Mental health in Gaza: a subterranean malaise

Israel/Palestine
on 38 Comments

As the international director of We Are Not Numbers, I interact daily with many young adults in Gaza, ages 17-29. This is the age when they finish high school or university and emerge into a crippled economy where about 60 percent of them will be unable to find jobs. Too much idle time, unable to afford marriage, memories of too many wars and scholarships lost due to the blockade.

In just one recent week, I found myself grappling with:

  • A distinguished colleague, an NGO head who normally is a rock upon which we all lean, dropped out for days. He was coming to grips with the sickening reality that he would never be allowed out of Gaza by the current “regimes” in Israel and Egypt. After numerous previous attempts, he tried to join the crowd heading to Mecca for the Hajj, and even then was turned back. Clearly, he has been “blacklisted.” His new WhatsApp profile icon: “I am here to stay.”
  • A 20-year-old university student had been preparing to leave for months after earning a scholarship to a school in Spain. He was assigned to the last of the buses to cross from Gaza to Egypt through the Rafah gate—but it was turned back at the border. The crossing hasn’t opened since. (The crossing had been closed for the previous 52 days, and there are about 15,000 people still on the waiting list to exit Gaza via Rafah.) “It’s my destiny,” he told me on Facebook chat, when I tried to find him after not hearing from him in days. “It’s a life without hope, a life without a future. Happiness and hope never last. Maybe because you are not in Gaza you can say that’s not true, but living here eradicates all the good feelings.” His new Facebook profile photo: the mask of the Joker.
  • Another youth carved deep cuts into his arm with broken glass. The cuts were not placed correctly to end his life; rather, they were a crude call for help, a shout of “I am here!” into what appeared to him to be a mute universe. His Facebook profile photo: His face only barely visible behind a curtain of shadow, as if he is slowly disappearing.

Alarmed at the collective depression I sensed among virtually everyone to whom I talked, I asked my project manager what we should do to help. “But everyone is depressed in Gaza; it’s all a matter of degree,” he responded.

According to Hossam Al-Madhoun, a therapist at the Maan Development Center in Gaza, suicide is on the rise in the Strip, despite the fact that it is haram (forbidden) in Islam. “There is at least one every day, although most are not being publicly reported by the Hamas government,” he says. “This is a dramatic change from 20 years ago, when there might be one every few years. Especially since the summer attack by Israel last year, there has been a huge increase.”

The most at-risk are youth and young adults, who have the highest hopes but also the highest unemployment—and are just discovering their dreams too often turn to dust. Yet most of the formal psychosocial support programs in Gaza that receive international funding are for children. In part as a result, Al-Madhoun says, the quality of mental-health care in Gaza is highly variable, and the most-reputed centers such as the Gaza Community Health Program are overloaded.

The other challenge is that anything labeled “therapy” or “psychological” (heaven forbid you say “psychiatric”) carries a heavy social stigma. In the minds of most Gazans, admitting to emotional problems is tantamount to exposing yourself as “weak” (a very negative quality). And if someone develops a serious mental illness, such as the psychosis one young friend recently developed, the common assumption is that he or she is possessed, and a sheikh is called in. Even meditation is a bit suspect; I have connected several young people to a friend who teaches the relaxation technique via Skype, but must be careful not to mention it to anyone else. Trust, I have learned, is also in very short supply there these days; as a foreigner, safely removed from Gaza, I am a “safe harbor.”

“A disaster brings people together, but when repeated over and over, it’s not. Everybody is exhausted, too busy coping with their own troubles,” Al-Madhoun explains, adding that he also thinks the Arab culture tends to be more judgmental.

Drama as therapy?

Al-Madhoun uses drama to help Palestinians of all ages expose and manage their inner demons. Drama, as well as other forms of art, he says, is a way of “tricking” them into opening up, and in turn, accept help. He begins with relaxation and simple, fun role-playing; he then slowly eases them into improvisation.

“Drama is like magic,” he smiles. “It’s play, but serious play. Everyone ends up enjoying it, and then you reach a moment when you throw everything out there.”

Al-Madhoun first discovered his interest in drama in 1992, when he was 22 and was caught writing anti-occupation slogans on the massive cement wall that separates Gaza from Israel. He was detained and accused of being a member of the Palestine Liberation Organization, which Israel considered illegal at the time. He was jailed in Israel’s Anssar Prison in the Negev Desert for nine months. (The following year, the PLO was recognized by the UN as the official representative of the Palestinians).

