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Saturday, November 8, 2014, Kartik 24, 1421, Muharram 14, 1436 Hijr

Gaza isn't just a physical wreck
I have never seen psychological devastation this intense. Almost all the hands I shake, seven weeks after the fighting has stopped, are cold with a "fight or flight" response that will not quit even though the situation no longer demands it
Publish Date : 2014-11-08,  Publish Time : 00:00,  View Count : 13
James S Gordon
"It feels", says Musallam Al Najaar, the retired customs official who is walking me through this small village in southern Gaza, 'like the Day of Judgement'.
It looks like it, too. Houses are as squashed and scattered as paper cups. A water tower is torn up close to the ground like a stalk of corn. Mosques, schools and factories are blasted, useless shells. Olive trees that were almost ready to yield their fruit are reduced to kindling. It goes on, block after block in Khuzaa, as well as in Beit-Hanoun in the north, Shejaia to the east of Gaza City and Rafah in the south. Altogether 20,000 homes are destroyed and uninhabitable, 39,000 people are still living in United Nations shelters and perhaps 100,000 more are homeless, crowded in with relatives. Building materials promised by the United Nations and international donors are stalled or unavailable.
However, the catastrophe there is not just physical. Upheaval has wrecked lives, severed families and upended routines. "The psychological damage is even greater", says Al Najaar, who is leading some local reconstruction efforts. "And it will take much longer and be far harder to repair." It is a tragically common refrain there - from political leaders, homeless women, university officials and my own team of trauma counsellors from the Centre for Mind-Body Medicine. I have worked for 20 years with psychological trauma - during and after the war in Kosovo, after the earthquake in Haiti, with US troops returning from Iraq and Afghanistan and during this summer's Israeli war on Gaza. And since 2002, I have worked in long-beleaguered, isolated Gaza, leading workshops, training local clinicians and leaders and setting up a programme of self-care and group support to deal with the population-wide psychological trauma.
In all these decades, I have never seen psychological devastation this intense. Almost all the hands I shake, seven weeks after the fighting has stopped, are cold with a 'fight or flight' response that will not quit even though the situation no longer demands it. When I ask children and adults in the half-dozen Mind Body Skills Groups that our Gaza team leads whether they have trouble sleeping, all hands go up. Just about everyone has regular nightmares of bombs falling, tanks roaring towards them, body parts lying in the street, children buried under rubble, screaming for help that never comes.
In a resiliency-building workshop I lead, ambulance drivers from the Palestinian Red Crescent Society share the symptoms of post-traumatic stress disorder that afflict them: The sudden rages, flashbacks of the dead and dying, the long withdrawn silences. These guys - as courageous, tough and funny as the New York City fire-fighters they resemble - now say they cannot think straight or remember the simplest things. Their wives say they thrash their arms and legs and scream in their sleep.
Gaza's long-enforced isolation and powerlessness continue to compound and reinforce every symptom. So, too, does an experience of Israeli aggression that everyone I speak with feels to be unprecedented. For Gazans there was, during this war, no safe place and no way out. People who were told by Israeli soldiers to leave homes that were about to be bombed said they rushed for safety to the next street, where they found more soldiers blocking their way, telling them to go back. When they returned to their own houses, bombs greeted them. "Something inside us broke," says a man in Shejaiah whose two sons - the sole survivors of 26 family members - cling to him. "We didn't think the Israelis would do this."
In the school in Rafah where 3,500 homeless Gazans sleep on thin blankets spread over concrete floors, uncertainty about the future is crushing. Mothers fear the next round of Israeli bombs will kill children on their long way to still-standing schools. Parents are sure they will never be able to rebuild their homes or pay for their children's university education. I have seen this level of distress, unaddressed, lead to fixed destructive biological, psychological and social patterns: Agitated children and adults focus and function poorly; impatience explodes in domestic abuse; and free-floating fear and anger push desperate people towards individual and collective violence.
Our Gaza team tries to restore some small measure of control and even hope. Children doing slow 'soft belly' breathing discover it is possible to loosen knotted shoulders and quiet fearful thoughts. They sleep better and their nightmares are less overwhelming. Adults who express their fear, anger and frustration in our groups feel, at least for a while, that their thirst for revenge is slaked. And those who help others, as well as themselves - in or out of our programme - can still summon considerable energy. Exhausted school principals and teachers, as well as neighbours, find comfort and inspiration in helping other people's children. They, like Al Najaar, the ambulance drivers, and my own team, move resolutely forward. "We want to rebuild. Of course, we must rebuild", concludes a principal sitting in one of our mind-body groups. "We need help to do it, help from Israel and the world. But it is not enough". The Quran, he assures me, "tells us before we change the outside, we have to change the inside - the mind and the heart".r
James S Gordon, a psychiatrist, is the founder and director of The Centre for Mind-Body Medicine and an author

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