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Homeland/The following text was published in Homeland and its republishing in the latest news does not mean its endorsement Elahe Mohammadi | In the world's military literature, there is a term called "bullet shock"; a shock not only from the physical impact of the bullet, but also from the sound of the shot, from the terror before it hits; a tremor that targets the brain before the body, scratches the ear from the inside, and its sound does not end for years. In Iran, we call the victims of this shock "waves"; people who were not hit by a bullet, but the wave of the explosion took away their peace of mind. Like the 45,000 fighters who fell victim to the silent virus of war in the Iran-Iraq war, without sustaining any visible wounds. Now, 37 years after the 8-year war, in the recent 12-day war, this virus has again crossed the embankments and reached the depths of Iranian soil; to the back of the treatment and relief front. To the hospitals. To the nurses. Technicians like Mohammad Reza Azizi, 49, a technician at the emergency medical center in the city of “Meanrahan” in Kermanshah province, who suffered shrapnel tore through his side and knees after an Israeli missile attack on the area on June 16. But he is now afraid of even the simplest movements. He cannot sleep. He has nightmares at night; nightmares of bombings and awakenings filled with body tremors: “When I am alone, it feels like the world is falling apart. My brain is about to explode. My body is shaking. My ears are about to go deaf.” Mohammad Reza says he has been so involved with his family, breaking windows in the house and beating his wife and daughter that his brother told him, “You are no longer the same Mohammad Reza you used to be.” Mohammad Reza was discharged from the hospital after a few days, but he was so broken, nervous, and uncontrollable that his family transferred him to the Farabi Psychiatric Hospital in Kermanshah; the same hospital that itself was not spared from the missile damage, and as Alireza Ebrahimi, the head of this hospital, told Hammihan, 300 of its 600 staff members have been suffering from symptoms of shock after the explosion on June 16, and some of them are in bad shape. That day, 150 patients were transferred from this hospital to Imam Reza Hospital in Kermanshah, and most of their families came and took them, but as the head of Farabi Hospital says, 20 of the patients had no one to come after them, and now they have returned to the only psychiatric hospital in Kermanshah, Farabi; with their minds more wounded than ever. In this war, the hospital was not only a workplace for Mohammad Reza and hundreds of other healthcare workers, but also a minefield for their psyche. They are now dealing with the most wounded part of the war; a silent, smokeless, and bloodless wound, but with a voice that still shoots in their heads. The war is not over for them yet. The whistle of a missile, the starting line of a life of waves, is not just a physical condition, but a broken life. Missiles that are still fired in the brains of survivors, windows that break in sleep and wakefulness, and a mind that is destroyed anew every day by the same whistle, the same wave. There is no longer a boundary between war and the hospital bed. During World War I, thousands of soldiers suffered from mental disorders after being exposed to explosions. At first, this condition was attributed to the physical presence next to exploding bullets, but it soon became clear that the psychological impact of war was unprecedented until then. Statistics show that more than 13,000 cases of gunshot shock were recorded in 1915 alone, and by the end of the war, this number had reached about 200,000. There is no exact figure for the number of people who suffered from gunshot shock after returning from the fronts of the Iran-Iraq War or who struggled with it years later. Some statistics say that about 45,000 people, many of whom were during and after the war, were hospitalized in mental hospitals. Now, Mohammad Reza, 49, with 27 years of experience in emergency medicine, is one of the "waves" of the new war, the 12-day war; he is a man who was caught in the heart of the medical center. He has been working at the "Meyanrahan" Comprehensive Health Center, a part of the Sahneh County of Kermanshah, since 2018, and was there as the head of the shift on the day of the Israeli missile attack. He was sitting there, unaware of what was about to fall on him; Until a strange whistle changed everything. “I heard the whistle of a missile... a whistle I never thought I would hear one day.” The missile targeted a shed just two meters from the base; those two meters were the distance between Mohammad Reza’s life and death. “If I had been outside, I would have been destroyed. That one wall saved me... but not my soul.” With the explosion of the first missile, it was as if Mohammad Reza’s brain had been put in a press; a tremendous pressure, a numb body and head, unconsciousness, and then transfer to the hospital in the “Scene” city, with a bloody face and head. When he regained consciousness, nurses were busy stitching up wounds that he still hadn’t erased from his mind. But the story