Yarden Bibas has become the first of the Israeli hostages held in Gaza to mark a second birthday in captivity. The gravity of this statement takes a moment to sink in. Yarden, the father of the widely known Ariel and Kfir Bibas, the young ginger children who were also kidnapped to Gaza on Oct. 7, 2023, is turning 35 while being held against his will for the second year running.

"It's unfathomable that a year has gone by and they're still being held captive," Ofri, Yareden's sister said. "I keep wondering when I'll reach my breaking point. When it will become unbearable. My son Afik is four months old. Kfir, Yarden's son, was taken when he was just nine months old. I can't help but dread the possibility that they might still be hostages by the time Afik reaches Kfir's age."

On Oct. 7, 2023, Yarden was taken from his home in Kibbutz Nir Oz. His wife Shiri and their children Ariel, then 4, and Kfir, a nine-month-old infant at the time were forcibly abducted in a separate incident. Hamas released video footage that captured the terror in Shiri's eyes during their abduction, an image that has haunted Israel and communities abroad alike.

"Yarden's last birthday marked the first time we received proof he was alive," Ofri recalled. "After seeing the images of Shiri in Gaza released shortly after the kidnapping, I was convinced Yarden had been killed. But when we were told he wasn't in the house and there were no signs of bloodshed, he was classified as missing. Three days later, on the morning of his birthday, someone contacted us saying they believed they had identified him in and sent us the image. It was indeed him. Since then, we've been in a constant state of anguish."

When asked what she would wish for her brother, she said: "Dodgy," using his family nickname, "I wish for you to return to life, to come back to us alive. To smile again, to laugh, to feel the warmth of sunlight, and breathe fresh air. I wish you freedom. And above all – I wish for you to kiss Shiri again and embrace Ariel and Kfir."

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Meeting former October 7 captives evokes a profound sense of respect. There's an unspoken code about what to ask and not to ask. You want to hug them, surround them with care, while also respecting their privacy. You embrace them from every angle because there's no right way to relate to someone who was in a safe room one moment, and in a basement with terrorists the next.

Some prefer not to talk, keeping their experiences to themselves, their families, or in closed notebooks. Others have made telling their stories their life's mission. Hen Goldstein Almog, who was kidnapped with three of her children from Kibbutz Kfar Aza and released in November after 51 days of horror, is one of them.

"I'm kind of working on telling our story," she says confidently to the camera. Her hair is tightly pulled back in a ponytail, her posture is straight and composed, as if trying to gather the broken pieces inside. "I understand that telling our story is part of the journey, and it also helps me process things. We went through so much in a short period of time, and I need to look at it several times a week to grasp it and digest it. It's exhausting, telling our story, but it's very important to me."

Walking a Timeline

"And today, today we are okay," she takes a deep breath when asked the simple question, "How are you?" "We are working on living. The grief and pain are always with us. They are ours to carry. And we have to work hard to live well. But it's important for me to build our lives as a family - a missing family, but a family that lives and hopes to live the best life we can. It's also very important to me to commemorate Yam and Nadav. We will not let October 7 define us."

Does time passing make a difference? I ask carefully, and Hen answers firmly: "Absolutely. I walk along a kind of timeline - on one hand, not long ago, we were a whole, strong family together. On the other hand, a lot of time has passed. The one-year mark is approaching, and we are still in pain, still in the midst of the event. We are still trying to cope with what we went through and the fact that we have living and dead captives to bring back. You're constantly in this whirlpool - one step forward, two steps back."

Hen and Nadav's love story, set to mark her 50th birthday this month, began in high school. Nadav was a well-known triathlete and VP of business development at Kfar Aza's "Kfarit Industries." Over the years, they built their home in the kibbutz, where they raised their four children: Yam, 20, who was brutally murdered; Agam, 18; Gal, 12; and Tal, 9. In August 2019, they moved into a new house in the kibbutz, where they created countless cherished memories - until October 7.

Early that morning, when terrorists overran the kibbutz near the border, Hen and her family locked themselves in the safe room. "A deathly fear," Hen described the feelings of that horrific Saturday in previous interviews, including in this newspaper. It was a terror from the gunmen who murdered Nadav and Yam, kidnapped Hen and her three surviving children with threats and screams. A fear of death.

For 51 days, Hen and her children were held by Hamas. They were freed on the third day of the hostage exchange deal in November. Now, the four of them are starting new lives. When Hen talks about Yam and Nadav, she allows herself to give in to tears. They are everywhere - inside and out. Their smiling faces greet visitors at the entrance to the temporary house where they now live. It's a different home but feels comforting. Hen keeps the location private, unable to shake the fear of the killers' promise that they will return in the thousands next time.

"I still live with the absence of Nadav and Yam, and the loss of our home. I found myself saying that 'longing' is too gentle a word because you can fondly look back on longing, but I'm still in the stage where Nadav and Yam were taken from me in a horrific way. And I need to deal with that absence, that nothingness, that loss. Now, for example, we need to decide whether to return to the south. These are decisions I always made with Nadav. Now I trust the kids, and we will make the right decision together."

Silence: The Word Hanging in the Air

"Nadav was the love of my life, my anchor. For 34 years, I admired him. He even wrote it down - he wrote a book in the past year where he said I was the love of his life, and sport was the mistress we never talked about. It was part of his essence - his dedication to sports and his work. He was self-taught and volunteered as a lecturer at Tel Aviv University, mentoring students who came to 'Kfarit.' He was a father in every sense of the word. He mastered the art of being present, even with the limited time he had at home."

She brushes her fingers across a photo of Yam on her phone. "Yam made me a mother," she says softly. "It was the happiest time of my life - becoming a mother. She was an amazing baby, spoke very early, understanding and active and joyful. She grew into an energetic child, full of confidence, then a teenager, and at 20, a woman. I felt that Nadav and I were managing the family and the children like a project together. And that fulfilled me."

"She was a lively child. Every Sunday when she went to the army, she would ask where we were eating on Friday. She was also very organized and planned her weekends, dividing them between home and her time with Tomer, her boyfriend."

What would she say now?

"Wow." She pauses. "If she were here and Nadav wasn't? We would grieve together that Nadav wasn't here. Nadav was seriously injured in a bike accident a few months before October 7, and she took care of him in an inspiring way. She took leave from the army to care for him, and we were gifted with her presence during that time."

"It feels good to talk about her," she wipes away her tears. "And she is so missed. Yam was so dominant, noisy. She left behind so much silence."

Silence. The word lingers in the air. A word repeated in many stories of mothers kidnapped or held captive with their children. A word that brings Hen back to the darkest days.

"In Gaza, there was a lot of silencing, especially of the children. People keep asking if we were exploited or abused. No, they didn't beat or sexually assault us. But they mostly silenced the children. And they're kids - they're naturally noisy, playful, talkative, and quarrelsome. There was a young man who would silence them a lot. And I would tell him, 'Is this your only way to communicate with the children? Just to tell them to be quiet?' It was infuriating."

"It was hard. I remember that during the first days in Gaza, I forced myself not to forget the sight of Yam, bullet-riddled. It was so horrific - I saw her for just seconds before I turned to the children. I ran. In my mind, I understood that people were dying in the house, and I was going outside, to the living. It was a terrible sight. And I remember forcing myself not to forget that image."

"It was a kind of self-flagellation - 'You will not forget this, and you will deal with it and be strong.' Fortunately, it fades with time, and I remember her now as beautiful, happy, laughing, and full of life."

Talking, hurting, remembering the absence – and sometimes laughing

Hen is a social worker by training, but focused on motherhood in recent years. She "stole" moments to talk with her children during lunch or bath times, waited for her daughters to come back from outings. When we step outside for photos, we meet Gal, smiling shyly while walking with one of his guides - the boy who witnessed the worst is still able to smile.

"The kids saw their father shot and passed by him, or in some way circled around him. It's tough, but they're very strong children, and their basic trust hasn't been shattered. They give of themselves and open up. They're supported by a multidisciplinary team at school, with psychologists and guides, and I'm very grateful for that. It's crucial for our ability to cope with all these challenges. I also lean on people. I'm surrounded by a team that not only provides therapeutic support but also advises me. I'm learning to listen and decide. I fill my day with sports and make sure my day is full. And if it isn't, I work to make it full."

Hen and Agam, who recently started a pre-army program, talk constantly about what they've been through. They hurt together. They remind each other of the absence. And sometimes they laugh. "There's nothing we can do, it's part of our battle - to be happy sometimes. The boys don't talk to me much, but I hear from others around us that they do open up to them. For example, Gal, who just started middle school, remembered how I told him about Yam's transition to middle school, and he smiled while talking about it."

"And there are things they remember from captivity. Tal remembers that during one of the transfers, they didn't let him take a stuffed animal he had found in one of the apartments. He started crying, and a young man shoved the toy into a bag, with its head sticking out. Tal walked half of Gaza with the head of that pink, unpleasant toy poking out. He remembers that they brought a lighter to burn things they had drawn or written. They weren't allowed to write in Hebrew, only in English, or to draw. In one of the houses we stayed in for five weeks, Tal drew pictures of fighting and war. He and Gal tried to sneak the drawings into their pockets, but they were taken out. These are the things they remember. And I constantly thank God that we are here. That we made it out of that hell. We survived October 7. We survived captivity. And we are alive."

"And it was such a terrible thought. If I can say something to the hostages still there, it's important for them to know that their families are fighting like lions for them. They're not losing hope. We will not be able to recover from this event if we don't bring them back."

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Twenty-year-old Sergeant Yitzhak grew up in an Ultra-orthodox home. He has a large family in Bnei Brak, with 14 siblings, and he was not obligated to enlist. But Yitzhak chose to sign a waiver giving up his yeshiva student status and serve in the IDF after a decision to leave religion.

"For me, it's a double gain – both to live the lifestyle I choose and also to give three years to the country," he says proudly. "I knew the choice to enlist would come at the price of family, and I was willing to take that risk because it was important for me to enlist. I went alone to the recruitment office and went through the enlistment process like anyone else in the country."

Yitzhak cut off contact with his family, and for a few months was part of the Givati Brigade's 432nd Infantry Battalion, also known as Tzabar. Today he serves as an operations manager in the Givati Brigade's operations department.

"I serve in a frontline brigade and take an active part in combat. The feeling is that you are part of something bigger than yourself and all of us, and you are contributing your part to this big thing. The transition from Bnei Brak to Givati is a very stark one. I was sure it would be partly difficult because I was open to other worlds, but I was a bit in shock. The first time I was in the army on Shabbat and could choose not to observe it without hiding, I was in shock. It's a different feeling.

"I now live in a soldiers' home in Tel Aviv, and am part of the Michael Levin Lone Soldiers organization. Here I meet soldiers with a similar background to mine, receive a listening ear and a warm corner, and mainly a sense of belonging. People who went through similar experiences to mine and took an unconventional path like me understand me more than those who had it easy to enlist or come from a different background."

Yitzhak has a firm opinion on Haredi enlistment in the military, "Everyone needs to contribute to the country – regardless of their way of life and the community they belong to. I had a choice, but my friends in Givati did not have a choice, they were obligated to enlist by law and this is an improper situation, that only people like me can choose.

"I enlisted out of choice and on my own. I simply Googled, found a form to waive yeshiva student status, and signed it. In less than three months I received my first draft notice and went through the whole enlistment process. It was clear to me that I was going to a combat role in order to contribute as much as possible. Initially, they assigned me to a non-combat role, and I fought to get to Givati. After all, I didn't just give up my yeshiva student status for nothing. I'm happy I got to where I am."

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"Covering fire for evacuation, covering fire for evacuation, Golani's 13th Battalion commander, the late Lt. Col. Tomer Grinberg, called out on the radio. Female soldiers from the "Sky Rider" unit, who were watching his sector from above, heard the call and immediately went into action. For more than two hours, they escorted the battalion as it entered the Gaza Strip, guarding it from enemy fire. They saw from above how the terrorists tried to get close to the battalion's Namer APCs and how, thanks to the orders and direction they gave to the forces on the ground, the terrorists retreated under fire. They are four young women, reserve soldiers, who were the eyes and shields of the fighting forces in the field.

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The four female soldiers, members of the Gaon squad, went to sleep after the battle burdened with the fear that the fire they had directed had caused losses to our forces. Only in the morning did they discover that thanks to their directions, the soldiers of Golani's 13th Battalion emerged from the fierce battle almost unscathed. The members of the squad proved once again that at the moment of truth, nobody beats the female combat soldiers.

"It was obvious to me that we would be called up, but still the attitude toward female soldiers in this war has surprised me," says Staff Sergeant R., a member of the squad. On October 7, she started making calls requesting to be drafted into reserve duty. Two days later, she was already down south. "I was surprised they took us south and that some of the female combat soldiers entered the Gaza Strip. We thought that first, they would only bring in squads of boys, but the girls have been here throughout this war. And the fact that we were able the job in the best way possible just goes to show that we can do anything."

Three of the crew members are A. and R., 23 years old, and S., who is 24. The Sky Rider unit they were called up to is an elite unit belonging to the 215th Artillery Brigade. Their role is critical. Using an unmanned aerial vehicle (UAV), the Sky Rider unit is responsible for providing an up-to-date picture of the situation and visual intelligence to forces maneuvering on the ground. Depending on the situation, they are responsible for dispatching combat helicopters or sending in additional forces to protect them.

