After a year of treatments and therapy, Haifa resident Rita Yadid, 34, can recount step-by-step — without breaking down in tears — how she, her husband and younger sister survived the bloody Hamas onslaught on the Nova dance party on Oct.7.

How they hid in a trailer with the door locked, but were still exposed, surrounded by 10 windows, waiting for death and hoping to be rescued; how her husband and another young man who was hiding with them were injured in a spray of machine gun bullets into the trailer; how miraculously the terrorists did not try to look in through the windows; how they heard the screaming and terror all around them, and how later in the day a civilian from Gaza did peer in through the windows, demanding their cell phones and money and then leaving. 

She can describe — without crying — how they heard Israeli helicopters overhead but none came to save them and how finally after eight hours of sheer horror a group of soldiers arrived and rushed them out to a safe place as they ran past corpses and burned-out cars.

But appearances can be deceiving and while Yadid can recall all of that without collapsing, like the vast majority of the other survivors of Hamas’ massacres, Oct. 7, 2023, is not over, and there are still times when she feels she is crumbling to pieces.

“Suddenly you discover that you are neither strong nor do you have your feet on the ground, and you still have a lot to work on,” said Yadid, who studied life coaching a decade ago and has always viewed therapy as a helpful tool to help her navigate life’s ups and downs. “I can’t say I don’t need therapy. I can’t say I’m fine, and [my husband] doesn’t need it. I need as many treatments as possible, as much as they can give me. I’ll take everything because I understand that today I’m in a different place [thanks to the therapy]. This is something I absolutely can’t stop now. A year has passed and there are still hostages in Gaza and my sister or my husband or me could have easily been one of them.”

Yadid is among some 3,000 Nova survivors who have sought help from the Safe Heart nonprofit, which was formed almost immediately in the aftermath of the attack. The organization is led by a team of psychologists and therapists who specialize in the effects of psychedelic and other types of drugs — both as a therapeutic tool and helping those using them recreationally — and who are often present at trance raves like the Nova festival.

Yadid credits her yet tenuous and fragile ability to confront the new reality of her life as a survivor of the massacre to the various forms of psychological help she has received through the group, which is a partnership funded by private donors and government sources.

With hundreds of thousands of Israelis like Yadid impacted by the events of Oct. 7 — including survivors of the terrorist attack, evacuees from the south and the north, friends and families of hostages, the families of reservists — Israel has been dealing with unprecedented numbers and trauma needs, the scale and content of which the country has never seen before, according to the Israel Trauma Coalition (ITC), calling it a “race against time” to reduce the risks of widespread chronic trauma to help Israelis “find hope and resilience once again.”

In 2007, the ITC, in conjunction with Israel’s Health Ministry, implemented the resilience center model throughout the country, establishing local resilience centers that offered treatments and support for area residents. A 14th center, the National Resilience Center, was created on Oct. 15 to provide services for all those who live in places where there isn’t a resilience center, said ITC CEO Talia Levanon. Based on the partnerships they have built over the past 20 years on the local and national level they have been able to provide responses in the areas of direct care, emergency preparedness, professional training and support and community resilience, which have benefited thousands of Israelis including in Arab municipalities.

The number of people needing therapy services is “mind-boggling,” Levanon said. In 2020 the resilience centers worked with 8,000 clients nationwide and since Oct. 7 that number has grown almost five-fold with 38,000 people reaching out to them, she said. The need is much greater than the number of clinicians available. For example, she said, even though they have increased the number of clinicians in the resilience center for the Gaza envelope from 240 to 1,400, it is still not enough.

In the past, Israel suffered from a shortage of trained therapists in the public sector — primarily due to low salaries and poor work conditions. Now, however, even with an influx of government and philanthropic funding for treatments, the country is still facing a shortage of properly trained clinicians across the board, even with private practices also providing services.

This will continue to be an issue going forward as Israelis — even those who were not directly affected by the Oct. 7 attacks — grapple with the past traumatic year and the ongoing fighting.

Estimates vary on the number of Israelis who are expected to experience post-traumatic stress disorder as a result of the attacks and the war, with some researchers putting the number in the tens of thousands while others put it in the hundreds of thousands. A recent study by the Social Finance Israel Group and the psychedelics research group MAPS Israel, as part of the latter’s HealingOct7 initiative, estimated that the increased number of PTSD cases in Israel will cost the country more than $50 billion over the next five years.

“We see people who were very highly exposed, who suffer from severe trauma and severe grief and complicated trauma and grief,” Levanon said. “But …there are many (other) people throughout the country who suffer from exposure to trauma. I think we’re all exposed to trauma, and we need to find ways to cope and understand ourselves and what’s happening. The issues we face are what is normal in this not-normal situation (as we) deal with it and (figure out) what control we have in this situation that we cannot control.”

