Troubled children in a troubled land

Boy amidst rubble in Gaza
Boy amidst rubble in Gaza

Over half a century of conflict in the Holy Land has left deep scars both on Israelis and Palestinians. Never have the levels of violence been as high as since the outbreak of the second intifada or Palestinian uprising in 2000. Israelis live in fear of more suicide bombings and rocket attacks; Palestinians fear new Israeli incursions, arrests and killings. The violence hasn’t spared anyone, not even children.

A 6-year-old Palestinian boy says “mommy, it’s going to be dark pretty soon’. And she says, ‘yes’. ‘And then the planes will come right?’ And she says ‘yes’. ‘And they will start shooting, right?’ And she says ‘yes, but we will be OK’. And then he says, ‘well, we’ll go to bed, right? And maybe we will wake up dead in the morning.’

Original broadcast: August 25, 2004

Photos: Eric Beauchemin

Transcript

Radio Netherlands, the Dutch International Service, presents “Troubled Children in a Troubled Land”. The programme is produced by Eric Beauchemin.

The Arab went to stab the brother in the stomach, but the brother managed to get away. Yacoub was sitting in a chair nearby. The Arab came over to him and stabbed him under his arm, right by his heart.

There’s the trauma that says I’m going to die. I’m going to get killed. The whole world is out of control and I don’t feel secure. I don’t feel safe.

When you ask a Palestinian how could you cope with this situation and they will say, we are used to it.We made a research on children at the age of 12 and we found that 36% of the boys say the best thing in life is to die.

Over half a century of conflict in the Holy Land has left deep scars both on Israelis and Palestinians. Never have the levels of violence been as high as the past four years, since the outbreak of the second intifada or Palestinian uprising. Israelis live in fear of more suicide bombings…Palestinians fear new Israeli incursions, arrests and killings. The violence hasn’t spared anyone, not even children… At a school run by the United Nations in the southern part of the Gaza Strip, classes resumed only a few days after a major Israeli military incursion. In less than a week, Israeli tanks destroyed over 150 buildings, leaving 2000 people homeless. Many of the children at this school in the Rafah refugee camp lost their homes, including 15-year-old Tahia Arafat.

She says that the house next to her house had been demolished and part of their house had been demolished. They were taken outside the house and they stood for more than 3 hours on one leg. EB: How can she explain such a situation during midnight? She was terrified actually. EB: What did they have to stand on one leg? The Israelis had asked them to raise up their hands and to stand on one leg. EB: And where are you and your family living now? They moved to Hay Salaam and a week later, the house they were living in had been demolished again. Now they are living in one room, the whole family. EB: How many people? 14 family members in one room. EB: And how big is the room? 4 times 4 metres square and it’s everything: the kitchen, the toilet, the room, the dining room, the living room, everything. So is there actually enough room for everyone to sleep at night? Each mattress get two persons. There’s not enough room for the 14 persons to sleep on.

Tahia Arafat
Tahia Arafat

The bad experience she had witnessed is that she had lost everything. The house is demolished in front of her. She cannot prevent it. She cannot help anything. Even the books of her school were falling in front of her. She cannot pick them up. She was really terrified. The good memories she had during life in this house now had been missed and she could not find these memories again, and when she wants to recall them, she starts feeling afraid, crying and shouting. EB: What about the rest of the family? How has the rest of her family reacted? Her small sister, as a result of the intimidation take place at night during the demolition, she could not speak well now. She’s almost afraid looking, absent-minded and so on.

According to our research only 3% of the people of Gaza do not show signs of anxiety, depression or post-traumatic stress disorder. 97% of the people here have some signs, some symptoms. 33% of them need intervention.

Dr. Eyad el Saraaj is the chairman of the Gaza Community Mental Health Programme, the leading trauma organisation in the Gaza Strip.

Children suffer the same way as adults because they are exposed to the same thing. The thing is that the impact on children sometimes is far deeper than on adults. To illustrate the point, we made a research on children of the age of 12 and we found out that 36% of the boys say the best thing in life is to die. Why? Because life is becoming so desperate and hopeless and so on.