Another set of eyes

 "In practice, we are another pair of eyes in the field and help identify the enemy from afar," says the girls' commander, Lieutenant S.T. On November 1, they set out for what appeared to be a routine intelligence-gathering mission with Golani's 13th Battalion. They positioned themselves on a high hill overlooking open ground and did not expect to spot such a large enemy force. "We knew the battalion from preparations for the maneuver," continues S.T., "I personally spoke quite a few times with the late battalion commander Tomer during preparations for the incursion into Gaza. Tomer was different from other battalion commanders. You could see it in his fighting spirit and in the way he saw the soldiers on the ground. He came out unscathed from that battle. It really hurt me to hear that about a month later he was killed."

"When Tomer radioed that fire was being directed at our forces, the girls went into high gear. "From our position, we saw with the drone heavy fire directed at our forces' vehicles." S.T. recounts the incident. "It was a complicated situation. At first, the battalion was ordered not to leave the vehicles to keep the soldiers safe. They were traveling with hatches and turrets closed, and they had no way of knowing what was going on outside the APCs. So, the fact that we were there with the battalion was critical for them."

The Gaon squad didn't take their eyes (in the sky) off the ground for a moment. Minute by minute, they managed to direct combat helicopters, as well as gun and mortar fire to the site of the battle.
Sergeant S. was not expecting an encounter on that scale. She has long fair hair and bright eyes. She understood just how important she was and the soldiers' calls for artillery support still echoed in her head. "Suddenly, we saw an insane amount of fire directed at our soldiers. These are soldiers we were with in preparation for battle, people we know; we're directing the troops and the helicopter and hoping that our directing fire is really helping our forces, but we have no idea how the incident will end."

Staff Sergeant A recalls how she saw an explosion right next to one of the tanks. She gathers her dark hair into a high ponytail and stands to attention. She knew they were coming to fight, but she didn't realize how dangerous the situation could be. "I think it was only then that I realized the magnitude of the event. Because we didn't know if the explosion was from the chopper we had called in, in which case it was helping our soldiers, or whether it was enemy fire. Then you hear over the radio that it's anti-tank fire, and you have to act straight way and direct a response."

"The terrorists were so close that it looked like they wanted to place IEDs on the vehicles. But the fire we directed at them managed to drive them away. And as soon as S.T. got on the radio, everyone went quiet, because they understood that her report could save their lives. It's an amazing feeling to see a tank moving in the right direction thanks to our reporting and then firing a shell that pushes the terrorists away. That's why I volunteered for this position. Just for that moment."

R told us: "At one point, there was so much shelling, both fired by the battalion and at the battalion that it was crazy. As a force we view events from above, we can't say whether our forces have been hit. It was only when we heard the call to 'hold your fire' over the radio that we realized the engagement was probably over."

After about two hours of intense combat, during which the soldiers deployed external fire elements such as mortars fired by a company in a defensive block or missile from the helicopter, the area fell silent. The battalion was no longer reporting that it was under fire; the enemy was no longer visible on the ground. The soldiers of the Gaon squad ended with a bad feeling. For better or worse, they are not responsible for evacuating the wounded, nor for the force's condition after the battle. Nevertheless, in their hearts, they found it hard to distinguish between the heavy fire they had just seen on the ground and the battalion's soldiers with whom they had prepared for the maneuver.

"After the battle, I had a very difficult feeling," says S. "I was certain that the battalion had suffered quite a few dead and wounded, because of the heavy fire. I was sure that after a few days, we would hear about the magnitude of the losses." The morning after was a great relief for her.

R.: "In war, communication is difficult. The battalion and the fighters in the field are in their vehicles and the battalion commander can't go vehicle to vehicle and check everyone is okay. It's only when the danger is over that can check to see if there are wounded. In this case, it took several hours before the battalion reached a safe place."

"It was really hard for us to deal with everything we saw in this battle, because we saw mostly terrorists directing massive fire at our forces. We saw squads of terrorists who wanted to hit our soldiers from close range. We were also afraid that they would try to kidnap soldiers. As a team, we were very upset because we didn't know what news we were going to wake up with in the morning. We were sure we had just seen the 13th Battalion hit really hard.

But on the morning of the day after the battle, the Gaon crew breathed a sigh of relief when they were told that the 13th Battalion had left the field with only seven lightly wounded from smoke inhalation. They had managed to protect the soldiers from enemy fire. "I found out that the division leaders heard me talking to the battalion commander and battalion sergeant, and pointing the helicopter in their direction," says the girls' commander, Lieutenant S.T. bashfully. "The incident even came up with the General Staff. When they realized that there were no wounded there, I understood that we had done something big. I wanted to know whether other Sky Rider teams had experienced engagements like ours, and it turned out that they hadn't, that it was all about us."

S.: "Someone from the unit came to me and was so excited to see me. He said, 'Wow, you don't understand what you did. The whole division was watching you yesterday and listening to your reports over the radio.' It was only then that I realized that we had been involved in a major incident in which we managed to prevent severe harm to our soldiers."
A.: "The battalion commander, Tomer, was encouraging the forces over the radio all the time. We heard him say that they would come out of it on top and that there were forces looking after them. Being the eyes in the sky, searching for the enemy, and constantly scanning the field so our soldiers wouldn't get hurt was a chilling experience."

"We are very proud that we successfully spotted targets and even managed to help eliminate the enemy. It was a difficult situation, and the results were amazing and they show the importance of our work."

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Kochi and Avner recall with pain how their son used to wander the streets in a desperate search to ease his pain. They speak about his repeated hospitalizations in mental health facilities, where he never wanted to stay. But what haunts them the most is the question of whether or not they could have prevented their son's death.

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The pain of Bar Klaf's family members – following his self-immolation and subsequent death after the refusal by the IDF to recognize him as a disabled veteran – knows no bounds. They still struggle to wrap their minds around how their sweet boy and dutiful soldier, who dreamed of specializing in social work and starting a family, became a broken vessel that chose to envelop himself in flames – just to stop the pain.

Kochi Arava, Bar's mother, points a finger at the Defense Ministry, saying her son, "who contributed, helped and was full of ambition, became broken.

"He suffered, spent entire days wandering the streets. No matter how hard we searched, we couldn't find a treatment facility that suited him and turned to the Defense Ministry, but they denied responsibility and didn't recognize Bar as a disabled veteran. It broke him. He just wanted to find the right place that would help him."

During the seven-day mourning period for Bar, his mother and father – Avner Klaf, 60, who lives in Tel Aviv – were both visited by IDF veterans, who shared in their pain, including frustration with the system.

Their struggles were similar to Bar's, with some having been recognized as disabled veterans by the Defense Ministry – and aided accordingly – while others fell through the cracks. But all agreed that under no circumstance could any fighter be abandoned in their hardship.

Kochi, 62, recalled, "A week before tragedy struck, Bar agreed to be hospitalized in a mental health institution. But he just could not stay there, and because he was not a danger to himself or society, he was released. He needed unconventional help, and above all he wanted to be recognized for his problem."

According to Kochi, the fact that Bar even agreed to meet a psychiatrist working for the Defense Ministry – in order to receive recognition – pointed to the extent of his distress.

"It wasn't easy for him to sit with therapists, but he was willing to do it to get help," she said. "The goal was not money, but help with food, living, and treatments. Everything that he lacked. His financial and health condition deteriorated due to his mental condition. The Defense Ministry did not recognize him, but they quietly sent us to get another opinion. In the meantime, Bar gave up, and did what he did."

Supporting lone soldiers

Kochi and Avner, who divorced around 20 years ago, had two children – Bar, 33 years old at the time of his death, and his younger brother Gal, 26.

Avner, an educator who taught at the same school where Bar studied growing up, said he was an active child who loved sports, dancing, and skateboarding.

In the IDF too, "they said he was sociable, friendly, and responsible. When I asked his commander what Bar was like in the army, he immediately responded 'dutiful,'" Avner said proudly.

According to the parents, Bar spoke very little of his military service. Avner recalled that on the weekends –when Bar would come home from the base – he would always insist on staying active.

"He probably went through unpleasant experiences, and I guess this way of dealing with them – repressing. He just told me, 'Dad, you don't understand what we experience during the week, so I always have to be active on the weekend.' And he would go out a lot and at the beginning of the week he would return to the army."

After finishing his military service, Bar lived with his father in Tel Aviv, where he found a job as a manager at a local pizzeria to become financially stable and move out. Bar eventually moved out and rented an apartment with his brother Gal near the beach.

"Oh, how much Bar loved the sea," Avner recalled.

He also said that when he and Kochi divorced, Bar "took it upon himself to look after Gal, who was a baby at the time, as if he felt the responsibility to do so. He always considered other people. During the holidays he would invite lone soldiers just so they would have a place to stay. At work he would make sure to bring coffee and pastries to the delivery people, to boost their mood. He's always been like that."

"Therapeutic setting in nature"

Around five years ago, Bar began showing signs of distress. According to the parents, he was unable to hold down a job and had episodes of impulsive anger as well as difficulty adhering to schedules.

Avner said, "Bar stopped eating. it probably helped him to suppress the difficult reality he was dealing with. He wandered outside all day, but at the same time wanted to be clean and would shower for hours. Two weeks ago I asked him why he was walking the streets all the time, and he replied that it made him feel 'liberated.'"

Sometimes, Kochi would join Bar on the long walks hoping he would share his pain and it would alleviate.

"He was going through a major crisis, and we were all looking for ways to help him," she said, with her voice breaking. "He was looking for a place to live, a place that would be his, but he couldn't find it. I couldn't help him financially, because I was having a hard time financially myself. Bar was unable to keep up with his work and ran into financial difficulties. In recent months – after couch surfing from friend to friend – he slept in a rented room in a neighbor's house in Netanya, near me. He had a place to rest, but during the day he would walk around from the grocery store and to the sea. He needed space.

"I suggested to Bar that we look for a therapeutic setting for him in nature, with the help of associations that help combat victims, a kind of good hospitalization alternative where he would eat properly, have a room, and receive proper treatment. That is what I've been working on in the past month, but Bar kept saying that he didn't like the people in these facilities and that he would leave after a day or two.

"I felt that he couldn't handle a conventional treatment facility. Sometimes he agreed to try and other times, he wouldn't hear about it. The therapists would tell me, 'Only when a broken person really wants to receive treatment – then we can help him.' Bar truly wanted help but did not succeed. After all, he did seek help and did not hide."

"The psychiatrist said Bar did not need to be hospitalized"

As time passed, the situation exacerbated, but no one expected it to lead to such a tragic turnout. Bar's friends even created a WhatsApp group – called "Bringing a smile back to Bar's face" – where they joined forces to arrange food and a place to sleep for him. Unfortunately, Bar never recovered.

Bar's uncle, Lior, recalled, "A year and a half ago he told us that if we all thought he should go to a psychiatric hospital – he was ready. We immediately went to the hospital, sat there for a few hours, and waited for the psychiatrist. He talked to Bar for a few minutes and at the end of the conversation said there was no reason to hospitalize him.

"It turns out that Bar told the psychiatrist that everything was fine, so there was no reason to hospitalize him immediately. From there, he no longer wanted to hear about hospitalization, but his condition continued to deteriorate. His fits of rage became more frequent and powerful. They saw that it was difficult for him, but it was not possible to hospitalize him when he wasn't ready to receive treatment.

"There are a lot of veterans walking among us and the Defense Ministry must help. I met them during the mourning period, each with their own pain and difficulties. We have joined a WhatsApp group for such fighters, and have become a part of this family.

"We couldn't save Bar, but there are many others among us and we owe them our lives. We were heartbroken to hear that a mere day after Bar set himself on hire, another fighter, the late [IDF veteran] Or Donio, committed suicide [after he too was rejected the recognition of disabled veteran by the Defense Ministry]. We need to save them, and the country must wake up."

"I told him how proud of him I was"

Hearing Kochi and Avner speak of Bar's last week alive is heart-quenching.

Avner said, "Two weeks ago I met with him and Gal, and Bar asked to go to the beach. We sat together and he began pouring out his heart. He said that he wanted love, and that he was ready to receive treatment, but didn't know how. He said that one part of him told him that he needed treatment, and the other said he didn't. I asked him, 'Do you want to be hospitalized?,' and he nodded. I said I wanted him to say it out loud. Then he looked at me and said: 'Dad, I want to be hospitalized. I want to be treated.'

"I immediately called Kochi to arrange the treatment, but just ten minutes later, Bar said he was giving up and wasn't ready to go. I told him how proud I was of him for at least trying, and that he was going through the process step by step. The next day he agreed to go to a hospital for a mental health check-up and was hospitalized. But a day later he again asked to be released."

Since, as mentioned above, Bar was not a danger to himself or society, the hospital could not keep him there against his will. After signing his release papers, he took a cab and returned to Netanya.

According to Kochi, "The hospital said he was a nice and gentle guy, nice and a little lost, but they explained that they couldn't force him to stay there. That's true, but very painful."

At the beginning of last week, after Bar was released from the hospital, Avner went with him to the municipality's welfare department to sign documents needed to receive a so-called rehabilitation basket. But when they arrived and had to wait to receive service, Bar insisted that they return home. A few days later he set himself on fire.

On the morning of the tragic incident, Kochi saw Bar in the morning. At around noon, she received a message from a friend telling her about what was on the news – that a former fighter suffering from PTSD set himself on fire. When Kochi read the message, her heart skipped a beat.

"At first I didn't understand what she was talking about. It was unfathomable. After all, Bar didn't show any signs that he would do such an extreme thing. He did show signs of desperation, and I was also desperate, but I didn't believe he would reach such a state.