Al-Madhoun says his months in prison changed him in two ways: “First, I learned how counterproductive politics can be,” he recalls. “In the prison, Hamas and Fatah fought each other constantly. I decided never to belong to a political party. “ The second consequence was more positive. “I met theater in prison. The other prisoners put on a play, and I participated. I discovered that it is another form of resistance that can also educate and raise awareness of my people’s daily life under occupation: the wall, the checkpoints, the blockade, the humiliation at the crossing points. I decided I would study theater.”

And he did. When Al-Madhoun was released, he joined an amateur theater group in Gaza called Theatre for Everybody. The troupe was founded in 1987 during the First Intifada, performing both internationally and at home.

Unfortunately, however, “Theatre in Gaza is not as it used to be anymore,” says Al-Madhoun,”both because of the conservative government and the effect of the blockade on our economy. Culture can no longer be such a priority. Historically, theater could never be a primary income source in Gaza. But now, we can’t make anything from it. I used to participate in two to three productions per year, performing hundreds of shows in Gaza and in Europe. But since 2006, I have participated in only three productions and have not been able to perform out of Gaza due to the blockade.”

Drama, and all forms of art, does live on in Gaza, however, as a form of therapy. Al-Madhoun insists he is an actor and director, not a writer, but his poem, “Here we are, after the war,” captures so eloquently the angst of the people:

Wars are a very strange thing, difficult to describe, my friend.
War ends and you believe you survived.
But after a while, you realize that the war is still going on within you,
Chasing you in your dreams, in the destruction around you,
In the funerals and the sad faces in the streets and the markets,
In the sorrow of those who lost their beloved relatives.
Wars do not end or leave simply.
Suddenly your 11-year-old child wets his bed,
  and your wife has nightmares;
You too, but you don’t admit it!
Your clever daughter is getting very low marks at school
  and she doesn’t know why.
Suddenly your kind and nice neighbor doesn’t stop yelling
  and shouting at his wife and kids.
Day and night and no one can stop him.
Your eldest son wakes up in panic with any strange sound.
A knock at the door, a cup falls and breaks,
  a fast car’s wheels scream in the street.

After war, nothing remains the same.
Before war, there were no people living in
  half-destroyed homes or sheltering in schools.
Before war there were no children or women
  looking for something to eat in the garbage.
Before war there weren’t thousands of beggars of all ages:
  Children, youth, women, men.
Before war there weren’t 50.000 people without homes.
Before war there weren’t 800,000 children suffering
  from fear, nightmares, bed-wetting, sleep disturbance, anxiety.
Before war… before war … before war… And after the war???????!!!!!!!!!!!!

About Pam Bailey

Pam Bailey is founder of WeAreNotNumbers.org and international secretary for the Euro-Mediterranean Human Rights Monitor. She is based in Washington, DC, and travels to the Middle East frequently.

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38 Responses

  1. JLewisDickerson
    September 25, 2015, 12:30 pm

    RE: “Mental health in Gaza: a subterranean malaise”

    ONE WAY YOU CAN HELP:

    Please make a tax-deductible donation payable to The Gaza Mental Health Foundation Inc.
    Your gift will be sent to The Gaza Community Mental Health Program, which is providing vital mental health support to the traumatized families of the Gaza Strip.
    Your donation is tax-deductible to the extent provided by section 501(c)(3) of the Internal Revenue Code.
    To donate, please print out brochure or send a check with your name, address, telephone number, and email address to:

    Gaza Mental Health Foundation
    PO Box 380273
    Cambridge MA 02238

    SOURCE: Gaza Mental Health Foundation – http://www.gazamentalhealth.org/

    P.S.
    GAZA MENTAL HEALTH FOUNDATION – BOARD OF DIRECTORS
    Bill Slaughter, President
    Donald McInnes, Treasurer
    Hilary Rantisi, Clerk
    Devin Atallah
    J. Timothy Davis
    Nancy Murray
    Alice Rothchild
    Sara Roy
    Othman Mohammad

    GAZA MENTAL HEALTH FOUNDATION – ADVISORY COMMITTEE
    Cindy & Craig Corrie
    Jess Ghannam
    Ellis Goldberg
    Elaine Hagopian
    David Hall
    John Pirroni
    Yale Rabin
    Ted Rynearson
    Therese Saliba
    Tom Suarez
    David Trimble

  2. Annie Robbins
    September 25, 2015, 1:51 pm

    Pam, thanks so much for calling attention to the radically crucial issue of mental health in gaza. it really astounding to try to comprehend how people are surviving there under these conditions, especially considering many are coping with both mental and physical health problems. for too many children it’s all they’ve ever known.

