Just walk through the front door of the Niv Nirel Center not far from the gorgeous beach in Michmoret (a bit north of Netanya), and you know you’re in a place that’s very special. It’s hard to explain how you know. Is it the limitless love and embrace that’s in the air? The care with which the new facility has been built and designed? The people’s faces?
Of course, it’s a sad kind of special. The men with canes, on crutches. The occasional wheelchair. Many of them, but not all, accompanied by a woman their age. Wife? Girlfriend? Sister? Hard to know.
But as Kfir Feffer, the psychiatrist who, along with Tami Raviv, is one of our two guests today and one of the key leaders of the Niv Nirel Center said to me as we glanced out the glass door of our room at these men, “You see those crutches? Those injuries will heal. What we’re about is the injuries that you can’t see, the ones that we hope and pray it’s not too late to heal.”
We hear today from Tami Raviv, whose daughter Niv, was killed in her kibbutz on October 7th, along with her boyfriend, Nirel. Niv had hoped to become a therapist, so in her memory, Tami created the Niv Nirel Center, offering world-class PTSD treatment to some of the thousands of soldiers who desperately need it.
The story of her work with Kfir Feffer, her colleague, is one of sadness, determination, love, hope and care. I drove away from the Center after a few hours there moved, and inspired. I hope that their work and their story will inspire you, too.
You can learn more about the Niv Nirel Center on their website, or if you’re inclined, support there work here.
The entrance to the Niv Nirel Center (note the soldier on crutches entering just behind the sigh to the right); a photo of Niv and Nirel, plus signs in their handwriting that greet you upon entering. Two more buildings at the Hadassah Youth Village in Ne’urim that will be added to the Center as soon as they, too, are renovated, and the photo of Niv and Nirel adorning the hardy cactus at the entrance which perhaps says more than whoever placed it there intended.
Tami Raviv is the Founder and Chair of the Niv Nirel Center, Israel’s first comprehensive trauma treatment center. Following the loss of her daughter Niv and Niv’s partner Nirel on October 7th, she transformed her personal tragedy into a mission of healing and resilience. She is also the CEO of Globalcon, a business development company connecting Israel and Japan, and holds a B.A. in Educational Psychology and Sociology from the Hebrew University of Jerusalem.
Dr. Kfir Feffer is the Clinical Director and Co-Founder at the Niv Nirel Center, previously served as head of active ward for the treatment of trauma related disorders and crisis intervention at Lev-Hasharon mental health center. He also leads the center of Advanced therapies and neuromodulation and holds an academic position at the faculty of medicine, Tel-Aviv University. He completed his residency in psychiatry at Shalvata mental health center and later continued to clinical fellowship at University of Toronto .
For his professional activity Dr. Feffer awarded the Ministry of health – Directorate of Government Medical centers award for outstanding employee award (2022), the University of Toronto Fellow award (2017), United Health Network, Toronto, Research Award (2017) and the Japanese Society of Psychiatry and Neurology (JSPN) Fellowship Award.
The link at the top of this posting will take you to the full recording of our conversation; below you will find a transcript for those who prefer to read, prepared for our paid subscribers.
I'm sitting at a new center, which I'm not even going to say a word about. The people who created it and run it and dreamed it up in response to unspeaking unspeakable tragedy will tell us who they are and why they did it. It's called the Niv Nirel Center. It's in a place called Michmoret. It's on the beach. It's gorgeous here. It's not too far from Netanya for people that want to go on a Google Maps and look for it. It's a very special place. You You walk in, which I did about an hour ago, and you just feel something both unbelievably heartbreaking in the air. You walk in and you look and your heart starts to break. And at the same time, your heart gets filled with a sense of gratitude and inspiration and a sense that this is a very Israeli place in the sense that take the worst possible things that can happen in life and turn them into something that actually brings a tremendous amount of good to people all over Israel.
And eventually, I imagine beyond because of what's going to get studied here and learned here and taught here. But that's all I'm going to say. Tami, we're going to start with you. Tell us who you are. Tell us who's sitting next to you. We'll come to you in a second, and then we'll tell the story.
