Wounded souls: the psychological cost of the Middle East conflict
A suicide bombing in Israel and a grim toll. Political rhetoric, Israeli military counter-strikes and Palestinians die. Another phase has passed without a resolution in sight and with the world community not even blinking.
Israelis and Palestinians do not see their war in such black-and-white terms. As victims, they suffer long after the blasts have died away.
The cost is not simply in terms of lives lost. Beyond the first circle of victims and their relatives are those who witnessed and heard about what happened - they endure a psychological trauma that could last a lifetime.
How the conflict is affecting Palestinians is not clear, as studies in the Gaza Strip and occupied territories have been rudimentary. But much research has been carried out in Israel, and the latest shows 20 per cent of the population is suffering what is known as post-traumatic stress disorder. That is 1.5 million people - a psychiatric challenge by any stretch of the imagination.
For Israel's faltering economy, sucked dry by a soaring defence budget and the financial downturn, it is a big problem. The cost of treatment is huge, while productivity is falling due to the rise in the number of workdays lost to illness.
Then there is the social impact - which is worrying the experts even more. Among them is Jonathan Perlman, the director of development at the Israel Trauma Centre for Victims of Terror and War, also known as Natal. The non-profit mental health organisation's office in central Tel Aviv is a 10-minute walk from Sunday's double suicide bombing which killed 23 people.
'Many people are not riding public buses and are staying away from pedestrian malls and shopping centres,' he said. 'Denial and avoidance are what the immediate coping mechanisms seem to be.'
Life has to go on, though. Mr Perlman said that Israelis did their best to avoid certain types of behaviour, but on a daily basis, they still had to go to work and buy clothes and food.
Some human behaviour simply cannot be denied, no matter how bad the fears of being the victim of a suicide bomber. Natal's offices are on a busy pedestrianised street and a fair takes place there every Tuesday. 'I imagine, as with most Tuesdays, the weather's going to be nice and there are going to be people out with babies in carriages,' Mr Perlman said. 'It belies the fact that [there was] a terrorist attack on Sunday about a kilometre from where we are.'
Natal operates a telephone hotline staffed by volunteers and all calls are monitored by mental health experts. Callers in need of help are referred to a team of 20 professional therapists.
While clients pay a minimal fee and the government gives some financial support, 90 per cent of the budget comes from donations.
Established in 1998 to help soldiers suffering combat distress and civilians caught in terrorist attacks, the centre's workload has risen dramatically, especially since the Palestinian intifada began two years ago. Then, the therapists were handling 30 cases a month, but they are now dealing with 10 times that number. On Monday, 40 calls were received.
The initial calls were from traumatised people who had just heard about the suicide attacks. A typical call went: 'How can I go on like this? This is just an impossible situation. I don't want to let my kids out of the house.' The second wave of calls started the following day, as people who had known someone killed or injured realised their loss. A third wave will start in a week as people who witnessed the attack decide to phone.
The same types of services are offered to victims of tragedies in the developed world, such as those affected by the September 11 attacks. But in Israel, technically a war zone, the traumas are having a far greater impact on society.
Palestinians are similarly affected, although their access to help is limited. Their poorer living standards and restricted living conditions would arguably put them at greater risk.
What is clear, though, is that the cost of the conflict goes well beyond death and injury tolls. The loss of the region's mental health is having just as destructive an impact.
Peter Kammerer is the Post's Foreign Editor