Gaza teenager with complex PTSD highlights war’s impact on children

UNRWA psychiatrist says psychological disorders caused by Israel’s war will become more common among Palestinian children

A girl stands by the rubble of a building that was hit by Israeli bombardment in Rafah, southern Gaza, in October 2023. AFP

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The sound of a child crying, a plane overhead or an argument may not upset most people but for Palestinian teenager Deena Zaghout they are enough to start her sobbing and send her into convulsions.

The 17-year-old's reaction is the result of trauma experienced over the course of the war in Gaza, her family and her psychiatrist say. After the war began in October 2023, her family fled their home in Al Karama, northern Gaza, because of Israeli bombing. They have moved 12 times since, fleeing air strikes and ground fighting in Israel's war on the Palestinian enclave.

"Deena would be very afraid and starts screaming 'strike, strike' for about two hours, until she gets tired and sleeps," her mother Nehaya Zaghout, 36, told The National.

Two months into the war, Deena was diagnosed with complex post-traumatic stress disorder (PTSD). As a result, her mental age has dwindled to that of a five-year-old child, her doctor said.

"It is a defence mechanism. Her childlike behaviour is a result of the trauma, as if it were a regression to a stage of life in which she used to live safely," said Dr Khaled Milad, a psychiatrist who treated Deena when her family was living in Rafah, southern Gaza.

Shortly after leaving their home, the family moved into an apartment in Nuseirat, central Gaza. Deena's younger brother Saeed, nine, had gone out to buy groceries when an air strike hit the building opposite. She fainted, thinking Saeed had been killed.

"She’s very protective of him and he’s her only brother," said Ms Zaghout. "She fainted for the first time and when she woke up we showed her that her brother was alive and well."

After this incident, Deena was plunged into a state of constant fear and anxiety, and began screaming, crying, fainting, locking her limbs and convulsing whenever she heard a loud noise nearby, especially the sound of planes or air strikes. Sometimes, even the memory of past events is enough to trigger sheer panic, her mother said.

"In this state, I treat her as if she is five years old," Ms Zaghout said. "Her little brother tries to comfort her. She brings him to her and hugs him because she gets scared for him."

At these times, Deena can fail to differentiate between her family members, sometimes mistaking her uncle for her father, her mother said. "The hardest feeling is when you see your daughter suffering in front of your eyes and you can’t do anything for her. I hope no other human feels what I feel."

The diagnosis

With Ms Zaghout's consent, The National viewed Deena's medical reports and spoke to her psychiatrist for a full picture of her diagnosis.

"Deena was exposed to several traumatic incidents near her during the war, which led to her suffering from many symptoms, including disturbing nightmares about the events, difficulty concentrating, outbursts of anger, remembering painful memories and a tendency towards isolation," said Dr Milad, who works for the UN agency for Palestinian refugees (UNRWA).

These come on top of epileptic seizures she has had since she was younger, which have become more frequent because of her trauma, he added.

The criteria for a PTSD diagnosis is exposure to a life-threatening traumatic event and persistent symptoms for at least a month afterwards, he said. In Deena's case, she is diagnosed with "complex PTSD", meaning prolonged exposure to traumatic events after the initial distress.

"There are many cases that resulted from this war and most of the children of Gaza suffer from symptoms of fear and anxiety, behavioural changes, acute stress disorder, frequent urination, agitation, irritability, difficulty sleeping and coping," he said.

He said psychological conditions such as depression, anxiety and PTSD would become more apparent in children and their caregivers after the war ends.

"This war, in the long term, will directly affect children who have been subjected to forced displacement, continuous and indiscriminate bombing, the sounds of bullets, destruction, terror and loss," he added.

Dr Milad said children such as Deena can recover but a long process of psychological treatment including medication, with continuous follow-up and social support.

Coping never easy

Before the war, Deena was an introvert who loved studying and dreamt of becoming a nurse, but over the past year her condition has worsened. She has not been able to see a psychiatrist for seven months after her family moved to Deir Al Balah in central Gaza, where they now live.

"Doctors said that she needs to be in a calm, quiet and safe place, but honestly there is no safe place in Gaza," Ms Zaghout said. "She also needs sessions and professionals to talk to, but the hospitals don’t have time for cases like these ... they [have to] treat the physically injured."

Deena's family often take her to hospital for sedative injections but Ms Zaghout says this is only a temporary fix that will not help her recover, but could hurt her in the long term.

She hopes that Deena can eventually leave Gaza for treatment. "I hope someone can take her outside [of Gaza] for treatment so she can get better. The most important thing is her treatment."