Tami Raviv
Okay, so thank you very much. My name is Tami Raviv. Sitting next to me is Dr. Kfir Feffer, who will introduce himself a bit later. I'll I would say about myself that before October 7th, I had a pretty perfect life, I thought. I'm married, I have three kids. Each one of them is in his own direction. I was happy with everything I had. I had a company that does business development between Israel and Japan. I was actually supposed to fly to Tokyo on the seventh of October at night. It was the first time flying a direct flight to Tokyo. Saturday morning turned my life upside down. On top of everything that happened in Israel, I lost my daughter and her boyfriend, who lived in Kfar Aza. They were renting an apartment just for five months before. They weren't there for very long. They came over to our house on Friday night on Simchat Torah, and they went back home that night. Niv, my daughter, was studying for an exam that takes you from first to second degree in psychology.
She wanted to be a therapist, right?
Tami Raviv
She wanted to be a therapist. And she was just three days before the exam. The exam was supposed to take place on the 10th of October. So she wanted to go home to be in a quiet place. She wanted to go home to be in a quiet place. It was like the last mile before the test. And Saturday morning, everything happened. It took a week for us to know what had happened. For three days, we thought they were stuck in the shelter room and we were just trying to get someone to open it for them.
Did they call it all that morning?
Tami Raviv
We had a very brief conversation at about 7:00. She said everything was okay. They were in the shelter room, and I didn't sense what was going on outside. I don't think they knew at that time what was going outside. At some point, we started to communicate with Nirel on WhatsApp, and he sent out messages. But by the time we understood what was going on, communication fell. Today, we know they jumped out of the window at about 10: 15, and they were both killed immediately. So three days, we thought they were stuck in the shelter Then three more days, we thought they were taken hostage. And then Friday, we were notified that they were identified. First, we got the message, and then Nirel's parents who live on a Moshv on the Gaza envelope, they were notified a few hours later. And after Niv's 30th days of morning, people started to say that we should think of how to commemorate. I didn't really understand what it meant at the time, but I understood. But they said that when someone wants to help, you need to take you need to take the assistance, otherwise you lose it. So I started to think. My husband wasn't ready to be with me to think it at all. So I started to think what I would be best. And people have suggested all kinds of things because Niv really did many things. She was 27 and she managed to do many things. She initiated things, and she volunteered in all kinds of places. But her core personality was to treat. She just touched every person who passed by her. So I thought I needed to go to do something that had treatment in it. Nirel, on top of the fact that he was an amazing guy, he was very severely injured in 2015 in Hebron in the army. He was a commander on a combat unit called Givati, and he had to have resuscitation. At the time, he was a miracle. He came back to life very quickly. He went back to his soldiers, and he wanted an army career. But after five years, he started to have heart failure, and he had to leave the army. When he left the army, he encountered PTSD. It took him time to understand, but when he understood, he went to ask for his rights from the Israeli Ministry of Defense, and it was very difficult to get his rights. So he aimed himself. At some point, he took a lawyer, he paid a lot of money, he got his rights, but he aimed himself to be a lawyer to help people get the rights because he said it doesn't make sense that someone needs to fight for something he should get. He had a physical injury and a mental injury, it was something that he deserved, but he never managed to study. So I said, Okay, I'll do treatment with PTSD. And I started my way by myself. And from one person to another, I met Kfir, who was sitting with me, and we started our way together. Maybe I'll let you introduce yourself. And we'll continue from here.
Kfir Feffer
So thank you for being with us. My name is Kfir, and I'm a psychiatrist. Up until, I would say about eight years ago, I was the manager of an open ward department in a mental health center that mainly focus on crisis intervention and trauma. So I have a lot of experience working with PTSD and on top of that, I'm a commander in a combat reaction unit.
What's the combat reaction unit?
