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Mental-health centre helps sufferers in the Gaza Strip

10 February 2017

Sally FitzHarris looks into the care of trauma survivors in Gaza


Scene of destruction: the town of Shujaya, in the Gaza Strip, in 2014/15

Scene of destruction: the town of Shujaya, in the Gaza Strip, in 2014/15

A GRANDMOTHER in Gaza, Um Hussein, sits alone. Pictures of smiling faces, seemingly elevated in clouds and daisies, look down from the walls of her room.

On a hot July afternoon, in the early days of Gaza’s last war, her elderly husband took seven of their grandchildren up on to the roof, to “relax and get some sunlight”. They had spent several days cooped up in the house, as the Israeli bombs hit Gaza, but the military had announced a brief truce, a report by Defense for Children International Palestine says.

They were still on the roof when two artillery shells struck. All were killed immediately, except for nine-year-old Ola, who died of her injuries in hospital, five hours later.

Ambulances, firefighters, neighbours, and journalists rushed to the house. Then, in an apparent “double tap”, two more artillery shells were sent into the crowd. Among the dead were two more of Um Hussein’s family, and another son was badly injured.

A plaque on the battered concrete walls of the four-storey al-Silk family house, where the generations live on different floors, commemorates the ten casualties of that day, aged from two to 69.

“I am not the only one suffering tragedy,” she says. “Many people are suffering.”


IN OPERATION Protective Edge, launched on 5 July 2014, 1391 civilians were killed, including 526 children. Of the 72 Israelis killed, six were civilians, including a four-year-old, an Israeli human-rights organisation, B’Tselem, has said in its most recent report.

“It was launched to put an end to the incessant rocket-fire from Gaza,” an Israeli government spokesman said.

In the aftermath of the war, some 370,000 Gazan children were suffering from post-traumatic stress disorder (PTSD), UNICEF says.

In the immediate wake of the bombing, teams from Gaza Community Mental Health Programme (GCMHP) visited all those who had lost multiple family members. “We use play therapy, psycho-drama, and family counselling to help children with severe PTSD,” Dr Taysir Diab, a senior psychiatrist, explained.

The programme is in the front line of training and providing mental-health practitioners in schools and clinics, and runs a 24-hour phone hotline, which has brought many more families to its door.

The director, Dr Yasser Abu-Jamei, who lost 28 members of his family in a single airstrike, describes some of the challenges: “The psychological wounds are harder to heal, because the ruined buildings and devastated neighbourhoods serve as a constant reminder of the violence. Each time there is a small escalation, and the sky is full of jet fighters — maybe just doing an exercise — this reminds children of bombardment.”

Psychodrama, alongside other psychosocial initiatives, was introduced two years ago. “Children from three to 11 love to play stories,” Ines, quietly spoken, says. She runs drama sessions in schools.

“They are in a kingdom with a king and a queen, and in their kingdom there is a plant,” she says. “And this plant can heal all diseases — in Gaza especially, we have difficult diseases, like cancer, and we do not have therapy for this — and we have invaders who want to take this flower; so we want to protect it. This is their own story.

“So we do a role-play, and each child chooses his or her role, and they give us, the therapists, our role. And they say to me: ‘You will be the flower,’ and to my colleague: ‘You will be the invader.’ So they learn from this story how they lead a team to protect their land or their goal, and they are not using aggressive behaviour.”


AT THE Palestine Trauma Centre, Dr Ghada Radwan and her team use teddy bears. Questions focus on the teddy: “What does he say? How are you going to look after him?”

Dr Radwan says: “It is important for the traumatised child to feel that intense attention is not directed towards him, and that discussion occurs in an open space. Mohammed, aged 12, tried to bury his teddy bear in the sand. The child’s father was a fisherman, and he was shot in his boat; so he imagines this teddy bear is his own father, and he can bury him in the ground.”

Role-play also reveals the inter-generational aspect of PTSD. “We gave an old man of 76 a teddy bear, and he started to remember 1948. He remembered digging a hole, and putting his sister and mother in that hole to try and keep them safe. He remembered his little sister saying “Why are we in this hole? Is this our grave?”

“That was such a painful moment; he has never been able to forget it. This touched me particularly, because this old man was my uncle, and his little sister was my mother,” Dr Radwan says.


RESILIENCE is a word much used in the context of Gaza and the Gazans. At the trauma centre, the therapists use a green olive-branch and a dry stick, and wood that is brittle and breaks under pressure. Patients choose one or the other to discuss their feelings.

The simple exercise perhaps underlines the singularity of Gazan trauma. Mental-health workers agree that trauma in Gaza is not truly “PTSD”, since it cannot be described as “post”: it continues.

“A ten-year-old child has witnessed three major wars in his life: in 2009, 2012, and 2014. He knows nothing except for war — bombing . . . dead bodies . . . destroyed houses: these are the images in children’s minds,” the director of external relations at GCMHP, Husam El-Nounou, says.

“We sit with children, we help them, and they improve, but we know we are preparing them for a new trauma. Our colleagues worldwide do not have this fear. The continuous threat of a new attack affects our work.”

Behind the expectation of another war lies also the knowledge that successive wars have increased in ferocity.

In 2014, Operation Protective Edge attack showed a significant increase in both fire-power and casualties: 7000 shells were fired into the neighbourhood of Shuja’iyya, where the al-Silk family lived, in one 24-hour period, a Pentagon summary said.


THE attacks on residential areas and civilian structures during Protective Edge raised further concerns about war crimes. A recent Defense for Children International Palestine report, Operation Protective Edge: A war waged on Gaza’s children, says that 164 children were killed in drone attacks. It cites evidence suggesting that children were directly targeted.

A missile attack on a school in Rafah, south Gaza, which was sheltering 3000 displaced civilians, was denounced as a “gross violation of international human-rights law” by the then UN secretary-general Ban Ki-moon, who confirmed that the IDF had been repeatedly warned of the location of such sites.

The recent military-aid deal between the United States and Israel, which was agreed before President Obama left office, is worth a total of $38 billion over ten years, beginning in the budget year 2019, Al Jazeera says. Analysts believe that munitions on Israel’s shopping list may well be used in future assaults on the Gaza Strip.

“The most difficult issue is to encourage hope,” Dr Abu-Jamei says.

Hazem Shawa, a man known throughout the Gaza Strip for his work with amputees, would agree: “The closure is very hard today. . . Gaza is like a big brazier with a very high heat coming inside the hearts of the people. . . The life in Gaza is miserable: they cannot bear this any more.

“We are waiting for what? There is no peace, no process for peace, the world . . . is a big machine for killing.”


Sally FitzHarris is a freelance journalist who now visits Palestine regularly since her first trip there during the Second Intifada, in 2003.

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