Medical Humanitarian Delegation Visits Gaza
In January, 2016, a nine-day medical humanitarian trip to Gaza took place with the Washington Physicians for Social Responsibility (WPSR), with support from Global Ministries.
The Gaza Strip is one of the most densely populated areas in the world, with most of the population living in cities, towns and eight crowded refugee camps. Nearly 80% of those living in Gaza are refugees from the 1948 war.
Global Ministries, Week of Compassion and our West Bank mission partner, the East Jerusalem YMCA Rehabilitation Program (EJ YMCA RP), have collaborated over the years to provide training in EMDR, an evidence-based psychotherapy especially effective in treating psychological trauma. The West Bank EMDR training team has tried unsuccessfully for years to obtain permission from Israel to enter Gaza to provide EMDR training to mental health clinicians there. With the opportunity to go to Gaza with WPSR, the EJ YMCA RP facilitated the provision of an introductory protocol for treating children in groups.
The delegation was hosted by the Gaza Community Mental Health Program (GCMHP) and included doctors and nurses in addition to professionals in the mental health field. These doctors were in high demand. They performed critical surgeries and trainings and, with the WPSR, brought $10,000 worth of medicine to the hospitals.
In Gaza, rather than posttraumatic stress disorder (PTSD), clinicians deal with ongoing continuous trauma that is experienced by nearly everyone living in Gaza. The director of the GCMHP lost 27 members of his family in the 2014 siege, an experience similar to many I trained.
A clinical psychologist on the trip described the situation:
Mental health professionals in Gaza are strained beyond capacity. Of the nearly two million residents of the Gaza Strip, there isn’t a single person here who has not experienced multiple traumas. Continuous grief, nightmares, disabling anxiety and hopelessness color everyone’s daily life. The therapists charged with healing these injuries are themselves victims of living in this traumatogenic environment. Their burden is thus two-fold: the trauma they share with their clients is compounded by repeat exposure to their clients’ own clinical material.
The clinicians at the training talked about the depression and loss of hope by many in Gaza, including children. Those under the age of 15 comprise 50% of the population. An eight year old child in Gaza has experienced three wars, has no experience of 24 hours of daily electricity, and is reluctant to make plans for the future, not knowing when the next bombing will occur. These psychological symptoms are a normal response to the abnormal situation of occupation and siege.
18 mental health clinicians were trained in an EMDR protocol to treat children individually or in groups to help them process their trauma and begin to move forward with their lives. During five days of training, the first day was spent teaching the clinicians the techniques, followed by three days of practice with children who are current clients, followed by a final day in which the clinicians practiced the protocol with each other, working on their own trauma. Mona Zaghrout, EMDR lead trainer from the EJ YMCA RP, talked with the trainees by Skype on the first and last days to address her team’s experience in using EMDR within the Palestinian culture and occupation, in Arabic. Further training by an outside expert was conducted with a translator, which necessarily slowed and simplified the training. The therapists were eager to learn and desperate for additional therapies to help those they treat.
One 9-year-old boy who lost a leg in the 2014 war was brought for treatment by his psychiatrist. The boy had been repeatedly unwilling to talk about what had happened to him and was having difficulty at school and home. On the second day of treatment, he talked for the first time about his experience. The psychiatrist is hopeful and grateful to have a therapy that will help his healing.
While there, a Gazan psychologist who begins work with the World Health Organization (WHO) in March indicated that WHO has asked her to coordinate EMDR training in Gaza. The Palestinian clinicians in Gaza and the West Bank believe WHO will be able to obtain permits for the West Bank training team to enter. A benefit of the visit was a connection madebetween the Gazan psychologist and Mona Zaghrout to pursue next steps and it is anticipated that an EMDR training will be conducted in Gaza in 2016. This is the most hopeful development in the last ten years in getting EMDR training to Gaza clinicians.
On one of the delegation’s last days in Gaza, it had a tour of the Gaza Strip, particularly the northern area that was hardest hit during the 2014 siege, by a representative of the UN Office for the Coordination of Humanitarian Assistance. Beit Hanoun and the industrial area still look bombed out, though those from the delegation who had been there a year ago said they could see real progress in clearing rubble. They were told that of the 18,000 homes in Gaza completely destroyed in the siege only 5 have been completely rebuilt due to Israel’s blockade of construction materials.
Nearly all young adults in Gaza are unemployed, with no hope of finding work or leaving. It is nearly impossible to get a permit to leave if you are under 35 years old. Most have lived their whole lives in Gaza with no chance to leave.
Participants reported being initially most impacted by the difficulty and suffering, but the longer they remained in Gaza, the more they noticed the smiles, jokes and celebrations, including the women’s party of the wedding of a family member of a clinician I trained. Gaza is a mixture of great difficulty and sadness and moments of joy. The delegation was repeatedly thanked for coming or asked to return. One of the doctors may have said it best when he described his work at the nearby hospital: “It’s remarkable what they can accomplish with what they don’t have.”
They also expressed awareness of the privilege both to go to Gaza and to be able to leave, which so many there would like to do. The participants are excited and hopeful for the next trainings they will do there.
The economy of the Gaza Strip is severely hampered by Israel and Egypt’s almost total blockade, the high population density, limited land access, strict internal and external security controls, the effects of Israeli military operations, and restrictions to access on labor and trade across the border.
According to B’Tselem (July 2015), there are now some 100,000 displaced persons in Gaza living with relatives or in rented homes, in tents, or in the ruins of their old homes. Nearly 20,000 houses were partly or completely destroyed last summer, and hundreds of thousands of people in Gaza still live in 150,000 damaged residences. Over 90% of the water is unpotable. Our group brought all our water for nine days with us.
Pollution is an environmental and health risk. Environmental problems include desertification, salinization of fresh water, sewage treatment, water-borne diseases, soil degradation, and the depletion and contamination of underground water resources.
Electricity is supplied sporadically. Even at full capacity – with electricity both supplied at maximum level from the power station and purchased from Israel and Egypt – the electricity supply in the Gaza Strip meets only 70 percent of demand, and residents routinely suffer deliberate power blackouts. I routinely drove through dark neighborhoods at night. When there are fuel shortages, blackouts can last up to 18 hours at a time.
According to the UN, unless remedial steps are taken to repair the basic infrastructure by 2020, with a further demographic increase of 500,000 and intensified housing problems, the Gaza Strip will become effectively uninhabitable.