Kfir Feffer
Starting from the second Lebanese war, IDF come up with a plan to assist soldiers with acute combat reaction after acute combat situation and give them a treatment right in the spot. We are together with the troops on the front lines, one tacked behind them. Whenever there is an extreme war event, we provide immediate therapy. We are very close to the troops themselves. We do it in the area of where they are currently located. The idea is to give the therapy as soon as possible and to be, as I would say, quick and intense in our support to bring them, again, back to function. This is the idea. During the years, we had a lot of practices to make the whole system working smoothly. But of course, we were not even preparing ourselves to anything, even close to what happened during the Iron sword war. But starting from October 8th, I'm responsible for the northern border. So my unit sits right in the border, and I'm bringing us all back to the first day of the war. We didn't know what to expect. For sure, we didn't know exactly what happened in the day itself in Octobers 7th, but we We were expecting something to happen in the Northern border, so we prepared ourselves. And in the first few days, we just saw troops coming from the South, sharing their story and their again, what they witnessed and feel. We were amazed. Again, it was heartbreaking. It brings to the focus things that we were never thought we're going to hear in this scenario. And one of the heartbreaking thing was that it's not a combat. It's everything that happens in the first days of the war happened in a, most of it in a civilian background, people in their homes, kindergarten, kids, everything. So the exposure was It was not a regular combat exposure. It was, again, much different than what we prepared ourselves. And we see the level of suffering, and we understood that we are dealing with a completely different situation. We had to change the way we work and create a different platform of intervention. For example, usually our interventions, it's mainly for a few hours, intense, but for a few hours. But the stories, the combat itself took so many hours, sometimes more than 36 hours in a row. In the modern history of war, there is nothing like it. When we're talking about combat situations, usually it's a matter of seconds or minutes, not hours or few hours. Here there's so much to go through and so much to discuss. The level of was something, again, beyond imagination. You had so much to work. We understood that we can do it in a time frame of a few hours. Then we need much more than this. We created some short term hospitalization that they stay with us for two, three days that we can deliver much more intense intervention. But we weren't ready for that prior. That's what I did for the first few weeks. As And then they asked for volunteers to go and see what's going on with the soldiers of mainly Golani that survived October 7h within the army posts surrounding the Gaza envelope. Of course, they survived. Those who I meant to see survived October 7h, but no one knew what's going on with them. They just took their weapons away, of course, so they won't commit suicide or or anything like it.
They took everybody's weapons away?
Kfir Feffer
Yeah. They just sent them home. They tell them, Okay, we don't know now. We don't have the infrastructure to help you right now. Again, I'm not judging. It was a complete chaos. But stay with your family at home. We will contact you soon.
And give us your gun.
Kfir Feffer
And give us your gun, yeah.
That means that they were worried already.
Kfir Feffer
Yeah, of course. Everybody knew what What happened that day. Again, we think we know. Even today, we are not exposed to all the images, stories. Again, some of the events are, again, beyond imagination. A human being cannot capture what happened during this day. I would just say that my brother, maybe after two weeks, came to one of the kibbutzim in the Gaza envelope, and he had to sleep in what used to be a kindergarten.
He was in the army at that point.
Kfir Feffer
Yeah, in the reserves as well. So all the beds were ready for the kids because this was Simchat Torah, so it was a day off, but the day after was the first day of kindergarten after a long break. So the kindergarten was ready. And that was the moment that he himself just fall to tears. Because, again, It's not always the horrific frames. Sometimes it's the regular frames in a horrific situation that surrounds it. Anyways, I started to see the soldiers that survived October 7th in their homes. And by the time, I thought, I know everything there is to know about post-trauma. I learned my lesson from the first few days and the first few weeks of this war.
Again, I was exposed to many stories, and I thought, again, I'm mastering it. Nothing to worry. And I remember my schedule for the first day. So I made an appointment with a soldier for an hour, commuting for the next place, half an hour, another hour, committing half. I had three or four meetings on the first day. I did only one. I had to cancel the rest because, again, nothing in my professional life prepared me to what I witnessed during those visits.
Can you just tell us what you did professionally before the war? I mean, aside from your reserve duty responsibilities.
Kfir Feffer
I was the manager of an open ward department that focuses on crisis intervention and trauma.
Not necessarily for soldiers.
Kfir Feffer
People of all sorts. Most of them were sexual trauma, but some of them during the years, we had veterans as well.
Open ward means it's not residential. They come for the day.
Kfir Feffer
It's residential, but they come from their own will. It's an open ward, you can go home whenever, but you stay in. It's an inpatient work. On top of that, I'm in charge of new technologies in psychiatry. I have my unit for advanced therapies, which involves technology and use of psychedelics in psychiatry. This is what I did prior. Again, I'm working in the field of trauma for many years. Theoretically, I knew everything in the books. But again, this is what we just experienced. It's not in the books. Not in the But not from the combat perspective, not from the trauma perspective, and I must say not even from the social perspective. So what Israel is going through in the last two years, again, we are still in the surge of the events. But we are not capturing still the full picture, what will be the social consequences? The the adverse ones and the positive ones. I'm just going back to the story. I went for the first house, and I found a soldier that it was two and a half months after the start of the war. So we're speaking early December. All the symptoms of PTSD were very vivid. He didn't sleep for most of the time, at night, especially. So his grandma came to be with him because she's not sleeping at night. So she said, I'm not sleeping anyways. At least he will not be alone. I found out very quickly that I was not ready to what I'm going to see and hear. Everything in this war is captured. They had footages of sometimes from three different perspectives, their own, from their own cell phones, sometimes from the Nukhba terrorists, and sometimes surveillance camera of the posts themselves. So some of them have a lot of data they want to share, but no one came to ask them about it. So again, the level of exposed from my end was enormous, but the need and the level of suffering was, again, something that I wasn't ready to meet. I would say that the effect on the families You know that in PTSD, the family that serves as a main source of support, usually takes a lot of the responsibility, but you are not expecting to find PTSD symptoms within the families. We understood that we are dealing with a completely different situation. Most importantly, that the current system, health system, mental health system in Israel, that even prior to October 7th was under staffed and budgets were very limited, we are not ready to deliver relevant therapies to this situation.