Trauma levels among Israeli children and adolescents are lower. But still, says Dr. Ronny Berger of the Israel Trauma Centre for Victims of Terror and War, the figures are worryingly high.

Dr. Ronny Berger
Dr. Ronny Berger, Israel Trauma Centre for Victims of Terror and War

In the research that we have done, we see that about 60% of the kids have been directly exposed either by being in the area of a terror attack or known someone – directly or indirectly, it could be a child, it could be a relative, it could be somebody close to them. So, in some ways, the degree of exposure to those violent activities and the potential to being dead is quite high. But just the fact that it’s on the TV, that people see it and hear it, that people

I know that buses have a potential to be dangerous, the kids these days in Israel in the last 3, 4 years since the beginning of the intifada, had been taught by the parents that in certain areas are more limited does place a certain cloud of threat that is there. They don’t feel it on a daily basis and it doesn’t affect them directly. But it’s there in the sense.

One of the most disturbing aspects of the violence is that it often seems to come out of nowhere. 12-year-old Yacoub came home from school one day three years ago. His brother started preparing a snack for him when there was a knock on the door.

Yacoub
Yacoub

He screamed that the door was open because he was sure that it was his middle brother. Then he saw that he’s not opening the door completely, so he got up himself and he started asking what are you doing, like why aren’t you coming in? And then his older brother came and asked him: what are you doing? What do you want? And then he asked if he could come in in order to make a phone call. They didn’t know who he was, so they said no. So the brother closed the door very, very slowly, and as he was doing that the Arab pushed the door back in and grabbed his brother and started stabbing him. The Arab went to stab the brother in the stomach but the brother managed to get away. Yacoub was sitting on a chair nearby and he was stunned. He couldn’t move. And the Arab came over to him and stabbed him under his arm, right by his heart. They were both considered in a bad situation. EB: What did you feel? What did you think? A terrible fear, especially that he would not be able to go back to his regular life and that he would not be able to live properly again because of the fear. Has that happened? He said no, that initially what had happened is that until he regained consciousness that he was very, very afraid, and then since then, when he goes back to his home, he gets very scared go outside the house, being home alone at home and being afraid. EB: Do you have a lot of nightmares? Yes. EB: Can you tell me about them? He said, yes, he does have nightmares. When you asked if he could tell about them that he doesn’t really remember so much. It’s probably a very sensitive issue, as well. EB: Do you still fear Arabs now? He said yes. EB: So whenever he sees an Arab, he’s afraid? Yes. EB: And how do you deal with that because there are lots of Arabs in Jerusalem. If he’s alone, then he runs away every time he sees one. If he is with his mother or something, then he holds her hand and tells them let’s go quickly.

When we did research on kids’ dreams for instance, we have seen that both Palestinian kids and Israeli kids dream about those things that related to war and terror. And so, if you are, in your dreams, approaching threats of that nature, it does affect you on a daily basis. It can affect you in terms of level of concentration. We know that kids start to behave more regressively, meaning they will be less independent, suck their thumb, you know, young kids for instance will wet their bed and stuff of that nature. What happens is when life is less stable, and you haven’t gained the sense of security and safety, you end up being more regressive, like a little kid.

Sister Rose Mesa
Sister Rose Mesa

I think the unpredictability, the lack of control is what exacerbates the situation, what makes it really worse because the trauma is constant. It doesn’t lift.

Sister Rose Mesa is the director of the Holy Child Programme outside of Bethlehem. The centre provides counselling to 30 severely traumatised Palestinian children, some as young as 4.

Some of them have stopped speaking, even though they were talking before. They could be 9 years old and selectively just stop speaking. We had one child who did not talk the first three months he was with us, not one word. We had children that were 7 years old and still not talking. Some of them withdraw and start hallucinating and seeing things that are not there, screaming. Some of them are shouting all night, having very bad nightmares. Most of them just cannot function in school and also cannot be tolerated at home. And out of desperation, the parents usually come, seeking for help. And often times it’s after they’ve taken the child to a psychiatrist and he’s been medicated and it’s still not helping.

