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Israelis died from scuds only by heart attack NEW YORK TIMES Israeli Study Sees Higher Death Rate From '91 Scud Attacks CLYDE HABERMAN. New York Times. (Late Edition (East Coast)). New York, N.Y.: Apr 21, 1995. pg. A.9 Full Text (584 words) Accepted wisdom here is that for all their understandable anxiety at the time, Israelis emerged little scathed from the Scud missiles fired at them by Iraq during the 1991 war in the Persian Gulf. But a newly published study by three Israeli doctors shows that the death rate soared when the missiles started to fall. It was 58 percent above normal on the day of the first Iraqi attack, Jan. 18, 1991, even though no one was directly hit then by a Scud. The researchers say they have no conclusive explanation for the high death rate. But the most likely, they add, is that many Israelis died suddenly from great emotional stress or from breathing problems created by gas masks that they, like everyone else, put on during the Scud attacks. Essentially, one of the doctors said in an interview on Wednesday, their analysis of hospital and morgue records reinforced the idea that it is indeed possible for some people to be frightened, literally, to death. "Acute psychological stress as a precipitator of sudden death is a concept firmly established in folklore," the Israeli team said in a study published this week in the Journal of the American Medical Association. The researchers were Dr. Jeremy D. Kark, Dr. Sylvia Goldman and Dr. Leon Epstein of the Hadassah Medical Organization and the Hebrew University-Hadassah School of Public Health and Community Medicine in Jerusalem. Altogether, Iraq fired 39 missiles at Israel on 17 separate days between Jan. 18 and Feb. 25, 1991. Because of fears that they might be carrying chemical warheads, Israelis put on gas masks when alarms were sounded and went to specially protected "sealed" rooms. The fears of chemical warfare proved to be unfounded, and as the weeks wore on, many Israelis got so used to the situation that they did not bother putting on masks. Most Scuds missed their targets or landed ineffectually. And while there were more than 1,000 recorded injuries, nearly half of them from flying glass, only two Israelis were killed by direct hits during the six weeks. But many others apparently died from stress, most conspicuously on the first day, when no one knew what kind of payload the missiles would carry. An analysis of records showed that the number of "expected deaths" for Jan. 18, 1991, was 93, the study said. Instead, the actual figure was 147, or 58 percent higher. In Tel Aviv and Haifa, the Iraqis' principal targets, the death rates were about 80 percent above normal. Heart attacks and other cardiac problems, all stress indicators, accounted for twice as many deaths as might have been expected, the doctors said. There was also a 50 percent jump in deaths from respiratory problems, suggesting that some people had problems with their gas masks or stayed too long in "sealed" rooms with poor ventilation. The researchers found that the increase in mortality was much higher among women than among men -- 77 percent to 44 percent. It could be, they said, that women had more difficulties handling their masks, or perhaps that some elderly widows faced the ordeal alone and found it too much for them. In any event, death rates dropped to nearly normal over the next six weeks, the doctors reported. It may be that the most vulnerable people died that first day, they said, or that ambulance services were not up to par at the outset. Another possibility is that people are simply flexible creatures and that "individuals adapted rapidly to the new situation."

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