I just want to make sure that people understand what you said. This is like an unheard of situation where it's not only the soldier himself, sometimes herself, but usually himself, who had the PTSD, but it wasn't the family that was offering support. The family itself had symptoms of PTSD, which is basically unheard of in the field.
Kfir Feffer
Because for an example, the footage that I had to see, they shared with their families. They don't have the capacity to work with it. They don't have prior knowledge. They don't have support system back then. Maybe today it's a bit better situation, but they had no one to ask for help, no one to guide them what to do, no one to guide them how to help their loved ones. So the effects were enormous. And now I want to take us to the another step because it's not just the patients and their families or the veterans and their families The numbers are so huge that the effect on society.
What are the numbers?
Kfir Feffer
I want to be very conservative and to say that we are talking about 12% of those who participate in the combat situation.
That's half a million people that were in the combat situation.
Kfir Feffer
Maybe the numbers are a bit less than this because we're talking about civilians and soldiers. I'm talking about army veterans, so let's talk about 200,000. If you're going to be very, very conservative, you're talking about new PTSD patient around 20 to 30 thousands. The system, prior to October 7th, is designed to treat about, let's say, 1800s. So we're talking about numbers that at least 10 times the full capacity of the system currently. If you're reading the news, in the last few weeks, people are starting to speak more loudly about suicidality. It's, of course, a huge problem because, again, the level of service that these people need is, I would say, supposed to 360 degrees of support for their own, their families. And again, it's a social component as well. And as you can see around you, most of the people who are Here are not just mentally injured. Some of them are physically injured as well. And I would say that here, about 90% of the patients that, again, their most severe injury is a mental injury, suffers from for physical disabilities as well. The connection between these two dots is, again, another very important, I would say, challenge for the system that, again, wasn't ready to deal with. It takes us back to the point that I met Tami because after the first round of reserves, I came back to my supervisor. He's an important part of what's going on here because he enabled me to, I told I cannot go to my everyday work. We need to be able to do something specific in the field of PTSD for veterans. He gave me his blessing and two days a week to create the infrastructure for this place. And a week afterwards, I met with Tami, and from there on, we are hand-to-hand.
Tell us about the place, Tami.
Tami Raviv
Maybe I'll say that our collaboration allowed my thoughts to have a very professional infrastructure. I think it allowed Kfir's ideas to be able to come out of the hospital scenery.
And to meet people in other settings.
Tami Raviv
To be in another setting like where we are. People can't see where we are, but we're just overlooking the ocean. We're sitting on a cliff that you can near the waves. And we're in a youth village. We found this place. Everything that happened to us just, we say, happened like a miracle. The way we met each other, the way we found this place and the way it came together just happened.
Can you tell us just a bit before we go on further about this place? What is it? What happens here? How many people are you treating? What percentage of the people who turn to you, do you actually have the capacity to treat? Just give us the basic rundown of what's going on. We can even hear them outside the door. I don't know if it's picking up on the microphone. If it is, it's totally fine. It's actually like holy sounds of people coming to become better. But tell us what's happening in the hallways and the rooms here.
Tami Raviv
The idea is to give all the services under one roof. It means that we give the one-on-one therapy. We've got, of course, Kfir, which is in Israel, a unicorn. To have a psychiatrist on board is really very unique. Of course, we give a psychiatry support. We have treatment, touch therapy, because we know that a lot of the trauma is caught in the body. To help ground and to help release tension from neck, shoulders, back.
That's with families also, right? Some of the touch therapy?
