TEHRAN- In global military terminology, there is a phrase called “shell shock”—a trauma not just caused by the physical impact of a bullet, but by the sound of gunfire and the terror before the strike. It’s a shock that targets the brain before the body, scrapes the ears from the inside, and its echo doesn’t fade for years. In Iran, we refer to victims of this trauma as “wave-affected”—people who were never physically struck by bullets but whose mental peace was shattered by the blast wave. Like the 45,000 veterans of the Iran-Iraq war who, without visible wounds, became silent casualties of war’s most elusive virus.

Now, 37 years after the end of that war, in the recent 12-day conflict, this virus has crossed trenches and reached deep into Iranian soil—into the rear lines of medical care and emergency services, into hospitals and among nurses. People like Mohammadreza Azizi, a 49-year-old paramedic at the emergency medical center in the town of Miyanrahan, Kermanshah Province. On June 15, following an Israeli missile strike on the area, shrapnel tore into his side and knees.

But now, even the slightest noise terrifies him. He can’t sleep. His nights are haunted by nightmares of bombings and violent body tremors. “When I’m alone, it feels like the world is collapsing. My brain feels like it’s about to explode. My body shakes. My ears feel like they’ll go deaf.” Mohammadreza says he has clashed with his family so much—breaking windows and beating his wife and daughter—that his brother told him: “You’re not the same Mohammadreza anymore.”

He was discharged from the hospital a few days later, but so mentally broken, irritable, and uncontrollable that his family admitted him to Farabi Psychiatric Hospital in Kermanshah—the same hospital that was itself hit by missile damage. According to its director, Alireza Ebrahimi, “300 of our 600 staff members showed symptoms of blast-related shock after the June 15 explosion, and some are in critical condition.” That day, 150 patients were transferred to Imam Reza Hospital, and most of the rest were picked up by their families. But 20 patients had no one to take them and have now returned to Farabi with minds more wounded than ever.

For Mohammadreza and hundreds of other healthcare workers, the hospital was not just a workplace—it became a mental minefield. They are now facing the most silent and invisible wounds of war, with a sound still echoing painfully inside their heads. For them, the war is far from over.

The Whistle of the Missile—The Beginning of a Life of Shock

Shell shock is not just a physical ailment; it is the ruin of an entire life. Missiles that keep firing inside survivors’ minds, windows shattering in their dreams and waking hours, a mind destroyed daily by the same whistle, the same blast. Here, there’s no longer a boundary between war and a hospital bed.

During World War I, thousands of soldiers developed psychological disorders after encountering explosions. Initially, this was attributed to physical proximity to detonated shells, but soon it became clear that the mental impact of war was unprecedented. Records show that more than 13,000 cases of shell shock were documented in 1915 alone, rising to 200,000 by the war’s end.

There are no exact statistics on how many Iran-Iraq war veterans developed shell shock or dealt with its effects years later. Some reports estimate about 45,000 people were hospitalized in psychiatric facilities during or after the war.

Now, Mohammadreza, with 27 years of experience in emergency medicine, is one of the “wave-affected” of this new 12-day war—a man the war reached inside a medical center. Since 2018, he had been working at Miyanrahan Comprehensive Health Center, part of Sahneh County, Kermanshah. On the day of the Israeli missile attack, he was on shift, completely unaware of what was coming—until a strange whistling sound changed everything.

“I heard the whistle of the missile… A sound I never imagined my ears would ever hear.” The missile hit a warehouse just two meters from their base—that short distance marked the line between life and death for Mohammadreza. “If I had been outside, I would’ve been gone. One wall saved me… but not my mind.”

With the first explosion, it felt as if his brain had been put in a press: intense pressure, numbness, unconsciousness, and then transport to Sahneh County hospital, his face and head covered in blood. When he regained consciousness, nurses were stitching wounds he still can’t forget. Shrapnel remains lodged in his back, side, and behind his knees—dangerously close to vital arteries. Doctors say it can’t be removed. As for his ears? The eardrums are intact, but the nerves are shattered. “Both ears feel like tunnels with constant wind blowing through. The sound of that cursed whistle is still echoing in my head.”

