I have been involved in collaborative research on the impact of trauma on children’s mental in the Gaza Strip for more than 15 years. There have been many studies since, but when I sighted the first data back in 1997, it was one of the first attempts to capture childrens’ own recollections of experiencing war trauma and then relating them to their mental health.
It is now well established that the proximity to and severity of trauma exposure is directly associated to different types of distress and emotional problems, predominantly post-traumatic stress reactions. These can include reminders of a traumatic experience through sensations, physical reactions or nightmares.
Since 1997 we have tried to better understand the risk factors for bad mental health but also protective factors that would give us pointers for interventions. Extreme deprivation in the Gaza Strip, such as overcrowding and unemployment, are risk factors that can lead to depressive and anxiety disorders. This is in keeping with the findings of other studies on displaced populations – although, ironically, there can be no displacement from the Gaza Strip because of the nature of the conflict and the regional dispute.
One key mediating factor is how trauma affected parental mental health. Protective factors are still in place in the Gaza Strip, namely nurturing, social and community support – but collective trauma can stand in the way of this. For example, in a recent study we found that nursing staff were more affected by their traumatic experiences than civilians because of what they experienced in their professional capacity.
Timing an intervention
Without treatment or help, mental health problems will continue in a substantial proportion of children – in at least 30% of them according to one longitudinal study. More worryingly, intervention trials of debriefing – a directed type of counselling in which the person is encouraged to talk their way through their experience – by our research group and, more recently the charity, Writing for Recovery, failed to show any improvement in the face of continuing trauma. This is not surprising, considering that the basic principle of child protection is the withdrawal of the abuse or other danger before any therapeutic approach is even considered.
A common, but as yet unproved, question is the link between victimisation during childhood and later aggression, including the sensitive issue over whether trauma creates space for suicide bombers, who are then positioned as martyrs by the Palestinians and terrorists by the rest. Although there has not been research in this field as yet, a potential mechanism is the concurrent externalisation (violence towards others) and internalisation (violence against the self) as a result of chronic exposure to trauma.
The roles of aggressors and victims are swapped during the recurrent offensives on the Gaza Strip from Israel, but again political attributions and sensitivities can easily flavour the interpretation of evidence. Few conflicts have produced so much angst and splits in the international community – but also increasingly within academia and across other disciplines.
Seeing both sides
I am always bemused to see media interviews that have to include representatives of both sides, as if competing for the voice and proof of inflicting pain. When reporting the associations between various life misfortunes over the years and children’s suffering, I’ve always looked to the evidence and have never thought of myself as a “representative” of any side. Children would present with similar problems if faced with the same adversity in Tel Aviv, Paris or rural Scotland.
This academic rule of focusing on evidence and generalising the findings to other contexts appears forgotten in this most emotive and continuous of modern conflicts. The political analysts can judge why only the children of Gaza have experienced this conflict for generations, to the extent that they are born and die in the same refugee camps.
In the latest report on the violation of human rights within the Gaza Strip by its government, Hamas, Amnesty International highlighted extensive torture and summarily killings of Palestinians accused by Hamas of collaborating with Israel during the 2014 conflict, and the extensive death and destruction that Israel inflicted on Palestinian people.
There are other mechanisms to demonstrate and communicate whether there was an abuse of human rights and, if proven, we should not take a back seat and accept them as justifiable. But whether or not there was such a violation, there is a multi-layered risk here, threat from both an internal and external aggressor, and at individual, family and community level. And it would certainly have adversely affected civilians – particularly children.