The children of the Gaza Strip know very well what suffering is. From birth, they have lived under a partial Israeli blockade, poverty and violence.
And now, with the escalation of the Israeli offensive and a total blockade following the rocket and ground attacks by Hamas fighters, their suffering will likely only get worse.
Dr Iman Farajallah, a psychologist in the United States and Dr Mamoun Mobayed, a psychiatrist in Qatar, have extensive experience researching and assisting with childhood trauma.
Al Jazeera spoke to them about Israel’s war on Hamas and the mental health effects living in the Gaza Strip has on children.
Here’s what you need to know about the trauma children in Gaza are coping with:
How does living in the Gaza Strip affect the mental health of children?
Farajallah, born and raised in Gaza before moving to California two decades ago, knows first-hand what it is like to live under the “Israeli occupation”.
“That’s why I became a psychologist – to help others living with trauma,” she said.
In a research paper, Farajallah published last year on the impact of war on Palestinian children, she found that children who survive wars do not emerge unscathed and can pay a high price psychologically, emotionally, or behaviourally.
Her research found that 95 percent of children from the Gaza Strip showed symptoms of anxiety, depression and trauma.
“They watch their family members, neighbours, and friends being killed, this causes anger and frustration in them, they tend to be more aggressive and suffer from depression, anxiety, and continuous traumatic stress disorder,” she said.
Now specialising in treating refugees and minority groups for trauma, Farajallah returns to Gaza “as often as possible” and has witnessed how childhood trauma stays with children into their teens.
She recalled meeting two girls recently, a 14-year-old sitting with her four-year-old sister on her lap, who had lost their home and all their family members in an Israeli raid in 2014.
“I will never forget. The 14-year-old didn’t even consider herself a child, she was forced into a caring role because she had no other choice,” she said.
Farajallah said that the older sister told her, “When I walk on the street, people always talk about when is the next war coming” and then, pointing to her baby she asked, “How are we going to protect these children?”
“That’s the impact of the war on Gaza,” Farajallah said.
What effect do poverty and poor infrastructure have?
“They do not live the typical lives of children,” Farajallah said.
Many children in Gaza are unable to attend school regularly because of military actions and they have limited access to essential school supplies, she said.
According to the Geneva-based Euro-Med Human Rights Monitor, Gaza struggles with a 47 percent unemployment rate, but the grim future children face isn’t as harmful to their motivation to achieve in school as other conditions.
“Education is very important in Palestinian culture, whether there are job prospects or not,” Farajallah said. “But with little food, children are malnourished, and with drones buzzing overhead 24 hours a day it’s affecting their sleep – they can’t concentrate, their childhood is shattered.”
What other trauma is caused by war?
A child exposed to war may introduce a traumatic element into playtime and storytelling, Farajallah said.
Farajallah has observed children playing games involving Israeli soldiers and Palestinians and likened it to children in the West playing “Cowboys and Indians”.
“Here, they hold sticks and pretend they are guns,” she said.
Some, however, display a lack of interest in everyday life, becoming withdrawn, while others present antisocial behaviour. Every child displays trauma in their own way.
“One boy I met, aged nine, he told me that when he hears a bomb he rushes to his home and layers up under the bedcovers. He did this in the hope that he couldn’t be seen and so wouldn’t be bombed,” she said.
Some may display restlessness, regression or violent behaviour.
“Others may not want to leave their mothers’ sight, they won’t even leave the room to go to the bathroom or kitchen without their mothers, and I’m talking about teenagers here,” Farajallah said.
Dr Mamoun Mobayed, a consultant psychiatrist and director of treatment and rehabilitation at Qatar’s Behavioral Healthcare Center, said that wartime conditions haunt children when they sleep.
“Nightmares are frequently experienced, and some experience bed-wetting because of the nightmares,” he said.
Do children become immune to these conditions over time?
Mobayed, who has travelled to occupied Palestine since 2002 as a volunteer with the Qatar Red Crescent Society, said that “people do not become immune to trauma and death”.
“They may reach a state of learned helplessness. It’s a state of despair where there’s a realisation that whatever they do it’s ineffective, they cannot escape the situation, they’re trapped,” Mobayed said. “Ironically, this phenomenon was discovered when psychologists were dealing with the Jewish people in Nazi concentration camps.”
Farajallah agreed and said that it is difficult to become desensitised to severe conditions that are still ongoing.
“You cannot become immune to not having water or no food on the table. That’s the reality now.”
How will this trauma affect their future?
“Trauma affects cognitive behaviour, it affects functioning, how can we totally ignore that? Living in a war zone – for generations will affect you,” Farajallah said, adding that violent upbringings will lead to more violence.
“We are not talking about individuals living in peaceful, healthy environments here. When you steal hope from these kids, steal their livelihood and childhood, what do you expect the product to be?”
Mobayed, who has decades of experience working with people affected by war, displacement and trauma, said he’s witnessed a pattern of transgenerational trauma.
“Trauma has been passed down, inadvertently, from one generation to the next. They have had no time for cognitive-emotional processing, for self-healing, and so the cycle continues,” he said.
“It’s alarming because it means, more violence not less will be on the horizon.”
Can war-related trauma ever be undone?
“From my own experience – I’d say no,” Farajallah said. “But we can work on it to undo some of the harm, develop acceptance, build resilience and move on with life.”
Speaking from personal experience, Farajallah said that trauma from war remains with her to this day. It’s been 20 years since Farajallah left Gaza and she still can’t stand to watch fireworks. The sounds bring her back to living in Gaza when it was under attack.
“The solution isn’t found in psychology – the only solution is a peaceful political resolution to solve the issue of Palestine,” she said.
“We are human and just like everyone else want to have healthy families and communities where we are free to enjoy life again.”