A few days later, he returned home—but not to his old life. “I thought being alive was enough.” But it wasn’t. His ability to make decisions was impaired, his temper flared, and he lost control of his behavior. “I clashed with my family. Broke windows. Hit my wife and daughter. My brother said, ‘You’re not the old Mohammadreza.’” He’s now under treatment at Farabi Hospital, receiving care especially from its compassionate director. “When my family showed me photos of my back, it looked like a tire had slammed against it—red and swollen.”

The veteran paramedic now wraps his head in cloth, hoping it will muffle that deathly whistle. His car, bought with years of hard work, was reduced to rubble in the explosion. He’s now financially strained. His medication dosage keeps changing, but nothing helps. As he says: “I’m one of the wave-affected now.”

Mental Health Damage Among Staff: Over Half Under Treatment

Dr. Alireza Ebrahimi, neurologist and director of Farabi Psychiatric Hospital in Kermanshah, recounts the tragic day when Israeli airstrikes devastated part of the province’s psychiatric care system. The hospital, home to patients with depression, anxiety, OCD, psychosis, and drug-induced psychiatric disorders, was heavily damaged.

On June 15, around 9 a.m., Ebrahimi and other faculty members from Kermanshah University of Medical Sciences were on rounds at Farabi when powerful explosions rocked the building, damaging much of the hospital. “Patients were running into the courtyard. Sections of the ceiling had collapsed. Most of the hospital had to shut down, except for the emergency ward. It was extremely difficult to transfer the patients to designated alternative hospitals.”

He says the hospital’s large ICU is still out of service: “Our mega ICU was severely damaged and is under repair. The psychiatric wards are functional again. The university president, provincial officials, and the municipality all helped. Psychiatric hospitals are different—most hospitals don’t accept mental health patients, and they need specially trained staff. The Red Crescent and EMS did a lot on the day of the incident.”

Estimates from technical experts place the damage at over 1 trillion tomans (about $2 million). But more concerning are the psychological wounds among hospital staff: “About 50% of our 600 staff showed severe anxiety symptoms: palpitations, insomnia, recurring nightmares, hearing issues, and signs of blast-related shock. We’re currently treating them for Acute Stress Disorder (ASD). PTSD has not yet been confirmed, but we worry some may develop it. Several colleagues are being treated for trauma from the life-threatening event.”

Eight staff members were physically injured but the psychological damage was worse. “They were caught in the explosion’s shockwave. These are typical symptoms of what we call 'wave-affected.' More may develop similar disorders over time.”

Interestingly, none of the staff (except the physically injured) have taken leave: “We insisted they return to work. Avoiding the trauma site can solidify psychological disorders. This is part of a treatment called ‘exposure therapy.’ Despite the difficulty, staff returned. Many still visit us daily, complaining of sleep disorders and explosion-related nightmares.”

Ebrahimi stresses that psychiatric patients cannot be easily transferred: “Psych wards need special equipment—from window designs to spatial layouts. We can’t just move them anywhere. On that Friday, most families came for their loved ones, but about 20 patients had no one. We temporarily housed them at Imam Reza Hospital until we could repair our wards.”

None of the psychiatric patients hospitalized that day have been newly diagnosed with blast trauma. “They already had mental disorders, so we haven’t seen new diagnoses among them. Psychiatric patients need specialized spaces. For instance, a neurology ward isn’t suitable for them due to the specific needs and safety features required.”

Ebrahimi recounts the emotional aftermath: “Now it's too late for families to come pick up their loved ones. By law, when a patient is discharged but not collected by their family, we take them home through our social work department. This isn’t just for this incident—it’s common even in normal times. Families sometimes abandon patients, and we have to return them home by ambulance and staff, which is costly and burdensome for the hospital.”

