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This book contains papers submitted to the international conference on Siege and Mental Health, Bridges Vs Walls, which is organized by Gaza Community Mental Health Program in cooperation with the World Health Organization, in Gaza, 27- 28 October 2008. Papers on the theme of Women, Children and Family Under Siege include: 1- Trauma, PTSD, Mental Health, and Resilience as mediator factor in Palestinian children in the Gaza Strip by Dr. Abdel Aziz Thabet Aim: The aim of this study is to investigate the frequency and reactions to trauma such as PTSD and general mental health, then examining resilience from the perspective of decreased vulnerability to PTSD and mental health problems in reaction to trauma. Method: The study sample consisted of 386 children from total of 400 children targeted as study population with respond rate of 96.5%, 201 of children were boys (52.07%) and 185 were girls (47.93%). Children age ranged from 7-18 years with a mean age of 13.44 years. Children were interviewed using Gaza Factional Fighting and Israelis Aggression Trauma Scales, Child Mental Health, UCLA-PTSD, and Resilience Scale. Results: Palestinian children exposed to mean of 10.18 events due to Israeli aggression and 7.42 events due to factional fighting. No gender differences in reported traumatic events. Posttraumatic stress symptoms mean was 25.94, re-experiencing symptoms mean was 7.50, avoidance symptoms mean was 8.21, and arousal symptoms mean was 7.65. Forty eight 48 children reported probable PTSD (12.4%), 103 children were reported one Criteria (reexperiencing, or avoidance, or hyperarousal) (26.7%), 86 of children reported two criteria-Partial PTSD (22.3%), and 149 chidren had no PTSD symptoms (38.4%). No gender differences in PTSD. Younger age children was significantly reported total posttraumatic stress symptoms than older age children. The results showed that total scores of PTSD were correlated with traumatic events due to Israelis aggression PTSD, reexperiences, hyperarousal, and avoidance. No significant correlation between trauma due to factional factions and posttraumatic stress symptoms. Mean mental health symptoms mean was 9.05, somatic pains mean was 1.31, depression symptoms mean was 4.36, anxiety mean was 2.21, and fears mean was 1.14. There were no significant differences between boys and girls in total general mental health, somatic pains, anxiety, depression, and fears. Fears were more in younger age children. Children reported mean resilience scores were 58.52, commitment subscale mean was 23.78, control subscale mean was 17.58, and challenging subscale mean was 17.60. There were no significant differences between boys and girls and age of children in total resilience, commitment, control, and challenging. The results showed that total scores of resilience were correlated negatively with total PTSD, arousal, and avoidance. Commitment was correlated negatively with arousal, children with better resilience had less PTSD, avoidance, and arousal symptoms and children with commitment had less arousal symptoms. Total scores of resilience were correlated negatively with total mental health, somatic pains, anxiety and fears. Commitment was correlated negatively with anxiety, control was negatively correlated with fears, and challenge was negatively correlated with fears. Conclusion and clinical implications These results highlight the important of starting programs in community and schools to develop better coping strategies and social skills training to increase children resilience. Also involving of parents and teachers in such programs may support the children and enable them of being able to overcome the adversities and trauma. Other factors such as family and social support had to be evaluated in next studies. More applied research in evaluating the effectiveness of social skills training and other methods of developing better communication and conflict resolution is needed. 2- Grieving the Catastrophe: Coming to terms with the American Shadow in Palestine Dr. Bill Slaughter, Harvard Medical School – USA, [email protected] Scapegoating is the universal human tendency to project unacknowledged negative attributes, or “shadow” material, onto others. The fascists did this in Europe to the 1940’s; afterwards, US policies in Palestine have produced many negative consequences. However, the collective American psyche does not acknowledge this shadow, and as a partial way of coping, projects the negative quality of “terrorism” onto others. The American collective psyche holds equality for all, regardless of race or religion, as a core value. In Israel/Palestine, one group is privileged over another. Many people around the world are aware of this, a core reason for the shift over recent decades from admiration of the US as a liberating supporter of the rights of all to disillusionment--in Israel/Palestine because of support for ethnic privilege. Others worldwide are more aware of this American shadow than is generally the case in the US. After acknowledging briefly various downsides of US Israel/Palestine policies, one specific area of negative consequences is focused on, by giving results of a literature search for academic articles on the mental health of people of Palestinian ethnicity regardless of geographical location. A summary is made of articles probing the results of political violence, the aspect of Palestinian mental health most directly resulting from American policies. Data on various types of psychological trauma are cited, including 70% child/adolescent Post-Traumatic Stress Disorder prevalence. Lack of information about large groups of the population, especially those awaiting return from refugee camps outside Palestine, is regretted as an important example of this shadow area of the US collective psyche. Though Palestinian resilience is clearly identified in studies, it is argued that healing on a much wider scale, for all peoples with ties to the region, will come as the American collective psyche acknowledges the many downsides of its actions there. 