"The accumulation of traumatic events will have serious consequences for the child population of Gaza"

When I ask them how they lived those fateful eleven days, all my colleagues mention that the intensity of the shelling on the Strip was much greater than in previous Israeli offensives; much stronger than those that took place in the summer of 2014. In fact, even those people who had already gone through similar experiences in the past have been seriously affected by what happened during the latest attacks.. Many of those who come to talk to me confess to having been terribly and atrociously afraid.

Fortunately, support networks were established very quickly, and many messages were shared in private groups on different social networks.. People exchanged photos of their families and told what they were doing to help their sons and daughters get through the airstrikes.. they supported each other. Their conversations reveal an enormous panic – above all, to die in a night air raid – but they also show mutual support.. “Do you have enough water and food?” “Have you received any notice about the state of security in your neighborhood?” The level of violence they endured made them relive previous episodes of the conflict and led them to revive within themselves a deep feeling of injustice and powerlessness.

Despite everything, they continued to work tirelessly.. Being humanitarian workers on the one hand and Gazans on the other, they are doubly exposed to the difficulties of having to live in the Gaza Strip; a small piece of land that has been under total blockade for almost 15 years. While they are in charge of treating people injured in the conflict, many of whom suffer terrible consequences and varying degrees of disability after participating in the Great March of Return protests and being shot by Israeli soldiers, they share with them their frustration, their precariousness and their very realities.

Consequently, I feel like all of them are exposed both professionally and personally.. They suffer, like all the inhabitants of Gaza, how hard it is to always have to live exposed to violence, surrounded by poverty, unemployment, hopelessness and with a terrible feeling of vulnerability, of not being able to offer a minimum security and well-being to their sons and daughters. They feel attached to their land and their memories, but are torn between hope and the reality of their daily lives.

40% of Gaza's population is under the age of 14, which is around one million people. All this million children have known is the blockade imposed by Israel and Egypt. They haven't seen anything else in their lives. They have experienced several Israeli offensives, protests and repression during the aforementioned Great March of Return. And as if that were not enough, now they have suffered this campaign of large-scale air attacks. Apart from periods when violence escalates, airstrikes are common in Gaza. Usually sporadic attacks launched at night. And together with the most intense and continuous offensives, which occur cyclically every few years, these events accumulate in the memory and feelings of the child population and increasingly reduce their ability to overcome them one day.

This is their reality, and this is how the people we help also describe it. Their access to basic services and the outside world is extremely limited. People who today are a little over 20 or 25 years old also lived through the Second Intifada as children, at the beginning of the 2000s.. Each new war further destroys the social fabric of Gaza: it affects families, fathers and mothers who are struggling to survive, to find a job, to get enough money so as not to sink into poverty, to survive the fighting -not only physically but also emotionally-.

This accumulation of traumatic events has long-term consequences for the child and adolescent population of Gaza. Bombs falling on Gaza City destroy not just a building, but an entire system that used to serve to protect this vulnerable population group.. For example, when schools close due to fighting, children are deprived of a safe space where they can interact and play.. A domino effect occurs: a depressed person is more likely to recover from his illness when he is surrounded by people who are in good health.. In Gaza, the entire family structure is affected by these brutal and recurring events.. The same happens in the West Bank, although the situation is different. Our organization supports boys and girls in Nablus or Hebron. They grow up in busy populations and know they may face arrest, harassment or ill-treatment. And as if that were not enough, movement within the West Bank is restricted and depends on the good will of the occupying forces – that is, Israel.

Exposure to such violence can have socioeconomic consequences, which translate into more precariousness, fewer academic and job opportunities, and food insecurity.. Also in mental health problems, such as higher rates of psychosis, depression, and post-traumatic stress disorder (PTSD), as well as a higher prevalence of noncommunicable diseases such as diabetes, asthma, and cancer.. We observe the same phenomenon among migrants arriving in Europe and African-American and Hispanic communities in the United States, as in many other populations exposed to constant adversity.

Psychological and emotional suffering is not measurable, but it is not for nothing that studies show how up to 40%, 60%-70% and 90% respectively of the young population of Gaza suffer from symptoms related to their mood, post-traumatic stress disorder ( PTSD) and other pathologies facilitated by stress. And a good example of this is that the number of suicides and suicide attempts in Gaza increased steadily in 2020, although it is clear that this is something that is not reported, mainly due to the stigma surrounding mental health problems. in Palestinian society.

Despite all this, Gazans display admirable resilience. They carry on overloaded shoulders the weight of their society, suffering, pain, and traumatic experiences, and yet they manage to respond to the needs of their loved ones, be they physical, social, or psychological, while they struggle to survive the bombs.. Today, they deconstruct the buildings destroyed by missiles to reuse the material in the construction of new structures.. They will do the same with their support structures, with their social ties. Their survival resources and their ability to rebuild themselves in the midst of adversity are enviable and from which we have a lot to learn, but they are not infinite.. The resilience of all material and of all people, even that of a Gazan, has a limit. And as long as there is no change, as long as these escalations of violence and this constant harassment continue to be repeated, their wounds will never be able to fully heal.

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Juan París is a psychiatrist with Doctors Without Borders in the Occupied Palestinian Territories since August 2020