Honouring GCMHP Work in Gaza

As I am writing these words, I hold within my heart not only my family, friends and colleagues but all the resilient people of Gaza. A very disturbing juncture in human history that marks a dark chapter in the ongoing Palestinian struggle for liberation and freedom.

I express my gratitude for allowing me a brief pause to reminisce about a Gaza that existed just a few months ago, before the current onslaught of genocide. The Gaza we once knew has been dismembered by the savagery of its occupier.

Gaza is not the same Gaza anymore.

In 1990, on Gaza’s Mediterranean shore, during a Thursday evening bathed in the warm hues of sunset, a small assembly of professionals, newly equipped with knowledge in nursing, psychiatry, psychology, and social work, gathered for a dinner. Guided and led by the late Dr. Eyad EL Sarraj, the prominent Palestinian psychiatrist and founder of the Gaza Community Mental Health Programme (GCMHP), this group dared to dream of a liberated, prosperous, and modern Gaza. A large freshly caught fish from the waters of Gaza was the centrepiece of the meal, marking a routine team-building evening, a respite at the close of a strenuous working week.

Seated at the terrace of Abu Hasira restaurant, one of Gaza Port’s finest fish establishments, with the vast expanse of the Gaza Sea before them, they were joined by a group of European and American friends and colleagues, showing a serious interest in the newly establish GCMHP work. Yet, to the ordinary Gazan Street passers, their gathering might have seemed merely ostentatious— an unusual scene in the grand tapestry of everyday life in Gaza.

At that time, I would have been 15 years old, somehow oblivious to the complexities that surrounded me. I did not know anything about GCMHP, and that group of Palestinian professionals who, well-acquainted with the struggles of youth, were deeply engrossed in understanding how we, the generation of the First Intifada, internalised and coped with the violence imposed on us by Israel. They pondered the profound impact of the turbulent times and how they could help as a team to mitigate its consequences.

On a Saturday morning, the reception of their clinic was bustling. Three clinical rooms, an administrative office, a team room with a long brown wooden table and black leathered seats, and a small training hall sat beside a beautifully manicured garden. A moment of silence in the middle of a therapeutic conversation revealed the distant sounds of Mediterranean waves.

In the team room, you could imagine the discussions shaped by numerous challenges – the heavy and dehumanising presence of the Israeli occupying forces, tearing Gaza streets with violence, causing visible and invisible wounds inflicted upon the body of Gaza. Another challenge they faced was a pervasive stigma towards mental health among the local population.

In their discussion, the team delved into topics of trauma and resilience, questioning whether the standard Western concept of Post Traumatic Stress Disorder (PTSD) could be usefully applied to describe what had been inflicted on Gaza’s people. The team grappled with where to begin and where to end.

Driven by their pioneering vision and culturally sensitive approach, the communal conversation about mental health had to be anchored in the daily suffering and reality of Gaza. For the first time, mental health was linked to the fight for better human rights. They right to live and the right to be free.

The team seized every opportunity to take the conversation into the public space. They acknowledged cross-generational suffering and emphasised the need to talk about the invisible pain. The essence of the conversation was that “we have suffered through generations, and we have endured a lot and we have to acknowledge the invisible pain in us and to find the courage to talk about it. It is Ok to somatise it or blame it on an evil spirit to take the shame away or even numb it, but there is more and there is a space for understanding and humanising our pain further.

Armed by compassion and a strong desire to connect Gaza to the rest of humanity, the team worked both inside and outside their clinic to bring people, political and religious leaders into the conversation.

Occasionally, they were challenged: How dare you label our x- political prisoners as mentally disturbed people? They are our heroes. Dr Sarraj or another member of the team responded: “They are our heroes, they are humans, and some of them were suffering in silence, psychologically tortured by memories of their dehumanising experiences in Israeli prisons. All our prophets suffered and showed tears and weakness and sought comfort in sharing”.

In the same team room, an idea came along; why don’t we train some of our heroes to become our ambassadors, share knowledge with them about mental health, trying to destigmatise the pain so those heroes become our referral points? And it worked, and the outcome was translated a few years later into the establishment of a robust partnership with the National Committee of Political Prisoners. Training courses and awareness workshops were consistently held, enriching the professional knowledge and authenticating our perspectives.

At the same time, another team focused on child trauma, addressing the consequences of the violence inherent in the military occupation.

Bed wetting was a problem for many households in Gaza, mothers were tired of washing and drying clothes everyday day without the luxury of washing machines. We as a team worked systemically with families at homes, nurseries, and schools, organising parents’ meetings in many neighbourhoods, linking bed wetting to the ongoing trauma and oppression. As Victoria Britain described beautifully in the Guardian, “every suffering family’s door was open to the GCMHP, which became a key part of Gaza’s ability to function against all the odds”.

From a small clinic at Gaza Beach, GCMHP expanded its service to cover every corner of the narrow strip. The core team grew to three large teams and 5 mobile clinics stretched across the Gaza Strip. The main clinics, located in central areas, were accessible to everyone.

