Gaza’s Children Face an Unseen Crisis
The psychological toll taken by nine months of war is in a category not seen before, experts warn.
By Hoda Serif
August 8, 2024
Source: New Lines Magazine
Until this year, the Alashi siblings — Said, 16, Jihan, 15, and Hanan, 12 — were at school and knew only the routine of life in Gaza. The two sisters aspired to be artists.
Now they dream of mastering English, driving a car like their mother and becoming physicians so they can save the lives of people in Gaza.
The children’s parents were divorced. They lived with their father in Gaza while their mother, Dina Massoud, lived in Staten Island, in a cramped, sublet one-bedroom apartment that she shares with her new husband and their newborn baby. Crucially, she is a U.S. citizen. In November her ex-husband, who requested anonymity, called Dina, urgently requesting that she obtain the necessary paperwork from the U.S. Embassy in Egypt to evacuate him and their children from Gaza. She worried about organizing their departure, knowing that the journey to Rafah crossing was extremely dangerous. With the help of Najla Khass, 43, a Palestinian refugee coordinator in New York City, Dina decided to risk getting her family out; it was a decision, she understood, that would put her young children in direct contact with the Israeli army and what she described as their “draconian commands.”
Said, Jihan, Hanan, their father and his family evacuated their home in northern Gaza in December, along with another 1 million Palestinians, following the Israeli army’s orders to move south. For several weeks they sheltered at the Abdullah Bin Rawahah primary school near Deir el-Balah, waiting for Dina to arrive in Egypt. Each family at the school-turned-shelter was allocated one classroom containing six small twin-size beds.
Bodies were packed tightly, and men sleeping in opposite directions stretched their legs out toward the faces of the others, Hanan recalled. Some slept on desks or on the floor, covered only with light blankets. Hanan rose early each morning to join the long line for the limited bathrooms, a daily struggle that usually took two to three hours. Running water was limited, and the children lived in constant fear of being bombed. With United Nations Relief and Works Agency (UNRWA) aid and food trucks turned away from Rafah crossing in the south and at the Beit Hanoun border in the north, Hanan stored a single packet of vanilla Oreos she had found on the floor under her pillow, taking small bites each night. A few weeks later the Alashi family set out on the journey to Rafah, where the few Palestinians who have managed to obtain a permit can cross into Egypt.
“And just two days after we left the empty school, Israel bombed it,” Jihan said. “We made it out.” Later, she said, “I don’t know if that makes us lucky.”
The sisters described with expressions of horror the sight of large Israeli tanks on Salah al-Din Road, the north-south artery that leads to the Rafah crossing. It was the first time they had encountered Israeli soldiers and Jihan remembers the racing beat of her heart. “Here, feel,” she said as she took my hand. The girls recounted seeing many dead bodies strewn across the main road, as they inched closer to the crossing. Jihan said her heart rate surged each time her gaze met her sister’s. “The thought of anything happening to Hanan or Said or Baba [Dad] — I wouldn’t be able to bear it.”
Jihan frequently reenacts the maternal, protective role over her younger sister, a natural instinct she attributes to a childhood spent without their mother. That day in the car, her thumping heart rate was accompanied by sweaty palms and frantic recitations of verses from the Quran as they sat huddled in the car.
“We held our hands up in the air, waved the white cloth, and didn’t look [Israeli soldiers] in the eyes. We had to stare straight ahead,” Jihan said, adding, “If we wanted to survive, this is what we had to do.” Almost in unison, the girls said, “Some survive, others don’t.”
At Rafah crossing, an Egyptian officer informed them that their father would not be permitted to enter Egypt. Because he was divorced from Dina, he was not considered a member of her immediate family and so was not eligible for a crossing permit. He embraced his children and they said goodbye, not knowing when they would see one another again.
In Egypt, the Alashi children and Dina spent a month hotel-hopping in El-Warraq, a municipal district of Giza near Cairo. Once all the necessary paperwork for entry into the U.S. was prepared, the family was set to fly to New York on Jan. 8. During the long flight, all the girls thought about was Gaza: when they would next touch the granular sand of their cherished beach, where they had flown their white kites with friends and watched as the sunset painted hues of deep reds and pinks, or when they could next visit the bakery that served their favorite mango ice cream. Said wondered most about when they would next see their father and who would take care of him now that they were gone.
As Israel continues its relentless bombing campaign in Gaza, trauma experts from around the world have expressed deep concern about the devastating impact this war is having on “successive generations of Palestinian families,” Dr. Vivian Abouallol, the head of the steering committee at the USA-Palestine Mental Health Network said. The group of mental health professionals at the network identify the Israeli occupation as the sole cause of turmoil to the mental well-being of both “the Palestinian and the Israeli public.” As of this writing, the number of Palestinians who have been able to leave Gaza remains unclear, while the process is becoming increasingly onerous and costly. As of this writing, UNRWA estimates that up to 1.9 million people in Gaza have been internally displaced, or about 90% of the population.