    • RoHa
      September 26, 2015, 12:10 am

      It’s astonishing that Gazans are not all gibbering wrecks. But perhaps the apparent sanity is an illusion, created by contrasting Gazans with what lies North of them.

  3. Annie Robbins
    September 25, 2015, 1:58 pm

    also, speaking of theatre in gaza and the excellent We Are Not Numbers project and Gaza’s Theatre for Everybody, — the Gaza manager for We Are Not Numbers, Mohammed Alhammami, wrote and excellent article here about a short version of Tolstoy’s classic “War and Peace.” recently performed in Gaza. http://mondoweiss.net/2015/09/tolstoys-peace-palestine#sthash.CNir1oiG.dpuf

    really fantastic. i wish they could skype it to the bay area!

  4. Pam Bailey
    September 25, 2015, 7:19 pm

    Well, the problem is that even if you fund the GCMP more, most adults and youth in Gaza will not access it. The stigma is too strong. What we need is more funding of programs like Hossam’s, which use “alternate” ways to reach individuals in need.

    • Marnie
      September 26, 2015, 1:42 am

      How can we get funds to Hossam?

    • Annie Robbins
      September 26, 2015, 4:36 am

      pam, while i fully agree “alternative” ways to engage people in mental health is highly effective and certainly the most common form of healing (i find working in my garden keeps me somewhat sane), especially when it’s integrated and advanced with trained professionals (like drama/improv w/trained therapists) i think ideas like this: anything labeled “therapy” or “psychological” (heaven forbid you say “psychiatric”) carries a heavy social stigma. In the minds of most Gazans, admitting to emotional problems is tantamount to exposing yourself as “weak” , will not remain stagnant and will evolve over time.

      my mom told me once she was way into her adulthood when her father told her he had once had a sister who lived in a closet. she had some severe mental illness from birth and that’s just what people did back then. people like that were kept in closets or mental institutions so the world didn’t see them, ever. my mom never met her aunt and never knew she existed until after her death.

      but people and societies change over time and sometimes it’s radical events that make those changes happen faster. you can’t hold back the future. it won’t always be that in gaza the idea of seeking treatment for depression, mental health or mental illness will be an anomaly. it might even be sooner than one thinks. in gaza, there’s undoubtedly a collective trauma/depression. how could there not be. given their circumstance i could imagine a gazan being the next world leader or innovator in discoveries surrounding mental health. really. their society and culture, they are not stagnant. it won’t always be like this. one of the identifying features of depression is the idea it will never change. but nothing remains the same, that’s an illusion. time continues and with it people’s minds evolve. even in gaza.

      • Marnie
        September 26, 2015, 11:00 am

        Thanks for the information re: help to Hossam.

  5. ckg
    September 26, 2015, 7:29 am

    My apologies for double posting this: Today Sep 26, 2015 at 2:45 pm EDT, C-SPAN 2 will re-broadcast the Aug 13 taping of a book discussion of Max Blumenthal’s The 51 Day War: Ruin and Resistance in Gaza. The broadcast was originally aired Aug 31. The complete 109 minute program can also be seen on the C-SPAN web site.

  6. a4tech
    September 26, 2015, 9:39 am

    Microanalysis of Gaza’s population by non-local organisations may present an exaggerated sense of mental health crisis that simply does not reflect the reality of the situation

    Of course there are people who are traumatized and depressed in Gaza, however it is a natural form of malaise that is rooted from external stressors, i.e. the Israeli aggression and blockade. This cannot be equated to mental illness, which comes from internal stressors which is significantly more common in the populations these aid-organisation comes from.

    I know this may be controversial to some but people in Gaza aren’t nearly in dire straits mentally or psychologically compared to the citizen populations of Israel and the western nations, especially USA.

    • just
      September 26, 2015, 10:49 am

      Huh?

      • a4tech
        September 26, 2015, 10:59 am

        Well the article make it sound like there is some sort of epidemic of mental illness in Gaza which is not the case.

        Given the past and current physical, economical and political constraints put onto the population, at levels that are arguably the worst in the world, the people in Gaza are going through daily life with dignity and poise. This simply cannot be possible without a psychologically sound population.

