Since 1996 Médecins Sans Frontières (MSF) has offered mental health consultations in the city of Hebron, in the occupied West Bank of Palestine, where civilians suffer frequent abuses such as the demolition of their homes, arbitrary detention, and systematic attacks by Israeli settlers with the tacit support of the Israeli army.

As well as experiencing physical injury men, women, and particularly children suffer from significant long-term mental health impacts of these routine occurrences.

Rahaf, 14, has experienced severe psychosomatic symptoms such as insomnia and trembling hands for the past two years following the arrest and detention of her father and three brothers.

“We were sleeping and we woke up to find them standing over our heads,” she says of the Israeli army, who have routinely raided the family home for as long as she can remember. “In one month, they raided the house twice.”

Rahaf’s breaking point came when they detained her fourth brother, Hamzeh, while he was at work.

“I never thought they would take Hamzeh,” she says. “When they detained him he was at work at the gas station. There was a video recording, and we saw them beating him. We didn’t hear anything about him until they brought him home 60 days later.”

Rahaf’s is a familiar story. Palestinians across the West Bank, and in particular in Hebron, suffer similar experiences every day. Some are persecuted by settlers wishing to establish ownership over the land, while others receive news that their home will be demolished.

Some witness the demolitions, while others enter into legal battles that can last years. Together, these experiences create an environment of constant instability, anxiety, and stress, which can take a serious toll on mental health.

Mother-of-six Raghda is familiar with this toll. She has been fighting a demolition order issued for the house she shares with two of her children for the past 11 years, and finally sought psychological help from MSF in 2014, when her then 12-year-old son was detained by the Israeli military and imprisoned for 6 months.

She breaks down in tears as she recounts this episode, describing the impact that it had on her and her children.

“I am not the kind of person who normally shows sadness, but because of everything I went through I began to cry in front of them. I was not like this before. When I reached this point I recognised that I was breaking.

I am not an aggressive person who hits children, so I started to break plates and glasses. I felt that I was letting my anger out by breaking these things, instead of hurting my children or myself.”

The mental health issues that arise in response to traumatic events like those suffered by Ragha can lead to a prolonged sense of frustration which, in turn, can result in familial or community breakdown.

In Hebron, MSF works to counter the worst impacts of mental health issues connected to the occupation by offering free psychological support by trained mental health workers to those who present with symptoms such as nightmares or trembling.

Abu Firas is one of the MSF psychosocial workers in Hebron who supports families showing symptoms of mental health issues. He has worked at the Hebron project with MSF for nearly 20 years.

“You can imagine what the response of a mother or a father might be when they witness the demolition of their house, which they previously considered a safe area. In these cases, people suffer from stress, anxiety, sleeping problems; they feel all the time that their lives are threatened, they have no vision of the future, they are always frustrated and hopeless,” he says.

“Our role is to try our best to help them and to introduce them to the resources they have, in order for them to be able to continue their lives normally. Some of them returned to their universities and schools, some of them were able to return to their work and some of them were able to support their families. For me this is an achievement.”

The effects of this type of violence are far-reaching and leave very few people untouched, with children in particular vulnerable to long-term mental health issues as a result of witnessing or suffering traumatic events.