PALESTINE MENTAL HEALTH: OVERVIEW

Long-term and systematic political violence causes a detrimental impact on mental health across different generations of Palestinians. Sociopolitical conditions are ‘key determinants’ of health in Palestine¹, perhaps more so than in other contexts due to the economic controls and restricted freedom of movement that impact healthcare, training and access to medication. Mental health conditions in Palestine (oPT) include Depression, Anxiety Disorder, and Post-Traumatic Stress Disorder². Mental illnesses can be chronic, long-term conditions and overlap with physical illness or physiological symptoms including chronic pain and insomnia. Around a third of the Palestinian population is in need of mental health intervention³, but there is a lack of funding and resources for mental health service infrastructure and training, as well as barriers to accessing treatment due to wider social perceptions and stigma towards mental illness. Palestinians live under a continual physical threat of violence to life, family and health through beatings, interrogations, torture and shootings by the IDF. Frustration, apathy and erosion of self-esteem can occur from encountering permanent checkpoints and roadblocks, harassment and humiliation from IDF soldiers there or from people living in settlements, or repeatedly witnessing violence or abuse. From having refugee status to the constant threat of house demolition, there is a continual lack of safety and security, which means people are unable to make longer-term plans and creates uncertainty about the future. There is also a narrative and ideology of ‘security’ by the Israeli state, whereby Palestinians are described and treated as a ‘demographic threat’ leading to a negative impact on self-perception. All of this impacts the ability of Palestinian families and communities to sustain themselves, and in the West Bank mental health problems are pervasive and have been described as an ‘invisible crisis’⁴. In the Gaza Strip, 38% of the population had mental health problems⁵, and the rates of PTSD in Gaza are the highest in the world outside of active conflict zones⁶They occur disproportionately in certain demographics, including women, older people and people with chronic physical illness⁷. However, mental illnesses in Palestine are often underreported⁸.
Encroaching settlements and expansion of Israeli infrastructure may seem like banal and everyday acts, but are part of the contemporary tools of dispossession⁹. As well as permanent checkpoints there are also sporadic temporary checkpoints and roadblocks that change on a day-to-day basis; this allows a mobile and flexible form of military border control, a process in which the built environment is ‘unpredictably and continuously refashioned’ and shrinking: ‘tightening around them like a noose’¹⁰. Expanding on biopower as the power of the state to manage the life of its citizens, Mbembe (2003) describes necropolitics as the extension of these powers to impose a condition of subjugation like a ‘living death’ or directly controlling whether certain citizens live or die ¹¹. Under the force of such oppression there is a reduction of life to the extent that people experience a ‘social death’, where Mbembe states that the ‘most accomplished form of necropower is the contemporary colonial occupation of Palestine’¹².

PTSD: WHAT IS TRAUMA OR PTSD?

Post-Traumatic Stress Disorder (PTSD) is a type of Anxiety Disorder¹³ that can develop when someone experiences or witnesses a traumatic or ‘extreme’, often life-threatening, experience. This can lead to symptoms and experiences that disrupt daily life and the ability to form healthy relationships with oneself and others. It’s symptoms can include ‘flashbacks’ (as if you were reliving the event), intrusive thoughts and distressing reminders of the event (including images, sounds, smells), physical symptoms like nausea, disrupted sleep through nightmares or insomnia, and hypervigilance—alertness or hyper-sensitivity to stimuli. This can lead to self-destructive or erratic behaviours, including self-harm and alcohol and substance abuse. Not all traumatic experiences necessarily automatically lead to long-term PTSD, where people may experience an 'acute stress reaction’ instead, and symptoms can develop much later on in life, as 'delayed-onset PTSD’.

Complex-PTSD (c-PTSD) is more likely to occur if multiple traumatic events happened over a longer time period, or earlier on in life e.g. as a child. You can also experience indirect, secondary or vicarious trauma, by growing up with or caring for someone suffering from c-PTSD or witnessing violence against others, or by seeing events on television. For c-PTSD the time-scale of intervention and treatment is important; it can take a long time between an initial appointment and eventual diagnosis, as PTSD and other ‘extreme’ mental illnesses are hard to diagnose and are often little-known among doctors and even among psychiatrists. The further delayed the treatment is since the traumatic event occurred, the more likely it is to develop into a longer-term condition. Increasingly, there are expanded notions of trauma, including collective trauma (PTSD experienced on a collective scale rather than an individual diagnosis), and the study of intergenerational trauma through epigenetics, or how certain stress responses can be passed on genetically. Rates of c-PTSD can arise from and are interconnected with wider social inequalities and marginalisation, where trauma becomes widespread and collective.

