Psychiatric Implications of Missile Attacks on a Civilian Population: Israeli Lessons From the Persian Gulf War

Objective.—To determine the proportion of hospitalized patients who had stress reactions as a result of missile attacks during the Persian Gulf War and evaluate the factors that influenced their evacuation. Design.—Review of medical records of patients hospitalized as a result of missile attacks. Setting.—During the Persian Gulf War in the winter of 1991, Israel received 18 missile attacks involving 39 surface-to-surface Scud missiles. The uncertainty in time, place, and type of warhead, conventional or chemical, was a source of chronic stress and the immediate cause for many traumatic stress reactions at or near the missile attack sites. Participants.—Data from victims who were injured after each missile attack were available through a central hookup between 12 local hospitals and the Medical Corps of the Israeli Defence Force. Main Outcome Measure.—The number of persons diagnosed in the hospital as psychological casualties after each missile attack. Results.—Approximately 43% of the 773 casualties evacuated to hospitals were diagnosed as psychological casualties, and an additional 27% had mistakenly injected themselves with atropine. Data also indicated that triage of psychological casualties to hospitals was more a function of the rescue team’s training and preparation than the severity or extent of injury or damage. Conclusions.—Optimal treatment during events that cause mass casualties requires proper preparation of rescue teams as well as reorganization of the hospital’s psychiatric services. The threat of chemical warfare affected the number and nature of stress reactions.