Being in close contact with Palestinian civilians at border crossings and having had to threat them badly them because of constant suspicion that they might attack has taken a psychological toll on soldiers; they face a higher risk of developing traumatic-stress symptoms and post-traumatic stress disorder, according to Israeli researchers. Drs. Avi Bleich, Dr. Mark Gelkopf, Rony Berger and Prof. Zahava Solomon of Natal (The Israel Trauma Center for Victims of Terror and War), Tel Aviv University and the University of Haifa published their study in the December issue of IMAJ (The Israel Medical Association Journal). Although the study focused on veterans who had ongoing contact with Palestinians during the second intifada and who left active service within the previous 10 years, it could be extrapolated to soldiers' exposure to Palestinian civilians during the current campaign in Gaza. The article, accompanied in the same issue by an editorial, was based on interviews with almost 230 men and women. Those soldiers who had experienced such close contact - especially those who were ambivalent about the moral righteousness of their duties - were more likely than those lacking such experience to suffer from intrusive re-experiencing of unpleasant events, guilt, shame, self-hate and regret. About half of those stationed at border crossings and other circumstances of close contact with Palestinian civilians had been victims of civilian-related violent incidents, while a third admitted to having perpetrated violence against civilians and 17.4% perceived their behavior as degrading to Palestinians. Many of the soldiers exposed to trauma did not seek or receive psychological help after their service. The authors concluded that "to avoid violent and sometimes degrading behaviors" toward Palestinians, "appropriate psycho-educational and behavioral preparation should be provided" by the IDF. The researchers wrote that while there have been studies on the psychological impact of the ongoing conflict on Palestinian civilians, there had not been any on the effects on the soldiers. They explained that due to the threat of terrorists getting through border crossings, Palestinians waiting to get into Israel to get to work, get medical treatment or for other purposes has often entailed waiting in lines for hours. Soldiers are constantly tense from this direct contact, and even "face dilemmas every time a Palestinian Red Crescent ambulance speeds toward them. In addition, soldiers may have to enter Palestinian homes suspected of harboring terrorists, fight door-to-door, guard roadblocks and face stone-throwing and gun-shooting mobs. When confronting civilians, soldiers usually worry about whether they are in fact terrorists in civilian clothing. Those veterans who had worked in close contact with Palestinian civilians in stressful situations were twice as likely to suffer from post-traumatic stress disorder (which should be treated within a short "window of opportunity") than those who had not. Without proper treatment, the syndrome can lead to chronic nightmares, psychological withdrawal, avoidance of situations that remind victims of trauma and impairment of social, occupational and other types of functioning. Just being involved in violent behavior - either as a perpetrator or a victim - does not necessarily lead to psychopathology, they wrote; however, whether soldiers perceived such actions as degrading predicted how severe post-traumatic symptoms would be. In the editorial, Drs. Rael Strous and Moshe Kotler of the Be'er Ya'akov Mental Health Center and Tel Aviv University noted that soldiers put in these situations are usually well-trained in military warfare but just out of high school, lacking life experience and untrained in civilian management. "Placing them in control of an often-hostile civilian population is begging for failure," they warned. "Removed from their regular stable environment with external controls and placed in a situation of conflict," soldiers may engage in inciteful and aggressive behavior. They should be taught by the IDF in advance, the psychiatrists concluded, to "keep their head and heart when others may be losing theirs and not to engage in any acts of violence or degradation" while on active duty.