There's nothing 'post' about traumatic stress in Gaza

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It is a cold, wet and windy evening in Vancouver as I prepare this article on my recent visit to Gaza. I am sitting inside, with heat and light that comes from a reliable energy source.

In Gaza it is also cold, wet and dark but there basic infrastructure is all but devastated. Power is unavailable for eight to 20 hours of the day. Streets are flooded. Medicine is in short supply and unemployment is the highest in the world at 43 per cent. Many live under tarps in the ruins of their bombed-out homes.

Last summer's 53-day military assault on the besieged Gaza Strip ended on August 26, 2014. It was Israel's third major military assault on Gaza in six years. The ferocity of that bombardment was beyond what anyone there had ever experienced. 2,205 Palestinians were killed, including 536 children. 1,800 children were made orphans. 17,000 homes were completely destroyed or severely damaged. A half million people (of a total population of 1.8 million) were displaced at the peak of the war.

95,000 people in Gaza remain homeless today.15 hospitals, 16 public health clinics and 83 UN schools were damaged. This devastation occurred within the context of an ongoing blockade that severely restricts movement of people and goods. Many speak of Gaza as being the world's largest open-air prison. Seeing life there, one understands that this is not a metaphor.

The chokehold on Gaza moved into its tenth year in 2016. The suffering born of a decade of human rights violations, poverty and three full-scale military assaults creates a psychological toll on the population which is inestimable. Homelessness, absence of freedom of movement, chronic water and electricity shortages, multiple deaths within families, severe injuries, and the ever-present threat of renewed Israeli bombardment create a psychological climate of ongoing continuous, collective trauma. As a clinical psychologist, I wondered how the population coped amidst this catastrophe and what form of assistance I could provide.

Post-traumatic stress disorder, as a clinical term, barely touches the enormity of the disabling psychological distress that permeates the reality of daily life here. There is nothing "post" about a continual, unrelenting, multifaceted catastrophe.

There is also no "disorder" in the sense that there is an intrapsychic disease requiring individualized treatment. The abnormality is the unabated war crimes that inflict suffering on the imprisoned, helpless civilian population. The rest of the world, moreover is turning its back on this political violence and is thus enabling the trauma-inducing occupation and blockade to continue. 

Mental health professionals in Gaza are strained beyond capacity. Of the nearly two million residents of the 360-sq. km area Gaza Strip, there isn't a single person here who has not experienced multiple traumas. Continuous grief, nightmares, disabling anxiety and hopelessness colour everyone's daily life. The therapists charged with healing these injuries are themselves victims of living in this traumatogenic environment.

Their burden is thus two-fold: the trauma they share with their clients is compounded by repeat exposure to their clients' own clinical material.  

An opportunity arose for me to join the January 2016 Washington Physicians for Social Responsibility delegation to Gaza. In prior consultation with my Palestinian mental health colleagues, the idea gradually evolved so that I could provide assistance by addressing the vicarious, secondary trauma that mental health professionals there struggle with. In one workshop I led for 10 therapists, four had their homes demolished and three spoke of having family members killed in last summer's massacre. Overlay on top of this traumatic loss, the painful events their clients unfold all day, and the magnitude of the psychologists' burden is clarified.

The aim of our training seminar was to introduce burnout prevention skills and the relevant literature on trauma and psychological resilience.  Cognitive behaviour therapy, behavioural self-care, self hypnosis, journal writing and  peer supervision for ongoing social support were among the therapeutic skills reviewed.

In an attempt to keep the material culturally relevant and subjectively meaningful, we created a relaxation script in Arabic for each participant using personally generated healing imagery. The visualization was then recorded by each therapist onto their mobile phones to be available as their tailor-made "portable" stress management strategy.

Moreover, as the political and the clinical are interwoven, we expanded the idea of "to exist is to resist" to include "resistance is resilience." Resisting oppression was conceptualized as adaptive coping in that it is a psychologically healthy way to counter hopelessness and promote resilience in face of adversity -- both for the psychologist and for the client.

The inverse is also true. Practicing self-care promotes resilience, which is an act of resistance. ("I will maintain my psychological health in spite your efforts to annihilate my self and culture".)

It didn't take long for a trusting environment to be established and for people to share details of their own experiences of trauma. We worked with this material as a way to model the therapeutic value of peer support, to learn new clinical skills, and to help cognitively integrate and in turn release some of the accumulated emotional pain that comes with living and working here. We plan to continue working together via Skype.

I learned much from my Palestinian mental health colleagues and am grateful for having met this extraordinary group. May the time come soon when the root cause of this trauma is ended and we can begin to truly speak of healing post traumatic injuries.

In this country we can play a part in ushering in a new era where Canadian foreign policy upholds its obligations under international and humanitarian law. The ever-expanding segregated colonies built on stolen land in the West Bank are illegal and continue to disposes Palestinians of their own land. The ongoing, near-total blockade of Gaza is a criminal, man-made humanitarian disaster. Schools, clinics and homes devastated in last summer's bombardment remain piles of rubble. 

In spite of being imprisoned in their besieged enclave, Gaza's youth are well educated and are keenly aware of the world around them. Their university may have been bombed, but the students remain intellectually vibrant and motivated. They spoke to me with hope and optimism about the election of Prime Minister Justin Trudeau.

One graduate student told me how her friends are hopeful that this new government will help end their long-standing suffering and work towards creating a new era of freedom and justice. Let's not extinguish their newfound spark of hope and pressure our elected officials to demand that Israel end its illegal, oppressive and indeed traumatic polices against the People and Land of Palestine.

Ending the military occupation is the foundation for both peace and security. 

John Soos, PhD is a Vancouver-based clinical psychologist and social justice advocate. He recently returned from Gaza, Palestine where he consulted with mental health professionals on the topic of vicarious, secondary trauma within the context of ongoing political violence.

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