Mental health toll of Israel-Gaza conflict will leave lasting damage, medics say

Children, frontline healthcare workers and families sheltering from rocket attacks will need psychological support

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  At UN headquarters in New York City, Rachel Zeitchik, right, and Jay Zeitchik attend an event for families of Israelis kidnapped by Hamas. AFP

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  Palestinians flee from northern Gaza towards the south after the Israeli army demanded the population of more than a million people leave before a ground invasion. AP

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  Demonstrators at a rally in support of Palestine face a counter-demonstration in support of Israel near Times Square in New York. EPA

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  Palestinians flee from northern Gaza to the south after the Israeli army issued an evacuation warning. AP

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  An injured man is rescued from the rubble of a building following an Israeli airstrike in Rafah, Gaza Strip. AP

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  Mourners take cover as sirens sound during the funeral of Tom Godo, killed during the attack by Hamas militants on the Kibbutz Kisuffim last week, in Kibbutz Naan near Tel Aviv. AFP

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  A Palestinian man flashes the victory sign as he and others leave northern Gaza before an expected Israeli ground offensive. AFP

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  Palestinians head south with their belongings after being ordered by Israel to leave northern Gaza on Friday. AFP

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  Israel ordered more than a million Palestinians to head south within 24 hours. Reuters

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  The UN criticised the directive, saying forcing such a large number of people to flee en masse would be catastrophic. Reuters

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  Gazans have to travel about 15km if they live in the northernmost part of the strip to reach the area south of the Wadi Gaza. Reuters

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  The UN said that more than 423,000 people have already fled their homes in the territory, with a sizeable number making the more than 10km journey on foot. Reuters

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  Palestinians with their belongings flee to safer areas in Gaza City. AFP

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  An Armoured Personnel Carrier drives near Israel's border with the Gaza Strip. Reuters

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  Supporters of Iraqi Shi'ite cleric Moqtada al-Sadr gather for mass Friday prayer during a protest in solidarity with Palestinians in Gaza, in Baghdad, Iraq. Reuters

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  A Palestinian woman waits to cross into Jerusalem's Old City through Damascus Gate next to Israeli soldiers. AFP

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  Israeli army infantry fighting vehicles deploy along the border with the Gaza Strip in southern Israel. AFP

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  Israeli soldiers detain a man while on patrol near Kibbutz Beeri, near the Gaza Strip. AFP

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  Students hold in a rally in support of Palestine at Columbia University in New York. Getty Images

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  Family and friends mourn Valentin Ghnassia, 23, who was killed in a battle with Palestinian militants at Kibbutz Beeri near the Israeli border with the Gaza Strip. Getty Images

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  A ball of fire erupts in Gaza city after an Israeli air strike. AFP

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  Palestinians inspect the rubble of buildings hit by an Israeli air strike at Al Shati refugee camp. AP

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  A fireball erupts from an Israeli air strike in Gaza city. AFP

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  People waiting for news of victims outside the morgue at Al-Shifa hospital in Gaza City. AFP

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  A girl mourns the death of members of the Samour family, who were killed in Israeli strikes on their house in Khan Younis in the southern Gaza Strip. Reuters

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  Israelis arrive to sign up at a weapons distribution point for people allowed to carry arms, at the Ayyelet HaShahar Kibbutz in northern Israel, near the Lebanese border. AFP

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  Mourners outside the morgue at Al-Shifa hospital in Gaza City as battles between Israel and the Hamas movement continue for a sixth consecutive day. AFP

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  Men dig graves to bury members of the Samour family, who were killed in Israeli strikes on their house in Khan Younis. Reuters

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  Palestinian children who fled their homes during Israeli strikes, play at a United Nations-run school in Gaza City. Reuters

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  Israeli soldiers near a self-propelled howitzer near the border with Gaza in southern Israel. AFP

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  Israel's Foreign Minister Eli Cohen, left, welcomes US Secretary of State Antony Blinken upon arrival at Israel's Ben Gurion Airport. AFP

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  Palestinian children in a makeshift shelter at Al-Shifa hospital in Gaza City. Reuters

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  Boxes of humanitarian aid and supplies from Jordan Hashemite Charity Organisation destined for Gaza, in Amman, Jordan. Reuters

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  Palestinians outside Al-Shifa hospital in Gaza City on the sixth day of fighting between Israel and Hamas. AFP

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  A pro-Israel vigil in Montevideo, Uruguay. EPA

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Children under four exposed to violence inside the war zones of Israel and Gaza have a greater risk of suffering long-lasting psychological damage, medics have said.

Healthcare workers dealing with battlefield injuries, as well as families sheltering from rocket attacks with young children, are also most likely to need psychological support.

Dr Maya Bizri, a clinical psychiatrist and global mental health consultant in disaster psychiatry in Beirut, said the psychological risks to people exposed to violence were two-fold, especially in children under four.

“There is a risk of post-traumatic stress disorder (PTSD), even if there is only indirect exposure to trauma,” she told The National.