didn’t end there. The shrapnel lodged in his back, side, and behind his knee, right next to vital arteries. The doctors said they couldn’t be removed. And his ears? Their membranes were intact, but their nerves were crushed; “Both of my ears are like tunnels with the wind constantly blowing through them. The sound of the explosion, the sound of that damn whistle still echoes in my head.” After a few days in the hospital in Sahneh, Mohammad Reza returned home, but not to his old life. “I thought that just being alive was enough.” But it wasn’t. His decision-making was chaotic, he became aggressive, and he lost control of his behavior: “I got into an argument with my family. I broke the windows in the house. I hit my wife and daughter. My brother said, ‘You’re not the same Mohammad Reza you used to be.’” Mohammad Reza is now being treated under the compassionate supervision of Farabi Hospital officials, especially the hospital director. “The photo my family showed me showed my back like a tire that had been hit hard; red and swollen.” Mohammad Reza, a veteran emergency room technician, now covers his head with a handkerchief so that he might hear the sound of that deadly whistle less. His car, the result of years of work, was pulverized in the explosion. Now he has only enough to live on. His medication dosage is changing, but it is of no use. He himself says: “I am a wave now.” Psychological injuries of personnel; more than half under treatment Alireza Ebrahimi, a neurologist and head of Kermanshah Farabi Psychiatric Hospital, talks about a bitter day when the deadly explosions caused by the Israeli attack targeted part of the province’s psychiatric treatment system and left a deep wound on the body of the hospital that is the only refuge for mental patients in the region; patients with mental disorders such as depression, anxiety, obsession, madness and psychiatric disorders caused by drug abuse who were hospitalized in this hospital. On June 16, at around 9 am, like other professors at Kermanshah University of Medical Sciences, he was visiting patients at Farabi Hospital when several terrible explosions shook the hospital and damaged a large part of the hospital. In an interview with Hammihan, Ebrahimi said that all the patients were running towards the courtyard: "Because many parts of the hospital were damaged, many parts of the roof of the hospital had collapsed and needed general repairs. Our hospital was closed for a while, except for the emergency department. The mental hospitals were in a bad condition. The mental patients were all inside the courtyard, but anyway, we transferred our patients to the designated hospital with great difficulty." Ebrahimi says that the mega ICU of this hospital is still in disrepair: "We have a large ICU that was seriously damaged, now it has been destroyed and they are repairing it. The neurology and psychiatric wards are now usable, and the university president and the deputy governors and mayors all came and helped. The mental hospital is not like other hospitals. No one is burdened with mental patients and wants their own staff. "The university, provincial, municipal, Red Crescent, and emergency medical services worked very hard and arrived quickly on the day of the incident, were present at the scene, and cooperated." According to estimates determined by the university's technical and equipment experts, more than 100 billion tomans of damage was caused to Farabi Hospital's buildings and equipment, but what is more worrying is the psychological damage inflicted on the hospital's staff: "About 50 percent of our 600 staff suffered severe anxiety symptoms. Heart palpitations, insomnia, frequent nightmares, hearing impairments, and symptoms of wavering are common among them. We are currently treating them with a diagnosis of acute anxiety disorder (ASD). The diagnosis of PTSD is not yet definitive, but we are concerned that some cases will go that way. A number of our colleagues are being treated for stress disorders resulting from this life-threatening incident." According to Ebrahimi, 8 hospital staff members were also physically injured and are undergoing treatment, but their psychological damage was greater: "The blast wave took these people and they suffered from these problems. The most important complication we found was the explosion itself. These are the conditions of people who are called "waves". It is possible that more of them will suffer from a wave-related disorder in the future." According to him, none of the staff members (except for those with physical injuries) have been given leave: "We insisted that everyone return to their place of service. Avoiding the scene of the accident stabilizes mental disorders. This is part of the treatment; we call it "exposure therapy." Despite the great difficulty, the staff members returned and continued to work. Many of them still visit us every day and complain of sleep disorders and nightmares related to the explosions." The head of Farabi Hospital in Kermanshah, emphasizing the special situation of mental patients, explains that it is not easy to move them: "The neurology ward requires special equipment, from windows to space design. It is not possible to transfer to any