Post-traumatic stress and the children of Gaza

Many of us would do anything for our children. We think about their health, their safety, their emotional well-being. We try to make sure they have nutritious lunches, enough sleep, doctors we trust, routine and stability. Imagine a situation (as some Canadians already can) in which you can't meet some of your child's basic needs. Now go one step further - imagine a situation in which you and your family are under constant siege. Your children are subjected to 'sonic booms'- the incredibly loud and distressing sounds of the supersonic flight of military planes. Shells are falling onto your neighbourhood, sometimes killing your neighbours. Your access to water and electricity is spotty at best. Sewage treatment is totally inadequate. When you try to take your child to the doctor, access to specialists and diagnostic facilities are limited and it can be difficult to get specific medicines. All in all, 90 percent of children under eleven in your community are having nightmares, experiencing severe anxiety and exhibiting physical symptoms of stress.

This is the situation in Gaza as described by Lancet editor Dr. Richard Horton in the New York Review of Books, by the United Nations agency stationed in Gaza and by dedicated and resilient health care providers on the ground like Dr. Mona El-Farra and Dr. Eyad El Sarraj. The picture that emerges from recent medical literature is devastating. According to a survey of children in Gaza conducted by Gaza Community Mental Health Programme (GCMHP) and published in 2004 by the World Psychiatric Association, 99.2 percent of children surveyed have experienced shelling of the home, 96.6 percent have seen shooting, fighting or explosions, 23 percent have seen a family member being injured and more than 35 percent have seen a friend or neighbour being injured or killed. Doctors are trained to deal with emotional trauma using a supportive, protective framework. In Gaza, the application of this framework is almost impossible. According to GCMPH, the entire community - even traditional sources of support like the family - has been undermined. Fundamentally, there is no safe place.

As Canadian health care professionals, we are deeply troubled by the current situation. We are worried for the future of these children. The combined stressors of war, poverty and the breakdown of civil society have resulted in symptomatology compatible with post-traumatic stress disorder - bedwetting, abdominal pain, paranoia and despair to name a few. Unfortunately, this framing is inadequate, as the trauma is ongoing and pervasive. What will happen to these children in adulthood? What will the long-term effects be of this endless trauma? And what can we, as Canadians, as health-care professionals and as parents ourselves, do about it?

We have concluded that the best response is both a humanitarian and political one. That's why we are working with concerned Jews and Palestinians in Toronto who are attempting to help change the situation. We are organizing a fundraiser to support the kind of civil-society, grassroots health-care operations that are providing primary health and mental health care in Gaza (see below for details). We are also asking that the Canadian government increase funding to Palestinian civil society. And, ultimately, we are asking for an end to the military occupation of Gaza, which, despite the 2005 pull-out of the Israeli settlements is, for all intents and purposes, ongoing.

Almost all children in Gaza have clinically identifiable symptoms of trauma and stress. There is both a public health and a mental health crisis unfolding at a breakneck pace. As Canadians, as Jews and as Palestinians, we all have a vital stake in helping to protect these children and making sure they have access to a viable future. The alternative is unthinkable.

Dr. Miriam Garfinkle is a family doctor.
Reem Abdul Qadir is an M.S.W.
March 4, 2007

Related topics from the Connexions Library Subject Index:

Children/Health - Children in Distress - Children/Mental Health - Children/Violence - Crimes Against Humanity - Gaza Strip - Human Rights Abuses - Human Rights and Health - Israel - Israeli Military - Occupied Territories - Palestine - Palestine/Occupation - Palestinians