3- Listening to Children Under Siege Dr. Elsa First, New York University Postdoctoral Program in Psychoanalysis and Psychotherapy; faculty, Trauma Specialization [email protected] or [email protected] A state of siege constitutes an attack on the possibility of ordinary life, and so is also an attack on children’s psychosocial and cognitive development. Children’s cognitive and emotional development is scaffolded on a sense of ordinary life from infancy onwards. Ordinariness means continuity and recurrences of experiences over time; expectations that can be sustained; understandings that can be shared and grow and emerge into reflectiveness. In ordinary life damage and harmfulness can be repaired, differences negotiated, responsibility and nurturance internalized. This presentation proposes considering the effects of siege on children’s mental development from the overarching perspective of the undermining of ordinary life, with a focus on the role of parent/child communication as a protective factor. Listening to children in a way that delights in particulars, and acknowledges and contains distress, facilitates transforming chaotic and destabilizing experiences into coherent narrative and mutuality, which is the stuff of ordinary family life. Listening to children is difficult for parents under siege because of parental shame at not being able to provide and protect, and confusion over what can be said. Parental anxiety, grief, helplessness, depression or despair may enter in. Some guidelines for parents will be suggested. Several particular features of current siege of Gaza will be considered with reference to psychological impact on capacities for parenting and on children’s understanding of the world: the prior “de-development” of Gazan economy; contradictions and ambiguities of political surround since “disengagement;” arbitrariness of interdiction of electricity and fuel supplies; sewage overflow and pollution of the sea; “collateral” destruction of local sources of food production; increased infant mortality; sites of recreation become sites of random death. Some material will be drawn from telephone interviews with parents and children in Gaza. Clinical literature on child survivors of wartime persecution, and 20th century siege memoirs will be referenced. 4- Walls within walls: Intersections between state, political and domestic violence Erica Burman, Khatidja Chantler and Nadia Siddiqui, Department of Psychology and Social Change, Manchester Metropolitan University, Hathersage Road, Manchester M13 0JA, UK [email protected] This paper considers how the divide between public and private is rearticulated within specific socio-political circumstances to present particular challenges to service providers working around interpersonal violence and mental health support. We review findings arising from several research projects (Chantler et al, 2000; Batsleer, et al, 2002; Burman, 2004, Siddiqui, et al, 2008) addressing domestic violence service provision for women from cultural-religious and national minority backgrounds in the UK. Significantly, the focus on domestic violence emerged through initial work on mental health support provision, since this turned out to be a key causal precipitant. Of particular relevance to this conference is how, in the UK context, state violence (in the form of immigration control) and institutional exclusion of non-citizens from access to state-funded support services was found to interact with the strategies used by perpetrators to prevent women from leaving violent relationships. Interestingly, interviews with senior service managers and policymakers almost uniformly indicated that they were unaware of how these material factors constituted additional barriers for women from such backgrounds in accessing services. The paper considers how the divide between public and private is rearticulated within specific socio-political circumstances to present particular challenges to service providers working around interpersonal violence and mental health support. 5- Siege and the Obstruction to the Right of an Education Dr. Hendrik Taatgen; Marga Kapka, Ph. D. in Anthropology from SUNY at Stony Brook M.A. in English Literature from Western Washington University
[email protected]; [email protected] The aim of this paper is to provide a rationale for the creation of a lobby group of educators for international education in Gaza. We postulate that every child has a right to an education, and every open society has the duty to provide its children with access to international education. We define international education as a school that offers an international curriculum taught by international teachers who prepare students to become citizens of a global world. We were members of the last team of administrators and teachers to implement such a vision for Gaza at the American International School – Gaza (AISG) in 2005 – 6. That was a difficult year, and we barely made it to the end. In spite of the obstacles, we left Gaza more convinced than ever that international education should be part and parcel of Gaza’s creation and development as an independent state. The siege must surely rank as the largest obstacle to achieving this goal. A country that is occupied cannot properly educate its children. The paper will provide detailed observations to support this point. Our analysis is based on information we collected through the anthropological technique of participant observation; we recorded our experiences and impressions during and after the time we worked at the school. 6- What are the Possible Reasons for Different Re-actions to Chronic Trauma? A Qualitative Study by Dr. Mohamed Altawil, PhD in Mental Health, and PhD in Psychology by Clinical Research, University of Hertfordshire, Hatfield, UK. Dr. Pieter, PhD, Consultant Clinical Psychologist and Academic Tutor, Doctorate in Clinical Psychology Programme, University of Hertfordshire, Hatfield, UK This research aimed to explore, in depth, some of the moderating factors relating to Palestinian children in the Gaza Strip who have been exposed to chronic traumatic experiences, particularly the children who are doing well or show low levels of PTSD. It formed part of a larger study (Altawil, 2008) about the effects of chronic traumatic experiences on Palestinian children in the Gaza Strip. The sample consisted of six children interviewed by using a semi-structured interview. They were aged between 13-18 years. Those children had all been exposed to at least 15 traumatic events which for some of them should be severe, showed low level symptoms of PTSD, and they should be living in clashing areas in the Gaza Strip. The measurements used were a semi-structured interview. The participants were interviewed in Arabic and the interview schedule was also translated into English. The results revealed that the moderating factors and levels of influence which protected children from developing PTSD are positive personality traits, ideological commitment, a network of psychosocial support, entertainment and adaptation or acclimatization. The study concluded that although some children in Gaza who have been exposed to traumatic experiences seems to be doing reasonably well at present, there is a significant risk that they will continue to be exposed to further traumatic experiences. If these and other less fortunate children in Gaza do not get adequate help (both preventative and reactive). We might face the prospect of a lost generation of Palestinian children.