ward or hospital. That same Friday, the families took most of the patients, but we hospitalized about 20 patients who had not been picked up with the help of Imam Reza Hospital so that our wards could be renovated." According to him, no patient who was in the hospital that day has ever come to us with a panic disorder: "They have their own problems, and it is not like we have diagnosed a new disorder in them. Mental illnesses require a specific location, and it is not possible to hospitalize a mental patient in any ward. The windows of the psychiatric ward are different, and the facilities available to psychiatric patients are different from those available to other patients. For this reason, it is not possible to admit a psychiatric patient to any ward. For example, a psychiatric patient cannot be admitted to the neurology ward because they require special facilities. The facilities available to psychiatric patients are more limited and are used with more caution. This is not the case in other wards. In Kermanshah, no center admits psychiatric patients, and only Farabi Hospital does so.” Alireza Ebrahimi, head of Kermanshah’s Farabi Hospital, recounts the days after the attack with some of the bitter yet humane incidents: “The time has passed for a family to come after their patient. According to the law, when a doctor discharges a patient and his family does not come to pick him up, we take the patient home through assistance. This is not unique to recent events; we face many such cases under normal circumstances. Sometimes families abandon the patient and we have to return them home with an ambulance and manpower. This is costly for the hospital and puts a lot of pressure on us.” He says that in the very first days, when the families found out about the incident, many of them came and took their patients: “We prescribed the medicines they were taking in the hospital and gave them to the families to give to them. But there were still about 20 patients left. With the help of our designated hospital, Imam Reza, we temporarily hospitalized them until our wards could be reactivated. Fortunately, with good cooperation, in less than 10 days, most of our wards returned to service.” Ebrahimi emphasizes that the emergency room has not been closed for a single moment: “Our insistence was on keeping the psychiatric emergency room active. A psychiatric hospital is different from other hospitals. No center accepts psychiatric patients, so we must always be ready. The women's, men's, IT and electrolysis departments are all active and we did not allow the emergency department to be out of service for a moment.” In another part of his speech, he assures that fortunately no suicide attempts have been reported – either among patients or staff: “We provide special care to patients. Even the transfer to Imam Reza Hospital was done carefully and with care. In no way were the patients transferred without a caregiver.” But his concerns are not limited to the patients. According to Ebrahimi, the hospital has suffered heavy damage in terms of buildings and equipment and has provided much of the equipment on loan: “We owe the market and people helped us a lot. But we expect the Ministry of Health to quickly step in and provide financial support.” Finally, he praises his medical staff: “Our staff were the real heroes of this crisis. Even those who were not on shift quickly made themselves available. "Controlling 170 patients who were suddenly thrown into the courtyard was not an easy task. But it was managed so well that not a single patient fell out of bed or was injured. We hope that these efforts are not just on paper. Real encouragement is worthy of the service that these people have provided without any expectations." He says that to date, none of the doctors have come to me for treatment: "Doctors usually start treatment themselves. But nurses, radiology technicians, laboratory staff, physiotherapists and occupational therapists have come to me, and most of the visits have been from nurses." Fire, broken glass and terrified patients At around 9 am on June 16, just as university professors were visiting patients at the Farabi Neurological and Psychiatric Hospital in Kermanshah, several massive explosions shook the hospital. In an instant, the roofs collapsed, the windows broke and everything was in chaos. The patients fled into the courtyard and the situation became critical. Some wards were rendered completely unusable, and the hospital was closed for a time, except for the emergency room. Ali Bahramian, head of public relations at Kermanshah University of Medical Sciences, was one of the first people to arrive at the scene after the attack on Farabi Hospital. What he describes is a scene like a fire nightmare, with mentally ill patients wandering around the hospital courtyard in fear and restlessness, terrified families running through smoke and broken glass, and nurses still standing there caring for patients. Three attacks, five and 10 minutes apart, targeted Farabi Hospital that day. Although no mortars directly hit the hospital building, the explosions set the back of the hospital ablaze. Bahramian, who arrived at the scene minutes after the attacks, told Hammihan about the severe