 After her son was killed and their house was destroyed by bombs, this mother moved with her other eight children to a garage on the other side of the street. The family depends entirely on support from others and participates in MSF's trauma treatment program.
Photo © Jorgen Hildebrandt/MOMENT |
Providing crucial mental
health and medical care
Since the beginning of 2004, the
humanitarian situation in the
Palestinian territories has continued
to deteriorate. A continuing
cycle of attacks and retaliation
between Israelis and Palestinians
killed 931 people in 2004. This
figure includes 816 Palestinians,
the overwhelming majority of
them minors, and 115 Israelis,
including eight children. Army
incursions, arrests, demolition of
property, sieges, rocket attacks,
targeted killings and suicide
bombings have become a horrifyingly
normal part of daily life
for most people.
The region's political atmosphere was
strongly affected by the announcement
of unilateral disengagement from Gaza by
Israeli Prime Minister Sharon in August
2004 and the illness and death of
Palestinian leader Yasser Arafat a few
months later. Both the direct violence
(incursions, shootings, bombings) and
indirect violence (occupation, closure,
control) have affected the mental health
status of the Palestinian population. MSF
provides medical and psychological care
to those who have been injured or mentally
traumatized by the conflict as well as
to those who lack access to medical care
in the cities of Hebron and Nablus in the
West Bank, and in the Gaza Strip.
MSF has expressed growing concerns
about the long-term psychological impact
that high levels of concentrated violence
can have on communities. MSF psychologists
conducted more than 4,000 consultations
during 2004 with patients in the
Gaza Strip, Hebron, the town of Jenin and
later Nablus.
After a traumatic event takes place, the
MSF team attempts to conduct assessments
of victims to identify their most
urgent needs. MSF provides medical and
psychological care or social support at the
request of families. Those who need longer-
term care receive home visits from the
team. While most of the psychosocial therapy
sessions are held with individuals, MSF
also provides a great deal of family therapy
and some group therapy with children and
teenagers. Whenever possible, MSF tries to
use the existing Palestinian network to
deliver medical and social care and urges
families to use this network.
The population of the West Bank lives amid
more than 700 roadblocks and permanent
checkpoints, which severely hamper their
movement within the territory. A significant
consequence of the closure policy has
been the collapse of the economy and the
impoverishment of the population. The
World Bank estimates that 47 percent of
the territories' population lives in poverty.
In the southern West Bank city of Hebron,
MSF's team of physicians and social
workers refers numerous patients to MSF
psychologists. The main health problems
encountered include gastrointestinal diseases,
skin infections (often caused by poor
hygiene) and respiratory illnesses (often
linked to harsh living conditions). Many
civilians complaining of body pain are
actually experiencing some sort of mental distress.
The Israeli authorities' decision to construct
a high concrete security wall to separate
Israel from the West Bank has made it
extremely difficult for civilians in the
southern Hebron district to obtain needed
health care. Immunization rates for children
have also declined. MSF continually
assesses whether Palestinians living in
communities near the wall need medical or
psychological help. Teenagers and children
who have witnessed violence during the
arrest of family members are among MSF's
target populations in this area, and the
organization has created a new therapy
group focused on women.
In the Gaza strip, a series of Israeli military
incursions has left thousands of people
homeless, especially in the town and refugee
camp of Rafah. Since January 2004, the
waves of incursions and demolitions have
increased, and approximately 90 homes
have been demolished each month.
Since September 2004, and the onset of
Israeli military action, MSF medical teams
have not received authorization from
Israeli authorities to visit the vast majority
of their patients in the southern and central
areas of Gaza. Even before this development,
MSF faced challenges gaining
access to patients among Gaza's three distinct
segments. Until September 2004, MSF
staff had been working with residents who
were confined to the area by strict security
rules and numerous military checkpoints.
When possible, an MSF doctor, three psychologists and a social worker had visited
families in their homes to listen to their
stories and provide psychotherapy, medical
care or social support. The team had
also used drawings and games to help children
overcome traumatic experiences such
as the destruction of their homes.
Leaving Jenin, opening in Nablus
In October 2004, MSF ended its activities in
the northern West Bank city of Jenin due to
a severe drop in symptoms and a large
decrease in patients. These improvements
seemed due in part to fewer destructive
incursions and a less volatile security situation.
However, in mid-2004, an assessment
conducted in Nablus in the northern part
of the West Bank found a population under
constant pressure, with Israeli army incursions
taking place nearly every day. In
November 2004, MSF began giving medical
care and psychological counseling to civilians
living in the area, which has been cut
off from the outside world by checkpoints,
security fences and other measures. The
teams report that the daily experience of
violence has had social, cultural and economical
impacts and has led to anxiety,
stress, depression and the weakening or
even destruction of some families.
MSF has worked in the Palestinian
territories since 1988. |
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