Mental health in conflict: ‘occupation therapy’ needed for Palestinians

The World Health Organization (WHO)
has recognised mental health as an essential component of health since 1946.
Yet, around the world, mental wellbeing is an underfunded, under-resourced and
largely misunderstood area of health provision. In extreme environments such as
war, the detrimental impact on civilian’s mental health is one of the most
significant consequences. Following recent events in Gaza and with the
Israel-Palestine conflict now in its seventieth year, Palestinian’s need for
adequate mental health services is a growing imperative.

Over fifty years of occupation
enforced by the Israeli Defense Force (IDF) has exposed Palestinians to
perpetual traumatic events including humiliation, imprisonment of youth,
torture, house demolitions, land confiscation, movement restrictions and
unemployment. These routine human rights abuses are continual and pervasive.
From apartheid road systems and checkpoints, to settlements and of course the
wall, the psychological
stress incurred by the occupation has left the population with
one of the highest rates of
mental health disorders in the Middle East.

Mental health workers across
Palestine treat a variety of symptoms that have manifested as a result of the
occupation. Israel has not fulfilled its international legal obligation as an
occupier to implement its own mental health act, leaving protocols as the
responsibility of individual psychiatrists, who are limited in number. In the
West Bank, just twenty-two are
trained professionals.

Unsurprisingly, trauma and anxiety
prevail as the most prominent effects of living in the occupied Palestinian
territories (oPt), with women and children suffering disproportionately from
mental health disorders. In Gaza, suicide rates have soared – grassroots NGO We
Are Not Numbers (WANN) noting 80
suicides per month in January and February 2016, an increase of
160 per cent compared to previous years.

For Palestinians, trauma is not a past
event – it is growing up in a continued traumatic environment with no end in
sight and thus individual diagnoses such as post-traumatic stress disorder
(PTSD) do not fit within the Palestinian context. In fact, placing such labels
on victims within this special context can do more harm than good. Individual
diagnoses strip individuals of their context and in the Palestinian case
vitally exclude the narratives of violation and injustice.

Hunaida Iseed, Director of the
Guidance and Training Centre for the Child and Family (GTC), believes the
normalisation of Palestinians’ experience of trauma in itself has negatively
impacted the mental health field. Iseed reports on the lack of commercial
interest in funding trauma and PTSD research because of the extent that it has
become an accepted part of everyday life in Palestine.

Mental health professionals depict
the challenges they face within the unique complex socio-political context of
the occupation. The narrative of violation and injustice emerges as integral to
the development of diagnosis. The clinical director of Bethlehem’s only mental
hospital Dr Ivona Amleh for instance, is currently guiding a transition from a
traditional medical model to one based more on recovery and empowerment – which
incorporates the way power and oppression work; what she describes as
‘occupation therapy’. Dr Amleh asserts the need for mental health workers to be
flexible, but shares the desire to shift towards specialising in order to
provide better services.

Public Health professor at Birzeit
University in the West Bank, Rita Giacaman helpfully frames the ongoing
conflict as a public health problem, which calls for an international response
to work towards political conflict resolution and the realisation of human
rights legislation. After all, psychological wellbeing is an intrinsic aspect
of the right to health; a point that was echoed by the UN Special Rapporteur
for the Right to Health, who stated, “there can be no health without mental
health and everyone is entitled to an environment that promotes health,
well-being, and dignity.”

Humanitarian aid and development
predominantly revolves around the basic physical needs of a vulnerable
population. Societies have been slow to progress with mental health provision
on a global-scale, and there is certainly a long road ahead before mental
wellbeing is treated as importantly as physical.

In Palestine, the deep US funding
cuts to the United Nations Relief and Works Agency (UNRWA) has left the
physical needs of Palestinians in dire short supply, but mental health services
must not go unaddressed. Psychological care must be integrated into primary
health care, so that professionals can specialise in the areas needed to treat
psychological effects of the occupation. More international mental health
professionals and institutions should partner with their Palestinian
counterparts to help deliver effective care programmes. For as long as the
occupation continues, Palestine’s health sector requires sustainable
development support from the international community so as to ensure that vital
infrastructure and services like local models of care are in place to better
respond to all health challenges of the population in need.