Providing Psychological Care in the Palestinian Territories


In Hebron and East Jerusalem, Doctors Without Borders/Médecins Sans Frontières (MSF) runs a medical and psychosocial program for people suffering from conflict-related trauma. MSF teams focus on people with psychological distress (acute stress, anxiety disorders, post-traumatic syndromes, depression) related to violent incidents with Israeli settlers, the Israeli Army, or other Palestinian parties. Here, an MSF psychologist describes a session with a patient in Hebron.

Today seems like another typical day in the MSF office in Hebron. But it’s not a typical day for Jawad, as he has decided that today he wants to talk about his time in prison.

I have now been working with Jawad* for almost eight months, since I arrived to Hebron, a very important city for both Islam and Judaism. It is the only city in the West Bank where Jewish settlers live within the boundaries of the city itself. Because of its religious and political significance, Hebron is often a hotspot for clashes between Palestinians and settlers, and the city and surrounding villages are closely monitored by a heavy military and police presence.

Jawad is from one of the villages surrounding Hebron. We meet almost every week, excluding times when he's been re-arrested or detained by the military or police. Jawad’s progress has suffered a setback each time he is re-contacted by police. He was initially referred by the ICRC [the International Committee of the Red Cross] following his release from jail. At his first assessment, he showed severe post-traumatic symptoms but until now he has never talked about what happened during his imprisonment.

The session begins and we sit opposite each other. Next to me is my interpreter E. who has also taken on the additional roles of cultural and Arabic teacher, advisor and friend. Jawad is a thin, well-dressed young man of 28 years, whose manner reveals a quiet intelligence. He smiles more now than when we first met, but there is always a seriousness behind his eyes and when he becomes stressed he rubs his eyes with his fingers and looks beyond us to the wall.

When reminded that we are supposed to deal with the topic of jail, Jawad looks away saying, “I’ve already told you about my time in there,” and looks surprised when I remind him he has in fact told me very little. Trust is of course a big issue in the Territories, especially for a man who has been arrested for political activism and has undergone countless interrogations in and out of jail. Much of our sessions have been about forming trust, especially considering there are elements of therapy which are similar to the interrogation process.

He tells me he was 22 years old when he started becoming more aware of the situation in Gaza. He began to meet with other politically aware men and women from his university and attended some local demonstrations. Then one day when he was at home on the computer, he heard a commotion outside. The IDF [Israel Defense Forces] had come to the house. He was arrested and detained for what was to become a sentence of four and a half years.

Jawad describes his time in jail in “phases.” Following the first phase of interrogations, during which he felt proud for keeping his silence, Jawad told me he was placed in a room with other prisoners. Following the stress of the previous experience, he started to allow himself to relax and felt relieved by the support he received from his comrades. However, when the soldiers returned he felt something was wrong. Then suddenly it became apparent that his fellow prisoners were “enemies.” All his conversations and movements had been recorded, his silence was broken, and now the interrogators were about to step up their pressure. At this point he told me “my whole world fell apart,” and “I changed as a person.” 

Phase two, he remembers, was much worse. The methods used during this period were extreme and he doesn’t remember a lot except the periods he spent in “isolation.” It was difficult for Jawad to talk about his experiences in words, but the images, sounds, and tactile sensations he felt during this time still return to him in terrifying and confusing nightmares.

Unfortunately, from here things got worse. Jawad remembers the third phase, when he got sick. After being rushed to the prison hospital it became apparent that he had a burst appendix and required emergency surgery. The next thing he remembers is waking up from the anesthetic, and looking down to see his bloody abdomen, open on the operating table.

At this point, the distress must have been too much for him and he went into a flashback. He was no longer in surgery, but back in the interrogation room, once again surrounded by guards, open, vulnerable and unable to move as he was then, his arms handcuffed to the table. Although the flashback ended, unfortunately, waking up to reality did not help matters, with three armed guards appointed to watch him in bed while he recovered.

From this point Jawad’s mental state deteriorated rapidly. He became physically unwell, but didn’t trust doctors to examine him. He developed severe depression and isolated himself completely from all relationships. After his release, he commented to me more than once that he would rather go back to jail than live his life as it had become.

“It’s good that you can explain my story,” he says. Under the current law in the Territories, he will never be allowed to leave the West Bank. “I can’t leave, but my story might cross the borders now.”

The week after this was written, Jawad was re-arrested and detained again for further questioning. 

In Hebron and East Jerusalem, MSF is running a medical and psychosocial programme for people suffering from trauma because of the conflict. MSF teams focus on people with psychological distress (acute stress, anxiety disorders, post traumatic syndromes, depression) caused by violent incidents involving Israeli settlers and Israeli Army, but also due to the intra-Palestinian conflict. In Hebron, MSF staff carried out 1726 individual mental health consultations and 945 medical consultations in 2011. In the beginning of 2011, MSF conducted a needs assessment in East Jerusalem and decided to start providing in this part of the city mental health care to the population who suffers trauma or psychological distress due to the consequences of violence caused by the conflict and who has no access to mental health services. MSF therapies started in July in the Shufat refugee camp and Silwan area and since then MSF staff carried out 223 individual mental health consultations.