“This is especially true for children who have had history of adverse childhood events, regardless of the type of previous trauma, such as neglect, bullying or physical violence.

“There are also non-war related studies that look at the risks of just social media violence – a topic that has been controversial for years.”

Millions of people have been exposed to horrific images by internet video.

Dr Bizri said that exposure to violent media can cause aggressive thoughts and behaviour, angry feelings, physiological arousal, desensitisation to violence and a view of the world or other people as hostile.

Every Israeli and Palestinian has some form of PTSD

Sarah Tuttle-Singer,
42, Israel

“It also decreases prosocial behaviour, such as helping others and empathy,” she said. “Again, this is not necessarily pertaining to war itself.”

More than 1,500 people in Gaza have been killed in six days of Israeli strikes, while Saturday's Hamas attack on Israeli settlements killed about 1,300 people. The majority of the dead on both sides were civilians.

Children in Israel have been told to delete social media apps to shelter from videos showing Israeli residents being shot at point-blank range, the massacre of revellers at a music festival and the abduction of young children and the elderly.

Home petrol bombed

Sarah Tuttle-Singer, a 42-year-old mother of three and author from California, has been living in Israel since 2010, and in Jerusalem since 2018.

Since the outbreak of violence, her home has been petrol bombed.

“There was no major damage or injuries, but the psychological impact is pretty tremendous,” she said.

“Most of the apartments don't have safe rooms, our building doesn't seem to have a safe place to go.

“We've always felt like Jerusalem was fairly safe because there are holy sites here, but not any more.”

Her family lives in a flat in southern Jerusalem, close to an access road that leads into the desert and the West Bank.

Schools have been shut across Israel since the first Hamas attacks on Saturday.

Ms Tuttle-Singer is worried about the conflict's impact on her three children – a baby boy, her 14-year-old son and daughter, who is 15.

“The impact is severe, but we don't quite understand it yet because we’re still living this,” said Ms Tuttle-Singer.

“I still have PTSD from the 2014 war. Every Israeli and also every Palestinian has some form of PTSD I’m sure.

“When things settle down, it's probably going to hit my children in a very real and painful way.

“Luckily here in Israel, online psychological services are offering free treatments.

“Therapists are working at a discounted rate in order to help kids and parents cope.”

Mental health support

The kind of mental health support framework in place across Israel is far from a priority in Gaza, where two million people are battling for survival, without power or running water.

An evacuation of north Gaza ahead of an impending ground invasion from Israeli troops will compound the trauma of many who have been under intense shelling for days, with more than 6,000 bombs already unleashed.

Dr Marc Sinclair, a Dubai-based specialist paediatric orthopaedic surgeon, was among six volunteer medics working for the Palestine Children’s Relief Fund who were trapped inside Gaza during shelling in May.

He now fears for the mental welfare of children forced to flee their homes, and medics inside the enclave.

“I've been going there for 12 years, so I have a lot of sympathy with the doctors working there,” said Dr Sinclair.

“These children cannot go anywhere and they see this every one to two years, so the psychology for them is huge.

Dr Marc Sinclair has been working for the Palestine Children’s Relief Fund in Gaza for 12 years. Photo: Dr Marc Sinclair

“More than half the children in Gaza are clinically depressed, but I think the number is actually more like two-thirds.

“Children self-harm because of the stress, and it's horribly upsetting.”

Without the luxury of widespread hospitals and clinics, psychological support for those in need will be in short supply, Dr Sinclair said.

“Psychological counselling is a specialty that requires repeat visits, a process that needs time,” said Dr Sinclair.

“If we're going to have volunteer psychologists that are available remotely on Zoom, where you can book appointments and talk to them, maybe that's a good thing.

“The need is there, there's no question.”

Frontline carers at risk

Mental pressures are also taking a toll on frontline healthcare professionals.

Despite being the first line of care for those with battlefield injuries, medics at Sheba Medical Centre in Tel Aviv, Israel's largest hospital, have struggled to come to terms with the unfolding carnage.

Yoel Har-Even (middle) director of Sheba Global at Sheba Medical Centre in Tel Aviv, where medics have treated hundreds of people since the conflict began. Photo: Sheba Medical Centre

Yoel Har-Even is director of Sheba Global at the centre, where more than 200 people have been treated since the latest conflict began.

“The most senior staff at our hospital are ready to see and treat such events – but we are all human beings,” he told The National.

“At the end of the shift, when you have a few minutes to think about what has happened, you get flashbacks on the way home or even when you are trying to get some sleep.”

The hospital has support services to help, including social workers working with staff and senior physicians who are debriefed every morning.

“You develop a resilience while you are working in such an area, in such a country,” said Mr Har-Even, who served in the army medical corps for 28 years.

“I heard one of the doctors say to me, as tough as it is for him to deal with, working on wounded patients is actually therapy for him.

“He's saving a life and he's putting people back together again. That makes him feel good.

“If he had to think about everything he had to deal with, it would destroy him.”