Gaza Community Mental Health Programme

21 January 2003

The founder of the Women’s Empowerment Project of the Gaza Community Mental Health Programme told me how the project started as a vocational training centre. In addition to the stresses caused by the occupation, many women have to contend with violence and abuse within the home. A husband or a mother-in-law may prevent a woman from attending a psychiatric clinic, but it is acceptable for women to have vocational training which helps them provide for their families. So they attend to learn handicrafts and office skills but also benefit from individual and group counselling and from making friends with women facing similar problems.

There is so much need for the services of the project that three other centres have been set up in different towns. There are crèches at the centres so mothers can get a break from their kids without having to worry about what they are up to. Staff also visit women in their homes, and so come in contact with other members of their families who may also need help.

People told me about nightmares they have of attacks by tanks, planes and helicopters -- which also feature prominently in children’s paintings. A doctor said he had just been consulted by a woman whose marriage was threatened because she was wetting the bed. After excluding possible medical causes, he told her that it was her reaction to the stress which everyone is experiencing in the occupied territories. Bed wetting is not uncommon in older children. Doctors told me that there is an increased prevalence of high blood pressure, even in young adults.

Workers in the Mental Health Programme have found that demolition of houses by the Israeli military causes anxiety, depression and symptoms of paranoia, not only in adults and children who have lost their own homes, but also in people witnessing the destruction of other’s houses. Being terrorized and forced out of home and homeland in 1948 have left Palestinian society with feelings of fear and insecurity which are reawakened by the ongoing destruction of houses.

Many people in Gaza tell me they feel imprisoned. Most are indeed unable to leave the Strip, even to visit relatives in the West Bank. Many would leave if they could. However a surprising number told me that they were determined to stay, particularly after the 1948 experience of many Palestinians who left their homes in Israel believing they would be able to return when hostilities ceased. I greatly admire the young doctors and ambulance workers I met who had trained and worked abroad, and could continue to do so, but had deliberately returned to live in Gaza to be with their families and work in their communities.

Torture is and has been used extensively to break the spirit of Palestinians and foster mistrust. An obviously disturbed man invited me into his house and told me his story. While a university student in Lebanon, he met Palestinian soldiers and enlisted. After four years in the army in Lebanon, he returned home to Gaza where he was arrested by the Israeli security. He was imprisoned for seven years and was tortured. He said he did not betray his fellow Palestinians and left prison a hero but a broken man. That was twenty years ago. He has not worked since and is continuously frightened that the Israelis will reoccupy Gaza City (a general fear) and will arrest him again. He attends a psychiatric clinic, chain smokes, drinks no end of very strong coffee, and has a peptic ulcer.

However the Mental Health Programme is able to help many who have been damaged psychologically by torture. Just as women will attend the Women’s Empowerment Project, ostensibly for vocational training, so men who have been tortured will attend clinics, saying they want physiotherapy. Some of those who were tortured have become therapists. Their experience makes possible a close rapport with others who have been tortured, to whom they can be of particular help.

A terrible tragedy of the occupation is the undermining of children’s security. The director of the Mental Health Programme says that in Palestinian society the father is normally looked on as an authority figure who provides for the family. Many children have seen their father humiliated and arrested by Israeli soldiers, or unemployed and therefore unable to provide. "They have destroyed the image of the father," he says. The Programme finds that children who have seen their fathers beaten and those whose homes have been demolished are particularly liable to psychological problems. Such traumatic experiences increase children’s anxiety and risk taking, such as throwing stones at Israeli soldiers and vehicles, but diminish their self esteem. Therapists see a range of symptoms suffered by children as a result of their experiences during the occupation: loss of concentration, truanting, fighting with siblings, clinging to parents, or withdrawal from family and friends. They find that the parents’ strength is decisive for a child’s recovery.

How do Palestinians survive under an occupation which makes life as difficult as it can for them, is getting more oppressive, and shows no sign of ending? Two hugely important factors underlying their amazing resilience are the strength of social support within communities and widespread religious faith. For many, support provided by the Mental Health Programme is also crucial. Some of the ways it provides help have been touched on, but it regards its training activities -- of individuals who become therapists, and of groups such as the police and counsellors of school pupils -- as its most important contribution to the future of society.

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