“We will die. All of us. I hope that the suffering we are living every second of will end soon.” My doctor sent me a text message last week. He works for Médecins Sans Frontières in the southern Gaza Strip. And it’s a sentiment not uncommon among those struggling to survive and care for one another in Gaza today.
What is this feeling called in Western medical terms? Suicidal thoughts? depression? Post-traumatic stress disorder? Whatever it is, we are taught that such thoughts are abnormal and require medical intervention.
When the bombing finally stops, rebuilding Gaza’s homes, schools, hospitals, and essential infrastructure will begin, a process Gazans are all too familiar with at this point. They will also begin processing trauma that many people on Earth cannot understand. When you wake up in the hospital, you discover that you are one of the last surviving members of your family. Watching a child killed in an airstrike being pulled out of the rubble. 2nd, 5th, or 10th displacement.
How do we mend the shattered hearts and emotions of these survivors? Where do we begin to help people recover from a state of mental anguish where the idea of dying early is seen as a small mercy?
As a Palestinian from the West Bank, I am well aware of the trauma that Palestinians face in the occupied territories, and I am able to answer these questions and explain the various injustices faced by Palestinians, especially the various injustices faced by Palestinians. I have spent my career capturing and communicating injustice. health. Most current frameworks on mental health are almost completely inadequate to account for and take into account the war-related trauma that Palestinians in Gaza have endured in recent months. And in turn, traditional methods of providing mental health care will no longer be sufficient.
The aftermath of this war will undoubtedly include a disastrous period of reconstruction that will require extraordinary financial and political investment. But now we need to focus on the mental health of those who have experienced such devastating collective trauma and the real healing needed to ensure that not only continued trauma but also hope and justice are passed on to the next generation. It is also a time to reconsider what that means. While military operations unfold, the numbers of dead and injured tell a single story: mental and emotional suffering is perpetuated, funded and justified.
Some studies suggest that PTSD and depression are the most common mental health disorders observed in people affected by war, but Our understanding of how these effects work is fairly new. PTSD itself was developed in 1980 after more than a decade of research and treatment in Vietnam veterans returning home with symptoms of what we had previously called “shell shock,” “war neurosis,” or “severe stress reaction.” It was not a proper medical diagnosis until . Tools and questionnaires used to screen for PTSD are generally developed and tested in Western countries, but have recently been widely implemented in populations affected by brutal wars, including in Syria, South Sudan, and Ukraine. Masu.
While these tools can be valuable, the literary field also explores how people explain trauma differently in different cultures and how they process traumatic experiences based in part on their perceptions of why trauma occurs. A growing number of critics have criticized the lack of nuance and context in some of these frameworks. We often rely solely on relatively simple and straightforward investigative analysis rather than on the time-consuming and more subjective experience of interviews, observations, and other methods of contextualizing.
Importantly, we also lack the tools to adequately measure the ongoing trauma that is deeply embedded in our communities. Because of Gaza’s extensive history of violence, deprivation, and other traumatic events, much research has been conducted on the mental health burden of war life, including on many children. A 2020 study of students aged 11 to 17 in Gaza found that nearly 54 percent of participants met diagnostic criteria for PTSD. A recent survey of Palestinians in the West Bank and Gaza Strip found that 100 percent of participants had been exposed to trauma in 2021. The trauma faced by Palestinians includes a variety of events, including land confiscation, detention, home demolition, loss of loved ones, and loss of family members. Fear of losing one’s life.
Sama Jabr, a psychiatrist with the Palestinian Ministry of Health, told Quartz in 2019 that after such persistent and unending trauma, “the effects become even more severe.” It doesn’t look like PTSD. ”
When trauma is so normal, it can become normalized. My own loved ones in Palestine ignore or laugh off an experience that would be extremely painful for most people. It’s also easy to overlook how poor mental health increases people’s risk of physical illnesses such as heart disease and diabetes. In situations like this, the limitations of our approach to mental health become very clear.
What does this tell us about Gaza’s next steps? Like every aspect of the besieged region’s health system, mental health care is underfunded. Humanitarian aid allocated to Gaza must include resources devoted to the provision of adequate mental health services. We are already working on a small scale to provide art classes and puppet shows to children in crowded shelters to help them cope with ongoing trauma, but we are expanding our mental health infrastructure to a larger scale. We need to start building to scale. This includes establishing a well-trained health workforce capable of delivering culturally appropriate mental health treatment to a wide range of affected populations.
However, in a large-scale disaster like this war, we cannot just rely on medical care alone. For proper mental health, adults need jobs, children need schools, and everyone needs shelter and regular access to food, water, and medicine. . Eventually people will have to return to their homes. Without stability, safety, and restored communities, strong mental health for survivors cannot be restored.
Importantly, health care professionals and researchers are not limited by the language of medical diagnosis and the treatments that derive from it. To call what people in Gaza are experiencing today PTSD misses the point that these people are not in a post-traumatic situation. Therapy may help Vietnam veterans realize that loud noises are not necessarily a threat. Treatment will not help convince children in Gaza that hearing bombs will not kill them. It does not comfort mothers who worry that their children may starve to death.
Rather than using the term post-traumatic stress disorder, many are calling for a reframing of how such suffering is viewed. Some call this chronic traumatic stress disorder, while others, including Palestinian academics, refer to it as “a feeling of being crushed or destroyed.” This is not just a question of semantics. These alternatives demonstrate that it is not enough to provide treatment options that place the abnormality within the individual rather than in the context in which he or she is experiencing it. Isn’t it actually quite normal and normal to feel broken and destroyed when everything you’ve ever known is reduced to rubble?
The scale and scope of suffering in Gaza today reminds us that people in war zones need healing, justice, and a true sense of physical and psychological security moving forward. Even if a temporary truce is brokered, what is the point in trying to recover from such trauma if you are almost certain to experience it again? Everyone in Gaza over the age of 10 has already experienced it at least once.
Until meaningful action is taken on the social, political, and economic determinants that limit people’s ability to grow, experience joy and security, and simply survive, the world’s most influential actors You cannot expect anything from mental health treatment that you do not want.
Yara M. Ashi is an assistant professor in the Department of Global Health Management and Informatics at the University of Central Florida and a visiting scholar at Harvard University’s FXB Center for Health and Human Rights. She was a Fulbright U.S. Scholar in the West Bank in 2020-21. She is the author of How War Kills: The Overlooked Threats to Our Health.
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