Gaza: pressure cooker

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A combination of Israel’s brutal blockade of this small patch of Palestinian land alongside the ravages brought by Covid-19 has produced an enormous level of stress and mental distress for tens of thousands of people. Yasser Abu Jamei, director of Gaza Community Mental Health Centre, reports.

Two million people are living in an area of 365 square km, with only 5 percent portable, piped water and eight hours of electricity a day. This is merely the tip of the iceberg of just how bad living conditions are in Gaza today.

Around half of the population live below the poverty line (53 percent), youth unemployment is almost 70 percent and around three-fifths of households are severely or moderately food insecure (62 percent). The United Nations warned in 2012 that Gaza would be uninhabitable by 2020 unless basic services and conditions are improved.

Shortly after that UN report, Israel launched a large-scale military attack, killing 171 Palestinians including 35 children and 14 women, injuring 648 more. Two years later, in August 2014, Israel embarked on another big military operation that lasted 50 days, killing more than 2,200 people, including 527 children and 299 women. Another 11,000 Palestinians were injured.

These were not the only operations since the Israeli “disengagement plan” of 2005. The first occurred in 2008 lasting 22 days, killing at least 1,400 and injuring around 5,300.

All of the military operations were characterised by continuous shelling and bombardment which spread fear and a feeling of imminent death to almost every inhabitant. The destruction of so many homes and workplaces devastated the economy and the people.

The 2014 operation internally displaced around 500,000 people, and when the attacks were over, more than 110,000 Palestinians had no home to return to. More than 8,000 remain internally displaced, despite huge reconstruction efforts. The people were not only highly exposed to trauma, but also continue to live in despair.

Most of Gaza’s population are refugees who were forced to leave their home over 70 years ago. This population has had to live under blockade since 2007. Israel claims it imposed the blockade because Hamas ‘took control’ of Gaza and wanted to remove them from power.

Many others note that the blockade is simply collective punishment, a procedure which violates simple principles of human rights. In any case, the strategy of removing Hamas failed, and the only clear thing is that the people continue to suffer.

In 2018 people chose to respond. They wanted to convey Gaza’s suffering to the world, and demand an end to the blockade. The Great March of Return demonstrations began in March and continued for over a year. Young people began to feel they had agency, instead of feeling powerless. The demonstrations sparked life in the spirits of the young, the poor and the suffering.

The message reached the world. Many started to call for an end to the blockade, but the cost was high. The excessive use of power by the Israeli army injured more than 30,000 people, including around 6,000 children. The high number of casualties overstretched the already-fragile health system. Many of the wounded had complicated injuries. Several dozen will continue their lives as amputees.

The Great March of Return demonstrations faded at the promise that the blockade would at least be eased, but then Covid-19 struck. Measures had to be taken to avoid the spread of the pandemic. These included closing schools and many businesses to ensure social distancing.

Many of those who work do so from hand-to-mouth. Tens of thousands of families were added to the poor as their breadwinners lost their income. Families had to deal with children no longer able to attend school.

While in the first few weeks people were afraid of the virus, more psychological stresses are now resulting from the deteriorating economy.

Many NGOs report an increase in domestic violence and negative changes in the behaviour of children. During the first six months of 2020, 37 percent of women who reached Gaza Community Mental Health Programme (GCMHP) for treatment were diagnosed with depression. Another 24 percent of them had an anxiety disorder.

With men, 23 percent were diagnosed with depression and 33 percent suffered from an anxiety disorder. Children presented in the clinics were irritable, aggressive and sometimes bedwetting. The Office for the Co-ordination of Human Affairs says that 210,000 people in Gaza have severe to moderate mental distress.

GCMHP was founded three decades ago by renowned psychiatrist and human rights advocate Dr Eyad El-Sarraj. The programme is designed to help people overcome the psychological stresses associated with such living conditions.

It was clear from the beginning that medical or psychiatric intervention alone is not enough. Community awareness and education is key to helping hundreds of thousands of people who are stressed. Families needed to understand that an aggressive child could just be in need of a hug and a listening parent.

Huge training programmes were established to equip teachers, health providers and other community workers to help people deal with the stress and prevent illness.

GCMHP community centres have multidisciplinary teams where children can receive art therapy, play therapy or psychodrama, and their parents receive psycho-education. Adults could receive psychotherapy and/or medication. The centres give an excellent example of how a biopsychosocial model works.

Throughout the years, success stories were written, but conditions got worse. International visitors kept repeating the same sentence, “Last time when we visited Gaza, we thought it couldn’t get worse. We were mistaken. It got worse.”

The worsening conditions are making Gaza like a pressure cooker that could explode at any moment. Such an explosion will not make anyone happy.