"I immediately called a friend that Bar lives with, and he said that he called an ambulance for him because he was suffering from burns. He said that he saw Bar in the shower 'red all over.' I informed Avner and drove to the hospital, where they told me that Bar was in critical condition. He arrived conscious, probably because of the adrenaline, and asked to be left alone.

"When I arrived, he was already sedated and connected to a ventilator. Seeing him like that, with bandages – it was an incredibly difficult sight. And it was even more horrible to bury him two days later. My child dreamed of a relationship, of five children, of studying social work. How did he fall like this between the cracks?"

Unlike Kochi, Avner immediately understood that the news was talking about his son. A moment before Kochi called him to tell him about Bar's hospitalization, his partner told him that a 33-year-old former soldier had set himself on fire.

"I put two and two together and broke down," he said. "Bar fought for his life for two days, until he couldn't anymore. And in those two days, in the hospital, I felt like I was coming apart.

"I think he wanted to rest, and that was his way of crying out. A terrible way. The doctors told us that he only had a slim chance of surviving. On Friday, when I entered his room, I cried a lot, and then I told him: 'You've done enough in your life. It's your time to rest.' I felt that he no longer needed to fight. A few minutes later he passed away. I felt that this was what he was looking for, rest."

"He couldn't find the strength"

Now Bar's family is trying to pick up the pieces. Hurt and angry, they are looking for answers.

Looking at a picture of Bar from his military days, Kochi says, "I hung this picture on my wall with pride. After all, Bar had accomplishments as a fighter in a unit that participated in quite a few operations. He also fought in Operation Protective Edge in 2014, as a reservist. Usually, fighters are proud of the things they did and their photos from the army. But when I showed the picture on the wall to Bar, he turned his head and walked away, unable to look at it.

"During the last Day of Independence, when I suggested to him that we should see the Air Force air show, he refused. Bar was a very moral, very ideological guy, and loved the country very much, but he was unable to see signs of the army. How could it have been perceived as anything other than PTSD?

With regard to the Defense Ministry, Kochi said that no fighter should be ignored after his service.

"I had the help of a close friend, who is familiar with the matter, and she advised me to contact the Defense Ministry and even wrote on the application form everything that Bar did during his service. The arrests, the long nights, the campaigns. Harsh things that could traumatize anyone. We went to psychologists who kept saying that they could not rule out PTSD. But in the end, the Defense Ministry decided it was not PTSD, and that's it.

"The Defense Ministry makes you feel like a liar and then makes you prove that you do indeed have PTSD. Bar suffered from anxiety, fits – all signs of PTSD. When a person asks for help, it's because he needs it, and does not really want to be labeled as disabled. Who wants to be restricted in this country? After all, everyone can be affected differently by events. One person can be hit by stones in Hebron, and it won't affect him, but for someone else, it will be traumatic."

One of the people supporting the family during Bar's hospitalization and later the funeral as well was IDF veteran Itzik Saidyan, who self-immolated at the Defense Ministry's rehabilitation department offices in Petach Tikva two years ago in protest of their treatment of veterans. Saidyan was diagnosed with PTSD but too was denied the recognition of a disabled veteran. Just like Bar, Saidyan too participated in the 2014 Gaza war.

"I don't know if they knew each other before or not, but Saidyan felt he needed to apologize because he said his act was supposed to bring about a change in the system. It's clear that he has nothing to apologize to us for, he's not guilty at all. In fact, he helped Bar. But a change is really warranted.

"Incomprehensible tragedy"

"We went through a tragedy that cannot be understood or accepted. As a mother, I told myself that my child will overcome the struggle, that he will rise and become strong. But he was in such a mental whirlwind that he could not deal with the pressure. He could no longer persevere," Kochi said.

Avner, on the other hand, prefers not to speak about the Defense Ministry. He was under the impression that the medical system was more at fault.

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"I understand that the system operates according to a certain policy, which must be adhered to, and according to the law, if a person is not dangerous to himself or others, and does not wish to be hospitalized – he can get up and leave. But I saw with my own eyes how Bar sits with psychiatrists and feels threatened when they talk to him matter-of-factly. When he was asked about the army he would remain silent, and when he felt attacked he would answer in an unpleasant way. He did not know how to deal with his difficulty.

"We must change the law and make sure that even a person who is not considered dangerous at that moment can be in forced hospitalization for a few days, at least until the drugs he receives have an effect. So that he can really understand whether he needs hospitalization and treatment, and if he is ready to receive them. He should not be allowed to make decisions at the moment out of pain.

The Defense Ministry said in response to an Israel Hayom inquiry, that it "shared in the grief of the Kalf family, for the death of the late Bar Kalf. The late Bar's request was examined in depth by a number of mental health experts from the Defense Ministry, and no connection was found between his mental state, which was not caused by PTSD, and his military service.

The ministry stressed that "a mere three days after he submitted the application for recognition, the late Bar was immediately approved for medical and psychological treatments funded by the rehabilitation department. In addition, throughout the stages of recognition, the officials in the rehabilitation department were in contact with Bar and his mother and offered him a variety of treatment options, but unfortunately, Bar did not implement them."

The post 'My child just wanted help': Mother of ex-soldier who died in self-immolation speaks out appeared first on www.israelhayom.com.

"I cannot breathe." With these heartbreaking words, Yehudit Bauman summed up the feeling of losing her daughter, former Israeli model Karin Bauman, to anorexia, who battled the eating disorder for over a decade. 

Karin, who was cared for by her mother with endless devotion, became a symbol of the fight against anorexia, a terrible disease that causes extreme malnutrition, and in some cases, death. A disease that has begun to alarm the government as it grows more widespread among the young generation. 

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"I'm afraid I won't have time for more activism and raising awareness, afraid of losing my life," Karin said in a trembling voice when she arrived at a meeting by the Knesset's Health Committee in January of last year, where she tried to promote treatment for eating disorders.

Despite the increase in cases, especially after the coronavirus pandemic, waiting times for treatment and hospitalization are months-long, and many parents find themselves fighting on two fronts: against the eating disorder and the health system, to seek appropriate treatment. 

Shirley Trello, whose daughter N., 16, suffered from anorexia for three and a half years, said, "The wonderful relationship we used to have has become difficult because I fight with her over the thing that scares her the most - eating. Now, years later, N. thanks me for not giving up on her, but at the time, it was not like this."

Orit Meoded, whose daughter B., 19, also suffered from an eating disorder shared, "We went through a major crisis. Even when B. was hospitalized, we had to look after her 24/7, as if we had a baby. But this is a 17-year-old girl who needs to make sure that she eats and is happy, and deal with outbursts of anger and pain, when, as a parent, you just want to help." 

Vicky Richter-Israeli still fights for the life of her daughter, 19-year-old L. 

"You take your child, a part of you, and entrust it to the care of other people. You have to trust them to take the best care of your treasure, and when she is at home you need to become her police officer, but you just want your daughter to feel well." 

The three women agreed to share their stories with Israel Hayom in honor of World Eating Disorders Action Day, which was marked on June 2. And all three, like Karin, expressed the need to fight for the health system to provide better care for eating disorder patients. 

Eating disorders are complex mental health conditions characterized by an obsession with food, body weight, or body shape. Common symptoms include severe restriction of food, food binges, and purging behaviors like vomiting or overexercising. A variety of factors may contribute to eating disorders, such as perceived pressures to be thin, cultural preferences for thinness, exposure to media promoting these ideals, and genetics.

According to Health Ministry data obtained by Israel Hayom, the rate of anorexia in Israel between the ages of 15-24 stands at 1.2% among women, and 0.2% among men. About 1,500 children and teenagers are diagnosed with an eating disorder in Israel annually. In 2020, there were 333 eating-disorder-related hospitalizations in Israel among those under the age of 15, and in 2021, the number stood at 468. 

Eating disorders are among the deadliest of mental illnesses, and according to Health Ministry data, have a death rate of 8-20%. 

"There were nights when I would sleep with B. the whole time, constantly checking that she was breathing, because of the fear of her heart rate dropping," Orit said. "It is about constant fear and helplessness. Because when a child is diagnosed with an eating disorder, and there is no proper guidance for the parents – we are left without an answer. These children grow weaker as they await treatment, and if there is a drop in heart rate, God forbid, you can wake up in the morning and find that your child is not breathing."

Orit has four children, and B., the second child, was diagnosed with anorexia at the age of 16. 

"B. is asthmatic, and after one asthma attack, she began to cut back on food. It was quite sudden, there was no process here. She had bacteria in her stomach and relied on the claim that it made it difficult for her to eat. But something didn't make sense to us, because it was too extreme. She lost about 20 kilos [44 pounds] in a month and a half, would faint at school, and felt very weak. A pediatrician referred us to the emergency room, where she was immediately diagnosed as anorexic."

B. was hospitalized for two and a half weeks, after which Orit immediately began to look for appropriate treatment.

"Although we had a diagnosis and a referral, we had to wait four months for treatment. I know that current waiting times are six-seven months, which is insane," she said. 

"While waiting, you – as a mother – must keep your daughter alive. Make sure she doesn't suddenly experience a drop in her heart rate during sleep, and that she doesn't suffer from depression. It's a big fear and a very serious shock for the whole family, who has to live in a pressure cooker. And while waiting for treatment, she occasionally had to be taken to the emergency room. She did not feel well, and was released after her specific problem was taken care of."

Finally, when the time for treatment arrived, the center told B. that she would need to be able to eat in order to begin. For weeks, Orit took her daughter to a nutritionist to make sure she began eating. After about three months, B. began hurting herself and was referred to a psychiatric hospital.

"The hospitalization, which lasted for about a week, traumatized B. because she saw all kinds of other patients and told us that she learned from them methods of how to hurt herself or how to vomit.

"Two days ago she told me that she had a dream, in which they took her by taxi to the psychiatric hospital, forcibly admitted her, and tied her up – while she was shouting 'Mom, no!' When she told me, I stood helpless. I told her that luckily it was all just a dream," Orit said, with tears streaming down her face. 

B. is now in recovery under the private care of a dietitian, psychiatrist, and follow-ups with the family doctor. Recently she even began working three times a week in a kindergarten.

"I really hope we will be able to say we've got over it, but we are still in the process. The treatment procedure is not easy either, because you have to find the right professionals who specialize in eating disorders, and there aren't many of them, and the expenses for treatments are about NIS 6,000 [$1,300] a month. It's a lot. I just want to save my daughter, I'm fighting for her every breath.

"People who met us would look at B. and say, 'She doesn't look anorexic,' because she wasn't really underweight. But that's exactly the problem, that this is a tricky disease that isn't always related to classic weight loss. If they had to decide to treat B. according to weight, she would not have received treatment until today, because she was a kilo over the underweight limit. 

"A few days ago I told B.'s therapist that I always believed in my daughter. Although the recovery process is not easy, I believe wholeheartedly that she will come out of it and fulfill herself. That she will love herself the way she is, that she will feel loved, and start a family.

"And you know what her dream is? To establish a home that will help girls who are dealing with eating disorders, without coercion like there is in the wards. A place that will provide a supportive framework. I wish her that she should succeed in realizing her dream. I know that I will help her achieve it."

'Children don't need to slim down'

According to Dr. Yanai Groen Frank, an eating disorder expert, anorexia is not about "a diet going wrong. These are mainly girls who feel bad, who have been traumatized or feel worthless, and they feel so bad that they don't even ask for help, feeling that they don't deserve help. They will try to solve the pain themselves, by cutting back on eating.

"The problem is that at no point in the eating disorder will the patient feel better, and we know on a biological-medical level that the more weight she loses, the more the compulsive thinking of the eating disorder will increase and this pit of feeling worthless will never be filled. Therefore, first of all, we need to heal this distress."

According to Groen Frank, social media plays a role in eating disorders but is not the source of the problem.

"During the pandemic, all interactions took place through social media," he said. "And this made everything extreme. Teenagers used the platforms to feel better, and the interaction became distorted so that those who were more extreme and sick received more prominence in the media. The goal was not to get help but to show the sick in the community.

"These girls need mental health care and are dealing with a major disorder. And the sooner they seek treatment, even if it is the beginning of treatment with a dietitian specializing in eating disorders and a family doctor, the faster we can respond. If we had services to catch these problems early, and if mental health care was more available, maybe it would be possible to provide a real solution faster to these hardships."

Groen Frank also said that while anorexia is more prevalent among teenage girls, in recent years, there have also been cases of eating disorders among boys, such as binge eating.

Professor Silvana Fennig, Director of the Department of Psychological Medicine at Schneider Children's Medical Center, who specializes in the early identification of eating disorders among teenagers, said, "Some 40% of children who are diagnosed today come to us with a different anorexia that we knew in the past. In medical terms, we call it Atypical Anorexia Nervosa. 

"There's now an entire population of children who used to be obese and lost weight in a significant way that hurt them, even though they are now not considered underweight. They come to us because they suffer from a drop in body temperature and blood pressure, and they have all the medical complications of anorexia, such as preoccupation with eating and periods of fasting, to drastically lose weight due to obesity.

"For the most part, the classic treatment for eating disorders is, first of all, reaching a normal weight, because without a normal weight there is no cure. But with atypical anorexia, there is no exact weight. After all, our goal is not to return to obesity, but to normalize eating, when the weight is less significant.

