Gaza Community Mental Health Programme

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Building Bridges in Gaza

The car is zigzagging, through streets filled with boys and girls pouring out of, and pouring into, blue coloured buildings on either side of the road. The shift change is underway at UNRWA schools. The profound lack of space in Gaza means the pupils who attend school in the morning must hand over their classrooms to another school full of pupils being educatedin the afternoon. This is life in Jabalja Refugee Camp , north of Gaza City, and clinical psychologist Jasser Salah is on a field visit.

Mustafa, 16, is causing trouble both in school and at home. He does not interact normally with fellow pupils, he stutters, and is increasingly aggressive towards his siblings. His mother tells us that now he’s been identified as a troublemaker, the difficulties he has communicating mean he also sometimes gets punished for things he didn’t do.

“And when did things start going wrong for Mustafa? ” Jasser wants to know. “It started after his father was killed by an Israeli rocket in 2008, and it hasn’t improved as Mustafa has grown older,” the woman replies.

A traumatized society

While therapist Jasser Salah is trying to convince Mustafa’s mother that her son needs psycho-educational guidance, Mustafa’s father watches over the family from a big portrait created in remembrance of his death . As someone killed in the struggle against Israel, he is regarded as a martyr. “Mustafa is a typical case,” Ahmed Abu Tawahina tells us later in his office. Ahmed is General Director of the Gaza Community Mental Health Programme. “Two wars in the past four years, coupled with the ongoing blockade, have created a traumatised society.”

“The dead and wounded are just the tip of an iceberg,” Ahmed adds, “The Gaza Strip is like a prison , sealed off from the neighbourhood. You would be right to say that the whole community has been affected.”

First steps

A few chairs and a table in a small flat. That’s how this determined group of psychologists began counselling people in the 1990s. The first years were not easy, Ahmed tells us, because suffering from mental illness is not readily acknowledge d in a traditional culture like Gaza’s. These difficulties are amplified in an impoverished society, where the institutional support taken for granted in the West is absent. “But we told people back then, and keep telling them today, that their behaviour is a normal reaction to an abnormal situation , and that their case s are not unique.”

Direct contact with the affected usually begins following talks the GCMHP regularly organises at community gatherings. “Of course, people only speak indirectly,” says Ahmed. “They might say that their brother or the daughter of their cousin is behaving strangely, when in fact they are talking about themselves."

Today, GCMHP operates three centres, located in the north, middle and south of the Gaza Strip. Apart from reaching out to communities, the centres also offer individual, family and group sessions. GCMHP estimates around 600 children lost one or both parents during the last two wars with Israel. Many of these children suffer irrational fear and poor self-esteem. These in turn lead to symptoms that might be as mild as bedwetting, or as severe as frequent outbursts of uncontrolled violence. The latter is behaviour affected family members often relate to the therapists during their sessions.

Violence and bedwetting

Mallek, 5, and Hadaye, 7, present such cases. These two very active sisters run around the house and pose for photos while therapists Ayat Shahwan and Mohammed Syliaby discuss their case with their father, mother and oldest brother. We are in Beit Lahia, an area replete with houses damaged during the most recent war late in 2012, and one where symptoms are common amongst youth and children. “On our first visits we therapists are sometimes mistaken for aid workers,” Ayat tells us, “People ask if we could get them sunglasses, clothes or financial support. But we don’t do that.”

On a field trip to Beit Lahia

Sometimes, even the therapists are surprised by what people are prepared to reveal. After hearing a thorough assessment of the condition of his daughters, this father of five acknowledges that he sometimes beats his son and treats his wife badly. This behaviour, he says, has two causes. The first is having been tortured in an Israeli prison. The second is unemployment. This internal turmoil, he thinks, he unleashes as violence on other family members.

“This is also a typical case," General Director Ahmed resumes, “since many former prisoners are victims of torture.” In one case he cites, a middle-aged man, otherwise of sound mind and body, would just not get out of bed to go to the bathroom in the morning. “This behaviour is related to a torture technique,” explains Ahmed, “The detainee would be woken and given a cold shower, in the middle of the night, even during wintertime. So now this man associates getting up and going to the bathroom with his experiences in an Israeli prison. “

After a long working day with the GCMHP teams, we sit talking over coffee and gazing out across the beautiful Mediterranean. Suddenly , a dull thump breaks off conversation. A Gazan fisherman has crossed the invisible line three miles out to sea that the Israelis have demarcated as the limit to which Gazans may travel by boat, and is warned back by the Israeli navy. We are all reminded by that single gunshot , of exactly where we are. Even including the limited offshore fishing zone, the entire area of Gaza is a plot of land slightly larger than Malta . And within this area, a population of more than 1.7 million increasingly stressed families and individuals do their best to find their way, trapped, reliant on handouts, frequently subject to violence from all sides, and with fewer and fewer choices to make.