Prepared by the Rights for Time Network Palestine strand

Headlines grabbing attention this week obscure the reality of the long-times of violence and trauma in Gaza. In this post, we showcase an excerpt from a forthcoming report prepared with our Rights for Time Network partner, Palestine Trauma Center UK (PTC).

Photo courtesy of the Palestine Trauma Center UK, showing a bakery in the central Gaza Al-Nuseirat refugee camp on 5th March 2020. The bakery’s massive fuel store–meant to ensure consistent bread production during regular power outages caused by a crumbling grid infrastructure and insufficient supply– exploded, causing fires that killed 25 people and injured 58. Many nearby shops were also completely burned.

In Gaza, the health emergency is made worse by realties of occupation, siege, isolation, a crumbling service infrastructure, global pandemic, unavailability of vaccines, but also intensified airstrikes and a military massing on the regularly patrolled walls and fences that demarcate the Gaza Strip.

Our report examines the adaptation of Mental Health programming designed to best assist the community in Gaza, where harm is ongoing, layered, complex, and intersecting. The case studies for this project include records of patient experience, their narratives of why they need help, and what was effective during their program participation. While the report ultimately declares the Mental Health work of the center a success, that success will do nothing to prevent further harm to their community under the current circumstances.

The things that are happening today in Palestine and Israel—while on a larger scale—have been happening for decades, and in variations for generations. As Palestinians remind us, by focusing on the ‘current crisis’ we fundamentally miss the point that history of evictions, occupation, and intimidation is long and sustained.

Usually, none of this is ‘news’. None of this qualifies for crisis intervention, because a crisis needs to be time limited, it needs to be boiled down to a single cause. Here, in the case of an ‘escalation’ in Israel and Palestine, the problem is (almost always) identified as a crisis of ‘violence.’

But as work at PTC (UK) testifies, the issues are not just about today’s violence, but precisely about generations of oppression and inequality.

With this background, we share one case study from our project with the PTC. It is the story of Amal (not her real name). Her story is the norm for the clients referred to PTC. While the details may differ, the process of accumulation, the way that experiences of harm overlap, are interconnected, are personal, but always link back to insupportable life conditions—these are the same for just about everyone the organization works with.


Amal is 28. She is a wife and stepmother to a young daughter from her husband’s previous marriage. Her parents died within a year of each other in 2008, of treatable kidney conditions. Treatments were unavailable in a crumbling and underserviced medical sector. Amal cannot have children of her own. She and her husband and stepdaughter live in extreme poverty (as more than half of the population of Gaza), in an area regularly targeted by airstrikes (since 2008 491 have been killed by strikes outside of ‘major hostilities’). Her marital home was destroyed by one of these strikes in 2014 (along with 1,500 other homes). Amal was referred to PTC in October 2020, her in-person sessions were cancelled when the Coronavirus broke out in the Gaza Strip and hit its first peak in December 2020. At this point her husband lost his job. During the program Amal contracted the novel coronavirus, suffered moderate to severe symptoms, and intense fear that she would infect her remaining family members. She continued her program with PTC online during her isolation.

At her pre-assessment interview, where all referred clients narrate in their own words their ‘condition’’ and the reason they are seeking help, Amal identified the most difficult thing she was dealing with as the loss of her father, who died of a kidney disease a few years after she married. She told her course leader (and the PTC staff member who carried out her pre-assessment) “I was unable to forget my father’s death; the memories of the funeral still remain with me. The pictures of medicines and bleeding are still images firmly in front of my eyes.” Her mother died not long after. She described nightmares and physical pain that manifested in her feet, and a desire to avoid locations that reminded her of her parents’ death. For Amal, their deaths meant the early disappearance of a family security network. This, for her, had been vital, because after her marriage life became even more precarious.