Diagnosing PTSD can be difficult, as there is a lack of understanding of trauma and its impacts even among mental health professionals. There are widely different emotional or behavioural expressions of trauma as visible ‘symptoms’ between different demographics, where, for example, symptoms of trauma may be perceived as aggression in men. This impacts who accesses and uses these services, where men in Palestine are less likely to seek or accept treatment, as there is a social perception of mental health services being only for women and children¹⁴.

Treatments for PTSD can include psychotherapy (’talking therapy’), and specific treatments to help ‘process’ traumatic experiences such as TRE (Trauma Release Exercises), EMDR (Eye Movement Desensitisation and Reprocessing), and DBT for emotional regulation (Dialectical Behavioural Therapy)¹⁵. Despite the length and depth of impacts of PTSD, various forms of treatment demonstrate neural plasticity, or the potential for the brain to change and form new neural networks. Medication for mental health conditions including PTSD can include antidepressants or antipsychotics ¹⁶.

Internationally, studies of PTSD have been skewed to state and military funding directed towards soldiers engaged in combat, but studies from the 1990s onwards account for changing forms of warfare that increasingly target civilians in urban areas¹⁷. Though Palestine is not categorised as a conflict zone, it is under military occupation by the state of Israel, and has shown a rapid increase in rates of PTSD. Higher rates of PTSD or different symptoms are linked to different types of trauma e.g. one-off events versus ongoing trauma, where victims of child displacement, torture, and sexual trauma are more likely to develop c-PTSD. Increasingly children are a demographic that experience PTSD in global conflicts, and this is also true in Palestine¹⁸. As well as a discourse that is culturally Western-focussed, there are other structural inequalities in global psychiatric research which tends to have a pharmaceutical dominance, with ties to companies based in Higher-Income countries aiming to expand their global distribution to Lower-Income countries as a ‘new market’ for their products.¹⁹

PTSD IN A PALESTINIAN CONTEXT

Research into PTSD is especially important in Palestinian society due to its ‘duration and persistence’ with the presence of multiple and ongoing traumas, which has cumulative effects²⁰. Rather than one-off events, Palestinian children are exposed to ‘daily (traumatic) events for a protracted period (lifetime)’²¹. While specific causes, experiences of trauma and impacts are unique to the individual, the scale of trauma is on a collective level, and on a timescale that is intergenerational. The doctor Omar Dewachi describes collective trauma as a ‘social wound'²², where there is a perceived injury or wound to a ‘people’ rather than individuals, and which also impacts the fabric of social interaction and community support. The extent of Israeli occupation is all-pervasive in Palestinian life with ‘the home front becoming the battlefront²³, and the impacts are both physical and psychological, where trauma is often deemed an ‘invisible injury’ or a ‘wound inside’²⁴. Imprisonment and torture by the Israeli state is widespread, where the physical and psychological consequences ‘form an important public health problem’ in Palestine²⁵. Palestinian men are disproportionately effected by this, but it can be difficult to accept mental health treatment due to stigmas around therapy, and as it may undermine their self-worth if they are perceived as ‘heroes’ for enduring imprisonment; most referrals are through family members rather than by the men themselves²⁶.

The structure of Palestinian homes has also changed because husbands are often absent, whether they are away for work in Israel, held in Israeli detention, killed by the IDF or suffering from the effects of trauma²⁷. A context of ongoing collective trauma also impacts home, family and gender roles, where up to 25% of women in Gaza have experienced domestic violence, as men seeking to reclaim control or power in a situation where they feel powerless.

