Tag Archives: Tsfat

Treating Wounded Syrians in Tsfat

Mural in lobby of Ziv Medical Center in Tsfat (Safed), where almost a thousand wounded Syrians have been treated over the past five years.
Mural in lobby of Ziv Medical Center in Tsfat (Safed), where almost a thousand wounded Syrians have been treated over the past five years.

Health care in Syria is almost nonexistent after six years of civil war. Yarden, an Arabic-speaking social worker at Ziv Medical Center in Tsfat (Safed), cited a few illustrative statistics: “Their medical system is 70% destroyed. About a million people live in the border areas, but there are only seven doctors.” One doctor for every 143,000 people? The number was shocking.

My husband and I were on an Honest Reporting trip to learn more about how wounded Syrians were receiving care in Israel. Ziv’s program has evolved in response to a need.

In March 2011, when the civil war startedi Syria, the IDF had a policy of watchful waiting. But then, on Saturday, February 16, 2013, seven badly wounded Syrians crossed the border into Israel. IDF medics evaluated them and transported them to the nearest hospital. Ziv doctors were called to come in for an emergency. They had no idea who the patients were or what the problem was until they reported for duty and met the wounded Syrians.

Syria has been at war with Israel since May 1948. Syria’s leaders have refused to participate in any peace talks. They have never considered negotiating a treaty. These wounded men were our enemies. But the doctors did not hesitate—an injured person is a person in need of care. The men were treated. When they recovered the IDF took them back to the border and sent them home. Since then Ziv Hospital has treated almost 1000 patients who have made their way over the border.

Yarden instructed us not to take any photos. Photos could endanger the men and their families. We never learned any patient’s name. All newspaper and TV stories about treatment of Syrians in Israel change patients’ names and either blur their faces or photograph them from an angle which does not reveal their identity.

Dr. Lerner describes care

We met with Prof. Alexander Lerner, the Director of the Department of Orthopedic Surgery. He first described the care of a young bearded Syrian man whose left arm looked like it was caught in a metal cage. The elaborate fixation device was attached by pins to his arm. Dr. Lerner explained that the man’s elbow joint had been destroyed. The hinge in the middle of the device was locked to keep the reconstructed joint still. As the bone and muscle start to heal, therapists will release the lock to perform physical therapy. Later, the patient will also need a skin graft.

Like many of the injured Syrians who are treated at Ziv, this young man will probably go home with the fixation device still in place. The devices cost $2000 to $3000 each. For local patients, they are used several times. But Syrian patients do not come back to the hospital for follow-up; the expensive devices are not returned.

Another young man walked out of the room with his left leg in a cage-like fixation device that was longer than his leg. His foot hung in the air several inches above the end of the device, which rested on the floor. Despite the disparity in the lengths of his legs, the device enabled him to walk. He had arrived at the hospital with a partial amputation of his leg. When he recovers from a leg elongation procedure, he will receive a special shoe to enable him to walk.

Both Yarden and Dr. Lerner pointed out that they know nothing about these patients. Unless the Syrians themselves choose to reveal something, the medical staff have no idea if they are civilians or fighters. Many of the men say they were injured in an accident, and leave it at that.

The lack of medical history is a serious problem. Previous injuries, chronic diseases, even allergies are all unknown. The doctors can only hope the patient is not allergic to needed antibiotics.

Complicated trauma frequently results in infection. Dr. Lerner said that similar injuries treated at Walter Reed Hospital in Washington have an infection rate of 17%. However, the Syrians at Ziv are all infection-free by the time of discharge. It’s not just a matter of antibiotic use. Dr. Lerner believes the difference lies in continuity of care. By the time injured US military personnel arrive at Walter Reed, they have already been treated at a field hospital, a local military hospital, and the military hospital in Germany. At each point, a different doctor with a different approach cares for them.

At Ziv, one doctor directs all care from initial admission until discharge. He plans the first surgery with follow-up care, future operations, and

Dr. Alexander Lerner's book about what the staff have learned about complex trauma from treating wounded Syrians
Dr. Alexander Lerner’s book about what the staff have learned about complex trauma from treating wounded Syrians

rehabilitation in mind. He can follow those plans throughout the patient’s hospital stay.

Someone asked what Dr. Lerner had learned anything caring for these patients. Had he published anything about such complex trauma?