Juliette Touma, director of communications at UNRWA, said that the current war in Gaza has, in addition to taking a death toll far exceeding that of previous wars, caused trauma on a scale worse than the intergenerational trauma that is the legacy of the Nakba in 1948, when the newly established Israeli army forced an estimated 850,000 Palestinians into what became permanent exile. When Touma visited Gaza with other UNRWA members in late October, she saw pain on a scale “unfathomable to the human mind.” She said the shock of it all keeps mourning Palestinians from crying. “It’s a reopening of an unhealed wound because many of them have either experienced the Nakba in 1948 or their grandparents have told them stories about it. For them to be forced to watch as their communities are bombed to rubble, forced to flee their homes and villages, or worse to evacuate their kids from Gaza entirely, is all part of revisiting that agonizing journey of exodus, of pain and no longer belonging.” What has transpired in Gaza over the past eight months, she adds, has created “the most destructive mental injury to the human brain, experienced by 2.4 million people, and these are just the numbers inside of Gaza.”
Najla El-Temawi Khass was born in 1980 in Shujaiyya, Gaza City’s largest neighborhood. This is where she lived when the First Intifada began in December 1987. By September 1988, riots and deadly military incursions had made the neighborhood unlivable; Najla’s parents left and settled in New Jersey, where they raised Najla and her five siblings.
Najla recalled that during the First Intifada, the Israeli army would raid the house of anyone suspected of violating the strict curfew. As an act of resistance, Palestinians would leave footprints in the sandy, unpaved streets; the Israeli soldiers would follow the footprints, raid the homes they led to and force their residents to show them their shoes. If children were caught, they were detained and tried in Israel’s military court system, which has a conviction rate above 99%, according to the Israeli army’s own records. Or they were kept in indefinite administrative detention.
“It was always little boys they wanted,” Najla said. “The goal has always been to dehumanize them. I understand now all their tactics to intimate and stoke fear.”
“One day, my eyes will speak. They will say they saw true horror. Worse than anything you can imagine,” she continued. “My ears heard it. My chest felt it. What’s happening in Gaza now is all very real to me.” She spoke softly as we sat down to drink our coffee. Her eyes wandered to a distant corner of her home in a penetrating stare, which occurred frequently when our conversations triggered memories of the Israeli military. Najla’s family is currently sheltering in displaced persons camps across Gaza. Her childhood home, which her parents had built, was demolished by an Israeli airstrike back in November.
Since settling in New York as a child, Najla has dedicated her days to serving as a full-time refugee coordinator with the Islamic Circle of North America’s ICNA Relief, a Muslim aid organization that provides services to victims of war and survivors of disaster, mostly from Palestine, Libya, Sudan and Iraq. Khalto (Auntie) Najla, as the kids call her, slowly became everyone’s aunt in her close-knit, predominantly Arab neighborhood in the New York City borough of Staten Island. The children she helped became something of a second family to her. “It’s the Palestinian way,” she said – a phrase she repeated often during our interview. “Keeping myself distracted is the only way I know how to survive,” Najla added.
The mental health crisis for Palestinians living in Gaza was already acute before Oct. 7, according to reports from UNICEF. Since 2006, Israel had imposed a military closure on Gaza, controlling everything from who and what entered or left the territory to the population registry and the daily allotment of electricity. The closure shaped entire generations that have grown up amid repeated cycles of violence, with military incursions, airstrikes and severely restricted freedom of movement. The Israeli military incursions as well as the constant surveillance and monitoring took an enormous toll; even before the current war, UNICEF estimated that at least 500,000 children in Gaza were in need of psychosocial support.
Caesar Hakim is a clinical psychologist who specializes in child and adult trauma. In addition to his private practice in Haifa he also lectures at the University of Glasgow. He was previously clinical director at the Guidance and Training Center for the Child and Family in Bethlehem. He treats patients with continuous traumatic stress disorder (CTSD) — a condition, he said, that is “radically unique” among classifications of trauma and is inherently rooted in every Palestinian’s experience.
Hakim treats patients in Haifa, Galilee, Jerusalem and the West Bank. Because Israel’s restrictions on movement make it impossible for him to see patients in Gaza, he offers remote assistance to psychologists there.
“Palestinians have long faced repeated danger,” Hakim said. “With no external protection systems to process any of their experiences, it throws them into a cycle of revictimization. It is far from what we can clinically describe as PTSD, where one’s fears are stuck in a traumatic loop, suggesting little to no likelihood of recurrence. In Palestine, that loop is reality. The threat is still there. It has always been there. This chronic, generational pain is the only breath most children have ever taken in Gaza.”
The term CTSD was first coined by South African writer Frank Chikane in the 1980s to describe the effects of apartheid on generations of children in South Africa. Children, he discovered, were particularly susceptible to developing CTSD from prolonged exposure to various forms of political repression, violence or systemic racism against their people.
The younger generation of children, Hakim says, is experiencing a resurgence of past traumas that they never had a chance to process. “What they need is stability — caretakers. Just imagine a child living in a world like this, when he was born, that there is no responsible adult to help them. Everyone is just focused on sheer survival.”
