An international aid agency says a “catastrophic” mental health crisis is occurring in Gaza as the Israel-Hamas war continues, affecting both civilians and humanitarian workers.
Since Hamas launched a surprise terrorist attack in Israel on October 7, 2023, and Israel responded by declaring war, more than 35,173 people have died in Gaza, and 79,061 people have died, according to the Hamas-run Gaza Health Ministry. More than one person was injured. . According to Israeli officials, more than 1,700 Israelis have been killed and more than 8,700 injured.
The physical toll of the war has been documented in photos and videos, with Gazans suffering severe injuries including the loss of limbs, malnutrition due to lack of food and clean water, and even “full-scale starvation.” . attacked northern Gaza.
But war also takes a psychological and emotional toll, with fear and anxiety hitting adults and children alike, and the hidden scars likely to last for decades, aid workers told ABC News. Told.
They added that humanitarian efforts, including mental health responses, are likely to collapse if Israel launches a full-scale ground offensive in Rafah, a city on the Gaza-Egypt border.
The mental health crisis is “already catastrophic and continues to get worse,” said Médecins Sans Frontières, or Médecins Sans Frontières (MSF), a psychiatrist based in Jerusalem until March. said Dr. Audrey McMahon, who was director of health activities. he told ABC News. “Gaza has become an uninhabitable place. It’s completely unfathomable. The basis of mental health is safety, security and predictability, and they don’t have that.”
Research shows the impact of war on mental health
Although there is little data documenting the mental health crisis of Gazans during the war, research on past conflicts shows the impact of living in a war-torn region.
A review of research by the World Health Organization found that at least 10% of people who experience trauma in armed conflict have serious mental health problems, and a further 10% have an “inability to function effectively.” “They begin to take actions that impede their efforts.”
The most commonly experienced symptoms are psychosomatic symptoms such as anxiety, depression, insomnia, and back and abdominal pain, the WHO said.
A study examining the psychological effects of war trauma on women in Bosnia and Herzegovina found that women exposed to severe war and traumatic events experienced more post-traumatic symptoms. .
Another 2017 British-Croatian joint study examining severe war-related trauma found that people exposed to such trauma were at risk of “interpersonal dysfunction 15 years after exposure to armed conflict.” It turns out that there is something.
Just recently, a study published in The Lancet found that the first survey on the mental health of Ukrainians was conducted in the first month of the Russian-Ukrainian war in March 2022, and 53% of Ukrainian adults reported severe mental illness. 54% were found to experience anxiety. and 47% had experienced depression. Six months into the war, 26% of parents remaining in Ukraine suffered from post-traumatic stress disorder (PTSD), and 15% developed complex PTSD.
In one of the only estimates available, the United Nations Children’s Fund (UNICEF) says it believes nearly all children in Gaza are in need of mental health and psychosocial support. According to the Vital Statistics Department, half of Gaza’s 2.2 million people are children under the age of 15.
Aid workers said Gaza is different from other areas of armed conflict because there is no safe zone and, unlike other war-torn areas, most people are not allowed to leave.
UNICEF spokesperson Tess Ingram, who was in Gaza three weeks ago, told ABC News: “Children are experiencing not just one traumatic event, but what is called complex trauma, and they are experiencing multiple traumatic events. “It’s the second most traumatic event ever.” “And that’s something we rarely see, because if you think about other conflicts, children may experience a traumatic event and then be able to flee to safety. But in the case of Gaza, the children are trapped and there is no place for them to go to safety. ”
“Childhood Violations”
Experts say children make up a large portion of Gaza’s population and are disproportionately affected by the war and, by extension, the mental health crisis.
Davide Musardo, MSF’s psychologist and mental health activity manager currently in Rafah, said that during his first days at the Rafah Indonesian field hospital, he came across a 10-year-old girl who had suffered burns from the heavy fighting and heavy fighting. Ta. She screamed that she couldn’t breathe.
“She was clearly having a panic attack,” he says. “start[ed] To realize that she was experiencing pain in her life every time she had to seek medical care. ”
Musard said he has seen many children in Gaza develop acute stress reactions, suffer panic attacks and scream even when sedated. He said some children are so traumatized by what they have experienced, such as the death of a parent, that they become closed-minded and do not express any emotions.
Ingram said that when she visited Gaza in April, parents told her that their children were becoming more withdrawn, talking less, playing less and sleeping less.