"The media and society encourage thinness, and the thinness ideal is not a good one. As medical professionals, we encourage young people to be healthy, and not to preoccupy themselves with aesthetics. Yes, obesity needs to be treated, but if the child is healthy – there is no reason to disturb him or her. I strongly advocate the concept that children should not slim down. They need to live a healthy life, and have good eating habits." 

According to Fennig, in recent years, anorexia has been diagnosed in younger populations, and even girls as young as 10 have been known to receive treatment. 

"This is also related to early puberty, but the pandemic certainly made its impact as well. After COVID, we saw an increase in applications for aid, and the waiting list increased accordingly."

'It started to get out of control'

N. Trello was diagnosed with an eating disorder at 12. Today, 16 years old, she receives private care that according to her mother, Shirley, is saving her life. 

"As a child, N. was a little bit overweight, and asked to go on a diet to lose weight," Shirley said. "At first, I welcomed it, because it is important to exercise and eat healthy, but little by little it started to get out of control."

At the age of 13, N. began to exercise excessively and limited her food intake more and more. 

"In the beginning, when N. just lost weight, she celebrated and bought a tank top and short jeans, but little by little she switched to big and long clothes, even when it was hot. The reason for the long clothes is not only to hide the thinness but also because those underweight are often cold.

"N., who used to be a talkative and happy girl, began to disappear. She sank. As a mother, you tell yourself that this is teenagehood, but you see that something bad is happening. Later on, she began to lie about food. She would tell me that she had lunch and went out, but when I would arrive home I would see that there was the same amount of food in the pot. Once I came home from work and my little daughter told me that she had weighed a shrimp on the cooking scale in the kitchen, and had only eaten that.

"It finally hit me what was happening and I realized that something had to be done, but I didn't really know what," Shirley continued. "A bad atmosphere began to prevail in the house, of anger and fights over food, and N. looked tired and sad. As a mother, I felt like I was talking to two different people, because when we spoke about other things, it was fine, but when it came to food, it was frustrating. We fought with her a lot about this, and mostly felt powerless."

Shirley then called her friend, a psychologist who works with teenagers who suffer from eating disorders and was referred to two clinics. 

"I remember the day I called one of the clinics, and I had to say out loud that I think my daughter has an eating disorder. I couldn't get that sentence out of my mouth, because at that moment it became real. In the end, I gathered my strength and said it. They referred me to a clinic in Kfar Saba, and in the meantime, I received a list of tests that need to be performed before the treatment."

That same week Shirley made an appointment for her daughter with a pediatrician. Tests revealed that N. was suffering from bradycardia, a slower-than-normal heart rate, which weakened the heart muscles. In N.'s case, this was caused by malnutrition. 

"The doctor sent us in a panic to Schneider, and N. was hospitalized in the children's ward because she was in a life-threatening condition. That night they also connected her to a feeding tube, so that the body would strengthen. After nine days of hospitalization, during which she was diagnosed with anorexia, she gained a little weight and was released from the hospital. 

"We were released home without knowing when N. would be accepted for treatment in the clinic. After all, it is obvious that when there is no treatment, the situation deteriorates again. We were given general guidance on what to do, but nothing thorough. They told us how N. should eat her food, but no one explained what to do if she was not ready to eat at all. 

"Fortunately, the dietitian at Schneider was willing to help us out of the kindness of her heart. It took about a month until we were admitted to the clinic, and it was a very tough and painful month, during which I had to watch N.'s every step. She received medication and emotional therapy that helped her cope with the anxiety from the weight gain, and to treat the factors that brought her to the disorder in the first place. Even after that, I had to be available for her all week. Drive her, prepare six meals a day, and sit next to her while she eats. It's like hospitalization, under the parent's responsibility."

In order not to overload a patient's system, which is already stressed, clinics usually work with eating disorder patients for two years. Although N. did not fully recover and still needs support, she was released from treatment at the clinic. Her parents took her to private therapy with a dietician and a psychologist.

"N. received treatment relatively quickly, and thus she was spared hospitalization, but not everyone is so lucky, which is why we speak out. We are constantly talking about increasing the budget for hospitals, and we say that hospitals are the final stop, so we need to invest in preventive care, at the community level. There is no reason in the world for these girls and boys to be hospitalized, and certainly not repeated hospitalizations. And when there is no primary care system, the patients deteriorate."

Q: In your conversations with your daughter, did you discuss what caused her anorexia in the first place? 

"Anorexia is a complex disorder, and it doesn't arise just because of a comment someone else made. I had conversations with N. about social media, and she tells me to this day that Instagram models were not what triggered her eating disorder. At the height of her illness, she had a Tiktok account, and we decided together to close it, because when she uploaded videos she received comments that were sometimes very offensive. So her difficulty was not caused by other models, but by cyberbullying. 

"Many times it also stems from perfectionism, which reaches a breaking point and self-harm. That's why I believe it's important for parents to emphasize empowering the child, even if he or she is not the right weight, you shouldn't bother with appearance. You never know where it will deteriorate."

'Like a bandaid on an open wound' 

L., Vicky Richter-Israeli's daughter, is still in a hospital setting, and for three years she has been moving between treatment settings, trying to find a cure for her condition.

"I spent whole nights and days worrying that my girl was going to die," Vicky said, "I would set an alarm clock to get up and check every time she was breathing. I would put a piece of paper under her nostrils, to make sure air was coming out of her nose. I would be around her all day, to make sure she wasn't alone in the shower, or alone in the room, because you don't know what she's doing there, behind the closed door."

L. is Vicky's middle daughter, 19 years old. But despite her age, she has not been recruited into the military yet, due to her medical condition. 

With a trembling voice, Vicky admits that she herself suffered from an eating disorder as a teenager, and was saved only thanks to the dedicated efforts of her mother who found a psychiatrist and psychologist for her. 

When L. started to exhibit symptoms, Vicky was in denial. But reality hit her in the face when L. lost a lot of weight within a short period of time. 

"L. was always outgoing and sociable, surrounded by a lot of friends who accompany her to this day, but at that time she closed herself off. Because I went through it myself, I knew what I was seeing before my eyes.

"When L. was first hospitalized, and the psychiatrist asked her why she wanted to be anorexic, she answered him: 'I want to shrink myself.' That is, it is not a desire to lose weight, but something much deeper, which characterizes many teenagers with eating disorders. Not everyone is someone who aspires to be a model or went on a diet that went wrong. L. wanted to reduce herself, and began to lose weight, but in every treatment setting they said she was not in danger of life, so she currently has no treatment.

"And while we wait for help, there is chaos at home. L keeps fainting and losing weight drastically, and we all live in anxiety. She doesn't know how to deal with the internal war that is going on inside her, and I see my daughter dying. Not just starving, but fading away.

"I went with her to our lovely pediatrician, and she fought for L. and sent her to the emergency room. We arrived at Hadassah Medical Center, but when they saw that her pulse was normal, they wanted to release her home. Luckily, the pediatrician insisted, and they agreed to keep her in the hospital. That's where our journey began."

L. was hospitalized for about six months. First in the children's ward and then in the psychiatric ward, although it is not a dedicated ward for eating disorders. 

"When she reached a normal weight, they let her go. They followed the procedures, but for us it was a problem. Because with an eating disorder, the problem is not only the weight. It's the mental aspect as well. Reaching the target weight is like putting a band-aid on an open wound, and when there is no possibility of receiving continued treatment in the community, a child immediately deteriorates back."

Vicky's eyes fill with tears as she painfully remembers how every time L. was hospitalized, she begged in tears to go home, and how she, as her loving mother, had to tell her that she needed to stay in the hospital and recover. About a month and a half after she was released, L. was hospitalized again, this time for five months.

"When she returned home, I took time off from work to look after her. If I didn't have managers supporting me, I would have already been fired. Everywhere she was hospitalized I felt that they were fighting for L., but even the systems have treatment limitations. But I will never give up on her."

'The budget is almost nonexistent

According to the Knesset Research and Information Center data from February 2022, Israel has several dozen treatment and hospitalization centers for treating eating disorders, sometimes combined with other disorders as well. 

In practice, these are several hundred beds while there are thousands in need of treatment. The lack of care and response led Vicky, along with other parents of children with eating disorders, to establish in October 2022 the Hamasa Shelanu (Our Journey) association for families dealing with eating disorders.

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Vicky said, "The state has failed in this treatment for so many years, and a fundamental change needs to be made in the treatment of eating disorders. The field of mental health is the backyard of the state, and eating disorders are the backyard of mental health. Many children are treated in the private system, and the parents collapse mentally and financially because they have to finance the treatments, and often resign from their jobs or reduce their work hours to be there for their children".

The association is poised to submit a petition to the Supreme Court against the government, demanding a significant budget to deal with eating disorders, that according to them is close to "nonexistent."

The Health Ministry said in a statement, "The field of mental health is at the top of the Health Ministry's priority list. Dealing with the coronavirus pandemic has overwhelmed the need to expand the response in this area.

As for eating disorders, "the Health Ministry is working to expand day treatments aimed at preventing hospitalizations while continuing the routine of life as much as possible. In 2022, another 40 positions were added nationwide. In addition, it was decided to allocate 23 more hospitalization beds for youth eating disorders in 2022 and 12 beds in 2023. Most of the beds have already been added to the medical institutions.

"Approximately 15 million shekels [$4 million] is earmarked for the treatment of eating disorders, both for shortening waiting lists at clinics and for the development of dedicated facilities to prevent hospitalization."

The post 'It's a war over what scares my child the most – eating' appeared first on www.israelhayom.com.

Adriana dreamed of giving birth naturally and could not imagine even in her worst nightmares that she would be pressured to take painkillers and induce labor. Bat Ami was recovering after giving birth to a baby girl when the nurse made her get up from the bed only to check out her back tattoo. Ariel was in agony when her obstetrician firmly pressed on her stomach – without prior warning – to get the baby out, using a maneuver considered outdated and highly controversial. Tal was told that unless she agreed to a C-section, she "was killing her baby." 

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Israel Hayom has spoken to dozens of women in recent weeks who had given birth and felt that their rights, especially those of bodily integrity and autonomy, were violated by the medical staff. 

A milestone as important as giving birth, which was supposed to have been intimate, profound, and exciting, turned horrific when doctors and nurses reportedly violated the patients' privacy, performing procedures without consulting them or asking their permission. 

"It felt like they took responsibility for your body, and you no longer had control over it," Bat Ami, who has gone through three difficult births in recent years, said. 

For Reut, who gave birth two years ago, the trauma is still present. 

Labor is when "I am in my most intimate state, and they take away my strength, control, and faith. They kept saying, 'The most important thing is that the baby comes out healthy,' which makes you think it's okay that they performed a procedure on you without asking first, and that maybe it's okay that the obstetrician pushed hard on your stomach to get the baby out, a procedure that is now not allowed to be performed in any hospital."

Reut was referring to the Kristeller maneuver, named after German gynecologist Samuel Kristeller, which was developed in the late 19th century and involves applying pressure to the uppermost part of the uterus directed towards the birth canal, in an attempt to assist spontaneous vaginal birth. A highly debated technique, it is considered dangerous due to the risk of broken bones, organ damage, and other painful health problems. 

"But it is terrible, terrible," Reut continued. "And that is why I have decided to share what I went through. So that no other woman has to go through what I went through." 

"Why did you have to give birth tonight?"

The women often said they felt "helpless" during labor, and that their original plan – to give birth at the hospital naturally – went awry when against their will, they either had to have induced labor or even surgery. 

Reut, for instance, planned to give birth naturally and chose a hospital near Tel Aviv, because she was told the staff actually listened to the mother-to-be. 

"In reality, it turned out to be the exact opposite," she lamented. It took me some time to arrive at the hospital, "and the moment I walked in, they scolded me for not having arrived earlier. They took me to the delivery room, and the midwives were really sweet. In the evening, I began to have strong contractions, and for hours I was with an open uterus, which signals readiness for giving birth [naturally,] but the doctor began to pressure me to induce labor.

"He would enter the delivery room every few minutes, saying that the monitor showed that the fetal heart rate was dropping, which signaled possible danger. But the midwife had told me that everything was fine and that the fetus was not in danger and that the heart rate had dropped only because of the contractions. 

"Then all of a sudden, during a contraction, while the nurse was supporting me, he told her to stop and told me, 'Listen to me now, you are endangering the fetus, and you need to give birth now – vacuum or surgery.' I told him I didn't want to, that I felt that I could give birth naturally.

"The midwife told him that she could already see the baby's head, that I could give birth naturally, but he approached me, pressed on my ribs in an effort to expedite the process [through the Kristeller maneuver]. I screamed in agony and told him he was hurting me. In hindsight, I don't understand how I allowed him to do this to me, but he did. When I screamed in pain, he took a step back and said to stop everything. He decided to perform a vacuum extraction. 'It's your decision, but my responsibility and you are about to kill your baby,'" he said. 

"I didn't want to oppose the doctor, because he surely knew what was best. But I feel that everything could have gone differently. The doctor might be walking around thinking he saved my life and the life of my baby, but for me, it was a very difficult experience." 

Adriana chose to give birth to her son at a hospital far from home because she too was told that the medical team listened to the patient, and even encouraged natural birth. 

But when she arrived, already in active birth, with contractions and an open cervix, she felt she was giving birth under pressure to follow medical protocols, which included taking painkillers, contrary to earlier promises, and the doctors and nurses being inattentive to her needs and requests. 

"My pregnancy went well and I dreamed of giving birth naturally without any intervention. When I first visited the hospital, it sounded to me like the staff would be really attentive to my needs. But when I got there, at 41 weeks and 3 days, I realized that I had been deceived."

