Psychology in Gaza and the West Bank

Anna Costin with the latest in our international series.

The Gaza Strip and the West Bank have a combined population of around three and a half million. They were part of the British Mandate of Palestine, which lasted until 1948 and which also included present-day Israel. When the British announced their intention to withdraw, a UN partition plan outlined the establishment of both a Jewish and an Arab state within Palestine, but an Arab state never emerged. By 1949 military action by neighbouring Arab countries against the newly formed Israel had failed. The ceasefire lines left Israel in control of much of Palestine, with the exception of the West Bank (held by Jordan) and the Gaza Strip (held by Egypt). These areas eventually came to be occupied by Israeli troops after the Six-Day War in 1967.
Armed resistance by the Palestine Liberation Organisation continued throughout the 1970s and 1980s, leading  in 1987 to the first intifada, a popular uprising aimed at ending Israeli occupation. In 1993, as part of the peace process, Israeli forces withdrew from major areas in the territories, and some powers were transferred to the Palestinian Authority (PA). The peace process collapsed in September 2000, and the second intifada erupted, after Israeli prime minister Ariel Sharon’s controversial visit to the Al-Aqsa mosque in Jerusalem. However, Sharon came to accept that Israeli security would be best served by withdrawal from the occupied territories.
In summer 2005 Israel transferred full control of Gaza to the PA.

Psychology in universities

Psychology is taught at four main Palestinian universities: An-Najah, Birzeit, Bethlehem and the Islamic University of Gaza. The Islamic University of Gaza also offers postgraduate psychology courses in the faculty of education and an undergraduate course in psycho-counselling. Bethlehem University offers a minor in psychology as part of its social work and sociology degrees.
Postgraduate courses are generally lacking in the territories. Clinical psychologists and those engaged in research train abroad – generally either in neighbouring countries such as Egypt and Jordan or in Europe and the United States.  

Clinical training

The Gaza Community Mental Health Programme (GCMHP) was founded in Gaza City in 1990, to provide mental health therapy, training and research in the Gaza Strip. It is chaired by the prominent Palestinian psychiatrist and human rights activist Dr Eyad el-Sarraj. The training and education department offers a two-year postgraduate diploma in community mental health and human rights, accredited by the Islamic University of Gaza and the Palestinian Ministry of Higher Education. The course is also accredited by the medical school at Suez Canal University
in Egypt as part of its master’s degree in psychiatry. The department has also established links with Oxford University. Senior staff from seven overseas universities work with local trainers to teach the course. The long-term aim is to establish an Arab Institute for Community Mental Health that will be a leading institute in the Middle East. At present the GCMHP relies on international links for senior research and teaching staff but hopes to organise distance-learning programmes at master’s and PhD level to enable local staff to take on this role.  

Research

Areas of special interest in research are of course the effects of trauma related to political violence, and motivational factors for suicide bombing attacks.
The research department at GCMHP analyses how the population of Gaza has been affected by political violence. They say that through research the extent of psychological problems in Gaza are explored, and by communicating them to the world they can help to relieve them. GCMHP organises international conferences and workshops for local and international experts to discuss mental health issues and to raise international awareness of the difficult situation confronting the Palestinian people. In 1998 the Palestinian Ministry of Health adopted a GCMHP study on stress-related disorders. Prior to this, mental health issues had been largely disregarded; they are now part of a five-year health plan.
Attacks by Palestinian groups such as Hamas and the Al-Aqsa Martyrs Brigades may often be termed terrorism, but the Palestinians themselves refer to them as armed resistance. Particularly following the 11 September 2001 attacks on the United States, much research on the psychology of terrorism has been undertaken by researchers around the world.
From studies that have been undertaken within Gaza and the West Bank on both suicide and non-suicide bombings, Dr el-Sarraj’s have gained the most international prominence in both the research community and the media. Dr el-Sarraj says that 36 per cent of boys and 17 per cent of girls said they wanted to be a martyr when they reached 18 years old. Research has shown that for (Palestinian) boys especially, seeing their fathers beaten or humiliated by Israeli soldiers – who are often only teenagers – is a powerfully traumatic image. For Arabs the image of the father as an all-powerful force is an important one. Boys turn to militant groups as a substitute father figure that can both protect them and seek revenge on the enemy – in their eyes the Israeli soldiers, government and civilians. Losing their homes – when destroyed by the Israeli army after suicide attacks or if they believe it is home to a member of an armed group – is also a highly traumatic event for children; the safe world they knew is literally shattered. Joining a group allows the individual to identify his personal trauma with that of the group. Dr el-Sarraj says that the children of the first intifada in the 1980s became the suicide bombers of the second, having carried that trauma with them.