The loss of a home through Israeli demolition has a psychological impact, as well as loss of asset or income, disrupting education and fragmenting the family and community networks of support, leading to poverty. Living with the continual threat of demolition is part of ‘chronic disruption’ to Palestinians²⁸, and often part of repeated displacement which represents a ‘continuous trauma’²⁹, rather than a single incident. The reduced material ability for families and communities to repair themselves after demolition is another contributing factor of Anxiety and Depression. Most demolitions occur without warning ³⁰, leading to injury and death, as people may be inside when demolition starts, and they can take place in the middle of the night. Demolition tends to effect the entire extended family, as many families live in high-density households with multiple generations living in one home or building, or with family based nearby. Demolition can target either one home, building or a whole neighbourhood, often to ‘punish’ one person living there who has been suspected of a crime. Inhabitants of demolished houses are forced to pay for the costs of demolition, or to ‘opt’ to demolish their own home at a lower cost. The majority of house demolitions happen while witnessed by the family, e.g., 19% of children in Gaza, and 97% of parents whose houses were demolished experienced trauma-related symptoms³¹ and Depression. Children and adolescents growing up with parental trauma were also more likely to display symptoms ³² demonstrating its intergenerational impacts. There are deep psychosocial impacts relating to distress, helplessness, and shame around Palestinian identity or perceived abandonment of the Palestinian ‘cause’ if they weren’t able to stay or couldn't resist the occupying power, which leads to demolitions being underreported; this shame and guilt can permanently damage the family structure, and demolition is considered an intentional form of ‘social destruction’³³. Palestine is also a key example of trauma being weaponised as a military strategy by the IDF, including the use of the Sonic Boom: an illegal tactic of flying high-speed military jets at low altitude over airspace in Gaza to break the sound barrier, sending shockwaves and a loud explosion³⁴. It is used in the middle of the night to disrupt sleep and induce fear and panic, and subsequently results in PTSD in children (seen through rates of Anxiety Disorder and bed-wetting), where in Gaza 32.7% of children suffer from severe levels of post-traumatic stress disorder, 49% moderate levels and 16% low levels ³⁵.

TRANSCULTURAL PSYCHIATRY

Transcultural Psychiatry is a term for critically accounting for the sociocultural norms implicit in psychiatric diagnoses and treatment. Though practiced globally, psychiatry is based on specific values and ideology that originates from Western cultures e.g. individualised approaches to illness, diagnosis and treatment. Modern medical sciences and psychiatry evolved simultaneously with Western imperialism, and so these medical models spread through colonisation, and pre-existing indigenous forms of healthcare and knowledge become marginalised and viewed pejoratively. The current model of psychiatric care is distributed and practiced through a global neoliberal economy. However, there is still a specific power dynamic, where predominantly Western countries export psychiatric treatment, training and medication to the rest of the world. The use of a global medical model to frame mental illness can be beneficial to gain recognition and legitimacy as a serious and disabling condition, and to use the same language of international humanitarian NGOs to request and access basic needs and services. However, as understandings and narratives of mental illness and disability are culturally specific, the use of a ‘global’ human rights discourse may re-enforce a neo-colonial attitude to disability in other cultural contexts³⁶.

The overwhelming nature of trauma or PTSD means that is hard to articulate and express, and people tried to suppress or avoid memories as a form of self-protection. There are many difficulties in attempting to ‘translate’ trauma into terms that other people can understand, either interpersonally or with health professional. The process of medical diagnosis requires a re-framing of experience into specific medical terms (knowledge of which may be impacted by formal education), depends the doctor's interpretation and referral to a team who then interprets this diagnosis, adding to the layers of mediation. This is all in addition to the stigma surrounding seeking treatment for mental illness that can further delay accessing treatment. There is also a power dynamic when you’re not speaking your native language but those of NGOs (e.g., English) to describe yourself and your experiences; it can form a specific neuropsychological relationship in the use of an external, dominant language which can be alienating, distant and objectifying, and this disconnection can lead to further behaviours and expressions that may be perceived as psychopathologies³⁷. The writings of Frantz Fanon and other post-colonial or critical psychiatryexplores the colonisation of the mind, where there is still a Western cultural domination and ‘medical imperialism’ in psychiatric practices and expectations of ‘compliance’ e.g. taking medication³⁸. The already limited infrastructures for psychiatry in Palestine leads to a reliance on international NGOs, where adapting these services to be more effective would require additional support to administer e.g. English to Arabic translators with experience in medical or psychiatric care. Despite the greater resources made available by international NGOs, there is still a process of ‘gatekeeping’ to access these, as well as the multiple cultural and language barriers and unconscious bias or prejudices by Western organisations may have towards clients effecting the treatment they receive. However, this is not to romanticise non-Western treatments, as they also have elements that may be unethical or detrimental to the client as well (such as spiritual exorcism, depending on how these practices are (mis)used). There is often a misunderstanding and (mis)use of the term PTSD in NGO humanitarian funding and distribution; the term ‘PTSD’ is often used to conflate different kinds of trauma responses into one category for practical purposes, and is often overestimated³⁹. PTSD as a a term has specific associations as being more ‘extreme’ and therefore worse or more urgent than other conditions (Depression, Anxiety Disorder, even though these can also lead to injury and suicide), and appeals to NGOs and their donors⁴⁰.