According to Adriana, from the moment she arrived, she was pressured to take epidural or laughing gas to help with the pain. "

"When I told the obstetrician I didn't want to, she shouted at me, 'You will do as we say.' I was shocked. I got up, while having contractions, and asked her why she was talking to me like that. In response, she sat me back down. I realized there was nothing I could do, and it was a very difficult feeling. I arrived at the hospital feeling well, and I thought I would have the birth of my dreams, but got to a point where I felt helpless. I was pressured to get epidural or painkillers, and no matter how much I explained that I wanted a natural birth, the staff kept pressuring me.

"At some point, the birth stalled, and when the senior doctor walked in and saw that there was no progress, he said, 'Why did you have to give birth tonight?' I will never forget that sentence. He didn't say 'Hello,' nothing. 'Why did you have to give birth tonight?'

"I felt they wanted to hurry the process along. Some women spend 20 hours in labor, and I was actually further along, but then the monitor showed a slowing heartbeat. I was having contractions, in pain, begging to be allowed to focus on the process, but after countless doctors came and went trying to pressure me into agreeing, I gave in. 

"The staff pressured me to have a C-section and even told my husband that if I didn't, I would be 'killing the baby.'" 

Adriana was put on full anesthesia, but it did not fully take, and she continued to experience the birth and even heard her baby cry upon exit. 

"What happened next amazed me. I was still unconscious, and they [the staff] approached my husband, telling him that the baby was not breathing and that a ventilator was needed – as if they were trying to make up an excuse to legitimize the surgery. 

"My husband was very angry with me at the time, but later, when I requested the birth procedure documents like any mother is eligible to do, I saw written in black and white that the baby did indeed cry when he was born.

"They also kept my baby away for a long time and vaccinated him without my permission. When he was in my arms, finally, they again rushed to take him away for tests. I ended up signing for an early release."

Adriana is now suing the hospital for alleged emotional distress. 

"I want to bring about a change so that no other woman has to go through this. Women who are giving birth must stand up for their rights," she said. "I felt helpless during the process, and after a lot of pressure, agreed to everything. They didn't let me focus on the birth, and half my energy went to dealing with the staff. It was a very difficult experience."

(phot here)

In March, the Birth Freedom Israel organization published a report on the treatment of women in delivery rooms, alleging humiliating behavior and rights violations. 

The NGO analyzed the calls of 609 women to its helpline, which did not reflect how widespread the phenomena could be, but did point to cases of mistreatment. 

According to figures, 70% of the women said they were verbally abused, and 64% said their right to informed consent was violated. Over half (55%) said the medical staff communicated with them poorly, and almost a third (32%) said they were abused. 

In addition, 29% said they felt they were neglected and the doctors did not give them the necessary attention, and 16% felt their privacy was violated. 

On average, every woman who called the hotline reported 4.4 abuses. 

Moreover, in March 2022, Birth Freedom Israel conducted an online survey, in which 1,700 women who had given birth participated, that showed that over half (58%) felt that someone else made the decisions pertaining to their birth. Some 68% said their privacy was not respected, 32% said they were verbally abused by the staff, 26% said they were abused by the staff, and 13% said procedures were performed without their consent. 

"The solution is to raise awareness among the women and the medical teams of the rights of the mother, and to create a fundamental change in the public and personal discourse regarding childbirth," Director of Birth Freedom Israel Hayuta Goren said, which is why the organization holds training workshops across Israeli hospitals on the subject. 

As some of the trauma sustained during labor is not of physical nature, some new mothers are left with a sense of violation that is unlikely to hold up in court. 

"Oftentimes there's no point in filing a complaint or a lawsuit like that," attorney Dganit Sommerfeld explained. "Contary to medical negligence lawsuits, where you might prove that damage was caused, with mistreatment during labor it is difficult to prove that a tangible injury was caused. 

"When the mother returns to work [after a three-month maternity leave] and leads a more or less normal lifestyle, despite the trauma, she cannot request financial compensation and prove that as a result of the birth she suffered future wage losses. The legal premise in such cases is that the mother gave informed consent, and if and when the doctor performs an operation on her without informing her – there was probably a medical justification for it."

To remedy the situation, MKs Michal Shir (Yesh Atid) and Keti Shitrit (Likud) submitted a bill that would ensure a fair economic mechanism for both those that give birth in hospitals as well as at home and in private institutions. 

"As of now, women who give birth in private centers or at home, do not get a maternity grant, and the financial aspect might affect someone's decision in terms of location," Sommerfeld said.

In response to an inquiry by Israel Hayom on the matter, the Health Ministry said that it "expected all medical teams to treat patients with professionalism and sensitivity.

As such, the Health Ministry's Health's National Council for Women's Health adopted a gynecological examination convention – recommendations that are also relevant to mothers, as published by the Israel Society of Obstetrics and Gynecology last year. The convention established rules of respectful, sensitive, and considerate behavior toward the women being examined and improving the communication with them, it said. 

The convention also stated that the patient must be given a preliminary explanation of her rights and procedures, receive her consent, provide warning and reassurance before painful operations, explain test results, and more. 

In addition, it includes a variety of ways to implement the improvement of communication between patients and medical teams in many settings, including medical faculties and different stages of specialization. This is through training, dedicated studies, control, and more. Every complaint that is received in the office is handled upon receiving, the statement said. 

The Tel Aviv Sourasky Medical Center said, "We make every effort to involve each patient in the decision-making, transparently and sensitively, while providing an explanation throughout all stages of the birth. We will make it clear that in Ariel's case, no Kristeller maneuver was used during the birth, and all operations were performed as usual. However, we regret her personal experience, And we took these things to heart."

The Shamir Medical Center said, "According to the records in our possession, this is a patient who received detailed explanations throughout the birth procedure, which was accompanied by her overwhelming opposition to any medical activity necessary to save the fetus and care for its well-being. Only towards the end of the birth did the patient agree to the intervention … when there was no other choice left. We regret that this is her personal feeling, but from our inspection, the conduct of the staff was flawless and enabled a successful birth. We wish health to the mother and her daughter. We emphasize that the medical center strongly condemns violence of any kind toward the patients and/or the staff."

The Soroka Medical Center said, "We are sorry for the feelings described by the woman, take them seriously and check every request that is received. At every moment and in every situation, the safety of the mother and the safety of the fetus is at the forefront of the team's attention, which will respond to her requests if they do not endanger her safety. The team does everything in its power to provide personalized treatment to each mother, to explain and update at every stage, and provides professional medical care according to her medical condition, to enable a meaningful and positive birth experience."

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The Hadassah Medical Center said, "The case described in the article, which happened a decade ago, is not in line with the spirit of service and care in Hadassah, which sanctifies the dignity of the human being in all forms. Therefore, we are very sorry for the feelings described by the mother. The team of the women's medicine system at Hadassah, like the teams of the other departments, recognizes the right of women to make an independent and personal decision regarding any procedure, including during childbirth, and even encourages it while maintaining a high sensitivity and consideration of the medical staff.

"Furthermore, the midwives in Hadassah have a variety of choices regarding the course of the birth, pain relief, processing the birth experience, and even early and long preparation for those who are dealing with stress or anxiety. As part of that same sensitivity, Hadassah also operates a dedicated clinic for women who are about to give birth, and who have experienced difficulties throughout their lives, such as sexual abuse or difficult emotional distress, where you can receive significant emotional support in preparation for childbirth."

The Sheba Medical Center, said, "We see great importance in providing an empowering and safe birth experience to the mother and the newborn. At Sheba, there are delivery rooms equipped with innovative technologies, to enable a unique and pleasant birth experience through the use of multimedia, mindfulness, and more. We make every effort to allow the mother to give birth in the way she chooses, with as few interventions as possible and depending on the medical condition, when maintaining the safety of the mother and the newborn is before our eyes first and foremost. This was also the case in this case."

The post Doctor knows best? Israeli women speak about traumatic birth experiences appeared first on www.israelhayom.com.

When May Partush complained of back pain, the doctors sent her to go on a diet and failed to diagnose what was later discovered to be advanced cartilage erosion. When Ronit Cohen was diagnosed with endometrial cancer, she was told she was too fat to undergo an operation and would have to receive conservative treatment. The doctor treating Sol Kantor, an endometriosis patient, ignored her pain and said she needed to get gastric bypass surgery, and Bat Sheva's doctor told her that even though her blood tests were normal, she should take weight loss injections before her pancreas gave out. 

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Dozens of complaints Israel Hayom has collected in recent weeks attest to a serious phenomenon: doctors across all medical disciplines who make offensive remarks or dispense unsolicited advice to overweight patients regardless of their expertise. 

Such comments have devastating effects, causing patients to avoid visiting doctors for treatment and even wrong diagnoses. Most of the complainants are women, but men also suffer from the phenomenon, indicating that the Israeli healthcare system is plagued by fatphobia: bias or discriminatory behaviors targeted at overweight and obese individuals because of their weight.

The scope of the issue is nothing short of outrageous and includes doctors who refused to treat women until they lost weight; medical conditions that worsened after patients avoid seeking treatment over derogatory remarks; doctors who work in the health insurance funds, hospitals, and even private specialists who show contempt toward overweight patients, thinking that they are helping them and encouraging weight loss. 

In many cases, however, these unwarranted comments have the opposite result. 

"Doctors feel that they are saving their patients' lives when they tell them to lose weight, but they don't know what happens to the patients after they leave the room," says Dr. Lena Sagi-Dain, head of the Prenatal Genetic Services Department at Carmel Medical Center in Haifa and a senior lecturer and at the Technion, who studied the phenomenon. 

"People can feel so hurt, that they stop coming in for tests or ignore pain because they are constantly told that their pain is due to obesity. This is a difficult and serious phenomenon that must stop."

The doctors who treated Sol Kantor, 31, couldn't bring themselves to look past her weight, either. 

As a teenager, she avoided going to doctors altogether, but years later, when she was diagnosed with endometriosis – a disease of the female reproductive system that causes severe pelvic and back pain – she could no longer avoid frequent doctor visits.

Being overweight all of her life means constantly dealing with fatphobia, she said. Of the myriad of examples she detailed, one stood out as the most egregious: "I've undergone three surgeries to excise endometriotic lesions over the past few years. The last surgery, which was complex, was in March 2020, and recovery proved difficult. My friend recommended a specialist – a gastroenterologist, who treats endometriosis patients – so I made an appointment," she said. 

"I arrived with a binder containing my entire medical history but before she even looked at it, she looked at me and said that I was obese and that my illness was irrelevant. She added that I needed to undergo gastric bypass surgery, and her tone was one of 'I don't care what you say, this is what needs to happen.'

"I was furious. She knows nothing about me; she didn't look at my medical file or bother talking to me about blood tests or anything – and I know my tests are fine. I told her that according to my BMI, I'm not a candidate for gastric bypass, but she didn't care. It didn't matter that I wasn't there to talk about surgery but for something else. To her, I was fat. End of story. I'm sure that had I emailed her and she wouldn't have seen me in person, she would have reacted differently. Her attitude was beyond dismissive."

Since that meeting, Kantor has avoided seeing any gastroenterologist. Other doctors, she said, also focus primarily on giving her advice about her weight. 

"It drives me crazy that when doctors see a fat person, they don't see beyond the weight. It's exhausting. I'm a woman with hormonal problems who can't lose weight because every time I try my body goes into shock, I experience excruciating pain and I end up in the hospital, where I have to endure comments from doctors, who say, 'Everything is fine, you're just fat.'"

Naama Paska Davis, one of the most prominent body-positive activists in Israel, manages a Facebook community numbering over 6,700 women, who share their daily experiences with fatphobia. 

She shared her own story about degrading remarks from medical personnel over her weight, and it resonated with group members in more ways than one. Dozens of stories from members who experienced similar treatment were not slow to arrive.

"After my first pregnancy, I suffered a hernia," Davis, 36, shares. "I underwent surgery to repair it, and during a post-op checkup, the doctor noted, 'You know that some women get gastric bypass because their husbands want them to?' My partner was sitting next to me, and he was also shocked. That remark was unrelated to anything. I said 'fine' and that was it, I didn't take that stupid comment to heart.

"Early in my second pregnancy, four years ago, I went to the doctor on the sixth or seventh week with bleeding. It's very early [in a pregnancy] and it's unlikely that you can really see anything on an ultrasound. The doctor immediately declared that I had a miscarriage and rebuked me, saying I needed to see a nutritionist, adding that she won't be able to see anything [on the ultrasound] because of my fat. 

"After that, I started seeing private specialists because I was unwilling to take that kind of attitude. Near the end of that pregnancy, I had to undergo an ECV," she recalls the procedure, an external cephalic version, in which a doctor attempts to rotate a baby from a breech position to the head-down position. "I was exhausted – it was a very advanced stage of pregnancy – I went to the doctor and he said, 'So big and with such a weak voice?' It was very offensive. Everything was normal with me and the baby except for the fact that he was in the breech position. There was no reason to comment on my weight."

When stories of medical fatphobia in Israel began going viral on social media, Sagi-Dain approached Davis and asked if she would partner with her on a study of the issue. 

"They never talked to me about discrimination on the basis of being overweight. Not as a student, not as an intern, and certainly not as a senior doctor. I understood that this was an important issue and contacted Naama so that we could gauge the extent of the phenomenon."

First, do no harm

The two formulated a research questionnaire, which Some 1,697 subjects answered, 96% of them women. The questionnaire was intended for people with a body mass index (BMI) of over 25. The results were jarring.