destruction of the wards and vital equipment that day: “The mega ICU ward, which had been open for less than a year, was damaged, along with the server rooms, monitoring equipment, and even the administrative sections. The windows were broken and the tables and chairs were overturned.” Immediately after the attack, 150 hospitalized patients were brought to the hospital’s open area and then transferred to designated medical centers such as Imam Reza Hospital. However, the consequences of the attack were not only physical; many patients in the neurology ward suffered psychological trauma again, a shock that their families also suffered. A number of medical staff suffered shock and some were injured in various parts of their bodies. However, medical services were resumed after a few hours. The patients who were transferred returned to Farabi within two to three days, and to make up for the shortage, beds were received on loan from other hospitals. Bahramian says: “The mega ICU department suffered the most damage due to its highly specialized and expensive equipment. The initial estimate of the damage is about 115 billion tomans.” Masoud Qaleh-e-Safidi, head of the Medical Emergency Center at Kermanshah University of Medical Sciences, told Hammihan that even Imam Reza Hospital and the surrounding faculties were not spared from the Israeli attacks: “Four of our medical centers were directly affected by missile attacks. The windows were broken, the walls cracked, and the complex faced structural problems. We also had two cases of ambulance destruction in Kangavar city. One belonged to Sahneh city, which was dispatched to help, and the other from Kangavar itself, which was overturned by the blast wave. The Mahidasht Health Center also suffered damage.” The faculties of nursing, paramedical, health and nutrition are the four faculties of the University of Medical Sciences that are located near Farabi Hospital, which, according to Bahramian, the Faculty of Nutrition has suffered the most damage. Qale-e-Safidi is also clear about the main demand of the University of Medical Sciences from the authorities: "We have sent a full report of the damages. The university is pursuing compensation for these damages. The return of ambulances, reconstruction of centers and restoration of the health service cycle require serious support from the Ministry of Health. Infrastructure must be restored so that the emergency medical system can serve the people with all its might." Ehsan Khajehvand, an emergency technician at Farabi Hospital in Kermanshah, also tells "Hammihan" about that bitter and unforgettable day; the day when the shadow of the explosion fell on the roof of a medical center: "The explosion was right behind the hospital; somewhere near the warehouse and the truck showroom. The blast wave was so intense that large stones were thrown from behind and fell in front of the emergency room. Many cars were damaged, and the back of the hospital, including the inpatient wards, suffered the most damage. He says that although the emergency room was located at the entrance of the hospital and suffered less damage, the scene in other departments was shocking: "All the windows in the inpatient wards collapsed due to the pressure of the blast wave. The hospital's false ceiling came down and many of the vital ICU devices were seriously damaged. The patients' heart rates were extremely high; from the fear and psychological stress caused by the explosion." A month after the incident, its consequences continue: "Every day, both patients and staff visit the emergency room. They have common symptoms; stress, anxiety, insomnia, headaches and hearing damage. We call these people the wave; because their symptoms are clear and identifiable." He says of the authorities' decision to follow up on the situation of these people: "A file has been opened for all patients who were in the hospital on the day of the incident, even if they have been discharged. This will ensure that if they return with symptoms of the outbreak, they will receive appropriate treatment." From Kermanshah to Mianrahan Farabi Hospital in Kermanshah was damaged in the Israeli attack on June 16, but more than that, the Mianrahan Comprehensive Health Center in Sahneh County, Kermanshah, suffered an accident. What Ali Bahramian, Director of Public Relations at Kermanshah University of Medical Sciences, and Masoud Qale-Safidi, Head of Emergency Medicine at Kermanshah University of Medical Sciences, saw there was a terrible and terrifying event. Bahramian speaks of the extensive destruction at the Mianrahan Comprehensive Health Center; a 24-hour clinic with a doctor, obstetrics and general wards, an emergency base, and doctors' residences: "No one was killed there either, but several people were injured. Many of the wards and equipment were destroyed. Several ambulances were also put out of action; ambulances worth more than 8 billion tomans each. Although no patients or staff were killed in the attack, several people were injured. The blast wave in the intersection was so intense that it threw the ambulance and people around.” Masoud Qaleh-e-Safidi, head of the Medical Emergency Center at Kermanshah University of Medical Sciences, also