In the Ramallah District alone, 8 out of 10 fifteen and sixteen year olds have witnessed shootings, nearly a third of them have seen a stranger killed, and 1 in 10 have observed a friend or neighbour slain.1 For 140,000 people in the West Bank there is only 1 psychiatrist available. Research is limited, but investigations have found that the prevalence of post-traumatic stress disorder in Palestinian children and adolescents is estimated to be 23–70%.2 Around one third of Palestinians are in need of mental health intervention, which makes mental illness ‘one of the largest but least acknowledged of all health problems.’3 Mental health in Palestine is in critical state. It can be said that ‘the policy of Israel is to put pressure on…the Palestinian psychological state unceasingly.’4 The situation is made harder by a society which has previously viewed mental illness as a test or punishment from God5 and as a point of shame. Moreover, as observed by Nadia Taysir Dabbagh, ‘suicide is about despair, about giving up, losing hope, which goes against everything that it means…to be Palestinian.’6 The concept of Palestinian identity revolves around the ability to survive and to endure, demonstrated by the focus on sabra (the prickly pear cactus) which is used as a symbol of Palestinian people. Whether in the poetry of Mahmoud Darwish, the classic cartoon figure of Handala, or in a destroyed village such as Lifta, the cactus stands as a reminder of Palestinian perseverance. Being incapable to remain resilient through trauma creates conflict with Palestinian identity. Furthermore, there is a larger focus on collective trauma and pain rather than on individual suffering and the individuals’ own mental health issues. This means that people often downplay their own trauma and focus on the community’s struggle, which makes it difficult for treatment to be effective or even received.
The system as it stands
The mental health system in Palestine is desperately underdeveloped, underfunded and has been struggling for many years. After 1967, mental health services in Palestine were managed by the Israeli Government leaving them almost neglected.7 Following the Oslo Accords, the Palestinian Authority began managing mental health services, and in 1996 community mental health services became independent and separated from psychiatric hospital management.8 Many services have been affected by the Israeli occupation, leaving them destroyed, inaccessible, and lacking proper resources. Combined with economic hardship, repeated violence and human rights violations there is a real issue of fragmented care and an imbalance of service provisions for each territory.9 Evidence shows that a definite majority of the population have experienced traumatic situations which would in turn suggest that many must be struggling with various trauma related illnesses such as post-traumatic stress disorder (PTSD). There are only 20 psychiatrists in the West Bank, and despite psychiatry not being the be all and end all of mental health care, this clearly demonstrates the lack of resources the population of Palestine have with regards to mental health care. The World Health Organization (WHO) have been responsive to this situation and began building community mental health centres in various cities, training mental health teams, and leading projects to reduce stigma.10 In spite of this, the total number of trained individuals and services remains low. Another issue within this is that many international donors ‘connect a biomedical approach to mental health treatment and their funding.’11 This has meant that they focus on PTSD, for example, as an individual problem without looking at the context surrounding the individual. In Palestine, ‘trauma is mostly interpreted according to specific collective meanings’,12 thus the focus must remain on this and treatment should be adapted accordingly. In a study conducted by UNFPA and FAFO, only 1% of civilians said they would look for individual counselling, with most finding talking to friends and family preferential.13 This information advocates for the idea that mental health treatment in Palestine should be community focused and community led.
The future of mental health care
Moving forward, there needs to be greater accessibility for mental health services, something more easily said than done given movement restrictions placed upon Palestinians. Accessibility can also be enhanced by funding, which requires the international community to start recognising the real issues faced by individuals trying to access healthcare within Palestine. NGOs such as Palestine Trauma Centre, Palestine Counselling Centre, and Treatment and Rehabilitation Centre have been successfully working and engaging the community, but with greater funding and support they could achieve so much more. An ever growing movement to reduce the stigma attached to mental health needs to continue to thrive, and hopefully will do so following in the footsteps of organisations such as the Mental Health Family and Friends Society (MHFFS). MHFFS runs campaigns in villages and municipalities, educating communities about mental health issues, the symptoms of sufferers and the challenges of living with mental illnesses. They also broadcast anti-stigma messages over the radio and engage with imams to help change community perceptions. If this valuable work were to be replicated across the country, we would see a real impact within so many people’s lives. Finally, the treatment and training for services must be focused upon the community. WHO have demonstrated through their centres how well this works, and following research this seems to be the most practical way to benefit individuals. Community support groups and group therapy appear to be the most effective treatments, thus we cannot allow individual care to take prevalence otherwise there is a complete disregard for the persons requiring help since it is simply not suited to their needs. Overall, this is a hard task and we cannot be naïve to the challenges. In spite of this, if mental health begins to become a talking point within society and access to effective treatment is increased, we can but hope that people’s lives will become just a bit easier in spite of everything that they face.
Endnotes
1 Marie, M., Hannigan, B. and Jones, A. (2016). Mental health needs and services in the West Bank, Palestine. International Journal of Mental Health Systems, 10(1), p4
2 Marie, M., Hannigan, B. and Jones, A. (2016). Mental health needs and services in the West Bank, Palestine. International Journal of Mental Health Systems, 10(1), p4
3 Marie, M., Hannigan, B. and Jones, A. (2016). Mental health needs and services in the West Bank, Palestine. International Journal of Mental Health Systems, 10(1), p.2.
4 Al-Rais, N. (1998). Suicide in the Time of Ashes. Al-Hayat.
5 Ciftci, A., Jones, N. and Corrigan, P. (2013). Mental Health Stigma in the Muslim Community. Journal of Muslim Mental Health, 7(1), p.23.
6 Dabbagh, N. (2005). Suicide in Palestine. London: Hurst & Co, p.81.
7 Marie, M., Hannigan, B. and Jones, A. (2016). Mental health needs and services in the West Bank, Palestine. International Journal of Mental Health Systems, 10(1), p3
8 Marie, M., Hannigan, B. and Jones, A. (2016). Mental health needs and services in the West Bank, Palestine. International Journal of Mental Health Systems, 10(1), p3
9 Mental Health Innovation Network. (2018). Mental Health and Psychosocial Support (Phase II) in Palestine. [online] Available at: http://www.mhinnovation.net/innovations/mental-health-and-psychosocial-support-phase-ii-palestine?mode=default&qt-content_innovation=1#qt-content_innovation [Accessed 25 Jul. 2018].
10 World Health Organization (2006). Community Mental Health Development in the occupied Palestinian territory.
11 Marie, M., Hannigan, B. and Jones, A. (2016). Mental health needs and services in the West Bank, Palestine. International Journal of Mental Health Systems, 10(1), p6
12 Marie, M., Hannigan, B. and Jones, A. (2016). Mental health needs and services in the West Bank, Palestine. International Journal of Mental Health Systems, 10(1), p6
13 Marie, M., Hannigan, B. and Jones, A. (2016). Mental health needs and services in the West Bank, Palestine. International Journal of Mental Health Systems, 10(1), p6