When Awni Abu Hatab was a toddler, he preferred to play alone.
His mother Nujoud, 28, noticed that his movements were jittery and excessive and that he was unable to make eye contact.
She grew concerned and took him to several doctors and hospitals in Gaza.
“At first, I thought that he could not hear,” Nujoud said. “I went to doctors and they confirmed that there was no problem with hearing. Others said that … the problem was psychological.”
Awni, now 8, has since been diagnosed with autism.
“We discovered this after years of effort,” Nujoud said.
The National Institute of Mental Health defines autism spectrum disorder as “a neurological and developmental disorder that affects how people interact with others, communicate, learn and behave.”
Marwa Atallah, a special education specialist at the Society for the Care of the Handicapped in Gaza, which was founded in 1975 and offers services to children with autism, said that children with autism often face misdiagnosis.
Many doctors, she said, “interpret cases of shock and delay in the use of personal skills in children as disability.”
Furthermore, children in Gaza already suffer from high instances of trauma as a result of Israeli violence. And children with autism, who are often highly sensitive to external stimuli, are particularly susceptible to the enduring impacts of war and conflict, which could potentially make diagnosis difficult.
Before Awni’s diagnosis, Nujoud left doctors’ offices feeling confused and frustrated, and while it was a relief for Nujoud to understand more about her son’s condition, life is not necessarily easier for their family post diagnosis.
At the family’s home in Gaza’s Beach refugee camp, Awni prefers to be near his mother. He likes to draw, but he doesn’t like loud noises and the dark.
“His brothers are young,” Nujoud said, “and they cannot bear his constant screaming and his nervousness. He hits everything on the ground, his movement is very fast, and we cannot control him.”
Nujoud has discovered that the resources for parents of autistic children in Gaza are extremely limited.
“There are no institutions to take care of him, no hospitals, not even specialists who provide sessions for free,” she said.
The Abu Hatab family struggles financially, as many do in Gaza due to Israel’s 15-year blockade. Awni’s father works as a laborer, and they share their home with three of his sisters.
Recently, though, Nujoud heard about Gaza’s Society for the Care of the Handicapped and let them know Awni was in need of services.
He was then enrolled in the society’s Shams school, where he attends classes headed by specialists who understand developmental differences in individuals with autism.
Nujoud is hopeful that the school will be a good place for him but, like other parents in Gaza, she understands that until the family’s financial circumstances improve, providing resources to their autistic child will be a struggle.
“I lose control over her”
Wafa Atallah, 26, first understood that her daughter Rawan was different when she turned 2 years old.
“We started to notice that she was not responding to her name and that she avoided eye contact,” she said. “At first, I thought that she only needed time.”
Just like Awni’s mother Nujoud, Wafa took Rawan to many doctors, all of whom did not offer a hopeful prognosis.
Rawan, now 6, was eventually diagnosed with autism.
“I wish we knew earlier that she was autistic,” Wafa said. “Maybe her condition would have been better.”
The family lives in al-Zaytoun neighborhood south of Gaza City and lives off of Rawan’s father’s income as a baker.
They pay $117 a month for Rawan to attend classes at Basmet Amal in Gaza, though they are unsure if they can continue to pay that long-term.
Basmet Amal, like Shams school, provides classes and developmental support tailored to individuals with autism.
Wafa is grateful to be able to afford the classes, but she acknowledges that the consequences of not having professional support to help with Rawan’s development is a daunting prospect.
Rawan’s behavior can be trying for Wafa, as Rawan often screams loudly and finds it difficult to be still for long.
“Sometimes I lose control over her and I end up crying,” she said. “I always say that if there were no blockade and if our financial situation were good, I would travel with her to receive better treatment and deal with experts who could provide me with the best techniques to deal with her.”
Ahmad al-Nawati, 22, also attends the Shams school.
“I enjoy being a student at Shams school,” he said. “My teacher is lovely and caring. I got to know new friends there.”
Ahmad’s developmental age is 8 years old, and he is progressing along a third-grade curriculum, learning mathematics and strengthening his reading skills.
His diagnosis of autism came later in life, said his mother Naima, 55.
“When he was born, there were no services offered to children with autism,” she said. “How would I know! In that time, there was not enough knowledge about it.”
Naima said Ahmad’s speech was delayed and that he found it hard to socialize with others.
“I was totally unaware of what was happening to him,” she said. “I clung to the hope that he would get better with time.”
Dr. Hamouda al-Dohdar, the head of the Nabeel Childcare Center in Gaza, which provides services for children with autism, said, “I believe that we are in dire need of conducting awareness sessions for all community members – parents, youths and mothers. We need to involve everyone, especially parents, in treatment plans.”
He believes that greater awareness of autism in Gaza would also help reduce the stigma that some parents say is a problem.
Yet certainly one of the biggest stressors on autistic individuals is Israel’s repeated wars on the Gaza Strip.
Naima said that during Israel’s wars on Gaza, Ahmad has found it hard to cope.
“I hate the loud sounds,” he said, “and I can’t stand the dark at all.”
The wars have worsened his condition, according to Naima. “He gets panic attacks, trembles and screams nonstop when he hears explosions nearby,” she said. “He experienced depression for a long time. Now, when he hears loud music from wedding parties or any loud sound, even the sound of a car door opening, he gets close to me and holds my hand tightly. I hug him to reassure him that we are fine.”
Dr. Al-Dohdar advocates for more behavioral therapy for children and adults with autism.
He called on Gaza’s health and social development ministries to provide more resources for individuals with autism and parents of autistic children, including the establishment of a government department that “includes a group of highly skilled specialists” who could provide accurate medical diagnoses.
Ahmad, meanwhile, is thriving at Shams school, though Naima said he longs to work at a shop because he enjoys calculations.
“He promises me that he won’t be easily deceived and would do the work perfectly,” she said. “I do hope this wish can be fulfilled.”
Yasmin Abusayma is a freelance writer and translator from Gaza, Palestine.