doctors. The unit is made up of two orthopedic surgeons, an internist, a gynecologist and an ear, nose and throat doctor, all in their late 30s and early 40s. Only Samet is a general surgeon with a background in emergency medicine. It’s not exactly what one might imagine as a trauma medicine dream team, but as reservists with combat experience, they’re precisely the kind of civilian-soldier doctors used in the battlefield. They were called up as part of an emergency call-up of thousands of Israeli reservists. Doctors were sent with the troops in greater numbers in this war than in past conflicts, said Dr. Gal Meiri, 42, the commander of Samet’s unit, which was assigned to a company of enlisted paratroopers. In the past, one doctor was assigned to an entire battalion, while in this war there was roughly one doctor assigned to each company, or about 100 soldiers — almost three times the ratio in the other wars. “Unlike regular wars with front lines where the medical teams can be a bit further back, here the medical teams were placed among the combat soldiers as fire came from all directions,” said Dr. Udi Lebel, 41, a pediatric orthopedic surgeon. He said doctors are instructed not to take part in the fighting themselves, adding dryly, “We’re needed after the fighting is over.” The value of having so many doctors in the battlefield was one of the most important lessons of the war, said Meiri, a child psychiatrist in civilian life. Most of the 116 soldiers killed in the monthlong conflict died immediately of wounds from anti-tank missiles or bullets, doctors said. “Usually there was nothing we could do for these cases,” Meiri said. But they were able to stabilize most of another 450 or so less critical cases, treating soldiers suffering from burns, shrapnel and smoke inhalation. Limbs often were saved, as were lives. The most commonly used procedures in the field were inserting chest tubes to help lungs reinflate or intubation to keep airways open; the doctors also gave intravenous fluids and applied tourniquets. One of the most difficult aspects of the job was trying to determine who needed immediate medical evacuation despite the risks of bringing in rescue helicopters, and who could wait long hours under heavy gunfire to be treated until it was deemed safe enough for an evacuation. “There were lots of injuries that came from people trying to save other people,” Samet said. “Hezbollah knows about our sensitivity to the injured, so when a rescue team would come, they would also try to attack them.” The most urgent cases were flown out by helicopter, while others were taken out in tanks and other armored vehicles or by foot. Most often, when soldiers took position in a village, a doctor would be assigned one of the houses as a clinic. There, among family portraits and wedding photos of Lebanese families who had fled — and very often under photographs of Hezbollah leader Sheik Hassan Nasrallah — a doctor and two medics would treat the injured. Sometimes the fire was so heavy between the houses that the medical team could not go outside to treat wounded soldiers in nearby homes. Many of the doctors in Meiri’s reserve unit have known each other for years, coming together for regular training exercises in combat and in emergency trauma medicine. They also served in Lebanon before Israel withdrew in 2000 after 18 years occupying a security zone in southern Lebanon. They remember a different, less hostile terrain. They recalled friendly relations with locals in the 1980s and 1990s in some of the same villages where they now endured intense firefights. They’re surprised to still be engaged with the business of war in Lebanon. “I ask myself how, at my age, am I still dealing with this stuff?” said Lebel, a tall, thin man with salt-and-pepper hair and two young daughters at home. He had changed his military fatigues for a rust-colored T-shirt. “It’s not our profession to be soldiers. We treat people with diseases and injuries and here I am, where injuries are created.”