While about half of the respondents agreed that being overweight placed them at risk for various medical issues and stated that they were interested in losing weight and would even be happy if the medical staff could offer them practical tools for doing so, 60% said that the fact the issue is raised in medical situations causes them considerable frustration.

Many said that they were told to lose weight despite having no interest in discussing the matter; 60% said they were told to lose weight regardless of the reason for which they sought medical advice; 58% reported being subjected to insulting, insensitive and judgmental remarks, as well as being told that their weight is the issue causing all other medical problems, and 40% stated that they frequently skip required medical treatments or tests so as to avoid being dismissed over the fact that they are overweight.

"These are very unfortunate results, they made me lose faith in humanity," Sagi-Dain lamented. "People reported hearing remarks like 'There were no fat people in the Holocaust,' to illustrate that you can lose weight if you don't eat, or 'Start eating lettuce,' which mostly indicates ignorance because eating only lettuce is also unhealthy. The results of our study made me more sensitive in my conversations with patients, and I strive to effect change among other medical personnel by giving lectures that specifically relate to the treatment of overweight patients."

Q: How do you raise awareness among colleagues?

"I start by explaining BMI and the damage of obesity and explain that while it's supposedly correct to tell patients that they should lose weight, we have to think about how to do it without offending them and making them distrust doctors.

"Think about how many medical issues we missed because patients didn't want to go to the doctor: fractures, herniated discs, genetic diseases of excess cholesterol that went untested because the doctor simply thought it was obesity. One of the subjects said that she went to the doctor over shortness of breath and was told it was because she was obese only to learn later that she had a heart problem – that can't happen," she stressed.

"I tell my colleagues that yes, being overweight is a health risk, but you have to be smart when broaching the subject. If we really want to help patients, we need to convey the message correctly. You can ask them if it's okay to talk about their weight. If they refuse – that's their prerogative."

Davis said she was not surprised by the results.

"The answers and data validated the extent of the phenomenon. I'm intimately familiar with the issue of avoiding medical treatments and receiving derogatory treatment. I encourage the members of my community to complain about doctors' attitude, mainly to raise awareness of the issue and show that a change can be made."

Q: How?

"HMOs and hospitals should train doctors. They should attend conferences and lectures on how they should behave when meeting overweight patients. With all due respect to the knowledge and experience senior physicians have, they still believe that obesity is dangerous to one's health and they must spare no effort to save this patient – including making remarks they shouldn't. We all have a common goal: to provide patients with the proper treatment."

The results of the study show that when doctors comment on patients' weight in an offensive way and without being asked for such advice, they do more harm than good and can often even aggravate the patient's medical condition – a fact to which 23-year-old May Partush could attest.

Partush complained about severe lower back pain for years, but three different doctors attributed it to obesity and didn't send her for further tests.

"Three orthopedic specialists told me that I was in pain because I was fat and didn't exercise," she recalled. "It was only when I enlisted in the IDF that I went to an orthopedist who decided to send me in for an X-ray. A week later he called me and said that I had a gap between two vertebrae in my lower back, which means that I'm missing cartilage, and all that was left was to treat the pain with local anesthetic injections.

"It was two-and-a-half years from the moment I complained of pain until I actually received treatment. It's possible that had they been more throughout from the get-go, they would have discovered low-level cartilage erosion that could still be treated. Maybe I would have become pain-free sooner. Anything is possible, but I missed that chance because the doctors only saw obesity and not the problem."

Partush underwent gastric bypass surgery two years ago. "I had a hard time with my weight, and I felt that I needed it. I'm not thin now, but I'm definitely thinner than I used to be, and when I go to the doctor, I'm treated differently," she said.

Things were much worse for Ronit Cohen. Over the years, the 57-year-old mother of four avoided tests and treatments for fear of facing comments about her obesity, including skipping knee replacement surgery, because she was told she had to lose weight first, which only made her give up in advance.

In mid-2020, however, she was diagnosed with endometrial cancer and was shocked by how the specialist whose help she sought treated her: "The doctor made my life miserable. He told me that they wouldn't operate on me because I would die on the table; that if I didn't die I would need constant care, and that let's face it – maybe I was 'going to die soon anyway.'

"I was stunned, speechless. When a doctor tells you something like that you think that the situation is really serious," she recalled. "They wanted to perform a certain test without anesthesia and I refused because it's a very painful test. He told me that the test was only painful because of my weight and that he wasn't about to put me under for that.

"I was really distressed when I left his office. I cried a lot, and I felt humiliated and angry. It's true, I'm fat, I'm battling my weight, but you can point out that it's not healthy in a different way. I didn't know what to do with myself. I was devastated. I couldn't function or work. I thought maybe it really was time for me to die."

A relative convinced Cohen to seek a second opinion from Dr. Liron Kogan, head of the Department of Gynaecologic-Oncology at Hadassah University Hospital in Jerusalem.

"He was very pleasant. He explained that there would be risks in the surgery because I am obese but it could still be performed. He even stressed that would be very unwise not to treat this disease because it could metastasize, from which there would be no going back. 

"I had the operation, and although it was difficult for me to wake up after it, I recovered relatively quickly. I went to him without hope – I thought he would also tell me that I was fat and that there was nothing I could do. But the day after surgery I was up and out of bed, and in less than a week I was back to work. I got my life back," she said.

"Every patient should receive the best possible treatment, no matter how much they weigh," Kogan stressed. 

"It surprises me that there are still doctors who are wary of treating such patients. This is 2022, and the Western world and obesity has been an epidemic for a long time, so even those who are overweight should receive the proper treatment. regardless of weight loss. 

"In most cases, we can and do know how to do it, and those who do not specialize in these cases should refer them to someone else. We can and should treat everyone."

Kogan noted that an extensive British study found that women who are obese are at higher risk for endometrial cancer, due to the high presence of insulin and testosterone hormones. 

"It used to be very difficult to operate on obese women but today, women who are significantly overweight can undergo robotic surgery to remove the tumor, as the robot can work in small, tight spaces," he explained. "It's amazing, because you can perform major surgery like a hysterectomy and using a robot, and you're able to cure a woman who used to be really difficult to treat."

Commenting on Cohen's case Kogan said that "unfortunately, this is not the first time I've encountered women who were refused surgery due to their weight and were told to pursue conservative treatment. Sometimes it's good enough, but in cases of advanced cancer like Ronit's, we couldn't wait."

Q: Is there really no risk in operating on an overweight person?

"Obesity can interfere with surgery when the volume of the intestine and the fat take up considerable space in the abdomen, making it technically difficult to reach various organs. Fat tissue also bleeds more easily. But even when we're talking about complex surgery, we can handle it and robotic surgery has clear advantages in such cases."

As for doctors commenting on patients' weight, Kogan said, "It's impossible to instruct a woman who has been overweight her entire life to suddenly lose weight because we warned her about it. I'm not the one who will be able to change that."

While women suffer from medical fatphobia the most, men are also at its receiving end, as 43-year-old "Yaakov" learned. 

Last year, he sought the advice of an orthopedist due to knee pain but received a scolding over his weight, instead. 

"I came to him because of knee pain, caused by an incorrect movement during exercise. Yes, I'm overweight, but I'm in good shape. The orthopedist took one look at me and all he had to say was that there was nothing wrong with me other than the fact I was obese, that no matter what treatment he prescribes, I need to lose weight, and that if I wasn't fat I wouldn't have had come to him in the first place. 

"He was very blunt. I left him without answers and with knee pain that didn't go away even after I lost weight. I guess doctors find it easier to say such things to men, thinking we're probably less sensitive about our weight than women, but when I go to the doctor I expect to get medical treatment - not unsolicited advice."

Obese medical personnel are not immune to medical fatphobia either. Adva Forer, a nurse at a baby wellness center, received quite a few comments about her weight from doctors, as well. 

"I suffered from prolonged menstrual bleeding following my second COVID vaccine," she shared. "The appointments to see an OBGYN were few and far between, so I went to my HMO's women's healthcare center. All the doctor saw fit to say was that I was fat and that all my side effects were the result of being overweight.

"I told her that my weight had nothing to do with it – there was clear evidence at the time that the COVID shot could interfere with the menstrual cycle and that it should be checked. The doctor examined me and said, 'Everything is fine, lose weight and that's it.' Lose weight. That's all she wrote in her notes, too - "morbidly obese, recommended to the patient to lose weight.' It was a complete disregard of why I sought medical attention and utterly unprofessional."

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Forer noted that fatphobia was "a known phenomenon among specialists like orthopedists, surgeons, and gynecologists. When I complain about pain in my leg, they talk to me about obesity. It's very easy to say that it hurts because I step on it with excess weight, but they ignore the fact that I'm on my feet for eight hours a day, for example. 

"As a nurse, I can attest to the fact that the growth curves the baby wellness clinics used to follow and the ones we follow today are worlds apart," she added. "I've come across plenty of young doctors who get it, but the older ones don't. True - being overweight is a risk factor for hypertension, diabetes, etc., but when an overweight patient walks through the door, there's no reason to label them as suffering from every disease out there without first diagnosing them correctly. 

"As part of the [healthcare] system, I have a better understanding of how words can affect a patient, so I choose my words more carefully. It all comes down to education."

The post The unsavory skinny on medical fatphobia in Israel  appeared first on www.israelhayom.com.

The Mark family was driving along a highway in the West Bank on July 1, 2016, when Palestinian terrorists opened fire on their vehicle, causing the car to crash and flip over. The father of the family, Rabbi Michael Mark, lost his life that day, and perhaps wife Chava, son Pedaya and daughter Tehila would have met the same fate were it not for the help provided by A., a Palestinian resident of a nearby Arab village, who was driving down the same road. 

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In an interview with Israel Hayom, he recalled the events of that fateful day. 

"My wife and I were driving on Highway 60, and near the Beit Hagai settlement, I heard shots all of a sudden at the vehicle right in front of us. The car swayed to the right, then to the left, right, left, and then flipped over and dragged along the road.

"I looked at my wife, I told her that I have a first aid kit in the car and that we should go help. I always have a first aid kit in my car, and this wasn't the first time I had to use it. I always try to save people's lives, but never before did I find myself in such a challenging situation.

"Even before getting out of the car, I immediately understood that it was a terror attack. There had been unrest in the area, it was Ramadan, when people do messy things, and the driver of the vehicle had a beard and the boy had hair on the sides of his face [sidelocks,] as observant Jews do. 

"I got out of the car and saw the flipped vehicle. The parents were in the front, the boy was screaming in fear, and the girl was frightened. She had been badly injured in her abdomen. She lost a lot of blood. I told her in Hebrew not to be afraid, that I was going to help her. I knew very few words in Hebrew back then, but I was able to tell her that I would help her. I am not even sure where those words came from.

"I was worried that the car would explode. The hood had been torn off, so I managed to disconnect the battery. I was very stressed. All I could think of were the children, and how I could get them out.

"I tried to break the window but did not succeed. It wouldn't break. Jews that live in that area have reinforced glass windows. I asked my wife to bring the jack from our car, and I managed to break the back window. I opened the door, and Tehila, at that time I did not know her name, she told me 'Get out of here, you killed our father.' And I told her, 'No, I came to help, don't be scared.' The moment I opened the door, she hugged me."

Soon after, A. was a wanted man in the Palestinian Authority because he dared save the lives of Jews. He received multiple death threats and was forced to flee. The Civil Administration allowed him to come to Israel to save his life, but he had to leave his pregnant wife and parents behind, as well as his job in the security field. 

A.'s permit did not allow him to work in Israel or to get a place here. For three years, he moved around the country, trying to make ends meet by working illegally. 

A.'s son was born in the PA after his escape. For the first two years of his life, the boy only saw his father via video calls or during hasty meetings at a Hebron checkpoint. 

Fortunately, a year and a half ago, A.'s wife and son also received temporary permits to move to Israel. 

"Every time I'm with my son, I thank God that at least this part of my life has returned to me. That is the part that gives me happiness. My family gives me a lot of strength."

A. met his wife, a nurse by profession, through matchmaking, as is customary in Muslim communities. The two only met once before their wedding and planned their future in their village. 

"I built a house for us before the wedding. I invested so much in it. Every time I added something to it, a stone, or paint, I would call to tell her. We planned where the nursery room would be. We planned our lives in that house. When we got married, she was 18, and the attack happened a few months after that. Today she is 24 years old."

A. never got to see his father again. He passed away recently without the chance to say goodbye to his son. "There was a special bond between us. I was told he wanted to see me, but I could not visit. It was too dangerous." 

A.'s family members received death threats as well. It is due to fear for their safety that A. chose to remain anonymous. 

"Over the years, after the attack, my family stood by me. My mother always strengthened me. My father used to tell me I did a good deed and that he was proud of me, no matter what other people said. He taught us to do good, to help when we can, and that is what I have done my whole life."

In November 2019, due to public pressure, the Interior Ministry provided A. and his wife with a temporary residence visa, which granted them all the rights of a regular Israeli citizen, except for voting. A. pays social security, he has Israeli health insurance, he even has a green passport to prove that he has been vaccinated against the coronavirus. His eyes, however, reflect the fear that when their current visa expires in November 2021, Israeli authorities might decide not to renew it. 

"I would like for us to become permanent residents here, to know that we can sleep peacefully. I don't know what might happen to me at any moment. I can get into a car accident, God forbid, and then my wife and child will be left alone. Maybe they will take away their temporary permits and return them to the PA, where their lives would end. There is nothing for them to do there. My son can't remember what it's like living there at all.

