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More than one month after a ceasefire was announced between the Israeli government and Hamas the mental health consequences of the conflict are still taking a heavy toll.

Twelve-year-old Mohanned and his aunt were in a car when the neighborhood they were passing through was hit by an Israeli airstrike. Mohanned survived the blast but was hit by shrapnel in his head, arm, and abdomen. “Look at him. He is a child. What did he do to deserve this?” said his father, Elsabea Musabeh, lifting Mohanned’s T-shirt to reveal layers of gauze dressing wrapped around his son’s waist.

“There is a war here every few years,” said Musabeh. “We are used to this—it’s just life. We don’t cry over destroyed buildings anymore. Our children are our only worry.” Mohanned was discharged from hospital several weeks ago. Some of his injuries have healed but the psychological trauma of the experience is still fresh. He doesn’t like speaking about the incident as it brings back memories.

For most Palestinians in Gaza, the 11 days of Israeli bombardment in May was not the first time they had experienced airstrikes. The mental trauma of fearing for your life, seeing your home in ruins, and the resulting economic hardship have long-term consequences. For many, this is on top of pre-existing trauma from previous episodes of violence and 15 years of life under a blockade, resulting in an acute mental health crisis in Gaza

Salma Shamali, 36, her husband, and their seven children only just managed to escape after their house was bombed at night. “We heard at least 15 explosions,” said Shamali. “We were all in one room. The children were sleeping. Then part of the house fell on us. We were confused. Nobody warned us or told us to evacuate.”

It took them several hours stumbling through the dark to reach the relative safety of a nearby bus station, where they took cover for five hours. From the bus station, they moved to a school. When the family returned home a week later, they found their house was badly damaged. They have had to rent another house.

The Israeli government has launched airstrikes on the Gaza Strip on two occasions since the ceasefire agreement last month. And the sound of drones above Gaza has not stopped. The noise torments people night after night, keeping them awake and on edge. Shamali’s children hide every time they hear it now. “We don’t want war,” they say, crying. She tries to keep calm and tells them not to lose hope.

Amira Karim, a mental health counsellor who provides psychological support to patients at the Doctors Without Borders/Médecins Sans Frontières (MSF) clinic in Gaza City, said that the stories she hears from patients affected by the recent bombings—particularly those from children—have triggered her own traumatic memories.

“I remembered the extreme fear of death,” said Karim. “I remembered how my kids held me tight when bombs were exploding close to my house at midnight. It was like nothing we have lived through before. We felt like those were the final minutes of our lives.”

In Gaza, everyone is constantly exposed to the triggers of psychological trauma, including health care workers. Their resilience is put to the test daily as they help others while experiencing traumatic events themselves. 

“During the latest escalation of violence, I did my best to provide support to everyone I could reach—my patients, colleagues, friends, and family,” said MSF psychologist Mahmoud Zeyad Awad. “This was while living through the same experience myself and processing the loss of two of my friends. Seeing patients feeling better gives me strength to keep doing this job, but I’m afraid of failing my patients or of becoming a patient myself.”

“Everyone in Gaza is affected,” said MSF psychiatrist Juan Paris. A reported 40 percent of young Gazans suffer from mood disorders, 60 to 70 percent suffer from post-traumatic stress disorder, and 90 percent suffer from other stress-related conditions. “The number of suicides and attempted suicides rose steadily in 2020,” said Paris. “But they’re clearly under-reported because of the stigma around mental health issues in Palestinian society.”  

To support patients, staff, and their families, MSF has scaled up its mental health services in Gaza. “People in Gaza are resilient,” said Paris. “Their resilience comes from a strong sense of commitment to their community, but it is being put to the test daily as they continue [to be] exposed to trauma. They have to endure this to be able to help others.”