March 22, 2015 part two, No time to mourn

I first saw the spanking new administrative buildings for the Gaza Community Mental Health Program in 2005; ten years later there is a rusty shabbiness to the exterior but the people working inside are energetic and spectacular. The property fronts a road and then a glorious sandy beach and the crashing grey blue waves of the Mediterranean.  Young people cluster on the sand and horses gallop along the shore. The Israeli navy shelled this area last July and it was on a nearby Gaza beach that four boys, aged two to eleven, were killed by an Israeli gunboat in front of a group of horrified journalists during the last invasion.  In any other country, this would be a resort.

We gather in a conference room with the breath taking view and are greeted by Dr. Yasser Abu-Jamei, the psychiatrist and executive director who has taken the helm of the center since the death of Dr Eyad el Saraj.  He welcomes us warmly to “planet Gaza,” announces that it is “pizza time” (as in red and white checkered boxes containing Domino taste-a-like pizza) along with sweet orange and grape drink. No humus and pita?

After the kissing and compliments and the tribute to our strong partnerships, the serious talk begins. Yasser notes that “after the agony,” “people are walking around, they are not obviously in shock; people are carrying on; it is uplifting.” “This is a nation of survivors, there is no other chance.  We are under occupation.”  75% of Gazans are refugees and everyone is subjected to the siege. “This nation has no other choice, we are freedom fighters, we have all the international resolutions but that doesn’t change the fact that we are still under occupation.  We were subjected to three different offenses in six years and we are still under siege.  Construction materials are not allowed to get into Gaza; people who have totally lost everything are scheduled to get funds ‘later’ so the worse the damage the less the help.” He notes that “Israeli citizens are cheated by their leaders,” that the idea that “Palestine will be a danger to Israel is nonsense. Occupation will never continue forever, we will have our own state.”

Yasser is equally harsh on the topic of the conflicts within Palestinian leadership.  “We do not even have a pizza to fight over…. We are closed minded people, we need new leadership.”  He shares a current joke making the rounds of the Middle East: Netanyahu is a new *Arabic* leader, “He makes big high tone speeches with empty meaning!” When things get politically tight, he manipulates just to survive. Privately I think it would be more funny, if it were less tragic.

We are worried about how Yasser and the staff are doing after the July/August 2014 invasion. After the joking, “terribly good,” he describes 51 days of intense fear and insecurity for adults and children, the daily fear of death. The GCMHP staff were urged to stay with family until the cease fire, but staff called each other once or twice per week, “so we are like one family.” During a small truce, staff returned to work, small management teams stayed in direct communication.  When the war stopped, “our work started, everyone give help.”

They found an enormous basic catastrophe, but also worked to stay sensitive to the amount of intrusion people could tolerate. Visiting a devastated family may expose them more than is helpful, their privacy is gone, the wreckage of their home and their lives is too public. Despite a financial deficit the GCMHP continued to function.  Donations came in, capacity and referrals increased. Yasser explains that the challenge is that with this level of trauma the normal capacity of people to overcome horrendous experiences is crippled, the political conditions are not improving, the environment is not improving, there is no reconstruction, people are depleted, they have no coping strategies, and no hope for improvement.  This is a form of continuous PTSD (or as I like to say, it can’t be “post-traumatic stress disorder if it is not yet post.”

Despite all this pessimism, there are fundamental shifts in the US post the Gaza wars, in Obama, and in Netanyahu’s speech to congress.  Husam el Nounou, the administrative director, explains, “We are winning the battle over Israel, occupation, colonialism, racism, this will not prevail, everyone who comes here is changed.” Unfortunately, Palestinian politics is linked to regional politics, so there is much proxy behavior as well as influence between the US (via Saudi Arabia) and Iran.  “We Palestinians should have one Palestinian leadership that can agree on a national project. Interestingly, the GCMHP supports the Boycott, Divestment, and Sanction movement, “this is the most important thing, boycott as an occupation not as a state of the Jews. We have nothing against Jews for being Jews.  BDS is increasing internationally; this will result on political pressure.”