"I did a human act that was obvious for me to do, but I would like the state to help us now, to take care of my family like any other citizen. That is the least they could do for us."

It later turned out that the terrorists that attacked the Mark family made a U-turn and planned on firing at the car again, but saw another vehicle with a Palestinian license plate nearby and decided to flee the scene.

Locals started to gather around the scene. A. was frightened but was determined to save the injured family members. He picked up Pedaya and Tehila and left them with his wife in the car, having locked the doors. A's wife kept pressing a bandage to Tehila's stomach to stop the bleeding.

"I was afraid the children would be kidnapped. They are in my car with my wife, people around me are cursing me, throwing stones at me, because I am helping them. I ignored. I told them it was an accident, asked them for help, but no one helped. I tried to stop Israeli vehicles on the road, but no one stopped.

"It was an awful sight to see. There was blood on the road, the flipped car, bullets, the children locked in the car. It was not easy. I am a human being too, I was scared as well. The mother was in the flipped car.

"I opened the door, put my hand under her nose, to check if she was breathing. I released her belt, she fell onto the roof of the flipped car, but she was breathing. I also got the father out, but I already knew he was dead. His head had been injured.

A. called the Red Cross. "I thought to myself, where will they take them, to a Palestinian hospital? I'm not sure they would really be able to save them there. The ambulance arrived, but they did not do much.

"I worried about the children. I got back to my car, and the boy yelled, 'You killed my dad, you killed my mom.' I told him, 'Don't be scared, I'll get your mom, I'll get your dad.' I tried to calm him down. I asked him for the police number, and he said, 'I will call.' I had an old LG phone back then, and I gave it to him. He called the police. In 15 minutes Magen David Adom and the army arrived.

"The soldiers aimed their weapons at me straight away. Tehila, who was in my wife's hands, shouted to them, 'He helped us.' We saved her life, and she, in turn, saved ours."

After Chava was rescued from the car, A. broke down in tears. "Someone came up to me, said he was the chairman of the Har Hevron Regional Council, Yochay Damri. He saw that I was scared, and he hugged me and said, 'Don't worry, it's going to be okay.' I later learned that he was a good friend of Michael's."

Members of the Mark family were taken to Hadassah Medical Center in Jerusalem. Chava had a head injury and arrived at the hospital in critical condition. Tehila had a moderate abdomen injury, and Pedaya was lightly injured. On Sunday, two days after the attacks, Michael Mark was put to rest.

A. and his wife wanted to visit the family to pay their respects. "Every night my wife and I sat and thought about what they were going through, how they were feeling. It was important for us to see them."

After receiving a permit from the IDF, the two arrived at the Mark house in Othniel. A. spoke very little Hebrew, and the Mark family did not speak Arabic. But the bond between the two families was forged immediately.

"That was my first time visiting a Jewish home. At school, we were taught that Jews had occupied [our land] and that Jews murder everything they see. But the Mark family welcomed us so nicely. They treated us with respect, as we did them.

"Tehila, who had just been released from the hospital after surgery, hugged my wife. I was embarrassed. It's a difficult situation when you know you did not save everyone," A. said.

News of the Palestinian security worker who helped a Jewish family reached Ramallah quickly, and the PA began to harass A. and his family.

"I had a good job back then, but suddenly my manager got an order from Ramallah to fire me. He called me into his office in the evening, told me not to come to work the next day. He did not explain why, he just said, 'It is not acceptable for a person like you to be in this position.' He did not explain what 'like you' meant.

"My brother was stopped [by Palestinian officers] at the checkpoint, and when they saw that the car was registered in my name, they told him I was a wanted man and confiscated the vehicle.

"My wife was harassed at her job in the hospital. They would call her 'the wife of the collaborator.' It was terrible. She was forced to leave.

"They began to send me letters, that I was wanted by the authorities. They shot at my house, threw Molotov cocktails. I asked the IDF for help, to come to Israel for protection. Luckily social activists helped me.

"I immediately understood that I had to flee and that my life was ruined. I left my wife behind, pregnant, without a breadwinner, without a husband. I told her I would divorce her, so she could continue to live an honorable life without me, but she refused. She waited. She is a patient person, she didn't give up."

A month after the terror attack, A. crossed the checkpoint into Israel, with nothing but the clothes on his back. He received a temporary permit from the Interior Ministry, and every month he had to apply for an extension and prove that his life would be in danger were he to return to the PA.

For three years A. moved around the country, without a roof over his head and without a job. He was supported by various human rights organizations, like B'Tselem and Shurat HaDin, as well as the Har Hevron Regional Council and residents from the area. Despite the support, life was not simple.

"I got a tent and slept on construction sites, in open areas, empty buildings. Each time a different place - Beersheba, Ashkelon, Ashdod. I did not have a work permit, so I had to work illegally, and was paid accordingly, 7-8 shekels an hour for cleaning equipment and cars. There was no place that did not take advantage of me, even Arabs.

"Some days, I ate from the garbage can because I had nothing to eat. I sometimes slept on the beach because I had nowhere else to sleep. I would wait for all the people to get out of the water and go in to wash up."

The Mark family supported A. as well, and the eldest son, Shlomi, made sure to stay in touch.

"They never forgot us. Shlomi would send me a message every Friday, asking me how we were doing, if we needed anything. Me or my family. He was truly a part of my family."

In the meantime, A.'s son was born. "I was not present at his birth, I did not see him. My wife sent me pictures of him over the phone, and that too was dangerous. If they knew that somebody from my family was in touch with me, they could have hurt him.

"When I spoke to my family, they always supported me. They told me I did a good deed, and even if I died, I would go straight to heaven. They supported my wife and my son. But they also struggled. They hurt us in every way possible, including the livelihood sources we had."

A. roamed the streets until 2019. "All this time, I safeguarded my way. I could have become homeless, like those homeless people I saw. But I go nowhere near alcohol, drugs. I took care of myself because I have strong willpower. I am an honest person who believes in justice.

"I had some temporary jobs that involved being in charge of big budgets, employers who said I worked great. But they couldn't keep me because I did not have a work permit."

Two years ago, on March 29, 2019, tragedy struck the Mark family again, when son Shlomi was killed in a car accident.

"I received the news from mutual acquaintances," A. said. "I was heartbroken. Despite the risks, it was crucial for me to visit the family and pay my respects."

With the help of friends, A. crossed the green line and traveled to Othniel. There, among the crowd of comforters, he saw Chava for the first time since the attack.

The woman he last saw fatally wounded was now on her feet. Chava currently lives in Jerusalem with her daughter and her family. She lost one eye in the attack, and her face had been damaged. She was still in rehab, but Chava was alive.

"I remember her, and I was glad to see her alive. My heart aches for Michael and for Shlomi, but when I see the children and the mother alive, I am glad."

Although the sight of the attack still haunts him, A. never asked for help with dealing with the trauma.

"In our society, it is not accepted for a man to speak about such things. I always say that no one will be able to help you unless you help yourself. And therefore, I help myself. Once I went to a doctor to ask for sleeping pills. I did not tell him why I couldn't sleep, only that I was not able to.

"I now work as a security officer at a large company in the center of the country. I work in shifts. I prefer to work at night, for I cannot sleep anyway. I am overwhelmed by thoughts. The events of that day do not leave my mind. I see a person who died right in front of my eyes. I see a family's car, with toys, with bags. A family that went on a trip and never returned."

A. feels a special connection with Israel. "I once even tried to volunteer for the police, but I was rejected because I am Palestinian. At some point, I got a job offer in security in Canada, but I turned it down because I prefer to continue living in Isreal. I feel I am part of the Israeli people.

"Despite all the hardships, I work with respectable people now. They respect me, and I respect them. I can't say that there is no racism here. Sometimes people speak ill of my family or me. But I act like a human being, and then I am treated as one. That's what's important."

In June 2019, A. received the Magen Israel award from Shurat Hadin for saving the lives of the Mark family members.

Yochay Damri and Yossi Dagan, head of the Shomron Regional Council, applied pressure on security forces to help A.

"Things began to change. People approached me without whom I couldn't have survived. There are so many people to whom I owe my life, thanks to whom I am here."

The pressure worked. On Aug. 7, 2019, then-Interior Minister Aryeh Deri granted A. and his wife a temporary residence permit. Their current one is valid until November 2021.

A. and his wife were assisted financially and with food, as well as a one-and-a-half-room apartment, the rent for which was paid in advance. The family lives in the same apartment, and A. has insisted in recent months to pay rent from his pocket.

"After suffering on the streets for three years, I appreciate having a roof over my head. Because of what I went through, I know how to appreciate the small things, and know that the main thing is that I am alive.

"I support our family with my salary. It is not a prosperous life, but it's life. I pay rent, electricity, taxes, my entire salary goes to utilities, but the main thing is that I'm here with my family.

"I have no words to thank everyone who helped me get the permits and get my wife and son back. Even actress Gila Almagor heard about us and brought toys and clothes for my son.

"In the years I couldn't be with my son, my wife told me he called my brother' dad,' and they would correct him. We talked via video calls, but he didn't really remember me.

"Now he's finally getting used to me. Every day I'm waiting to come home and hug him. Now I want to make my and his dreams come true."

Q: What dreams?

"There are a few. The first is that there should be no more bloodshed. I hate terrorism. I am looking forward to when people will understand that we are all human beings, no matter where we come from.

"The second dream is for me to become a permanent resident here because I am afraid for my family. I want them to live here, with these people. If my son were to return to the village, the situation would be even worse because now they know he was here with me."

A.'s wife is pregnant with their second child. "To me, it's like a first pregnancy. I was not with her when she was first pregnant. I see her belly growing, and I'm excited that there's a soul in there. It's amazing.

"She is also experiencing what it's like to be pregnant when I'm there for her. I don't let her lift heavy objects. I make sure to cook her delicious food. I am very happy that we are all together now. I would like to know that we can stay here permanently. That the state cares for us."

The co-author of this piece, Orit Mark Ettinger, is the daughter of the late Rabbi Michael Ettinger. It was her mother, brother, and sister that A. saved.

"Seeing A. is an emotional experience each time," she said. "I first met him on the fourth day of my father's shiva [the traditional seven-day mourning period following the death of a family member] in the summer of 2016. He came in the afternoon with his wife and several other members of his family.

"My brother and I sat with him. It was the first time I met the man, who, it was obvious to us by then, had saved my mother, Pedaya and Tehila.

"During the shiva, army officers arrived and explained to us that the attack could have been much worse. After firing the 29 shots that killed dad and wounded mom, Pedaya, and Tehila, the terrorists turned back the car and wanted to murder everyone who remained alive. Thanks to A. and his wife, who stopped to help, they quickly turned around and fled.

"Meeting them was strange because they did not speak Hebrew. One relative translated half-sentences, which helped us convey to them that we were grateful, that no words would be enough to thank them. They were glad to see us, to pay their respects, and wished a speedy recovery to mom, who was fighting for her life in the hospital.

"The next time I met A. was much later. I heard from him about the shocking conditions he was living in, and I just couldn't believe it. How was it possible that a person, who is a hero to me, who saved my family, lived in such a degrading way?

"Dad's death caused a fracture in our family that we mend to this day, and I can not imagine how we would have dealt with the loss of mom, Pedaya, and Tehila. I cannot think about this.

"Therefore, every meeting with A. raises in me a strong feeling of gratitude, but also guilt, because A.'s life was destroyed because he helped my family.

"He lost his family, in a way. He lost the life he had with his wife, her first pregnancy, the birth of his eldest son. As I experience my own first pregnancy now, it hurts me even more, because I do not understand how it can be done without a partner. A. lost his home. He lost so much, because he helped a Jewish family, because he chose to act humanely and help injured children and a woman who needed help.

"Instead of living with dignity, as a hero in the State of Israel, he lived in the streets for a long time. He ate food from garbage bags, if at all, and worked hard at various jobs to support his wife and son that he had not seen in almost three years.

"To this day, he lives in fear that maybe one day his temporary permit (for which he has to fight every year) would be cancelled, and he will be returned to his village in Judea and Samaria. If he returns there, his life and the life of his family will be in great danger.

"In my opinion, A. deserves to be a torch lighter on Independence Day. He chose to sacrifice himself to save the lives of Israelis, to save the lives of my siblings and my mother. For him, too, this experience was soul scarring, to this day.

"When I asked him whether he would do it again, he said immediately 'Despite the nightmare that I have been going through for the last four and a half years, yes, I would do it again."

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There is a naval superstition that women can't operate machinery on combat vessels. Veteran captains will explain that because "machine" in Hebrew is feminine, it might become "jealous" of women sailors and refuse to cooperate. For years, until a few months ago, women were barred from working as machinists on combat ships.

Sgt. Jessica Klempert, 22, the first female machinist to serve on an Israeli Navy missile ship, is responsible for monitoring the ship's machines and operating its generators and motors. She is currently the only woman in Israel to hold this job, and was one of the four sailors entrusted to bring Israel's new Sa'ar 6-class corvette warship, the INS Magen, to the country from Germany.

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Klempert, who wears a pendant shaped like an anchor, was born in Israel to parents who immigrated from Ukraine. She studied electrical engineering at the Naval Officers School of Acre. Her father was the chief machinist on a Dabur-class patrol boat.

"I was raised on the sea, on the Navy, on ships. In 11th grade, our entire class sailed a yacht to Cyprus, and every student did every job on deck. When I chose to study in a machinist track, my father asked why I needed it. He suggested I study electronics. But I realized that I was going to smash the stigma," Klempert tells Israel Hayom.