The children at Sister Rose’s centre are playing a game. They’re trying to eat a cucumber hanging from a string without using their hands. Sister Rose has to make difficult choices this summer. As she watches the 20 children playing, she explains that she’s evaluating which ones should be admitted to her programme. All 20 of them urgently need counselling, she says, but she only has space for five. The other children will have to go back to a regular school in the autumn, even though they’re so traumatised they won’t be able to learn.

Boy playing game at Holy Child centre in Bethlehem
Boy playing game at Holy Child centre in Bethlehem

I have spoken to some principals and I described the symptoms of children they should watch out for. And one of the principals of a pretty big school of 500 children in elementary said I have at least 2 or three of those in every classroom, the ones which you describe, which means the children with severe trauma symptoms. But less severe ones, they all need treatment.

On the other side of Bethlehem, in the Aïda refugee camp, 11-year-old Wawud can’t forget the day two years ago that Israeli soldiers blasted their way into her house.

We hadn’t locked the door, but they used explosives to come in. The blast was very powerful and all the glass was broken. The door burst into pieces, and some of them hit my mother. Of course, we all started crying when my mother was hit. A lot of Israeli soldiers came in and they wouldn’t let anybody leave the house. They didn’t allow us to see our mother. She was lying on the ground and they only allowed my father to stay with her. We tried to call the ambulance but our camp was surrounded by troops. After two hours, they finally allowed an ambulance in. A paramedic came in and he and my father took my mother away. The soldiers wouldn’t allow us to leave. The Israeli soldiers were digging through the wall of our house to get to the next house. That’s how they’d go from one house to the next. When my father came back from the hospital, he told us that our mother died on the road to the hospital. We just had to accept it. I was very afraid. We’re scared that the same thing that happened to my mother might happen to us. EB: Are you still afraid? Yes. EB: Do you have a lot of bad dreams? Yeah. EB: Can you tell me what your bad dreams are about? A lot of my dreams are about the soldiers entering the house or patrolling in the camp. Sometimes I dream of my mother. I dream that she doesn’t love me because she abandoned me.

It’s not only children who are being traumatised. Parents too are struggling to cope with the ongoing violence.

The times that it really comes close and it’ s very difficult is when it reaches your children.

Dr. Danny Brom, director of the Israel Centre for the Treatment of Psychotrauma in Jerusalem
Dr. Danny Brom, director of the Israel Centre for the Treatment of Psychotrauma in Jerusalem

Dr. Danny Brom is the director of the Israel Centre for the Treatment of Psychotrauma.

One of my daughters was with a friend of hers, stood in front of one of the cafés here in Jerusalem when it blew up. She had just finished a course of first aid. So immediately she went out of the car and into the café and tried to save lives. Well, hearing how she was exposed to the most horrible sights, although she was able to save lives and to help people really, then it comes too close and then you feel it gets into your system. And I feel the same about my children going into the army. I don’t know how I will cope with it. It’s going to happen next year and I feel that it’s almost impossible. And what keeps me busy most is not only how bad it will be to be in the army, but how it will change them. And that is one of the worst things I think of ongoing violence, that you see how it corrupts society, how it changes people who are reasonable people into people who can see only one thing and that is that we have to hit back. And that’s one of the frightening things about living here.

Palestinian parents have other worries, perhaps the biggest one being how to move around. Israel’s security fence or wall as well as checkpoints like this one in Palestinian towns and cities are making it increasingly difficult for people to get to and from work or to go anywhere, for that matter. Dr. AbdelFattah Abu-Srour is the director of the Al-Rowwad Cultural and Theatre Training Centre near Bethlehem. He and his family live in East Jerusalem, but because he doesn’t originally come from Jerusalem, he doesn’t have an Israeli ID card, enabling him to enter the city.

