I was approached to write this piece a few weeks back. Everyday matters took precedence: a family visit, work deadlines, an imminent house move. Yesterday, after saying I didn’t have time to write it, I woke up to see Jon Snow’s report from his recent visit to Gaza and had contact with a child psychiatrist who works on the ground there, and I had to change my mind.
It’s clear that young people are getting caught in the crossfire of the latest round of fighting between Israel and Palestine and the conflict is taking a huge toll on them. And the effects of the war are not just physical. Having studied how the ongoing war affects the mental health of young people in the Gaza strip, I would like to share some of the insights I’ve found and learned from colleagues who continue to work there.
From the outset I’d like to state that the physical and mental well-being of Palestinian and Israeli children is of equal value and concern. Research regarding the mental health of children and young people in Gaza is critical due to the devastating impact that the fighting has on them. They also have a relative lack of power and control over events taking place, yet they have an important role to play in future efforts to establish a peaceful solution to the longstanding conflict between Israel and Palestine.
War zones and mental health
Previous work in this area has found children and young people living in war zones are at high risk of developing mental health problems such as Post Traumatic Stress Disorder (PTSD), anxiety, depression and behavioural disorders.
The way we cope with stressful situations indicates whether our mental health is negatively affected. Adaptive methods of coping such as attempts at problem solving and seeking support from friends and family can act as a buffer to these kinds of stressful events and can protect our mental health.
In contrast, maladaptive coping such as denial, avoidance and alcohol consumption can be linked to poor mental health. Where stressful circumstances are unavoidable, for example for those living in a war zone, the stress may be overwhelming, especially when focus on survival is paramount. By looking at coping strategies we can see why some people cope better with the same stressful circumstances than others and services can be developed to address this as a result.
Coping strategies
A study of adolescent males in Gaza, a population that may be at particular risk of engaging in current or future conflict, indicated that they experienced high levels of maltreatment such as physical injuries and emotional abuse. The way these young men tended to cope was often dysfunctional, for example by denying that there was a problem and blaming themselves.
A recent study indicated that in a sample of 358 adolescents in Gaza, the vast majority had been exposed to traumatic events such as seeing mutilated bodies on TV, hearing and witnessing shelling and hearing jet fighters overhead. More than half met the partial or full criteria for a diagnosis of PTSD with females reporting more PTSD and anxiety than males. PTSD symptoms include intrusive thoughts, flashbacks, and avoiding situations that remind sufferers of traumatic events.
Even nursery age children are affected due to the poor mental health of their parents, many of whom report feeling “imprisoned” in Gaza. This is often linked to child mental health and behavioural problems. Children who experience problems in attachment to their caregiver often struggle to trust others or establish healthy adult relationships.
Very early life experiences are clearly crucial to healthy psychological development and so services must target primary caregivers as well as their children. Poor mental health as a child is strongly associated with adult mental health problems. Experiencing trauma in childhood is associated with a range of poor outcomes as an adult including impulsive behaviour, substance misuse, physical health problems, poor self esteem, poor educational attainment and unemployment.
We are now confronted with a generation of children and young people damaged and brutalised by the ongoing conflict in this region. Alongside the physical injuries we can see in the news, poor mental health is a significant side effect – and research shows it is likely to persist into adulthood.
Mental health concerns may not seem like an immediate priority, but Palestinian children are the adults of the future and they will be central to future efforts to promote peace in the region. We must therefore pay attention to their mental health as well as their physical injuries.