Hakim said that a significant number of his patients are increasingly reflecting on their past, with many expressing a strong desire to go back in time. “Patients come in with all the questions. They ask me: How can we live in a place like this? How can we take care of our families? Why am I here? How can I survive here?” He added: “Each one of them has his own story in his own personal life of how they lived this trauma over and over. And now it is all coming out. And they can’t avoid it, nor can they face it. There is nowhere to turn.”
The cornerstone of therapy, he says, is being able to provide a safe haven for those in need of security. For many of Hakim’s patients, his office serves as their sole sanctuary. The high rates of attempted suicide, according to Hakim, remain a daunting reminder that the Palestinian sense of alienation is everywhere amid the violent social, cultural and historical atmosphere of Israel today.
Ifirst met Said, Jihan and Hanan at Najla’s Staten Island home a week after they arrived in New York. The school day had ended and Najla, who had made a habit of picking them up each day, had just brought them home. Their mother, Dina, and I were sitting on the black leather couch in the living room as the children ascended the stairs, 16-year-old Said trudging up slowly behind his sisters and greeting me with uncertainty. He was a reserved, quiet young man with a towering posture and wavy dark-brown hair that framed his face. He did not raise his eyes to acknowledge my presence or engage in conversation. Instead, he walked silently, his feet tapping the light-orange wooden-paneled floor with the slow, uncertain steps of a man twice his age. His gaunt shoulders sagged underneath his gray hoodie as he moved, slowly but carefully, always pausing for balance before taking the next step.
Slumped in a beige armchair, legs extended, the 16-year-old became engrossed in his iPad, which Najla had gifted upon their arrival. “His head is always in that thing,” Dina said.
Before the children fled Gaza, their father had buried 12 of Said’s friends, all in the same month — a tragedy I discovered not until weeks later. I did not learn much about Said; he was withdrawn, averting his gaze when spoken to. I watched as Najla offered him a glass of water and he remarked: “Who’s getting Baba water now?”
Said remembers the last time he retrieved water for the family; he carried it alone from the well back to his home using carts laden with plastic containers. He was in Haraat al-Daraj, northwest of Gaza City, where he’d managed to acquire just two six-liter containers of briny water for four shekels ($1.10). This ration had to last his extended family of 50 for an entire week.
“Right now, you are in America, not Gaza. You can eat and get full, and you can even eat again after that,” Najla reassured Said, pushing a bowl of spicy macaroni and cheese toward him. The sisters refused meals that did not involve their ritual of sharing with one another, a reminder of their ceaseless struggle to procure food in Gaza’s ruins, where the act of eating alone was a luxury they could never afford.
They had become unaccustomed to tasty, wholesome food after subsisting for weeks on end on paltry meals — cans of tuna that had passed their expiration date, fava beans or ramen. “That’s all that we could find. The bread, if any, was moldy.” The girls were sometimes afraid to open the tuna cans because they had heard that some were booby-trapped with explosives.
Said was resolute in minimizing electricity usage as much as possible. That day, he walked around Najla’s home, vehemently switching off lights and unplugging unused appliances — from hair straighteners to iPhone chargers — a habit that was a legacy of Israel’s control over the electricity supply in Gaza, which was limited to four hours per day even before the war and then cut off completely on Oct. 8.
Jihan appeared slightly happier about the move than her two siblings did. Her hope, I learned, was in the power of academia. If they had stayed in Gaza and if there had been no war, she would have completed high school in al-Daraj, at the same school her mother, aunts and uncles had attended. “But I barely had the chance to start,” Jihan said. Her school was bombed just one month into the start of the academic year. She was most looking forward to her advanced art class, where she would learn how to create abstract canvases with oil paint. With her brother, Jihan is now enrolled at Wagner High School on Staten Island, where she has yet to forge any friendships that feel authentic. Stabraq, her best friend from Gaza, will never be replaced, Jihan tells me. “I hope she is still alive and that I can meet her again soon. We did everything together.”
“It is as if the war is not happening or people don’t seem to care as much here,” Hanan told me, referring to the school’s bleak social climate. Jihan added: “I still have nightmares. Of course I do. I can hear the sound of the bombs. But I keep it to myself. I am so lucky to be safe. To have escaped. Of course I don’t feel lucky, but I can’t complain. All I can do is work hard to achieve the grades I need to help my people.”
Dr. Samah Jabr, 47, grew up in East Jerusalem, which is occupied by Israel. For eight years she has been chair of the mental health unit at the Palestinian Ministry of Health in Ramallah, overseeing all mental health provision in the West Bank, Gaza and East Jerusalem. She said that all the traumatized patients she sees in her office show a strong lack of trust, belonging and hope in human relationships: “My patients tell me they are supposed to contain their pain inside their heart, no matter how distressed, to avoid the shame of sharing it,” she said. “Such reactions are not just limited to individuals. Attitudes like these have become generalized over generations in Palestine, forming a body of maxims and proverbs that communicate a loss of faith, pervasive fear of danger and an avoidance of disclosure for both men and women. These reactions are all barriers to their healing,” she said.