said about the shockwave that hit some staff at Farabi Hospital and the Mianrahan Comprehensive Health Center: “In these attacks, many staff, especially at Farabi Hospital, were injured. A total of eight of our personnel suffered serious injuries, including a doctor, several technicians, and nurses. Some are still receiving treatment, and for others, the effects of the shockwave may occur later.” He says the Mianrahan Comprehensive Health Center was severely damaged: “The missile was only one or two meters away from our emergency medical center; the medical pavilion was completely destroyed, several vehicles were destroyed, and two emergency technicians who were present at the scene miraculously escaped death but were injured. One of them is still hospitalized in Farabi Hospital.” Qale-e-Safidi means that one person, Mohammad Reza Azizi. The same person Ali Bahramian also mentions; the technician at the Mianrahan Emergency Center who was hit by the powerful blast wave that day and has not let go yet: “What can I say, it’s been a wave, a wave.” According to Bahramian, Mohammad Reza was hospitalized that day and is now in the neurology ward of Farabi Hospital. Farabi Hossein Kermanpour Hospital suffers the most damage, says the head of the Public Relations and Information Center of the Ministry of Health, to Hammihan. During the 12-day war, hospitals and medical centers in the country were damaged from minor to 50 percent, but none were completely destroyed and closed. According to him, Farabi Hospital in Kermanshah suffered the most damage in the entire country, which was largely destroyed, and they are now reconstructing the damaged parts. He says that by destruction, he does not mean rubble: "But the percentage of destruction was such that some parts of the damaged hospitals lost their therapeutic efficiency. During the war, basically nothing was done for reconstruction because we were afraid that the same thing would happen again and that what we were doing would be ineffective." According to Kermanpour, when Farabi Hospital in Kermanshah was damaged, patients were transferred from that hospital to another location: “Now that the war is over, or rather, a ceasefire has been reached, Farabi Hospital officials are working to ensure that the necessary reconstruction is carried out.” He says that some centers were completely destroyed in those 12 days: “The emergency base in Hoveyzeh was one of the centers. We had four or five emergency bases that were severely damaged. Or, for example, the health center, a comprehensive health center where vaccinations for children and care for pregnant mothers are carried out and general practitioners go there to visit people, was also severely damaged. One of these centers in Kermanshah was also completely destroyed, and is now being rebuilt so that it can resume its work.” According to Kermanpour, when emergency centers are attacked, the situation worsens because these centers are the closest places to treat people in the event of an accident: "If a base is destroyed in an area, then if an ambulance wants to take its patient there from another place, it will have a problem; because the same time that the ambulance spent to get to the medical center, it must spend again to transfer the patient to another center and the patient may be harmed." He says that the parties to the war must adhere to the international conventions of sustained war, which of course Israel did not: "This destruction harms patients. Several of our ambulances were out of order, which makes it difficult to provide relief." Kermanpour says that as far as he knows, no one was killed in these centers and hospitals that were damaged, but there were injuries: "For example, when Farabi Hospital in Kermanshah was attacked, several patients were injured. But the important thing is that the hospital where our most oppressed patients are hospitalized was damaged; that is, the patients with mental disorders. The condition of many of these patients is such that sometimes they really need someone to accompany them and they cannot do many of their tasks themselves.” He continues: “When a bomb was dropped near Shahid Motahari Hospital, which is an accident and burn hospital, many windows and ceilings collapsed. In this hospital, patients have special bandages that they cannot walk properly with. Now imagine if something like this happened. That day was very scary and terrifying for these patients. In other words, they felt very lonely. Naturally, this incident would not only disrupt their treatment, but also affect them with its psychological consequences.” Kermanpour says that several pre-hospital emergency technicians, or 115, were also injured: "When technicians were providing care to patients in ambulances, a missile landed near them, and the blast wave damaged the vehicle that was quickly transporting the wounded. Our colleagues were also seriously injured and were hospitalized, receiving treatment, and several were killed." In the Israeli attack on Evin Prison, in addition to Dr. Shirvani, the prison doctor, two technicians who were helping in the Evin hospital were also killed. According to Kermanpour, the rest of the medical staff who were killed were in their homes.