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© Healing Psychological Wounds of Gaza's War"When we first went to the summer camp in the bus they told us the camp's motto, and it was "This camp is a joy" " Ghouzalan, 7 years old from Khan Younis, Gaza, Palestine.
As the devastation in Gaza continues unabated, teams of medical professionals work to combat the psychological impact on children raised in that densely populated and blockaded human laboratory. Many of those children have already lived through 3 major military offenses. I saw a photo today of some of those beautiful kids — visiting the graves of their fathers and brothers killed in Gaza during the summer slaughter of 2014 — and wondered how those kids were holding up.

Reminded of some people I met who cycle around the globe raising funds for children's mental health in Gaza, I visited Cycling4Gaza's (C4G) Facebook page and coincidentally intercepted some drawings they'd posted from the Gaza Mental Healthcare Project, launched in partnership with the Palestine Children's Relief Fund (PCRF). The eyes in this drawing bore into me:
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© PCRF, Cycling4Gaza“We will celebrate Eid despite Pain/ With PCRF, there’s nothing impossible” Gaza Mental Health Project.

There was a commonality to the children's artistry. I contacted my friends at C4G asking about the children and if they knew who took the photos. Shortly thereafter they connected me to a woman right here in the Bay Area, Dr. Bahar Al Hashemi. I recognized Hashemi's name as one of the people cycling on C4G's Hague ride last summer. Hashemi specializes in pediatric psychiatry and she's currently in Gaza leading the development of the project, which includes working with health professional partners — social workers from the Center for Mind Body Medicine (CMBM) and the Gaza Community Mental Health Programme, (GCMHP), who help treat children suffering from different levels of post-traumatic stress disorder (PTSD).
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© Gaza Mental Health care project
"I took pictures of them on my last visit to Gaza," Hashemi told me, "they were created by children from the mental wellness summer camps we launched this past summer. We held three summer camps for a total of 120 children from our screening, who had high levels of trauma/depression symptoms."
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© PCRF, Cycling4Gaza“We want to be happy, in peace together I want Eid” Gaza Mental Health Project.
These drawings are from children from two families, nine to twelve years old, which somewhat explains similarities in quality of their artwork. Aside from the summer camps social workers from the Center for Mind Body Medicine go on home visits working off a central database (PCRF's innovative applications of technology for mental health in Gaza using the latest mobile and cloud based technology) of over 1000 children screened using questionnaires developed to gauge exposure to trauma events and mental health symptoms.
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© C4GDr. Bahar Al Hashemi with Yamen and Janna. They were pulled out of the rubble after their three level family home was bombed last year killing 19 of their family members.
Dr. Hashemi, who previously volunteered for many years with PCRF in the the West Bank, told me the new program represents a historical intervention because the "nature of the trauma is unique" and symptoms evolve in children from living through three wars. Social workers went into the homes after the summer 2014 assault and with consent from the families, chose children with the highest symptom loads of PTSD.

I asked Dr. Hashemi if there was a stigma attached to mental health in Gaza and if it was challenging to get the families and children to participate. She told me that mothers welcomed her:
"All of them were positive, so grateful. They saw their kids so happy to go, a good buy-in for the families. One parent said 'It was like magic for my son'. The early intervention — the positive reaction was really nice to hear. Even families you wouldn't expect to be — the parents were committed to get their child into treatment. One girl with a broken leg, her parents were so committed they arranged special transport.

"They see their kids suffering, and talking about it in the context of injustice and something done to us, it's easier to accept, to empower them. 'This is why my child is suffering and I want to empower them', was very well received. And the staff is getting training from Mind and Body [CMBM] — amazing continuous sessions. It's an outlet to talk about their care of the kids - the social workers."
Two days ago C4G forwarded me a letter Hashemi had written after arriving in Gaza:
This was my fourth trip to Palestine but my first entry into Gaza. Nothing could prepare me for the experience I had there. From the moment I saw the crossing point at Erez, I immediately understood why Gaza is referred to as an open-air prison. With turnstiles for people and their luggage to maneuver through, the long narrow walkways with barbed wire and concrete walls, I couldn't help but feel the experience was made to make humans feel less human.

The first meeting of the day was with the PCRF staff, who blew me away. They are a lively, energetic group who are passionate about their work to heal children in the face of such big challenges. They insisted on starting our meeting with deep breathing exercises which they learned in the training from our partner, the Center for Mind Body Medicine. Soon after, they broke the silence with a traditional Gazan welcome song. I was thrilled to hear the very positive feedback about the work they did with the Center for Mind Body Medicine. They went from not being sure they could buy into the mind-body skills group techniques to a transformative experience over their five-day training. As you can imagine, our staff have endured and witnessed unimaginable amounts of trauma and suffering, which has a direct impact on them in varying ways. The need for self-care and support from one another cannot be understated. ......

I also attended the first follow up group for the children who took part in our mental health summer camps. CMBM is providing these children with weekly follow up mind-body skills groups for 10 weeks, and 10 months thereafter. Witnessing firsthand the beautiful job the group leader did in engaging this group of children was deeply moving and gave me a renewed appreciation for this work. It was having a clear positive impact on the children.

With the social workers, I went on various home visits to see the kids who were part of our screenings. Despite being a child psychiatrist who hears troubling stories in my day-to-day work, listening to Palestinian children and families in Gaza talk about their experiences, their traumas, and their daily lives, was overwhelming at times. But in many ways, I also received an education about resilience and strength unlike anywhere else; parents doing what they can to provide a sense of security in an environment where this simply cannot be guaranteed; children trying to get an education and build their own dreams for a future that cannot be guaranteed. To continue to fight to live life to its fullest capacity, maintain faith, love one another and nurture compassion and kindness for their community. This is also Gaza. And these are some of its people.
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© PCRFDr. Bahar Al Hashemi and colleagues/social workers from Gaza Community Mental Health Programme (GCMHP) visit Ibrahim’s home in Rafah.
This is Ibrahim, whom we visited in his home in Rafah, in the South of Gaza. He and his brother are both receiving treatment from the Gaza Community Mental Health Programme (GCMHP), and Ibrahim also attended our summer camps. They witnessed their 16 year old brother die from an Israeli bombing and both sustained significant injuries. The boys suffered from intense symptoms of trauma, including bed-wetting, nightmares, trembling, and flashbacks. Their schools and home life were impacted significantly. They have made some noticeable improvements; as Ibrahim said, "step by step" he is feeling better and more optimistic. His father was incredibly grateful to the PCRF for providing mental health support and pleased with his son's improvements. He even joked with us, saying that the PCRF is stuck with him and they would have to throw him out the window before he agrees to go somewhere else for support!
After my conversation with Dr. Hashemi, she sent along this video about the program.

Here are more of the drawings some of the kids drew. They were asked to visualize their hopes and dreams, their future:
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© PCRF, Cycling4Gaza“We wish to live safely” Gaza Mental Health Project.
My favorite:
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© PCRF, Cycling4Gaza“Let Gaza be free” Gaza Mental Health Project.
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© PCRF, Cycling4Gaza“Gaza, save us” Gaza Mental Health Project.
PCRF to the rescue?:
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© PCRF, Cycling4GazaGaza Mental Health Project.
There are nearly 800,000 children in Gaza. 54% of those screened by PCRF had symptoms of PSTD classified as criteria 4. Unicef estimates 373,000 children in Gaza are in desperate need of psycho-social support. If you'd like to support them go here.

Translations in children's art by Fidaa Abuassi