Alex Delmar-Morgan. All rights reserved.After Heba Hmaid’s husband, Raed, was injured in the civil war in the Gaza Strip ten years ago, their marriage nearly broke down. Scarred by a serious injury to his right leg in the civil war between Hamas and Fatah in 2007, at first he grew nervous and irritable at home. Then he became violent.
“My husband began hitting me daily after he was wounded. And he was hitting my son sometimes,” Heba, 34, said through a translator. “ I knew that [the injury] had affected his behaviour. I tried cope with him, to deal with him in a different manner, but I couldn’t manage the situation.”
Before she married, Heba did a brief training stint at a place called the Palestine Trauma Centre (PTC) in Gaza after her university degree in media. Once married, her husband told her she must drop her studies, give up work and live at home. It was then that her problems started.
Heba’s situation grew increasingly desperate: a violent, unpredictable husband and a traumatised son, now seven years old, who has already lived through two wars – and now had to cope with the added burden of an abusive father.
At breaking point, Heba sought help eight months ago for her and her son, Mahmoud, at the PTC, Gaza’s only trauma unit - the same place she had trained at fresh out of university.
Located in Gaza City, it was set up in 2007 in conjunction with the Palestine Trauma Centre UK, a British charity that provides technical and financial assistance to the unit.
Other mental health programmes exist in Gaza. Some are run by UNWRA (The United Nations Relief and Works Agency for Palestine Refugees) and the well-established Gaza Community Mental Health Programme (GCHMP) provides psychotherapy and rehabilitation services.
But the PTC is the only centre of its kind in the strip, offering highly specialised psychological and counselling services to trauma victims and families.
PTC treated 65 families, around 500 people, in 2016 for a range of psychological conditions. Many patients are children, who are the worst affected. Anxiety, post-traumatic stress disorder (PTSD), bed-wetting, nightmares and fear are common. Adults can be severely depressed, sometimes threatening suicide.
Staff are stretched and work six days a week to keep pace with the volume of patients coming through the door. They can’t possibly cater to all of the two million people who live in this narrow coastal strip through a hellish cycle of war, random airstrikes, shaky ceasefires, poverty and fear.
“The situation is Gaza is very bad and everyday it becomes worse. We have a lack of fuel, electricity and salaries for employees – the crisis affects everyone,” said Rasha Qandeel, the director of the PTC.
Gaza City and the outlying suburbs in the north of the enclave, bear the worst scars of the last three military offensives by Israel, most recently Operation Protective Edge in 2014, which the UN says killed 2100 Palestinians, compared to 73 Israelis, 66 of them soldiers.
The war may have stopped and things have been relatively quiet over the last three years by Gaza standards, but bombed out buildings are a reminder of what life was like not so long ago.
Gaza Trauma Unit. The Palestinian Trauma Centre. All rights reserved.It’s hardly surprising that Palestine has the highest rate of mental health disorders in the MENA region. According to a study published earlier this year by Raghid Charara of the American University of Beirut, some 54 percent of Palestinian boys and 46.5 percent of girls aged 6 – 12 years are thought to have behavioural and emotional disorders.
Frequent exposure to violence and trauma since the 2007 blockade thanks to three Israeli military campaigns in six years between 2008 and 2014 has exacerbated the mental health crisis in Gaza. A report after the 2008-2009 offensive by Medical Aid for Palestinians (MAP) found that 30 percent of adolescents met the criteria for PTSD
Living under siege, the feeling of physical entrapment is common. Some 95 percent of Gazans said they felt imprisoned, a survey by GCMHP said. Mass employment, triggering a feeling of powerlessness and uselessness also contributes.
With Gaza’s well-documented shortage of resources and equipment, help for those suffering from poor mental health is in short supply. The PTC employs thirty staff; a mix of psychiatrists, psychologists, psychotherapists and counsellors. There are eighteen full-time psychiatrists all trained in Gaza, while visiting professionals come from Europe and the US to provide training to local doctors.
There are many, obviously, who don’t get the specialist treatment they need or deserve. Many don’t know about the centre or can’t afford to travel into Gaza City from neighbouring towns.
“We can’t reach everyone and a lot of them cannot come to the centre because they don’t have money for transportation. We try to do the best we can,” said Qandeel.
So they have never turned patients away? “No, no, no”, says Qandeel firmly, “they need our help”.
So much for turning people away, some may not come in the first place. With mass unemployment in Gaza, it is particularly difficult for men in Arab culture, traditionally powerful family figures, to come to terms with not being able to look after their wives and children, she says. Pride, and a reluctance to confront psychological issues, means many are unwilling to come forward and seek help.
That said, the PTC aren’t short of patients. Three new cases, on average, arrive every week, putting staff under constant pressure.
Running costs, including salaries, top US$ 200,000 a year. Totally reliant on foreign money, charities and humanitarian organisations such as Interpal, PTC’s largest donor, Muslim Aid and Mercy Corps all provide vital funding.
Gaza Trauma Unit. The Palestinian Trauma Centre. All rights reserved.Interpal, a British Muslim charity, has funded the PTC’s Family Therapy programme since 2013. It is one of the most active UK charities in the Gaza Strip, involved in dozens of projects, from supporting staff salaries at Sanabel School for kids with disabilities, to providing much-needed medical equipment to El Wafa Hospital in the south that was destroyed in the 2014 war.
The Vision Project, its flagship education initiative in Gaza - in conjunction with UNWRA - completed this year, helping over two hundred blind and visually-impaired children to learn and study using digital technology and iPads.
Few Gazans could claim they are unaffected by the trauma of living in this near constant theatre of war. When bombs aren’t going off, they suffer under the blockade; medical equipment and drugs are limited, few can leave, travel or experience a normal life.
But with mental health, you don’t need equipment, or expensive machines. You don’t need drugs and state of the art hospitals. You need time, dedication and training – and in the case of the PTC, from a small group of very qualified, badly-paid professionals who spend their lives helping others.
Certainly Heba and her son were one of the lucky ones.
The counselling and psychotherapy Heba received has helped her overcome 90 percent of her problems, she said, vastly boosting her self-esteem. After eight months of treatment, she now comes monthly, not weekly, to the centre.
Relations with her husband have improved, the violence has stopped and she even used the word “rehabilitated”. Mahmoud’s behaviour has also stabilised and he’s happier at school.
Heba’s situation may be vastly improved, but she talks of “coping” and making do. Her voice is also tinged with sadness and despair when she reflects on causes of family’s unhappiness. Naturally, she can’t help straying into politics – and her message is stark:
“The political and economic situation is very difficult because of the occupation. All the people are suffering and we deserve to live. We ask the world to help us.”
*Alex Delmar-Morgan was a guest of Interpal in Gaza.