It has taken Mansour’s mother a long time to learn to cope with her 12-year-old son’s changing personality.
Once a top student, Mansour has become aggressive and disobedient. His grades are down, his mother says, and he suffers night terrors.
Mansour’s mother can date his transformation to Israel’s war on Gaza in 2014.
“He was a top student before then. He used to be a cheerful boy,” she recalled.
During the assault, the family had to evacuate their home and move to a UN shelter, a school that was then also bombed. Since then, Mansour’s mother told The Electronic Intifada, he now prefers to be alone at school or at home. He has also started wetting the bed.
“He is easily terrified by loud sounds like thunder,” according to his mother, who, like others interviewed for this story, declined to be named in order to protect her privacy.
These are classic signs of post-traumatic stress disorder, or PTSD, though as health care professionals at the Gaza Community Mental Health Program (GCMHP) never tire of pointing out, in Gaza there is never any “post.”
GCMHP, Gaza’s best-known mental health care provider, founded in 1990, has noted a sharp rise in the number of children and adults with PTSD since the 2014 attack.
Psychological first aid
In the six months after the war, 51 percent of the children who received services from GCMHP were diagnosed with PTSD, according to the organization’s director, Dr. Yasser Abu Jamei.
“Since the war, people have been so absorbed with how to manage their lives that they neglect their psychological welfare,” Zahia al-Qarra, a mental-health professional with GCMHP, told The Electronic Intifada.
The enormous stress endured during the 51 days of bombing — as well as during two previous large-scale Israeli assaults over the past eight years — and the nine-year Israeli blockade that is still preventing most reconstruction, has affected the whole population, al-Qarra said.
Studies prior to the 2014 attack had demonstrated already high levels of PTSD among the population in Gaza as a result of exposure to earlier wars and trauma.
In this situation, health care professionals are struggling to keep up.
“Our work is to intervene to provide the psychological first aid for affected communities,” al-Qarra said.
GCMHP has paid special attention to children. They have registered an alarming rise in the number of children exhibiting one or more symptoms of PTSD, attention deficit disorders, sleep walking, memory loss, nightmares and other anxiety disorders.
It has been nearly a year and a half since the war and Mansour still fears he is dying. He worries that poisonous insects will enter his room at night and bite him. “I feel I walk with a knife in my heart,” he said.
The source of his fear is no mystery. His family home still bears the scars of the intense bombardment the Beit Hanoun neighborhood in northern Gaza suffered during the 2014 onslaught.
There is neither money nor material to repair the holes in the walls.
The kind of visualisation of fear that haunts Mansour is very common among children, according al-Qarra.
GCMHP works with children like Mansour to allow them to express their fears in other ways.
“We see the scars of war explicit in children’s productions like narratives or drawings,” al-Qarra said. “What they tend to draw are pulverized buildings and mutilated bodies laid out on the ground.”
GCMHP says it has mobilized 28 mental-health professionals into nine teams in mobile clinics in an effort to cope with the burgeoning needs.
According to al-Qarra, such clinics have reached nearly 21,500 children and adults who otherwise might never get treatment and who certainly cannot afford it.
It is clinics like these that reach children like Mansour, or Salim.
Just 9 years old, Salim has been diagnosed with obsessive-compulsive disorder. Since the 2014 attack, he is always touching surfaces, tables and walls. He has begun to pull out chunks of his own hair.
Salim’s mother contacted GCMHP because she didn’t have anywhere else to turn. “He lost a lot of his hair due to this habit. And he can’t stop,” she told The Electronic Intifada.
She has had to go to Salim’s school to explain his situation to his teachers and friends.
“I don’t want anyone to talk to him about his hair. Negative comments from others could hamper the treatment,” Salim’s mother said.
Treatment in a place where so many experience trauma is an almost insurmountable challenge, however. Due to the great demand, GCMHP prioritizes care for the families of the dead or injured, or those whose homes were completely or partially destroyed.
Group sessions are practical with such numbers, but the psychiatrists, psychologists and nurses working with GCMHP try to use a mix of approaches including group and individual therapy and play therapy for children.
But clinical interventions cannot succeed in the absence of wider social support.
“A community-based approach is an integral part of our treatment. The family, school and all other cultural and religious institutions play a part in supporting those with mental health issues,” al-Qarra said.
“We try to reassure the children, to make them feel as safe as we can,” al-Qarra added. “Memories of war are deeply embedded in their minds.”
But in Gaza no one feels safe. Successive Israeli attacks have wrought extensive damage to an impoverished territory that is defenseless against them.
Assurances that things will get better — the kind adults like to give children — ring false when houses are not rebuilt, when there are no jobs and there is no hope for the future.
There is no certainty that the horrors Palestinians in Gaza have already witnessed will be the last. “At every anniversary of the war, you start to listen to people’s speculations that another conflict is looming,” al-Qarra said.
International pledges in October 2014 for an unprecedented amount of money to rebuild Gaza gave people a rare moment of optimism.
Much of that money has not materialized and the Israeli blockade on supplies entering and exiting Gaza has remained in place. As a result, despair returned with even greater intensity, al-Qarra said.
Ayman, 8, is from Rafah, Gaza’s southernmost city, specifically the area Israel bombarded intensely as it implemented the so-called Hannibal Directive on 1 August 2014, after reports that the Palestinian resistance had captured one of its soldiers.
Israel’s ferocious shelling of homes killed scores of civilians in indiscriminate attacks Amnesty International concluded were often motivated by a desire for revenge.
At the time, Ayman’s family fled in fear. Their home was partially destroyed, though they were able to return and now live there.
Since then, Ayman shuns company and is prone to flashes of temper.
“He is terribly detached from the rest of the family,” his mother said.
He is easily irritated and avoids conversations about the war.
Ayman has been diagnosed with a panic disorder and now attends regular therapy sessions at a clinic affiliated with GCMHP.
But his mother still detects his fear and alienation.
“He lost hope of ever having an easy life. He is sure that he will fail.”
Isra Saleh el-Namey is a journalist from Gaza.