The INS Magen ("Shield") is one of four new ships ordered by the Israeli Navy. The other three are due to be delivered over the next two years. The Magen is currently docked in Haifa, without the advanced electronics systems with which it will be outfitted over the next few months. It took nearly two weeks to sail it the 7,500 kilometers (4,660 miles) to Israel from the shipyard in Germany where it was built.

Standing on the bridge, one can see Israel's other Sa'ar boats, models 4.5 and 5.

"See how powerful this boat is compared to the others," says Sgt. Einav Eshuel, 20, a navigation technician. "All of a sudden, they look small."

Eshuel grew up in an observant home on Moshav Sde Yitzhak. Her parents, who both served in the Israeli Air Force, were surprised when their daughter opted for the navy.

"The mystery surrounding ships always attracted me," she says. "I'd see the hunk of steel without knowing what went on inside, and that moved me. I knew that there were a lot of men on missile ships, and I said to myself, this would be a test for me. I could see if I'd be able to leave my comfort zone, which was comprised only of girls, and get used to [serving in] a mixed force. I thought we'd be a group of girls, but now I can say that my best friends are the boys who serve with me. I quickly got used to having guys around all the time."

"The adrenaline on a missile ship is crazy," says Klempert. "You always feel like you're part of something secret. You're doing something that no one knows you did, which is kind of a shame, but still – it's a good feeling. My dad was in the navy for years, and even now, even after I enlisted, he hasn't told me everything he did there."

Israel Hayom meets these sailors, along with communications specialist and medic Sgt. Irina Polianker, 20, from Maaleh Efraim, and Capt. Shira Klieger, 23, an electronics and defense officer on the INS Magen.

Klieger points to the Haifa neighborhood of Bat Galim. "That's where I live," she says. Klieger was born and raised in the city's French Carmel neighborhood, and now she rents an apartment with roommates in the seaside enclave. Sometimes, when the ship is docked, she goes home for an evening and comes back the next morning. She has served on all the Israeli Navy's Sa'ar 5 ships: the Eilat, the Hanit, and the Lahav. Now her job is to make the Magen operational.

Klieger leads us into the belly of the ship, down 10 narrow stairs. The heart of the ship is the "machine," to which feminine characteristics are attributed. This is where its main motor and generators are located. "Don't be fooled. The vibrations of the floor aren't from the waves," Klieger warns.

Klemfort smiled: "So far, the machine has been my friend. We haven't fought yet."

The ship is controlled from the adjacent control room. Beyond that is the combat intelligence center, which is where Klieger will control the ships' defenses. On the voyage from Germany, due to a lack of manpower, she was stationed on the bridge.

"Aside from the fact that I walk around with a drill and a laptop, my goal is to determine when there is a threat to the ship, and deploy the proper response so that threat doesn't hit the ship or any asset we are defending, like a natural gas drilling rig," Klieger explains.

The living quarters are on the lower decks. Each boasts three triple bunk beds, three closets, and a drawer for each sailor. Generally, the newest sailors sleep on a mattress on the floor for a few weeks, but Klempert, Eshuel, and Polianker got a room for women. Each chose a middle bunk – because no one steps on it to get up, but they're not too high. They will keep their bunks when additional female soldiers arrive – and 20 out of the 80 personnel who will be serving on the ship are expected to be women. Unlike her three female shipmates, Klieger shares a room with two male officers. When space is short, male and female officers are allowed to room together. The shared room boasts two standard bunk beds and has a private toilet and shower.

In 2000, Ora Peled became the first woman to complete the Israeli Navy's officers training course. She served on a Sa'ar 4.5 ship. In the November 2018 recruitment, nearly two decades later, the navy allowed women to train to serve on missile ships. They serve two years and eight months, and some sign on for an additional time.

The female sailors who enlisted two years ago were trained to serve on the INS Magen as part of a long-term strategy. The new ship was planned from the beginning to accommodate both male and female sailors, unlike the previous models of missile ships, which were retrofitted to include bunks for women. On the older missile whips, sailors' shower time was limited to 20 seconds to save clean water. The INS Magen carries more water and has a better filtration system, as well as a heating system that provides constant hot water.  

"The only difference between us and the guys is the separate quarters, bathroom, and shower," says Eshuel. "Nothing other than that. We're all friends, even kind of a family. You don't feel a difference. We were with the same crew on the Sa'ar 5, so we all got used to each other."

Klempert: "On the Sa'ar 5 they really had to get used to the presence of girls. There were a few who arrived before us, and separate quarters and bathrooms had to be provided for them. The guys also had to adjust themselves to the presence of girls. There were a few who took a minute or two to realize that they couldn't walk around in a towel after getting out of the shower. After everyone gets used to it, you can find lifelong friends here. I see my friends from the ship as family. You grow with them, breathe with them, do everything with them, more than on other bases."

When Klieger began serving as an officer on the INS Hanit ("Spear") at the end of 2017, she realized she would have to share a room with two men. "I had a moment of embarrassment. What do we do now? How do we dress? Do I have to go to the bathroom far away and get dressed there? But I came in with confidence, and together we decided on rules about how to handle it. When I wanted to get dressed, they'd leave, and I'd lock the door and dress. When they wanted to get dressed, I'd leave. On the INS Magen, we have an adjacent bathroom and shower, it's a different world."

Polianker: "Anyone who hasn't lived on board might think there's always sexual tension between the guys and the girls. But everyone here knows the limits, and what each one of us [women's] limits are, and what will make her uncomfortable if they go beyond that. I don't think there was any moment on a missile ship when I felt uncomfortable."

Klempert: "The guys here know that I can work just like any of them can, and there's no reason for me not to be one of them. No one would come up to me and say, 'You're upset because you have your period,' or anything like that."

Klieger: "I'd like to see a guy say something like that. I believe that each one of us has a strong enough personality to say, if necessary, that someone has gone too far. Happily, that hasn't happened. It's possible that in the first couple of days guys will say, 'Hey, there's a woman in command,' but after two days, when I prove myself professionally, it won't matter."

Q: There was a recent report that an NCO in the Israeli Navy is accused of taking pictures of female sailors in the shower. Did it ever occur to you that something like that could happen on board the ship?

Klieger: "It has occurred to me. When I get dressed in a shared room, I lock the door and don't leave it open so no one will come in without knocking. But we're all aware, and the environment on board is different. When we say that we're all family, it doesn't mean I want to see my brother walking around in his underwear. When it comes to that, we are very careful about privacy."

None of the four is currently in a relationship. Klieger last had a serious boyfriend when she was in officers' training, and they later broke up. Klempert dated a combat soldier before she was in the military, but since she enlisted, she hasn't been romantically involved.

Q: Is it possible that men avoid dating you because of your jobs?

Klempert: "There have been guys who started to flirt with me, and when they heard I was in combat and spent a lot of time at sea and on a ship, said it wouldn't work for them. As if it were obvious that a man can be a combat soldier and go home to his girlfriend only every so often, but when it's a female combat soldier, it's different. Right now I don't feel emotionally available for a relationship, because I prefer to concentrate on my job."

Sailors assigned to the INS Magen spent the last six months in Germany to prepare the ship to sail to Israel. They stayed at a hotel and were required to adhere to strict security protocol, such as wearing civilian clothes and staying in small groups, and avoiding loud conversations in Hebrew. They also had to change their travel routes frequently. Only on deck did they wear black utility trousers and long-sleeved blue shirts. They were flown to Israel for visits in April and in August.

On Oct. 29 the Israeli flag was raised on the deck, and command of the ship was officially handed over to the Israeli Navy. Since then, the four female sailors have barely set foot on dry land. They have learned every part of the ship, down to every screw, and practiced sailing it.

"We studied a lot of theoretical material in Germany, but you can only put it together once you're on board," says Klempert.

Klieger: "To completely know the ship, you need to live on it and sail on it. You need to know what's good and what's bad about it, experience it thoroughly."

Polianker: "On a voyage, we're together 24 hours a day. You live and work on board, and the only quiet time you have is when you draw a curtain [in the bunk]. Everything happens on the ship, and everyone finds her own quiet place."

Klieger: "On other ships, there wasn't even a curtain, so this is an improvement … With nine people in a room, you don't really have space for time to yourself. So either you get into bed and draw the curtain, or you talk to one of your friends on board."

The sail from Germany wasn't easy. "The sea was rough," Polianker says. "I handed out anti-nausea medication to everyone, and I took it, too. Other than a few guys who could handle the sea better, everyone was throwing up. There was even someone who lost a lot of fluids and had to get an IV."

Klempert raises her hand: "That was me. So embarrassing. I don't know how I vomited so much on such a big ship, which is supposed to be stable. After the IV I recovered, got up, and went to my shift. They didn't have to substitute anyone."

Eshuel stresses that this doesn't happen on every voyage. "Throughout my entire service, I've thrown up maybe twice."

Klieger: "There's no one who doesn't throw up at sea … If a person is born with a tendency to get nauseous, like me, will feel it even on an ordinary day at sea. I throw up on car trips, too. There are vomit bags on board, you step aside, everyone plugs their ears, and that's it. You tie up the bag, throw it in the trash, rinse out your mouth, and go on. The first time I was seasick, the crew comforted me and told me it happens to everyone … The goal is to be able to throw up and keep on going. When there are enough people on board, we try to let a person rest, so it won't be a trauma. But after a few voyages, people need to get used to not feeling drained after they throw up."

There were also exciting moments. "You're sitting on the bridge, everyone's serious, gazing at screens, and suddenly someone points and shouts, 'Dolphin! Dolphin!' We also saw whales, sea turtles, and strange fish that I have no idea what they're called," Klempert says.

All four women have been on operations outside of Israel's territorial waters. "You recite the traveler's prayer before you sail, and know that you're doing something super important. It's an amazing feeling. Crazy adrenaline," says Eshuel.

Klieger: "Enemy missiles can reach Israel's shores, too, but when you're at sea, especially when you're outside Israeli waters, the entire crew is on alert. There's more tension. Then you get back after a crazy mission, and you can't tell anyone … not even sailors on other ships. At least you know you took part in something bigger than you are."

They admit that every voyage entails fear of the unknown. "The first time I sailed as an officer, a year ago, I was really frightened," says Klieger. "While the entire defense of the ship didn't depend on me, if we don't complete an important mission like intercepting a missile, the responsibility lies with me. It's stressful.

"I was always telling myself, it wasn't my first time at sea, that I had an experienced crew, everything would be all right. The more time passes, you gain more and more confidence. One of the big advantages of serving on a ship is that it's a group game, not a solo game, like a plane. There's always more oversight, and more people who can help," Klieger adds.

Eshuel: "The first few times I was on board the INS Lahav ("Blade"), the last ship I served on, I imagined the Dakar submarine. The thought that I serve on a missile ship that is exposed to threats and not always defended put me off. I was anxious. How could I know that if a missile were fired at us, all the systems would work, and how could I be sure I wasn't heading out on a suicide mission? I talked to my commanding officer about it. He sat with me and took me through all the defense systems until I understood the basics and the reasoning behind all sorts of things we do on the ship that are designed to protect us. It also calmed me down, because I know what happens at every stage of the mission.

Q: Do you still have stressful thoughts?

"Yes. Before we left Germany, I asked the commanders if we would be accompanied or on our own, because the ship wasn't armed. They explained that we had ships with us … but I truly stopped being afraid only when I saw the Israeli Navy ships join us in the last few kilometers before we arrived."

En route from Germany, they missed their families keenly. Use of cellular phones is not allowed at sea, so sailors are cut off from the world. Eshuel says she was impatient to talk to her mother and tell her how excited she was about the new ship, and Klempert, who was promoted at sea, in accordance with missile ship tradition, had to wait days to tell her parents.

The Israeli Navy collected video footage of the sailors' families and would show it as a surprise from time to time during the voyage.

"The guys tried to stay cool, but we burst out in tears. Even the sailors who have kids cried when they heard their children," Klieger says.

Irina: "I cried when I saw other people's videos, it was really moving."

While at sea, news updates are collected for the sailors – five minutes of news and a few sports scores.

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Klieger: "There's a rule that they don't announce terrible things that happened in your city so we don't find out in the middle of a voyage that something happened so someone close to you. In any case, there's nothing we can do about it from the middle of the ocean. There's actually something good about that detachment. It gives you a few days when you're only with the people who serve with you, and you leave your routine and enter a kind of calm. Because the sea is simply beautiful, and you see the sunrise, the sunset, and stars, and the moon, and a lot of nature that's hard to notice when you're stressed by work."

After a few days of leave to recover from the long trip from Germany, the women returned to the ship. They stowed their gear, put on utilities, and started to work. The ship is due to be outfitted with radar, a cannon, 16 anti-ship missiles, a system to defend the ship from missiles and aircraft, and more. A full 90% of these systems are Israeli-made, which means that the work is slated to continue for another year and a half – long after Eshuel and Polianker are due to be discharged.

Eshuel: "There's something very exciting about the fact that this is the first ship of its kind, and we are trying out the systems and the structure. I really want to stay and see how it looks at the end, but I'm not sure I'll sign on for extra service just for that … we'll cross that bridge when we come to it."

Klieger: "Even I don't think I'll be privileged to see the ship operational. My 'money-time' is now, because my job is to oversee all the installments of the defense systems and make sure that everything is as it should be. I'd be happy to have the privilege of serving on it once it's operational."

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