Alex Delmar-Morgan. All rights reserved.After
Heba Hmaid’s husband, Raed, was injured in the civil war in the Gaza Strip ten
years ago, their marriage nearly broke down. Scarred by a serious injury to his
right leg in the civil war between Hamas and Fatah in 2007, at first he grew
nervous and irritable at home. Then he became violent.
“My
husband began hitting me daily after he was wounded. And he was hitting my son
sometimes,” Heba, 34, said through a translator. “ I knew that [the injury] had
affected his behaviour. I tried cope with him, to deal with him in a different
manner, but I couldn’t manage the situation.”
Before
she married, Heba did a brief training stint at a place called the Palestine
Trauma Centre (PTC) in Gaza after her university degree in media. Once married, her
husband told her she must drop her studies, give up work and live at home. It
was then that her problems started.
Heba’s
situation grew increasingly desperate: a violent, unpredictable husband and a
traumatised son, now seven years old, who has already lived through two wars – and now had to
cope with the added burden of an abusive father.
At
breaking point, Heba sought help eight months ago for her and her son, Mahmoud, at
the PTC, Gaza’s only trauma unit – the
same place she had trained at fresh out of university.
Located
in Gaza City, it was set up in 2007 in conjunction with the Palestine Trauma
Centre UK, a British charity that provides technical and financial assistance
to the unit.
Other
mental health programmes exist in Gaza. Some are run by UNWRA (The United Nations Relief and Works Agency
for Palestine Refugees) and the well-established Gaza Community Mental Health Programme
(GCHMP) provides psychotherapy and rehabilitation services.
But
the PTC is the only centre of its kind in the strip, offering highly
specialised psychological and counselling services to trauma victims and
families.
PTC treated 65 families, around 500 people, in 2016 for a range of psychological conditions. Many patients are children, who are the worst affected. Anxiety, post-traumatic stress disorder (PTSD), bed-wetting, nightmares and fear are common. Adults can be severely depressed, sometimes threatening suicide.
Staff
are stretched and work six days a week to keep pace with the volume of patients
coming through the door. They can’t possibly cater to all of the two million
people who live in this narrow coastal strip through a hellish cycle of war,
random airstrikes, shaky ceasefires, poverty and fear.
“The situation is Gaza
is very bad and everyday it becomes worse. We have a lack of fuel, electricity
and salaries for employees – the crisis affects everyone,” said Rasha Qandeel, the
director of the PTC.
Gaza
City and the outlying suburbs in the north of the enclave, bear the worst scars
of the last three military offensives by Israel, most recently Operation Protective Edge in 2014, which the UN says killed 2100 Palestinians, compared
to 73 Israelis, 66 of them soldiers.
The
war may have stopped and things have been relatively quiet over the last three years by Gaza standards, but bombed out buildings are a reminder of what life
was like not so long ago.
Gaza Trauma Unit. The Palestinian Trauma Centre. All rights reserved.It’s
hardly surprising that Palestine has the highest rate of mental health
disorders in the MENA region. According to a study published earlier this year by Raghid Charara of the American University of Beirut, some 54 percent of
Palestinian boys and 46.5 percent of girls aged 6 – 12 years are thought to have
behavioural and emotional disorders.
Frequent
exposure to violence and trauma since the 2007 blockade thanks to three Israeli
military campaigns in six years between 2008 and 2014 has exacerbated the
mental health crisis in Gaza. A report after the 2008-2009 offensive by Medical Aid for Palestinians (MAP) found that 30 percent of adolescents met the criteria for PTSD
Living
under siege, the feeling of physical entrapment is common. Some 95 percent of Gazans
said they felt imprisoned, a survey by GCMHP said. Mass employment, triggering
a feeling of powerlessness and uselessness also contributes.
With
Gaza’s well-documented shortage of resources and equipment, help for those
suffering from poor mental health is in short supply. The PTC employs thirty staff; a mix of
psychiatrists, psychologists, psychotherapists and counsellors. There are eighteen full-time psychiatrists all trained in Gaza, while visiting professionals come
from Europe and the US to provide training to local doctors.
There
are many, obviously, who don’t get the specialist treatment they need or
deserve. Many don’t know about the centre or can’t afford to travel into Gaza
City from neighbouring towns.
“We
can’t reach everyone and a lot of them cannot come to the centre because they
don’t have money for transportation. We try to do the best we can,” said Qandeel.
So
they have never turned patients away? “No, no, no”, says Qandeel firmly, “they
need our help”.
So
much for turning people away, some may not come in the first place. With mass
unemployment in Gaza, it is particularly difficult for men in Arab culture,
traditionally powerful family figures, to come to terms with not being able to look
after their wives and children, she says. Pride, and a reluctance to confront
psychological issues, means many are unwilling to come forward and seek help.
That said, the PTC aren’t short of patients. Three new cases, on average, arrive every week, putting staff under constant pressure.
Running
costs, including salaries, top US$ 200,000 a year. Totally reliant on foreign
money, charities and humanitarian organisations such as Interpal, PTC’s largest
donor, Muslim Aid and Mercy Corps all provide vital funding.
Gaza Trauma Unit. The Palestinian Trauma Centre. All rights reserved.Interpal,
a British Muslim charity, has funded the PTC’s Family Therapy programme since
2013. It is one of the most active UK charities in the Gaza Strip, involved in
dozens of projects, from supporting staff salaries at Sanabel School for kids
with disabilities, to providing much-needed medical equipment to El Wafa
Hospital in the south that was destroyed in the 2014 war.
The
Vision Project, its flagship education initiative in Gaza – in conjunction with
UNWRA – completed this year, helping
over two hundred blind and visually-impaired children to learn and study using digital
technology and iPads.
Few
Gazans could claim they are unaffected by the trauma of living in this near
constant theatre of war. When bombs aren’t going off, they suffer under the
blockade; medical equipment and drugs are limited, few can leave, travel or experience a normal life.
But
with mental health, you don’t need equipment, or expensive machines. You don’t
need drugs and state of the art hospitals. You need time, dedication and
training – and in the case of the PTC,
from a small group of very qualified, badly-paid professionals who spend their
lives helping others.
Certainly
Heba and her son were one of the lucky ones.
The
counselling and psychotherapy Heba received has helped her overcome 90 percent of her
problems, she said, vastly boosting her self-esteem. After eight months of treatment, she now comes
monthly, not weekly, to the centre.
Relations
with her husband have improved, the violence has stopped and she even used the
word “rehabilitated”. Mahmoud’s behaviour has also stabilised and he’s happier
at school.
Heba’s
situation may be vastly improved, but she talks of “coping” and making do. Her
voice is also tinged with sadness and despair when she reflects on causes of
family’s unhappiness. Naturally, she can’t help straying into politics – and her message is stark:
“The political and economic situation is very
difficult because of the occupation. All the people are suffering and we
deserve to live. We ask the world to help us.”
*Alex Delmar-Morgan was a
guest of Interpal in Gaza.