Key words: Chronic trauma, childhood PTSD, moderating factors, Palestinian children. 7- Issues and Challenges in Studying the Mental Health Consequences of Children’s Exposure to Political Violence: The Case of Palestinian Children Muhammad M. Haj-Yahia, Ph.D.- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem [email protected] In recent years, extensive research has been conducted on the mental health consequences of children’s exposure to political violence in war zones, including Palestinian society. Although these studies have elicited abundant data on the topic, there are still some conceptual, methodological, and ethical issues that pose significant challenges for future research. In this presentation, I will review issues related to research on the topic among Palestinian children, and will present challenges for future research on the psychological effects of Palestinian children’s exposure to political violence. With regard to conceptual issues and challenges, I will discuss the following topics and their relevance for future research: the responses to and patterns of coping with political violence in Palestinian children’s families; well-being and quality of life in the Palestinian family; the structure, processes, and dynamics of the Palestinian family; and parenting patterns in the Palestinian family, and the impact of those patterns on children’s mental health. In addition, I will discuss the importance of investigating the potential for intergenerational transmission of the consequences of political violence (i.e., from grandparents to parents to children). Furthermore, I will discuss the need for research on protective and resiliency factors and buffering variables (i.e., personal, interpersonal, familial, organizational, and cultural factors) that can mitigate the negative mental health consequences of children’s exposure to political violence. With regard to the methodological domain, I will highlight issues and challenges related to sampling and sample size, measurement and operationalization of political violence, the use of Western measures for mental health constructs, and research designs. 8- The Impact of the Siege on the Palestinian girls: Listening to the Girls of Qurtoba School Saida Affouneh, PhD, Educational Consultant, Birzeit University, Palestine E-mail: [email protected], [email protected] 9- Psychological and Social Adjustment among Deaf Children under Siege This study aims to identify the extent of psychological and social adjustment among deaf children under siege. It also aims to identify the impact of siege on the mental health and behaviour of deaf children with a view to develop recommendations for the psychological support and counseling services needed by the children and their families. The authors will use the psychological and social adjustment scale, translated and prepared by Ain Shams University. The scale will be adapted to the Palestinian context. The authors will use a descriptive analytical methodology. The SPSS program will be used to undertake the appropriate statistical analyses of results. The authors hope to reach relevant conclusions that can be of service to Palestinian society.
Finally, with regard to the ethical domain, I will deal with issues and challenges related to anonymity and confidentiality, informed consent, harm caused to children when they participate in research on the topic, and services that can be offered to Palestinian children and their families.
Many reports have highlighted the violations of human right to life, health, and education during times of conflict. In the case of Palestine, where the conflict is continuing and taking different shapes, children have suffered from the impact of the conflict on their lives and development. Many reports show that girls and children are mostly affected by war and crisis as civilians, this article examines the case of Palestinian girls and the impact of the conflict on their lives. The article consists of four sessions. The first section provides some contextual information on the political situation in Palestine. The impact of the conflict from the eruption of the second Intifada will be discussed in the second section, while listening to the experience of Qurtoba school girls will be presented in the third section. The data was collected through interviewing the girls and teachers of Qurtoba School. The final section reflects on the developmental needs of the school girls and possible ways forward.
Naim Abdel Hadi Kabaga & Bassem Abdel Rahman Koraz