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A Permanent State of Anxiety

How the Occupation Impacts Palestinian Children’s Mental Health

Courtesy of Save the Children

“We survived today but what about tomorrow? We survived yesterday but what about today?” was the only thought occupying 15-year-old Mohammed* as Israeli bombs rained down on his neighborhood in Gaza, killing and maiming tens of children. For eleven days, survival became a question, a doubt – not a simple right for children such as Mohammed. He would wake up to read the news: Did he lose a friend? Was a schoolmate among the dead? He prayed it was not them, as names appeared on his phone screen.

The Abadi family in Al-Shati Refugee Camp, Gaza. Photo by Saman Saidi/Save the Children.

The physical wounds of this latest conflict will take some time to heal, and the mental scars will remain for life for thousands of children. Save the Children’s teams on the ground are witnessing severe mental health and behavioral issues among the children of Gaza. Worrying signs of distress that include constant shaking, insomnia, and uncontrolled urination, have been reported by our teams. Parents are telling us how their children cling to them and are startled by the sound of an ambulance; many wake up in the middle of the night with nightmares.

Science tells us that war and violent conflict can cause children to live in constant fear of violence, suffer from long-lasting anxieties, and develop physiological responses to stress. A study conducted in Gaza a year after the 50-day conflict in 2014 revealed that seven out of ten children in the worst-hit areas were still suffering from nightmares, and three-quarters of children were still bedwetting regularly.*1 Almost all parents reported that their children were constantly afraid.

A follow-up study conducted in early 2018 looked at the mental health of children in Gaza by assessing them through three different lenses: emotional state, conduct, and relationships with peers.*2 The responses of children were scored, revealing that the ranges in which children reported fell within the high or abnormal levels, meaning that they would most likely be given a mental health diagnosis by professionals.

It is evident that Palestinian children will bear the mental consequences of this war for years to come.

Mohammed, like many children in Gaza, is a survivor of four wars on the besieged Strip. In fact, the average 13-year-old in Gaza has change to: experienced a war on average every three years of their young lives. Furthermore, as of last month, the Gaza Strip has been under an Israeli-imposed land, sea, and air blockade for 14 years, which has significantly impacted the economic, health, and wellbeing outcomes of the children who live there.

Salem (14) walks through Hebron with his school counsellor Raji. Photo by Jonathan Hyams/Save the Children.

This reality does not just apply to Palestinian children in Gaza but also to those in the West Bank, including East Jerusalem. Palestinian children have grown up in a state of ongoing occupation, conflict, and political uncertainty. Most children have experienced traumatic events, including attacks while accessing schools, the disruption of education, detention, and house or school demolitions – areas that Save the Children has researched intensively over the past two years.

A study released in 2020 looked at how attacks on education have impacted children.*3 As a result of attacks by Israeli forces on schools and on children on their way to and from school, a quarter of the surveyed students in the West Bank, said that they didn’t feel safe at school. Teachers reflected that the regular – yet unpredictable – nature of attacks has resulted in school children feeling trapped in a perpetual emergency response mode.

The mental health ramifications of the Israeli occupation are also heavily felt by children who have been detained in the Israeli military detention system. In research conducted with over 400 Palestinian former child-detainees from across the West Bank, children and young people emphasized that the impact of detention is not limited to the period of imprisonment, but that their horrific experiences haunt them for many years to come.*4 About half of the children said that they have not felt able to fully return to their normal lives, and almost all said that they have irreversibly changed. One child, Zuhair* questioned: “Is there nowhere safe for me now, will I just live in the same room forever? What will my life look like?”

The Israeli occupation of the Palestinian territory and the blockade on Gaza have severe and long-lasting effects on the mental health of Palestinian children. According to a peer-reviewed article in PLOS One, the occupied Palestinian territory has the highest burden of mental health issues in the Eastern Mediterranean.

With their sense of security shaken, many former child-detainees experience profound repercussions on their mental and physical health and wellbeing that manifest in physical signs of distress such as uncontrollable shaking, excessive crying, insomnia, and chest pains. Children almost universally reported heightened anxiety around others and difficulties in social situations, including with family and friends. Their place in society – or their perception of it – has shifted, leading to a fractured sense of self and complicated social relationships.

Finally, a study looks at how home demolitions and forced evictions impact Palestinian families, especially children.*5 It is highly unsettling for them to witness the destruction of the homes in which they grew up and formed pleasant memories and the throwing out of their possessions onto the street. Displaced children often do not feel settled or at home in the communities into which they move, with seven out of ten children reporting that they feel disconnected from their communities, while nearly half reported feeling socially isolated.

Faris speaking to a Save the Children officer. Photo by Antonia Roupell/Save the Children.

Being uprooted can shatter children’s sense of stability, creating lasting psychological effects that can prevent them from reaching their full potential. As 12-year-old Kinan said, “I feel insecure and exposed. Every day and night, I feel unsafe. I feel terrified of the soldiers and settlers all the time. When they demolished my house, I felt that my whole life had come to an end.”

Parents in Gaza or the West Bank who are seeing their children affected by the recent events in both places are advised by our mental health experts to attentively listen to their children when they talk about their feelings; support them in their attempts to resume their regular activities; expect the unexpected because children have different abilities in processing traumatic events and are affected by them in various and different ways; and be mindful of their own behavior around their children. Most importantly, They are encouraged to spend time with their children and encourage group activities such as playing educational or recreational games.

There are many Palestinian organizations that work directly with children, families, and those most impacted by the occupation and blockade. Save the Children is fortunate to be able to partner with and support a number of these great organizations in protecting, rehabilitating, and helping children who have been impacted by the occupation.

Mariam (14), in the middle, participates in a psychosocial support session supported by Save the Children, in Gaza. Photo by Jonathan Hyams/Save the Children.

All children have the fundamental right to protection from conflict or harm. All wars and conflicts are waged against children, and responsible parties must take every action necessary to protect children. Palestinian children deserve to be healthy, to be protected, to be educated, and to grow up to have a chance to make a difference in their communities.

Ultimately, the root causes of this conflict must be addressed in a way that ends the occupation and lifts the siege on Gaza. Otherwise, children such as Mohammed will continue to tell us, “The aftermath of war remains: The rubble, the destruction, the negative effects of it in our hearts, the tears on the cheeks of children that still haven’t dried. It’s true that the fire has burned out, but we won’t forget the burns that have affected all of Gaza.”

Raya (14), from Gaza, fills a water bottle from a water tank. Photo by Mohamed N. Ali/Save the Children.

* The names used in this article have been changed.

*1 “A Living Nightmare: Gaza One Year On,” Save the Children, 2015.

*2 Claire Mason, et al., “A Decade of Distress: The Harsh and Unchanging Reality for Children Living in the Gaza Strip,” Save the Children, 2019.

*3  Claire Nicoll, “Danger is Our Reality: The Impact of Conflict and Occupation on the Education in the West Bank of the Occupied Palestinian Territories,” Save the Children, 2020.

*4 Claire Nicoll, “Defenceless: The Impact of the Israeli Military Detention System on Palestinian Children,” Save the Children, 2020. 

*5 Policy on Palestinian Children and Their Families.”

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