Tami Raviv
Touch therapy for now is only for the patients. We have movement therapy for people who can just need to release their attention through movement. It's yoga. It's sensitive for trauma. And we do give support to the family. So we have one-on-one, it's not one-on-one, but sessions for family intervention for the parents and for the spouses.
There's a lot of use of technology here, too. But I think when people think therapy, they think a couch and a chair and a very skilled professional listening and talking, which is obviously a critical part of it. But there's technology. You see it in all these rooms. When I see boxes new equipment that have just arrived that have not been unpacked yet. What's all this technology stuff?
Kfir Feffer
It goes back to my career prior to October 7th. I'm dealing a lot with technology in psychiatry. The fact that we are a high tech country, now we are a PTSD country, we need to bring them both together. We have a lot of companies that want to cooperate and deliver new options for treatment for PTSD.
Israeli companies, foreign companies, both?
Kfir Feffer
Most of them are Israeli. Some of them are not Israeli. Some of them are from the US, for example. I can give a few examples.
I think people will be very interested in knowing, like when they hear therapy or PTSD and then technology, it sounds like it doesn't fit in the same sentence.
Kfir Feffer
For example, one of the things is taking an existing technology and just to make the adjustments for PTSD. For example, neurostimulation, which is a way to treat mental disorders without pharmaceutical intervention. It's basically use of magnetic fields, the same that we use for MRI. We do it for many years in depression.
How's it applied? Are they in a machine?
Kfir Feffer
It's a machine that, it's like a helmet. It goes on your head and deliver a magnetic pulses for about 20 minutes. Again, it's something that we use for depression for many years now, maybe for almost three decades. But the technology is like our cell phones. We are now maybe in the second generation. We are able to text and we're able to make calls. But again, there is a whole world behind this type of therapies. What we do now is we adjusting it to treat PTSD. It's a bit different areas of the brain, and you need a different intervention to support it, but we do it here. We aim to help PTSD with one of the most debilitating symptoms, which is sleeping disorders. We know that if you treat a PTSD patient and you don't help him with the sleeping problems, then even the benefits are short-lived. We know that this is a core aspect of well-being. We cooperate with a lot of, at least now, four companies that has some technology that helps with with sleeping. They were not aiming first for helping PTSD, but we adjusted their technologies for our needs. Two of them, for example, one that you can have a home-based sleeping lab that you can take home with you.
In the morning when you wake up, I get all the information for my cell phone, so I know where we are starting, and I can keep a track and whether my is helping and in what? In regards to sleep. Another company, this is one of the US-based companies, is a company that, for example, we know that in PTSD, people find it very hard to come down and to fall asleep. There is a phase before you're falling asleep that your thoughts are becoming a bit more weird and loose. People with PTSD doesn't reach this point. The company that we're working with is creating, what they're doing is, practically, is playing your own brain, playing music to fit your own brain. If my idea is to bring you to a stage of falling asleep, what they helped me with the technology is to create the music that will bring you what we call Delta waves, that are the waves that are very important for the sleeping process. So they helped me get it to the patient and help him to fall asleep.
I just want to ask you a question not about PTSD for a second and not about the Niv Nirel Center, just an Israeli social question. My impression informally, and I'm not a professional in this at all, but my impression informally is that sleep issues have now become an enormous social problem in Israel. Is that buttressed by data? I mean, are we prescribing many more sleeping pills now than we were three years ago?
Kfir Feffer
You can see from the Ministry of Health that the prescribed medication for sleep, there is a surge in use. But it's very, I would say, understandable because just taking into account two years of continuous stress, alarms during the night, sirens, the war with Iran right now, the level of stress that we had deal with in the last two years. Again, if we have wrote this story two years ago, no one will buy the book because it's too weird.
It's just too outlandish.
Kfir Feffer
Yeah. But this is the reality now. We have, as a society, we are practically very adjustable. But again, there is a price that we are paying. One of the prices are sleeping problems. The other one you see with depressive symptoms and anxiety, mainly anxiety. There are a lot of prices that Israeli society is paying. But I want to also point that whenever you are experiencing such adverse times and challenges, when you survive them, there is also a winning aspect, right? It's very important for me to share that I'm working with the youngsters in Israeli society for the last two years, this is practically what I'm doing. Most of them are between the age of 20 to 35. The fact that they're going to be the leaders of our country in the years to come, it brings me a lot of hope.
Tell me why.