Jabr has conducted training sessions for hundreds of medical professionals in Palestine, Afghanistan, Libya and Jordan. Each day, she sees up to 30 people experiencing personality changes and emotional torment, often manifesting as physical ailments. Political trauma in Palestine is both “transgenerational and collective,” she said, adding that her unit has nearly reached its capacity.
“Even if we had the funding and professional resources to address this, how do we begin to solve a trauma that is man-made, deliberate and ongoing? It is a mistake to believe it is any easier, mentally, for the child when living abroad. We, as marginalized Palestinians, do not fit the current framework by which the West defines trauma.” There is no safe place to help them anywhere in the world, Jabr adds, so long as the root of the problem endures: the Israeli occupation. “Giving people who lost their humanity, who have been reduced to nothing, their dignity back is all part of the solution. Psychologists can’t do that alone. We need responses at state and international level. We need the rest of the world to stand with us.”
Samar Harfi is a licensed clinical psychologist in Illinois. She works with the Khalil Center, a Zakat Foundation project where her clinical approach focuses on traditional Islamically integrated psychotherapy. Harfi received the President’s Volunteer Service Award for her work with refugees and treating war-related trauma in 2012. She spoke to me about the Alashi children, who are “rare cases” she says, of civilians who have been able to flee since the onset of the war. She says that what they have been exposed to in Gaza will live inside them for a long time; they have lost the sense of belonging that children desperately need for healthy development and recovery.
“This is the epitome of CTSD: shame, survivor’s guilt. Why them, not me?” Harfi added: “It is the mind that is still colonized, even if the body is physically removed from the violence.”
Back in the car, Najla was driving us to the American Veterans Memorial Pier in Brooklyn, where she had organized a kite-flying session for the children and other community members. Said opted out, as he did most days, preferring to spend the day playing basketball with Najla’s sons.
“That’s how he deals,” Najla told me. “He won’t even stay in the room if we turn on the TV, afraid he will hear the bombs off Al Jazeera.”
I watched Hanan, who was particularly thrilled by the roads, record videos of the scenery with her new iPad. On her face was an expression of wonderment at a world preserved beyond the flames of perpetual war and bombardment. Hanan looked forward to sending the videos to her father and other family members still in Gaza. “So they can see that the whole world doesn’t also look so dull. I swear, we forgot what the sun and a clear sky looks like. Listen to the birds!” she cried out. The girls ate chips while Najla tended to at least 30 unread chats about refugee relief on WhatsApp. “Welcome to a day in my crazy circus life.”
As we pulled up to the 25-foot-high memorial on the Brooklyn waterfront overlooking lower Manhattan, a group of people — some 30 children and their parents — awaited Najla, the organizer, who hurriedly removed the box of white kites and posters from her trunk. The kids sprinted to her, all waiting to choose their favorite ones. Without hesitation, Hanan pointed to the white kite coiled with green, black and red strings, then clapped her hands and launched it into the air almost immediately. Jihan stayed behind to keep a close eye on her sister.
She was only four years older than Hanan, but Jihan worried incessantly about her younger sister’s safety, afraid she might lose track of her amid the overwhelming crowd of kite flyers. “Please make sure we can always see her,” Jihan said. Najla reassured Jihan, so that she would release the protector’s burden and see that within it, joy too could be found. After all, Najla would later argue, that was her job now — and one she fully embraced.
For over two hours, Hanan immersed herself in the joyful pursuit, every movement radiating pure happiness. She darted through the crowded space, lost in the bustle of New Yorkers, the kite trailing behind her like a ribbon in the wind.
The weariness set in as soon as Hanan paused to catch her breath. She reminisced about lying in Gaza’s moist sand; those were special moments when she would gaze up at the sky where white kites flown by children seemed to dance like ghosts in the wind with the sun shining down on them and their feet anchored in the glistening sand. “It was so beautiful,” she said. On days when safety concerns kept them from the beach, the girls improvised by flying kites out of their window, a gesture to let those on the beach know they were with them in spirit.
I marveled at the sheer happiness that the simple act of flying a kite could generate for a child ravaged by war.
“This was our freedom,” she told me.
Hanan wishes she had some way of letting the kids in Gaza know that she is thinking of them. She is sure that one day they will return to play with kites on their beloved shores of Gaza.
“I have to believe,” she said. Najla silently nodded, her pencil-thin eyebrows descending toward her black, beetle-leg eyelashes: “Our beach was our only escape. Sometimes, our only hope.”
The sun had started to set, and Najla’s vision blurred with the onset of floaters, a recurrence she attributes to her many long days. Together, the sisters and Najla strolled back to the car, arms linked, ready to return to Najla’s house. The sky was sprinkled with black, red and green kites. Najla smiled.
“I was once them,” she said. “They don’t understand where they’re allowed to take up space in this world, to just exist. I do this work to remind them, and myself in the process, that hope comes with the fight and to find meaningful ways to live through this grief,” she said, speaking softly. “These are our wounds.”