In the early days after the strike, many families came and took their patients home: “We wrote prescriptions for the medications they used at the hospital and gave them to families. But about 20 patients remained. With help from Imam Reza Hospital, we temporarily admitted them until our wards reopened. Thankfully, with good cooperation, most departments were back in service in under 10 days.”

Ebrahimi emphasizes that the emergency department was not shut down for even a moment:
“Our insistence on keeping the psychiatric emergency unit operational was intentional. A psychiatric hospital is not like other hospitals. No other center accepts psychiatric patients, so we must always be ready. The women's and men's wards, IT, and electrolysis departments all remained functional, and we didn’t let the emergency services go offline even for a second.”

In another part of his remarks, he reassures that fortunately there were no reported suicide attempts—neither among the patients nor the staff:
“We took special care of the patients. Even the transfer to Imam Reza Hospital was done with great care and proper supervision. No patient was transferred without an escort.”

However, his concerns are not limited to the patients. According to Ebrahimi, the hospital sustained significant structural and equipment damage and had to borrow much of its medical equipment:
“We owe a lot to the market, and people have greatly helped us. But we expect the Ministry of Health to act quickly and provide financial support.”

In conclusion, he praises his medical staff with admiration:
“Our personnel were the real heroes of this crisis. Even those who were off-duty rushed to help. Managing 170 patients who suddenly spilled into the courtyard was no easy task. But it was handled so well that not a single patient fell from their bed or suffered injury. We hope this effort is not just acknowledged on paper. Real appreciation is due for the selfless service they provided.”

He adds that so far, none of the doctors have sought treatment for themselves:
“Doctors usually begin their own treatment. But nurses, radiology technicians, lab workers, physiotherapists, and occupational therapists have come to me. The majority of these visits were from nurses.”

Fire, shattered glass, and terrified patients

Around 9 a.m. on June 15, just as university professors were visiting patients at Farabi Neuropsychiatric Hospital in Kermanshah, several powerful explosions shook the facility. In an instant, ceilings collapsed, glass shattered, and chaos erupted. Patients fled into the courtyard, and the situation turned critical. Some departments became completely unusable, and the hospital—except for the emergency unit—had to shut down temporarily.

Ali Bahramian, Head of Public Relations at Kermanshah University of Medical Sciences, was one of the first to arrive at the hospital after the attack. What he described resembled a nightmare: fires, mentally ill patients wandering in panic, frightened families running through smoke and shattered glass, and nurses who remained at their posts, caring for patients.

That day, three attacks struck Farabi Hospital at intervals of five to ten minutes. Although no rocket directly hit the building, explosions ignited fires at the hospital's rear. Bahramian, who arrived shortly after the blasts, told Ham-Mihan about severe destruction to key sections and essential equipment:
“The Mega ICU, which had been operational for less than a year, was damaged along with the server rooms, monitoring equipment, and even administrative offices. Glass was broken, and furniture was scattered.”

Immediately after the attacks, 150 inpatients were moved into the hospital yard and then transferred to designated facilities like Imam Reza Hospital. But the impact was not just physical; many psychiatric patients suffered psychological trauma again, and their families were affected as well. Several staff members experienced blast shock, and others were physically injured. Nevertheless, medical services resumed within hours. The patients who had been relocated returned within two to three days, and temporary beds were borrowed from other hospitals.
“The Mega ICU suffered the most damage due to its specialized and expensive equipment. The initial estimate of damage is around 115 billion tomans,” said Bahramian.

Masoud Ghaleh-Safidi, Head of the Emergency Medical Center at Kermanshah University, told Ham-Mihan that even Imam Reza Hospital and nearby colleges were not spared from the Israeli attacks:
“Four of our medical centers were directly affected. Windows shattered, walls cracked, and the entire complex faced structural issues. We also lost two ambulances in Kangavar—one from Sahneh County dispatched to assist, and another from Kangavar itself that overturned from the blast shock. The Mahidasht Health Center also sustained damage.”