“This represents an increased level of anxiety among children, who have often experienced multiple evacuations and understand that the place they are in is not safe,” she said. says.
She said that at a hospital in Rafah she met a boy, about 9 or 10 years old, who had been seriously injured during a previous military operation and had lost his father. Since that incident, he hasn’t talked much. The boy had been diagnosed with depression and PTSD, and it was his sister, a young woman in her early 20s, who explained the boy’s condition to Ingram.
For adults with mental health issues, the main intervention is talk therapy, but for children, the main goal is to make their lives feel as normal as possible, Musardo said. . He said the MSF team mainly organizes play-based activities for children, such as parties, listening to music and watching movies.
Musard gave the child a nurse’s uniform and a doctor’s pen as a way to stop her panic attacks as she cried out that she couldn’t breathe, and began working and playing with her, calling her a “doctor.” He said he called him. As the days went on, he said, she was able to calm herself down and her panic attacks became fewer.
McMahon said an MSF team also wrote children’s stories about grief and how to cope with the loss of many family members and friends.
“If we can provide space, such as a safe play area, we often do that with younger patients,” she says. “They can’t always play. Some children can’t play anymore. This is a very worrying sign for their development and mental health, and they haven’t been to school for six months. This is just a violation of childhood.” , Really. “
The mental health of aid workers is also deteriorating.
Healthcare workers in Gaza have also seen their mental health deteriorate over the past seven months. With limited supplies, many people are risking their lives to provide medical care.
Mr McMahon said many of MSF’s medical staff in the Gaza Strip were working under intense psychological stress. Some people feel pain and guilt after being trapped in a hospital by an Israeli military attack and forced to decide whether to abandon patients or save their own lives.
“They’re in an impossible situation,” McMahon said. “Depending on who you talk to, they both feel like they are heroes in the sense that they are doing the impossible and providing care, but they are also put in situations where they have to make extremely important choices. It’s difficult. “
She continued further. “Would you choose, for example, a person who comes to the hospital with a bleeding wound and in need of urgent surgery, or a child who is acutely malnourished and struggling to survive? And both are in dire straits. “Who?” Do you choose it? And they face it all the time. ”
Musardo said he has seen medical staff affected during the war while treating patients, giving them materials on how to self-care and letting them know they are there if they want to talk. He said part of his role is to provide support. According to him, staff often come to visit him during the hospital’s quiet hours during the night shift.
Many of the region’s health workers are Gazans and therefore suffer from the same problems as many civilians.
McMahon said one staff member reported that she couldn’t go to work one day because she hadn’t been able to find food or water for her children for the past three days and had to prioritize the search. “That’s the situation with medical staff,” she added.
The looming threat of the Rafah invasion
On May 6, the Israel Defense Forces (IDF) distributed leaflets and texted approximately 100,000 people in Arabic to evacuate eastern Rafah and head north to the al-Mawashi Humanitarian Corridor as airstrikes began. . Some 600,000 people have since been evacuated from Rafah, the United Nations said on Wednesday.
The US assesses that Israel has amassed enough troops to proceed with a full-scale invasion of the suburbs of Rafah, but it is unclear whether Israel has actually made the final decision to invade, two US officials said. people told ABC. Wednesday news.
UNICEF’s Mr Ingram said it would be “catastrophic for mental health” if Israel launched a full-scale invasion of Rafah.
“The past seven months have already had a huge impact on children’s mental health, and if this situation continues it will only get worse by the day, with children finding themselves in situations where: , our ability to treat children’s mental health is diminished. It’s unsafe and nearly impossible,” she said.
“While combat continues, not only is the trauma compounded, but our ability to deal with that trauma is incredibly limited,” she continued. “The attack in Rafah will therefore have a huge impact from both angles in terms of escalating the problem while continuing to limit the response.”
Experts say their organization and several others are calling for a ceasefire to end the fighting, the release of hostages being held in Gaza, and more support to gain access to the Gaza Strip. .
It also argues that a ceasefire is the only way Gazans can begin to deal with the emotional and psychological scars inflicted by the war.
“The scars are long-lasting and will remain with you for the rest of your life,” McMahon said. “What has been and continues to be going on is completely horrifying and completely abnormal. … War can be traumatic for anyone. But again, against civilians and children… Some kind of organized attack has a huge impact on your worldview, your humanity, and this is very amazing [difficult] Because then it changes or heals. ”
ABC News’ Luis Martinez and Serena Wang contributed to this report.
