Occupation and the Mind
- Dr. Samah Jabr exposes the damage done to the
emotional health of Palestinians by the Israeli
Occupation and the Mind
by Dr Samah Jabr
The New Internationalist
Ahmad, a 46-year-old man from Ramallah was doing well, until his last
detention. But this time he just could not tolerate the long
incarceration in a tiny cell, with complete visual and auditory
deprivation. First, he lost his orientation to time. Then he became
over-attentive to the movement of his gut and started thinking that he
was 'artificial' inside his body.
Later, he developed paranoid thinking, started hearing voices and
seeing people in his isolated cell. Today, Ahmad is out of his
detention, but still imprisoned by the idea that everyone is spying on
Fatima spent several years doctor-shopping for a combination of severe
headaches, stomach-aches, joint pain and various dermatological
complaints. There was no evidence of any organic cause. Finally,
Fatima showed up at our psychiatric clinic and spoke of how all her
symptoms started after she saw the skull of her murdered son, open on
the stairs of her house, during the Israeli invasion of her village of
Beit Rima on 24 October 2001.
Such are the cases I see in my clinic. The traumatic events of war
have always been a major source of psychological damage. In Palestine
the kind of war being waged needs to be understood in order to
appreciate the psychological impact on this long-occupied population.
The war is chronic and continuous, over the lifetime of at least two
generations. It pits an ethnically, religiously and culturally foreign
state against a stateless civilian population. In addition to daily
oppression and exploitation, it involves periodic military operations
of usually moderate intensity. These provoke occasional Palestinian
fractional and individual responses. The vast majority of people are
never consulted about such actions. While their opinion does not
matter, it is they who must endure pre-emptive Israeli strikes or
collective punishment in retaliation.
Demographic factors complicate the picture. Those living in the
occupied territories make up just a third of Palestinians; the rest
are scattered around the region in a Diaspora, many in refugee camps.
Almost every Palestinian family has experiences of displacement or
major painful separation. Even inside Palestine, people are refugees,
expelled in 1948 to live in refugee camps. The massive displacement of
70 per cent of the people, and the destruction of over 400 of their
villages, are referred to by Palestinians as the Nakba or Catastrophe.
This remains a trans-generational psychological trauma, scarring
Palestinian collective memory. Very often, you will encounter young
Palestinians who introduce themselves as residents of towns and
villages from which their grandparents were evacuated. These places
are frequently no longer on the map, either razed entirely, or now
inhabited by Israelis.
Palestinians perceive Israel's war against them as a national
genocide, and to resist it they give birth to many children. The
fertility rate among Palestinians is 5.8 - the highest in the region.
This leads to a very young population (53 per cent under the age of
17) - a vulnerable majority, at a crucial stage of physical and mental
development. The geographical enclosure of Palestinians in very small
neighbourhoods, with the separation wall and a system of checkpoints,
encourages consanguineous marriages, increasing a genetic
predisposition to mental illness. Walling off friends and neighbours
from each other also has a debilitating effect on the cohesion of
But, it is the violent environment in which they live which most
undermines the mental health of Palestinians. Population density,
especially in Gaza - with 3,823 persons per square kilometre - is very
high. Elevated levels of poverty and unemployment - 67 per cent and 40
per cent respectively - undermine hope and deform personality. The war
has left us with a huge community of prisoners and ex-prisoners,
estimated at 650,000, or some 20 per cent of the population. The
handicapped and mutilated make up six per cent. Recent screenings
found a disturbing level of anaemia and malnutrition, especially among
youngsters and women. The intense emotional hostility provoked by our
daily friction with the Israeli soldiers at our doorsteps is a
constant stress factor. Many Palestinian kids have been
living with daily violence since birth. For them, the noise of
bombardment is more familiar than the singing of birds.
During my medical school training in several Palestinian hospitals and
clinics, I saw men complaining of non-specific chronic pains after
they lost their jobs as labourers in Israeli areas; school children
brought in for secondary bed-wetting after a horrifying night of
bombardment. My memory of a woman, brought to the emergency room
suffering from sudden blindness that started when she saw her child
murdered as a bullet entered his eye and went out from the back of his
head, remains all too vivid.
In Palestine, such cases are not registered as war injuries and are
not treated properly. This realization provoked me to specialize in
psychiatry. It is one of the most underdeveloped medical fields in
Palestine. For a population of 3.8 million, we have 15 psychiatrists
and are understaffed with nurses, psychologists and social assistants.
We have an estimated three per cent of the staff we need. We have two
psychiatric hospitals, in Bethlehem and Gaza, but it is difficult to
get to them, due to checkpoints. There are seven outpatient community
mental-health clinics. In developing countries like occupied
Palestine, psychiatry is the most stigmatized and the least
financially rewarding medical profession. Psychiatrists work with
desperately sick patients and, in the eyes of their communities, are
far removed from the glory of other medical specialties. As a result,
competent and talented doctors rarely specialize in psychiatry.