Until this year, the Alashi siblings — Said, 16, Jihan, 15, and Hanan, 12 — were at school and knew only the routine of life in Gaza. The two sisters aspired to be artists.
Now they dream of mastering English, driving a car like their mother and becoming physicians so they can save the lives of people in Gaza.
The children’s parents were divorced. They lived with their father in Gaza while their mother, Dina Massoud, lived in Staten Island, in a cramped, sublet one-bedroom apartment that she shares with her new husband and their newborn baby. Crucially, she is a U.S. citizen. In November her ex-husband, who requested anonymity, called Dina, urgently requesting that she obtain the necessary paperwork from the U.S. Embassy in Egypt to evacuate him and their children from Gaza. She worried about organizing their departure, knowing that the journey to Rafah crossing was extremely dangerous. With the help of Najla Khass, 43, a Palestinian refugee coordinator in New York City, Dina decided to risk getting her family out; it was a decision, she understood, that would put her young children in direct contact with the Israeli army and what she described as their “draconian commands.”
Said, Jihan, Hanan, their father and his family evacuated their home in northern Gaza in December, along with another 1 million Palestinians, following the Israeli army’s orders to move south. For several weeks they sheltered at the Abdullah Bin Rawahah primary school near Deir el-Balah, waiting for Dina to arrive in Egypt. Each family at the school-turned-shelter was allocated one classroom containing six small twin-size beds.
Bodies were packed tightly, and men sleeping in opposite directions stretched their legs out toward the faces of the others, Hanan recalled. Some slept on desks or on the floor, covered only with light blankets. Hanan rose early each morning to join the long line for the limited bathrooms, a daily struggle that usually took two to three hours. Running water was limited, and the children lived in constant fear of being bombed. With United Nations Relief and Works Agency (UNRWA) aid and food trucks turned away from Rafah crossing in the south and at the Beit Hanoun border in the north, Hanan stored a single packet of vanilla Oreos she had found on the floor under her pillow, taking small bites each night. A few weeks later the Alashi family set out on the journey to Rafah, where the few Palestinians who have managed to obtain a permit can cross into Egypt.
“And just two days after we left the empty school, Israel bombed it,” Jihan said. “We made it out.” Later, she said, “I don’t know if that makes us lucky.”
The sisters described with expressions of horror the sight of large Israeli tanks on Salah al-Din Road, the north-south artery that leads to the Rafah crossing. It was the first time they had encountered Israeli soldiers and Jihan remembers the racing beat of her heart. “Here, feel,” she said as she took my hand. The girls recounted seeing many dead bodies strewn across the main road, as they inched closer to the crossing. Jihan said her heart rate surged each time her gaze met her sister’s. “The thought of anything happening to Hanan or Said or Baba [Dad] — I wouldn’t be able to bear it.”
Jihan frequently reenacts the maternal, protective role over her younger sister, a natural instinct she attributes to a childhood spent without their mother. That day in the car, her thumping heart rate was accompanied by sweaty palms and frantic recitations of verses from the Quran as they sat huddled in the car.
“We held our hands up in the air, waved the white cloth, and didn’t look [Israeli soldiers] in the eyes. We had to stare straight ahead,” Jihan said, adding, “If we wanted to survive, this is what we had to do.” Almost in unison, the girls said, “Some survive, others don’t.”
At Rafah crossing, an Egyptian officer informed them that their father would not be permitted to enter Egypt. Because he was divorced from Dina, he was not considered a member of her immediate family and so was not eligible for a crossing permit. He embraced his children and they said goodbye, not knowing when they would see one another again.
In Egypt, the Alashi children and Dina spent a month hotel-hopping in El-Warraq, a municipal district of Giza near Cairo. Once all the necessary paperwork for entry into the U.S. was prepared, the family was set to fly to New York on Jan. 8. During the long flight, all the girls thought about was Gaza: when they would next touch the granular sand of their cherished beach, where they had flown their white kites with friends and watched as the sunset painted hues of deep reds and pinks, or when they could next visit the bakery that served their favorite mango ice cream. Said wondered most about when they would next see their father and who would take care of him now that they were gone.
As Israel continues its relentless bombing campaign in Gaza, trauma experts from around the world have expressed deep concern about the devastating impact this war is having on “successive generations of Palestinian families,” Dr. Vivian Abouallol, the head of the steering committee at the USA-Palestine Mental Health Network said. The group of mental health professionals at the network identify the Israeli occupation as the sole cause of turmoil to the mental well-being of both “the Palestinian and the Israeli public.” As of this writing, the number of Palestinians who have been able to leave Gaza remains unclear, while the process is becoming increasingly onerous and costly. As of this writing, UNRWA estimates that up to 1.9 million people in Gaza have been internally displaced, or about 90% of the population.
