Since the Israeli army first occupied the West Bank in 1967, there has been a massive military presence in the area. A complex system has been developed to keep the local population under control, which extends far beyond the wall separating the West Bank from neighboring Israel. On a daily basis, Palestinians have to negotiate a series of checkpoints, spot checks and road blocks, all under the watchful eye of the army’s surveillance towers.

Meanwhile, Israeli settlements – illegal under international humanitarian law – have mushroomed through the area. Hebron, the most populated town in the West Bank, has several settlements, one of which is in the historical centre of the city, its 800 residents closely guarded by the Israeli army.

For Palestinian civilians, harassment by Israeli soldiers and settlers, restrictions on their movements, and violence amongst Palestinian factions are a constant fact of life, which leave many struggling with feelings of fear, hopelessness and frustration. These can have a severe impact on their mental health and for many, especially children, the consequences can be severe.  

MSF has been running a mental health programme in the West Bank for more than 10 years. More than half of our patients are children who have directly experienced violence related to the conflict. Mostly they have experienced incursions by the army – according to the UN, more than 60 of these happen every week. During an incursion, soldiers cordon off a street during the night and force their way into people’s homes, searching for activists. Usually the incursions are aggressive and violent, involving armed soldiers, tear gas, dogs and broken furniture. Often they end up with family members being taken away into detention. The humiliation and helplessness experienced by the families in these situations is often overwhelming.

In our programme we work with many children who have experienced incursions on their homes and are suffering severe consequences, including feelings of isolation, night terrors, being constantly on alert and behaving aggressively. They may wet their beds or their language or behaviour may change. The constant tension can also cause physical problems like fatigue, aches and pains, sleeping difficulties and loss of appetite. These natural reactions may feel overwhelming to the children and their families and, if not treated in time, may have an irreversible impact on the child’s development.

Children not only witness events like the Israeli army’s incursions on a daily basis, but they are also the direct victims of abuse. According to the military laws imposed by Israel in the Occupied Palestinian Territories, children over the age of 12 can go to prison, while those of 16 years and over are treated as adults. There is published evidence, by organizations like Unicef, of severe abuses carried out by the Israel army on minors during detention, interrogation and imprisonment.

The treatment that MSF offers is provided by a multidisciplinary team which includes  psychologists (both Palestinian and international), social workers and a medical doctor. With  specialized psychosocial support, we aim to alleviate the suffering of these children and their families and help them to overcome the consequences of the violence. We also try to strengthen their capacity to cope with new difficulties, as the environment they live in is violent and threatening, and is likely to continue to be so. We provide support on a one-to-one basis, to families and to groups.

We have recently set up a similar project in divided East Jerusalem, a complex urban context where a geopolitical war is taking place. Children, trapped amongst a net of interests and political pressures, are again the most vulnerable. Anxiety and behavioral problems are common amongst the young people seeking help in our programme.

In an armed conflict, the normal structures by which we maintain our identity as individuals –territory, family, status, dignity – are destroyed. Adapting to this requires a huge effort and often suffering. Anxiety, sadness, guilt and frustration are feelings constantly expressed by our patients. We start by helping patients to understand that these emotions are natural, logical responses to the situation, and we try to generate safe, private spaces where patients can share their experiences and decide on a course of action to help alleviate the pain.

Working in the Occupied Palestinian Territories is fraught with difficulties due to the complexity of the context. As well as the Israeli-Palestinian conflict, there is also fighting amongst different Palestinian factions. The length of the occupation has also had chronic consequences on people’s access to healthcare and jobs, and has brought about rising levels of social and domestic violence. People’s coping mechanisms are stretched to their limits, and dealing with the overwhelming feelings of hopelessness is a daily challenge.