On July 8th, 2014, Israel launched its third and most devastating air, ground and naval assault on the Gaza Strip in 6 years. For many of the 1.8 million residents of Gaza, the effects will last a lifetime.
The statistics that emerged in the immediate aftermath of the 51 days of violence were shocking. According to the UN, over 2,200 Palestinians were killed, the majority of them civilians. 551 of those killed were children.
Six Israeli civilians including one child and 67 IDF soldiers died during the conflict and a UN report says both sides may have possibly committed war crimes.
One year on however, what is equally as shocking, is the statistic that
300,000 Palestinian children remain in desperate need of psychosocial counselling
During Operation Protective Edge, Israel conducted 6,000 airstrikes and fired more than 50,000 tank and artillery shells in response to thousands of rockets and mortars launched by Hamas and other militants groups into Israel.
The intensity of the attack left over 18,000 homes in Gaza either destroyed or severely damaged, displacing tens of thousands of people. In the past year, no significant reconstruction has taken place with many families still trying to survive without electricity or water in the bombed out shells of their homes.
It's within this environment that the minds of a generation of traumatised children are being treated by an over stretched and exhausted group of psychologists.
Budour (29), is the head of the Psychosocial Program at the Near East Council of Churches (NECC) health clinic in Shijaia district in Gaza City and has witnessed first hand the increasing need for psychosocial care. Budour was one of the first psychologists employed by the NECC in the wake of Operation Cast Lead in 2008, the first of the three major wars in Gaza. She said, 'There was no need for psychosocial services prior to these wars happening. However, the health community quickly realised (after Operation Cast Lead) that they needed permanent centres to deal with the high demand of post traumatic stress disorder (PTSD) cases. The need has increased with each year and each war."
"The latest war was so bad. We have had so many severe cases of PTSD and a huge increase in people asking for help."
One of Budour's latest patients is Tarek (5), who was showing severe symptoms of post traumatic stress while trapped for days with his family by the bombing. Their home in Shijaiyah district was one of the most heavily targeted areas in Gaza.
Tarek's mother, Maha said, "During the war there was bombing all around us and lots of people got stuck in our kitchen looking for safety. Tarek became very scared when cracks appeared in the walls and then the ceiling fell down in the kitchen. He thought the house would crumble on top of our heads. You can imagine the kind of mental and psychological state that we were going through, the stress. He was the worst case of all."
Maha was deeply concerned by the change in Tarek's behaviour after the war. "He used to be very active but he then became aggressive, hyperactive and did not want to communicate with anyone. He would constantly smile. Now he wakes in the middle of the night and hits the floor with his head or hands or starts hitting himself. His kindergarten teacher thought that he was mute and that he couldn't talk.", explained Maha.
"The only thing he would talk about was what happened during the war. How the Israeli soldiers would come and shoot everyone and the experience of what happened in our house"
Holding Tarek's hand gently, Budour smiles as she helps him draw pictures during the second of 14 psychosocial sessions to help him overcome the trauma. She said, "He is still hyperactive but less so than during the first session. He didn't draw anything or talk at all but today he talked a bit and he drew some simple things. He also played with his brother. This is an improvement over the first session so hopefully he will continue to open up."
Budour continued, "If trauma like this is addressed in the early stages, he can recover quickly. If it's not treated, the disorder can last a lifetime and affect him at school and socially with his family and friends."
Nervously observing the session, Maha is thankful that she found a clinic able to treat her son. She said, "I believe that it's really important for him to get this kind of treatment since I cannot deal with this alone. I just hope that my kids can live in a safe environment and have a life like any other kid in the world."
For many children, the trauma of war has been compounded by life threatening injuries. Nour (10), also a resident of the devastated Shijaiyah district, was hit by shrapnel, which remains lodged in her brain.
Nour only has vague memories of the night she was injured but remembers, "I was sleeping next to my siblings when a bomb exploded and shrapnel got into my brain through my ear. I was bleeding for four hours and they couldn't get an ambulance because it was too dangerous to reach us because of the bombings. My father carried me on his shoulders and he was running with me to the hospital. There was blood all over his shoulders."
"I could hear people calling my name and I could remember myself talking to them saying I'm exhausted and in pain but they didn't hear me."
Nour stayed in hospital for a month but the doctors said it was too risky to operate. Her situation was so precarious, she was granted rare permission to travel to a hospital in Jordan where it was decided there was only a 5% chance of success, so she had to return to Gaza to face an uncertain future.
