Miraculously, therapeutic care for Gaza's deeply traumatised people is happening
More than a year after the genocide began to engulf Gaza before the eyes of the world and as many people have stopped watching horrors they cannot bear to see, a new professional mental health report lays out just how Gaza's traumatised children are living in unthinkable torment.
Four months after its first report on the mental health impact of Israel's military assault on every aspect of life in the besieged strip, where Gaza's mental health professionals are working, the Gaza Community Mental Programme (GCMHP) released its second detailed report: "There, People Suffer And Die."
The new report's details will further trigger widespread disgust at the staunch refusal of the US, UK and a dwindling number of other countries to heed world opinion, stop arming Israel and force a ceasefire in Gaza.
Despite the "unimaginably challenging context" of their work, after many more forced displacements into more crowded and unsafe spaces where malnutrition, starvation, lack of clean water, loss of innumerable family members and homes, schools, universities, hospitals, these GCMHP medical professionals work on.
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Difficult access to fuel and reliance on solar power for internet access always make administrative work exhausting.
They have mourned three colleagues killed by Israeli bombing, their three centres destroyed, and, like every Palestinian in Gaza, innumerable personal losses of their own family members.
Nonetheless, in recent weeks, they have repaired and opened a new clinic in Gaza City, following the opening of others in Khan Younis and Deir al-Balah over the last six months.
These have enhanced the provision of previous months' precious mental healthcare and healing among the crowded tent encampments.
Depth of trauma
There are now 73 staff working in Gaza and 10 working remotely in Egypt.
This is a record of qualitative data made by 18 people from GCMHP professional mobile mental health teams on the ground who filled out an online questionnaire of people's responses to three open-ended questions about their needs, psychological and social complaints and symptoms, and their coping mechanisms.
A young woman thinks of taking her own life as it 'has become with no value after I have lost my whole family'
The teams worked with more than 26,000 survivors between 1 January and 25 October 2024.
Many were referred to one of GCMHP's centres for specialised therapy programmes, which included play and drawing with a therapist for children, and talking for adults.
Others received a series of therapist visits in their tent or provisional shelter.
Vivid and detailed children's drawings illustrate the reality of these desperate lives under bombs and shelling and contrast them with their previous happy lives of play, school, friends, and family more intensely than any words.
And the stories of some patients show the depth of trauma, despair, terror, and grief: a young woman thinks of taking her own life as it "has become with no value after I have lost my whole family"; a 13-year-old girl becomes mute; a disabled boy suffers uncontrollable anger; a child screams from nightmares every night, waking the whole family in their tent, and neighbours.
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Their stories show, too, how loving care and therapy transformed these families' lives from unbearable to liveable.
Over the past year, the mental health professionals have been quietly working in the tents and temporary centres before the opening of the new building.
The survivors' lists of needs all start with food and water - people are starving, and the old save their food for the young. Then come tents, mattresses, waste containers, and power supply.
Gas for cooking and cooking utensils come next - indicators of the absolute deprivation in which people are living through extreme terror every day and night.
Medications, women's hygiene kits, psychological support, and job creation are next on their lists.
Hungry, terrified children
For children, the lists include diapers, learning spaces and play spaces.
These essentials are in 3,800 trucks blocked by Israel at the border since early October. Only about 30 trucks a day are allowed to enter the Strip, compared with 500 a day before the war began.
Hungry, terrified children who have lost everything familiar, including sometimes their entire families, show helplessness, hopelessness or withdrawal.
Nightmares, crying, bedwetting, intense ongoing fear and sadness, concentration problems, sleep problems and aggressive behaviour are very prevalent.
The assessments of adults show how they try to avoid thinking or talking about the traumatic events they have lived through, nightmares and severe emotional tension or physical reactions to anything reminding them of a traumatic event.
They have revealed their most intimate thoughts to these trusted professionals.
Negative thoughts about themselves and others, pessimism about the future, memory problems, difficulty in maintaining relationships and feelings of persistent insecurity are widely reported.
Additionally, they, too, have difficulty sleeping and concentrating, have angry outbursts and persistent feelings of guilt and despair.
They have suicidal thoughts and low self-esteem, and many are unable to take care of their babies and even have thoughts about harming them.
Social problems
Social problems are particularly acute among women, who are not only bereft of family support because of the frequent forced displacements but have often lost husbands and sons, so they are carrying very heavy family responsibilities.
The loss of hospital and medical care for pregnancy and childbirth leaves many women facing traumatic births, followed by a painful inability to care for new babies without safe places, hygiene and water, suitable food and vaccines.
Women have no money and often face divorce from their husbands due to family problems derived from the war.
The prevalence of increased violence against women and girls in all forms - physical, verbal and sexual carries with it a burden of shame, secrecy, and denial.
However, both men and women, especially youths, raised the issue of domestic violence in the community meetings in recent weeks led by one of GCMHP psychologists, both in tents and in an orderly new centre.
Men, too, face new social problems. Their participation in first responder services is always risky and sometimes fatal, and injuries are extremely common.
Nonetheless, men and boys flock to assist the wounded and carry the dead away to a dignifying mass prayer and burial. Many men have been injured seriously, too, while doing daily tasks like searching for food and bread, fetching water, and setting up tents. Many lost jobs and businesses in the war.
Thousands were arrested, paraded publicly in their underwear for hours, imprisoned, starved and brutally tortured in dehumanising circumstances of abuse and intimidation in Israeli prisons such as Megiddo and Sde Teiman.
Historical trauma
GCMHP has a long history of working with former prisoners of the Israelis and with their families.