The nursing, paramedical, public health, and nutrition faculties of Kermanshah Medical University, located near Farabi Hospital, were affected, with the nutrition faculty suffering the most. Ghaleh-Safidi clearly stated the university's main demand:
“We've submitted a full damage report. The university is pursuing compensation. Replacing ambulances, rebuilding facilities, and restoring the healthcare system requires serious support from the Ministry of Health. Infrastructure must be repaired so that emergency services can fully function again.”

From Kermanshah to Mianrahan

While Farabi Hospital in Kermanshah was damaged on June 15 in an Israeli attack, the Mianrahan Comprehensive Health Center in Sahneh County suffered even worse. According to Bahramian and Ghaleh-Safidi, the scene there was horrific.

Bahramian described extensive destruction at Mianrahan, a 24-hour clinic with general and maternity services, an emergency station, and doctor accommodations:
“Fortunately, no one was killed, but several were injured. Many sections and medical devices were destroyed. Several ambulances were rendered unusable—each worth over 8 billion tomans. Though no patients or staff died, the blast force flung ambulances and people around.”

Ghaleh-Safidi also noted that many personnel at Farabi Hospital and Mianrahan suffered from blast shock:
“Many staff, especially at Farabi, were affected. In total, eight of our personnel sustained serious injuries, including one doctor, several technicians, and nurses. Some are still under treatment, and others may show symptoms later.”

He said the missile struck just 1–2 meters from their emergency base:
“The doctor's quarters were completely destroyed. Several vehicles were lost, and two emergency technicians narrowly escaped death but were injured. One remains hospitalized at Farabi.”

That individual is Mohammadreza Azizi, a technician at Mianrahan's emergency base. Both Bahramian and Ghaleh-Safidi mentioned him. Azizi, affected by the shockwave, is now hospitalized in the psychiatric ward of Farabi.
“He’s become ‘moji’—shock-affected,” Bahramian said.

Farabi Hospital sustained the most damage

Hossein Kermanpour, Head of the PR and Information Center at the Ministry of Health, told Ham-Mihan that during the 12-day war, hospitals and medical centers across the country sustained varying degrees of damage—some minor, others up to 50%.
“None were completely destroyed to the point of shutting down. But Farabi Hospital in Kermanshah suffered the most nationwide and is now under reconstruction.”

He clarified that by “destruction” he didn’t mean total collapse:
“Some departments lost their medical function. During the war, we couldn’t begin repairs since we feared repeated attacks that would undo our efforts.”

When Farabi Hospital was damaged, patients were relocated elsewhere.
“Now that the war is over, hospital officials are pursuing reconstruction,” he added. During the war, some emergency bases were completely destroyed, such as the one in Hoveyzeh.
“Four or five of our emergency bases were severely damaged. Even basic health centers for maternal and child care suffered major damage—one in Kermanshah was totally destroyed and is now awaiting rebuilding.”

Attacks on emergency bases are especially harmful because they are the first point of care during crises:
“If an ambulance has to travel farther due to a destroyed base, patients lose critical time, increasing the risk of harm.”

Kermanpour stressed that both sides of war should abide by international wartime conventions—something Israel did not do:
“These damages endanger patients’ lives. Several ambulances were disabled, which hampers rescue operations.”

He said no civilians were killed at these centers, but injuries did occur:
“For instance, when Farabi was attacked, some patients were wounded. What's worse, these were some of our most vulnerable patients—those with mental health issues, who often can’t take care of themselves and need constant supervision.”

He added: “When a bomb exploded near Shahid Motahari Hospital—a burn center—windows and ceilings collapsed. Burn patients with special bandages cannot walk easily. Imagine their terror that day. Not only was their treatment disrupted, but the trauma also worsened their mental condition.”

Several pre-hospital emergency technicians (EMS 115) were also injured: “Some were inside ambulances providing care when rockets landed nearby. The blast damaged vehicles and injured staff, some of whom were hospitalized. A few were killed.”

During the Israeli attack on Evin Prison, in addition to Dr. Shirvani—the prison doctor—two medical technicians were killed. According to Kermanpour, others from the medical staff were killed in their homes.