Kfir Feffer
Because as psychiatrist, I have a lot of colleagues around the world, and we are a people that travel and understand and visit other societies. We see what's going on in the young generation, especially about being more self-absorbed and more worried about myself, very subjective.
You're saying that it's around the world in general?
Kfir Feffer
The Western world. We are speaking about a generation that's putting Sometimes the subject is the most important thing. And what we just witnessed in the last two years is how a generation that we didn't have a lot of expectation from the top generation. How they are amazingly came together. And what's going on right now, for example, in the center, prior to the opening day, this was a completely derelict building. We decided that we're going to start right away in April of 2024. The first day, we opened our doors for patient in just four years, just a year from now. August 18th was the first day of operation. We had four months to make this place look like this.
It's unbelievably beautiful. People can't see it, but there's a lot of building going on that it's getting more and more. But It's an unbelievably beautiful place. The ocean is gorgeous and all that, but the rooms are gorgeous. You feel like you've walked into a very high class clinic. And a lot of that time, you said, was donated. I mean, not all of it, but a lot of it, right? I mean, doors and air conditioners and electric.
Tami Raviv
All the furniture here, what you see was donated. Everything. The bulbs, the paint, the colors, the brushes, everything. The furniture, everything was donated.
These are what? These are companies who donated it or they're individuals who donated? We got air conditioners.
Tami Raviv
No, the companies.
And you just went to them and asked them?
Tami Raviv
I think people went to ask. It wasn't a direct request. As Kfir started to say, at the beginning, people just came and volunteered. The actual work here in this place was done by volunteers. So they went back to their companies or to their units in the army. And this is how it went from word of mouth to people that this place is coming together.
So it actually is not only supporting the patients and their families, but the people who are volunteering are also, it sounds like, getting something that's very helpful for them to cope with the horrible time that we're in.
Kfir Feffer
I think that the social aspects we are speaking all the time about the three levels, the personal level, the family level, and the social level. And coming here and see people, soldiers on the week off during the war, came as a unit to volunteer here, and because they knew that one of their friends need help, and this is the way that they could bring him here.
What did soldiers volunteer to do here?
Tami Raviv
They actually painted the walls. They worked physically. They put together the grass, the gardening.
They're coming back from combat, and they have a week off, and what do they want to do with their week? They want to come here and work in this place. That's just such an Israeli story.
Kfir Feffer
I want to point out something. It's important for me because some of the troops that worked here, they knew that they have someone within them that needs help. They didn't want to send him to a place. Again, in the Israeli society, mainly when you're in a combat unit, asking for help for PTSD, it's not something that you easily do. I think this was one of their ways.
The soldier who needed help came with the group and saw the place.
Kfir Feffer
Yeah, and they saw who are the people around here. They make him feel comfortable because he's part of the place already. And the first few patients that we saw, it was more or less the same story. Units that came here, some Some of them directly, some of them because they came and they had someone in a close circle that they knew that need help.
What's the order? I mean, what's the size? How many people are getting treated here? Just give us that data?
Tami Raviv
We just have a bit over 150 patients.
Who come once a week, every day?
Tami Raviv
Each one has his own treatment plan. We really tailor it to their needs. Just very important to say that 30% are women.
30% of the patients are women.
Tami Raviv
30% of the patients are women. This is very unique.
They were soldiers? They were partners of soldiers?
Tami Raviv
For now, the patients were all soldiers. Their trauma is from the army.
So there are women soldiers who have PTSD.
Tami Raviv
Yeah. They don't have to be combat, not fighters, but they sometimes to support combat, fighting. Some of them have very harsh stories of identifying bodies. Some were just, how do you say Tazpitaniyot?
They were the lookouts on the computer screen. So they were basically abandoned. I mean, just completely. So you have about 150 people here now are getting treatment of some sort. Is it a waiting list?
Kfir Feffer
This is including the supporting circles. So this is just the core patients. There are, again, three circles.
You're also working with their families?
Kfir Feffer
Yes.
Tami Raviv
So we're giving support to the parents and the spouses. For now, most of the people don't have children, or if they have children, they're very young because the ages that come here for now are mostly between 20 to 30. We do have some people that are coming from that are older We have a few from Yom Kippur war that they said for 50 years, they managed to hold it in. And then after the 7th of October, it was a trigger to events that they encountered, and they couldn't hold it in anymore. So we have a few from Yom Kippur. But most of the people are between 20 to 30. And as I was talking about the women, we're writing new protocols to treat women because there's nothing in the writing, nothing in the books that talks about women that encounter trauma. You want to elaborate about this?
