Bedwetting, nightmares and trembling. The war in Gaza takes a heavy psychological toll, especially on children

DEIR AL-BALAH, Gaza Strip — Nabila Hamada gave birth to twins in Gaza at the start of the war, in a hospital that stank of rotting corpses and was filled with displaced people. When Israeli troops threatened the hospital, she and her husband fled with only one of the babies because medical staff said the other was too weak to leave. Soon after, Israeli troops stormed the hospital, the largest in Gaza, and she never saw the boy again.

The trauma of losing one twin left 40-year-old Hamada so afraid of losing the other that she was paralyzed and unable to cope with the daily burden of survival.

“I am unable to care for my other, older children or give them the love they need,” she said.

She is one of hundreds of thousands of Palestinians struggling with mental health issues after nine months of war. The trauma is unrelenting. They have endured family and friends killed in Israeli bombings. They have been wounded or disfigured. They have huddled in homes or tents as the fighting raged, and have fled again and again, with no safe place to recover.

Fear, anxiety, depression, lack of sleep, anger and aggression are widespread, experts and doctors told the Associated Press. Children are particularly at risk, especially because many parents have difficulty controlling themselves.

There are few resources to help Palestinians process what they are going through. Psychologists say the unrest and the overwhelming number of traumatized people limit their ability to provide real support, so they offer a kind of “psychological first aid” to ease the worst symptoms.

“There are about 1.2 million children who need mental and psychosocial support. This basically affects almost all children in Gaza,” said Ulrike Julia Wendt, coordinator for children’s emergencies at the International Rescue Committee. Wendt has been visiting Gaza since the beginning of the war.

She said simple programs like play sessions and art classes can make a difference: “The goal is to show them that not only bad things happen.”

Repeated displacements compound the trauma: an estimated 1.9 million of Gaza’s 2.3 million residents have been displaced from their homes. Most live in squalid tent camps and struggle to find food and water.

Many survivors of the October 7 Hamas attack in southern Israel that sparked the war in Gaza also bear traumatic scars and are looking for ways to heal their wounds. The terrorists killed more than 1,200 Israelis and took around 250 hostage.

Jehad El Hams, who was sheltering near the southern city of Khan Younis, said he lost his right eye and the fingers of his right hand when he picked up what he thought was a can of food. It was an unexploded bomb that detonated, nearly hitting his children.

Since then, he has suffered from insomnia and disorientation. “I cry every time I look at myself and see what I have become,” he said.

He turned to one of the few mental health initiatives in the Gaza Strip, run by the United Nations Relief and Works Agency for Palestine Refugees (UNRWA).

Fouad Hammad, a mental health officer at UNRWA, said they typically see 10 to 15 adults a day in the Khan Younis shelters with eating and sleeping disorders, extreme anger and other problems.

Mahmoud Rayhan saw his family destroyed. His young son and daughter were killed in an Israeli attack. His wife had to have a leg amputated. Now he isolates himself in his tent and sleeps most of the day. He speaks to almost no one.

He said he didn’t know how to express what was happening to him. He was shaking. He was sweating. “I’ve been crying and I feel nothing but heaviness in my heart.”

A relative, Abdul-Rahman Rayhan, lost his father, two siblings and four cousins ​​in a strike. Now, when he hears a bomb attack, he trembles and feels dizzy, his heart races. “I feel like I’m in a nightmare and I’m waiting for God to wake me up,” said the 20-year-old.

The psychological consequences of the war can have long-term effects on children’s development, says Wendt. Children in Gaza have nightmares and wet the bed because they suffer from stress, noise, crowding and constant change, she says.

Nashwa Nabil from Deir al-Balah said her three children have lost any sense of security. Her eldest is 13 and her youngest is 10.

“They can no longer control their urine, they chew on their clothes, they scream and have become verbally and physically aggressive,” she said. “When my son Moataz hears a plane or a 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 reality of war and giving them space to play.

“In the event of an attack, they go into a fetal position and seek shelter away from buildings or windows. We run scenarios, but anything is possible in Gaza,” says project manager Georgette Al Khateeb.

Even for those fleeing Gaza, the psychological burden remains high.

Mohamed Khalil, his wife and their three children were displaced seven times before reaching Egypt. His wife and children arrived in January and he joined them in March. Their 8-year-old daughter hid in the bathroom during the artillery shelling and shooting, saying: “We are going to die.”

Her six-year-old son could not sleep until his mother told him that death as a martyr was an opportunity to meet God and ask for the fruit and vegetables that were not available in famine-stricken Gaza.

Khalil recalled the fear they felt as they fled on foot through a designated “safe corridor” while Israeli gunfire fired nearby.

Even after their arrival in Egypt, the children are introverted and fearful, said Khalil.

They have signed up for a new initiative in Cairo, Psychological and Academic Services for Palestinians, which offers art and play therapy sessions, as well as math, language and physical education classes.

“We saw a need for these children who have experienced more horrors than any of us will ever see,” said founder, psychologist Rima Balshe.

She recalled a recent trip with five-year-old twins from Gaza who were playing and suddenly froze when they heard helicopters.

“Is that an Israeli fighter plane?” they asked. She explained that it was an Egyptian plane.

“So Egyptians like us?” they asked. “Yes,” she reassured them. They had left Gaza, but Gaza had not left them.

There is hope that the children traumatized by the war can heal their wounds, but there is still a long way to go, Balshe said.

“I wouldn’t say they’re recovering, but I certainly see signs that healing is beginning. They may never fully recover from the trauma they’ve endured, but we’re working now 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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For more AP coverage, visit https://apnews.com/hub/israel-hamas-war.