Juliette Touma, director of communications at UNRWA, said that the current war in Gaza has, in addition to taking a death toll far exceeding that of previous wars, caused trauma on a scale worse than the intergenerational trauma that is the legacy of the Nakba in 1948, when the newly established Israeli army forced an estimated 850,000 Palestinians into what became permanent exile. When Touma visited Gaza with other UNRWA members in late October, she saw pain on a scale “unfathomable to the human mind.” She said the shock of it all keeps mourning Palestinians from crying. “It’s a reopening of an unhealed wound because many of them have either experienced the Nakba in 1948 or their grandparents have told them stories about it. For them to be forced to watch as their communities are bombed to rubble, forced to flee their homes and villages, or worse to evacuate their kids from Gaza entirely, is all part of revisiting that agonizing journey of exodus, of pain and no longer belonging.” What has transpired in Gaza over the past eight months, she adds, has created “the most destructive mental injury to the human brain, experienced by 2.4 million people, and these are just the numbers inside of Gaza.”
Najla El-Temawi Khass was born in 1980 in Shujaiyya, Gaza City’s largest neighborhood. This is where she lived when the First Intifada began in December 1987. By September 1988, riots and deadly military incursions had made the neighborhood unlivable; Najla’s parents left and settled in New Jersey, where they raised Najla and her five siblings.
Najla recalled that during the First Intifada, the Israeli army would raid the house of anyone suspected of violating the strict curfew. As an act of resistance, Palestinians would leave footprints in the sandy, unpaved streets; the Israeli soldiers would follow the footprints, raid the homes they led to and force their residents to show them their shoes. If children were caught, they were detained and tried in Israel’s military court system, which has a conviction rate above 99%, according to the Israeli army’s own records. Or they were kept in indefinite administrative detention.
“It was always little boys they wanted,” Najla said. “The goal has always been to dehumanize them. I understand now all their tactics to intimate and stoke fear.”
“One day, my eyes will speak. They will say they saw true horror. Worse than anything you can imagine,” she continued. “My ears heard it. My chest felt it. What’s happening in Gaza now is all very real to me.” She spoke softly as we sat down to drink our coffee. Her eyes wandered to a distant corner of her home in a penetrating stare, which occurred frequently when our conversations triggered memories of the Israeli military. Najla’s family is currently sheltering in displaced persons camps across Gaza. Her childhood home, which her parents had built, was demolished by an Israeli airstrike back in November.
Since settling in New York as a child, Najla has dedicated her days to serving as a full-time refugee coordinator with the Islamic Circle of North America’s ICNA Relief, a Muslim aid organization that provides services to victims of war and survivors of disaster, mostly from Palestine, Libya, Sudan and Iraq. Khalto (Auntie) Najla, as the kids call her, slowly became everyone’s aunt in her close-knit, predominantly Arab neighborhood in the New York City borough of Staten Island. The children she helped became something of a second family to her. “It’s the Palestinian way,” she said – a phrase she repeated often during our interview. “Keeping myself distracted is the only way I know how to survive,” Najla added.
The mental health crisis for Palestinians living in Gaza was already acute before Oct. 7, according to reports from UNICEF. Since 2006, Israel had imposed a military closure on Gaza, controlling everything from who and what entered or left the territory to the population registry and the daily allotment of electricity. The closure shaped entire generations that have grown up amid repeated cycles of violence, with military incursions, airstrikes and severely restricted freedom of movement. The Israeli military incursions as well as the constant surveillance and monitoring took an enormous toll; even before the current war, UNICEF estimated that at least 500,000 children in Gaza were in need of psychosocial support.
Caesar Hakim is a clinical psychologist who specializes in child and adult trauma. In addition to his private practice in Haifa he also lectures at the University of Glasgow. He was previously clinical director at the Guidance and Training Center for the Child and Family in Bethlehem. He treats patients with continuous traumatic stress disorder (CTSD) — a condition, he said, that is “radically unique” among classifications of trauma and is inherently rooted in every Palestinian’s experience.
Hakim treats patients in Haifa, Galilee, Jerusalem and the West Bank. Because Israel’s restrictions on movement make it impossible for him to see patients in Gaza, he offers remote assistance to psychologists there.
“Palestinians have long faced repeated danger,” Hakim said. “With no external protection systems to process any of their experiences, it throws them into a cycle of revictimization. It is far from what we can clinically describe as PTSD, where one’s fears are stuck in a traumatic loop, suggesting little to no likelihood of recurrence. In Palestine, that loop is reality. The threat is still there. It has always been there. This chronic, generational pain is the only breath most children have ever taken in Gaza.”
The term CTSD was first coined by South African writer Frank Chikane in the 1980s to describe the effects of apartheid on generations of children in South Africa. Children, he discovered, were particularly susceptible to developing CTSD from prolonged exposure to various forms of political repression, violence or systemic racism against their people.
The younger generation of children, Hakim says, is experiencing a resurgence of past traumas that they never had a chance to process. “What they need is stability — caretakers. Just imagine a child living in a world like this, when he was born, that there is no responsible adult to help them. Everyone is just focused on sheer survival.”
