Bedwetting, nightmares, and more: How Gaza war takes a mental toll on children

Israel’s nine-month-old war with Hamas in Gaza has decimated the territory’s medical system.

Israeli raids have wreaked physical destruction on hospitals, and health facilities have been hit and evacuated.

Hundreds of thousands of Palestinians in Gaza, especially children, are struggling to maintain their mental health with few resources and no safe places to recover.

A toll on mental health

The trauma of hundreds of thousands of Palestinians has been relentless.

They have suffered through friends and family being killed by Israeli bombs.

They’ve suffered injuries or disfigurements. As the violence raged, they gathered in houses or tents and repeatedly ran, never finding a safe place to rest.

According to experts and practitioners who spoke with The Associated Press, anxiety, fear, depression, sleep deprivation, anger, and aggression are common.

Early in the conflict, Nabila Hamada gave birth to twin boys in Gaza, in a hospital crowded with internally displaced people and the stench of rotting corpses.

When Israeli forces threatened the hospital, she and her husband escaped with only one of the babies, as medical staff said the other was too weak to leave.

The largest hospital in Gaza was overrun by Israeli forces shortly after, and she never saw the boy again.

Hamada, 40, was traumatised by the loss of one twin and became so terrified of losing the other that she became frozen and ill-prepared to face the daily struggle to survive.

“I’m unable to take care of my other, older children or give them the love they need,” she said.

There are few resources to help Palestinians process what they are going through.

Mental health practitioners say the turmoil and overwhelming number of traumatised people limit their ability to deliver true support. So they’re offering a form of “psychological first aid” to mitigate the worst symptoms.

Children are the most vulnerable

For children, the mental toll of war can have a long-term effect on their development, said Ulrike Julia Wendt, emergency child protection coordinator with the International Rescue Committee. Wendt has been visiting Gaza since the war began.

They are having nightmares and wetting their beds because of stress, noise, crowding and constant change, she said.

“There are about 1.2 million children who need mental health and psychosocial support. This basically means nearly all Gaza’s children.”

Repeated displacement compounds trauma: an estimated 1.9 million of Gaza’s 2.3 million people have been driven from their homes. Most live in squalid tent camps and struggle to find food and water.

She said simple programming, such as playtime and art classes, can make a difference, “The goal is to show them that not only bad things are happening.”

Nashwa Nabil in Deir al-Balah said her three children have lost all sense of security. Her eldest is 13 and her youngest is 10. “They could no longer control their pee, they chew on their clothes, they scream and have become verbally and physically aggressive,” she said. “When my son Moataz hears a plane or tank, he hides in the tent.”

In the central town of Deir al-Balah, a psychosocial team with the Al Majed Association works with dozens of children, teaching them how to respond to the realities of war and giving them space to play.

“In the case of a strike, they place themselves in the foetal position and seek safety away from buildings or windows. We introduce scenarios, but anything in Gaza is possible,” said project manager Georgette Al-Khateeb.

Even for those who escape Gaza, the mental toll remains high.

Mohamed Khalil, his wife and their three children were displaced seven times before they reached Egypt. His wife and children arrived in January and he joined them in March. Their eight-year-old daughter would hide in the bathroom during shelling and shooting, saying, “We are going to die.”

Only after his mother explained to their six-year-old boy that becoming a martyr gives him the chance to meet God and ask for the fruits and vegetables they were denied in the hunger-ravaged Gaza, could he go to sleep.

As they fled on foot along a designated “safe corridor” with Israeli guns shooting close by, Khalil recounted their terror.

According to Khalil, the kids are scared and reserved even now that they’re in Egypt.

They have registered for classes in math, language and physical education as well as art and play therapy sessions at Psychological and Academic Services for Palestinians, a new initiative in Cairo.

“We saw a need for these children who have seen more horror than any of us will ever see,” said its founder, psychologist Rima Balshe.

On a recent field trip, she recalled, five-year-old twins from Gaza who were playing and suddenly froze when they heard helicopters.

“Is this an Israeli warplane?” they asked. She explained that it was an Egyptian aircraft. “So Egyptians like us?” they asked. “Yes,” she reassured them. They had left Gaza, but Gaza had not left them.

There is hope that children traumatised by the war can heal, but they have a long way to go, Balshe said.

“I wouldn’t say ‘recovering’ but I certainly see evidence of beginning to heal. They may not ever fully recover from the trauma they endured, but we are now working on dealing with loss and grief,” she said. “It’s a long process.”

Bearing the scars of trauma

Many of the survivors of the Hamas attack in southern Israel on October 7, which set off the Gaza War, are traumatised and looking for ways to recover. Over 1,200 Israelis were killed by the militants, and they also abducted over 250 more.

Taken into hiding close to Khan Younis in the south, Jehad El Hams claimed that after picking up what he believed to be a food can, he lost his right eye and fingers on his right hand. It was an unexploded ordnance that detonated. His children were almost hit.

He’s been disoriented and unable to sleep since then.

“I cry every time I take a look at myself and see what I’ve become,” he said.

He reached out to one of the few mental health initiatives in Gaza, run by the United Nations Agency for Palestinian Refugees, known as UNRWA.

Fouad Hammad, a UNRWA mental health supervisor, said they typically encounter 10 to 15 adults a day at shelters in Khan Younis with eating and sleeping disorders, extreme rage and other issues.

Mahmoud Rayhan saw his family shattered. An Israeli strike killed his young son and daughter. His wife’s leg was amputated. Now he isolates himself inside his tent and sleeps most of the day. He talks to almost no one.

He said he doesn’t know how to express what’s happening to him. He trembles.

He sweats. “I’ve been crying and feel nothing but heaviness in my heart.”

A relative, Abdul-Rahman Rayhan, lost his father, two siblings and four cousins in a strike. Now when he hears a bombardment, he shakes and gets dizzy, his heart racing. “I feel like I’m in a nightmare, waiting for God to wake me up,” the 20-year-old said.

With inputs from The Associated Press