The big challenge is how to link mental health with human rights, a fundamental belief of the founder and late Dr. Eyad. International peace is the basis for Palestinian peace.  Husam explains that ISIS is filled with anger, frustration, desire for revenge.  In general people are heavily frustrated and hopeless and this is a recipe for violence which can take the form of violence against self, family, children and women, as well as communal and tribal violence, shootings in the neighborhood.  All of this is increasing, most of those who cannot express their anger are like a time bomb, “young, poor, hopeless is time bomb, easily maneuvered by more militant groups…the environment encourages this, we need to diffuse [the anger], open the borders, improve the economy.”

Yasser talks of intervening as early as possible, working in schools with students and teachers, with people who are subjected to oppression or bullies in school, teaching teenagers other ways to deal with anger, it is important to listen and hear,.  If someone is showing anxiety and depression, people need to talk, make themselves hear themselves and hear it in a different way. “Your ability is limited because the environmental conditions are so bad, with 40% unemployment overall, much higher in the 25-30 year old age group.”  He sees people are desperate, fleeing to Italy by sea.  “Is this suicidal or trying for better life, or join ISIS?” The media he notes is often less than helpful.  He notes that even Israeli generals are advising Netanyahu to lift the siege for the sake of the Israeli government.

But Syria, Yemen, Iraq, Libya, and Egypt complicate the picture and he is not optimistic.  Even when the border with Egypt opened up, 200,000 Gazans left to shop, see families, etc, but when asked to return, they complied. If all the necessary reconstruction materials were to reach Gaza and a vigorous Marshall-like Plan enacted, it would take ten years to rebuild, but otherwise the estimates are more like 50 years before an improvement in living conditions, barring further wars. Between dysfunctional Palestinian leadership, Israeli control, and Turkey’s wavering, political conditions do not exist that would allow a positive future; Gazans cannot even rebuild their destroyed homes.  Yasser is strongly in favor of the boycott, divestment, and sanction campaigns.

On a more personal note, Yasser explains that he lived in the UK, but returned to Gaza with his wife and children because, “this is my country and my children deserve to live in a dignified country where their grandparents live.”  He was born in Saudi Arab, but feels Gaza is “my land.” He talks of changing the very constructs of people’s mentality. “With a patient, I cannot offer something I cannot have for myself, I can only offer containment of fears and processing of trauma and direct him to a better future, get him back to school, help abusive parents, etc.” It seems to me, in Gaza the therapists are suffering at similar levels to their patients.

Husam relates a troubling story; he was driving his car ten years ago and there was a rocket that landed in front of him and his son, a huge BOOM. The child grabbed his neck, but Husam was able to reassure him and drive home.  Two days later the child developed symptoms of post-traumatic stress syndrome (PTSD).  Husam tried to help him.  I week later he told his father, “I want to die, I want to be a martyr. You cannot understand how you feel. I am a bad father, I cannot help my children, why?  What is the meaning of life if you can be killed for nothing? So kill and be killed for something.  I was in a big moment of confusion, it is good to die for home/people but it is much better to live for it. Need to convey this message, so containment and love from extended family and religious faith” is critical. He continues that in Islam, “it is said everything comes from God, and if it is good, be grateful, God will reward you.  If it is bad, be good and God will reward you.  This gives you strength and power. The lucky ones come to our clinics.  I am really concerned for the thousands who cannot come to our clinics.”

We ask, so how do providers care for each other? Yasser tells us a story of Hassan al-Zeyada, a staff member whose family was killed.  “It was something very unique.  I have 24 years of experience. I hear bombardments continuously.  You do not know who is dying and who is living. I had to maintain good internet connection and smart mobiles do the trick. They keep you all the time connected good and bad.”  When the IDF bombarded the compound with people, Hassan left immediately.” The family received a warning missile he explains pensively.  “I know that Hassan’s family lived there, born there, raised there, I didn’t know what to do… and the mobile phone was ringing…They all died of the shelling.  That was a question.  What to do.  The news was really shocking… it is very dangerous.  They were destroying everything, what to do?” He spoke with another staff member and then talked to Hassan. “I didn’t know what to say, I lost some of my cousins, but it is not like losing your mom.  I heard him breathing, and crying, I couldn’t speak.”

