Enduring Disorder: PTSD in Gazan Children

BY SOPHIA KECSKES

“I miss the sea, I miss my friends, I miss ice cream, I miss happiness and joy. I MISS MY ORDINARY LIFE,” tweeted Farah Baker, a 16-year-old girl from Gaza who self-describes as a “modern Anne Frank.”1 With 199,000 followers, this young girl spreads awareness about the nature of her life in the Gaza Strip. Especially popular this summer, Farah’s Twitter features live tweets about her experiences living in fear during Israel’s Operation Protective Edge, a conflict that ravaged the area from July 8, 2014 until an open cease-fire was announced on August 26, 2014.2 In the Gaza Strip, Farah is far from being a unique case—43.8% of people are under the age of 24.3 This demographic represents a generation of youth who have spent their entire lifetime in turmoil.

A fire erupts in a populated square. Source: en.wikimedia.org

Children and adolescents who grow up in such hostile environments never forget the images they see, bombs they hear, and insecurity they feel—all of which become a pervasive part of daily life. One view on this conflict is exemplified in a recent Arab Psychiatry Journal article, which contends that Israelis engage in systematic psychological warfare, methodically humiliating and demoralizing Palestinian populations, as well as instilling a deep sense of insecurity through bombings.4 Further, land ownership has great psychological importance in Arab culture; the lack of land control felt by the Palestinians results in a great loss of honor.5

More than half of youth ages 15-18 living in the Gaza Strip experience partial or full posttraumatic stress disorder (PTSD).6 The causes of this tragedy are multifaceted but can almost universally be attributed to the constant presence of violence in youth’s lives.7 A 2008 study of 1,137 children discovered that 97% of youth had heard the sound of bombs and explosions and 84% had witnessed shelling from tanks, artillery, or military planes.8 73% of kids have also personally witnessed political violence.9 In addition to the direct impacts of violence, women face additional risks for PTSD due to factors such as an increased likelihood of sexual violence, physical and mental abuse, human trafficking, and prostitution.10 Women suffer from PTSD during conflict at greater rates than men; during the Lebanese Civil War from 1975-1990, rates of PTSD among women were in fact six times higher than those among men.11

While rates of PTSD among Gazan children are comparable to those of refugee children fleeing previous conflicts in Cambodia, Lebanon, South America, and Bosnia and Herzegovia,12 the Gazan situation is unique because of the prolonged nature of the conflict. Instead of just an eight year civil war, as was the case in Cambodia, these Palestinian children have never lived without exposure to trauma. While it’s vital to aid all children suffering from mental illness due to unnecessary conflict, the Palestinian case requires specialized, long-term attention.

Many strike missions by aircraft over insurgency areas involve the use of flare drops. Source: en.wikipedia.org

The impact of violence in Gaza is exacerbated by children’s proximity to the fighting. With an area of 139 square miles, Gaza is the same size as the American cities of Detroit, Portland, Las Vegas, and Philadelphia. The population density in this small area is about the same as in Boston, Massachusetts—there are 1.82 million people total living in the Gaza Strip.13 With no safe area for escape, many children are even drawn into the fighting; some join the Palestinian army while others participate in the “national struggle” in less tangible ways, such as by helping to initiate and organize uprisings and demonstrations against Israeli forces.14

Through such direct engagement, Gazan children are more directly affected than children who solely observe the violence, which is the case in many recent conflicts—including Iraq, Afghanistan, and Syria. Researchers explain that Gazan children have “grown up too fast” and have become “children of stones,”15 reflecting a youth desensitization to violence. This in turn impacts familial relationships. Considering that El Hamula (one’s extended family’s support) remains integral to Palestinian culture, the perception that parents and other family members cannot protect children from violence and displacement pushes children to the more rapid assumption of responsibility for their own lives and for their families’. Insecurity and the inability to trust one’s elders for protection have deep psychological impacts on children.16

The societal and individual costs of this mental health epidemic remain unclear, but it is estimated that 20% of Gaza’s population (approximately 360,000 people) will need long-term treatment for mental health disorders, long after conflict is resolved.17 Children who suffer from PTSD are at a higher risk of developing attention deficit disorder, becoming violent, performing poorly in school, suffering from addiction, and resorting to extreme criminal behaviors or radicalism.18 Such problems become more serious in the Middle East, due to the prevalence of such strong sub-currents of terrorism and extremism; radical groups are more likely to recruit individuals with mental health challenges.19

An example of this phenomenon was demonstrated in 2009,when John Horgan, the director of the Pennsylvania State University’s International Center for the Study of Terrorism, conducted interviews with 60 former terrorists to explore their motivations for terrorist activities. Main themes discovered through these interviews correlate very closely with the causes and symptoms of PTSD. Horgan found that those who are more open to terrorist recruitment and radicalization tend to:

“Feel angry, alienated or disenfranchised, identify with perceived victims of the social injustice they are fighting, believe that joining a movement offers social and psychological rewards such as adventure, camaraderie and a heightened sense of identity, and believe that engaging in violence against the state is not immoral.”20

