Since October 7, 2023, the Gaza Strip has been experiencing a continuous war that has resulted in the martyrdom of over 42,000 individuals, including more than 16,000 children, and the destruction of over 360,000 buildings, according to the Palestinian Central Bureau of Statistics, encompassing residential buildings, mosques, churches, schools, and even hospitals. While the international community contemplates ways to end the war and rebuild Gaza, which UN organizations estimate will cost billions and may take decades, the psychological harm suffered by children in Gaza has not yet received adequate attention. These children face new traumas daily; lacking basic needs such as food, clean water, and safe housing, they are exposed every day to scenes of bloodshed, dismemberment, and family loss. This has caused wounds that may not be visible to the world now but could lead to a generation devoid of trust in the world, filled with anger and hatred.
What the children in Gaza have endured over the past year, resulting from the brutal crimes of occupation, should be a source of concern for the world. What can the world expect from a generation of children who will not escape from psychological disturbances? According to UNICEF estimates prior to this war, more than 500,000 children needed psychosocial support in the Gaza Strip. Now, the organization estimates that all children in Gaza, without exception—approximately over one million children—are in need of psychosocial support. In this context, questions arise regarding the devastating effects of war in terms of damage and psychological suffering for the children of Gaza.
Ongoing Disturbance
The psychological effects of the disturbances experienced by children in Gaza due to exposure to trauma have begun to manifest since October 7 in the form of fear, anxiety, convulsions, bedwetting, and persistent worry, as a reaction to the complex and ongoing psychological trauma, which involves accumulated stresses that overwhelm individuals’ ability to cope and adapt.
While the psychological impact of war may vary from person to person, it is generally agreed that wars often lead to “Post-Traumatic Stress Disorder” (PTSD), where emotions and conditions associated with war are termed “war trauma.” The effects of such trauma are not confined to the present moment but can lead to long-term consequences for an individual’s mental health.
PTSD involves several symptoms, including emotional numbness, difficulties in cognition and memory, detachment from reality, a lack or complete loss of pleasure in activities, unexplained physical pain, negative self-perception, identity disturbances, hyper-vigilance, and avoidance behaviors. Symptoms of trauma commonly appear in children as difficulty sleeping, frightening dreams, and nightmares.
Children in Gaza have exhibited several symptoms related to severe psychological trauma, such as convulsions, bedwetting, fear, aggressive behavior, and anxiety, as well as an inability to separate from their caregivers.
The psychological damage suffered by children extends beyond PTSD; the continued exposure of children in Gaza to war will lead to the worsening of disorders that may persist for years after the conflict, including severe depression, anxiety, phobias, and sleep disturbances, as a natural reaction to what they face daily. Consequently, psychological experts believe that the experiences of children in Gaza should be reconsidered as a new disorder, as it cannot be referred to as “Post-Traumatic Stress Disorder,” since trauma in Gaza is ongoing and unending.
Autistic Children and War
We cannot overlook autistic children in Gaza, estimated to number between three to five thousand, whose suffering has multiplied during the war. Although this group was marginalized even before the war due to the absence of official institutions to take care of their affairs and provide them with rehabilitation services, their conditions have undoubtedly deteriorated since October 7.
The situation of autistic children has become more complex since the war; their suffering during the conflict is compounded compared to other children, especially as the characteristics of their disorder make them more vulnerable in conflict areas. With limited communication, lack of expressive language, and difficulty adapting to changes associated with war—such as displacement, destruction, and loss of families—their reactions to these catastrophic circumstances can be difficult and unpredictable. They may express their fears through a wide range of behaviors, including withdrawal, increased violent and aggressive behavior, or deteriorating disabilities. Additionally, symptoms such as sensory sensitivity, which some autistic individuals may experience, can lead to an inability to tolerate loud noises and chaotic environments, increasing their feelings of fear and confusion, which may result in episodes of agitation, pushing affected individuals toward a desire to flee, often without awareness.
Aside from the lack of medication, which is fundamental in the treatment of most cases, the destruction of limited rehabilitation centers, loss of familiar environments, and the need to adapt to new and hostile surroundings—factors that can lead to a decline in skills and behaviors—the war has added extra layers of suffering for these children due to what they have faced regarding displacement, abandonment of safe environments, and a continuous sense of terror from bombardment. Just like other children, the war may lead them to PTSD, which could manifest in autistic children as increased excitability or aggression, withdrawal from usual activities, sleep disorders, regression in speech or behaviors, heightened sensory sensitivity, and repeated nervous breakdowns.
Unmet Developmental Needs
While the world aims to emphasize the mental health of children and adolescents, striving to ensure the provision of basic needs for raising well-adjusted generations, no one has addressed the developmental needs—specifically the psychological and social growth—that the children of Gaza have lost amid the conflict.
In this context, psychologist Abraham Maslow highlighted in his theory of basic needs, which he argues are essential for an individual’s fulfilling and complete life, that to ensure human development and growth, the needs he referred to in what is known as “Maslow’s Hierarchy of Needs” must be met.
According to Maslow, the most critical human needs are physiological (food, water, physical health), followed by the need for safety (both psychological and spiritual, represented by physical safety away from violence and security within the family), followed by social needs (healthy familial relationships and belonging). These three primary needs form the foundation for healthy growth for any individual.