Hakim said that a significant number of his patients are increasingly reflecting on their past, with many expressing a strong desire to go back in time. “Patients come in with all the questions. They ask me: How can we live in a place like this? How can we take care of our families? Why am I here? How can I survive here?” He added: “Each one of them has his own story in his own personal life of how they lived this trauma over and over. And now it is all coming out. And they can’t avoid it, nor can they face it. There is nowhere to turn.”
The cornerstone of therapy, he says, is being able to provide a safe haven for those in need of security. For many of Hakim’s patients, his office serves as their sole sanctuary. The high rates of attempted suicide, according to Hakim, remain a daunting reminder that the Palestinian sense of alienation is everywhere amid the violent social, cultural and historical atmosphere of Israel today.
Ifirst met Said, Jihan and Hanan at Najla’s Staten Island home a week after they arrived in New York. The school day had ended and Najla, who had made a habit of picking them up each day, had just brought them home. Their mother, Dina, and I were sitting on the black leather couch in the living room as the children ascended the stairs, 16-year-old Said trudging up slowly behind his sisters and greeting me with uncertainty. He was a reserved, quiet young man with a towering posture and wavy dark-brown hair that framed his face. He did not raise his eyes to acknowledge my presence or engage in conversation. Instead, he walked silently, his feet tapping the light-orange wooden-paneled floor with the slow, uncertain steps of a man twice his age. His gaunt shoulders sagged underneath his gray hoodie as he moved, slowly but carefully, always pausing for balance before taking the next step.
Slumped in a beige armchair, legs extended, the 16-year-old became engrossed in his iPad, which Najla had gifted upon their arrival. “His head is always in that thing,” Dina said.
Before the children fled Gaza, their father had buried 12 of Said’s friends, all in the same month — a tragedy I discovered not until weeks later. I did not learn much about Said; he was withdrawn, averting his gaze when spoken to. I watched as Najla offered him a glass of water and he remarked: “Who’s getting Baba water now?”
Said remembers the last time he retrieved water for the family; he carried it alone from the well back to his home using carts laden with plastic containers. He was in Haraat al-Daraj, northwest of Gaza City, where he’d managed to acquire just two six-liter containers of briny water for four shekels ($1.10). This ration had to last his extended family of 50 for an entire week.
“Right now, you are in America, not Gaza. You can eat and get full, and you can even eat again after that,” Najla reassured Said, pushing a bowl of spicy macaroni and cheese toward him. The sisters refused meals that did not involve their ritual of sharing with one another, a reminder of their ceaseless struggle to procure food in Gaza’s ruins, where the act of eating alone was a luxury they could never afford.
They had become unaccustomed to tasty, wholesome food after subsisting for weeks on end on paltry meals — cans of tuna that had passed their expiration date, fava beans or ramen. “That’s all that we could find. The bread, if any, was moldy.” The girls were sometimes afraid to open the tuna cans because they had heard that some were booby-trapped with explosives.
Said was resolute in minimizing electricity usage as much as possible. That day, he walked around Najla’s home, vehemently switching off lights and unplugging unused appliances — from hair straighteners to iPhone chargers — a habit that was a legacy of Israel’s control over the electricity supply in Gaza, which was limited to four hours per day even before the war and then cut off completely on Oct. 8.
Jihan appeared slightly happier about the move than her two siblings did. Her hope, I learned, was in the power of academia. If they had stayed in Gaza and if there had been no war, she would have completed high school in al-Daraj, at the same school her mother, aunts and uncles had attended. “But I barely had the chance to start,” Jihan said. Her school was bombed just one month into the start of the academic year. She was most looking forward to her advanced art class, where she would learn how to create abstract canvases with oil paint. With her brother, Jihan is now enrolled at Wagner High School on Staten Island, where she has yet to forge any friendships that feel authentic. Stabraq, her best friend from Gaza, will never be replaced, Jihan tells me. “I hope she is still alive and that I can meet her again soon. We did everything together.”
“It is as if the war is not happening or people don’t seem to care as much here,” Hanan told me, referring to the school’s bleak social climate. Jihan added: “I still have nightmares. Of course I do. I can hear the sound of the bombs. But I keep it to myself. I am so lucky to be safe. To have escaped. Of course I don’t feel lucky, but I can’t complain. All I can do is work hard to achieve the grades I need to help my people.”
Dr. Samah Jabr, 47, grew up in East Jerusalem, which is occupied by Israel. For eight years she has been chair of the mental health unit at the Palestinian Ministry of Health in Ramallah, overseeing all mental health provision in the West Bank, Gaza and East Jerusalem. She said that all the traumatized patients she sees in her office show a strong lack of trust, belonging and hope in human relationships: “My patients tell me they are supposed to contain their pain inside their heart, no matter how distressed, to avoid the shame of sharing it,” she said. “Such reactions are not just limited to individuals. Attitudes like these have become generalized over generations in Palestine, forming a body of maxims and proverbs that communicate a loss of faith, pervasive fear of danger and an avoidance of disclosure for both men and women. These reactions are all barriers to their healing,” she said.