Dr. AbdelFattah Abu-Srour
Dr. AbdelFattah Abu-Srour

We are living in East Jerusalem since five years. And we requested a permit so that I can just go to my house. I don’t ask for the nationality or whatever, just a simple permit to get in and out. And since 5 years till now, we don’t have that permit. That means I have to sneak around every time I want to go to my house. And this is the complete challenge. Sometimes I succeed. Sometimes I’m not. Sometimes I’m captured by the Israelis, make me sign papers and so on, and that continues. Whatever you try to plan is always a challenge as well because you are never sure when you can do it, when you can’t do it. Of course, when I try to sneak around and go in hills and mountains to arrive to my house 5 or 6 hours later, then what do you think would be my relation to my children or to my wife? Would I just still be that nice guy who would kiss his wife and kiss his children and permit them to play with him, or just leave me alone! I want to sleep, or whatever.

Dr. Abu-Srour continues to make the journey every day, despite the difficulties. The programme he runs is designed to offer children in the Aïda refugee camp a safe place off the streets. Al-Rowwad organises theatre performances and classes in painting, dancing, computers and foreign languages. It also provides trauma counselling to children, and during times of crisis and curfews, the al-Rowwad Centre operates as an emergency clinic since there is no health post in the camp. Dr. Abu-Srour tries to provide the children a sense of normalcy, but even simple things like organising an excursion to the beach – which is only 100 kilometres away – are virtually impossible.

Most of these children have never been to the sea because the sea or the road to the sea is controlled by Israelis, even to Jericho. Busses, trucks, vehicles, people go only by this and there is a checkpoint on that road controlled by the Israelis. The road which would usually take 40 minutes would take 4 hours or 5 hours or never at all. So it is always a challenge to take them in an excursion. You are never sure of doing anything, anytime.

The most dangerous consequence of this constant uncertainty, says Dr. Abu-Srour, is that people are becoming accustomed to it. No one really knows what’s normal anymore.

The children will talk about someone who was injured, a comrade or a classmate who was injured next to them and they would laugh. Well, he was injured and you were injured and so on! With this laugh, it’s like comic. When you ask a Palestinian – whether it is a child or an adult – how could they cope with this situation and they will say, we are used to it. And this is abnormal. Nobody should be used to misfortune or occupation or pressure or torture in such a humiliating way. Nobody should be used to curfews, not going to school or to university or to work, go around the checkpoint instead of passing a normal way in the street. And this is like a change in the psychology, in our psychology. We try in a way to help the occupation finding solutions for things. They block away. We find an alternative to it, and this is not normal.

When we asked kids how many kids changed their behaviour since the intifada and the terrorist threat, we find that the majority has not changed their behaviour. 60% behave just the same. But about 35% become more avoidant. They go take less buses. They go less to parties, etc. They sort of secluded their life to some extent. And they changed their lifestyle. Maybe they don’t suffer that much, but still, life is not as open as it was. But about 5% changed to the worst in terms of taking more risks. They will specifically go to areas that are potentially dangerous. It’s as if they spit to death in the eyes. It can be generalised to other risk-taking behaviour, for instance, not paying attention ‘cause you know anyway this is a crazy country and if you die, why not do crazy stuff like take drugs and flirt with death in certain ways. Those are the kids that also – when we check their level of distress – and you know, what we call post traumatic stress disorder, the ability to take in stress negatively – they’re the ones who we seem to think have more problems. So those kind of kids are more at risk. And 5% is a fair number. We have to worry about those. Yeah, but 5% is a relatively small number given the level of violence in this country. Those are not the only kids who have trouble. We have about 5% who have full post traumatic stress disorder. And post traumatic stress disorder is not just a little distressed and upset. It’s kids who have symptoms such as avoidant behaviour, not sleeping well, not concentration, with decrease in their academic performance and their behaviour. So this is really severely impacted kids. But we have another 10% who have partial PTSD. They have already symptoms. Their functioning is going down. It’s not to the level where we give them a full diagnosis. Still though, we’re talking about 15% with some significant distress. That’s not a small number. I’d say that’s a problem.