The doctor smiled. He proudly showed us a photo on his phone of his latest book, Complicated War Trauma and Care of the Wounded, which he co-edited with Salman Zarka. The book describes not only orthopedics and other surgical treatment, but also psychological therapy and ethical issues involved in treating soldiers and civilians from an enemy country.

Getting to Ziv Hospital

As word spread that free medical treatment was available in Israel, more and more Syrians started showing up at the border. They always arrive at night; it is impossible to safely cross the border during daylight. The IDF carries out initial stabilization of patients, and transports them to Ziv or to Poriya hospital for treatment. Because they arrive at night, it is often easier to get time in an operating room than during the day. The patients arrive with nothing. After an incident when a fighter pulled a weapon hidden in his clothing, the hospital only accepts patients in their underwear. The Red Cross provides them with clothing, a toothbrush, soap, and other necessities.

The patients are unaccompanied. No family member or friend can visit during their entire hospital stay, which can last several months. The only exceptions to this rule are children; a parent accompanies patients less than 18 years old.

Recently, Ziv has opened a free one day pediatric clinic. Every three weeks a bus brings Syrian children from the border. A parent accompanies each child. The clinic provides standard well child checkups as well as treatment for more complicated problems. Most of the children return to the border at the end of the day. Occasionally a child will stay for further treatment. Although they arrive during the day, like the wounded men, they probably travel to the border under the cover of darkness.

All patients are given a summary of their medical treatment when they return to Syria. Written in Arabic on plain paper, the summary has nothing on it to indicate they received treatment in Israel. I suspect the Syrian doctors know where their patients were treated. Injured people could not have found the sophisticated treatment in their home country’s collapsed medical system. And they could not have afforded care in Lebanon or Jordan.

The wounded Syrians are not charged for their care. It is paid for by the Israeli government, Ziv Medical Center itself, and by individual contributions to Ziv. The medical center brochure we received points out that contributions to Ziv are tax deductible in both the US and Israel. (Friends of Ziv Medical Center, Inc. is a registered 501(c)(3) charity).

We’re not the only visitors who have come to observe the treatment of Syrians at Ziv. A few weeks ago Conan O’Brien stopped in during his tour of Israel. His team was allowed to film in the Syrians’ room, on condition that they not show any of the patients’ faces. His hospital visit became part of his Israel show.

Breslov in Tsfat

The entrance stairs to the Breslov area of Tsfat (Safed)
The entrance stairs to the Breslov area of Tsfat (Safed)

Tsfat is one of the four holy cities of Israel. It is the old city of the mystics and the new city of Bar Ilan University Medical School. Spelled Zefad by Google maps and Safed in history books,  it is built on the steep hills in the heart of the mountains of the Galil. Stairways are everywhere.

What struck me as my friend Miri guided me through the Breslov community last Spring was the number of stairs we had to go down from the main area of the town. The Breslovers, like most Hassidic sects, have large families with many children. How do they, I wondered, manage the stairways with baby buggies? Miri agreed the stairs are a problem. She then added, “You saw the supermarket up on Jerusalem street?”

I nodded, remembering the market over a hundred steps above us on the main street that Allen and I had walked past the previous day,

“That’s the nearest place to buy food,” she said.”There are no makollets in the Breslov area.”I grimaced at the idea of pushing, dragging, lifting, all my groceries along with a baby and toddler in tow, up and down all those stairs. The stairs were the standard limestone stairs you see all over Jerusalem , the kind that get very slippery when they are wet. “What about winter?” I asked.

One of Tsfat's shorter stairways
One of Tsfat’s shorter stairways

“That’s a problem. When they get snow or ice on them, they’re very bad. And these railings,” she gestured to the iron rail I was holding, “They’re relatively new.”

That day Miri and I walked the perimeter of the Breslov enclave–down the steps and along a flat street that gave magnificent views of the forested slopes of the Galilee Mountains to Mount Meron on the other side of the valley. At the far end of the Breslov enclave, we climbed back up to the main area of the city.

Last week, however, I got to enter the Breslov area. On a trip to Tsfat with my class on prayer, we met with Rabbi Simcha Mirvis. Rabbi Mirvis, who originally hails from Nashville, TN, welcomed forty of us into his home. When he realized how large our group was, he sent to neighbors for more chairs, apologizing for his wife’s absence. They had just welcomed a new baby and she was spending time at a special rest home for new mothers.

