Mahmud Hams/AFP/Getty Images

Gaza’s kids affected psychologically, physically by lifetime of violence

Al Jazeera asks medical experts about the psychological, physical and generational effects of war on Gaza’s youth

Click here for the latest news and analysis.

Beyond the immediate loss in Gaza — destruction of property, infrastructure, and the deaths of more than 1,600 people, mostly civilians — Israel’s onslaught will have long-term mental and physical effects on the Palestinian children who survived weeks of airstrikes and naval and tank shelling. 

Many of them watched as family members were killed and homes, schools and mosques bombarded. Others suffered life-altering injuries. Israel’s military campaign may also affect the unborn, as mothers and fathers struggle with traumatic stress, health experts warn.

Psychological impact

Even before the current military offensive, young Gazans bore the mental scars of years under siege and previous episodes of bombardment. After the 2012 war, the rate of post-traumatic stress disorder (PTSD) among children in Gaza doubled, according to the United Nations Relief and Works Agency, which provides assistance for Palestinian refugees. Mental health experts fear that the latest bombardment may create detrimental repercussions too difficult for children to overcome.

Jesse Ghannam

Palestinian children in Gaza are exposed to more violence in their lifetime than any other people, any other children, anywhere in the world. If you look at children right now who are 10 years old, they’ve been through Cast Lead in 2008 and 2009, the invasion in 2012 and now the invasion and destruction in 2014, in addition to the siege. If you look at the statistics, for example, even before Cast Lead, 80 percent of Palestinian children in Gaza have witnessed some sort of violence against them, a friend or a family member. And now you’re getting to the point where probably close to 99 percent of children in Gaza are being exposed to a level of violence where they have seen family members be killed, murdered, burned alive. There’s nothing like the levels of traumatic exposure that any child in the world has ever been exposed to on a chronic and daily basis.

We can rebuild a broken bone, but when it comes to rebuilding someone’s psychological integrity, this is something that the people in the West and the Israelis don’t understand. They’re creating psychological damage for these kids that will be with them for the rest of their lives.

The psychological damage makes it difficult to function, to be successful in school, to have relationships with friends and family, to take care of yourself and at a more profound and deeper level — when we’re talking about creating a solution for the Palestinian-Israeli conflict and the West wanting peace between the Israelis and Palestinians — they aren’t growing up interested in peace and wanting to make things better. They just grow up deeply traumatized and very distraught and angry.

Brad Parker, international advocacy officer and attorney, Defence for Children International, Palestine

Brad Parker

Children in Gaza are traumatized. They’re suffering trauma from killing that they witnessed, maiming that maybe they themselves suffered, the injuries that they see around them. They’re traumatized by loss of their family members, by the fact that their homes have been destroyed, that they’re displaced and living in a shelter with a bunch of strangers.

With conflicts and displacements, there tends to be an increase in instances of child abuse and violence and things that make children even more vulnerable to abuse and other violations of their rights. The bombing is one thing, but it leads to a variety of other challenges for child protection.

Jennifer Leaning

You’ve got a situation where grandparents, parents and uncles are already very stressed, and that would show in a number of ways: depression; certain clampdowns of emotions; and a tendency to get very upset at small incidents.

All of this really has an impact on kids growing up. They’re realizing that their entire structure for safety and protection is not doing very well.

I would say that in all studies of disaster and in war crisis, the fundamental feature that protects the children from serious psychological stress is their certainty and their confidence that their parents or grandparents will be able to protect them and hold them. If they can get the sense that the parent is OK, then they will be able in the long-term. In the short term they may be upset, but in the long term they will be OK.

You have now complete disruption of the very structures for psychological stability of the parents, and grandparents are also suffering greatly.

It will be important for — as soon as possible — stability to be restored and the parents to get it together for themselves to create a sense of confidence in themselves for their children. But I think the odds of that are not high for two reasons: One is there’s going to be ongoing violence and lingering uncertainty for some time in Gaza, even if there is hopefully a cease-fire that can be arranged. The worry will continue on the part of the adults and the children will remain terrified and unable to relax, literally and figuratively, in the arms of their family.

And then secondly, the parents and grandparents and others themselves, are in no psychological position to be able to convey that umbrella of hope and safety for the children. The resilience of the Palestinian population in general is not going to be as deep or robust as any of us want it to be and certainly as they would want it to be, just because this have been extraordinary series of acute stress on top of chronic stress.

Dr. Jumana Odeh, director, Palestinian Happy Child Centre

It’s tough for our children here in the West Bank too. For example, if a child with autism comes with his parents to be treated, they have to deal with several checkpoints first. It’s not easy to get around, and lately it has become more complicated. So this affects them and their parents.

