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Providing Psychosocial Care in Hebron and Gaza
October 2, 2002
The children have sketched scenes in crayon that explode with violence. Some depict soldiers, tanks, or helicopters firing steady streams of bullets and missiles into roughly drawn houses, bulldozers crushing homes, and stick figures lying wounded and bleeding.
These images have not sprung from any imaginary source, but rather from the harsh experiences of Palestinian children in Hebron and Gaza who receive psychological support from MSF.
"You could collect thousands of these," says Frederica Cecchini, an MSF psychologist treating between 25 and 30 families in the Gaza Strip. "I just give them paper and pencil and ask them to draw." "They give trauma a form," MSF psychologist Donatella Paioro says of similarly disturbing drawings produced by children she supports in Hebron. They help the children organize episodes that have ripped the continuity of their lives. "That is the first step in dealing with a traumatic event."
Since she arrived in late July, Paioro has been counseling 22 patients and almost 40 families suffering from the constant stress resulting from life under military occupation. Violence among adults is increasing, she says, as is sleep disruption, bedwetting, and hyper-aggression in children - all markers of post-traumatic stress disorder. Usually such symptoms are normal after a trauma, but if they persist for prolonged periods of time, medication may be required.
Weekly counseling sessions for 3 to 8 weeks - sometimes up to a year - then focus on reinforcing the natural ways families deal with stress. "We try to find the concrete, basic things they do to protect themselves," she said.
"All of the psychologists see about 30 families," said Cirre Emblem, the MSF medical coordinator. "And the goal is short term emergency psychological therapy," she explains, "to try to reduce the symptoms that follow a traumatic event."
Such events are common near Israeli settlements and their bypass roads, where the stress rarely lets up. Near these friction points, the Isareli Defense Forces continue to bulldoze or explode homes, uproot olive and fig groves, while snipers keep vigilant watch over the terrain, often times firing at the slightest movement.
"They thought I was a terrorist," said an unbelieving Ziad el Aidi from the porch of his house in El Moriaga, in the Gaza Strip. He pointed to a fig tree in his front yard where he and his mother went to sleep one July night in an attempt to escape the stifling summer heat. "That is where my mother was killed," he said. He motioned to a building a few hundred meters away near the Israeli settlement of Netzarim, and added, "shot from there." When the soldiers realized the extent of their deadly mistake, they rushed the bleeding woman to a hospital inside Israel, but to no avail.
The el Smiri family live similarly close to another Israeli settlement at Al Mawasi, further to the south. Their home sits in a field of rubble next to the highway, the last one standing after six neighboring homes were razed. The isolation and pressure is intense. The father must ask soldiers in a watchtower for permission anytime he or his 9 children leave the premises to go to work or school. At night, tanks roar by non-stop, and the family of 11 often sleeps huddled together on the kitchen floor to avoid being hit by errant bullets.
"We don't know when we will die," says the mother, Oum Mohammed.
The el Aidi's and el Smiri's are just two of the dozens of families MSF psychologists visit near such "flashpoints."
"We go where no one else goes," said logistician Arnaud Ghizzi. "To see families who are utterly isolated."
Getting there, though, is often the most difficult part. MSF teams have come under fire several times, and in August, alone, the IDF has denied MSF 41% of their coordinated movements within Gaza.
In Hebron, many Palestinian families have also faced the turmoil of the Israeli army taking over their homes without warning. One morning, 24-year old Hamoud arrived at MSF's office unannounced. The night before, he said, the Israeli Defense Force (IDF) broke into the apartment building at 2 am, forcing the families out of the upper stories. Since Paioro counsels his younger brother weekly, Hamoud hoped MSF could visit the shaken families.
Emergency visits like this are becoming common in Hebron, where MSF has met with the families from 4 occupied homes since the beginning of August. The team visits the families soon after the occupation has occurred to assess any emergency needs for shelter, water, food, and medical care, and psychological care.
An armored personnel carrier was parked in front of Hamoud's four-story apartment building atop one of Hebron's many rolling hills. Camouflage netting hung down the faÃ§ade. After a few tense moments, an armed soldier granted Hamoud, his grandmother, and the MSF team permission to enter the home.
Inside, many of the 17 children - from 7 months to 18 years old - were restless, and three women were making bread on the living room floor.
"They came in the middle of the night, pointing their guns," said one outraged woman. "The children were screaming and are still very afraid!"
Paioro and Diego Cameno, the field coordinator for the project in Hebron, told the women what to expect - how the soldiers would be unfamiliar because of constant rotation, how the occupation would last between a few days and a few weeks, and that they could call on MSF for any medical or psychological support they might need.
MSF also visits several families affected by violence in Hebron's Old City, where an enclave of 3-400 Israeli settlers rests uneasily amidst thousands of Palestinian homes. The IDF has reconfigured the area to obtain strategic advantage, either by stretching barbed wire across passageways, or setting up sniper posts on the rooftops of many Palestinian homes in the quarter.
What used to be the center of Hebron's bustling market is now all but void of trade. Wire nets form a canopy above the narrow, stone streets to catch the garbage and rocks that settlers routinely hurl down. Most of the tiny carpet or knick-knack shops are shuttered, with anti-Palestinian graffiti scrawled on the gates. Water pipes have also been sabotaged in an effort to force Palestinian families out.
In July, a Palestinian gunman shot dead an Israeli woman from the settlement, and the subsequent grief turned to violent revenge as hundreds of settlers stormed Palestinian areas of the Old City, attacking people and ransacking homes. In the aftermath, several homes were destroyed, and one 14 year-old Palestinian girl was killed.
Paioro, who worked in Kosovo with MSF until last February, finds differences between the two situations striking.
"Kosovo was completely destroyed, but the war was over," she said. "When I first arrived here, I was surprised to find a country with houses and shops." In Kosovo, the clear end to the fighting allowed her to properly treat people for neuroses like severe anxiety, manic depression, and nervous reactions. "Here, the war goes on."
But the needs in Hebron and Gaza far outstrip the means. When reflecting on the impact a handful of psychologists can have in a place where nearly everyone's life has been disrupted by the constant stress from military occupation, Cecchini says, "It's like trying to cool the Mediterranean with ice cubes."