Palestinians%20Refugee:%20mental%20health%20situation

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Palestinians Refugee mental health situation
Abdel Hamid Afana, Ph.D Director of Research
Training, GCMHP
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ThemesHistorical ContextMental
health,Transgenerational effectsSteps of
interventions
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Al Nakbah (the catastrophe)

• In 1948 914,221 Palestinians were displaced or
  become refugees
• 531 Palestinian villages and towns were
  depopulated or demolished

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In 1948 fully 531 Palestinian villages and towns
were depopulated or demolished.
In 1948 more than 914,221 refugees
First uprooting (Al Nakbah)
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The Second Displacement

• In 1967 the second displacement
• 325,000 Palestinians from the Gaza Strip and the
  West Bank were displaced, many of them refugees
  originally displaced in 1948, the majority sought
  refuge in neighboring Arab states.

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In 1967, 175,000 became refugees for 2nd time
2nd uprooting
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Third Displacement

• 312,000 Palestinians were working and living in
  Kuwait in 1990, but as a result of the Iraqi
  invasion of Kuwait in 1991, the vast majority of
  those refugees were displaced and are still
  without secure residency.
• Only 30,000 Palestinians were living in Kuwait in
  2000. (Shmil.com)

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Scattered everywhere

• The total number of Palestinian refugees are
  around 5 million persons, of which more than 4
  million are registered with the United Nations
  Relief and Works Agency for Palestine Refugees in
  the Near East (UNRWA).
• No accurate figures are available for Europe, the
  United States, Canada, Scandinavian countries,
  Australia, Latin America, Africa and South
  America.

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UNRWA Reigestered RefugeesUNRWA 2005
Camps In camps Not in camps Total
Jordan 10 281,211 1,477,063 1,780,701
Lebanon 12 210,952 189,630 400,582
Syria 10 112,882 311,768 424,650
West Bank 19 181,241 506,301 687,542
Gaza 8 471,555 506,301 961,645
Total 1,259,813 2,995,307 4,252,120
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2. mental health Transgenerational effects

• Since 1948, Palestinians
• - have experienced oppression, trauma, related
  socioeconomic and political problems
• - Al Nakbah represents the loss of the homeland,
  the disintegration of society, the frustration of
  national aspiration and the beginning of a rapid
  process of destruction of culture and community.
• The psychosocial consequences of Al Nakbah were
  very dramatic and devastating people lost their
  land, livelihood, and political power.

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• Al Nakbah is a moment when the majority of
  Palestinians become homeless and stateless
• a state that is associated with a deep sense of
  insecurity, fear, anger, hopeless and powerless.
• In this situation, the house key has become the
  symbol of the former home and of the return to
  it, and the land has become the dream that
  transmits from one generation to another.

Connecting Souls to Land
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Culture and Identity Struggle for Survival

• First Intifada 1987
• The cost of the Intifada has proved to be high
  and has affected all sectors of the Palestinian
  community. Men and women of all ages suffered
  general stress, frustration and hopelessness
  which inevitably activated new waves of violence
  and aggression aimed at restoring peoples
  dignity and self-esteem. However, thousands have
  been killed or left handicapped, and young adults
  are ready to sacrifice everything -- including
  their life -- for the cause of liberation of
  their land and for the promise of life hereafter.

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The stalemate in the peace

• First recognition (Oslo agreement in limbo)
• Raise the Palestinians expectations
• More restrictions
• Confiscation of land
• No tangible results
• re-opened wounds created by the loss of important
  family members and friends, causing more stress

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Second Intifada 2000

• The conflict escalated further in which Israelis
  fight with lethal force and Palestinians resist
  with whatever they have.
• Shelling by Israeli helicopters and tanks, and
  bombings from fighter jets, have become a part of
  Palestinian daily life on socioeconomic,
  political and family structures, and resurgence
  of Palestinian painful memories of being
  uprooted, being expelled from their villages to
  refugee camps in the Gaza Strip etc.

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Second Intifada 2000

• 73,105 Palestinian houses have been demolished.
  Feeling of collectively punished.
• In the last 5 years (from Sep. 2000 to
  Sept.2005), over 4,000 Palestinians were killed
  by the Israeli Army, among them 766 children. An
  additional 45,486 Palestinians were injured, and
  8,600 individuals put in prison, among them 288
  children. (Al-Jazeera, 2005).
• A survey showed that about 56,000 Palestinians
  had to change their place of residence (PCBS,
  2001)

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Mental illness or Disease of Living\ Mental
health situation

• 88.5 of teenagers in Gaza had a close family
  member beaten by the Israeli soldiers.
• 55.7 of the sample witnessed, or knew of the
  arrest of their close family members, while 31.1
  reported that they had close relatives in prison.
  
