Shell-shocked Gazans seek to expand mental health services in wake of conflict

September 2014

WHO Gaza
Mervat and her family in Gaza have suffered psychological scars from the recent conflict.

Psychologist Hasan Zeyada lost his mother, three brothers, a sister-in-law, and a nephew when their home was destroyed on 20 July during the recent hostilities in Gaza.

The 50-day conflict kept the Gaza Community Mental Health Centre, where Zeyada is director, from operating, and he had to wait more than a month before the 26 August ceasefire allowed him to return to work . All that time he knew what was awaiting him: a vastly increased number of people needing help, with many feeling as he was feeling. Or worse.

“I’m a human being,” he says. “I know more than ever what they feel. They are overwhelmed. A lot of people need help. Among children alone, we are talking about insomnia, nightmares, hyperactivity, fatigue, headaches, attention problems, stuttering, and bedwetting.”

WHO estimates that about 360 000 people - 20% of Gaza’s population – are suffering a range of mental health challenges after this summer’s conflict, according to Dyaa Saymah, the World Health Organization’s mental health officer for Gaza.

Studies suggest that armed conflicts cause significant levels of depression and post-traumatic stress disorder (PTSD) – on average, 17% of an affected population will suffer symptoms of depression, and 15% will experience PTSD. Zeyada and Saymah say the rates of mental health problems in Gaza will be higher because of the claustrophobic conditions and the general sense of helplessness that prevailed during the assault.

“I know more than ever what they feel. They are overwhelmed. A lot of people need help. Among children alone, we are talking about insomnia, nightmares, hyperactivity, fatigue, headaches, attention problems, stuttering, and bedwetting.”

Hasan Zeyada, Director of the Gaza Community Mental Health Centre

Assessing service gaps and needs is key

The priority now is to assess the impact the conflict has had on Gaza’s mental health services, and to scale up the services rapidly, Saymah says.

Even before Gaza’s most recent crisis, its mental health system was having trouble meeting demand. After the ceasefire, the Gaza Community Mental Health Centre, which belongs to Gaza Community Mental Health Programme, set up six crisis intervention teams that make 16 to 20 field visits per day. Zeyada says they have identified 30 cases needing long-term psychiatric care, with many more expected.

“The demand is very much there. We, as the humanitarian health sector, should avoid investing resources and time in replicating assessments that will tell us something we already know about the character of the problem,” Saymah explains. “The best strategy is to find those who need help and to invest in developing the system so that it can respond short- and long-term. The suffering is huge and will stay for a long time.”

One consequence of the prolonged bombardment is that some Gazans are suffering from symptoms reminiscent of the shellshock first described in the First World War. Gaza residents were in a restricted space with no way to flee, surrounded by explosions for weeks, seeing people nearby killed and injured, and wondering if the same would happen to them. The stunned and incapacitated condition that sometimes results can be accompanied by loss of identity, memory, or speech.

The human impact

WHO Gaza
Abdullah now receives counselling once-a-week.

Abdullah, a 52-year-old man, was just outside his door when a shell landed nearby. “He can’t remember anything before the event,” Saymah reports. “He can’t recall people he knows. He’s been that way for two months.” Abdullah’s hand was broken, but tests showed no brain damage. He currently is receiving once-a-week counselling.

Mervat, a 29-year-old mother of five, left a shelter to look for her husband, and apparently fainted. Revived at the hospital, she doesn’t speak, Saymah says, adding: “She just sits and looks at things. She can’t feed her baby.” She now goes to a local mental health centre. Her house was destroyed and the seven-member family lives in one small room at her father-in-law’s house.

People such as Abdullah and Mervat require intensive long-term care which is not readily available in Gaza, Saymah says. “We have to invest in the system so that it can do this. These people shouldn’t have to leave to get the treatment they need.”

Strengthening mental health care

There is an urgent need to develop the skills of mental health workers and integrate mental health care within health, social, and education services to respond to the increasing mental health burden, Saymah says. In addition, he notes, steps are needed to reduce the stigma still often associated with mental health issues.

WHO has supported the Ministry of Health in Gaza in developing mental health and psychosocial services since 2002. Now it is working with partners to expand the integration of mental health services into the primary health care centres operating in Gaza. Services now are available in more than half the centres. WHO aims to help the Ministry of Health provide such services in all 53 centres.

In addition, WHO is working to expand rehabilitation services for people with relatively severe mental health problems. It is planned that most such care would be provided in day programmes, allowing patients to return home at night and thus avoid the stigma of hospitalization.