Just a few days after the Oct. 7 Hamas massacre, medical clowns Nimrod Eisenberg and Smadar Harpak — and their alter-egos, “Maximiliano” and “Shemesh” — went to the Dead Sea to visit members of Kibbutz Be’eri, one of the hardest hit of the southern communities in the attacks with 100 members murdered and 29 taken hostage into Gaza.

Veterans of medical clowning, Eisenberg and Harpak, members of the Dream Doctors nonprofit, have worked with many communities who have suffered trauma due to natural disasters and war, most recently in Ukraine. But this time, it was different.

“I know the atmosphere and the environment. I know my place in it. But everything was very different. I have very close friends in Be’eri. This time it was very strong emotionally and personally,” said Eisenberg, who is also the head of development of the nonprofit Dream Doctors. “It was very clear because we were dressed up and had red noses, that we were clowns, but the first half-hour people avoided eye contact with us, the children were running around with excess energy. We were sad ourselves.”

And then an older woman took them aside, looked them in the eyes and told them: “Your sadness is our sadness. Only you can change this.” They hugged, in tears.

From that moment, they realized how they needed to work and how to be attentive and sensitive to the people’s reaction to them. “Maximiliano” — “Max” for short — who juggles with numerous colorful handkerchiefs, playfully tossed them out, and he and “Shemesh” began crying into them in a clown-y sort of way. That caught the children’s attention and they also started taking some of the handkerchiefs and mimicking the two clowns crying effusively into them, beginning to interact with “Max” and “Shemesh.”

“This is how clowns can connect sadness with happiness, with childish joy, bringing the strength to confront what is difficult to confront,” said Eisenberg. “The very clown thing evokes emotions, and provides the ability to deal with difficult emotions. If we play, we can turn the heaviness into lightness and deal with the heavy emotions.”

Since mid-October, Rinat Feniger-Schaal and Tamar Benbenishty of the University of Haifa’s Graduate School of Creative Arts Therapies have been leading an observational study dealing with the role of the medical-humanitarian clowns on behalf of the Dream Doctors association, working with the families of evacuees from the south as part of the mental health system. 

Initial conclusions from the study indicate that medical clowns have played an important role in healing the psyche of the population that experienced trauma on Oct. 7, uniquely helping to deal with emotional vulnerabilities, according to Feniger-Schaal.

“From the material we are collecting, a clear and strong picture emerges of the significant work of the medical clowns from Dream Doctors and the unique characteristics of their work, even compared to other professionals in the field,” she said.

Visiting the evacuated survivors on a weekly basis, the researchers interviewed parents, children, mental health professionals and the medical clowns, whom they also observed at work.

Dream Doctors is a nonprofit organization established in 2002 with a mission to make medical clowning a recognized profession in the health system in Israel. Today, the group partners with 33 medical centers in Israel and since 2004 is working in all aspects of humanitarian missions globally around the world and also during wartime in Israel. Since 2016, Dream Doctors has been recognized as reservists for Israeli military field hospitals sent to aid in natural disasters and refugee aid missions. Its clowns have gone on 20 missions to work in refugee camps in Ukraine, Moldova and Poland.

Because of the nonprofit’s experience and networks, it was  able to send out clowns on Oct. 8 to families who were affected by the attacks and evacuated to the Dead Sea, Eilat and the north, said Dream Doctors CEO Tsour Shriqi. The group also added extra hospital hours in rehabilitation centers where injured soldiers and citizens were hospitalized. Shriqi estimated its clowns have done 20,000 interventions working with some 4,000 families across Israel since Oct. 7.

Based on Dream Doctors experience, though it may appear counterintuitive to bring a clown into such a situation where people have lost their homes and loved ones, when done with sensitivity it has an “enormous positive effect” on everyone, he said.

“We were giving emotional support especially to kids, and also to parents and adults to get to normalization of the event,” said Shriqi.

The clowns themselves were going through various levels of personal trauma and sadness — as was everyone in Israel, he said, and they added more intensive and personal interventions to their regular emotional support system for the clowns. One of the Dream Doctors clowns, Shuli Victor, is from the Nir Oz kibbutz, where a quarter of its 427 members were either murdered or kidnapped in the massacre.