The Breslov sect, followers of Rabbi Nachman of Breslov (1772-1810), are known for several things: their joy and their practice of hitbod’didut (seclusion). Their joy is expressed by wild, psychedelic painting on the trucks that show up at celebrations playing loud music for everyone to dance to. The young men race into crowds of onlookers or soldiers, grabbing hands to pull men into their circles. One subgroup of the Breslov Hasidim is known as “Na Nachs,” because of the slogan they paint on any, and all, available walls, and rocks, as well as their sound trucks. All over the country you see the phrase in Hebrew “Na Nach Nachma Nachman m’Uman.” This slogan, which is simply Rav Nachman’s name spelled out one syllable at a time, was revealed by the Rabbi 112 years after his death in a note to one of his followers. The Na Nachs believe these words form the ninth of the Ten Songs of Redemption.

"Na Nach Nachma Nachman" on foundation of building in Tsfat (photo courtesy of Renee Hirsch)
“Na Nach Nachma Nachman” on foundation of building in Tsfat (photo courtesy of Renee Hirsch)

I’ve seen “Na Nach Nachma Nachman m’Uman” on stickers plastered to cars and apartment doors, and painted on abandoned buildings, fences around construction sites, and large rocks in national parks. The retaining wall of Har Menuchot, one of the largest cemeteries in Jerusalem, is clearly visible from Road 1. Riding on a bus one day, I looked up and saw “Na Nach N” in bright red and purple letters on that wall. How horrible, to see that outside the resting place of your loved ones! A few days later, the letters had been covered with paint that almost matched the color of the stones. Since then, no one else has deface the cemetery wall. However, you can still see the whiteness of the covering paint, however.

My class on prayer was not in the Tsfat Breslov enclave to discuss red and purple paint, but to learn more about hitbod’didut, the distinctive spiritual practice of Breslovers. Hitbod’didut, which means seclusion, is freestyle personal prayer. The Breslov Hassidim go to quiet, secluded places, preferably a field or forest, and talk privately to G-d. Unlike meditation, it is performed aloud. Ideally, according to Rav Nachman’s formulation, it should be done for at least an hour a day, in the middle of the night or early morning when all is quiet and there are no distractions. Rabbi Mirvis said that sometimes, like this week, he can’t get away from the house, so he sits in the corner of his living room and does his hitbod’didut there.

In Tsfat, many of the Breslov men go out in the middle of the night in small groups of three or four. They drive a few minutes out of town into the mountains. Each man goes his own way to find a suitable place to talk to G-d, arranging a time to meet back at the car. If someone does not show up, the others know to go look for him. Rabbi Mirvis says you can tell a Breslover by his shoes. Most Hassidim wear wing-tip shoes, or perhaps Yeshiva-style loafers. But Breslovers wear boots, so they can hike through the mountains or trek through fields. The ideal is to show up for morning prayers at 6 AM with fresh mud on your boots. The others will look at you and think, with admiration, “he’s been doing his hitbod’didut.” I was amused to hear that these Hassidim, who dress modestly to avoid attracting undue attention to the externals, might check each other out that way.

When he finished his explanation, he asked if there were any questions. Someone else asked the question I wanted to—what do you talk about in hitbod’didut?

“You talk about what is on your mind’’ replied the Rabbi. There is no set format. As Rambam said in his ”Laws of Prayer” you say what you need to say, thank G-d for something, ask for help. It’s your time—you say what you want. If you are working on a middah, a spiritual characteristic such as holding back anger or doing specific acts of loving kindness, tell G-d how you are coming along with that. And if you can’t think of anything to say, start with that. Tell the Holy One, Blessed is He, you can’t think of anything, that your mind is empty right now, that it is hard to know what to say to G-d. You’ll think of more to say as you go on.”

“And if you can’t go out to nature, it’s okay to do it at home?”someone else asked.

From Breslov area of Tsfat: Mt Meron (background) & old cemetery (middle)
From Breslov area: Mt Meron (background) & old cemetery (middle)

 “This week, with my wife not here, I can’t go out. But when I sit here, in this corner, I can feel G-d’s presence. And with this view,” he pointed out the large window that had an unobstructed view of the forested valley and mountains leading up to Mount Meron, a few miles away, “why would I want to leave?”

