In April, I attended a conference on Mental Health and Human Rights in Palestine. I considered it an important opportunity to learn from my colleagues there, and also share the research I had done a while ago on South African former political detainees.
My work as a psychologist and researcher over the past several years has focused on the mental health concerns of people living under conditions of oppression and marginalisation in southern Africa. I had also previously served on a working group of the World Health Organisation that examined ways of diagnosing stress-related mental disorders. And now, two years after the most recent war in Gaza, Palestine, it was possible to attend and present a paper at a conference there.
Entering Gaza from the Erez border crossing in Israel, one passes through a series of security checkpoints, and then proceeds on foot through a kilometre-long open-air corridor that is fenced in on both sides. Security cameras at various points make it clear that everyone who enters is under surveillance by the Israeli authorities who control access to the area.
For the past several years, the people of Gaza have been subjected to a siege that is as unrelenting as it is brutal. Visitors are only granted a permit to enter under special circumstances. There is no doubt that when you visit Gaza, you are entering a prison.
Gaza, one of the most densely populated areas in the world is dry, dusty and under-resourced. Its people are poor.
They face restrictions in terms of imports, food, medical supplies, fuel, water and electricity. Aware that a complete embargo on Gaza will lead to starvation and famine, and in turn provoke an international outcry, the Israeli government allows only enough food and resources in so that the people may survive.
The people of Gaza know war, which in some sense is an inaccurate term because it assumes a symmetry of power. Civilians are defenceless against the military might of the Israeli Defence Force.
Apart from the thousands of deaths of innocents over the past several years, the survivors, many of them young children and youths, live with amputations, spinal cord injury, traumatic brain injury, wounds and scars.
The conflict two years ago saw the indiscriminate destruction of homes, schools, hospitals and clinics, which in turn disrupted families and community support structures. A 10-year-old child living in Gaza today would have survived three wars – in 2008, 2012 and most recently in 2014. It will come as no surprise that grief and trauma are ubiquitous here.
Israeli attacks have included the use of incendiary explosives with white phosphorous. The short-term effects of white phosphorus are deep third-degree burns which in some cases can cause liver, heart and kidney damage, and eventually death.
Long-term effects are cognitive deficits and learning problems so that those who survive, many of them children, face difficulties at school and work.
The siege means that access to goods and services is extremely limited, which in turn has devastated the local economy. Few people have jobs and those who do work for the international NGOs that provide humanitarian aid.
At the Islamic University of Gaza, whose buildings were bombed in the war of 2014, a favourite major among students is English as it enables them to find work as translators, tutors to young children, and in the NGOs. Yet, over 60 percent of young people are unemployed even though many have university degrees. They stay home with nothing to occupy themselves, and no income.
Besides its physical and social effects, war has also exacted a psychological toll. Many Gazans experience depression, anxiety, post-traumatic stress, grief and hopelessness.
Suicide, a taboo topic in this highly religious society, has become a noticeable trend, especially among young men. Parents, children and adolescents experience constant fear, anxiety and anger. They have few coping resources, leading to violence and family dysfunction.
Men and women who suffer from depression are socially isolated and in need of psychological support. The constant humiliation and degradation of the Palestinian people in the Occupied Territories is palpable, but nowhere is this more evident than in Gaza. In this society, men usually assume the role of the family breadwinner.
Yet, many cannot find work, and those who do earn a paltry amount. Their humiliation debilitates them.
For the first time, some Gazans speak of wishing to leave their homeland so that they may find a peaceful life somewhere else.
But this is not possible because Gaza is a prison – entry and exit are strictly controlled by the Israeli government in the north and the Egyptian authorities in the south.
There is no doubt that the cumulative trauma of war has had devastating effects.
Yet, in the midst of this devastation, psychological concerns often take a low priority. One of the exceptions is the Gaza Community Mental Health Programme (GCMHP), started in 1990 by the late psychiatrist and human rights activist Dr Eyad Sarraj. Its mission is to provide mental-health services to the people of Gaza, especially victims of violence, torture and human rights violations.
The GCMHP offers psychotherapy and counselling, including anonymous telephone counselling, crisis intervention, rehabilitation, and occupational and physiotherapy. Patients are taught cognitive problem-solving skills, emotional expression and activities that promote self-esteem, even in the context of what is often seen as a hopeless political situation. The centre also offers a place of social inclusion for youth, including those who are apolitical and not associated with religious groups.
The trauma of war has placed an enormous strain on families, who struggle to survive. Parents, deeply affected by their inability to protect their children from harm, have difficulty coping. Some resort to domestic violence in the context of their frustration and constant humiliation.
Fostering positive parent-child interactions and attending to the mental health and coping of parents is thus an important function of the GCMHP.
In a society under constant threat of annihilation, getting through the day is a challenge. Life continues, in a way, but hopes of a better life are dim.
The prison that is Gaza is an unforgiving place. What keeps people going are their families, their religious and political beliefs, and a focus on learning and education. Collectivist notions of struggle and resistance give Gazans meaning, but an end to the siege of their homeland is not in sight. There is a tacit acceptance that it is only a matter of time until the next Israeli attack.
A just peace has proved elusive for the Palestinian people at this moment in history. Yet, alleviating trauma and suffering, both physical and psychological, is the imperative for health professionals and scholars who work in this forgotten corner of the world.
Conferences on health and human rights play an important role in bringing the devastation experienced by Gazans to the attention of the global community of academics and clinicians. Sharing knowledge of how to enhance coping and resilience is a way to assist the people of Gaza to attain some semblance of a decent life under inhumane conditions.
● Kagee is professor of psychology at Stellenbosch University, and chairperson of the Board of Trustees of the Trauma Centre for Survivors of Violence and Torture