In Gaza, from afar: How survivors struggle with the trauma of war and occupation after leaving

Post-traumatic stress disorder (PTSD) is not the most apt description of what Palestinians go through with regard to mental health disorders and traumas; we’d rather call it OTSD (Ongoing Traumatic Stress Disorder). However for those of us who have survived, labels matter little; it’s clear we are in need of healing. A means to continue with life without “getting used to” what is abnormal . . . to grow and to process our futures in the healthiest ways that we can. 

For many Palestinians, it is a difficult journey. While Palestine is considered to have the highest per capita rates of mental illness in the world, according to Dr. Samah Jabr, the chair of the mental health unit at the Palestinian Ministry of Health, there are only 32 treating psychiatrists in the Palestinian Territories.

When I came to New York City from Gaza at the beginning of 2017 to pursue my studies in a Masters Program at CUNY, I found myself dragged into a seemingly endless discussion, if not debate, about mental health issues and how they can be defined and dealt with when cast in the light of different backgrounds, cultures and experiences.

Obviously, in recent years issues of mental health are no longer reduced to simply bad moods or tucked away as stigmas that we don’t or can’t talk about, especially for those of us who come from distant lands and suffer from complicated violence related mental trauma such as OTSD . . . or PTSD. Yet arriving in New York where mental health disorders are common we are not alone: every year, more than 1 in 5 New Yorkers has symptoms of a mental health disorder. Not an ideal setting to begin a healing process when suddenly confronted with a new life in a new world far from my own. 

Upon my arrival as almost pure instinct, I did a quick search on Google for “health services for war trauma victims.” Most results led to assistance for veterans’ PTSD support or services for those who survived terrorist attacks. Not much was available for those of us with special mental health needs triggered by collective massacres and the daily stress of a lifetime of oppression punctuated by periodic all-out attacks. And while NGO’s have sent experienced healthcare and humanitarian experts to Palestine to help with our fairly unique needs, though they came with a sense of urgency, no matter how well-intentioned, many lack a deep understanding.

Anxiously, in November of 2018, I posted on Facebook asking people from a background similar to mine to share whether they had found successful therapy experiences or not. My post quickly opened an emotional debate that included people of different war-trauma backgrounds ranging from Syria to Lebanon to Palestine.

Earlier this month I reopened the discussion on social media platforms trying to move from general dialogue to more personalized stories specifically from Palestinians that had sought help from psychiatrists and its results. There was no shortage of replies; from those who were encouraged by their experiences to others who found it largely useless because of a struggle to find a therapist who could understand the context of their life. All complained of cost and most wanted to contact me privately to discuss their experiences on a one-to-one basis. One comment, in particular, came from a Palestinian friend from Gaza who is currently based in the United States: he asked “Since you tried therapy, does it work? Do you think I need it too?”

From there I spoke with a number of other young Palestinians who have left Gaza in recent years. Hopefully cathartic, they have decided to share their stories and insights with Mondoweiss. 

Jamal Ashour is a 24-year-old visual artist from Gaza City who managed to leave during the Israeli aggression of 2014 to settle in Washington, DC as an international student. Ashour told Mondoweiss about how he arrived in the U.S. in the middle of the fall semester to an ESL class with zero English language skills, facing a new world and a new educational system and an ongoing war back home:

I failed all the classes that semester. However, I didn’t lose my F1 visa. 

During a few years of learning English as a second language, I have been asked from one of my instructors to be checked by a psychiatrist for ADHD and dyslexia. At that point, my therapy journey in the US began.

Since I don’t have that much money nor able to get health insurance, I had to ask my father who is a psychiatrist back home in the Gaza Strip if he knew any psychiatrists in my area of the U.S. to at least help in any way. Later, he put me in touch with one psychiatrist in D.C.

I was focused mostly on my “American” experience and issues because I never felt that I was understood from my own side of the world. Also, it was very tough to explain where I come from or to be able to explain my soul in another language. I kept seeing him and being checked by him for a few semesters, but it was too expensive and exhausting.. . During my school, I used to take Adderall but I never liked it. Later, I dropped out of school, and now I am under asylum trying to work on getting back to school in the near future.

Heba Al Hayek, 25, is a writer and Social Anthropology student at Oxford University in Ohio: 

To be completely honest, I would’ve not gone to therapy if it wasn’t for free and the university I worked and studied at. They offered free counseling sessions for graduate students and my chair told me that I should give it a shot.

I’m all for therapy, and I do think it could be very helpful. It is true that it’s one of the things we don’t really consider as Palestinians because our lives are constant and continuous traumas just built up upon each other. It’s so hard to see a way out, even if the idea of it seems appealing.

When I left home I was told that I will be dealing with PTSD and that I will need to listen to myself and treat my anxieties carefully now that I’m alone. I later realized that I’m never “post” my traumas. I’m constantly scared for my family, my eight-year-old sister that was born during the blockade, my friends and my country. As a Palestinian, I’m never given a real chance to process because I’m still there even if my body isn’t.

Anyways, I went to counseling and I had to stop after three months. I wouldn’t say my counselor was bad, but she had no clue who I was and what I’ve been through. I’m convinced that we need a special kind of therapy with therapists who are at least informed about our struggle to exist. I’m still planning to go to therapy again. There’s so much more to the ways I’ve been ruined as a person than only occupation and war. I’m a woman of color who’s living in the Midwest… there’s so much work to do and not enough time or money or heart to do it at the moment.

