GAZA CITY, Gaza Strip — Hassan al-Zeyada has spent decades counseling fellow residents of the Gaza Strip who suffer from psychological trauma. Now, as he prepares to aid his neighbors after a new round of combat and carnage, he has a challenging new patient: himself.
An Israeli airstrike demolished Zeyada’s family home July 20, killing six close relatives, including his mother and three of his brothers.
“You try to help the people with their suffering,” the doctor said recently in his Gaza City living room lined with psychology textbooks. “It’s totally different when you have the same experience. You lose six from your family — three brothers, your mom, one of your nephews, your sister in-law. It’s really” — he paused, red-eyed — “unexpected.”
He took a mental step back, to diagnose the hallmarks of trauma in himself: He was exhibiting dissociation, speaking in the second person to distance himself from pain, as well as denial. When he heard about new shelling near where his family lived in the Bureij refugee camp, he picked up the phone to call his oldest brother there. He had forgotten that the house was already gone, his brother already dead.
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Zeyada, 50, works to destigmatize mental-health care for a Palestinian population exposed repeatedly to war and displacement, practicing at the Gaza Community Mental Health Program, which was led by the pioneering Palestinian psychiatrist and human-rights advocate Dr. Eyad El-Sarraj until his death from leukemia in December.
Zeyada is not the only Palestinian caregiver to become a trauma victim. In the three weeks of attacks that Israel has said are meant to root out rebel rocket fire and destroy clandestine tunnels into Israel, one of Zeyada’s colleagues at the program lost a brother, and their boss, Dr. Yasser Abu Jamei, lost 26 members of his extended family, including 19 children, in a single bombing.
It is difficult — even absurd, the clinicians say at their darkest moments — to try to mend psyches in the Gaza Strip, where even in calmer times the conditions are hardly conducive to psychological health, and safety is never more than provisional under the many cease-fires that have come and gone.
People cannot flee Gaza; Israel and Egypt keep their borders virtually sealed. Residents can flee their neighborhoods, but even U.N. schools being used as shelters in Gaza have come under deadly fire. And in downtown Gaza City, where Israel has urged people to go for safety, Israeli airstrikes have repeatedly hit apartment buildings packed with residents and refugees. One strike collapsed most of a building and killed the family of a bank employee who had fled there on Israeli instructions.
The border restrictions, stemming from an eight-year standoff between Israel and Hamas, the group that dominates Gaza, have steadily eroded livelihoods in Gaza, adding to a sense of powerlessness. Even during relative lulls in violence, Israeli strikes periodically kill rebels — and bystanders. People who do not want Hamas and other extremists to use their farm fields to fire rockets, for fear of return fire from Israel, say they cannot always stop the combatants.
The healthy processing of grief and fear works best when sufferers feel they are out of danger, Zeyada said. But that is impossible in Gaza as long as the larger conflict persists.
Sometimes, he said, he was troubled by the ethics of treating people who were likely to be traumatized again.
“You are,” he said, “like a prison doctor treating a victim of torture, making the prisoner healthy to be interrogated and tortured again.”
He spoke flatly and deliberately, his body rigid in a visible effort to maintain his composure.
“I am so afraid in this building,” the doctor said, pointing out his sixth-story window. Several apartments here, he said, are crammed with 60 people or more as residents take in fleeing relatives.
“They may hit it at any time,” he said of the Israeli military. “There is no safe place. Psychologically, that is the problem.”
As they visit the grieving in their homes and shelters, and prepare to reopen their clinics when the fighting stops, Gaza’s mental-health counselors face a huge job.
One-third of Gazan children showed signs of post-traumatic stress disorder even before the latest outbreak of fighting, according to Dr. James Gordon of the Washington-based Center for Mind-Body Medicine, which runs a program in the territory. Now, with the death toll for the past three weeks exceeding 1,500 Palestinians — relative to the population, the equivalent of nearly 200,000 deaths in the United States — nearly every Gazan has heard or witnessed shelling, and most know someone personally who was killed or injured.
A few blocks from Zeyada’s apartment, Younis al-Bakr, 9, sat curled on a sofa, chewing on his fist like a much younger boy. His family said he had not spoken a word since he witnessed the shelling that killed four of his cousins on the Gaza City beach July 17. Younis and three more cousins survived the attack, suffering shrapnel wounds along with less visible ones.
“We didn’t lose four,” said his uncle, Hamis al-Bakr. “We lost eight.”
One of the surviving boys sneaks out of the house to visit his cousins’ graves again and again, despite warnings of the danger. Another reacted to a later airstrike in the neighborhood by shaking so violently that he was taken to the hospital.
The only one willing to talk — Montasser, 10 — launched in a trembling, reedy voice into a speech that mixed stock political slogans with thoughts from a small boy’s world.
“I tell the European world, the Arab world, we were playing on the beach,” he said. “I can go now and play, but they will kill me. I’m afraid of death.”
Group and individual counseling can help trauma victims find resilience and move on with their lives, Gordon said. Many feel a mixture of guilt and powerlessness and a hunger for revenge that can fuel new cycles of militancy, he said, but “as they’re able to express their anger, the vast majority find other ways to build their society.”
Still, he said, “there’s got to be a solution — you can’t keep people in this prison.”
For his own part, Zeyada said that he would seek peer counseling and go back to work, not least because, as the oldest surviving brother in his extended family, he is now responsible for 11 of his dead siblings’ children.
“There is no other choice,” he said.
Also maddening for Zeyada was trying to imagine Israel’s logic. He said two of his brothers were in Palestinian police forces — one a municipal officer employed by the Hamas administration and the other under Fatah, the rival faction that was sidelined when Hamas took over in 2007. Police forces have often been Israeli targets, but his brothers were not militants, he said — and anyway, “I am not looking for justifications.”
His family had had “absolute faith” that Israel would warn them if their house was going to be bombed, but there was no warning, he said.
Through clenched teeth, he noted that his young daughters have now experienced three wars.
“Can you imagine what that means to the new generation?” he said. “Scared parents cannot assure or secure scared children.”