While she refrained from describing Israel as a country in trauma, and stressed that not everyone will require trauma treatment, Levanon said ITC is providing training in a broad envelope of responsive tools which are needed ranging from psychoeducation, coping tools, self-help tools, and community resilience—including treatments aimed specifically for therapists, social workers, emergency squad members and first responders, Nova survivors, children and couples experiencing marital stress.

In addition, she said trauma treatment for Oct. 7 survivors needs to be viewed in a different perspective, with short-term therapy not even in the lexicon for their treatment.

Since Oct. 7 the government has funded 36 therapy sessions for anyone exposed to a terrorist attack, said Levanon, and though the Health Ministry and the National Insurance Institute recently announced an increase of 12 sessions for Oct. 7 survivors until the end of December 2024 and permitting off-duty soldiers who attended the Nova festival to receive equal compensation as the other survivors, there are still conditions for treatment the government has placed which need to be discussed, she said.

She noted that during Israel’s disengagement from Gaza in 2005, it was determined that a full rehabilitation for those suffering from trauma would be considered only five years after they were settled in their new homes. And now a full year since Oct. 7, there are several entire communities who are not even back in their homes, she said.

“We are not home yet,” she said. “We have a long journey of healing.”

Efrat Stern, the director of the Joint Distribution Committee’s Israel office’s division for people with disabilities, said the population that previously had stable lives has suddenly found itself in a vulnerable state with some 55% of the population in Israel experiencing anxiety on a clinical level. In addition, according to a JDC statement, with 83% of Israeli children showing symptoms of profound distress since Oct. 7 Israel has seen a significant increase in the number of individuals requiring mental health services. However, 65% of the population do not recognize themselves as people that need some kind of help, making reaching out to them for treatment more complicated, Stern said.

“When we talk about the mental health situation of people in the population in Israel, it’s [not just] about people with mental illnesses, we’re talking about the mental situation of each and every one of us,” said Stern.

For years the paltry government budget allotted for the mental health system had left it “starving,” she said, with the bulk of the funding going to programs for people with mental health disabilities. So now that Israel is facing a staggering number of people needing treatments for trauma, there are almost no existing big solutions for their needs, she said.

“We know whatever we do, there will never be enough therapists, there will never be enough psychiatrists, psychologists, social workers,” she said. “We know that we need to have a very wide range of solutions for every person in the country. But we need to make sure that the interventions we offer are good enough [for the needs]. We also need to have systems or programs or professionals who know how to identify people who need help.”

In response to these needs the JDC has implemented a comprehensive strategy combining trauma training, in-person interventions and advanced technology, according to a JDC statement. Drawing on its extensive experience from previous conflicts and crises, JDC has trained hundreds of front-line workers in trauma detection and established emergency services to support traumatized young children and their families. It has created the National Mental Health Initiative, featuring the Nafshi platform available on phone, tablet, or computer, which offers validated mental health resources tailored to individual needs, freeing senior healthcare professionals and one-on-one therapists to handle severe cases without leaving others untreated. Additionally, JDC has implemented “Quiet Rooms,” VR-guided spaces designed to help individuals process their trauma in a calming environment. These efforts are a result of partnerships with tech designers, therapists, social workers, local and national government, NGOs working in the mental health field, and the Jewish Federations of North America and other funders.

The government has been collaborating with numerous groups to organize mental health trauma treatment, noted Stern, including a NIS 72 million ($19.2 million) two-year project in collaboration with the JDC to train new professionals in over 100 municipalities in the field of mental resilience and enable them to formulate strategic plans to implement the correct therapy solutions for their residents, she said.

“We are working with the municipalities, we’re working with the social sector, we want to work with the philanthropic sector, with the business sector, to create resilience for the population of Israel,” said Stern. “If you’re asking me if it’s enough, no, there’s a lot more to be done. But if you’re asking me if it’s a good beginning, yes, it’s a good beginning.”

For the Nova survivors, it has been critical that therapists who work with them deeply understand the distinctive experience they have been through, noted Safe Heart co-founder and clinical psychologist Reut Plonsker.

“The trauma is the main part of it…they saw horrible things. But we realized that the effect of the psychedelic drugs is also a part of the story,” Plonsker said, and working with therapists who are not judgmental of that scene is fundamental.

Some 400 Safe Heart therapists are currently treating about 1,000 patients as well as families of survivors, she said, and they are collaborating with Haifa University researchers on a first-of-its-kind study which looks at trauma experienced under different psychedelics.

“I think one of the biggest problems with giving therapy to survivors of Oct. 7 is that the war is still going on,” said Plonsker. “It’s not over. So a lot of them have friends that are in captivity in Gaza, or a lot of them have friends who are still soldiers and still dying…or some of them went to reserve duty.”

In reality, added Igal Tartakovsky, psychotherapist and co-founder of Safe Heart in charge of group therapy, they can’t really begin to talk about rehabilitation and healing now.

“It’s more kind of holding it together,” he said. “It’s important right now, but we know that the true rehabilitation is going to start after the war, whenever that’s going to be. And so we know we still have a long time ahead of us for all this.”