For Victor, a second-generation Holocaust survivor who lost many friends in the massacre, his work is also allowing him to work through his own trauma. 

“The pain, mourning and grief is like a spring that explodes through humor. I can be a better clown because of the tragedy. As a second-generation Holocaust survivor there was always pain,” Victor said. 

Victor was in Tel Aviv at the time of the attacks. Two days later, he was working and interacted with a 75-year-old woman whose husband had slowly died in her arms over eight hours while waiting for someone to come rescue them. “I told her I was a medical clown and had come to make her laugh. She asked me to give her something optimistic.”

He told her a joke comparing her experience to a medical procedure he had just gone through, and she laughed.

“If I can make someone who has just lost her husband laugh, that is my job,” he said.

Dream Doctors is now shifting its work to more coordinated activities as part of the routine for the communities, Shriqi said.

The organization is mostly funded by philanthropists around the world, with a clown for one year in a hospital costing $18,000. This includes the Australia-based Moose Happy Kids Foundation, as well as a number of private, anonymous donors, Shriqi said. All emergency donations for the evacuees have gone directly to their work with those communities, he said. So though they had a higher total budget in 2023, they found themselves struggling to fundraise for their core program. The group’s budget for 2024 is $1.58 million. 

Dream Doctors has just launched a pilot project for the first certificate program for medical clowning as part of health-care academic studies globally, in conjunction with the Shamir Nursing School of the Hebrew University Shamir Medical Center.

The study on medical clowns began last year in cooperation with Dream Doctors and a European medical clowning organization working in refugee camps in Europe, but following Oct. 7 the two Israeli researchers realized that after the horrific event in Israel, they were not emotionally available to continue with the study in Europe, she said. Instead, they decided to focus  their efforts into studying the role medical clowns were playing in helping the Israeli communities deal with their trauma, visiting evacuated communities — including from the kibbutzim and Sderot — in the spas and hotels that were hosting them.

“We didn’t know what to expect. People were very suppressed, talking to each other but there was a sense of silence,” said Feniger-Schaal of their first visit to Kibbutz Sdot Yam, located along the Mediterranean Sea where survivors from Kibbutz Zikim and Moshav Netiv HaAsara were being hosted. “Then the clowns came, just playing with the children — it was different, the very opposite of what we saw with the adults. The clowns brought a sense of playfulness, contradictory to the sense of stillness, stress and depression. It was very obvious they were bringing something else: a sense of life, something vivid.”

The clown “Avital” explained to her that as opposed to party clowns — many of whom came to visit with good intentions but were not readily accepted — medical clowns do not try to put on a good performance or make people happy. Their intention is to help people connect to their ability to heal themselves, to their inner forces by being creative and playful.

In later interviews, one woman revealed that she and her sisters had not been able to speak with each other about what they had gone through. Then one day they had a birthday party and the medical clowns joined in and started making dark jokes and that had opened up the floodgates allowing them to start sharing their experiences, she said. Another woman said that a clown had asked permission to make jokes about the “safe rooms,” and then it wasn’t difficult to hear the jokes. A father explained how he wasn’t able to be there emotionally for his children because of the myriad of concerns he now had, but seeing the clowns allowing his children to be playful and express their feelings through play was a big support for him. A social worker who was interviewed said at first she felt frozen, not knowing if it was OK to laugh, and then the medical clowns arrived and brought with them a sense of life, giving permission to laugh, play and be silly — demonstrating that it is OK to be a part of life.

“The quality of a medical clown is that they are very sensitive, and brave. When other people maybe won’t be able to tell jokes, a clown will say: OK, let’s talk about what people are not talking about, death and loss. At the same time, they are very sensitive to enter and see where it is acceptable,” Feniger-Schaal said. “Every time I observe it I am so inspired by how they help bring people back to life.”  

Medical clowns are not necessarily funny, she added, but she believes they are the best agent of play, specialists in making an encounter.

“They come to a child, or an adult, who are shattered, and help them rise up a bit to meet the clown,” she said. “There are so many people trying to provide emotional and mental help, but the uniqueness of clowns is that they are not sitting in a clinic but are outside, meeting people where they are. There is no sense of hierarchy.”