Then he added that women, with more responsibilities in the house, tend to do their talking to G-d at home, in small snatches of time during the day. They should also set aside time, but the small snippets of time are very powerful because the women are constantly in touch with G-d. Hitbod’didut doesn’t have to be about issues of supreme importance, it can be as simple as, “Please don’t let the cake fall in the oven,” or “Help me not to lose my temper with my four year old this morning.” The important thing is that is spontaneous, rooted in the here and now, yet strengthening your own path between you and G-d.

Having grown up in the mainstream of Jewish tradition, in which all prayer is strictly rooted in the words of the siddur, the prayer book, hitbod’didut  was a refreshing idea. In a way it validated what I have been doing all my life, talking to G-d several times a day, as the need arises. These little snatches of prayer are in addition to my daily prayers, which I recite at the specified time. Unlike Rav Nachman and the Breslov Hasidim, however, I don’t go out to the fields or forest to do it. Maybe one day I will.

Exploring Old Tsfat

Yosef Karo synagogue in Tsfat
Joseph Karo synagogue in Tsfat

Tsfat is said to have been settled in the time of the First Temple. Jews supposedly lived here in the Second Temple period as well. Unfortunately, there is little evidence supporting either claim, because the city has been destroyed by earthquakes every 100 to 200 years. There is almost nothing truly ancient here. Even the Old City, with its old architecture and obviously renovated buildings is not very old by Israeli standards—most buildings were constructed after the 1837 earthquake.

The layout of Tsfat (also spelled Safed, Zefat, Tzfat, S’fath) high in the mountains of the Galil, has a logic of its own. Or illogic. There are two roads that encircle the Old City, but once you start down a side street, you are on your own. Most of the streets do have names, although street signs are rare. Even long time city residents do not know street names, but navigate by landmarks. Miri tells of ordering a cab to come to the corner of Korscak street. When the cab company said they did not know where that was, she said, “You know Yossi, with the two big black dogs? We’re at that corner.”

“Oh, Yossi with the dogs, sure. We’ll be there in 10 minutes.”

Besides the lack of street names, there is the problem of building numbers, which are not always consecutive or posted on the buildings. And the streets themselves, which may look car-friendly at one end, tend to narrow and wind, and quickly become impassable for any vehicle wider than a donkey cart. That is, the streets that don’t end as stairways. The Breslov neighborhood, which is relatively new, seems to be all stairs, and it looks like many stairways lead to only one door, which means if you go up the wrong one, you have to go back down and then up a different set. Supposedly there are passages between apartments that people who live there know about. All I could think about was trying to take the groceries home, up and down all those stairs, pushing a baby buggy and holding a toddler’s hand. And since Breslovers have large families, that is not an unlikely scenario.

The most famous set of stairs in the city is the large broad stairway built by the British to separate the Arab and Jewish neighborhoods after the 1929 Arab riots. These stairs go up and up and up, over 100 steps from the lower part of the city to the main street. At several points they widen into a landing where a road cuts across them. Just going from the level of the artists’ colony in the Old City up to the main street made me out of breath. Walking down from the main street to a level below the artists’ colony made my thighs ache.

People who live Tsfat develop strong leg muscles.

Tsfat is known as the city of mystics. Kabbalism flourished in the 16th century, when many of the great Kabbalists lived and studied here. Rabbi Isaac Luria, better known as the Ari HaKadosh, is one of the best known. He is called the Ari because it is the acronym for the “Ashkenazi Rabbi Isaac,” but the name also means the Holy Lion. Although the Ari was born in Jerusalem, he spent most of his formative years in Egypt, and moved to Tsfat in 1570. He lived and taught here for the last two years of his life, but in that short time he changed the city and Judaism itself. Some of the customs he instituted we still follow today. For example, he compiled the prayers welcoming Shabbat, taking his followers out to an open area at sunset where they recited a Psalm for each day of the week. The service culminated when they turned to the West and welcomed the bride, the Queen Shabbat. Today, Jews around the world still sing L’cha dodi, a beautiful hymn which ends with the words “Come, oh Bride; Come, oh Bride” which was written by Rabbi Shlomo HaLevi Alkabetz. The Ari did not write much himself; most of teachings came down to us because his student, Rabbi Chaim Vital, wrote them out. But such is his reputation that several of the most holy places in Tsfat bear his name. These places are not memorials to the Ari, but are in daily use today.

