Even before October 7, 2023, many Palestinians from Gaza suffered from depression and frustration, injuries and amputations suffered in previous wars, as well as unemployment and poverty. Doctors Without Borders/Médecins Sans Frontières (MSF) mental health teams have witnessed these effects on Palestinians both in Gaza and in Amman, Jordan, where our teams are providing care to the few children who have been able to medically evacuate from Gaza.
More than 95,000 Palestinians have been injured by Israeli attacks since October of last year, of whom 12,000 need urgent medical evacuation, according to the World Health Organization. Only a tiny fraction of injured Palestinians have been allowed to leave the Strip to seek adequate care in other countries, and after a long and murky process. Every evacuation has to be approved by the Israeli authorities, which can take many months and doesn’t appear to be based on clear, transparent criteria.
MSF calls on the Israeli authorities to ensure medical evacuations for Palestinians in need of specialized medical care, including their caregivers, and for other states to receive and facilitate treatment outside of Gaza, while ensuring that all patients and their caregivers are guaranteed a safe, voluntary, and dignified return to Gaza.
Below, Dr. Ahmad Mahmoud Al Salem, MSF psychiatrist at the hospital in Amman, discusses the mental health symptoms of Gazan children at the hospital and the support our teams are providing to improve their well-being.
What are some of the mental health issues MSF teams have seen among Palestinians coming from Gaza since October 7, 2023?
A lot of patients coming from Gaza to the Amman hospital are experiencing not only post-traumatic stress disorder (PTSD), but even acute stress syndrome. Many young Palestinians have witnessed the destruction of their homes, the killing of their siblings, and some have even suffered life-changing injuries. But on top of that, they are constantly hearing about the loss of more family members and friends.
This is not a normal trauma. This is a huge, tormenting catastrophe, so psychologically their minds are unable to bear all this stress. These patients usually develop something that we call acute stress syndrome. Acute stress syndrome means that the patients usually [experience] a lot of nightmares and a lot of flashbacks, as well as low mood, insomnia, and avoidance of the whole traumatic memory.
If acute stress disorder stays with the patient for more than a month, then this becomes PTSD. But if a patient with PTSD keeps receiving bad news from Gaza that many other family members have been killed, then they develop a new acute stress disorder or a new grief, so it becomes a complex trauma. It's not one trauma, it's a sequence of traumas.
How do MSF’s mental health teams treat patients who are suffering from these conditions?
First, we have to diagnose the patient. If the patient has depression, anxiety, or addiction, then we go through medications and cognitive behavioral therapy. But if the patient is suffering from PTSD, we have to go for medications and eye movement desensitization reprocessing (EDMR), as well as supportive psychotherapy.
In general, when a traumatizing event happens, the brain does not only save the scene; it saves the emotion [associated] with the scene. So when we want to treat any trauma related to a psychological issue, we have to try as much as possible to disconnect the misery from the memory. For example, if someone was burnt and he remembers the kerosene and the fire on his arm, he will have memory of pain but also the memory of the misery that follows, because he feels that his arm will never be normal again.
With EMDR, the aim is to disconnect the memory from the sadness, and to give some hope to the patient, and direct him to once again experience pleasure in the right moment by detaching the past from the present.
The aim is to first encourage the patient to experience reality here and now, and secondly to disconnect misery and pain from the memory.
How do adolescents deal with trauma they have experienced?
Adolescents can suffer real misery, as they are just starting to form their personality and their identity. They are beginning to understand their place in the world and they are asking themselves, “Will I be productive one day? Will I be attractive? Will I be able to earn money?”
Adolescent patients who have suffered horrific, life-changing wounds will need long-term psychotherapy, as they don't only need help to get through the bad memories and traumas, but they need to be introduced to a new and daunting life, where they might not feel accepted.
Teenagers are forming their identity, so in general, if they have had their limb amputated or their face burned, then the meaning of their independence becomes crushed. They lose their self-esteem, and their identity becomes threatened and hurt. And their feeling of being wanted becomes hurt.
These kids need support to rebuild their self-worth and self-esteem. We try to work with them to empower them through occupational therapy and by showing them that they can grow and recover. But it takes time.
For someone who is younger, around 10 years old or less, as long as their parents are resilient, they can get through it more easily than someone who is in their teens or someone who is old enough to understand what has happened.
These patients need comprehensive and long-term therapy. Here at the MSF hospital in Amman we work with the patients through a myriad of methods, including one-to-one therapy, educational activities, and in more severe cases through psychiatry and medication. The goal is to support these kids so that they can love themselves and love life again, but they will need this psychotherapy for years to come to support them and to help alleviate the psychological effect of the traumatizing event that they have experienced.
