~tasha~
Age: 124
Total Posts: 47628
Points: 0
Location:
United Kingdom, United Kingdom
May, 2007
Samah Jabr exposes the damage done to the emotional health of Palestinians
by the Israeli occupation.
Ahmad, a 46-year-old man from Ramallah, was doing well, until his last
detention. But this time he just could not tolerate the long incarceration
in a tiny cell, with complete visual and auditory deprivation. First, he
lost his orientation to time. Then he became over-attentive to the movement
of his gut and started thinking that he was ‘artificial inside his body’.
Later, he developed paranoid thinking, started hearing voices and seeing
people in his isolated cell. Today, Ahmad is out of his detention, but still
imprisoned by the idea that everyone is spying on him.
Fatima spent several years doctor-shopping for a combination of severe
headaches, stomach-aches, joint pain and various dermatological complaints.
There was no evidence of any organic cause. Finally, Fatima showed up at our
psychiatric clinic and spoke of how all her symptoms started after she saw
the skull of her murdered son, open on the stairs of her house, during the
Israeli invasion of her village of Beit Rima on 24 October 2001.
Such are is the cases I see in my clinic. The traumatic events of war have
always been a major source of psychological damage. In Palestine the kind of
war being waged needs to be understood in order to appreciate the
psychological impact on this long-occupied population. The war is chronic
and continuous, over the lifetime of at least two generations. It pits an
ethnically, religiously and culturally foreign state against a stateless
civilian population. In addition to daily oppression and exploitation, it
involves periodic military operations of usually moderate intensity. These
provoke occasional Palestinian fractional and individual responses. The vast
majority of people are never consulted about such actions. While their
opinion does not matter, it is they who must endure pre-emptive Israeli
strikes or collective punishment in retaliation.
Displacement
Demographic factors complicate the picture. Those living in the occupied
territories make up just a third of Palestinians; the rest are scattered
around the region in a Diaspora, many in refugee camps. Almost every
Palestinian family has experiences of displacement or major painful
separation. Even inside Palestine, people are refugees, expelled in 1948 to
live in refugee camps. The massive displacement of 70 per cent of the
people, and the destruction of over 400 of their villages, are referred to
by Palestinians as the Nakba or Catastrophe. This remains a
trans-generational psychological trauma, scarring Palestinian collective
memory. Very often, you will encounter young Palestinians who introduce
themselves as residents of towns and villages their grandparents were
evacuated from. These places are frequently no longer on the map, either
razed entirely, or now inhabited by Israelis.
Palestinians perceive Israel’s war against them as a national genocide, and
to resist it they give birth to many children. The fertility rate among
Palestinians is 5.8 - the highest in the region. This leads to a very young
population (53 per cent under the age of 17) – a vulnerable majority, at a
crucial stage of physical and mental development. The geographical enclosure
of Palestinians in very small neighbourhoods, with the separation wall and a
system of checkpoints, encourages consanguineous marriages, increasing a
genetic predisposition to mental illness. Walling off friends and neighbours
from each other also has a debilitating effect on the cohesion of
Palestinian society.
But it is the violent environment in which they live which most undermines
the mental health of Palestinians. Population density, especially in Gaza -
with 3,823 persons per square kilometre - is very high. Elevated levels of
poverty and unemployment - 67 per cent and 40 per cent respectively -
undermine hope and deform personality. The war has left us with a huge
community of prisoners and ex-prisoners, estimated at 650,000, or some 20
per cent of the population. The handicapped and mutilated make up six per
cent. Recent screenings found a disturbing level of anaemia and
malnutrition, especially among youngsters and women. The intense emotional
hostility provoked by our daily friction with the Israeli soldiers at our
doorsteps is a constant stress factor. Many Palestinian kids have been
living with daily violence since birth. For them, the noise of bombardment
is more familiar than the singing of birds.
Sudden blindness
During my medical school training in several Palestinian hospitals and
clinics, I saw men complaining of non-specific chronic pains after they lost
their jobs as labourers in Israeli areas; school children brought in for
secondary bed-wetting after a horrifying night of bombardment. My memory of
a woman, brought to the emergency room suffering from sudden blindness that
started when she saw her child murdered as a bullet entered his eye and went
out from the back of his head, remains all too vivid.
In Palestine, such cases are not registered as war injuries and are not
treated properly. This realization provoked me to specialize in psychiatry.
It is one of the most underdeveloped medical fields in Palestine. For a
population of 3.8 millions, we have 15 psychiatrists and are understaffed
with nurses, psychologists and social assistants. We have an estimated three
per cent of the staff we need. We have two psychiatric hospitals, in
Bethlehem and Gaza, but it is difficult to get to them, due to checkpoints.
There are seven outpatient community mental-health clinics. In developing
countries like occupied Palestine, psychiatry is the most stigmatized and
the least financially rewarding medical profession. Psychiatrists work with
desperately sick patients and, in the eyes of their communities, are far
removed from the glory of other medical specialties. As a result, competent
and talented doctors rarely specialize in psychiatry.
I find psychiatry a humanizing and dignifying profession – not least because
it helps me personally to cope with all the violence and disappointments
surrounding me. I move from Ramallah to Jericho to see psychiatric patients.
In one working day I see between 40 and 60 patients; 10 times the number I
used to see during my training in Parisian clinics. I observe my patients’
disorganized behaviour, listen to their overwhelming stories and answer them
with the few means I have: a bit of talking, to pull together their
fragmented ideas; some pills that might help them to organize their
thinking, stop their delusions and hallucinations, or allow them to sleep or
calm down. But talks and pills can never return a killed child to his
parents, an imprisoned father to his kids, or reconstruct a demolished home.
The ultimate solution for mental health in Palestine is in the hands of
politicians, not psychiatrists. So, until they do their job, we in the
health professions continue to offer symptomatic treatment and palliative
therapy - and sensitize the world to what is taking place in Palestine.
Resistance
Nowadays, Palestinians are pressured to surrender once and for all, when
they are asked
