Q&A: Confronting trauma in Gaza City

Gaza City – Since this summer’s devastating war in the Gaza Strip, the number of patients seeking help from the Gaza Community Centre’s mental health programme has jumped by close to 50 percent.

The centre, which previously handled about 15 patients daily, is now seeing up to 25, administrators say – and the Gaza City centre is just one of three branches of Gaza’s mental health network. The NGO’s psychiatry, social work and physiotherapy services are available for free to residents, but social stigma still prevents an untold number from seeking help.

Psychologist Hasan Zeyada spoke with Al Jazeera about the challenges facing Gazans in the wake of a war that killed 2,200 Palestinians, and amid an ongoing, crippling siege.

Al Jazeera: How has your patient load changed since the summer war?

Hasan Zeyada: We have more cases that are referred to our centres. It’s the immediate reaction after war. A lot of people had psychological and behavioural consequences because of the trauma during the military Israeli aggression. A lot of people, they are in need of consultation, they are in need of intervention. We started to do our intervention immediately through field visits for the families who lost their homes and lost their family members, and for the injured people.

The war was brutal and it was for a long time, and it’s the third experience for the children here in Gaza, so a lot of people have already developed acute stress disorder and post-traumatic stress disorder. They are in need of intervention.

AJ: What are the most common psychological issues stemming from the war?

HZ: We are talking about sleep disturbances, like nightmares and insomnia; for children we are also talking about night terrors and sleep walking. We are talking also about re-experiencing and flashbacks among people related to the trauma.

There is avoidance behaviour, like thinking about the trauma, avoiding the places and stimulus that will make them remember the trauma. Also we are talking about hyper-arousal, hyper-vigilance; they are easily provoked, less tolerance.

There is marked impairment in daily functions and interpersonal relationships, and in work and academic achievements among their children.

Some of the people have somatic complaints like headaches, back pain, abdomen pain and general fatigue. It’s psychological, without any organic cause. It’s easier for the people to talk about physical complaints than to talk about psychological pain.

Sometimes they try to communicate with the people around them through their physical complaints, because we still have stigma and sensitivity around coming to a community mental health centre to be served. Because of that we also have our free phone counselling, which is totally confidential. 

AJ: Some of Gaza’s young children have been through three wars, and living in a war zone is all they know. How are the impacts compounded for these children?

HZ: For children we are talking about feeling insecure, anxiety about the future, that they are not guaranteed it will not happen again. They have clinging behaviour to their parents – all the time they want to be beside them. Children become more hyperactive and have attention problems and concentration problems; it’s one of the main complaints among parents and teachers at the schools, that the children are in need of more time to achieve the same academic level.

Children have nightmares. Some of them have regressive behaviour like bed-wetting. Some of them have somatic complaints, more fighting with other children; some of them refuse to go outside the home alone, they need to be with an adult. 

Children are all the time concerned about the future and how it will be next time, and how they will react. The multi-traumatic losses among the children is one of their main concerns. They are scared that they are about to lose their immediate family members, like their parents, their home, toys, their brothers and sisters, and sometimes they are so worried if their father or family member leaves the home. Some children have stuttering problems.

When there’s thunder, all the children react immediately as if it were shelling or rockets or bombs. For a lot of children it is not easy to fall asleep. They want their parents to be beside them.

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AJ: How do you treat someone who has lost their home and family in the war? How does someone recover from that?

HZ: It depends on the severity of the trauma and the character of the child and his resiliency. It depends on the family and social support and family resilience. If the child has his own family and he’s socially supported by the family – they can accept the psychological and behavioural consequences and they will contain the child – it’s a positive indication that the child will gradually overcome the consequences.

But if the child has lost one of his family members and his home, it will take more time and it will affect him psychologically more than others. 

After the comprehensive clinical assessment, we have our own management plan for them through expressive art therapy and drawing, and sometimes they join their family in family counselling on how they can deal with the consequences. In some cases, we have a combination of psychotherapy, play therapy and drawing, and some medication.

AJ: How many cases of psychological trauma do you think are going undiagnosed in Gaza?

HZ: Our expectation, according to scientific research, is that 35 to 40 percent of the children of the Gaza Strip will develop a post-traumatic stress disorder needing specialised intervention.

According to research we conducted in 2012 about the long-term effects of the second war, 30 percent of the children already developed post-traumatic stress disorder, but after this war, we are talking about 35 to 40 percent of the children.

They are not all coming to this centre. Some of them will have immediate reactions and may be able to overcome through their family, through psychosocial activities in the school. But if the child already has post-traumatic stress disorder, they need specialised intervention.

AJ: The future remains uncertain for Gaza. What does this mean for the mental-health outlook for residents here?

HZ: We are concerned. No-one can guarantee war will not happen again. We are doing our best on the ground to help the people to overcome the consequences, but without a real protection for the people, we cannot talk about real recovery, because the people are still so occupied and worried about the future. 

In Gaza you are talking about a restrictive siege, ongoing trauma, a chronic situation at all levels; this is one of the maintaining factors that the people will keep suffering from their situation.

When we talk about psychological intervention, we try to help the people and the community, but the situation in Gaza will not be healthy if we keep living in the same environment and the same situation. We have to talk about the political context here in Gaza.

There is no psychological well-being without real respect for human rights. And under the occupation, all the time you are talking about human rights violations. The link between mental health and human rights issues is so strong.

We are doing our best to help the people, and we have hundreds of psychosocial and mental health professionals.

But one political decision will affect all the aspects of our lives. The psychological well-being among the people will be improved if you make just one political decision; to end the siege, to end the occupation.

This would have a huge impact.

Follow Megan O’Toole on Twitter: @megan_otoole