The ‘invisible bullet wound’: Gaza’s mental health crisis worsened by funding cuts, aid workers warn

What do you do when your child starts waking up screaming?

This was the question Ghaliah Gharabli, 35, a mother of four in Gaza, desperately asked friends when her daughter Nour started to change.

The 11-year-old had stopped speaking properly. She began wetting the bed, was afraid to go to the toilet on her own and clung to her mother “like a shadow”. 

The family was reeling from a series of personal tragedies, including the death of Nour’s brother Mohamed, 15, the bread-winner of the family who was himself depressed.

He was shot in the head by Israeli soldiers on 14 May 2018, when he snuck off to join protests against the US moving its Israeli embassy to the contested city of Jerusalem.

Living in the vulnerable border area of Shajaiya, the Gharabli home was bombed in all of the last three wars between militants in Gaza and Israel. Nour, who was born just months before the 2008 conflict, has lived through each one.

But it was the death of her brother in August, and the recent rounds of airstrikes and rocketfire, that was the breaking point.

“She stopped speaking properly. If I asked her why she was silent she would cry,” Ms Gharabli tells The Independent, under a portrait of her dead son.

“She started screaming in her sleep and having these night terrors of soldiers entering the house to kill her. I didn’t recognise my little girl,” she adds.

Aid workers, including officials at the United Nations Palestinian refugee agency (Unrwa), warn of an unprecedented mental health crisis unfurling across Gaza, exacerbated by a surge in violence over the last year and funding cuts to vital psychosocial support programmes.

The hardest hit are the children, like Nour, who live near the perimeter fence. 

The Norwegian Refugee Council, which runs a three-tiered psychosocial support programme for children that Nour joined, estimates two-thirds of minors living in border areas like Shujaiya have clear indications of psychosocial distress. 

Their study published in March revealed that a staggering 81 per cent of schoolchildren struggle academically due to conflict-related stress.

At Nour’s school, the NRC now runs morning breathing and relaxation sessions to fight anxiety, panic attacks, anger and violent outbursts that the pupils are increasingly suffering from. 

“I was afraid I would die before I started the programme,” a transformed Nour says, as she patiently sat next to her mother.

“I was afraid of everything, that there were threats everywhere. But I feel safe now.”

Abu Hussein Madi tells The Independent that psychosocial support has been invaluable for his 11-year-old son Nabeel, who also began shouting in his sleep.

Like Nour, Nabeel’s teenager brother, coincidentally called Mohamed, was also killed during the protests on the border fences.

Nabeel, who had participated with other children that day, witnessed the moment his brother was killed.

“Psychological support is essential to children,” says Nabeel’s father Abu Hussein, explaining that his son needed months of help.

“It was the only way to get my son back.”

But funding cuts are threatening the future of Gaza’s mental health support. 

Dr Iyad Zaqout, the head of Unrwa’s mental health and psychosocial support unit in Gaza, says that despite the fact that mental health challenges have worsened over the past year, they have had to slash their psychosocial support programmes due to lack of funds.

The US, once the agency’s biggest donor, cut all funding last year leaving Unrwa with a $400 million funding deficit.

In order to keep Unrwa schools open and to feed a million people who rely on its the food assistance, the agency had to sacrifice the mental health services, seen as less essential.

“We were only able to reach 10,000 children in Gaza last year, down from 25,000 in the years previously,” Dr Zaqout tells The Independent from his offices in Gaza City.

They used to have just over 260 full-time counsellors attached to Unrwa schools, but were forced to employ them on a part-time basis. They had to fire an additional 80 assistant counsellors on top of that.

If they do not secure additional funds soon, they will have to slash a further 44 counsellors attached to their health centres.

Dr Zaqout says the consequence of this is anecdotal evidence of an increase in self-harm, disruptive behaviour among students, and suicide.

“The mental health crisis is at its worst and is getting worse. Maybe the worse is still to come,” he says.

“It is putting children’s lives at risk, children’s futures at risk.”

Unrwa, which supports some 5 million Palestinian refugees in Gaza, the West Bank, Lebanon, Jordan and Syria, held a funding conference this week to urgently raise more money. It secured $110 million in pledges, including a £19 million injection of cash from the UK, which although encouraging, was signficantly short of the organisation’s annual budget of $1.2billion. 

Elizabeth Campbell, director of the agency’s Washington office, tells The Independent that they still need more funding. 

“Mental health remains precarious – it won’t be restored in the West Bank and cuts remain in place in Gaza,” she adds.  

There is little research into the complex mental health concerns in Gaza, and suicide remains a sensitive, stigmatised subject in the deeply conservative society.

Just a few weeks before The Independent entered Gaza, a young woman in a northern neighbourhood died an incident her family described as an accident.

But her friends were convinced she took her own life, telling The Independent she had a troubled history and had posted on social media about having suicidal thoughts. 

Dr Jamal Abdel-Atti, whose organisation “Centre for Mind-Body Medicine” runs programmes for children and families with trauma, says there is an urgent need for initiatives to de-stigmatise suicide. 

He says he has observed an increase in suicide attempts since the last war in 2015. But over the last few years, funds to his organisation have been slashed by 70 per cent, as US cuts to Palestinian funding influenced other donors to withdraw, piling pressure on already scant resources. 

The financial crisis that the Palestinian Authority is now facing has worsened the situation for local charities.

“Right now people are so zoned out they do not even check when they cross the road,” he describes.

His point was reiterated by Abdelaziz Thabet, a professor of child and adolescent psychiatry, whose own studies and clinics have not been funded in years.

He warns that the scale of the crisis in Gaza – a predominately young society – could pose a “national security threat to Israel”.

“You are talking about a million youth who are severely traumatised, with no future.”

Nour’s mother likens the mental health crisis to invisible bullet wounds.

“For the longest time when I tried to take a deep breath, I felt like I couldn’t breathe with all that was going on,” she says in tears.

“It’s a massive problem – you just can’t see it as easily as bullet wounds. I saw many mothers that can’t handle their children, pushing them into the streets telling them to go. We need help.”

For confidential support call Samaritans on 116 123. You can also contact the following organisations for confidential support:

https://www.mind.org.uk/

https://www.beateatingdisorders.org.uk/

http://www.nhs.uk/livewell/mentalhealth

https://www.mentalhealth.org.uk