The Gaza Community Mental Health Program Meets Challenges of Peace

By Janet McMahon

Dr. Eyad El Serraj is a softspoken man with a mission. Five years ago, in April 1990, the 48-year-old Palestinian psychiatrist and former director of mental health services for the Gaza Strip founded the Gaza Community Mental Health Program to help his community survive and overcome the trauma of long-term, oppressive occupation.

At the time of its founding, the GCMHP was a symbol of Palestinian identity and autonomy in an environment where "most institutions belonged to the occupation," Dr. El Serraj told the Washington Report. Still the only locally run institution of its kind in Gaza, its staff has treated some 7,000 patients, "mostly traumatized children or victims of torture," since its founding.

Gaza's children have been both the moving force behind and the symbol of the intifada. "Throwing stones became essentially a form of therapy, not only for Palestinian children, but also for the entire Palestinian nation," Dr. El Serraj observed. "Years of helplessness and frustration gave way to active resistance and defiance. The collective sense of injured pride and humiliation was transformed overnight into a state of self-respect."

Yet the price has been high. "The 'children of stones' are not made of stone," the doctor emphasized. "They suffer pain and fear. The extent of their exposure to traumatic events is horrific." Dr. El Serraj describes Palestinian children as "angry and defiant, tense and vigilant," and worries about their future.

"Many will continue to harbor the pain, the guilt, and the anger," he fears. "Some will turn against their own children and against themselves. Some will also turn against the world."

Basic to GCMHP's approach is its policy of "engaging the family in the process of therapy and follow-up." Not only is the family the basic social unit in Palestinian society, but much of the emotional damage and loss has taken place within the family context—from the occupier's deliberate humiliation of the father, the breadwinner and traditional head of household, to the mother's assumption of that role due to the imprisonment or unemployment of her husband, and of course the constant threat of death or injury to their children.

Because the effects of the Israeli occupation on Gaza have been so all-pervasive, the GCMHP has developed several programs to meet the community's needs. In addition to its therapy services, it offers occupational therapy and vocational training workshops as a means to "enable people to function as independently as possible in their everyday life and working environment," Dr. El Serraj explains. Each vocational training participant also receives a monthly wage—crucial in a situation where the ability to earn a living is so tenuous—and learns a marketable skill, such as carpentry. In the organization's embroidery classes, women are taught a skill and centuries-old traditions are preserved and passed along to a new generation.

Training of in-house staff as well as of workers in other institutions, including UNRWA doctors, community workers, teachers and parents, has been a GCMHP priority from the beginning. Seminars and courses cover such diverse topics as group therapy, children and violence, family therapy, and working with political prisoners.

Ironically, on Sept. 13, 1993, as PLO Chairman Yasser Arafat and Israeli Prime Minister Yitzhak Rabin were signing the Declaration of Principles on the White House lawn, the Gaza Community Mental Health Program was hosting an international conference on "Mental Health and the Challenge of Peace." Dr. El Serraj recalled "the sudden surge of hope" in Gaza, as "the participants in the conference enthusiastically joined the jubilant crowds in the streets."

Still-Unanswered Questions

After the initial weeks of euphoria, however, "gradually opposition to the agreement grew, as people became anxious that their questions remained unanswered and their hopes might be turning out, yet again, to be illusions.

"Israeli and Palestinian interpretations of peace are fundamentally different," Dr. El Serraj observed. "The Israelis are concerned to the extent of obsession about security. The Palestinians want justice and acknowledgment of their right to establish their own state and regain their dignity."

The ending of the Israeli occupation of Gaza, in addition to meaning "no more curfews, no more roadblocks, no more barbed wire," has also posed new challenges. The release of Palestinian political prisoners, the large majority of whom were subjected to various forms of torture by their Israeli captors, will have a significant impact on an already traumatized society. A GCMHP study of 500 ex-prisoners showed that 41 percent of the subjects found it difficult to adapt to family life, 45 percent found it difficult to socialize, nearly one-fifth experienced sexual and marital problems, and 75 percent contended with economic difficulties. One-third of the ex-prisoners reported more than eight symptoms from a list indicating the presence of post-traumatic stress disorder.

In response, the GCMHP is designing a Rehabilitation Plan for ex-prisoners and their families, as well as for the families of collaborators, many of whom "were killed brutally and whose families must now live in shame." Evident in their response to this crisis is the commitment of Dr. El Serraj and his colleagues to help the individual within the larger context of the family and, indeed, the community.

The nongovernmental sector is now under the threat of dissolution.

Dr. El Serraj hopes to turn the Gaza Community Mental Health Program into a Palestinian Institute for Mental Health Science, which will "train doctors, psychologists, social workers and nurses in mental health and certify them as professional mental health workers."

In yet another cruel irony, however, Dr. El Serraj discovered that "the funding of the program has suffered due to the peace agreement—in fact, the viable nongovernmental sector is now under the threat of dissolution." Funds from international organizations such as UNRWA and UNICEF, nongovernmental organizations including Save the Children and AMIDEAST, and friendly governments and individuals, are finally beginning to trickle in. But the economic situation in Gaza is dire and the need is great. The loss of such a unique institution as the Gaza Community Mental Health Program would be yet another blow to a people struggling to reclaim their lives and their country.

Janet McMahon is the managing editor of the Washington Report on Middle East Affairs.