Jabr has conducted training sessions for hundreds of medical professionals in Palestine, Afghanistan, Libya and Jordan. Each day, she sees up to 30 people experiencing personality changes and emotional torment, often manifesting as physical ailments. Political trauma in Palestine is both “transgenerational and collective,” she said, adding that her unit has nearly reached its capacity.
“Even if we had the funding and professional resources to address this, how do we begin to solve a trauma that is man-made, deliberate and ongoing? It is a mistake to believe it is any easier, mentally, for the child when living abroad. We, as marginalized Palestinians, do not fit the current framework by which the West defines trauma.” There is no safe place to help them anywhere in the world, Jabr adds, so long as the root of the problem endures: the Israeli occupation. “Giving people who lost their humanity, who have been reduced to nothing, their dignity back is all part of the solution. Psychologists can’t do that alone. We need responses at state and international level. We need the rest of the world to stand with us.”
Samar Harfi is a licensed clinical psychologist in Illinois. She works with the Khalil Center, a Zakat Foundation project where her clinical approach focuses on traditional Islamically integrated psychotherapy. Harfi received the President’s Volunteer Service Award for her work with refugees and treating war-related trauma in 2012. She spoke to me about the Alashi children, who are “rare cases” she says, of civilians who have been able to flee since the onset of the war. She says that what they have been exposed to in Gaza will live inside them for a long time; they have lost the sense of belonging that children desperately need for healthy development and recovery.
“This is the epitome of CTSD: shame, survivor’s guilt. Why them, not me?” Harfi added: “It is the mind that is still colonized, even if the body is physically removed from the violence.”
Back in the car, Najla was driving us to the American Veterans Memorial Pier in Brooklyn, where she had organized a kite-flying session for the children and other community members. Said opted out, as he did most days, preferring to spend the day playing basketball with Najla’s sons.
“That’s how he deals,” Najla told me. “He won’t even stay in the room if we turn on the TV, afraid he will hear the bombs off Al Jazeera.”
I watched Hanan, who was particularly thrilled by the roads, record videos of the scenery with her new iPad. On her face was an expression of wonderment at a world preserved beyond the flames of perpetual war and bombardment. Hanan looked forward to sending the videos to her father and other family members still in Gaza. “So they can see that the whole world doesn’t also look so dull. I swear, we forgot what the sun and a clear sky looks like. Listen to the birds!” she cried out. The girls ate chips while Najla tended to at least 30 unread chats about refugee relief on WhatsApp. “Welcome to a day in my crazy circus life.”
As we pulled up to the 25-foot-high memorial on the Brooklyn waterfront overlooking lower Manhattan, a group of people — some 30 children and their parents — awaited Najla, the organizer, who hurriedly removed the box of white kites and posters from her trunk. The kids sprinted to her, all waiting to choose their favorite ones. Without hesitation, Hanan pointed to the white kite coiled with green, black and red strings, then clapped her hands and launched it into the air almost immediately. Jihan stayed behind to keep a close eye on her sister.
She was only four years older than Hanan, but Jihan worried incessantly about her younger sister’s safety, afraid she might lose track of her amid the overwhelming crowd of kite flyers. “Please make sure we can always see her,” Jihan said. Najla reassured Jihan, so that she would release the protector’s burden and see that within it, joy too could be found. After all, Najla would later argue, that was her job now — and one she fully embraced.
For over two hours, Hanan immersed herself in the joyful pursuit, every movement radiating pure happiness. She darted through the crowded space, lost in the bustle of New Yorkers, the kite trailing behind her like a ribbon in the wind.
The weariness set in as soon as Hanan paused to catch her breath. She reminisced about lying in Gaza’s moist sand; those were special moments when she would gaze up at the sky where white kites flown by children seemed to dance like ghosts in the wind with the sun shining down on them and their feet anchored in the glistening sand. “It was so beautiful,” she said. On days when safety concerns kept them from the beach, the girls improvised by flying kites out of their window, a gesture to let those on the beach know they were with them in spirit.
I marveled at the sheer happiness that the simple act of flying a kite could generate for a child ravaged by war.
“This was our freedom,” she told me.
Hanan wishes she had some way of letting the kids in Gaza know that she is thinking of them. She is sure that one day they will return to play with kites on their beloved shores of Gaza.
“I have to believe,” she said. Najla silently nodded, her pencil-thin eyebrows descending toward her black, beetle-leg eyelashes: “Our beach was our only escape. Sometimes, our only hope.”
The sun had started to set, and Najla’s vision blurred with the onset of floaters, a recurrence she attributes to her many long days. Together, the sisters and Najla strolled back to the car, arms linked, ready to return to Najla’s house. The sky was sprinkled with black, red and green kites. Najla smiled.
“I was once them,” she said. “They don’t understand where they’re allowed to take up space in this world, to just exist. I do this work to remind them, and myself in the process, that hope comes with the fight and to find meaningful ways to live through this grief,” she said, speaking softly. “These are our wounds.”
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