The treatment of trauma involves taking the child out of the traumatic situation. That’s the best cure for trauma. So when you can’t do that, we have to find other options of making the child secure. You have to help the parents to be secure themselves as much as they can, to give them support, and that they can give their children some assurance that when you are with me, you are safe. Basically what’s holding our children is a lot of hugs because physical security is what they need and they need to feel it in their bodies. So we meet with the parents and encourage them to hug their children a lot, to be close to their children, to do something with their children every day and to pray so that their children can have confidence in someone stronger. And when they are in school, we try to take away if only for five hours the threat by letting them have fun. As you can hear, we have music going on now and we dance and we have parties and we try to learn as much as we can and enjoy learning. And basically we provide them with moments of respite, you might say.

In Israel too, mental health specialists have developed programmes to help children and adolescents suffering from post traumatic stress disorder. With the blessing of the Ministry of Education, they’re also trying to help other students cope with the stress they face on a daily basis.

One programme, the teachers do with the whole class. They basically give them tools and explain to them what happens to them when they are threatened. For instance, the biology starts to kick in. They become more anxious. There are certain symptoms. And they normalise those symptoms. Then they teach them… What do you mean they normalise the symptoms? Just telling them that those are normal reactions, for instance, if there is a threat of bomb, your heart rate will raise up. You might have some dreams at night but those are normal things that passes by themselves. Once kids know that it’s easier for them to cope with that. But that’s just one level. The other thing that they need to know is that when they are anxious and when they are afraid, what to do? We legitimise, for instance, their need to avoid certain activities. That’s OK. They’re not just cowards and sissies and whatnot. They need to realise that their natural responses are OK. Then we help them develop ways to recognise how they cope with any problem. What do they do naturally and how do they ask for help? So we help them develop ways in which to cope better. We teach them relaxation. We teach them self-talk. We teach them breathing technique within the school. That’s one programme that the teacher are helping the entire class and we do it in schools that are being more threatened, in towns like Netanya, Haderah, Jerusalem, where there were many attacks and kids are very aware and we see a high level of PTSD there. Then for kids who are more disturbed or are more distressed, who have PTSD, we have a questionnaire where we know what…how to identify those kids who are more in trouble, who have more symptoms, whose level of academic performance has gone down, etc., etc. And for those school psychologists do a group process – a little bit longer – and teach them specific ways in which to process their traumatic experiences.

The counselling and self-help techniques have helped many youngsters and adolescents cope, but only up to a certain point.

In the long-run it does change one’s approach to life in general, one’s trust in others, you know. It creates, in my view, more stereotypisation against Arabs and vice versa and Palestinians against Jewish people, and in the long run, colour life in a certain way if you live in an area where there is war and terror, colour life, you know. Life is more dangerous, life is more at risk. We also think that moral development might change. By that I mean, kids that live in an area where conflicts are being resolved by violence tend to take those ways in other areas, generalize to other areas. OK, so the general conflict between Israelis and Arabs are resolved by violence and they see it all over the place. Lets him them back. They hit us, and so on. The cycle of violence. Why not apply it to my friend who is bothering me?

Dr. Eyad el Saraaj, chairman of the Gaza Community Mental Health Programme
Dr. Eyad el Saraaj, chairman of the Gaza Community Mental Health Programme

The cycle of trauma has been taking hold of this place for a long time. Violence and trauma will only produce violence and trauma. Victims today will become aggressors tomorrow. The only way to stop it is through treating the victims today so that they will not be victimising others in the future.

Another child says, ‘mommy it’s going to be dark pretty soon’. And she says, ‘yes’. ‘And then the planes will come, right?’ And she says ‘yes’. ‘And they will start shooting, right?’ and she says, ‘yes, but we will be OK’. And then he says, ‘well, we will go to bed, right? And maybe we will wake up dead in the morning.’

“Troubled Children in a Troubled Land” was produced by Eric Beauchemin. This has been a Radio Netherlands’ presentation.