    • Froggy
      September 27, 2015, 2:26 pm

      a4tech : One must never confuse mental illness with the mental and emotional side effects of being forced to live with/through trauma.

      • a4tech
        September 27, 2015, 3:45 pm

        That’s exactly what I meant to say. However, often articles show up on MSM and advocacy sites claiming to highlight growing mental illnesses in Palestine such as depression, suicides etc which to me suggests that a much deeper social issue within the Palestinian society itself.

      • Froggy
        September 27, 2015, 9:29 pm

        A4tech : “However, often articles show up on MSM and advocacy sites claiming to highlight growing mental illnesses in Palestine such as depression, suicides etc which to me suggests that a much deeper social issue within the Palestinian society itself.”

        If you believe that, it’s clear that you don’t have a clue.

      • a4tech
        September 27, 2015, 10:26 pm

        Upon reading my comment again it appears to be really poorly worded. I meant to say often articles on mental health in Gaza go on to suggest there is some sort of deep social illness here that fuels the phenomena, such as religious oppression, highly conservative society etc. However, the reality of the situation is almost 99% of the mental health issues in Gaza is due to external factors beyond the controls of population, namely the Israeli aggression and blockade.

      • bryan
        September 28, 2015, 5:13 am

        a4tech – I don’t think you should generalize about broad social problems based only on your own predicament. Yesterday you were a Moslem, today you are an Islamophobe: what possible sort of credibility does that give you? You must be a self-hating troll.

      • a4tech
        September 28, 2015, 9:12 am

        Bryan what are you talking about? What is Islamophobic about stating that most mental health issues in Gaza arises from external factors, not a byproduct of a flawed society?

      • bryan
        September 28, 2015, 1:36 pm

        @a4tech – Perhaps I over-reacted to your words that the problem was not the Occupation or the relentlessly brutal bombardments derived from the Israeli war-machine, but (in your words) “a much deeper social issue within the Palestinian society itself.” It may be my fault of course, or it may be the fault of Zionist trolls who cast wild and unreferenced aspersions, and then step back when challenged, seeking to manipulate the audience they are addressing, and come back with righteous indignation about having been misinterpreted. Perhaps you should articulate your argument properly, rather than constantly shifting your ground in order to complete the derailment of the thread. Please be clear whether you are a Moslem or a non-Muslim war-crimes apologist and let’s know who pays your salary. I’m sorry but I don’t trust people who say “this may be controversial”, and then “that’s exactly what I meant to say”, and then “Upon reading my comment again it appears to be really poorly worded” and then “what are you talking about?” If you have a point to make, make it clearly and precisely, and without beating around the bush.

  7. Citizen
    September 26, 2015, 2:41 pm

    Yeah, all those US soldiers afflicted with PTSD has nothing to do with US foreign Policy, with them as the implementers.

    • a4tech
      September 26, 2015, 4:59 pm

      Exactly and that’s just the tip of the iceberg, what with the multitudes of public shooting by teens, increasing youth homelessness, generally hateful public discourse on everything political (as was clearly seen during the recent Republican debates) and a homicidal government that espouses violence domestically and in far away foreign land. How is this society not mentally ill?

      And all this without someone else oppressing and
      destabilizing the country as well, UNLIKE GAZA.

    • Keith
      September 26, 2015, 8:16 pm

      CITIZEN- “Yeah, all those US soldiers afflicted with PTSD has nothing to do with US foreign Policy, with them as the implementers.”

      It probably wouldn’t be as bad if the US policy wasn’t so corrupt. A big scandal now is the US tolerance of Afghan War Lords sodomizing young boys on US military bases and the GIs powerless to stop it because they are our allies. The story appeared in the Seattle Times having originated in the NYT. Supporting democracy? Supporting those who “share our values?” Are things going from bad to worse or what? As Lily Tomlin says “No matter how cynical you become, it is never enough to keep up.”

  8. Bill Slaughter
    September 27, 2015, 3:05 pm

    Hi Pam, all– Bill Slaughter here with Gaza MHFoundation–big thanks for great attention to the societal trauma in the Strip. I don’t think any donation can go too wrong; our group’s approach has been to focus on long-term tie-building (with GCMHP GCMHP.com/en/ ), given its decades of service–at many levels, including coaching many grassroots orgs, broad school, social media, etc) certainly reducing stigma etc)–all supports to social services in Strip will likely be helpful–keep up the good work!
    Bill S.
    GMHFoundation

    • just
      September 28, 2015, 8:00 pm

      Many thanks for posting and for all of the critically important work that you do, Dr. Bill.

