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On October 10, 2005, international campaigners launch a campaign to try to shake the stigma over seeking help in mental health related issues. In the following article, Isabelle Humphries highlights the extent of suffering causing mental health difficulties over generations in Palestine, and considers community initiatives working to address this overwhelming issue.
Continuous Dispossession
The elderly woman visibly folded into herself as she described the behavior of her nephew’s children in Jenin. “You should see what the noise of the planes has done to them. They are too frightened to sleep separately, so they all sleep in the same bed, huddled up close together. The poor little things.”
Dispossession has tailed the lives of Umm Khalil and her family over generations, a typical tale of how trauma is rooted in the lives of uprooted Palestinians. In 1922 her tenant farming family was kicked from their land as an Ottoman landlord (not Palestinian) sold it to Zionist Jews meticulously preparing for the takeover of the land. By 1948, Umm Khalil was married with three young daughters when all were forced to flee the village of Al-Mujaydil to nearby Nazareth.
Without enough food to feed her daughters, Umm Khalil didn’t know what had happened to her husband for months until he returned from the prison labor camp to which he had been taken. “In the first days we just kept worrying about what had happened to the bodies of those killed in Al-Mujaydil. We believed we could smell them even though we were six kilometers away in Nazareth. But they wouldn’t give us permission to go back to bury them. We were frightened more men would be killed, so in the end the women went. They were unable to dig graves, so they just sprinkled earth on top. Some of the women were literally driven ‘out of their minds’ by seeing body parts strewn across the ground.”
This is no trauma long gone, but fresh in Umm Khalil’s mind; an inseparable story from what is happening to her relatives in Jenin today. Many of her family became West Bank refugees, and as her own children and grandchildren stand around her today, they know what is happening to their cousins, one of whom is being kept as a political prisoner in a jail not so far away. The Nazareth neighborhood that they live in is 90 percent refugees from Al-Mujaydil. “I used to speak with the grandchildren about what happened,” says Umm Khalil, “but now I don’t do it so much. They get so angry about what they have lost.”
Gaza: Where to Begin?
Tackling mental health issues is a challenge in any community, but where do we start in an overcrowded strip of land where military assault is a daily reality for every person?
While the Gaza Community Mental Health Programme (GCMHP) deals with 1,500 individual clients a year, the project addresses the problem of trauma with a wider approach. “Psychological trauma and distress in Gaza cannot be divided into isolated cases. We cannot begin to reduce people’s suffering if we don’t make the link between mental health and human rights,” says GCMHP director Dr. Salah Abdel Shafi. “There can be no well-being when people are oppressed; thus, we must look to expose the root causes of stress in the community.”
One of the projects that GCMHP runs is community clinics, with sites selected to be accessible to large numbers in the highly populated residential areas around, without dangers of travel and impossibility of closure. In addition to providing a suitable environment for individual therapy, centers provide facilities for community sessions, meetings, and training. The building is designed with the needs of specific therapy in mind, e.g., green areas have been created for children’s play sessions.
GCMHP focuses its work on trying to raise awareness of the suffering caused by mental distress, and to spread an understanding of coping mechanisms. Effectively tackling a problem requires a professional needs assessment, and GCMHP has an extensive network of professionals working both in Gaza and in foreign universities researching Post-Traumatic Stress Disorder. The results of this work are used for international advocacy, raising awareness of the depth of community suffering and stress caused by the ongoing occupation, but the research is also central to help the development of situation specific coping mechanisms. From specialized research focusing on vulnerable groups such as children or former detainees, the GCMHP team is able to design the most suitable ways to work with the community to ease collective pain and stress.
So how does this work in practice? “We are under no illusions that we can somehow ‘solve’ the mental health crisis in Gaza, but we believe that by increasing awareness of coping mechanisms within the community, we can start to make a real difference in many people’s lives,” says GCMHP director Dr. Salah Abdel Shafi. Research has shown that only 30 percent of mental health problems are detected by GPs, showing a clear need for training amongst primary health care workers. Psychological distress often surfaces in physical illnesses, meaning that people seek help from their GP not a psychiatrist. GCMHP is working with primary health care workers to provide training in identifying the symptoms of mental suffering.
Another example of community work is GCHMP’s meetings with religious leaders. People listen to and seek advice from religious authorities as respected elders, and thus it is essential that leaders are able to assist their communities.
Children are a central focus for GCMHP, so training and working alongside teachers and school counselors is a large part of the work. “Children may not verbalize their fear and distress, and it comes out in symptoms such as bedwetting, insomnia, and loss of concentration. For example, if teachers are not aware that lack of concentration demonstrates that the child is traumatized, the child may be punished and then the situation becomes even worse,” stresses Dr. Salah Abdel Shafi. The project conducts collective therapy such as art classes in schools, and encourages parents and teachers to find positive ways to ease children’s distress.
Women and Mental Health
It is impossible to deal with the problem of domestic violence for women in Gaza in isolation from their experience of political violence. The organization has a specific department addressing women’s psychological needs and dedicated to empowering them to overcome the effects of trauma. The project offers therapy and counseling on a psychological level, but also legal counseling and practical vocational training to allow women to have new interests and develop possibilities of economic independence. GCMHP runs Women’s Empowerment Centers in Beach Camp, Gaza City, Deir El Balah, and Rafah, where women can seek the ongoing support and help that they require.
Ex-prisoners are another group to which GCMHP pays particular attention. Many thousands of Gazans have at one time or another been held as political detainees in Israeli jails, and such tortuous experiences can have a lasting and terrifying impact. The stigma attached to discussing mental health makes it particularly difficult for men to seek help, for they often mistakenly believe that to express fear is a sign of weakness. GCMHP works to challenge taboos in order to reach out to this group who are often suffering from severe Post-Traumatic Stress Disorder.
Breaking Through the Barriers
There are other associations that deal with mental health issues, from large medical services such as the Red Crescent, to other specific centers like the Palestinian Counseling Center based from East Jerusalem. “As a direct result of the psychological trauma from military occupation, our work is focused on the problems created for the average person in an abnormal situation,” explains director Rana Nashashibi. “The effects of suffering direct military assault or living with the everyday frustration of not knowing if you can reach school or work are psychologically debilitating in the extreme.” The PCC provides counseling and mental health services for the kinds of problems that occur within any society, but the focus is on proactive support for collective trauma and distress within the whole of society.
The PCC is conducting extensive research into the damaging effects of a life ruled by checkpoints, humiliation, and frustrations of closure. “We want to be one step ahead in helping people, rather than always being reactive and merely dealing with the resulting effects. We want to use our research to develop specific coping mechanisms and strategies to spread a deeper understanding among the grassroots and professionals within the community,” said Nashashibi.
Imagine life behind walls, both walls that physically exist, and imaginary walls that symbolize the limits of opportunities living inside a land under occupation. This is the daily life of a Palestinian; “disengagement” is irrelevant. Without an economy and opportunities, there is no hope and no future. In such a situation, services provided by community support networks are essential.
To find out more, or to send much needed support, please check Web sites at:
www.gcmhp.net
www.pcc-jer.org
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