Within these sanctuaries, the teams warmly welcomed children and parents in play therapy rooms, paying close attention to the smallest details from the moment a client stepped through the door to the moment they departed, offering a space for restoring the soul and nurturing hope. The devoted teams extended their reach to schools and nurseries to mosques and primary health clinics, weaving a tapestry of care that touches every corner of the community.

In 1995 a training department was established, bringing together professionals from seven international and local universities, including the Islamic University of Gaza, Utrecht University – Netherlands, University of Oslo – Norway, University of Tunis – Tunisia, University of San Francisco- USA, and Flinders University – Australia. These dedicated professionals collaborated to deliver a two-year postgraduate diploma in community mental health. I was honoured to be part of the second cohort and shortly after my graduation, I joined the core team at the GCMHP clinics in Gaza City and Khan Younis.

The diploma programme saw a diverse group of professionals, doctors, nurses, social workers, and psychologists graduate with a shared professional language and vision, contributing to the provision of mental health services in governmental, educational, and health sectors.

The training department continued to conduct courses determinedly until last October, disseminating knowledge and expertise. These courses covered a wide spectrum, ranging from educating police officers on the impact of torture and trauma to training teachers, doctors, Imams, and policymakers.

Psychological research forms the core of GCMHP’s mission. The department welcomed renowned international researchers and anthropologists from around the globe, inviting them to perceive Gaza through the lens of GCMHP.

Tens of research papers have been published in globally accessible journals, offering a contextualization of psychological suffering and providing both academic and practical insights in circumstances such those that were experienced in Gaza and across Palestine.

Foreign delegations, diplomats, journalists, writers, and novelists, eager to listen to Dr Sarraj and our team, to gain insights into Gaza’s news. Our perspectives on mental health care were always warmly welcomed, especially during challenging times.

The last time I visited GCMHP was in the summer of 2022. I conducted a day-long training session on culturally sensitive case conceptualization for a large group of second-year students enrolled in the GCMHP diploma program, which had evolved into a master’s degree certified by the Islamic University of Gaza. It was an honour to take a class where my teachers had sat during my time as a student. The general director’s office, remained a hive of activity, hosting visitors and journalists from around the world.

During my visit you could feel the enduring weight of all the Israeli offensives since 2008 and the challenges posed by the ongoing COVID-19 pandemic. The team’s shoulders bore the increasing pressure with resilience. The hunger for knowledge, connection, and the unwavering desire to serve, never waned.

Until last October, every year more than four thousand clients received individualised treatment at Gaza’s mental health clinics, while an additional twenty-three thousand individuals benefitted from psychological first aid. Media materials were internally designed and used, and the team actively engaged with the public through local TV, radio stations, and social media platforms. More than three thousand individuals found support through telephone counselling.

I am certain that many of our GCMHP colleagues, like hundreds of thousands of Gazans, are currently scattered in tents or shelters, perhaps facing hunger, with very little to call their own, horrified by the incalculable loss, and living in constant fear for their lives and the lives of their loved ones. Some of our GCMHP colleagues have lost dear ones, and they have not had the opportunity to grieve properly. Three of our newly employed female colleagues have been tragically murdered by the Israeli occupying forces. The headquarter of GCMHP in Gaza city has been partially damaged by the Israeli bombing, and the clinic of Deir Elbalah has been hit directly by Israeli missiles.

“BUT IT WILL END, IT WILL END”.

These are the words of my Dad who is in Gaza now.

And I say, our colleagues will return to their homes to rebuild or repair them, to bury their loved ones, bid their farewells, and perhaps restore some semblance of life’s order. They will overcome what they now talk about the most, Khuzlan, a deep and crushing sense of being let down and betrayed by the political world and by those who should have come earlier to rescue and protect the people of Gaza. They will gather strength to prepare for the next day’s work, welcoming the most affected in their clinics, lending their souls and hearts again to continue restoring others’ hope and humanity. Mental health support will undoubtedly dominate discussions, with international funds likely pouring into psychological first aid projects, perhaps at the expense of prioritising rebuilding houses, hospitals, universities, schools, playgrounds and ancient markets. To those concerned, rebuilding infrastructure is inherently tied to psychological well-being and the restoration of dignity, perhaps defying the murderous ideology of the occupier. Ensuring access to food, clean water, clearing the rubble by families and neighbours, and rebuilding children’s playgrounds are actions of recovery and hope. Efforts led by international ‘trauma experts’ and their funders should be informed and guided by local professionals, phased, and integrated into the collective ways of coping and Sumud- steadfastness.

Until that moment, keep the Palestinian voice alive. You are a comrade in the pursuit of human dignity and liberation. As Lilla Watson, said: “if you have come here to help me, you are wasting your time. But if you have come here because your liberation is bound up with mine, then let us worktogether”.

Thank you,

Mohammed Kamal, PhD

Psychologist

Cambridge,

UK