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.