On 13 January, 99 days into Israel’s most recent onslaught in Gaza, 23-year-old Haya escaped the Strip to Cairo. During the attacks, Haya’s family home was destroyed by an Israeli airstrike, and many of her friends were killed.
‘When I left Gaza, I couldn’t stop crying,’ she recalls. Haya is now physically safe, but fearing for her family still in the strip has left her in a state of near-permanent anxiety. ‘I usually can’t sleep till 5 or 6 AM, because I can’t stop thinking about Gaza.’
When Haya does sleep, she’s plagued by nightmares of being back in Gaza; of being bombed and losing loved ones. ‘I always wake up so scared,’ she continues. She now lives near Cairo airport, and feels terrified every time she hears the sound of a plane, fearing it’s an airstrike. ‘I don’t think I’m going to live a good life, after I’ve lived through this. I think this impact will be forever with me.’
Haya is one of many Palestinians dealing with severe trauma as a result of Israel’s bombardment of the Gaza Strip. Gaza’s healthcare system is collapsing, and this includes its mental health services. On 6 November, Gaza’s only psychiatric hospital was bombed by Israeli forces. In addition, the six community mental health clinics which work with thousands of patients across Gaza are not functioning as a result of the airstrikes.
Dr Bahzad Alakhras, a mental health doctor at the Gaza Community Mental Health Programme, has been trying to stay in touch with some of these patients via WhatsApp, but it’s often impossible due to Israel’s destruction of the Strip’s phone and internet connection. Children are among the most vulnerable, ‘devastated’ people Alakhras speaks with. ‘They ask difficult questions, like ‘Why is this happening?’, ‘What did we do to deserve this?’’ says Alakhras. ‘I hear [from] children who are wishing to die.’
According to Audrey McMahon, a child and adolescent psychiatrist working in occupied Palestine for Médecins Sans Frontières, much of what her colleagues have been dealing with in Gaza since October 7 is unprecedented. She recalls discussing a recent case with a colleague in Rafah caring for a ten-year-old Palestinian boy. The boy’s home was hit by an airstrike, which killed his uncle and required his leg be amputated without anaesthetic.
McMahon says that the boy will go ‘from screaming in incredible pain’ when his wound is being treated to retreating into himself the rest of the time. ‘[My colleague] says that it’s impossible to have eye contact. He doesn’t speak, and he looks completely absent,’ she tells Tribune.
More than 10 children per day, on average, have lost one or both of their legs in Gaza since conflict erupted three months ago, many without anaesthetic or other forms of pain relief. ‘With that level of physical pain on the brain [alongside] the emotional pain, I’m truly wondering about the impact on the neural pathways,’ says McMahon. ‘There’s a lot that we don’t know about the mental health impact.’
A Crisis as Old as the Occupation
Before Israel’s latest onslaught, Palestinians in Gaza and the West Bank were already suffering severe trauma from prior attacks. More than half of the adult population in the West Bank and Gaza screen positive for depression. In Gaza alone, the rate climbs to 71 percent. Meanwhile, a 2022 survey by the nonprofit Save the Children found that 80 percent of children reported feeling in a perpetual state of fear, worry, sadness, and grief. Three quarters of children were bedwetting in fear, and a growing number were exhibiting reactive mutism. More than half of those surveyed had contemplated suicide.
‘When the numbers are that high, what it really means is that the context is pathological,’ says McMahon. Indeed, the mental health crisis in Palestine must be understood within the context of occupation. An International Monetary Fund report says more than 60 percent of Gazans recently lived in poverty, while the West Bank’s share was 19 percent at the end of 2022. Well before October 7, 97 percent of Gaza’s water was undrinkable and 33 percent of the population were food insecure.
Palestinians living in the West Bank may not have to deal with constant bombardment, but they face their own challenges, from routine humiliation at checkpoints and Israeli censorship to arrests and settler violence. ‘You don’t need to be a psychiatrist or a mental health professional to understand that occupation harms people’s minds,’ says Dr Samah Jabr, a Palestinian psychiatrist and psychotherapist. ‘People suffer distress, rather than depression. So they don’t need treatments, they need better life circumstances.’
Recognising that colonisation is at the heart of Palestine’s mental health crisis means seeing the trauma as a collective one. In this context, Western healthcare paradigms, which tend to treat people individually for their suffering, are insufficient. ‘In terms of mental health practice, we are still doing the traditional things: we rely on medication, and some psychotherapy or treatment. But I think we don’t provide an adequate response to the political distress,’ says Jabr. ‘I find it more important to talk about the impact of violence on people and to challenge those who are silent about it than to do therapy to the affected individuals.’
Jabr highlights the importance of ‘collective processing’ in addressing collective trauma. ‘When we address [someone’s suffering] in a group setting, people listen to others who suffer in a similar way, and there is a normalisation of their anger or their distress,’ she says.
Likewise, the use of terms like PTSD – often applied to Palestinians who have been exposed to Israeli violence – are wholly inadequate when it comes to describing the experience of Palestinians living in Gaza. ‘The development of the construct of PTSD came from the experience of soldiers who do their work and go back to the safety of their homes. They still feel a threat that is not reality,’ explains Jabr. ‘This construct doesn’t work for the people of Gaza, because the threat is very real; it is surrounding every aspect of their life.’
In Gaza, there can be no addressing the mental health crisis without a ceasefire. The extreme levels of bombardment and the lack of safe spaces make trauma an inevitability. ‘Mental health is not just therapy, it’s having our basic needs responded to; it’s having a sense of safety,’ says McMahon. ‘Most of the interventions we are used to will not be helpful.’
Jabr stresses that the most important thing mental health professionals can do at this moment in time is challenge ‘the complicit or silent institutions, for whom the humanity of Palestinians counts less’. She points to the statement released on October 11 by the American Psychiatric Association, which condemned ‘terrorist attacks in Israel’ without mentioning Israel’s 75-year-long occupation of Palestine. As Jabr puts it, ‘That’s the real issue: racism.’
The Power of International Solidarity
While it is virtually impossible to begin to treat the mental health crisis in Gaza and the West Bank without a ceasefire in place, South Africa’s genocide case against Israel at the International Court of Justice (ICJ) has offered some hope. ‘The ICJ won’t solve everything, but it is a possibly very healing gesture in the eyes of Palestinians, because it makes them feel seen, and like someone is trying to protect them,’ says McMahon. ‘That’s key in trauma in general. What makes us resilient is not the trauma itself, it’s having someone to support us.’
Haya makes a similar point about the importance of international solidarity in healing the collective trauma faced by Palestinians. ‘I felt so happy when I saw all the people around the world raising the Palestinian flag. Knowing that people know the reality and the truth of the Israeli occupation, knowing this is a conflict and not a war,’ she says. ‘It made me feel safe.’
‘Solidarity is therapeutic,’ says Jabr. ‘If we are left to the discourse of official regimes and mainstream media, Palestinians will hate humanity, they will feel isolated. But this feeling of isolation will be worse without the grassroots street protests and solidarity that is expressed in big capitals. It validates the Palestinian experience, it tells us that we are seen and that our pain is felt.’