"When I went back home I felt like a stranger. The home was damaged with bullet holes in the ceiling." said Nour. Initially Nour was too scared to go back to her room and would sleep next to her mum. It was only when she started psychosocial counselling sessions with Budour did she open up and talk about what had happened to her.
"The counsellors were really nice and I feel better after the sessions, I feel more active. We had to introduce ourselves in a group and we got to know each other and we talked and played some games. We had a good time." Nour added.
Her mother Eman said, "The sessions with the counsellor in the NECC clinic really helped because she didn't know how to express herself. There she was drawing and talking about what had happened to her. At the beginning she was drawing mothers and injured people that she had seen at the hospital and then with time she was drawing more cheerful stuff like houses and trees. She became better and better with time."
For Budour, hearing about such changes in people like Tarek and Nour are what drives her but the constant workload and strain is immense. Just this year staff have treated over 4,000 children suffering from trauma along with 4,300 mothers. With the blockade making it almost impossible to leave, most of the psychologists working for the NECC have the same lived experience as their patients, often having narrowly survived the recent wars themselves. Hearing stories of trauma on a daily basis triggers many emotions. Budour said,
"I often feel like crying but I don't in order not to upset the patients. It is very difficult to listen to all these sad stories."
"What gives me the most pleasure in my work is the feeling I get when I know I've succeeded in a positive outcome. I love seeing how children improve after our meetings."
Enthusiastically talking about the psychosocial program she continues, " We run 14 sessions with 15 children in each group. The first 7 sessions are about healing the trauma they are suffering. We have activities such as breathing exercises, relaxation techniques, play therapy, story telling and drawing to help them."
The next 7 sessions are about improving their daily behaviour and learning how to express themselves better. In most cases the children show improvement but if they don't improve after the sessions they are referred to other specialists. "
"People are becoming more aware that they can be psychologically damaged as well as physically damaged, so they are now more confident to seek help."
Whilst the psychosocial counselling helped Nour come to terms with her injury, she still has constant headaches and pain and finds it difficult to concentrate but she was determined to get back to school when they reopened. "My mum wanted me to stay home for a while to recover but I really missed school so I only missed out a day." said a determined Nour.
No one knows what effect her injury will have on her in the future. For now she is surviving on painkillers and antibiotics. Nour said, "I want to become a doctor to cure the little children I've seen in the hospital who are suffering a lot and I'd also like to be a lawyer to defend my country and let everyone know how proud I am of it. " Her mother encourages her to live positively everyday and is optimistic about her future but wants access to more specialised medical care saying,
"The only hope is that she can be transferred to Europe or somewhere else."One year after the war, the need for the NECC run psychosocial counselling sessions remain desperately high but so do all their other primary health care services, especially mother and child care. The combined effect of three devasting wars and an eight year long blockade means the situation in Gaza remains critical.
Somaya, a midwife with the NECC has been conducting house to house screening of all children under 5 in the Shijaiyah district. She said, "Many of the homes I visit are very poor and have no money for food which is effecting their children's health"
"We are finding many cases of anaemic and malnourished babies here."
Once tested, Somaya gives any anaemic children iron drops and brochures are provided to the parents with advice on how to feed their babies food that is high in iron such as meat and vegetables. They are then immediately referred to the main NECC clinic in Shijaiyah.
The NECC has been working in Gaza since 1952 and the bustling clinic sees over 150 children every day as part of its well baby program. It has built up a strong and trusted relationship with the local community, treating generations of families. They have also seen a dramatic increase in cases since the last war.
Dr Fadi, a paediatrician at the clinic said, " We are seeing high rates of anaemia in our clinic at the moment. Around 38% of children have moderate to mild readings, some are severe. We are also seeing lots of stunting because of malnutrition. There are many cases of severe malnutrition because of insufficient food, especially after the war. "
"Parents complain that they have no homes, no money, so they are unable to buy good food for their children."
Dr Waffa Kannan, the Health Program Coordinator for NECC said, "The women and children here are very strong and determined to have a life. This is the best thing about this Gaza population. We have many dreams and things we want to do in the future."
"We believe in peace and justice, so we are looking for more and continuing support to the Palestian people who live here in Gaza. All Palestians are looking for peace. Without wars. We just want a better future for us and our children."
Filmed, photographed and produced by RICHARD WAINWRIGHT whilst on assignment for Act for Peace.
Thanks to Act for Peace, Ebaa the amazing translator, all the staff at the NECC and residents of Gaza for their incredible hospitality and resilience)
(Note:- Some names have been changed to protect identities)