Clinical services

The Palestinian Authority’s National Mental Health Plan focuses on the need to introduce community-based mental health care through establishing community health centres, staffed by one psychiatrist, two psychologists, two mental health nurses, two social workers and an occupational therapist. GCMHP runs four clinics and emphasises the importance of the family in the therapeutic process in order to achieve a successful outcome. Therapy is rooted in a culturally sensitive approach, adapting Western approaches to Palestinian society. GCMHP has 200 staff trained in psychology and psychiatry as well as hundreds of community workers.
Since its establishment, the GCMHP has worked to raise awareness of mental health issues through holding public meetings, and distributing brochures
and posters. It issues Amwaj, the first specialised mental health magazine in Palestine. The programme’s Crisis Intervention Project was launched one month after the Al-Aqsa intifada in September 2000 to deal with the psychological effects of the violence. Often symptoms are somatic, not psychological. ‘A problem is how to recognise psychological conditions in people presenting with somatic symptoms and how to educate health workers,’ says Dr el-Sarraj. The project provides free telephone counselling services for those unable to get to the clinics.
There is also a Women’s Empowerment Project, dealing specifically with female victims of violence – both political and domestic. There are high rates of domestic violence, as men released from prison turn their suffering on the women in their household, who in Arab society are traditionally dependent on male family members.
The Union of Palestinian Medical Relief Committees (UPMRC) runs a counselling programme in Gaza and the West Bank. It estimates that 30 per cent of the Palestinian population could benefit from psychological counselling, but that only about a third of this group will receive appropriate care. The organisation says that children are particularly vulnerable to the consequences of political violence and are prone to problems with development and personality. UPMRC deploys teams to conduct home visits to help mothers and children deal with fear and anxiety. It has also conducted workshops on mental health needs assessments in some areas, enabling people to take part in creating a mental health support structure for their community. UPMRC also uses theatre to create dramas that address various mental health issues in a reassuring fashion that is devoid of stigma.
Dr Rasmiyya Abdul-Qader, a clinical psychologist working in the West Bank, has said that although the Palestinian people have suffered negative psychological effects due to the socio-political conditions in the region, they are more resilient to such pressure than others would be, due to the long-period of suffering they have endured. As Dr el-Sarraj put it: ‘Palestinians have high coping skills because they believe in a divine justice that one day will come.’

Looking to the future

Following the Israeli withdrawal from the Gaza Strip in 2005, there may be greater opportunities for academic organisations in Gaza to collaborate with overseas organisations and improve research ties, as the PA takes full charge of national affairs. The Council for British Arab Understanding (CAABU) is one organisation that aims to foster links between Britain and the Arab world and will continue to do so in the sphere of education and healthcare – the two sectors which psychology embraces. More postgraduate courses are undoubtedly needed to allow Palestinians to undertake professional training and doctorate level research without going abroad. The socio-political change resulting from the Israeli withdrawal will itself provide fertile research ground for social psychology. On the clinical side, the withdrawal may go someway to alleviating political and religious tensions and lead to a reduction in stress-related disorders; although the political situation in the
West Bank is set to remain unchanged. Furthermore, there is already much lawlessness and fighting between rival groups in the two territories, so overall violence may not significantly decrease.

- Anna Costin is a terrorism reporter at Jane’s Information Group, and co-author of  An Introduction to Peace Psychology (Cambridge University Press, 2005).

Further reading

Punamaki, R.L., Kanninen, K., Qouta, S. & El-Sarraj, E. (2002). The role of psychological defenses in moderating between trauma and post-traumatic symptoms among Palestinian men. International Journal of Psychology, 37, 286–296.
Samir Qouta, J. & Odeh, J. (2004). The impact of conflict on children: The Palestinian experience. Ambulatory Care Management, 28, 75–79.

Weblinks

Union of Palestinian Medical Relief Committees:
www.upmrc.org
Council for Arab–British Understanding:
www.caabu.org
Gaza Community Mental Health Programme:
www.gcmhp.net

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