ACAPS Thematic Report – Palestine: Impact of the conflict on mental health and psychosocial support needs in Gaza (03 September 2024) – occupied Palestinian territory

OVERVIEW

Over ten months of intense conflict in Gaza have caused and aggravated mental health and psychosocial support (MHPSS) needs. MHPSS needs were already high prior to October 2023, as decades of occupation, conflict, and economic deprivation contributed to widespread depression, post-traumatic stress disorder (PTSD), and other mental health and psychosocial problems.

Since October 2023, the 2.1 million Palestinians living in Gaza have witnessed or experienced an unprecedented number of violent and traumatic events, including direct violence, repeated displacement, and the loss of loved ones, homes, and belongings (NRC 13/12/2023; Protection Cluster 24/05/2024; KII 09/08/2024). Such experiences have increased anxiety, depression, and other mental health and psychosocial problems. Extensive destruction of the healthcare system prevents even basic treatment of these conditions in the immediate and long term (Health Cluster 05/05/2024; CSIS 22/01/2024; KII 09/08/2024; KII 13/08/2024).

KEY MESSAGES

• While intense conflict and severe access constraints have prevented comprehensive assessments and studies since 7 October 2023, humanitarian responders and those affected in Gaza have reported a significant increase in MHPSS needs, including widespread depression, anxiety, and trauma (MSF 29/04/2024; KII 09/08/2024; KII 12/08/2024 b). Both adults and children are expressing the wish to die rather than live through further displacement, violence, and deprivation (KII 28/08/2024; KII 12/08/2024 a). As traumatic experiences are relentless and continuous, ‘post-trauma’ is not necessary to diagnosing PTSD (UNRWA 13/08/2024; KII 28/08/2024).

• Almost all of the estimated 1.2 million children in Gaza are in need of MHPSS (UNICEF 14/07/2024). Problems include depression in children as young as five, anxiety, regressive behaviours (e.g. bedwetting in children as old as 14), and suicidal thoughts. High numbers of unaccompanied and separated children are at particularly high risk of developing mental health and psychosocial problems.

• Women are experiencing a significant increase in MHPSS needs, aggravated by the challenge of meeting their family’s basic survival needs, increased gender-based violence (GBV), and urgent sexual health and reproductive rights needs because of minimal access to WASH, health, and NFIs.

• Many men are unable to provide for or protect their families, damaging their sense of self and agency. Social norms and assumptions about masculine displays of emotion lead to under-recognition of men’s MHPSS needs.

• Older people and people with disabilities have lost access to essential healthcare, social support, and assistive devices, causing feelings of helplessness, isolation, and a higher risk of mental health and psychosocial problems. People with pre-existing mental health and psychosocial conditions have no access to consistent medication or treatment.

• Healthcare and other frontline workers providing MHPSS are experiencing the same stressors and needs as their patients, compounded by exhaustion from overwork and the constant need to make ethically challenging decisions.

• Security is a basic minimal requirement for effective psychosocial support and treatment, but there is no safe place in Gaza. Without physical and emotional security, Gazans’ MHPSS needs will continue to increase rapidly (MSF 29/04/2024; KII 09/08/2024; KII 12/08/2024 a; KII 12/08/2024 b).

• Recurrent conflict, the Israeli blockade, and domestic governance problems were among the factors contributing to Gazans’ high MHPSS needs prior to 7 October. The 2022 PPCS found that an estimated 70% of Gazans screened positive for depression (WB et al. 22/11/2022).