Gaza Mental Health ProgramGaza Mental Health Program

The Gaza Strip is a relatively small piece of land, inhabited by nearly one million people. About 50% of the population are under sixteen. The average population density is approximately 2150 persons per square KM, making the Strip one of the most densely populated areas in the world. Unemployment is very high in the Gaza Strip, with conservative estimates putting the figure at some 40% in the early 1990s. For this reason, employment in Israel is especially important for people living in Gaza. But this, in turn, leaves Palestinians vulnerable to exploitation on the Israeli labor market. Unemployment puts a unique stress on the individual and the family, frequently resulting in increased health problems and greater health care needs at a time when income is low.

Mental health is one of many neglected areas in the Palestinian health system. The recently revised national health plan, while acknowledging the need for rehabilitation on paper, has little to offer in terms of translating this into practice. There are currently two psychiatric hospitals in the autonomous territories, one in the Gaza Strip, and the other in the West Bank. They have limited staff, and offer bedside care without any community mental health services. The 32 psychiatric beds within the Gaza psychiatric unit represent a figure of 0.04 beds per 1,000 people, and in a region afflicted with some of the most acute psychological problems anywhere in the world. Nor are there any NGOs working in the area of mental health in the Gaza Strip other than the GCMHP.

The Palestinian uprising, "The Intifada", was a mass movement of civil disobedience and rebellion against the foreign military occupation.

The cost of the Intifada was high, as the Israeli authorities exercised violent means to suppress the uprising. 50,000 were arrested during the Intifada. 250,000 Files for Palestinian prisoners were opened in Israeli Military court since the occupation in 1967.(El Damier, 1997).

The Landau Commission, set up by the Israeli High Court of Justice (Siegel-Itzkovich, 1993), has confirmed that Israeli military and secret police use methods of torture, especially during the interrogation of the detainee. Landau Commission guidelines themselves permit the use of moderate physical pressure. The UN Committee against Torture considered Israels initial report. The Committee found the authorization of the use of moderate physical pressure to be completely unacceptable and expressed concern at the large number of heavily documented cases of ill-treatment in custody. The Committee recommended that the interrogation procedures be published and that all interrogation practices in breach of the Convention be ended immediately (Amnesty International Report, 1995).

The report of Human Rights Watch/Middle East on Israeli interrogation of Palestinians from the Occupied Territories (Sept. 1997) mentioned that the two main Israeli interrogation agencies in the Occupied Territories engage in a systematic practice of mistreatment and torture -- according to internationally recognized definitions of the terms -- when trying to extract confessions or information about third parties.

The overriding strategy of Israeli interrogation agencies is to get uncooperative detainees to talk. They do so by subjecting them to a coordinated, rigid, and increasingly painful regime of physical constraints and psychological pressures over days and very often for three or four weeks during which the detainees are, almost without exception, denied visits by their lawyers and families.

The methods used in nearly all interrogations include prolonged sleep deprivation; prolonged sight deprivation using blind folds or tight fitting hoods; the forced and prolonged maintenance of particular body positions, which grow increasingly painful; and verbal threats and insults. These methods are almost always combined with some of the following abuses: confinement in tiny, closet-like spaces; exposure to temperature extremes, such as deliberately overcooled rooms; prolonged toilet and hygiene deprivation; and degrading treatment, such as forcing detainees to eat and use the toilet the same time. In a large number of cases, detainees are also moderately or severely beaten by their interrogators (El-Sarraj, 1995).

Palestinian detainees continued to be systematically tortured or ill-treated during interrogation by the General Security Service (GSS), often while held incommunicado. Methods used included hooding with dirty sacks, shackling in painful positions for prolonged periods, beatings, sleep deprivation and confinement in dark, closet-sized cell (Amnesty International Report, 1995).

In the last three years of Palestinian National Authority (PNA) rule, it launched a number of collective imprisonment campaigns, directed mainly against the members of opposition parties, with a particular focus on Hamas and Islamic Jihad. The number of political prisoners has reached approximately 1593 (Palestinian Center of Human Rights 1997). From our clinical experience in treating some of these prisoners, we have found that various kinds of torture methods have been employed. In fact, many have been subjected to torture techniques similar to those used by the Israelis.

The Human Rights Team was established in 1994 to deal with the consequences of human rights violations. The Team had consists of 19 professionals, including psychiatrists, clinical psychologists, social workers, psychiatric nurses, occupational therapists, physiotherapists, and paramedics. In the last three years, the Team has treated 506 victims of human rights violations. It utilizes various therapeutic approaches, such as supportive therapy, counseling, cognitive-behavioral therapy, occupational therapy, and family counseling in order to study the effects of torture on its victims, and on the community as a whole.