The Ari mikve (ritual bath) is near the base of one of the mountains on the edge of the city. The hill going down to it is very steep, and the road curves past the cemetery. Because it uses water from a mountain spring, the water is icy cold. One of my friends tells of going there with friends when they were yeshiva students forty years ago. As they were dipping in the mikve, an older man rushed in and yelled at them to get out of the water immediately. The three naked boys scrambled for their clothes and before they had time to get fully dressed, four men came in carrying a dead man on a stretcher. The boys watched in shock as the men performed the tahara, the ritual washing of the dead before burial. Although today the Ari mikve is no longer used for taharas of the dead, he said that in all the years since that incident, he has never been tempted to revisit it, even when he is spending Shabbat in Tsfat.

But others do use the mikve for ritual purification. Some Birthright groups visit Tsfat and the young men dip themselves in the mikve. They tell us that going to the Ari mikve is one of the highlights of their trip.

Aron kodesh of  Ari synagogue in Tsfat
Aron kodesh of Ari synagogue

The heritage of the Ari is also claimed by two synagogues, one Sephardi and Ashkenazi. The original Ashkenazi synagogue where the Ari prayed, on the edge of the Old City, was destroyed in the 1837 earthquake. Twenty years later a new building was erected on the same site. It has a raised platform in the middle of the room for the Torah reading, and an arched ceiling. It also has an elaborately carved and painted olive wood aron kodesh where the Torah scrolls are kept.

Top section of aron kodesh showing lion with human fact , Ari synagogue, Tsfat (Safed)
Top section of aron kodesh showing lion with human fact (bottom, center)

Unfortunately, someone sent inaccurate measurements to the German workshop where it was made. When the aron arrived at the synagogue, it was too tall to fit into the niche reserved for it. The top section, therefore, tilts forward. In the center of the tilted section sits a lion with the face of the Ari HaKadosh.

In the heart of the artists’ colony in the Old City is a Sephardi synagogue, built where it is believed Rabbi Joseph Karo studied in the early 16th century. Rabbi Karo compiled the first widely published code of Jewish law, the Shulchan Aruch or The Set Table. Today the Shulchan Aruch is still the definitive guide for observant Jews. Like most of Kabbalists in medieval Tsfat, Karo was Sephardi. He came to Tsfat from Turkey, where his family had lived since the 1492 expulsion from Spain. His book details the Sephardi way of observing the laws, so later Rabbi Moses Isserles wrote Mappah, The Tablecloth, explaining where the Ashkenazi tradition differs. Many editions of the Shulchan Aruch print Karo’s original text in regular Hebrew letters, with Isserles’ additions in Rashi script, which would be equivalent to showing the text in a regular font and the additions in a cursive one.

When we visited the synagogue, we entered through a door whose sign indicated we were entering a yeshiva. When we went in, however, we were in a store selling tourist merchandise. We walked through the store, watched by the storekeeper, through a small door into a beautiful synagogue. In 1948, when the building was the home of the Chief Rabbi of Tsfat, this room was his library. One wall is still lined with glass-fronted bookcases. We could tell it is a Sephardi synagogue by the way the benches are arranged: in a square against the walls. The benches all have long blue cushions on them and face towards the raised platform in the middle where the Torah is read on Shabbat and holidays. The two small Torahs on the platform’s railing are in wooden cases, as is the custom of the Sephardim. The ark in which the Torahs are kept is on the southern wall, the direction of Jerusalem. The room is plain, the only decorations being tall bookcases, a few prayer plaques on the walls, and the colorful lamps hanging from the ceiling. The ceiling is painted blue.

Ezrat nashim (women's section) of Joesph Katro synagogue in Tsfat
Ezrat nashim (women’s section) of Joesph Katro synagogue

A heavy curtain hangs at one end of the room, opposite the windows. This is the section designated for the women, the ezrat nashim. Several of us went through the curtain to look at it. Unlike the men’s section, the ezrat nashim has thickly upholstered chairs and wide divans. The women who pray in this synagogue might sit in comfort, but they are blind to what is going on. Despite the cushy seats, I still prefer to pray where I can see and feel more a part of the congregation.

And here’s where Tsfat is located–Google prefers to spell the city’s name Safed