For more than two decades, Dr. Yasser Abu-Jamei has worked at the Gaza Community Mental Health Programme, the largest mental-health organization in the Gaza Strip, which he has been running since 2014. Gazans have long faced an array of mental-health challenges brought on by Israel’s blockade of the territory, which began in 2007, and its frequent bombings and raids. Since October 7th, the Israeli government has prosecuted a military campaign that has displaced most of the population of Gaza and killed more than thirty-three thousand people.
I recently spoke by phone with Abu-Jamei, who left Gaza for Egypt, where he arrived about a week ago. We discussed how he has managed to continue his work in the past six months and how he has approached treating children specifically. Our conversation, edited for length and clarity, is below.
Can you tell me a little bit about the history of the work you do?
The Gaza Community Mental Health Programme is a non-governmental organization that was established in Gaza, in 1990. It was founded by the late Eyad el-Sarraj, who was a human-rights activist and psychiatrist. This was around the time of the first intifada, when he was still working at a psychiatric hospital, the only mental-health facility on the Gaza Strip. And he noticed that many of the people were coming to the hospital talking about the difficulties that their children faced. These were not mental illnesses that required hospitalization but, rather, symptoms of the hard conditions that people were under in the eighties.
He was thinking all the time about what he could do to help children and their families and the community at large cope with difficulties, and how he could alleviate the implications of the living conditions, the occupation. He was introduced to the concept of community mental health. And that’s basically when a multidisciplinary team that is composed of a psychiatrist and psychologist, social worker, and maybe a psychiatric nurse simply works together to offer what we now call social psychiatry or community psychiatry.
El-Sarraj began with a handful of technical people, professionals who joined him to establish the first community center. One of his main goals was to help children and their family members who were victims of torture or ill treatment, or ex-detainees who were in Israeli prisons. He also tried to provide some counselling and awareness-raising sessions to the community in order to combat stigma associated with mental-health issues.
When did you get involved with this work?
I joined in 2002.
Can you describe the political context of the work you all did in Gaza before October 7th?
The first intifada ended with the peace process that led to the Oslo Accords. That’s how the Palestinian Authority was established, how we as Palestinians started to be able to have some source of autonomy in the Gaza Strip and parts of the West Bank. But time was moving without any improvement. And, in 2000, the second intifada began. Then, in 2006, elections yielded a victory for Hamas over Fatah. There were a lot of disputes between Hamas and Fatah that ended with Hamas taking power in Gaza and starting its own ruling system that was not accepted by the Palestinian Authority or by the international community.
That led to putting the Gaza Strip under a blockade. And, in addition to the blockade, Gaza was exposed to many Israeli military operations. There were thousands of people who were killed, thousands who were injured, and, as professionals working in mental health, we knew that this put a continuous strain on the community. We were living in a pressure cooker. And, since October 7th, you can imagine the level and span of trauma that the population has been exposed to. Let’s keep in mind that more than 1.3 million people within Gaza are now internally displaced and living in very dire conditions.
Where are your clinics situated, and are they still there?
We have three locations. One is in Gaza City itself, where we have our headquarters. The second one is in Deir al-Balah. The third is in Khan Younis. What we know is that our Gaza community center used to be a six-story building, and only one floor is still there. Our Deir al-Balah center is still up, but it was affected by the destruction of the neighboring buildings. Our rented place in Khan Younis was burned, and we’re not sure if the building is still up there or not, but it’s also not usable.
That’s why we have rented a couple of places. One’s in the middle of Gaza, and the other one is in Rafah, in the south. Through both places, we have been able to provide some services. This is not the optimal means of offering what we really want to provide, but the circumstances, again, are getting worse and worse. A lot of my colleagues are wondering about their safety. So we are doing our best, given the current conditions.
Were you living in Gaza City?
My house is situated on the eastern side of Khan Younis. I worked in Gaza City in the main building. I was displaced from Day One. And, since December, I was staying in Rafah. I stayed for a couple of weeks in a shelter, which was a school. Then I moved to a tent where I stayed for about three months.
Were you able to do your work at all during that time, or were you mostly just moving from place to place? What was that like for you?
