<< Return to InPsych August 2006

By Stephen Heydt MAPS, United Nations Relief and Works Agency (UNRWA), Community Mental Health Programme, Gaza and West Bank, Occupied Palestinian Territories

As the sun breaks over the Strip, the residents begin to stir and blink their bleary eyes in the harsh sunlight. The Sheikh calls them to prayer over loudspeakers so that they can thank Allah that they are alive. All night they have huddled with their families and children while listening to the artillery bombardment that has shattered nerves and scores of lives since February. For the past few nights the regular deafening shelling has been punctuated every few minutes by the thunderous percussion of sonic shock waves, targeting the jam-packed homes of the crowded refugee camps and cities; intent on intimidating.

The insurgency has followed days, weeks and months, since November, of a roller coaster of hope and despair that has followed decades of longer cycles, where peace always seemed to be just around the next corner until dashed by a fatal militant expression of rebellion or a disproportionate military demonstration of nationalism.

Somewhere in this ‘fowda' (chaos), people try to live ordinary lives. Babies are born and children and young adults study at schools and universities with aspirations for the future. They get married, have children of their own, set up homes in either half-built or half-collapsed structures and try to lead productive lives. Unemployment is ostensibly at 75 per cent but they still try to live as do people everywhere.

Every Gazan parent worries daily as to whether their family will still be intact at sunset, knowing that the chances narrow every day. If the parent is a community counsellor trying to bring sanity to a ‘nakhba' (catastrophe) while living the same situation, it is a terrible and terrifying challenge. After a mostly sleepless night, it is hard to leave home each morning, to bring support and succour to a community when one's own children and family are in need of the same. It takes time and patience to travel by battered taxi (when there is petrol for them to run) along artillery potholed roads obstructed by concrete barricades and weary donkeys pulling impossible loads. The destination is a crowded bomb-damaged residence where a destitute and desperate family awaits; ravaged not only by the occupation, but by the hopelessness and despair of feeling disowned, disempowered and disenfranchised by the world.

Here, without the extensive training of their professional colleagues in other countries, the 200 community counsellors must try to bring hope to the longest enduring and largest refugee population in the world of one million people. The obvious psychological difficulty of traumatic loss for children and adults is only one of a range of complex problems to be faced and supported by the counsellors. There is also the ‘epidemic' of night terrors and enuresis in infants and children. The elsewhere unusual phenomenon of children who, while asleep, run around wildly, screaming and cannoning off objects and walls is commonplace. Men lie in bed for days on end staring at the walls and ceiling in profound psychomotor retardation, while women no longer care for their families even to cook the rudimentary meal that may be possible with meagre resources. It has all been too hard for too long and depression is no longer a disorder but a way of life. Emotions are always on edge where the slightest misperception can lead to distress and violence. Elevated sympathetic nervous systems seem apparent when almost everyone has sweaty hands and breathes in irregular deep sighs.

Here hospitality and friendliness are not only good manners but intrinsic to culture and tradition; people with nothing proffer everything that they might own or borrow to complete strangers. Kindness extends to exhibiting concern about wealthy westerners, safe outside Gaza, while the bombs are falling. When the headless torso of four month old Haitham is being buried while adults try to find impossible answers to the unasked questions evident in the eyes of terror stricken and injured sisters, Huda (12), Hadeel (8) and Latifa (6), it is possible to evince neutrality. It is not possible to be neutral. The counsellors continue in their work because that is who they are and what they do. I am fortunate to be here to support them.