I also noticed lately that some kids — say, one with Down syndrome — are afraid to move because they fear being burned alive like Mohamed Abu Khdeir. So everybody knows that seeing traumatic, bloody or sad events — even through television — can traumatize children. They watch it on TV, they see it going from one place to another crossing checkpoints, and they hear it from their parents, from their grandparents. If we talk about PTSD, here it is a continuous PTSD, and this is the most dangerous and the most painful, because we don’t know how this will affect the future generations. It is difficult to think of the future when children are under fire, especially in Gaza. There’s no place to run, no place to hide.

Physical impact

For more than 7,300 people, including many children, recovering from injuries will be challenging, as the siege on Gaza also affects medical facilities. Leaning warns that many of the injured won’t survive, adding to the 300-plus children killed, or will be left with chronic complications.

Jennifer Leaning

Leaning: The hospitals there are valiantly overwhelmed and short of supplies, and in those situations they inevitably have to perform triage. They can operate only on people whose injuries are within the skill set of the doctors and the capacity operating rooms have and nurses to treat.

There are people who are coming into these hospitals with traumatic wounds from the bombings and machine-gun fire, who in a well-equipped and highly skilled or emergency area in the West would survive. But in these hospitals, they won’t survive because there’s just not the capacity to care for these extremely extensive wounds. There are more people dying of wounds in Palestine now than there would be if they had a stable and fully equipped trauma center.

The wounded range from being rather minor to chronic. And the Gaza Strip at the moment does not have the capacity to handle chronic wounds. You can’t keep people in the hospital for long because it’s overrun by new injuries. Nursing care is very short.

A number of these people who are wounded are going to have difficulty surviving over the longer run. They may have left with wounds to be cared for at home, but taking care of those injuries is a skill situation. Another point is that people need to be in one place to heal. They are running from places. That’s very difficult, and there are very few safe havens for people where they could rest for a week and have their bones knit or their abdominal wounds begin to close or their head injuries not reopen. I worry that there is going to be a significant number of people with longer-term disabilities because they have not been treated adequately or taken care of enough in the immediate term.

The number of dead and the number of wounded convey a false impression that the wounded are going to be OK.

Jesse Ghannam

Ghannam: Palestinian children in Gaza are on what the Israeli military leadership has called a starvation diet. You have almost 80 percent of Palestinian children living on less than $1 a day. They’re at levels of what we would call poverty and extreme poverty, with extensive food insecurity. That’s just another way of saying that most Palestinian children in Gaza go to bed hungry every day, so their caloric intake has been significantly reduced since the siege began within the last seven years. In addition to the reduced number of calories they take in, the kind of nutrients they’re getting is also decreased, so what we see is this medical phenomenon called stunting, which results in lower birth weights for Palestinian children. Their average birth weight is going down. Their height and weight are below what you would consider basic international norm values for children that age.

People pay attention to Gaza only when bombs are dropping on their heads, but when I was there in December, I was devastated to see the kind of food insecurity, the lack of nutrition, the kind of starvation that Palestinian children have to suffer on a daily basis. And this is an Israeli policy. The policy is to let in only so much food. Not enough to kill people, but it’s a slow death. You see it in Palestinian children.

Impact on the unborn

In addition to Gaza’s children who are experiencing the war, even children who are not born yet may suffer. Radioactive materials in Israeli bombs may cause birth defects and abnormalities for years to come, according to researchers who studied Israel’s previous military campaigns in Gaza.

Paola Manduca, professor of genetics, University of Genoa, Italy

Paola Manduca

In Gaza we learned that among the population with children born with birth defects, if you compare them with those who are born normal, regardless of other factors, in the ones with birth defects the mothers reported exposure to white phosphorus, white phosphorus and bombing or bombing in Cast Lead in 67 percent of the cases.

One very important thing we learned from a study conducted two years after Cast Lead was that children born two years after the operation — therefore the mothers in the next year or so before becoming pregnant were not directly exposed to ammunition — still were constant correlation. That can be because the mothers were continuously exposed to a toxicant, which is compatible with the fact that the mothers have been staying in the same place as when Cast Lead occurred. Most of the people have fixed their houses or cleaned the mat from the rubble and used the materials to rebuild them.

There’s not much space in Gaza to go and build somewhere else. So if contaminants were in the ground, the contaminants would have stayed there. Of course, contaminants that may have been there will stay in the environment and in the body of the people who got contaminated, which persist in the organisms and stay in the organisms.

We already studied and knew that toxicants and teratogens — that is, substances that can cause reproduction malformation — were present in the land and in the weaponry used in Gaza. These metals were at one point in people who were wounded by different kinds of metals. So we studied, and eventually, if the children with malformation were in fact contaminated by teratogen or toxicant metals, we found very specific contamination for some elements in children with birth defects different from the children born premature and different from the normal births. High levels known to be teratogenic were found in the birth defects of children that were not found in premature children.

Find Al Jazeera America on your TV

Get email updates from Al Jazeera America

Sign up for our weekly newsletter

Get email updates from Al Jazeera America

Sign up for our weekly newsletter