Mental health care in Gaza: An accumulation of traumatic events

A young man in a stretcher holds his hand up to his head in pain

Occupied Palestinian Territories 2021 © Tetiana Gaviuk/MSF

Doctors Without Borders/Médecin Sans Frontières (MSF) psychiatrist Juan Paris has been working in the Palestinian Territories (OPT) since August 2020, providing mental health support to our teams. Here, he looks back on the 11 days of rocket and air attacks between Israel and Gaza, and reflects on the consequences of daily violence for people’s mental health.

A ceasefire came into effect on May 21 after 11 days of airstrikes and exchanges of rocket fire between the Israeli army and Palestinian militant groups. You provide mental health support to MSF’s Palestinian teams in Gaza. What have they been saying, and how have they reacted?


Gaza: Trauma continues long after the bombing stops

The teams in Gaza tell us about horrific bombings of an intensity they’ve never seen before, and nothing like the war in Gaza in summer 2014. Even people who’d seen it all before were seriously affected by the fighting and taken by surprise at the acute fear they felt. Their loved ones were their main concern, especially their kids, and needing to know if they were coping physically and emotionally.

Support networks were set up really fast, with lots of messages shared in private groups on social media. They exchanged photos of their families and said what they were doing to help their children get through the airstrikes. They supported each other.

Their conversations reveal a great deal of fear, especially of being killed in an airstrike in the night, but also mutual support. Do we all have food and water? Has everyone received a message about security in a particular neighborhood? The level of violence during the 11 days reminded them of previous conflicts, rekindling a profound sense of injustice and helplessness.

Through it all they carried on working, with no breaks. As aid workers and Gazans, they’re twice as exposed to the realities of life in the Gaza Strip that’s been under blockade for almost 15 years. They treat people wounded in the conflict. In recent years, most have been Great March of Return protestors, many presenting with bullet wounds in their legs.

So the teams in Gaza are exposed, both professionally and personally. Their work reminds them of how hard life is for people living there, what with the fighting, poverty, unemployment, and lack of protection for their children. They’re attached to their land, to their memories, torn between hope and the reality of their everyday lives.

Forty percent of Gaza’s population is under the age of 14—around one million people. What are they exposed to, and how are they affected?

All these one million children have ever known is the blockade imposed by Israel and Egypt. Nothing else. They’ve lived through several Israeli offensives, the suppressed Great March of Return protests, and now this campaign of massive airstrikes. Outside the periods when the violence escalates, airstrikes are common occurrences in Gaza. Sporadic strikes launched at night. Added to the spikes in the fighting, these events accumulate over time and reduce the children’s capacity to get through them.

All these one million children have ever known is the blockade imposed by Israel and Egypt.

Juan Paris, Doctors Without Borders/Médecin Sans Frontières (MSF) psychiatrist

This is their reality, and it’s how the people we care for describe it. Their access to basic services and the outside world is extremely limited. Young adults in their 20s also lived through the Second Intifada in the early 2000s. Every new war destroys the fabric of Gazan society that bit more. It affects their families—their parents who struggle to survive, find work, get enough money to avoid sinking into poverty, survive the fighting—physically as well as emotionally.

This accumulation of traumatic events has long-term consequences for Gaza’s children and adolescents. A bomb that falls on Gaza City destroys not only a building but also an entire system that used to protect them. They don’t have a safety net anymore. For example, when schools close due to the fighting, children don’t have a safe space where they can interact and play together. There’s a domino effect. A depressed person is more likely to recover from their illness when they’re surrounded by people in good health.

In Gaza, the whole family structure is impacted by these brutal and recurrent events. It’s the same in the West Bank, although the situation is different there. For example, we provide care to children in Nablus in the north of the West Bank. They’re growing up in an occupied city and are aware they might be arrested, harassed, or abused.

They’re growing up in an occupied city and are aware they might be arrested, harassed, or abused.

Juan Paris, Doctors Without Borders/Médecin Sans Frontières (MSF) psychiatrist

Exposure to this violence can have socioeconomic consequences, which means more precarity and mental health issues with a higher number of people experiencing psychosis, depression, and post-traumatic stress disorder (PTSD), but also a higher prevalence of non-communicable diseases like diabetes, asthma, and cancer. We see the same phenomenon among migrants arriving in Europe and African-American and Hispanic communities in the US.

Young Gazans suffer from mood disorders, PTSD, and other stress-related conditions at extremely high rates. The number of suicides and attempted suicides rose steadily in 2020, but they’re clearly under-reported because of the stigma around mental health issues in Palestinian society.