      Thanks for the info about “GCMHP director psychiatrist Yasser Abu Jamei’ MD will be on his first U.S. tour next mo.–Bay Area to Seattle, Boston to DC…”, too!

  9. Bill Slaughter
    September 27, 2015, 3:11 pm

    PS–GCMHP director psychiatrist Yasser Abu Jamei’ MD will be on his first U.S. tour next mo.–Bay Area to Seattle, Boston to DC–watch our and other activist websites for final venues, dates–

  10. John Fearey
    September 28, 2015, 1:27 pm

    When I was in Jerusalem last November for only a week I managed to leave my Lexapro back in Connecticut. I haven’t been depressed in years but still take it because the doctor says why not. So I didn’t think much of it until I found myself retreating to my room in the Lutheran guest house by myself and weeping.. Way embarrassing and not something that’s happened to me in years. I managed to get a partial refill from a pharmacy, which helped, but it wasn’t just the lack of Lexapro. that caused the weeping now was it? Generally you can go a few weeks without it and not notice. But not in Jerusalem, Seeing what’s happening to the Palestinians will just break your heart. The horror of it; and how do they cope.? I had a conversation with a cab driver (which turned into lunch) who was struggling mightily with depression and not going back to drinking and drug dealing but wasn’t able to support his family by just driving a cab (tourism was way down). He did receive treatment through the government and was clean and was taking Prozac. He has two young daughters (and his wife was still with him) who were just scared to death for him and with very good reason. He has a harrowing story., And no good choices. One bright moment was when we talked about our dogs and for a moment he was transformed. I admire the courage, tenacity and grace of every Palestinian I met. Their captors, not so much. And thanks for the donation info..

    • James North
      September 28, 2015, 1:38 pm

      Jerusalem is one of the most depressing places I have ever visited.

      • John Fearey
        September 28, 2015, 1:48 pm

        No one smiles, except maybe shop owners, but not really

    • John Fearey
      September 28, 2015, 1:43 pm

      …make that “genocidal captors”

    • Kris
      September 28, 2015, 6:35 pm

      This is a profoundly moving testimony. Thank you.

      • just
        September 28, 2015, 7:06 pm

        It surely is, Kris.

        Thank you for sharing your powerful testimony, John.

  11. Spring Renouncer
    September 28, 2015, 2:08 pm

    It is sad and ironic how much media attention (though not necessarily material resources) goes toward a few thousand U.S. Soldiers who have acquired PTSD after volunteering to kill people abroad, while their hundreds of thousands – or millions – of victims receive no help, let alone recognition. When our government and its allies – Israel, Saudi Arabia, and Europe – destroy scores of families, violence and insanity are totally predictable. It is not a stretch to say that whole generations probably suffer from war related mental health issues in Afghanistan, Iraq and Palestine. This severe trauma is one explanation for the radicalization occurring in in Iraq and Syria (AKA ISIS. The other explanation, is that we dismantled the Iraqi state and its institutions, etc.)

  12. John Fearey
    September 28, 2015, 2:28 pm

    I went to Lexington MA to hear Chomsky, Walt, Pappe, Zaru, Braverman , Roy at the Society for Biblical Studies National Conference (Sept 17 to 19) which I think I learned about from you, James, or a commenter to one of your posts and for which I thank you/them because it was a tour de force gathering. The reason I mention it is that Dr Sara Roy told the audience that if you want to do something to help the people in Gaza, just “go there.” The people of Gaza are so–what’s the word??-bereft,, lost, abandoned-that just for them to know that there are people in the world out there who know and who care is worth more than any money you might send them. Worth more than money. Think about that, because lord knows they need that too.
    (I’m trying to write up some of what I heard in Lexington, but it’s slow going. But Dr. Roy’s statement might have been among the most amazing things I heard…”just go there.””

  13. Katie Miranda
    September 28, 2015, 2:38 pm

    Another way to help: Provide an economic opportunity for someone in Gaza. One way to do it is if you need some task done like web development or programming, translation, or internet-related task, go create an account at http://www.upwork.com, make a job posting there and narrow the pool of applicants to those living in Gaza.

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