'Normal responses to abnormal situations'

Talib* had tried to commit suicide three times by the time his family brought him to see clinical psychologist Ahmed Abu Tawahina, PhD. Living on the Gaza Strip under Israeli occupation, the husband and father, responsible for 13 family members, had been unable to find a job. Talib's continued, unsuccessful attempts to find work spiraled him into a deep depression.

For Abu Tawahina, executive director of the Gaza Community Mental Health Program (GCMHP), Talib is one of a growing number of Palestinians suffering from psychological distress since the al-Aqsa Intifada or uprising began on Sept. 28, 2000. The ensuing Israeli crackdown on the Palestinian territories has left many people traumatized, according to GCMHP reports. Not only are they unable to find jobs due to Israeli-imposed border closures, they've witnessed loved ones being injured or killed, suffered shell shock, and watched their homes being demolished. As a result, Abu Tawahina has seen sharp increases in anxiety, acute stress disorder, post-traumatic stress disorder (PTSD), depression and panic attacks.

"You can talk about all kinds of psychiatric problems here. The whole population is lacking the feeling of security," says Abu Tawahina, an expert on trauma disorders. "They are not safe at home. They are not safe at school. They are not safe at work. They are not safe anywhere."

Helping Palestinians cope during the current crisis is one of the main goals of GCMHP, a nongovernmental organization founded in 1990, which has clinics in Gaza City, Jabalia, Deir El-Balah and Khan Younis. To accomplish this, Abu Tawahina and his team of therapists frequently go to communities and homes throughout Gaza, educating people about mental health issues and counseling families in crisis.

"In our current circumstances, we usually talk to them about how to cope with daily hassles and ongoing stressors," says Abu Tawahina. "Also, we answer their questions concerning symptoms they experience like fears, nightmares, anxieties, etc. And we highlight that these symptoms they are experiencing are normal responses to abnormal situations. We do that because the stigma attached to mental illness [negatively] affects the attitude of Palestinians in general toward mental health services."

Learning about mental health issues and getting crisis intervention after a tragedy are enough to help some people cope with daily stressors. "People can survive while they are suffering from certain symptoms and signs....They can carry out their daily activities and tasks. They can go to their school or work--if they're lucky, they have jobs," says Abu Tawahina. Other patients such as Talib, who need more extensive therapy, can go to one of GCMHP's four clinics or have a therapist come to their home.

But, according to Abu Tawahina, Israeli restrictions on Palestinian travel have also created roadblocks to patients getting therapy. For instance, the stigma of mental illness causes some Palestinians to seek therapy in nearby towns. They don't want their neighbors to see them going for treatment. And making home visits, one of GCMHP's "major services," has become dangerous, Abu Tawahina says.

Much of the organization's crisis intervention work takes place near Israeli settlements. "It's a high risk for professionals to go and visit those people. It might cost them their life," he explains.

As part of its crisis-intervention program, GCMHP has made home visits to the families of suicide bombers or "martyrs as they call them in our community," he says. Therapists debrief them about their experiences in order to provide or make referrals for emotional or social support.

Abu Tawahina says none of the families he's counseled knew in advance their loved one was going to participate or be involved in such acts. "That's what makes the trauma worse--it's not predictable," he says. Families often learn several days after the fact that their relative was a suicide bomber. Some family members "deny what took place...but after a few days or weeks, they [can face] reality."

In other cases, family members who suffer pathological grief won't accept the death and imagine that their loved one is still there. "They [might] prepare the dining room--the food, the dishes--as if the [loved one] is sitting around the table," he reports.

The situation is perhaps most devastating to Palestinian children, who make up half the population of the Gaza Strip. They suffer from anxiety, depression, PTSD, behavioral disorders, bedwetting and nightmares, "all on a large scale," according to GCMHP research.

"During this time, the kids see that they [cannot] be protected by their parents or by their teachers. This has complicated and deepened the feelings of powerlessness, feelings of hopelessness, and feelings of fear," Abu Tawahina says.

But although the situation is "catastrophic," Abu Tawahina remains optimistic about the future. It's the reason he goes to work every day, he says. "Our ultimate goal is to give the people hope."

*Not his real name.