Well, we tried to keep the services running despite all the difficulties. We are a big organization that has about a hundred staff members, and we wanted to make sure that at all times there was someone who could, for example, give medication to patients or receive someone who is in need of emergency intervention.
At the same time, we have a toll-free line that we tried to continue to operate. We were also connecting or forwarding the calls to our partner organizations in the West Bank. For example, the counselling service was available, and we were opening the clinics whenever there was a chance—not the one in Gaza City, unfortunately, but the one in Deir al-Balah and the one in Khan Younis, until the situation got worse in Khan Younis. And since January we have stopped working from Khan Younis, but we started to work in Rafah in February.
The other difficulty was the availability of medicine, because we used to procure medications from pharmaceutical warehouses, and those warehouses were not capable of bringing in any medication for the past six months. We tried to ask international organizations to help. We received other medications from the W.H.O. last week. We are still lacking different types that we hope we’ll be able to receive in the coming months.
One of the difficulties was to continue making the drugs available for mental-health patients or psychiatric patients who are in need of them. It’s lifesaving if you keep the medications available for many of those patients. We tried to do that, and we managed to with some success, but it was not an easy job at all. Most of our staff members are internally displaced. Some of them live in tents, some of them live in shelters, but we are trying one way or another to manage. About a month ago, we also started to visit the shelters to provide psychological first aid and to try to meet children to give them some little gifts. Encourage them to draw, encourage them to have some fun. We are trying. We are successful to some extent, but, again, the conditions we’re working under are not the best.
When you’re trying to talk to children, what do those conversations look like? What are your strategies to talk to them? I can’t imagine what it’s like.
Well, we have dozens of unattended children. There are about a thousand children who have lost at least one limb. Most of those children and their families are trying to overcome these challenges. And many of them do not access mental-health services. Some of them are, let me say, doing good, but a lot of them are not doing that good. What we try to do is to help them speak, help them get rid of their stresses, help them open their eyes to something that they can do in their lives. I mean, to try to find some strength point in their life. But it’s really hard.
One of the main difficulties that children face has to do with the conditions. If someone was traumatized or just pulled from under the rubble, how can you help him or help her if the bombing sounds continue? It’s really very difficult. It’s a basic and essential thing for our work—to have a ceasefire, to allow some feeling of safety for children and their parents. The population is struggling with very basic needs. Struggling to hold the tent when it’s windy, struggling to find a place where you can just find a good meal, trying to find some resources, trying to find some food that is donated by different kitchens, for example. Many mental-health issues are now masked by the ongoing atrocities, by the ongoing traumatic conditions and by people basically being in survival mode.
There are all these mental-health issues, but there are so many practical concerns and there is so much practical danger right now that you can’t stop to think about them. Is that what you were saying?
Yes. Unless the person is severely traumatized and showing serious symptoms, then people will not really . . . I mean, it’s not that they are uninterested in seeking mental-health services, but the issue is that they are too occupied with so many other things, with very practical things that are essential. They sometimes have to choose whether they are going to try to find food for their child or they’re going to try to spend half the day just attempting to reach a mental-health service.
In previous conflicts, we noticed that, even when the ceasefire takes place, people will not come to your service immediately. Some people will continue to visit your center and come to your practices when they are severely affected. But other people who show moderate symptoms will start appearing at least a couple of weeks after the ceasefire takes place. That is when people start to look around and figure out what happened to them and start to deal with the realities that were put in place by the impact of the attacks.
I read an article from the Guardian about you that was published last year, before the October 7th attacks, and in it you said, “People do not have means to recover and people are not given the space to recover.” If that was true then, I can only imagine what it’s like now.
Well, Isaac, I’ll tell you one thing that’s definitely correct. A lot of people now are comparing what happened when they were displaced after October 7th with what happened in 1948. And they say that this time is even worse. The damage is so huge, the level of destruction is so huge, the number of the people killed is so huge, the brutality is so huge. Gaza had a population of 2.3 million people who were trying their best to live and challenge their circumstances. And, suddenly, it’s not just a few villages here and there that got affected but everything.
