“Have you ever seen a six-month old baby with exaggerated startle response?” One of my colleagues who works on our telephone counseling service was calling me for advice on how to respond to several distraught mothers asking her how to help their babies who had started showing such distressing symptoms of trauma during the recent bombing. Our telephone service was back and responding to callers on the third day of the attacks on Gaza, though of course with certain difficulties.
The question took me back 20 years to when I was a young resident in the pediatric department at Nasser hospital in Khan Younis, Gaza’s second biggest city, in the southern part of the Gaza Strip. Then, my plan was to become a pediatrician. The hospital, on the western side of the city was not far from the Israeli settlements. Often in the middle of the night I used to receive mothers arriving in the pediatric emergency department with tiny children who had started screaming with no clear reason. Physical examination mostly revealed nothing abnormal. Perhaps this was the trigger that made me train to become a psychiatrist.
During those nights, you could often hear shooting from inside the Israeli settlement’s high fortifications, with the bullets mostly ending in the walls of the Palestinian homes and other buildings that faced the settlements. That was the common experience we adults were used to, and of course something that children, even the very youngest, also had to live with.
Thinking about those mothers and babies, I then asked myself about the likely psychological consequences of this 11-day offensive on the people of the Gaza Strip, and how it is going to be different from 2014’s Gaza war which lasted for seven weeks through July and August, including a ground invasion into Gaza. There were then 2,251 Palestinians killed and 11,000 wounded.
AFTER THE 2014 WAR
In 2014, we formed in the Gaza Community Mental Health Program (GCMHP) what we called crisis response teams, that were usually composed of a man and a woman, both psychologists. Their main task was to provide Psychological First Aid: to give some psychological support and detect and refer cases in need of further interventions to our three community centers. Parents often were talking about changes that their children had begun experiencing. Children were having poor concentration, sleeping difficulties and night terrors, bed-wetting and irritability. Younger children were clinging to their parents.
During the four months that followed the attacks in 2014, 51 percent of children visiting our centers were diagnosed with post-traumatic stress disorder (PTSD), another 11 percent were diagnosed with bedwetting. For adults, 31 percent were diagnosed with PTSD while 25 percent were diagnosed with depression. During those months, almost 20 percent of the people that were visited by the crisis teams were referred to our community centers for further assessment and therapy. The U.N. Children’s Emergency Fund (UNICEF) reported then that more than 370,000 children were in need of mental health and psychosocial intervention. Would these figures predict anything for after the 2021 offensive?
We know now the physical effects: at least 242 people were killed in Gaza, including 66 children, 38 women (four pregnant) and 17 elderly people. The injured are around 1,948 people—an iconic figure for every Palestinian. It includes 610 children and 398 women and 102 elderly people. Moderate-to-severe injuries affect 25 percent of the injured. During the offensive 107,000 people were internally displaced with about two thirds of them seeking shelter at United Nations Relief and Works Agency schools.
We saw six hospitals and 11 clinics damaged, and there are some ironic stories. It was on May 17 that the Rimal primary health care center situated within the Ministry of Health (MoH) compound in Gaza city was attacked. The center included the main laboratory for COVID-19 tests and was partially affected. The MoH had to stop the testing and asked people who were supposed to get their second shot of vaccine to go to Al-Daraj primary health care center across Gaza City. However, that center, too, came under attack, as there was a house in the area that was bombed in an air strike. The Rimal clinic was also the place to get vaccinated in Gaza city. Luckily the damage to both clinics was partial and the Rimal clinic soon resumed service. However, a young physician, Dr Majed Salha was severely injured on his head, and his condition is critical.
ONGOING MENTAL HEALTH CHALLENGES
Only weeks ago, COVID was the main concern in Gaza as in any other place in the world. People calling our telephone counseling line at GCMHP or people we were meeting either in the community or at the community centers presented with two main and interlinked complaints or challenges. One was how deeply the economic conditions were affecting their lives. The unemployment rate in Gaza, even before the bombings, was 43.1 percent, and for people under 30 it was 65.5 percent. Even among those working, many are in casual employment, living from hand to mouth. Taxi drivers, or those who sell vegetables at the open markets were badly affected by the COVID-related restrictions on movement and other measures such as social distancing and closing of some of those open markets. Depression and high anxiety were rife as men were unable to provide either sanitizers or simply food for their families.
The second fear was always how to deal with their children under such restrictions and with schools closed. We have on average five children per household, and we live in one of the most crowded areas in the world with more than 13,000 persons in one square mile. Those children, not being allowed to leave their homes because of COVID restrictions, were badly in need of support.
Two weeks before the offensive the MoH was dealing with the second wave of COVID with about 35 to 40 percent of the people being tested showing positive. Suddenly those COVID-related concerns were overshadowed by the fears related to the airstrikes, the bombing and survival. How is that going to impact the psychological wellbeing of the population?