‘They have seen bombs, deaths and bodies’: Sharp rise in chronic traumatic stress disorder among Palestinian children

Even before the war in Gaza broke out, people in the besieged Palestinian territory had some of the worst mental illnesses in the world.

The Israeli and Egyptian blockade of the Mediterranean is now seventeen years old; a generation has grown up that knows nothing but cyclical escalation, a dire lack of public services and virtually no freedom of movement. Research published by Save the Children in 2022 found that four in five children in Gaza said they live with depression, sadness and anxiety, and three in five self-harmed.

Since October 7, the charity found that, unsurprisingly, there has been a dramatic deterioration in children’s mental health. “Children here have seen everything,” one father, Wasseem, told Save the Children researchers. ‘They’ve seen the bombs, the dead, the bodies… We can’t pretend anymore. Now my son can even see what types of explosives are being dropped.”

According to Dr. Samah Jabr, chairman of the Hamas-run Mental Health Department of the Palestinian Ministry of Health, experiencing such horrors does not easily translate into the clinical definition or treatment for post-traumatic stress disorder (PTSD). Tools for evaluating depression, such as the Beck inventoryDon’t consider circumstances where fear is a reasonable response.

“If Western society considers a car accident traumatic, can we use the same word for the level of atrocities taking place in Gaza?” she said in an interview with the Observer. “The clinical description of PTSD reflects the experience of, for example, a soldier going home… Trauma in Palestine is collective and continuous. With PTSD, your mind is stuck in a traumatic loop. In Palestine the circle is reality. The threat is still there. Hypervigilance, avoidance – these symptoms of PTSD are not helpful to the soldier who has gone home, but for Palestinians they could save your life. We see this more as a ‘chronic’ traumatic stress disorder.”

Jabr, 47, grew up in Israeli-occupied East Jerusalem. Today she is responsible for mental health care in East Jerusalem, the West Bank and Gaza. A noted public speaker and writer on mental health and human rights, she obtained her early medical training and clinical rotations during the Second Intifada, the Palestinian uprising, of the 2000s, which led to an interest in psychiatry and analytic psychotherapy.

“One of the collective punishments the Israelis imposed was closing the checkpoints, leaving Palestinian workers unemployed,” she said. “Young men started having headaches, palpitations, back pain… These were all medically unexplained symptoms and I understood them to be psychological.”

Jabr’s is inspired by the work of mid-20th century psychiatrist and political philosopher Frantz Fanon. Fanon, an anti-colonialist from Martinique who joined the Algerian independence movement, also pioneered the concept of “community psychology” and contributed much to the understanding of the psyche of oppressed and occupied peoples.

Jabr said: “I had advanced psychiatric training in Britain, France and the US, but when I returned to Palestine I began to doubt what I had learned. Much of it was relevant and universal. But in the case of Palestine, political violence and power dynamics are a very important element in understanding mental health issues.”

She believes that where racism and humiliation at checkpoints, Israeli army raids, home demolitions and administrative detention without charge occur, political realities must change for her patients to make a meaningful recovery.

She has trained hundreds of medical professionals in Palestine, as well as Afghanistan, Libya and Jordan, and often sees up to thirty people a day exhibit personality changes and emotional distress that manifest in physical problems.

“For example, if you work with someone whose relationship with the Israeli prison is like a revolving door, we can’t stop that. What we can do is provide solidarity, recognition, support and validation,” she said. “I also work a lot with mothers who have lost their children due to political violence. A woman from Jericho held her grief for a long time and was very depressed, but talking about it with me didn’t really help her; she was tired of expressing her feelings. We organized other mothers to come visit her from Jenin, and a friendship developed. She found a lot of support in that.”

Sumudan Arabic word that has no direct translation but is related to steadfastness or resilience, is an important shared political and cultural value for Palestinians, and one that Sabr foregrounds in her clinical work.

The ability of people to help themselves continues to amaze Jabr. Young people whose childhoods were marred by time in Israeli prisons don’t necessarily want to come to her clinic, or be stigmatized as “sick,” but what has helped is a grassroots program in which adult men with prison experience spend time with the teens. .

Providing professional mental health care is a persistent problem. Jabr has only 34 trained psychiatrists to care for the mental well-being of 5 million Palestinians. In Gaza, there were only six public mental health centers and one psychiatric hospital before the war. None are functional now.

From a study published last year in Middle East current psychiatry agreed with Jabr that PTSD and continuous traumatic stress disorder (CTSD) among Palestinians “cannot be changed unless the root of the problem is solved by ending 74 years of life under occupation.”

Justice and solidarity, Jabr believes, will be important corrections to the damage caused by this unprecedented war. “Giving people who lost their humanity, people who were reduced to nothing, their dignity back… Psychologists cannot do that alone. We need answers at national and international levels. We need the rest of the world to support us.”