Husam El Nounou

Amid the humanitarian crises facing the people of the Gaza strip there exists a less well known or talked about crisis, that of mental health. Israel’s tightening of the illegal closure of Gaza in 2006, and its 2008-2009 offensive, has meant that, for Gaza’s 1.7 million civilians, reality is a mix of isolation and violence. This mixture has contributed to a sense of vulnerability, hopelessness, imprisonment and loss of control amongst Gaza’s residents.

Mental health outcomes have, predictably, dramatically worsened over the last number of years. Medicine San Frontiers stated in 2010 that over half of children under the age of 12 in Gaza were in need of mental health intervention, and that one third of these cases are severe. According to Husam El Nounou, Public Relations Director at the Gaza Community Mental Health Programme, the overwhelming cause of the worsening mental health situation is the political and human rights circumstances facing Gaza’s population, specifically the closure of Gaza and continuing Israeli attacks.

The illegal closure of Gaza, first implemented in 1991, but tightened extensively in 2006, means that the movement of both goods and people in and out of the Gaza Strip has become severely restricted. Husam believes this has lead to a sense of hopelessness and imprisonment amongst the Gazan population who are unable to do such basic things as meet relatives abroad or travel to study, work or seek medical attention. According to Husam, “the effect is most felt by those who are in greatest need of travel such as students studying abroad, the sick requiring medical attention unavailable in Gaza and people whose work requires them to travel or trade in exports and imports.” 

According to the World Health Organisation, the link between physical health and mental health is well established. The closure, according to Hussam, “has lead to a situation of dramatic food shortages which in turn leads to poor nutritional outcomes and poor physical health which exacerbates mental health problems.” This is compounded by poor sanitation conditions arising from the targeting of sanitation facilities by Israeli forces and the closure-related refusal to allow the import of materials necessary for their repair. Husam points to a study by the Gaza Mental Health Community Programme conducted after the tightening of the closure in 2006, which showed dramatically decreased mental health outcomes. The report noted an increase of 17.7% in the cases of depression in the six months following the tightened imposition of the closure, while 95% percent of participants surveyed claimed they felt “imprisoned.”

 The Israeli offensive in 2008-09 and ongoing military attacks has also had a significant effect on Gazans’ mental health outcomes, especially amongst children.  Husam points out that in a GCMHP report “On the Psychological Consequences of the Israeli War on Gaza” it was found that 82.1% of Gaza’s children believed they were exposed to danger during the offensive, 67.6% have fears that there will be a reoccurrence, and 40.9% expressed a severe desire for revenge. This effect has been supported by other research; in a study by Dr Jameel Tahrawi, from the Islamic University in Gaza, analysing the impact of the assault on children’s psyche through their drawings, it was found that 82.3% of the drawings analysed were related to the offensive. In a UN study on the effects of the offensive on Gaza society, approximately two thirds of those surveyed said they had experienced worse health outcomes since the offensive, the overwhelming nature of which was mental health related.

Husam explains that “Gaza society shares a lot of the traditional Arab view of mental health problems as being possession by evil spirits.” Such a viewpoint leads to increasing stigma of those affected, which in turn tends to isolate the victim and contribute to a worsening of the condition. “Women especially tend to bury mental health problems as it may reduce chances of marriage”, says Husam. Men often display an increased tendency towards violence and risk taking, which is often taken out on women and children family members.  For children, violent behaviour and reduced attention in the classroom results in reduced educational outcomes, which reduces later life opportunities, in turn increasing feelings of entrapment.

Recognising a lack of fully qualified mental health professionals within Gaza, itself a result of the restrictions placed on travel to study or train, the Gaza Mental Health Programme has started a post graduate course in proper mental health intervention for health and counselling professionals in Gaza. The course involves two years of full time study and focuses on mental health intervention that is sensitive to the traditional view of mental health problems prevalent amongst Gazans. However, for Husam, the mental health situation in Gaza will remain critical until the human rights situation is improved; the Israeli closure on goods and people must be lifted to reduce feelings of entrapment and hopelessness; the restrictions on food, medicine and sanitation materials must be lifted to improve physical health outcomes in turn improving mental health outcomes; the regular bombings by Israeli forces which result in feelings of mass insecurity and helplessness as well as exposure to extreme violence,  must end.