PTSD TREATMENT IN PALESTINE

In Palestine, there are grassroots movements to develop mental health and disability frameworks that don’t use the language of, and are not materially reliant on, external funding which forms a relationship of dependency rather than self-sufficiency. According to Yoa’d Ghanadry-Hakim, one of the head therapists at the Palestine Counseling Centre, the term ‘PTSD’ may not be accurate or relevant given the continual ongoing trauma in Palestine, where imported Western terminologies are limiting⁴¹. In this context Ghanadry-Hakim suggests that ‘CTSD’ or Continuous Stress Disorder could a more relevant description for the constant re-traumatisation, and there is further need to re-evaluate DSM definitions of mental illness in the context of occupation.
As an alternative to predominant methods of psychiatric institutionalisation and electroconvulsive therapy (ECT), organisations such as Palestinian Counseling Centre (PCC) and Wings of Hope Trauma (WoH) Centre in the West Bank were set up to offer psychotherapy services, and to campaign to overcome the stigma of discussing mental health. WoH also uses TRE or ‘tapping therapy’ as physical exercises to release muscular tension, and Gaza Community Mental Health Programme (GCMHP) also offers a community-based approach to address mental illness, with specific services for domestic violence. The Institute of Community and Public Health (ICPH) at Birzeit University (BZU) undertook cross-disciplinary research and activism from the 1980s onwards, connecting health to wider social conditions in Palestine. They continue to provide training, such as the Birzeit Women’s Charitable Society (NGO) program to train village health workers⁴² as part of primary health care (PHC), and community-based rehabilitation (CBR) for the physical and social integration needs of disabled people. They also began to use context-specific forms of measuring quality of life in Palestine, with different scales and nuanced understanding of perceptions of dignity, humiliation, distress fear and threat. In Gaza, there is a lack of recognition of risk factors and symptoms of mental illness by general practitioners in PHC (Primary Health Care), and very few referrals are made to mental health services⁴³. General practitioners without specific knowledge or training in mental health could misdiagnose patients, and even between mental health practitioners, there are a vast range of different opinions on mental health diagnoses, treatments and medication or dosage for PTSD. These organisations emphasise long-term, holistic and community-based mental health treatment. They have a multifaceted, intergenerational approach to young clients within schools, families and neighbourhoods, in contrast to the predominant Western model which focuses on individual treatment of an illness or pathology. They are able to partly fill the gaps where traditional forms of support in Palestinian society, such as the family and community, have been worn down by occupation. However, even if mental health services are available, there are many practical or logistical barriers to accessing them such as checkpoints or road blocks, or the economic blockade in Gaza, where for example poverty in combination with increased fuel prices increases the cost of driving to clinics.

PALESTINIAN RESILIENCE AND COPING

Treatments that respond to the local context adapt and include the ways that different Palestinian communities have formed their own culturally-specific coping mechanisms to ongoing collective trauma⁴⁴, which can vary according to factors like ethnicity, religion, age, education, and class, among others. In terms of culture and religion, there is a Muslim majority in the oPt, which (broadly speaking) has specific cultural attitudes towards mental illness, with moral or spiritual values that prioritise collective social unity rather than personal needs or individual agency⁴⁵. Religious or spiritual beliefs can provide structure to a community and increase their sense of autonomy, where beliefs in fatalism or in God’s Will can offer a way to cope with distressing circumstances like loss or grief⁴⁶.