Mousa Tawfiq, a 25-year-old student is currently doing his masters degree in International Media in Paris after leaving Gaza in 2017, fulfilling a dream he had worked hard at for five years to achieve:

When I arrived in Paris, I realized that it will take me some time to overcome all the bad memories caused by everything I’d lived in Gaza, including wars, siege, power cuts, and lack of freedom of expression. Therefore, I thought that taking pictures with the Eiffel tower or walking in the nearby forest would help me, but in time I discovered that it won’t be easy to get rid of all the consequences of living for 23 years in a place like Gaza.

Then, I heard from some of my French colleagues that they regularly visit psychologists to share their feelings, depression, or just to talk. I was surprised by the fact that it isn’t something abnormal to visit a psychologist in those countries, and my colleagues didn’t feel ashamed while talking about those visits. As a result, I started thinking about visiting a psychologist to find answers and solutions for everything I’m going through, especially the depression after every Israeli aggression on Gaza or after every video call with my family. I needed to know more before taking such a step, especially since the culture of visiting psychologists isn’t very popular in a society like Gaza’s, therefore, I read a lot about the advantages of having a psychologist, and I decided to talk with my French friends about it.

When I asked my friends about their visits to their psychologists and the details they share with them, I was shocked and I changed my mind on the whole idea. The very first idea that came to my mind was “how will a French psychologist understand my concerns?! How will a psychologist understand me while he is used to listening to his patients talking about their depression caused by transportation, by family violence, by previous experiences of being raped or harassed, or by feeling oppressed in a patriarchal society? How will he/she understand the depression caused by having electricity for 24 hours a day while my family doesn’t? Or the depression caused by having all the freedom of movement and expression while my family is still living under siege? Will he/she be able to understand the depression caused by seeing a forest, a lake or a mountain for the first time, and video calling my nephews and nieces to see this environment with me? I decided that this won’t work. And it will be almost impossible for a white or privileged psychologist to understand and help me.

To better understand and connect the shared and unshared stories of individual Palestinians in their personal journey of psychotherapy, I spoke with Jehad Abusalim who works as the Palestine-Israel program associate at the American Friends Service Committee in Chicago. His insight is telling and powerful on both a personal and professional level. 

I believe that seeking psychotherapy after leaving Palestine (or any war zone) is not only important but key to reclaiming our entire lives as oppressed people. We are born and raised under a violent military occupation and so were our parents and their parents. Generation and after generation, trauma and psychological problems get passed, creating a context where there is a general collective trauma in society in addition to the individual trauma experiences by each person. So here we are dealing with not only the individual trauma experience by one person, but also a reality in which their parents, siblings, and almost everyone around them suffers from trauma as well. This creates a situation where it is hard for one individual to think about her or his own trauma and seek healing. If there’s no break from trauma, people don’t get to have the opportunity to think, reflect, and examine ways to identify the problem and seek solutions. So when we are in Palestine, we don’t have the privilege of trying to heal because the same causes of our individual trauma and the collective trauma are still in place.

Under such circumstances it becomes hard for people to admit that there’s something wrong, that is, to identify the problem. If trauma is the norm, the rule, the thing that defines people’s lives since they are born until they die, and passed from generation to another, it becomes hard for people to see it and feel that it’s a problem.

When it comes to the psychological impact of decades of violent occupation and settler-colonialism, our society is like a sinking ship with many holes, and no one knows exactly which one to plug. That leads solutions like therapy and psychosocial support to be met with cynicism in Palestine because if the conditions that are at the root of why there are such problems are not resolved, many question the point of seeking therapy under such conditions. That is not to say that seeking psychosocial support in Palestine is pointless, it is very important that people seek it. But while it’s important to seek therapy and healing, we shouldn’t forget about the political work that needs to be done to address the source of all evils: Israeli occupation.

Also, for Palestinians who leave Palestine, and mainly the Gaza Strip, the challenges become enormous as they are beginning to establish and lead a new life abroad. Being physically away from the place where people experienced trauma can have either a positive or negative impact on people’s psychological and emotional wellbeing. 

In a powerful conclusion Abusalim notes . . . While some become able to reflect on their past and think about the sources of their anxiety, stress, fear, and other issues that haunt them, others continue to intentionally and unintentionally deny their trauma as they did back home. While these people can manage to lead normal lives, their denial of their trauma doesn’t resolve their problems, and dealing with the effects of their trauma becomes harder and harder as they age and establish families.

More Palestinians from Gaza have left these past five years than before. Most have found their escape through student visas to obtain higher education to improve their own lives and that of their family. However, as an international visitor with no health insurance in the United States, it is a financial burden. One that adds to the mental health anxieties they bring with them. To get mental health assistance to deal with our lingering, and new anxieties, in many cities the cost for necessary services typically runs from roughly $75 to $150 per 45-minute session; while rates in New York City can be upwards of $200. 

When meeting newly arrived Palestinians from Gaza in other countries, it is both obvious and painful to observe their reactions to their new environment. Lost, physically stressed from sudden sounds, and depressed, many do not want to connect with one another after years of forcibly living together in an open-air prison. Lots of them do not believe in therapy, but just think all will be well if they just begin to live a fresh new life with new people and new surroundings. It doesn’t work. Yet, some do believe in the need to see a therapist to help them cope but struggle in their new cultures and systems, typically without financial resources.

Healing is a long-term commitment and a difficult personal search to find what best fits your needs. It can only happen if we admit to our OTSD and see that it is neither shame nor weakness to seek psychotherapy. It is an act of power and steadfastness to continue fighting and finding ourselves, be it in Palestine or in our new lives outside it.