Kfir Feffer
I would just say that we have a very close collaboration with friends in the US, in the VA, and in Mount Sinai, and Colombia. And so we have a very close collaboration. And as you always do, when you're creating your service, you want to understand all the record information possible. On combat PTSD among women, there is very limited data. So everything that we are doing here, again, we are pioneers in the field. Not just in this specific aspect, but I want to say that the first patient here was a female because we knew, a female patient because we knew we're going to propose a program for a female with PTSD. We are now about to publish the data of the first 100 patients that we saw here and what are the unique manifestation of PTSD among women. This is also part of our obligation to spread the knowledge because we don't want to be an island. We need to have a lot of centers like us in the country. I'm thinking that the model that we are creating here can be replicable in other places also.
You mentioned to me, we'll come back to it in a second. I want to hear something about the vision because when you were taking me to the other building, you showed me this large area that's going to be, I don't know if it's an auditorium or a convention place, but then you said over here is going to be the research center. I remember you pointed to an area that's just being built now. So give us the vision of the place, I don't know, for the long run, but for the immediate around the corner. In other words, two, three, four years from now, what's your hope in terms of the numbers of people that you're going to be serving? Who's it going to reach out to? Who's going to do research? Where's the research going? Just give us some of this. This is obviously, as we say here, it's the. This is just in the very early stages. It's like the diaper stage. It's just off the ground. It's amazing. But where is it headed?
Tami Raviv
We're now literally closing the first year. We're opening very soon, hopefully in two weeks or maybe one week. The intensive daycare for people who will come with more severe symptoms and will come for three full days and work in a group for 10 weeks. And then they will fit in to continue, hopefully, less intensive care. And we're now working to build what you said, the convention Center for the continuation of treatment because for now we're giving six months, which are very intense, but it ends, and they want to continue, and we feel they need to have a community here. We're building now, hopefully it will start very soon, a continuation treatment that will allow them to continue to come every once in a while to fit in a group. So hopefully, by the end of '26, we hope to have the whole building renovated and working. And by that time, we're planning to have about 1,000 to 1,200 patients per year.
At any time, at per year. Tell me something just about PTSD of this sort in general. These people that are going to be treated for life, are they going to need support for life? That's my first question. And my second question is, because you mentioned the societal implications before, and you said that this generation gives you a tremendous amount of hope, which is counterintuitive, right? I mean, you wouldn't necessarily think that looking at such a traumatized, quote, unquote damaged generation would give you hope. But I want to ask you, first, do people, because I don't know anything about this, really, do people who suffer this grievous PTSD need to be treated for life? And second of all, say something about Israeli society. I mean, I know it's not directly related to the Niv Nirel Center, but it's a society in trauma. I'm in my late 60s, so maybe I won't be around. But when my children and grandchildren, my grandchildren, who are all less than 10, are parents, and they're raising their own children. What's going to be the implication in Israeli society of these years? If you had to guess, and obviously you don't know, but you're a psychiatrist, so what's your sense?
So start first with, do people need trauma, do they need treatment for the rest of their lives and then the implications for society?
Kfir Feffer
So even the first question, I will separate into two different questions. So the first part will be whether people with PTSD in the long term have the same trajectory? And of course, the answer is no. Some of them after the intense therapy, and we see it already now because, again, we have a few dozens of patients that already concluded the treatment. Some of them, They went back to their normal life. They are very thankful for what they got here, but I'm not sure that they need us. At least they don't need us now. Some of them, I would say it's about 50/50. You can sense that they need additional push in the back. The idea behind this place, the next step, is to create here the center will be a hub for them for whatever their needs will be. It might be that for the next two years, they just need to come for social events. They create some community. But we know that for some of them in the long term, that there are times of worsening of the symptoms. I don't want them to start all over again. I want them to be part of something with very easy access to therapy and treatment with people who know them, but they feel comfortable. They know exactly what they can get. So we don't have to start everything from scratch. So the idea behind the next level of this program is to create a community. And again, I'm not sure that it will be for everyone, but I'm expecting it to be relevant for at least 50% of patients. And based on the beauty of the place, people, I want to say that the staff here is amazing.
When you walk in the door, you feel quality. You feel love, I have to say.
Kfir Feffer
This is Tami.