• 95.0 of the teenagers said that Israeli soldiers
  broke into their homes on at least one occasion.
• Helou et al (1994)

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Helou et al (1994)

• Significant increase in fear, anxiety, anger and
  hatred toward Israeli soldiers.
• Ways of coping with fear included prayer and
  reading Koran, reading books, talking with
  elders, meeting friends, and sleepingalthough
  sleep was associated with nightmares.
• Coping with anger involved religious rituals such
  as prayer, making wudu, going to mosque and
  directing their anger towards the IDF. The rest
  became agitated and cried when they were angry.

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Memories of LossHouse demolitions Triggers
the uprooting
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• Women who had their homes demolished expressed
  more anxiety and depressive symptoms than those
  who simply witnessed others homes being
  demolished.
• Children whose homes were demolished showed
  significantly more psychological symptoms.
• Common symptoms were fear of the army, diminished
  concentration, constant weeping, and
  reexperiencing the traumatic event the most
  common symptoms in the witness group of children
  were fear, irritability, easily provoked and
  having night terrors. Qouta et al 1997

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Thabet et al 1998

• 21.5 of children in Gaza had anxiety disorders.
  Girls reported higher levels of anxiety than
  boys.
• The most frequent abnormal behaviours indicated
  by teachers were lying (10.5), disobedience
  (10.5) and bullying (11). The most frequent
  emotional symptoms were worries (17.3), fears
  (11.8), and feeling miserable (5.9).

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Punamaki et al 1997

• Exposure to traumatic events increased childrens
  political activities regardless of the quality of
  perceived parenting
• Traumatic events increased the childrens
  psychological adjustment problems regardless of
  the quality of perceived parenting
• Poor parenting can make children more vulnerable
  in traumatic conditions.

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• Lifetime traumatic event was reported by 36.8.
  The most frequent events reported were
  imprisonment (16.1) and torture 15.4
• Qouta et al 2001
• The most recent research about PTSD among
  Palestinian children between the ages of 6 to 16
  found that 58 of girls and 50 of boys had
  severe PTSD.
• Qouta et al 2003

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Culture, Religion Mental Health

• Arab society consists of complementary patterns
  of family structures. It emphasizes the
  collective over the individual.
• The family, therefore, is important to harmonize
  interrelationship between the individual and
  group. One of the most important parts of its
  affiliation is the hamula, which includes a
  number of generations in a part lineal line that
  have a common ancestor.

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Culture, Religion Mental Health

• Religion as a form of self-identity, hence a
  threat to their culture, encourages people to
  return to their religious roots in order to
  protect their culture.
• Religion imparts explanatory mechanisms,
  including meaning, purpose and specific
  aetiologies.
• Mental disorders and Possession
• Physical presentation of mental disorders

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Somatized Suffering
Most common presented symptoms in primary care
(Afana et al 2003)

• Every thing is an effort 44.7
• Nervousness 26.8
• Hopelessness 21.4
• Depressive mood 17.5
• Worrying too much 17.5

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Women endorse more somatic symptoms than men

• questions dealing with anxiety, and somatic
  complaints

Headache
Crying Easily
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Cont., Results

• Men reported three symptoms more frequently than
  women

worries about the future
insomnia
having no interest in things
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• The prevalence of anxiety and depression symptoms
  was 73 and higher among females
• Refugees living in refugee camps demonstrated a
  higher prevalence of symptoms than those who were
  living in other settings.

In General, Refugee population constitutes around
75 distributed as follows 56 in 8 refugee
camps 46 outside camps
Afana et al 2003
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being a parent is one of the most complicated
tasks

• a quarter of women in Gaza were exposed to
  domestic abuse at least once in their childhood.
• The changing roles for women (involved in the
  political struggle)
• Many of these women whose husbands were arrested,
  imprisoned or killed in the struggle, had to
  become the head of the household.

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Is there there a room for optimism?
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Community Intervention Model

• Philosophy
• Enabling families to cope with the wide range of
  mental health problems, compounded by human
  rights violations, emphasizing a social support
  network as an effective way to face mental
  ill-health issues
• The responsibility of the health professionals is
  to move from intra-personal focus to
  interpersonal oriented care

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Ground for optimism

• Mobilize local services in the community to
  assist individuals in feeling that they are
  responsible participants, contributing to their
  health.
• Building bridges for peace through developing
  strategic partnerships with individuals and
  institutions concerned with justice, peace and
  respect for human rights.

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In Protracted conflictsWhat does Trauma mean?
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What conistitutes PTSD?
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Thank you for your listening
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