The May 20 ceasefire between the Israeli government and Hamas ended the latest round of conflict in the region and led to a collective sigh of relief from besieged Palestinians in the Gaza Strip.
But the deep wounds that the violence has opened remain fresh.
Eleven days of Israeli shelling on the besieged enclave left 256 Palestinians dead, including 66 children. Nearly 2,000 were injured. Houses, offices and hospitals were destroyed.
While the fragile ceasefire seems to hold, those who survived the conflict are once again trying to rebuild their lives. But the damage inflicted during those 11 days was not only physical and material. The mental health of Palestinians in Gaza was also bombed during those dark days.
Living in fear of the next air attack, the specter of death looms. Losing loved ones and homes. It’s hard to imagine how traumatic their reality was.
The people of Gaza have suffered layer after layer of trauma for decades. The deadly Israeli assaults are the most damaging – four in the past 14 years – but they occur against the backdrop of the chronic trauma imposed by the occupation.
Atrocities such as the seizure and demolition of houses, police repression, unlawful killings, detention without trial and torture all inflict profound psychological damage. Such perpetual submission can destroy self-esteem and leave victims in a state of “learned helplessness” – resigned to their plight and vulnerable to depression.
Israel’s illegal blockade of Gaza also amounts to psychological seizure. The resulting economic deprivation led to widespread unemployment and poverty – well-known risk factors for mental illness – and left health services underfunded, underdeveloped and unable to meet demand. Each war on Gaza decimates them further – at least six hospitals, two clinics, a health center and a Palestinian Red Crescent facility suffered damage this time around.
For most other countries, COVID-19 is currently the main public and mental health problem. In Palestine, it’s almost an afterthought, replaced by more dangerous attackers – air strikes and oppression. Nonetheless, more than 110,000 people in Gaza have been infected with the virus so far, with more than 1,000 deaths. There are only enough doses available to immunize 60,200 people out of a population of over 2 million. Thus, pandemic anxiety is also rampant in Gaza, adding to the mental burden.
All this turmoil translates into real mental illness. In Gaza, rates of post-traumatic stress disorder (PTSD) – characterized by disturbed sleep, a constant feeling of nervousness and easily startled, flashbacks and nightmares of trauma and emotional numbness – are incredibly high . A 2017 study found that 37% of adults living on the Strip qualify for the diagnosis.
In my work as a psychiatrist, I have treated refugees with PTSD from the wars in Iraq and Afghanistan. It can be serious, complex and prolonged. It would be almost impossible to begin healing as long as the root causes persist. The head of mental health services in Palestine once said that her people do not suffer from post-traumatic stress disorder because their trauma is ongoing. The current traumatic stress disorder may be a more apt description of their experience.
As is often the case in these situations, it is the children who suffer the most in Palestine. A study conducted in 2020, before the last conflict, found that 53.5% of children in Gaza suffered from PTSD. Almost 90 percent had experienced personal trauma. The Norwegian Refugee Council reported the devastating news that 11 of the children killed by recent Israeli airstrikes were participating in its trauma program. No wonder UN Secretary-General António Guterres called Gaza “hell on earth” for children.
Of course, the Israelis also suffered. Twelve were killed by Hamas rockets in May, including two children – a tragic loss of life. But for Israelis, the Iron Dome defense system and bomb shelters provide a vital safety net and a sense of security Palestinians live without. Their highly developed health services are much better equipped to deal with both the physical injuries and the psychological impact of rocket fire. They also don’t live in the mental anguish of the occupation. All of this is reflected in their lower PTSD rates, ranging from 0.5 to 9 percent of the population.
In 2008, I traveled to post-conflict Somaliland to teach psychiatry to medical students. The civil war that plagued the region ended in 1991, but its effects on the mental health of the population and the health infrastructure were still evident some 17 years later. They still continue to this day. It will take time to rebuild the fragmented minds and health services in Gaza, but there is little hope for them until Israel ends its illegal occupation, settlement expansion and blockade. of Gaza.
The oppression of the Palestinians led Human Rights Watch to the conclusion that Israel was committing the crime of apartheid. Perhaps viewing this situation through the prism of human rights violations and their grave impact on mental health could spur the international community to pressure Israel to act. Both Palestinians and Israelis deserve safety and protection from trauma. The best way to do this is to grant the Palestinians their basic human rights.
The opinions expressed in this article are those of the author and do not necessarily reflect the editorial position of Al Jazeera.