DEIR AL-BALAH, Gaza Strip (AP) 鈥� Nabila Hamada gave birth to twin boys in Gaza early in , in a hospital reeking of decaying bodies and full of displaced people. When Israeli forces threatened the hospital, she and her husband fled with only one of the babies, as medical staff said the other was too weak to leave. Soon after, Gaza鈥檚 largest, and she never saw the boy again.
The trauma of losing one twin left the 40-year-old Hamada so scared of losing the other that she became frozen and ill-equipped to deal with the daily burden of survival.
鈥淚鈥檓 unable to take care of my other, older children or give them the love they need,鈥� she said.
She is among hundreds of thousands of Palestinians struggling with mental health after nine months of war. The trauma has been relentless. They have endured the killing of family and friends in Israeli bombardments. They have been wounded or disfigured. They have huddled in homes or tents as fighting raged and fled , with no safe place to recover.
Anxiety, fear, depression, sleep deprivation, anger and aggression are prevalent, experts and practitioners told The Associated Press. Children are most vulnerable, especially because many parents can barely hold themselves together.
There are few resources to help Palestinians process what they are going through. Mental health practitioners say the turmoil and overwhelming number of traumatized people limit their ability to deliver true support. So they鈥檙e offering a form of 鈥減sychological first aid鈥� to mitigate the worst symptoms.
鈥淭here are about 1.2 million children who are in need of mental health and psychosocial support. This basically means nearly all Gaza鈥檚 children,鈥� said Ulrike Julia Wendt, emergency child protection coordinator with the International Rescue Committee. Wendt has been visiting Gaza since the war began.
She said simple programming, such as playtime and art classes, can make a difference: 鈥淭he goal is to show them that not only bad things are happening.鈥�
Repeated displacement compounds trauma: an estimated 1.9 million of Gaza鈥檚 2.3 million people have been driven from their homes. Most live in and struggle to find food and water.
Many survivors of the Oct. 7 attack by Hamas in southern Israel that precipitated the war in Gaza also bear the scars of trauma, and . The militants killed more than 1,200 Israelis and took around 250 hostage.
Sheltering near the southern city of Khan Younis, Jehad El Hams said he lost his right eye and fingers on his right hand when he picked up what he thought was a can of food. It was an unexploded ordnance that detonated. His children were almost hit.
Since then, he experiences sleeplessness and disorientation. 鈥淚 cry every time I take a look at myself and see what I鈥檝e become,鈥� he said.
He reached out to one of the few mental health initiatives in Gaza, run by the United Nations agency for Palestinian refugees, known as UNRWA.
Fouad Hammad, an UNRWA mental health supervisor, said they typically encounter 10 to 15 adults a day at shelters in Khan Younis with eating and sleeping disorders, extreme rage and other issues.
Mahmoud Rayhan saw his family shattered. An Israeli strike killed his young son and daughter. His wife's leg was amputated. Now he isolates himself inside his tent and sleeps most of the day. He talks to almost no one.
He said he doesn鈥檛 know how to express what鈥檚 happening to him. He trembles. He sweats. 鈥淚鈥檝e been crying and feel nothing but heaviness in my heart.鈥�
A relative, Abdul-Rahman Rayhan, lost his father, two siblings and four cousins in a strike. Now when he hears a bombardment, he shakes and gets dizzy, his heart racing. 鈥淚 feel like I鈥檓 in a nightmare, waiting for God to wake me up,鈥� the 20-year-old said.
For children, the mental toll of war can have long-term effect on development, Wendt said. Children in Gaza are having nightmares and wetting their beds because of stress, noise, crowding and constant change, she said.
Nashwa Nabil in Deir al-Balah said her three children have lost all sense of security. Her eldest is 13 and her youngest is 10.
鈥淭hey could no longer control their pee, they chew on their clothes, they scream and have become verbally and physically aggressive,鈥� she said. 鈥淲hen my son Moataz hears a plane or tank, he hides in the tent.鈥�
In the central town of Deir al-Balah, a psychosocial team with the Al Majed Association works with dozens of children, teaching them how to respond to the realities of war and giving them space to play.
鈥淚n the case of a strike, they place themselves in the fetal position and seek safety away from buildings or windows. We introduce scenarios, but anything in Gaza is possible,鈥� said project manager Georgette Al Khateeb.
Even for those who escape Gaza, the mental toll remains high.
Mohamed Khalil, his wife and their three children were displaced seven times before they reached Egypt. His wife and children arrived in January and he joined them in March. Their 8-year-old daughter would hide in the bathroom during shelling and shooting, saying, 鈥淲e are going to die.鈥�
Their 6-year-old son could sleep only after his mother told him that dying as a martyr is an opportunity to meet God and ask for the fruits and vegetables they didn鈥檛 have in hunger-ravaged Gaza.
Khalil recalled their terror as they escaped on foot down a designated 鈥渟afe corridor鈥� with Israeli guns firing nearby.
Even after arriving in Egypt, the children are introverted and fearful, Khalil said.
They have enrolled in a new initiative in Cairo, Psychological and Academic Services for Palestinians, which offers art and play therapy sessions and math, language and physical education classes.
鈥淲e saw a need for these children who have seen more horror than any of us will ever see,鈥� said its founder, psychologist Rima Balshe.
On a recent field trip, she recalled, 5-year-old twins from Gaza who were playing and suddenly froze when they heard helicopters.
鈥淚s this an Israeli warplane?鈥� they asked. She explained it was an Egyptian aircraft.
鈥淪o Egyptians like us?鈥� they asked. 鈥淵es,鈥� she reassured them. They had left Gaza, but Gaza had not left them.
There is hope that children traumatized by the war can heal, but they have a long way to go, Balshe said.
鈥淚 wouldn鈥檛 say 鈥榬ecovering鈥� but I certainly see evidence of beginning to heal. They may not ever fully recover from the trauma they endured, but we are now working on dealing with loss and grief,鈥� she said. 鈥淚t鈥檚 a long process.鈥�
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Associated Press writers Julia Frankel in Jerusalem and Kareem Chehayeb from Beirut contributed to this report.
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Fatma Khaled And Wafaa Shurafa, The Associated Press
