Guest Post: Save the Children on Child Protection and Mental Health and Psycho-Social Support in Gaza
In the lead up to the highly anticipated ‘Uniting Knowledge, Resources and Solidarity – Gaza Health Initiative Conference’, KIT Institute is hosting with the Gaza Health Initiative on the 13th of September, Save the Children has shared this in-depth analysis on the urgent Mental Health and Psycho-Social Support needed for the children in Gaza with us.
In it, they look at mental and psychological impact that prolonged war has on children, and what is urgently needed for recovery and genuine healing to begin.
In 2024 our partners shared numerous shocking stories during their interventions with children and their families in Gaza, detailing their mental health conditions. One of the cases is about the sole survivor of his family, a 14-year-old boy who lost his entire family while he was fetching water from their neighbors. He witnessed rocket fall on his home and its complete destruction. His family is still buried under the rubble. After the loss of his parents, siblings and their home he is left with pain, hunger, fear and sleepless nights. The psychologist following his case shared that after each two hours session with boy he finds himself crying because he feels powerless in the face of the harsh reality of this boy who has to return to his tent alone, struggling without his family. While all he wants is to have his family back.
This story and many others shows that children’s mental health in Gaza is being pushed beyond breaking point after almost a year of siege and relentless bombardment. They have suffered unimaginable mental harm from the violence, serious physical injuries, and the loss of families, homes, and their schools. Many children and families are left waiting with traumatic anticipation for news about their relatives, unsure whether they are alive or how to find them. This type of loss is known as ‘ambiguous loss’ and is considered the most stressful type of loss with long-lasting mental health implications.
Saleem’s story
The humanitarian situation unfolding in Gaza is catastrophic. As of September 4th 2024, 40,861 Palestinians have been killed, of which 70% are women and children, and 94,398 persons have been injured . Around 50% of displaced civilians are children, who are now living in over-crowded shelters or informal sites such as in the streets. The unsafe environment and lack of privacy put children in danger of child rights abuses (including death and injury from war), alongside health concerns such as preventable disease and malnutrition.
Palestinian children have spent their entire lives in an occupied territory, facing barriers that stem from the Israeli occupation and jeopardize their safety and right to protection, even prior to the escalation of conflict on 7 October 2023. An estimated 8 out of 10 children were already experiencing emotional distress pre-escalation, and half of Gaza’s children were already in need of mental health services.
There are more than 17,000 children separated from their families in Gaza, and around 20,000 children are missing in the chaos in Gaza. The number of children with disabilities due to war injuries has also increased, with UNICEF estimating over 1,000 children have had one or both legs amputated. In addition, girls and women and also boys and men are facing additional gender-based violence and risks.
Save the Children’s response
As the leading actor for child rights in the occupied Palestinian territory, Save the Children’s response is across almost all sectors to meet the most urgent needs of affected children and families, including providing multi-purpose cash assistance, food, water, hygiene items, shelter, nutrition, health, child protection and mental health and psychosocial support as well as education. Save the Children’s Child Protection and MHPSS programming aims to improve the protection, mental health and psychosocial wellbeing of boys and girls and their caregivers affected by the ongoing war in Gaza. The program focuses on enhanced access to child protection services and improved and safe access to MHPSS services for children and their caregivers in shelters, schools and the surrounding community in Gaza.
Challenges
Almost all of the estimated 1.2 million children in Gaza need mental health and psychosocial support. Problems include depression in children as young as five, anxiety, regressive behaviours (e.g. bedwetting in children as old as 14), and suicidal thoughts. The high numbers of unaccompanied and separated children are at particularly high risk of developing mental health and psychosocial problems
Children’s psychosocial wellbeing in Gaza has been on a dangerous trajectory for years due to long-term exposure to extreme stressors and traumatic experiences. Recurrent conflict, the Israeli blockade and domestic governance problems were among factors contributing to high MPHSS needs prior to7 October. The more extreme stressors children (and their caregivers) are exposed to, and the longer the escalation of violence lasts, the more difficult it is going to be for children to recover and live the life a child deserves.
According to parents and caregivers this humanitarian crisis in Gaza is unlike any that came before. For children, this translated into a destruction of the fundamental tenets of childhood. Children have no escape from the reality of war, no stable routine, no opportunity to learn or play – and for many, no family.
The forcible – and often repeated – displacement of children and their families have been a major factor in children’s emotional distress, as this affects their sense of safety and belonging. This displacement presents multiple risks to the psychosocial wellbeing of these children.
The collapse of mental health services in Gaza also means the loss of a variety of psychosocial support, counselling, rehabilitation services, programs and activities that benefitted to children, youth, women, including persons with disabilities. Health care and pathways for humanitarian aid have been systematically blocked, with almost 500 health care workers killed, 26 hospitals damaged or destroyed, and border crossings closed. Healthcare and other frontline workers providing MHPSS are experiencing the same stressors and needs as their patients, compounded by exhaustion from overwork and the constant need to make ethically challenging decisions.
The future of MHPSS in Gaza
It is of critical importance to provide long term comprehensive and integrated MHPSS support in both the emergency response and recovery efforts. This includes a commitment to integrating MHPSS components across all core sectors such as health, education and relief and social services. A long term and cross cutting approach should be prioritized over short term projects. Save the Children is urging the international community, including donors, to investing in the long term mental health needs of children and families:
- Prioritize urgent accessible and inclusive MHPSS approaches and services in all humanitarian aid for Gaza and address scaling up of urgently needed MHPSS service delivery.
- Mainstreaming of MHPSS across sectors to enhance coordination and across the different phases of the response and the recovery efforts, to meet protection and wellbeing needs for children (e.g. health, mental health, shelter, nutrition, education).
- Ensure access to MHPSS orientation, and training for and supervision of health workers, teachers, child protection workers, community members and caregivers on psychological first aid and on existing and available MHPSS services.
- Develop and support adequate and tailored MHPSS response for unaccompanied children.
- Urgently recognize the need for and fund education in emergencies within the humanitarian response by providing immediate, cross sectoral lifesaving, resources to caregivers, communities and partners to support children’s physical, social, emotional and cognitive safety and wellbeing.
The situation unfolding in Gaza is likely to cause lasting and severe psychosocial impacts, unless urgent action is taken. This is due to the fact that protective factors have been ripped away, while simultaneously, trauma, with all the risk factors for lasting harm including intergenerational trauma, are present. The sole way to ensure MHPSS services are delivered at the scale required to prevent permanent harm to children is through an immediate and lasting ceasefire and unfettered access of aid. Without a lasting ceasefire, recovery and genuine healing cannot begin.