Okay, say it. It has nothing to do with me. When you walk in the door, you just feel, I don't know. There's no really English word for "Echpatiyt", that just a sense of caring is the oxygen in here. You just saw people were talking and interacting with a, I saw, but right when I walked in the door, there was clearly a veteran soldier, and a woman was with him, his girlfriend, his wife. I have no idea. But you just made everybody react. I mean, just you could see this is a place, it's safe, it's high quality, it's beautiful, it's peaceful. The ocean is here. There's something about just being in here that heals the soul, even if, like me, you're very fortunate that you're not dealing with that. So there's a tremendous amount of quality, a tremendous amount of beauty. And that's part of the vision of this place, too, I think, plus the unbelievably high quality care that they're getting.
Kfir Feffer
I think that this is also why you asked the question about treatment and then about the effect on society, because, again, our aim is to create here a community that's part of the services coming from the community around us. We have a lot of support from the community around us. This is what the uniqueness of Israel, I think nowadays, it's all about. We can fight with each other on a lot of things.
And we do.
Kfir Feffer
And we do. And we will continue. But when it comes to caring for each other, this is something I believe is very unique. And again, we were fearful that with the generations, with the next generation, it will maybe fade out and will be less salient. But we do feel that there is something in this generation that is not willing to give up, not on the country, not on being together, not about including minorities. Look what happened in the last year or two with the Druze, and we had a meeting a week ago because we have a program for minorities. This is a different story. It's still a challenge, right? PTSD and mental problems within minorities groups in Israel is a challenge. But one of the veterans we spoke with, he said, In the last two years, the Druze had came to a clear decision about their identity. Even the fraction of the Druze community that were living in the Golan Heights, they have families in Syria. They had a very hard time to find their path within the Israeli society. We are experiencing a change. So it comes from both sides, right? They took the decision, but it's because of actual deeds to become more closely related with the Israeli society. And I think that the Israeli society is doing the same thing within its inclusion of other groups. It wasn't always a clear path.
Which is one of the things, I guess, that gives you hope.
Kfir Feffer
And again, this This is one of the positive side effects of war, that you as a society, need to take decision to make changes. This is what we see here from our perspective.
To me, it's very compelling that you come to a place on theory, tremendous brokenness. But, Tami, you've taken the ultimate horror and transformed, your life will, of course, always be changed. And the sadness never goes away. But the transformation that you've brought to so many other people as a way of making your daughter's memory something forever is, I think, a very Israeli step. And for me, what you're saying is that this is a very traumatized society. But ironically, that trauma is going to be a source of strength and cohesiveness internally, but also to minorities and other people beyond. That's, I think, we need reasons to feel hope, and we need reasons to believe in the future. And I'll just say as somebody who, I'm new to this place, and I'm grateful to my friend, Doron, who's sitting behind me, who said, you can interview them over the phone, but you really should come. And he was a thousand percent right. It's unbelievably inspiring. And the news is so horrible, politically, militarily, emotionally, socially. It's just so horrible that to come to a place like this that is just quality, love, caring, and rebuilding. It is the embodiment, it seems to me, of what this whole country has to do.
I know that you're in the middle of a very busy day, and you took time out, and you can hear all the activity going on outside the door here. First of all, obviously, for all of us, our heart goes out to you for the horror that nobody who has not been through it can really understand. But to the two of you who have taken one of the worst periods of Israel's history, perhaps the worst period of Israel's history, and transformed it into an oasis of hope and inspiration and building again on behalf of all of us in the country and out of the country who deeply believe in this place and who desperately wanted to be a great place for our children and our grandchildren. From the bottom of our hearts, thank you for who you are and thank you for what you do.
Tami Raviv
Thank you. I just want to add two sentences. First, I want to say about Kfir that he's too modest to say that he left the management of the ward and he's now our Clinical Manager of the Niv Nirel Center. And he brought his hospital to give the clinical support. So we're privileged to have a mental health hospital support to such a place. And we're also privileged to have the support of the Federations of the United States, the JFNA, that supported the Ministry of Health financially, and we're getting the support through the hospital. And of course, the support of many Americans. I don't know who's listening, so I hope people who've been listening. Some of them have supported us. So just to say thank you. And we hope to grow and create what we're planning because we feel like there's a lot of support also from the Israeli side that understand the need and are here to help us. So thank you for this opportunity.
To help you as you're helping others, which is basically what this is all about. Thank you both very, very much.
