DEIR AL-BALAH, Gaza Strip — Nabila Hamada gave birth to twins in Gaza early the war, in a hospital smelling of decomposing bodies and full of displaced people. When Israeli forces threatened the hospital, she and her husband fled with just one of the babies, as medical staff said the other was too weak to leave. Soon after, Israeli forces stormed the hospital, The biggest in Gaza, and she never saw the boy again.
The trauma of losing one of her twins left Hamada, 40, so afraid of losing the other that she was left frozen and ill-equipped to deal with the daily burden of survival.
“I can’t take care of my other older children or give them the love they need,” she said.
She is among hundreds of thousands of Palestinians struggling with mental health after nine months of war. The trauma was relentless. They endured the death of family and friends in Israeli bombings. They were injured or disfigured. They huddled in houses or tents as the fighting intensified and fled. again and againno safe place to recover.
Anxiety, fear, depression, sleep deprivation, anger and aggression are prevalent, experts and professionals told The Associated Press. Children are most vulnerable, especially as many parents can barely keep it together.
There are few resources to help Palestinians process what they are going through. Mental health professionals say the turmoil and overwhelming number of traumatized people limit their ability to provide true support. Therefore, they offer a form of “psychological first aid” to mitigate the worst symptoms.
“There are around 1.2 million children who need mental health and psychosocial support. This means basically almost all children in Gaza,” said Ulrike Julia Wendt, emergency child protection coordinator at the International Rescue Committee. Wendt has been visiting Gaza since the start of the war.
She said simple programming, like games and art classes, can make a difference: “The goal is to show them that it’s not just bad things that are happening.”
Repeated displacements compound the trauma: an estimated 1.9 million of Gaza’s 2.3 million inhabitants have been expelled from their homes. The majority live in squalid tent camps and struggle to find food and water.
Many survivors of the October 7 attack carried out by Hamas in southern Israel, which precipitated the war in Gaza, also bear the scars of trauma, and are looking for ways to heal. The militants killed more than 1,200 Israelis and took around 250 hostages.
Sheltering near the southern town of Khan Younis, Jehad El Hams said he lost his right eye and the fingers on his right hand when he picked up what he thought was a can of food. It was an unexploded ordnance that he detonated. His children were almost run over.
Since then, he has felt insomnia and disorientation. “I cry every time I look at myself and see what I have become,” he said.
He contacted one of the few mental health initiatives in Gaza, run by the United Nations agency for Palestinian refugees, known as UNRWA.
Fouad Hammad, mental health supervisor at UNRWA, said they typically encounter between 10 and 15 adults a day in shelters in Khan Younis with eating and sleeping disorders, extreme anger and other problems.
Mahmoud Rayhan saw his family torn apart. An Israeli attack killed his son and daughter. His wife’s leg was amputated. Now he isolates himself inside his tent and sleeps most of the day. He doesn’t talk to almost anyone.
He said he doesn’t know how to express what is happening to him. He trembles. He sweats. “I’ve been crying and I feel nothing but a heavy heart.”
A relative, Abdul-Rahman Rayhan, lost his father, two brothers and four cousins in a strike. Now, when he hears a bombing, he shakes and becomes dizzy, his heart is racing. “I feel like I’m in a nightmare, waiting for God to wake me up,” said the 20-year-old.
For children, the mental impact of war can have long-term effects on development, Wendt said. Children in Gaza are having nightmares and wetting the bed because of the stress, noise, crowding and constant moving, she said.
Nashwa Nabil in Deir al-Balah said her three children have lost all sense of security. The oldest is 13 years old and the youngest is 10.
“They could no longer control their pee, they chewed on their clothes, screamed and became verbally and physically aggressive,” she said. “When my son Moataz hears a plane or tank, he hides in the tent.”
In the central city of Deir al-Balah, a psychosocial team from 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.
“In the event of a strike, they place themselves in the fetal position and seek safety away from buildings or windows. We introduced scenarios, but anything in Gaza is possible,” said project manager Georgette Al Khateeb.
Even for those who escape Gaza, the mental toll remains high.
Mohamed Khalil, his wife and three children were displaced seven times before arriving in Egypt. His wife and children arrived in January and he joined them in March. His 8-year-old daughter hid in the bathroom during the bombings and shootings, saying, “We are going to die.”
The 6-year-old son was only able to sleep after his mother told him that dying as a martyr is an opportunity to find God and ask for the fruits and vegetables they didn’t have in famine-ravaged Gaza.
Khalil recalled the terror they felt as they escaped on foot through a designated “safe corridor,” with Israeli weapons firing nearby.
Even after arriving in Egypt, the children remain introverted and fearful, Khalil said.
They signed up to 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.
“We saw the need for these children who have seen more horror than any of us will ever see,” said its founder, psychologist Rima Balshe.
On a recent field trip, she recalled, 5-year-old twins from Gaza were playing and suddenly froze when they heard helicopters.
“Is this an Israeli warplane?” they asked. She explained that it was an Egyptian aircraft.
“So the Egyptians like us?” they asked. “Yes,” she reassured them. They had left Gaza, but Gaza had not left them.
There is hope that children traumatized by war can heal, but there is still a long way to go, Balshe said.
“I wouldn’t say ‘recovery,’ but I certainly see evidence that I’m starting to heal. They may never fully recover from the trauma they have suffered, but we are now working to deal with the loss and grief,” she said. “It’s a long process.”
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Associated Press writers Julia Frankel in Jerusalem and Kareem Chehayeb in Beirut contributed to this report.
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