Last May, Israel launched a 15-day assault on the Gaza Strip, killing 256 Palestinians, injuring 2,000, and bombing 232 high-rise buildings, forcing over 70,000 to flee their homes. Since then, Israeli violence against Palestinians has not relented. Continuous deterioration in infrastructure due to a blockade by Israel, in place since 2007, has rendered 97 per cent of Gaza’s water undrinkable. Palestinians in Gaza get 12 to 13 hours a day of electricity. 53 per cent of Gazans live under the poverty line. Meanwhile, Israel presses forward with plans to dispossess Palestinians of their homes and land across colonised Palestine, including in the Jordan Valley, Beita, Jerusalem, Masafer Yatta, and the Naqab. Israeli settlers in the West Bank are attacking Palestinians with increasing intensity, with the complete complicity of the Israeli state.
It is, unfortunately, not a surprise to see a raging mental health crisis among Palestinians. Many Palestinians are constantly plagued with fears of violence. Mohammed, a 23-year-old from the Gaza Strip, reports being preoccupied with thoughts about war instead of a bright future, according to Médecins Sans Frontières (MSF), which provides a range of medical and psychological services to Palestinians. Adel, a resident of a village that has been frequently targeted by settler attacks against Palestinians, told MSF: “We live in a state of constant fear. Everyone feels stressed for himself, for his brothers, for his children and friends.”
These stories are representative of a wider pattern. After the May 2021 Israeli attacks on Palestine, a World Bank team conducted a Facebook-based survey, in which they found that “70 per cent of Gazans and 57 per cent of West Bank residents surveyed reported symptoms consistent with post-traumatic stress disorder”.
Most organisations working in the mental health space respond by providing individual psychological services to reach an ever-increasing number of people who exhibit symptoms of mental ill-health and seek help for them. The undue focus on this model of care is rooted in healthcare paradigms from the Global North, which neglect the environments that determine people’s health and wellbeing, instead, placing an exaggerated focus on individualistic and over-medicalised services that deal with what are perceived to be diseased minds. This individualised model of care is incapable of diagnosing or treating the mental health crisis in Palestine.
The basic idea of a “disease” is that of an individual experiencing disruption to their lives due to something that affects them personally. But a Palestinian experiencing stress, lack of hope, or persistent negative thoughts in response to a settler colony aiming to erase them is not necessarily a sign of disease. As Dr. Samah Jabr, chair of the mental health unit at the Palestinian Ministry of Health points out, many symptoms of mental ill-health “are a normal reaction to a pathogenic context”. Colonial violence – killing, maiming, incarcerating, and dispossessing Palestinians – is the disease.
Similarly, using post-traumatic stress disorder – the most commonly diagnosed mental health condition in Palestine – is simply inaccurate. Trauma in Palestine is often viewed as Israel’s intense bombardment campaigns, in which it kills hundreds of Palestinians over a matter of days. In reality, however, the trauma is constant. Since last May’s ‘ceasefire’, Israel has killed 86 Palestinians, including national icon Shireen Abu Aqleh, a journalist who was assassinated by Israeli forces while covering a raid on Jenin refugee camp. Mass incarceration, movement restrictions, house demolitions, land grabs, and denying the right of refugees to return to their homes all continue. Israel has even attacked Palestinian funerals, refusing to even let Palestinians mourn in peace.
In Gaza, PTSD is non-existent.
It is not post-traumatic. It is chronically traumatic. The trauma is constant and relentless. It is "repetitive, ongoing and continuous", quoting the Palestine's Head of Mental Health Services Dr Samah Jabr.
— Malaka (@MalakaShwaikh) May 20, 2021
Therefore, understanding the mental health crisis requires looking beyond individual diagnoses to recognise the violence that Israel subjects Palestinians to. Similarly, preventing and healing these symptoms should focus on ending the colonial violence that causes them.
The other inadequacy of Western paradigms is that they overlook social and cultural traditions as potential enablers of well-being, mainly treating them as a hindrance instead. At worst, mental health initiatives reproduce orientalist lies, such as that stigma around mental health in Palestine “comes from religious views that say mental illness is a test or punishment by God”. Even well-meaning services established by Palestinians, such as The Treatment and Rehabilitation Centre for Victims of Torture, adopt methods that individualise political violence, which run counter to the understanding of those who experience such violence. This imposition of universal solutions from the Global North, often supplanting local knowledge, is symptomatic of coloniality.
Addressing the mental health crisis in Palestine, therefore, requires the dismantling of two colonial structures: coloniality and settler colonialism. Breaking the chains of coloniality means rooting solutions in local knowledge, culture, and tradition. Rather than providing even more individualised psychological services, for example, mental health providers should support the long Palestinian tradition of sumud, which describes resilience and steadfastness as anti-colonial resistance that is the product of community solidarity and support. Doing so requires power going back into the hands of communities so they can articulate and plan the services that they need.
Thanks to tireless work by Palestinian scholars and activists, there is growing recognition of the centrality of Zionist settler colonialism in harming the health and wellbeing of Palestinians. Health professionals are often reluctant to be seen as political activists, but a growing body of professionals and scholars, politics, and health are demonstrating that these things are deeply connected. So scholars’ and practitioners’ commitment to the health of their patients and the population must lead them to be politically active and boldly call for decolonisation. Although these seem like tall orders, such transformative solutions are necessary if we are to stem the mental health crisis in Palestine.