I find psychiatry a humanizing and dignifying profession - not least
because it helps me personally to cope with all the violence and
disappointments surrounding me. I move from Ramallah to Jericho to see
psychiatric patients. In one working day I see between 40 and 60
patients; 10 times the number I used to see during my training in
Parisian clinics. I observe my patients' disorganized behaviour,
listen to their overwhelming stories and answer them with the few
means I have: a bit of talking, to pull together their fragmented
ideas; some pills that might help them to organize their thinking,
stop their delusions and hallucinations, or allow them to sleep or
calm down. But talks and pills can never return a killed child to his
parents, an imprisoned father to his kids, or reconstruct a demolished
The ultimate solution for mental health in Palestine is in the hands
of politicians, not psychiatrists. So, until they do their job, we in
the health professions continue to offer symptomatic treatment and
palliative therapy - and sensitize the world to what is taking place
Nowadays, Palestinians are pressured to surrender once and for all,
when they are asked to 'recognize' Israel. We are asked to accept,
reconcile ourselves with and bless the Israeli violation of our life.
The fact that our homeland is occupied does not, by itself, mean that
we are not free. We reject the occupation in our minds, as far as we
can cope with it; and learn how to live in spite of it, rather being
adjusted to it. But, if we recognize Israel, we are mentally occupied
- and that, I claim, is incompatible with our wellbeing as individuals
and a nation. Resistance to the occupation and national solidarity are
very important for our psychological health. Their practice can be a
protective exercise against depression and despair.
Israel has created awful facts on the ground. What remains for us of
Palestine is a thought, an idea that becomes a conviction of our right
to a free life and a homeland. When Palestinians are asked to
'recognize' Israel, we are asked to give up that thought, and to
renounce everything we have and are. This will only sink us deeper
into an eternal collective depression.
After several years in Paris, I returned to a tired, starved
Palestinian people, torn apart by fractional conflicts as well as by
the separation wall. Palestinians are especially demoralized by the
infighting taking place on the streets of Gaza, but orchestrated
elsewhere in order to abort the results of last year's democratic
elections. Those who have stopped all money from going to Palestine
are, in effect, sending us guns instead of bread. They encourage the
psychologically and spiritually impoverished to kill their neighbours,
cousins and ex-classmates. Even if the factions settle up, Palestinian
society will be left with a serious problem of intra-family revenge.
We shall overcome
It is hard not to wonder whether Israel's targeting of Palestinians is
deliberately designed to create a traumatized generation, passive,
confused and incapable of resistance. I know enough about oppression
to diagnose the non-bleeding wounds and recognize the warning signs of
psychological deformity. I worry about a community forced to extract
life from death and peace through war. I worry about youth who live
all their lives in inhumane conditions; and about babies who open
their eyes to a world of blood and guns. I am concerned about the
inevitable numbness chronic exposure to violence brings. I fear also
the revenge mentality - the instinctive desire to perpetuate on your
oppressors the wrongs committed against yourself.
There has yet to be a comprehensive epidemiological study of the
psychological disorders in Palestine. And, despite all that is
published on Palestinian war-related psychopathology, my impression is
that mental illness is still the exception in Palestine. Resilience
and coping are still the norm among our people. In spite of all the
home demolitions and extreme poverty, it is not in Palestine that you
find people sleeping in the streets or eating from trash cans. This
resilience is based on family foundations, social steadfastness and
spiritual and ideological conviction.
Still, we do have a mental-health emergency. Services are urgently
needed for people who have suffered and endured crises so that they
can restore their recuperative powers and coping capacities. This is
crucial if they are not to crack when peace finally comes, as so often
occurs in a post-war period. It is not just at a small number of sick
individuals but an entire wounded society that needs care. Our trauma
has been chronic and severe, but by recognizing our suffering and
treating it with faith and compassion, we shall overcome.
Dr. Samah Jabr works as a psychiatrist in occupied Palestine.
Ophthalmic team treats refugees in Lebanon
On May 19, Dr. Francis Nathan, an ophthalmic surgeon from Australia,
and Baillie Brown, a nurse from the USA, arrived in Lebanon to begin
a week of treating refugees in the camps suffering from cataracts.
This is their third mission to the Middle East through the PCRF this
year, as they did missions in Nablus, the West Bank earlier in the
year. They are working at the Haifa Hospital in the Bourj Al
Barajnah refugee camp in Beirut. Despite the fighting around the
Nahd El Barad refugee camp in the north of Lebanon, the team
continues to provide humanitarian services for the refugee population
in Lebanon, who are suffering in Lebanon due to poverty and
discrimination as refugees.
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