Their home was destroyed in 2014 (during the last massive Israeli military operation targeting Gaza). During the shelling she mentions almost offhand, “We took shelter in a neighbour’s house and remained to live there in a state of disruption, insecurity, but also safety after the bombing of our house.” This insecurity reminded Amal of the loss of her parents: again, she was left without a firm back-up unit of support if anything were to happen to her current family unit. With no family in Gaza, there is no final backup. Amal has a double loss here as she also in a sense unable to ‘create’ her own family (the primary social care network), due to infertility. In her pre-assessment interview Amal mentions an anxiety about this, as after several years her and her husband had been unable to have children. She looks back on her life with her parents—before their deaths, her marriage and discovered infertility, and also the string of bombardments on the Gaza Strip—as a time and environment of “love and respect.” So, Amal feared and avoided all the things that made her feel precarious: old neighbourhoods, homes, cemeteries, and even extended family gatherings where she would be reminded of her infertility, the loss of their home, or her parents.

The practitioners at PTC assessed Amal as suffering with an “overwhelming accumulation of psychological and physical stress symptoms.” As Amal described it: “Blackness had begun to haunt my thoughts and feelings and everything that beats with joy (c. 2014). When I started to feel a bit better [taking part in the program], I was infected with Coronavirus. My relationship with my family became stressful and full of fear.” The coronavirus further imperilled the only unit of support (the family) that Amal felt she had. Not only did she contract the virus and felt she was putting her husband and stepdaughter’s health at risk, but their financial security declined with the loss of her husband’s job.

Through her work with PTC Amal ultimately gained a new perspective on her losses. Two things were most impactful. First, the fact that the program she joined was a group one, where she learned how similar her own experiences were to those of other women in Gaza. These women listened to her, and she listened to them. Together they reminded each other that all of the systems and structures that have caused the harm and grief endured is collective. As collective, the harm is neither their own, their fault, or something they can control. Lost in time, they had suffered alone: together they could be stronger. What they can do, sessions remind Amal and her peers, is refuse to lose sight of themselves and the parts of life that remain—despite it all—beautiful. Many cite the relationships forged within the group as one of those beautiful things. They also get to decide what they want their reactions to harm to be. Many choose to share what they have learned with their families, further reinforcing bonds of what PTC calls ‘communities of care.’

Urgent corrective to concepts of harm

What these programs don’t do is stop the inequalities and injustices from happening. They can only prepare people for how to react and respond in ways that keep them caring for themselves and, importantly, others. While PTC programs intervene in contexts of inequality, and design programs that avoid the perpetuation of inequality, no amount of trauma therapy can stop a family being evicted from their home, or their home being destroyed.

In Gaza, people know that politically, a very great deal needs to happen—corrupt governments need to go, effective leadership restored, accountability made possible, partners for a political solution identified. However, on the ground, between people, a great deal is already happening. Despite largely absent political leadership, there is a strong and unified message coming from Palestinians in Gaza, the West Bank, East Jerusalem, Israel, and places of exile/diaspora. Activist networks and citizen journalists have created vital communities of care that listen, amplify, and re-state the nature of experiences like Amal’s—demanding that this experience be foregrounded in any discussion of what is happening today.

Working with the narratives of clients of the Palestine Trauma Center UK this week, ahead of our report’s publication, we cannot help but notice that the recorded experiences speak poignantly to the profound inequalities made invisible by coverage of this week’s events. This is not ‘clashes,’ and it is just not a ‘war’ in the making. It is inequality, and an absence of freedom and dignity in its most profound sense.

In this long year of calls for justice, where many have grappled personally and politically with frames of reference that do not recognize the harms to those less powerful, those oppressed, the real war is against mainstream frames of reference.

The report on Mental Health programs and COVID in Gaza will be released in June. Follow@rights4time for updates.

Dr Altawil and the Palestine Trauma Centre team are speaking at “War On The Mind” Trauma, Survival and Resilience in Palestine and Israel” this Saturday May 15th, which is being organized in partnership with the UK-Palestine Mental Health Network and will be kindly hosted by the Balfour Project. Check out the event, or their webpage for more on center activities.

Dr Nora Parr is a co-investigator for the Rights for Time Research Network, and leads the Palestine Case Study. She is researching concepts of trauma in Arabic Literature with an Alexander von Humboldt fellowship hosted at the Freie Universität Berlin, and she is also a Fellow at the University of Birmingham’s Department of English, Drama and Creative Studies.