Children running away from the sound of air strikes. Source: commons.wikimedia.org

For these reasons and many more, it is imperative that the international community acts swiftly to stem the spread of PTSD and take action to rehabilitate kids already impacted. PTSD and other disorders only get more severe as one continues to endure violence. According to the United Nations Relief and Works Agency (UNRWA), after the conflict in 2012, rates of PTSD among Gazan children doubled.21 PTSD further worsens when one experiences extreme poverty, insecurity, deprivation, lack of education, and a weak support network.22

In spite of these grim facts, not all hope is lost; through school-based counseling, the UNRWA has begun to address trauma-related issues. Several other aid organizations, such as International Medical Corps, have also pledged their assistance.23 However, more needs to be done, considering that long-term assistance and relationship building with single counselors are most helpful for traumatized children. The international community must aid Gaza to create a comprehensive, national development plan that prioritizes mental health care, reduction of poverty, improved legal systems to combat women’s abuse, and a more stable education system. Most importantly, however, it is vital that the Gaza Strip does not become re-entangled in conflict. The impacts of such violent engagements spread far and wide, regardless of how minimal the official death count is. With every violent image on TV and with every threat screamed into the radio, children are harmed.

_________

1. Anderson, Lane, “‘Modern Anne Frank’ Documents her Family’s Struggle…On Twitter,” Deseret News National, August 18, 2014, accessed October 27, 2014. http://national.deseretnews.com/article/2152/39modern-anne-frank39-documents-her-familys-struggle-in-gaza8230-on-twitter.html.

2. Sherwood, Harriet and Hazem Balousha, “Gaza ceasefire: Israel and Palestinians agree to halt weeks of fighting,” The Guardian, August 26, 2014, accessed October 27, 2014. http://www.theguardian.com/world/2014/aug/26/gaza-ceasefire-israel-palestinians-halt-fighting.

3. “The World Factbook: Gaza Strip,” The Central Intelligence Agency, last modified June 22, 2014, accessed October 27, 2014.

4. Niaz, Unaiza, “Psychiatric Impact of Wars and Terrorism on Muslim Women,” The Arab Journal of Psychiatry 25 (2014): 1-17, accessed October 27, 2014. http://www.arabjpsychiat.com/media/PDF/2014_n/the_arab_journal_2014.pdf.

5. Sait, Siraj and Hillary Lim. Land, Law and Islam: Property and Human Rights in the Muslim World. London: Zed Books, (2006), 8. Accessed November 9, 2014.

6. Thabet, Abdelaziz, Omar EL-Buhaisi, and Panos Vostanis, “Trauma, PTSD, Anxiety and Coping Strategies among Palestinians Adolescents Exposed to War in Gaza,” The Arab Journal of Psychiatry 25 (2014): 71-81, accessed October 30, 2014.

7. Quota, Samir and Eyad El Sarraj, “Prevalence of PTSD among Gazan children in the Gaza Strip,” The Arab Journal of Psychiatry 2 (2004): 8-13, accessed November 9, 2014.

8. Altawil, Mohamed, et al., “The effects of chronic war trauma among Palestinian children,” in Children: The invisible victims of war – An interdisciplinary study, ed. Parsons, M. (Peterborough-England: DSM Technical Publications Ltd.).

9. Thabet, et al., “Trauma, PTSD, Anxiety…”

10. Niaz, “Psychiatric Impact of Wars…”

11. Ibid.

12. Quota and Sarraj, “Prevalence of PTSD among Gazan children in the Gaza Strip.”

13. Jacobs, Harrison, “These Maps Show What the Gaza Invasion would look like in Major US Cities,” Business Insider, July 25, 2014. Accessed November 8, 2014.

14. Quota and Sarraj, “Prevalence of PTSD among Gazan children in the Gaza Strip.”

15. Ibid.

16. Ibid.

17. “WHO appeals for US$ 8.7 million to rejuvenate, improve Gaza’s health system,” World Health Organization, October 14, 2014. Accessed October 30, 2014.

18. Singal, Jesse, “A Youth-PTSD Catastrophe is Brewing in Gaza,” New York Magazine, July 22, 2014. Accessed October 29, 2014.

19. Victoroff, Jeff, “The Mind of the Terrorist: A Review and Critique of Psychological Approaches,” The Journal of Conflict Resolution 49, February 2005: 3-25. Accessed November 9, 2014.

20. DeAngelis, Tori, “Understanding Terrorism,” American Psychological Association 40 no. 10, November 2009. Accessed November 9, 2014.

21. “Serious upsurge of post-conflict trauma in Gaza, says UN,” United Nations Relief and Works Agency, January 22, 2013. Accessed on October 29, 2014.

22. Allen, Nick and Inna Lazareva, “Gaza conflict ‘causing PTSD in children’ after seeing dead bodies and witnessing heavy shelling,” The Telegraph UK, August 7, 2014. Accessed October 30, 2014.

23. “Gaza: Mental Health,” International Medical Corps. Accessed on October 30, 2014.

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