The late founder, Dr Eyad Saraj, was himself imprisoned by both Israel and the Palestinian Authority in the 1990s and later treated uniformed Palestinian guards who had acted out their own Israeli prison experiences by abusing him and other PA prisoners.
'People feel they are abandoned by the international community, who have failed to do what was necessary to stop the war'
- Dr Yasser Abu Jamei, GCMHP
Dr Eyad carried out pioneering psychiatric work with prisoners and the youth of the First Intifada, who had experienced years of their fathers' imprisonment as well humiliation by Israeli soldiers at checkpoints, night raids at home, and often brutal enforcement of Israel's myriad rules governing the occupation.
The names of infamous Israeli prisons, like Khiam and Ansar (in occupied southern Lebanon), wherein the 1980s Palestinians and Lebanese were held in inhumane conditions and tortured by the Israeli proxy force, the South Lebanese Army, are seared into Palestinian collective memory.
Historical trauma is now repeated.
Following Dr Saraj's death in December 2013, psychiatrist Dr Yasser Abu Jamei, who had been working in GCMHP since 2002, became its head.
Dr Abu Jamei has deepened GCMHP's unique research work and expanded the 35 years of international support from Sweden, Norway, Germany, Switzerland, the European Commission, the US, OCHA, OHCHR, and the UN fund for victims of torture.
Dr Abu Jamei expressed gratitude for the dedicated staff: "Most importantly, they have a culture of support for each other and of the people they see - thousands and thousands of people in this time of crisis and genocide. People feel they are abandoned by the international community, who have failed to do what was necessary to stop the war. With the GCMNP staff, they find a source of comfort," he said.
Coping with grief
Gaza's men, seeking the relief of speaking out to these GCMHP staff in recent months, also talked about having no medicines for chronic diseases such as high blood sugar and high blood pressure.
They also spoke of private matters, such as not having space to cry or talk about their feelings and the helplessness they feel in conducting their daily lives.
They also spoke about the difficulty in dealing with their wives and children in a calm manner and said that "violence has become a part of daily life".
Among children, smoking, substance abuse, aggression and denial were all reported.
The researchers also analysed survivors' positive coping methods, which included "spiritually derived contentment and praying and reading the Holy Quran".
Communicating with neighbouring tents was important, as was linking to the GCMHP free phone counselling or starting a small business.
The teams worked in the tents and shelters of Deir al-Balah and Khan Younis, offering psychological first aid to 24,034 people in the last eight months, and referring 1,922 of them with severe symptoms to specialised mental health services.
Among those referred was seven-year-old Ahmad, who, on the first day of Eid, went out to play with his sisters on a trampoline set up for the festival.
The researchers also analysed survivors' positive coping methods, which included 'spiritually derived contentment and praying and reading the Holy Quran'
As they bounced and laughed, they were bombed, and his two sisters were killed while he suffered a life-changing brain injury.
A GCMHP team visited the family and explained how Ahmad and the whole family would receive visits from specialised staff who would help them individually to cope with the devastating loss of two daughters and Ahmad's new life.
The grandmother and uncles, who were now sharing the family home after being displaced, were also counselled to assist them in helping the parents cope with their grief-filled reality.
After four sessions, the family reported back on a new atmosphere at home of calm and relief. Ahmad himself had come out of his shell and enjoyed his friends visiting him to play: "I like it when my friends come and play. I like to play with them because it's boring when I'm alone," he said.
All family members reported feeling relief in the tent after Ahmad's previous moods of aggression, tears, and irritation had passed.
"He would fight with everyone," said the grandmother. "Now he even comes and plays with me." Therapy and counselling continue for the family.
Beacons of hope
A poignant picture drawn by ten-year-old Hala, displaced in terror multiple times, is titled: "School is no Longer a Place for Learning and Playing; There, people Suffer and Die."
Her picture is in the courtyard of a Unrwa school where people live, with planes and helicopters on the Strip of sunny blue sky above the school.
An Israeli tank and armed soldiers pointing their guns occupy the foreground, with wounded and dead bodies and Palestinian men in their underwear with arms above their heads.
After one of the displacements, Hala would go to the school with her father daily to fetch whatever food was available as the family was registered there, but there was no space for the family to stay.
Crowds filled the school as they waited for food. Hala was treated for post-traumatic stress disorder (PTSD) and, through drawing and other therapy, began to make a recovery.
Thirteen-year-old Sarah's picture has an ambulance in the middle of a bombing raid and tank fire from all directions. Dead bodies lie in pools of blood.
Sarah was wounded in the leg in such an Israeli attack and taken to hospital, carried by her mother, and then put on a donkey cart. She cried out for her father: "I'm dying. Where are you, Dad? I need you. I want to see you for the last time before I die."
She and her siblings did not know that their father was sick with cancer and was receiving treatment abroad, unable to come back because of the war.
Sarah became mute after her operation and returned home. She didn't speak a word for three months; she just made signs or wrote notes.
Her mother then contacted GCMHP, and Sarah was assessed and a psychotherapy plan put in place. "Drawing was the threshold of her recovery", the therapist team reported as she began to recover from severe PTSD symptoms.
Every such modest recovery is a triumph. It brings hope to the family and tight community, all sharing the unthinkable pain and loss around them in the tent encampments or crowded, battered schools.
These teams of skilled mental health workers are beacons of hope for Palestinians.
They include Dr Hossam Abu Safia, the director of the besieged Kamal Adwan Hospital in Beit Lahia, who refused Israeli orders to leave his hospital and its 150 patients as the army moved on taking over all of northern Gaza - just like the Palestinian journalists dodging death every day and the educators who keep teaching in the tents.
They exemplify the current determined humanity that lives on in Gaza.
The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Middle East Eye.
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