This time what is happening is not a secret. It’s not hidden. The international community is watching what is happening to children, hospital attacks, all of these things, and nothing is really moving. It’s really an issue that we have been struggling with for decades: how to get freedom, to live in dignity. And that’s why I’m not surprised when you reminded me of what I had said. We would love to live normal lives. I don’t know how to explain it. But we don’t feel like people are. . . . We need to have our rights like every other people in the world. Our children have the right to live dignified lives. To play and enjoy their childhood rather than think all the time of the trauma they’ve experienced.
Can you talk about how your work with children is different than with adults? How do people respond differently?
Well, we have distinct ways of approaching children. It depends on the symptoms and their severity. It depends on the diagnosis, and what problems they have developed. It also depends on the available resources. We work with the children and we work with their parents. The presence of parents in therapy telling them what to do and what not to do is very important and very essential.
The basic thing is to try, first of all and above all, to make the child feel that his place is a safe place, that his environment is good and that the danger is not there anymore. This is extremely essential, to allow the child to start to recover, one way or another. And then, in therapy, we use several techniques. We have different approaches that help the children express themselves, talk about their fears, show their fears.
And, when they show the fear, then the parents and the therapist have the chance to calm the child down. But if the child doesn’t express his fears or her fears, then it’s more subtle and it’s more problematic. We encourage the children to draw. You can find some of those on our Facebook page. Sometimes you just ask the children to use toys to tell stories. Sometimes children pick different toys, like, for example, a house toy, and they say, O.K., this happened here. The airplane came here, it bombed us. We were under the rubble and then left. And the therapist tries to accompany the child, get rid of the fears, help him feel that it’s gone, safe, that this is not now, that if his house was destroyed, for example, it will be rebuilt.
In the severe cases, when relatives are killed, we try somehow to calm the child and then ask questions: What are you going to do tomorrow? What are you going to do the day after tomorrow? Something like that. And it’s not easy. It’s not easy at all. It doesn’t happen after one session. It could take three months, six months, even more than that.
But children surprise us all the time. Palestinian children surprise us with their ability to recover. And they surprise us all the time when school starts, when they start jumping their way to school, when they feel happy, when they return, see their classmates, and they’re like all the children of the world. They want to enjoy normal life.
They want to enjoy going to school, going to kindergarten, getting some good grades, and talking to their classmates and so on. Sometimes we work with groups of children. They sit in one group and they tell their stories. They help each other with their presence and their supervision. They try to bring some poems and show what happened, and it works.
How is it different for medical professionals to treat people when you are going through some version of the same thing?
This is a very important question. First, throughout the years we have learned the importance of staying together and standing for each other as a professional community, as mental-health workers. Of course, some of us were severely affected because our loved ones were killed. Many of us lost houses. Almost every one of us was displaced. And all the time it’s important that we talk to each other, that we find a space where we sit together and we talk. We call it “care for caregivers.”
Through that, we try to empty our cups, if we can use this proverb, because we try to get rid of our traumas, of our injuries, and we try to find a space where we can start helping others. And each one of us has at least one weekly supervision session.
We have a group of very nice people among us who are well trained in these practices. But, when we have good Internet, for example, we also really receive good support from our colleagues, whether they’re Palestinians outside the Gaza Strip or professionals from the international community. A lot of people just connect personally or on a one-on-one basis with some of our therapists. Without that, we would not really be able to survive these conditions.
I read that you lost more than twenty relatives in a strike during a previous bombardment. Is that accurate?
Yeah.
Your family that survived—how have they been doing during the past six months?
Well, what can I say? I mean, I’m not sure that you can find any family on the Gaza Strip now that hasn’t lost a member or hasn’t had someone who has been injured. Nowadays, again, the question is survival. People are all the time thinking about their homes, whether their homes or houses are standing. Whether their house is one they can return to or they cannot return to, whether it’s possible to inhabit it or there is no way to live in it. I mean, there are many things that are going on in people’s minds. Honestly, I’m sure that most of the population hasn’t had time to mourn their losses. And this is something that will come later, when things calm down. ♦