Given what children in Gaza have been suffering since October 7, they lack the three basic needs, struggling daily for the most basic of their rights—food and clean water—living without security in the face of constant bombardment and a continuous threat of death. They have lost their social needs, having lost their families, homes, and the country to which they belong.
If the world could provide even a small part of the physiological needs for children in Gaza, compensating them for their need for safety and social needs may be an impossible task. Alongside the destruction of their homes and the loss of their city, UNICEF estimates that at least 17,000 children, or 1% of the 1.7 million displaced persons in Gaza, are separated from their parents, making compensating them for lost social needs an impossible mission.
Multiple Efforts
In light of the humanitarian crisis and widespread destruction caused by the war, the issue of providing psychological support for the children of the Gaza Strip has garnered the attention of many actors, both international and regional, governmental and non-governmental.
At the official governmental level, alongside its urgent efforts for a ceasefire agreement and ensuring the necessary humanitarian and relief aid enters the Strip immediately, the Egyptian state has also intensified its efforts to provide psychological support to the residents of the Gaza Strip. Since November 2023, the General Secretariat for Mental Health and Addiction Treatment, part of the Egyptian Ministry of Health, has formed several medical teams dedicated to providing psychological support for the injured from Gaza receiving treatment in Egyptian hospitals as well as supporting the medical teams treating them.
The General Secretariat has also enhanced the preparedness of a mental health hotline to receive calls from Palestine, which has already received many calls from within the Gaza Strip requesting psychological support.
At the international level, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) reaffirmed its commitment to providing psychological and social support for the children of the Strip, alongside facilitating access to vital humanitarian assistance for the displaced in the area. UNESCO called on member countries in November 2023 to “provide displaced children and their families with mental health care and psychosocial support, adapting to emerging needs on the ground.” From February to May 2024, the organization, in cooperation with the Teacher Creativity Center in Khan Younis and Rafah, provided psychosocial support to 1580 children using art, freedom of expression, and relaxation techniques. The organization also offered a set of workshops on psychosocial support for the families of these children and caregivers to enhance their capacity to provide support for themselves and the children they care for.
On the front of international NGOs, psychosocial support tasks have formed part of the work of many of these organizations engaged in providing relief services to the residents of the Strip. For example, “Doctors Without Borders” provided more than 8,800 sessions of psychological and social support to the families of Gaza, and the organization worked to provide psychological support for children in Gaza at the organization’s clinic in the Mawasi camp in Rafah and in Nasser Hospital in Khan Younis, helping children to relieve stress using play as part of the treatment for overcoming trauma, pain, and managing emotions. The Turkish Humanitarian Relief Agency has also conducted many recreational activities aimed at alleviating the trauma experienced by children.
On the civil society front, several active civil organizations in the Strip have made psychological support a priority in their field activity. Alongside their focus on providing material assistance and medical and food relief, the Egyptian Red Crescent has also sought to provide psychological support for the residents of the Strip, especially for children, in an attempt to lift their spirits and alleviate the horrors of war.
The ongoing humanitarian crisis faced by the residents of the Strip and the resulting deterioration in their psychological conditions have led to some launching initiatives aimed at addressing the psychological traumas produced by the war. For instance, Palestinian activist living in Egypt, Farah Shan’ah, along with the O7 platform for psychological therapy, launched the initiative “Rays of Remedy,” aimed at assisting displaced families in coping while providing free psychological treatment for war survivors, working with a group of psychological counselors to treat trauma, chronic grief, loss, and suffering. This initiative is currently focused on establishing art therapy sessions to help survivors—especially those unable to express themselves or those suffering from severe trauma. Meanwhile, the “Olive Tree Descendants” initiative (a voluntary Egyptian educational and recreational initiative) aims to rehabilitate children from Gaza in Egypt, focusing on psychological recovery through customized programs for teaching and treating Gaza’s children suffering from the effects of war.
In conclusion, we cannot ascertain the effectiveness of the psychological support efforts extended to the children of Gaza, as achieving significant progress in mental health or developing psychological programs for children in Gaza remains impossible without reaching a political solution that grants Palestinians the right to self-determination. The ongoing war will not be the last as long as the anticipated ceasefire agreement does not lead the parties toward a political solution that ensures a two-state settlement, termination of the Israeli occupation, and the establishment of a Palestinian state, as stipulated by international legitimacy, allowing for the rebuilding of Palestinian children’s lives.
Thus, the international community must highlight these children and explore ways to provide them with psychological support and treatment alongside the reconstruction of their devastated city. Failure to achieve this in the near future could result in a generation of youths who hold no convictions or beliefs supporting the idea of “peace.” Continuous exposure to violence may lead to the emergence of generations seeking revenge. Additionally, the complexity of this issue is increased by the deprivation of education and schooling for Gaza’s children due to the destruction of schools and educational facilities in the Strip. If this problem persists, it may result in a lack of awareness among them, making them more susceptible to adopting erroneous ideas and beliefs with extremist dimensions, potentially transforming these children in the future into extremists who organizations can easily recruit into their ranks.
