Inside Gaza’s looming mental health crisis

Sewar Elejla

Mondoweiss  /  October 6, 2022

In light of the mental health crisis affecting nearly everyone in Gaza, including medical staff, how long can resilience and steadfastness last?

“My son gets startled when he hears any thud,” my friend tells me about her 5-year-old son. She expects me to give her magical advice just because I’m a doctor. Ironically, I console her: “Don’t worry. My little brothers get that too. And so do I.”

The conversation ends with nervous giggles about how silly we are, remembering how we sometimes freak out when we hear the door slam or a tire blow out. 

But there’s nothing silly about trauma. 

More than a month has passed since Israel’s last escalation on Gaza, which killed 49 people including 17 children. It also left behind untold numbers of survivors, who have to deal with the attack’s repercussions, both physical and psychological, for the rest of their lives.

The airstrikes have stopped for now, but their effects are far from over, and their heavy psychological toll has led to a looming mental health crisis in the Gaza Strip.

Some Gazans may — I repeat, may — get used to losing their houses, struggling for food and clean water, and dealing with all the bitterness that comes from living under siege for 15 years. But one thing they can’t get used to is losing their loved ones. They cannot tolerate seeing their kids killed in the blink of an eye, or suffer from injuries, permanent disability, and constant psychological trauma. 

Since the Second Intifada of 2000, at least 2,200 Palestinian children were killed by the Israeli military, of whom around 83 were killed in the last two years in the Gaza Strip. During the May 2014 war, according to UNICEF, 444 children were injured and 30,000 were displaced. This war alone created more than 1,500 new orphans. 

War is a knife that twists in the wound

More than 2.1 million Gazans live in a highly dense territory. They fight the hardships of the lingering years of Israeli occupation and never ending blockades. They have insufficient food, an ongoing power crisis, and scarce water resources — 90% of which is not even fit for drinking. All this has had a devastating impact on health, sanitation, and education. 

Palestinians in Gaza work tirelessly to make ends meet for their families. They can hardly find jobs, and payment is scanty. Some youth reach the age of 30 unmarried, and ask for pocket money from their parents, suffering the shame of being this old yet dependent. Men are unable to fulfill their families’ needs. They easily get frustrated, which sparks domestic violence.

Every facet of social life is being impacted, and the results are showing.

Of course, domestic violence is never justified, but the pressures Israel adds in its constant attempts to “mow the lawn” lead to all sorts of societal problems, from kids wetting their beds to bullying, from domestic violence to divorce, from unemployment to brain drain, and from disillusionment to suicide. All of these are just a glimpse of what Gazans are going through on a daily basis. 

Suicide on the rise

I recently finished my rotation as an intern doctor at the ICU department at Al-Shifa Hospital, the largest hospital in the Gaza Strip. Just within a three-week period, I witnessed seven suicide attempts. 

Admission to the ICU department means that these cases are serious. Five were young males aged between 20 – 35, and two were females. We lost some, and others we “saved,” even though the after-effects of their suicide attempts will add to the suffering — long-term side effects from burns and drugs. Many of them will try to commit suicide again. 

All these suicide attempts share a common thread — a father who could not afford school requirements for his children, a mother who lost her husband in the war and was left alone in this world, and a young man who surrendered to addiction before ending his life by an overdose. 

There are many more stories. Some Gazans live without a shred of hope that the situation may change for the better. They see no way to escape this hell, except death. 

In Gaza, suicide is stigmatized, becoming a scar that will haunt the family forever. 

Often the family is blameless — many never expect their loved ones to even think of killing themselves. According to official statistics, 38% of young people in Gaza have considered suicide at least once. Moreover, a high rate of 24.58% for suicide ideation and of 25.28% for suicide attempts was reported among Palestinian adolescents. Accurate numbers of suicide and suicide attempts are not available, suffering from chronic under reporting for fear of social stigma and shame, as well as invasive police investigations. 

Attempting suicide is a crime according to Palestinian law. The police would normally assume foul play and interrogate the already bereaved family to rule out homicide attempts, especially in the cases of young women attempting suicide. 

How long can resilience last?

Often, Gazans are portrayed as resilient. People say they cope easily and handle things creatively. They absorb war as a routine. Not anymore. Their “steel” resilience is put to the test so often that it’s now breaking down and no longer working. 

This does not mean Palestinians will ever surrender to Israeli colonialism. 

The recent three-day bombing campaign on Gaza only added to the stockpile of trauma, which has added up over the course of 15 years, and decades of occupation.

Usually, Gazans avoid talking about their experiences during wartime. It brings back memories of the horror and loss of life, the scenes of the destruction of their homes, and the death of their loved ones. They do not share their daily battles. 

Consequently, they end up forgetting that they are not alone. Everyone is affected. It is no use complaining or asking for pity. Things accumulate and end up bursting.

If that wasn’t enough, the buzzing sound of Israeli drones in the sky added salt to the wound, continuing to torment the people of Gaza day and night, unable to function because they’re always on edge, fearing a military airstrike.

Gaza’s children are the damaged generation

Everyone in Gaza — everyone — contends with massive tension and anxiety. According to Doctors Without Borders, 40% of young Gazans suffer from mood disorders, 60% – 70% experience post-traumatic stress disorder (PTSD), and 90% have other stress-related problems. A steady rise in suicidal attempt numbers was also reported

Children represent 47.3% of the Gaza community. About 1.02 million children are trapped in a painful reality and unknown future, confronting wars that have worsened the already existing reality of an open air prison. 

Save the Children reported that since 2018, 4 out of 5 children live with depression, grief, and fear. Rising numbers are attempting suicide. Children pay the cost of the misery in Gaza.

They usually manifest their mental problems as hyperactivity, aggression, depression, isolation, nightmares, and bed wetting. 

After the recent wars, many children are desperate, due to their loss of limb, vision, hearing, loved ones, friends, or peace of mind. They are starting a new life struggling to fit in with new special needs. The facilities they need to integrate are for the most part unavailable.

These mental health effects also have social repercussions among their peers. Often, they may be teased, bullied, and ostracized. Unless they receive enough support, their mental health will continue to worsen.

The lack of a health infrastructure in Gaza is, of course, a given. But lacking also is the necessary awareness that seeking mental health support could help

The mental health crisis in Gaza has decidedly political roots. The Israeli occupation must end. The economic deprivation and 15-year blockade must end. 

We need to invest in mental health services, integrate them with schools and primary care centers, enhance mental issues detection and treatment, and spread awareness. But none of that can happen while Israel continues its merciless onslaught.

As a physician, I usually find myself unable to even advise traumatized parents struggling with their kids. We do not have a magic wand to solve their problems — yes, because the origins of these problems are political, but there’s another reason as well. We’re traumatized too.

Sewar Elejla is a doctor at Al-Shifa Hospital in Gaza