Health care and children in crisis in Gaza

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For years, children have been exposed on a daily basis to heavily armed Israeli military personnel and tanks threatening them on the streets.

The children of Gaza are in crisis.

In spite of the removal of the Israeli settlements and permanent army bases from Gaza in the summer of 2005, Israel continues its occupation. According to a report by an Israeli-based legal rights group, Gisha, Israel continues its control over Gaza's air space, its waters, its borders, the movement of goods and people, the taxation system and the population registry.

After the 2006 election in Gaza, Canada was one of the first countries to withhold world funds from the Gazan authorities. This has left the population in a terrible situation.

Gaza is one of the most densely populated areas in the world. In an area of only about 365 square kilometres there is a population numbering about 1.25 million. Three-quarters of the population is living in poverty. Forty per cent are unemployed. Food and water supply are precarious and sewage treatment is totally inadequate.

According to Dr. Robert Horton, editor of the Lancet, in a recent article in the New York Review of Books, there are desperate shortages of medical specialists. Diagnostic facilities are unavailable to large sections of the population and procurement of medicine is difficult.

Over 60 per cent of the population in Gaza is under the age of 18. As a result of the ongoing and escalating conflict, children are showing increasing symptoms of stress and depression. According to a survey of children conducted by the Gaza Community Mental Health Program (GCMHP) and published in 2004 by the World Psychiatric Association, a vast majority of children under the age of 11 suffer with significant multiple symptoms that have been identified with “post-traumatic stress disorder.”

Increasing numbers of children have been observed to be bedwetting as old as nine or ten years of age and severely disrupted sleep and night terrors are common. Moodiness, anxiety and hyperactivity are other behavioural manifestations of extreme stress in these children.

Since the year 2000, more than 5000 houses have been demolished in Gaza. In fact, of the children surveyed by the GCMHP, 99 per cent have experienced a shelling of their home. The loss of home has an enormous impact on children. Home is associated with security and comfort. Israeli forces also often raid and vandalize homes. Children, witnessing the powerlessness of their parents to protect them against these acts are left feeling insecure and anxious.

The survey also reveals that 96 per cent of children have witnessed shooting, fighting or explosions often resulting in the death and injury of civilians. Sonic booms — the incredibly loud and distressing sound of the supersonic flight of military planes similar to thunder — have become an increasing feature of Israel's occupation. The Israeli air force carries these out over populated areas especially at night and in the early morning. Physicians for Human Rights-Israel and the Gaza Community Health Program petitioned the Supreme Court of Israel demanding these flights be halted.

For years, children have been exposed on a daily basis to heavily armed Israeli military personnel and tanks threatening them on the streets. Children have had to cross random military checkpoints on their way to school and have had their schools attacked with gas and live ammunition.

The term post-traumatic stress disorder is not really valid here because there is no “post” for these children — the trauma is ongoing and pervasive. Health care providers are trained to deal with emotional trauma using the supportive and protective factors in a child's life. In the Gaza situation it is difficult to find these factors. Fundamentally there is no safe place.

These days one hears a lot about the Canadian soldiers in Afghanistan who are adults who have been specifically trained for warfare. Yet many of them are traumatized by the experience of seeing comrades injured or killed, or suffering injuries or danger themselves. The trauma goes on, long after the experience has ended and they are back in a place of safety. How much worse then for children who witness and experience these events day after day, week after week with no end and with no place of safety.

As Canadian health care professionals, we are deeply troubled by the situation and worried for the future of the people of Gaza and especially these children. What will the long-term effects be of this endless trauma? What can we, as Canadians and health care professionals, do about it?

Resilient health care providers on the ground, like Dr. Mona El-Farra and Dr. Eyad El Sarraj, have been struggling to provide adequate grassroots primary health and mental health care in Gaza for years against these mounting odds. We have worked with a group of Palestinians and Jews in Toronto to organize a fundraiser to support the health care operations in which these physicians are involved. We are also insisting that the Canadian government restore and indeed increase its funding to Gaza.

We also demand that Israel stop its continued methods of collective punishment of civilians in direct contravention of international law. Ultimately there can be no solution to this horrific situation until there is an end to the military occupation of Gaza and the West Bank, which continues and indeed escalates, despite the 2005 pull-out of Israeli settlements.

There is both a public health and mental health crisis unfolding in Gaza at a breakneck pace. As human beings, as Canadians, as Jews and Palestinians, we all have a moral obligation and vital stake in protecting these children and giving them access to a viable future. The alternative is unthinkable.

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