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 For seven straight minutes the children, peppered with burns and
shrapnel wounds sustained in Israeli shelling that hit their home in
north Gaza, stare at him blankly, emotionless.
Eventually, as Hamouda gently teases them, pretending to mix up
their names and holding out a present while another counselor sings
quietly, a smile creeps across Mohammed's face and the older one,
Omar, cries out his name.
"At the beginning, Omar was not responding to us at all, he was not
even willing to say his name," explains Hamouda, who heads a team of
150 psychotherapists working for the Palestinian Center for
Democracy and Conflict Resolution in Gaza.
"Big progress has been made with these children," he says with a
sense of relief and quiet accomplishment. "At the beginning they did
not talk, they refused to communicate. But now, with the sixth
session, we are witnessing good progress."
Omar and Mohammed are just two of the 400,000 Gazan children the
United Nations estimates are in need of psychological care as a
result of not just the latest war in the territory but the three
previous conflicts fought with Israel since 2006.
The most recent conflagration has been the deadliest, with 1,945
Palestinians killed, many of them civilians and including an
estimated 457 children. On the other side of the border, some 64
Israeli soldiers and three civilians have been killed.
Whether the result of Israeli air strikes, having parents or
relatives killed before their eyes, hearing militants firing rockets
from their own towns or themselves being wounded, the psychological
trauma for Gaza's young is profound.
The symptoms range from nightmares, bed-wetting and behavioral
regression to more debilitating mental anxiety, including an
inability to process or verbalize experiences.
There is also deep trauma on the other side of the border, with tens
of thousands of Israeli children mentally disturbed by the regular
rocket fire from militants during the month-long war and over the
seven years since Hamas seized control of Gaza.
While the conflict's destruction of buildings and livelihoods is
clear to see and documented daily in television footage, the damage
to minds is mostly invisible, yet can have far more damaging and
longer-lasting consequences.
"The first time a child goes through a traumatic event like a war
it's just deeply terrifying," said Chris Gunness, the spokesman of
the United Nations Relief and Works Agency, which has 200
psychotherapists working in up to 90 clinics in Gaza.
"The second time is terrifying-plus-one because the child remembers
the worst parts of the last war as well as the impact of the current
one. Then the third time is plus-plus as the compounded memories of
conflict build up.
"This time, for an eight- or nine-year-old child in Gaza, it's very,
very intense indeed because there is this cumulative toll of trauma
from repeated conflicts since 2006."
SMALL STEPS
Hamouda and his team, like other psychotherapy units working across
the small territory - home to an estimated 1.8 million people, more
than half of whom are aged under 18 - can barely cope with the
number of patients requiring help.
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The treatment is by necessity basic - an effort to draw children
out, to have them paint pictures of their experiences or emotions,
to get them to verbalize their circumstances.
While a lot can be achieved with such simple techniques, many more
require longer-term, personalized psychological care because of the
enormity of the mental damage suffered.
"First we provide wounded and traumatized children with immediate
pyscho-social support and we give parents some guidance on how to
deal with them," says Hamouda. Then there is home care and follow up
for the more severe cases.
"Houses can be rebuilt and some physical wounds can be healed, but
the people's psychological condition needs more than money and
time," he says. "It needs a big effort and persuasion, and overall
it needs calm and stability."
One of Gaza's most successful trauma assistance projects is the Gaza
Community Mental Health Programme, launched in 1990.
Hassan Zyada, a psychologist with the project, describes the latest
conflict as easily the worst since 2006, with scores of Palestinians
having lost multiple family members.
"Our expectation is that more than 30 percent of the people here in
Gaza will develop a psychiatric disorder," he said.
Even health professionals are not immune. Six members of Zyada's own
family were killed during the war: his mother, three brothers, a
sister-in-law and a nephew. He is now receiving counseling from the
clinic's chief therapist.
"It is a really traumatic loss and it is not easy for me to deal
with," he said, adding that several others on the team had suffered
similar experiences.
So widespread has the psychological damage become that UNRWA, which
runs schools throughout the Gaza Strip, has now made psychotherapy a
regular part of the curriculum.
"We are rolling out a pretty massive program of parental and child
therapy," said Gunness. "We're having to integrate this kind of
therapy into our schools."
(Additional reporting and editing by Luke Baker and Crispian Balmer)
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