The team members participated in GCMHP's second intentional conference, "Palestinians in Transition: Rehabilitation and Community Development, and third international conference, "Health and Human Rights", which were held in Gaza in 1995 and 1997 respectively.

The Human Rights Team has also launched a program of various training activities for the local community. In three years (1994-1997), 14 journal clubs, study days, seminars, and case conferences have been conducted by the Team. Two courses in community mental health for 24 health professionals were conducted in the last two years, as well as six courses for social workers, former political prisoners, community leaders, and community development workers. 106 people participated in these courses. Furthermore, 16 workshops were held for health and non-health professionals in the field of mental health and human rights. The Team, in an effort to increase public awareness of the psychological effects of torture and of new approaches to the torture experience, held 28 public meetings. These meetings attracted people from various sectors of society from all over the Gaza Strip.

Moreover, Team members have attended international conferences outside Gaza in an effort to share their particular experience with other professionals in the fields of mental health and human rights.

The Teams continuing in-service training is a part of the general training programme. Team members participated in two courses: A course in group therapy (1994-1998), which is supervised by a South African consultant psychotherapist, and a course in psychotherapy (1993-1997), which was held at Tel-Aviv University.

1) To clarify the health, social, educational and economic needs and capacities of survivors of human rights violations.

2) To improve the quality and quantity of therapy provided by the GCMHP staff survivors of human rights violations.

3) To increase in the capacity of rehabilitating of survivors of human rights violations.

1) Ex-detainees and ex-prisoners who have been detained/imprisoned and tortured by Israel due to their opposition to Israel and the peace process (i.e. members of Hamas, Palestine Islamic Jihad and other individuals or groups who oppose the peace process).

2) Ex-detainees and ex-prisoners who have been detained/imprisoned and tortured by the PA because of their suspected opposition to Israel and the peace process and/or their involvement in armed attacks against Israel.

3) Ex-detainees and ex-prisoners who have been detained/imprisoned and tortured by the PA because they are critical of the PA and its practices (i.e. human rights activists).

1. Plan to contribute to provide an integral treatment comprising of, among other approaches, psychotherapy, physiotherapy, social counseling, and occupational therapy to approximately 330 primary and secondary torture victims per year which amounts to a total of approximately 1,000 torture victims for the 1998-2000 period. The treatment will include both individual sessions and group sessions (family therapy and family counseling).

2. Conduct follow-up visits to a certain number of the torture victims homes in order to estimate the efficacy of the treatment and to receive feedback from the persons who have received treatment.

3. Refer survivors of human rights violations to other humanitarian organizations, according to their needs; and to available occupational rehabilitation courses or employment according to their skills.

4. Increase the support given to the survivors of human rights violations and former political prisoners by other institutions, including institutions that engage in the victims re-integration into society. At the same time, strengthen the existing network of collaborating organizations.

Training:

1. Conduct 2-year diploma courses in community mental health for 45 health professionals from the local community.

2. Conduct training courses for 195 health professionals, social workers, and teachers who work in primary health care centers, general hospitals, community rehabilitation centers, community women centers, social and welfare institutions, community development centers, and schools.

3. Provide regular training to the GCMHP multi-disciplinary treatment team in the fields of individual, group and family counseling, short-term and psychodynamic psychotherapy, behavioral therapy, treatment of Post Traumatic Stress Disorder (PTSD), and community outreach strategies.

5. Approach various non-governmental and governmental health institutions not included in the GCMHP network of collaborating organizations in order to explore the possibilities of initiating collaboration in the fields of patient referral, training, and general awareness.

6. Continue our existing collaboration with local NGOs under the auspices of the NGO umbrella, entitled Palestinian Non-Governmental Organizations Network (PNGO).

7. Difficulties that confront the diploma students were discussed. Problem based learning and recruiting students into training posts were adopted. Thus, the diploma schedule was altered. These posts require students to participate in the study schedule of the diploma as well as selected training activities of the GCMHP. At the commencement of their first year, students will be allocated to one of the GCMHP teams. They will also be given a clinical supervisor who will be responsible for the schedule of the students when they are not attending formal classes. Each student will be required to undertake tasks allocated to them and they will be required to complete a predetermined number of hours of community/clinical work per academic year.