“‘Hasan, I don’t know what to say,’ Yasser said, ‘I know,’ some words you try to say; that was one of the most intense phone calls during the offensive.  I had to call, we have 65 staff, I try to call them all (every week or two). When the place is more affected than another, you start to worry.  We were thinking of creating toll free hotline operated by male and female hotline.  I picked the male, social worker, ‘How are you?’ ‘I am fine.  How is everything?’ Yasser finds that the colleague’s whole building is not there anymore, he is staying with colleagues, in the north of Gaza, (close to a dangerous area).” Yasser asks how can a staff person who has lost his house, “What would he offer someone? How could he contain the sorrows?”

Some staffers appreciated the phone calls and text messages, the attempts to stay in touch. But it was difficult to be the person making those calls. “I cannot never forget the moment that Hassan was on the phone.  I really couldn’t meet him until the truce….” “The other thing our receptionist, Osama Al Ramlawi, he lost his brother and his house was partially affected.  His brother was a member of our crisis team, a social worker after the second offensive (2012).  Yasser planned to hire him after the most recent assault.  “At least he could have some income, he has two children, he said it was early morning, they decided to leave the neighborhood of Shigaia. Ahmad decided to stay in a few minutes, he was standing in front of his house doing nothing.  He was killed at that moment by shrapnel and suddenly he was not there and it happened after Hassan…”

“I left one day pass, gathered myself and I called him, I know what happened, I couldn’t come to you, there nothing we can do.  We talked about religion, Osama was weeping. His twin brother, that brother used to bring happiness to the family and I remember…. So suddenly Ahmad is not there.”  Osama had an extremely difficult time, “we stayed with him, more than once, he needed lots of support.   A few months ago [his wife] gave birth to a boy and they named him Ahmad, after the brother who was killed.  So you live with such people, you work with such friends, and you have community but you have no other chance but to go on.”

We discovered that it was impossible to observe a traditional mourning period due to the Israeli assault, “because they were targeting any gathering immediately, like praying in a mosque, going out together and it happens like that they were bombarded, no mourning at all took place.  My grandmother died, 95 years old for natural reasons, she passed away, we took her from the hospital to her daughter’s house and then to the cemetery, everything happened in 10-15 minutes.  People were targeted in the cemetery.” Yasser explains, “that something delays the processing of PTSD, because even natural ways of grief and closure does not take place, people couldn’t say goodbye to the dead.” He feels “crazy but I come to work everyday.  We have one million nine hundred thousand crazy people.”

Husam adds that the desire for life, family, and religion along with the responsibilities and supports of family have kept the Palestinian community from collapsing over the past 70 years. “The bad effects of trauma, trauma makes you stronger and stronger, for sure there is something changed in you, more power to cope with the difficulties in your life.”  His grandmother is from Lod, (now Lyd in Israel) and his mother was born in Yaffa. His family fled south and he remembers the stories of the Egyptian refugee camps, and life in Gaza.  “You have these memories born in the camps, had to face the difficulties, the trauma, the poverty, at the end they are different, they are strong, they have an innate capacity to survive.”

Yasser questions, “What could we do? If people here are given the chance to become productive, things will become a thousand times better, but it is unfortunately not allowed.” He reviews the growth in Jewish settlements in the West Bank and East Jerusalem, “It is not logical.”

Husam adds that peace is critical and that when it comes to genuine politics, the details of the right of return for Palestinian refugees to return to their homes is negotiable.  Every Palestinian knows they can never go home,” even his 75 year old mother does not want to return to Jaffa because she has children and grandchildren, but an acceptable compromise needs to be developed. Netanyahu’s recent election does not bode well for Palestinians, “He is a fox, a liar, excellent with making money and it just got better.”

According to the Gaza Community Mental Health Program website:

Dr. Yasser Abu Jamei has reportedly lost 28 members of his family when an Israeli air strike on July 21 flattened the house in which they were gathered for the evening meal at the end of the daily Ramadan fast.

Other GCMHP staff members who have reportedly also suffered personal losses include Hassan al-Zeyada, Osama Al Ramlawi, and Marwan Diab.