There is a particular cruelty in diagnosing trauma while the traumatic event is still unfolding. For mental health workers in Gaza, that has been the defining professional and moral condition for decades — not treating wounds that have healed over, but trying to bandage people in the middle of a storm that never fully passes. The language of post-traumatic stress disorder assumes a “post.” In Gaza, that premise has rarely held.
Eyad El-Sarraj and the Founding of a Movement
The most sustained institutional answer to that condition was built by one man, starting nearly nothing. Dr. Eyad El-Sarraj, a psychiatrist born in Beersheba in 1944 and displaced to Gaza as a child in 1948, founded the Gaza Community Mental Health Programme (GCMHP) in 1990. The organization was, at its inception, radical in its context: a community-based mental health service in a territory where psychiatry barely existed as a recognized discipline, staffed by Palestinian clinicians trained in part by El-Sarraj himself.
El-Sarraj’s framing was always political as well as clinical. He argued publicly — at cost to himself; he was detained by Palestinian Authority security forces in 1995 and 1996 for speaking out — that occupation was not merely a backdrop to psychological suffering but its direct cause. He wrote in The Lancet and other peer-reviewed journals that the cumulative experience of military rule, dispossession, siege, and humiliation produced measurable psychiatric harm across the population. He was among the first clinicians anywhere to document the psychological consequences of Israeli military operations on civilian populations in Gaza systematically.
El-Sarraj died in 2013, but the GCMHP he built has continued operating through four major military escalations, the 2007 Hamas takeover and subsequent blockade, and the catastrophic violence that began in October 2023. It has trained generations of Palestinian psychologists, social workers, and counselors who have become the thin spine of mental health capacity in the territory.
The Scale of Need Before October 2023
Even before the current war, the numbers were stark. The World Health Organization, in its assessments of the occupied Palestinian territory, estimated that more than one in four children in Gaza showed symptoms consistent with PTSD — a figure that preceded the destruction of 2023 and 2024. A 2020 report by WHO and partners found that approximately one million people in Gaza were in need of some form of mental health or psychosocial support, in a population that at the time stood at roughly 2.1 million.
Against that need, the infrastructure was brutally inadequate. Gaza had, according to WHO data, fewer than two psychiatrists per 100,000 people — a ratio that places it among the most underserved territories on earth. The total number of trained psychologists and psychiatric nurses was similarly constrained. Physical infrastructure was limited to a single dedicated psychiatric hospital, Al-Amal Hospital in Khan Younis, supplemented by outpatient services run by the GCMHP, the Ministry of Health, and a handful of international NGOs.
UNRWA, which provides services to Gaza’s registered refugee population — itself a majority of residents — incorporated psychosocial support into its school and health programs, but chronic underfunding left those programs perpetually stretched. A 2022 UNRWA report noted that psychosocial counselors in its schools were each responsible for caseloads that far exceeded any clinically recommended ratio.
Children PTSD Gaza: A Generation Shaped by War
The research on children is where the data becomes most difficult to absorb. Studies published in peer-reviewed literature — including work drawing on GCMHP clinical data — have documented that Gazan children exposed to military operations showed elevated rates of bedwetting, sleep disturbance, anxiety, aggressive behavior, and dissociation. A study published in The Lancet following the 2014 war found that children in Gaza exhibited PTSD symptom rates significantly higher than those documented in children in other conflict zones.
What made — and makes — the Gazan case clinically distinctive is the concept researchers and clinicians began calling “continuous traumatic stress” as distinct from the classical post-traumatic model. The framework, developed partly in response to communities in South Africa and conflict zones where danger is chronic rather than episodic, holds that standard PTSD diagnostic categories and treatment models were designed for people who had survived a discrete event. For children who have lived through three, four, or five major military escalations before the age of fifteen — as was the case for many young Gazans by 2023 — and who live under a blockade that restricts movement, food, water, medicine, and electricity between those escalations, the psychological architecture is different. The nervous system does not get to reset.
Dr. Samah Jabr, a psychiatrist based in the West Bank who has written extensively on Palestinian mental health, has described this phenomenon in published essays as “a new normal of abnormality” — a condition in which hypervigilance, grief, and anticipatory dread become so embedded in daily experience that their psychiatric dimensions become invisible to those living them.
WHO Mental Health Gaza: System Under Siege
The WHO’s Health Cluster reports from Gaza, published throughout 2023 and 2024, document what the current war has done to what little capacity existed. Al-Amal Hospital in Khan Younis sustained damage and was at various points forced to reduce or suspend services. GCMHP facilities in Gaza City were damaged or rendered inaccessible by displacement. Staff — those who had not themselves been killed or displaced — were attempting to deliver psychological first aid in tent camps, often without the basic material conditions that any therapeutic intervention requires: privacy, safety, consistency, continuity of care.
The WHO has repeatedly flagged mental health as among the most critically under-resourced components of the humanitarian response in Gaza, noting in Health Cluster updates that referral pathways for serious psychiatric cases had largely collapsed. People experiencing acute psychosis, suicidality, or severe trauma-related dissociation had, in practical terms, almost nowhere to go.
The Collective Question: When Trauma Has No End
There is a question that runs beneath the clinical literature and the funding appeals and the damage assessments — a question that El-Sarraj asked in different forms throughout his career, and that his successors continue to ask: what does healing mean when the wound is kept open?
Mental health frameworks developed in stable societies rest on the assumption that treatment can eventually outpace harm. In Gaza, the ratio has been inverted for generations. The GCMHP and the clinicians it trained have not been operating under the illusion that they can resolve what politics and military force keep producing. They have been doing something harder and more honest: accompanying people through suffering that has no foreseeable end, documenting its contours, and insisting — as El-Sarraj insisted at professional and personal cost — that it be named for what it is.
That insistence is itself a form of resistance. And in the current war, with the humanitarian system fracturing and the practitioner community itself traumatized and displaced, even that has become nearly impossible to sustain.
Sources
- Gaza Community Mental Health Programme (GCMHP), gcmhp.net — institutional history and clinical programs
- World Health Organization (WHO), Health Cluster reports on occupied Palestinian territory, 2020–2024, WHO EMRO oPt
- UNRWA, Annual Operational Reports, 2022–2023, unrwa.org
- El-Sarraj, Eyad; Quota, Samir; et al., published research on trauma in Gaza, The Lancet and associated journals (1990s–2010s)
- Jabr, Samah, writings on Palestinian mental health and continuous traumatic stress, various published sources
- WHO Mental Health Atlas, occupied Palestinian territory data, 2020
- OCHA oPt, Humanitarian Situation Reports, 2023–2024, ochaopt.org