Political engagement and activity with an ‘ideological commitment’⁴⁷can also offer a form of resilience, by making meaning out of the experiences of Occupation and giving people a sense of common purpose. Acts of opposing the occupation can be considered part of a ‘struggle’ and ‘resistance’⁴⁸, which can vary from caring for the vulnerable to physical self-defence or rock throwing, and Sumud or perseverance as a collective political strategy. A sense of collective political purpose was seen to be a core part of Palestinian children’s psychological adaptability in otherwise potentially destabilising situations in the Gaza Strip⁴⁹.

Psychiatry and human rights discourses often overlook the power and agency of Palestinians who experience imprisonment, interrogation and torture by Israel, and the role of Sumud, or more specifically the refusal to confess or reveal secrets to interrogators that became prevalent during first intifada (1987-1993), as anti-colonial resistance⁵⁰. In this case, torture or pain is endured as a form of self-sacrifice for the collective, acquiring ‘political meanings that transform the ways in which they are conceived and felt’ and may exist in ways that are more complex or multi-dimensional than the established psychiatric understanding of and treatments for trauma in global ‘humanitarian psychiatry’⁵¹. Trauma studies in Palestine have tended to focus on specific events over others, such as individual imprisonment rather than collective experiences like the ‘Nakba’ of 1948⁵².

The extended family acts as a social support network; as such, more ‘traditional’ gender norms or social structures may be re-enforced, as they provide a known way of providing security and therefore of coping with the trauma of occupation⁵³e.g. through marriage, or having a male economic ‘provider’. However, undertaking or maintaining these gender roles may be at odds with international NGOs and their specific ideas of what female ‘empowerment’ may look like⁵⁴. Despite Israeli state restrictions, commemorating the dead in a culturally traditional way can act as a form of ’psychosocial resistance⁵⁵and a person killed during the Occupation can be commemorated as a martyr (from posters in public spaces to social media) to see their death as part of the wider political cause. How adults respond to traumatic events can impact a child’s trauma and their resilience and coping mechanisms, e.g. by intervening or supporting them which forms a ‘buffer’ or ‘protective factor’⁵⁶to the development of PTSD. However, due to social taboos surrounding mental illness, people may not communicate their experiences of distress or trauma for fear of social rejection, so it may not be visible until it reaches a more ‘extreme’ state e.g. suicide, of which there are increasing rates that disproportionately effect women⁵⁷. Forms of coping are interrelational, and so are in a dynamic flux between individual and social environment, mediated by beliefs, values and material resources. There are also other forms of networks and coping that are less traditional, including online communities, transnational diasporic connections, and Queer (or non-heteronormative) communities and friendships.

In discussing PTSD in Palestine, the conversation needs to be re-framed and the terms need to respond to the local context. Rita Giacaman (2018) has noted how the pervasive use of Western medical language in treating trauma is a large part of contributing ‘to concealing the social and political meaning that we Palestinians attributed to our collective experience’⁵⁸.

(TOWARDS A) SHORT CONCLUSION

There are specific trauma responses for people exposed ‘to political and military violence’
that are long-term, intergenerational and complex (c-PTSD). In the context of Palestine it is important to understand trauma (PTSD) beyond the biomedical, as the ‘personalization of war and politicization of health⁵⁹where the impacts of occupation are all-pervasive and insidious, causing a ‘social and psychological apartheid’ as well as one that is institutionalised⁶⁰. In terms of treatment in the context of military occupation and apartheid, it may not be helpful to see trauma as a disorder or individual pathology, but a very proportionate response to the context. Complex and long-term conditions cannot be adequately treated with continual short-term changes in healthcare policies, where long-term sustainable structures are needed. The fragmentation of Palestine through the division of territory, makes healthcare provision (and society as a whole) fragmented. At same time, globalised psychiatry and humanitarian organisations focus on individualised and medicalised symptoms of PTSD, rather than address the causes on collective and structural level. These humanitarian organisations operate within a neoliberal market framework, contributing to a dependency on external aid for basic healthcare, and redirecting emphasis from Palestinians to grow and sustain their own healthcare system. Any humanitarian aid towards healthcare and community support from Western countries through international NGOs like the WHO or UNWRA, is structurally undermined by continued sales of arms and military aid that goes to the state of Israel, that directly causes physical and mental injury to Palestinians.

