From surviving hours under the rubble to constantly cowering from incessant air raids, Gaza's one million children face the traumatic consequences of war ravaging their home.
“When we brought him to the hospital he was unconscious and we thought he was dead,” said Basma Manoun, at the bedside of her seven-year-old son.
Zaid, whose eyes are ringed with bruises, was playing outside in the Jabaliya area when the building next door was bombed. He suffered serious injuries, including a fractured skull, bleeding on the brain and a broken femur.
On a ward in Gaza City’s Shifa hospital, toys sit idly while he struggles to lift himself. Zaid talks little and in a whisper.
“He needs psychological treatment,” said his mother, 27, who is worried that he cannot remember what happened.
Yasser Abu Jamei, director of the Gaza Community Mental Health Programme, said even those who escaped physical harm were affected by the urban warfare.
"People were simply exposed in different areas, on different days, to a continuum of this very large bombardment," he told The National, describing a "feeling of imminent death".
"Your nervous system was extremely alert, there was no pause. There was no capacity for people just to hold their breath, not even to be able to tell your children that everything is going to be OK," Dr Abu Jamei said.
Although the air strikes have ended, Gaza is littered with the ruins of buildings that were once offices or homes. The absence of the children killed also ricochets through society.
"They not only belong to families, but they go to schools, they have friends, they have colleagues, they have teachers, they will be remembered all the time," Dr Abu Jamei said.
"They are not just numbers, these are real human beings who had lives," he said.
In Gaza City, Abbed Al Rahman, 10, said he was sad about two girls who were killed in his neighbourhood.
He was being hugged by his father in their high-rise apartment when strikes flattened the adjacent residential block. More than 40 people were killed, according to health officials.
“It’s not a good feeling,” he said, a few metres from the rubble. “I can’t play when there’s bombing.”
Nearby, a passerby said children had become afraid of car doors slamming and vehicles that sounded like incoming fire. His nephew was rendered speechless after one attack.
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A Palestinian man plays with a child among the ruins of a building destroyed during recent Israeli bombing in Rafah, in the southern Gaza Strip. AFP -
Damage at an agricultural fertilisers factory hit in recent Israeli air strikes, in Beit Lahia. AFP -
A Palestinian girl in the rubble of her family house in Beit Hanoun town, in the northern Gaza Strip. EPA -
Palestinians gather round a fire between their destroyed homes in Beit Hanoun in the northern Gaza Strip. EPA -
Life goes on among the ruins of buildings destroyed during recent Israeli bombing in Rafah, in the southern Gaza Strip. AFP -
An agricultural fertiliser factory targeted in recent Israeli air strikes, in Beit Lahia. AFP -
The view from a damaged shop in a building partially destroyed by recent Israeli air strikes on Gaza City. AFP -
A Palestinian woman makes coffee in the kitchen of her destroyed house in Beit Hanoun, northern Gaza Strip. EPA -
Debris litters an area of Beit Hanoun hit by an Israeli air strike during an 11-day war between Gaza's Hamas rulers and Israel. AP Photo -
A Palestinian boy recovers his toys from the rubble of his house in Khan Yunis in the southern Gaza Strip. AFP -
Beit Hanoun neighbours gather in a clearing strewn with debris from an air-strike before a ceasefire that halted the 11-day war in Gaza between Hamas and Israel. AP Photo
"[When] he hears any strong sound, he is shocked and so afraid," he said.
Just days after the ceasefire came into effect, staff at the Gaza Community Mental Health Programme were seeing the impact among children.
Parents report their children are having stomach aches and other pains in their body, as a physical manifestation of their trauma. Others have started wetting the bed, or waking up screaming.
Suzy Ishkontana, 7, was trapped under the rubble of her home for hours after an attack that killed her mother and four siblings.
“Sometimes she’s woken up during the night and cried,” said her father, Riad Ishkontana, whose hands are bandaged after he was rescued from the ruins.
“When I asked her about her experience while she was under the rubble, I asked her: ‘Who did you see? Who did you hear? Did you hear anyone?’ She keeps silent,” he said.
"I think that maybe she saw something under the rubble and she is afraid to talk about it," Mr Ishkontana said.
After the walls of their home caved in, Suzy may have heard her brothers and sisters.
"I heard my children calling me from under the ground: 'Daddy, Daddy, Daddy'," Mr Ishkontana said.
“It was dark and I was alone, and I was hearing the voices of my children, one by one, go silent,” he said.
Since the attack, Suzy shies away from strangers and is distant from
her father. She asks where her mother is.
"I don't have any psychological support," her father said. "Maybe there is someone who can tell me what are the suitable conversations to have with my child."
A fourteen-year blockade imposed on Gaza by Israel and Egypt has impoverished the enclave's health sector, with few doctors to meet the needs of the community.
The situation is compounded by the four wars fought with Israel since 2008, in addition to cross-border skirmishes that remind children of the wars.
"There isn't enough support for such a place, because I think we are experiencing what is called a national disaster," Dr Abu Jamei said.
“We are extremely under-resourced,” he said.
Gazans can visit community centres or call a helpline for support, while doctors have run social media and television campaigns to inform the public about trauma.
But there is no end in sight to the cause of the mental health crisis, since peace talks between Israelis and Palestinians faltered years ago.
"Unfortunately, we expect the worst," said Dr Abu Jamei, who is bracing for diagnoses of post-traumatic stress disorder and other illnesses in the weeks to come.
In Shifa hospital, Zaid lies propped up on a pillow and briefly smiles. He may soon be discharged, but his physical and mental recovery will take months, possibly years.
It will depend on the help that he receives, as well as whether he is exposed to further violence.
"I have to be strong so I can give him strength," his mother said. "So he can carry on."
