Treating collective trauma in Gaza | New Yorker

The thread outside the clinic outside Dr. Bahzad Al-Akhras began to assemble before Sunrise, before Sunrise, half-light standing barefoot or ripples of the body in the worn sandals, waiting for the situation to pass the care now. His clinics are everywhere they need: in a corner of the shelter compound, movement while walking around the yard, or behind a temporary screen of a sheet pulling between the two poles, if allowed. Typically, Akhras sees patients hiding in hundreds of other such tents in a tent space in the dense spread of Al-Mawasi on the southern end of the Gaza Strip.

Akhras, a psychiatrist with children and teenagers, lost his home to Israel’s strike in early 2024. He and his family were displaced many times, living in tents where too many bodies in the canvas sweat were pressed into too small spaces. He no longer sits in a white wall office or wears badges. But he continued to work, seeing about fifty patients every day, most of whom were children. One of his regular patients is a young girl, no more than 14 years old, who survived and killed her entire family. She woke up alone, unable to understand where everyone went. Now she sat in silence before Akhras until she asked him time and time again if he could bring them back. He had no answer, only a pencil stub and a coloring book that he hoped she could use to express and process his emotions.

With almost no running system and few resources, practitioners like Accras rely on the few tools they leave behind: psychosocial support, cognitive behavioral therapy (CBT), and improvised coping strategies. They teach breathing exercises, emotional regulation and techniques to manage invasive thoughts. When possible, they use limited psychotropic drugs with overwhelmed medical staff, providing limited psychotropic drugs to patients with severe depression, psychosis or suicidal thoughts. But, as Akhras told me, most professional support scales back the voice notes between colleagues, who ask only one question: “Are you still alive?”

Medical staff sometimes suffer from secondary traumatic stress, which is attracted by witnessing the pain of others. But the trauma experienced by mental health experts in Gaza is not much secondary. “We are struggling, mourning, living and working,” Accras told me. “My emotions have no space. They sit on my chest like stones.” When he is not with the patient, he is looking for water or trying to calm his parents. There is no time to write notes or process, and there is no room to even crash. “We tried to hold others so they didn’t fall,” he said. But he fell, just quieter.

In Gaza, treatment has become a language of holding. Within twenty months, 60,000 people have been killed. But the hidden losses span across the entire flat community and erase the community. Those facing general famine, collapsed access to health care and the daily horror of survival.

Three hundred days after the war, External still life An analysis was sent out to describe trauma in Gaza as “chronic and uncomfortable,” a collective manifestation of serial trauma disorder (CTSD), a disease that originates from living under ruthless trauma. Unlike PTSD, this stress disorder occurs after a difficult experience, with CTSD without purpose. Gaza people have adapted to chronic dangers, living in the slow erasure of any imagined future, in a state of overmaintenance, emotional numbness and separation.

The impact on children is especially disastrous. By 2024, UNICEF It is estimated that almost all 1.2 million children in Gaza need urgent mental health and psychosocial support. Not a child The war was not impressed. Many people didn’t sleep, or they were screaming all night, clinging to their terrifying companions. Many children have already had speech problems. Some explosions with stones are called “air raids” games or kill death.

By February 2024, UNICEF It is estimated that at least 170,000 children are unaccompanied or separated from their families. By April of that year, the Ministry of Health of Gaza had recorded 120,000 Injured childAccording to a report UNICEF. A person, displaced and traumatic, still alive children are very psychologically vulnerable. Even before the recent war, children in Gaza have shown signs of stress: A 2022 Save the Children survey found that 84% of people were scared, while 78% lived from grief. In November 2024, a report from the Community Crisis Management Center found that 96 percent of children living in this war believe their death is coming, and nearly half say they want to die.

My three and a half year old son, Rafik, first asked me, “Are you going to die today?” About two months after the war began, in December 2023. We lay in a recovery bed, still trembling from the explosion that buried us under the concrete roof of the Gaza city house. My entire family had passed out before we were found bleeding. Rafik huddled down on the ground, close enough to me to see him, but it was too far away to reach out and hold him. After pulling out of the rubble, I remember thinking, This is the time to rewire forever. I’ve been watching this transformation happen before me ever since.

Nour Jarada, mental health manager in Gaza, sees this kind of rewiring every day. She works inside medical tents without insulation, each containing a folding bed that separates the trauma from the trauma. Patients arrive on foot – Some have walked miles, many are led by families who don’t know what to do. “Some people don’t speak,” she told me. “They stare and sometimes scream. Most people cried for hours without video.” The children asked Jarada if she could go back to school, just like normal people were still hiding somewhere nearby.

Jarada told me a fourteen-year-old boy who went out to buy things in early 2024. When he left, an air strike stabilized his house and killed almost everyone in his family, except for his younger brother. Both are now completely the same person. “I wish I had passed away with them,” the older boy told Jarada.

Jarada used to work in a clinic with moderate therapy rooms: toy stands, carpets and illustration books. It is a space to listen to the inner world of children too young to bear so much pain. Now, like Accras, she relies on things like salvaged toys and colored pencils to comfort young patients. “I told them to cry,” she said. “But I whispered because I don’t want to break it either.”

For Akhras and Jarada, the traditional therapeutic framework is no longer enough to be overwhelmed in places of constant suffering. A few months before the war began, they traveled to the United States to complete an observer with the International Visitor Leadership Program, a government initiative that brought together professionals from around the world to promote cooperation and exchange knowledge. They returned to Gaza in June 2023 with new ideas, but soon encountered a reality that continues to go against everything they have learned.

During the days of the war, Gaza’s mental health infrastructure began to collapse. On November 5, 2023, a psychiatric hospital in the area ceased operations after reportedly suffered damage. Meanwhile, community mental health clinics have been closed or relocated due to insecurity or lack of staff. As a result, nearly one million individuals struggling with mental health conditions do not have access to basic care.

Humanitarian actors are trying to fill the gap, but the scale of the crisis is overwhelming. According to the World Health Organization, in the second half of 2024, about 800,000 people in Gaza and the West Bank received some form of mental health or psychosocial support. These assistance range from child-friendly spaces and group activities to offer UNICEF Emergency psychosocial interventions by NGOs, such as American East Repugee Aid, has established structured activities for more than a thousand displaced children in shelters and camps. However, these forms of support are largely short-term and basic, and are designed for psychological stability rather than long-term healing. In the context of large-scale displacement and prolonged trauma, the urgent need for continuous intensive care remains. this External still life According to reports, of the approximately 1.3 million people displaced in Gaza in August 2024, only about one thousand received counseling support and about seven thousand received professional treatment, including those with mental illness.