Palestinian Territories: Providing crucial mental health and medical care

"This year, it was not uncommon in Gaza to find, within one single family, violent experiences ranging from a death, to the destruction of the house, to the arrest of some members and a wide incursion into the area where they live."
- Sue Mitchell, MSF psychologist in the Palestinian territories

A continuing cycle of attacks and retaliation between Israelis and Palestinians killed 931 people in 2004. This figure includes 816 Palestinians, the overwhelming majority of them minors, and 115 Israelis, including eight children. Army incursions, arrests, demolition of property, sieges, rocket attacks, targeted killings and suicide bombings have become a horrifyingly normal part of daily life for most people.

The region's political atmosphere was strongly affected by the announcement of unilateral disengagement from Gaza by Israeli Prime Minister Sharon in August 2004 and the illness and death of Palestinian leader Yasser Arafat a few months later. Both the direct violence (incursions, shootings, bombings) and indirect violence (occupation, closure, control) have affected the mental health status of the Palestinian population.

MSF provides medical and psychological care to those who have been injured or mentally traumatized by the conflict as well as to those who lack access to medical care in the cities of Hebron and Nablus in the West Bank, and in the Gaza Strip.

MSF has expressed growing concerns about the long-term psychological impact that high levels of concentrated violence can have on communities. MSF psychologists conducted more than 4,000 consultations during 2004 with patients in the Gaza Strip, Hebron, the town of Jenin and later Nablus.

After a traumatic event takes place, the MSF team attempts to conduct assessments of victims to identify their most urgent needs. MSF provides medical and psychological care or social support at the request of families. Those who need longer-term care receive home visits from the team.

While most of the psychosocial therapy sessions are held with individuals, MSF also provides a great deal of family therapy and some group therapy with children and teenagers. Whenever possible, MSF tries to use the existing Palestinian network to deliver medical and social care and urges families to use this network.

The population of the West Bank lives amid more than 700 roadblocks and permanent checkpoints, which severely hamper their movement within the territory. A significant consequence of the closure policy has been the collapse of the economy and the impoverishment of the population. The World Bank estimates that 47 percent of the territories' population lives in poverty.

In the southern West Bank city of Hebron, MSF's team of physicians and social workers refers numerous patients to MSF psychologists. The main health problems encountered include gastrointestinal diseases, skin infections (often caused by poor hygiene) and respiratory illnesses (often linked to harsh living conditions). Many civilians complaining of body pain are actually experiencing some sort of mental distress.

The Israeli authorities' decision to construct a high concrete security wall to separate Israel from the West Bank has made it extremely difficult for civilians in the southern Hebron district to obtain needed health care. Immunization rates for children have also declined.

MSF continually assesses whether Palestinians living in communities near the wall need medical or psychological help. Teenagers and children who have witnessed violence during the arrest of family members are among MSF's target populations in this area, and the organization has created a new therapy group focused on women.

In the Gaza strip, a series of Israeli military incursions has left thousands of people homeless, especially in the town and refugee camp of Rafah. Since January 2004, the waves of incursions and demolitions have increased, and approximately 90 homes have been demolished each month.

Since September 2004, and the onset of Israeli military action, MSF medical teams have not received authorization from Israeli authorities to visit the vast majority of their patients in the southern and central areas of Gaza. Even before this development, MSF faced challenges gaining access to patients among Gaza's three distinct segments.

Until September 2004, MSF staff had been working with residents who were confined to the area by strict security rules and numerous military checkpoints. When possible, an MSF doctor, three psychologists and a social worker had visited families in their homes to listen to their stories and provide psychotherapy, medical care or social support. The team had also used drawings and games to help children overcome traumatic experiences such as the destruction of their homes.

Leaving Jenin, opening in Nablus

In October 2004, MSF ended its activities in the northern West Bank city of Jenin due to a severe drop in symptoms and a large decrease in patients. These improvements seemed due in part to fewer destructive incursions and a less volatile security situation.

However, in mid-2004, an assessment conducted in Nablus in the northern part of the West Bank found a population under constant pressure, with Israeli army incursions taking place nearly every day.

In November 2004, MSF began giving medical care and psychological counseling to civilians living in the area, which has been cut off from the outside world by checkpoints, security fences and other measures. The teams report that the daily experience of violence has had social, cultural and economical impacts and has led to anxiety, stress, depression and the weakening or even destruction of some families.

MSF has worked in the Palestinian territories since 1988.