Local, community-based knowledge from Palestine is important, where Giacaman (2018) states that ‘knowledge production’ becomes ‘part of the resistance to our settler-colonial predicament’⁶¹. The occupation of Palestine follows on from previous forms of settler-colonialism, but has been refined its techniques and expanded the pervasiveness of its methods of control. The Israeli state is also exceptional in the frequency with which it ignores, and has impunity from, international law. Media representations often portray a reductive or essentialist binary view of two ‘sides’ in a ‘conflict’. How seemingly ‘contentious’ or ‘unresolvable’ it is as a ‘topic’ allows the evasion of international community to address it. Political struggles are complex, intersectional and transnational. You can be both the oppressor and the oppressed, where historical and current oppression of Jewish people globally is real, but so is Israeli state apartheid in occupied Palestine; certain narratives of oppression are strategically and cynically exploited by the Israeli state for its own politico-economic ends, that doesn't help protect any minority group to be safer. The Israeli state intentionally produces ‘chaos’, to strategically exploit ‘complexity—geographical, legal or linguistic’ with highly bureaucratic procedures that are ever-changing, in its aim to be considered ‘too complex’ for international bodies to intervene. A reliance on expertise to resolve the occupation ‘beyond the reach of the general public’ has been ‘one of Israel’s most important propaganda techniques’ (Weizman, 2006)⁶². Self-organised grassroots approaches, such as Boycott Divestment Sanctions (BDS), offer a way to counteract this as an organised transnational movement to highlight the oppression of Palestinians and end apartheid.

Boycott Divestment Sanctions (BDS): https://bdsmovement.net/

Cover Image (female woodworker in Gaza) by Palestinian photographer Hosny Salah

1. Giacaman R, Khatib R, Shabaneh L, et al. Health status and health services in the occupied Palestinian territory Lancet Journal (2009) Issue 373 pp. 837–49
2. Definitions of PTSD, Anxiety and Depression from Mind, a UK Mental Health Charity
3. Mental Health Needs in Palestine(2004) by Abdel Hamid Afana, Samir Qouta and Eyad El Sarraj, and Gaza Community Mental Health Programme, for Humanitarian Practice Network.
4. Médecins Sans Frontières (2019) ‘The Invisible Mental Health Crisis Plaguing the West Bank’
5. Integration of Mental Health-care with Primary Health-care Services in the Occupied Palestinian Territory: a Cross-sectional Study (2013) Mustafa El Masri, Dyaa Saymah, Mahmoud Daher,Fuad Al Aisawi
6. Gaza is not officially categorised as a ‘conflict zone’ despite the frequent military attacks by the Israeli Defence Forces (IDF), including now at the time of writing (September 2020).
7. Integration of Mental Health-care with Primary Health-care Services in the Occupied Palestinian Territory: a Cross-sectional Study (2013) M. El Masri, D. Saymah, M. Daher, F. Aisawi
8. Mental health needs and services in the West Bank, Palestine (2016) Mohammad Marie, Ben Hannigan, Aled Jones
9. E. Weizman (2006) Hollow Land: Israel’s Architecture of Occupation. Verso Books: London.
10. Ibid (2006:5).
11. Mbembe, A. (2003) Necropolitics Public Culture 15(1): 11–40, Duke University Press.
12. Ibid (2003: 27)
13. More information on Post-traumatic stress disorder and treatments, via Mind (UK mental health charity, in English) and via Royal College of Psychiatrists, UK (translated into Arabic)
14. Author conversation with Ursula Mukarker, Wings of Hope trauma centre, Bethlehem, December 2019.
15. Arabic translations of these therapies can be found here.
16. More information on Antidepressants (UK) can be found here.
17. Qouta, Samir (2000). Trauma, violence, and mental health: the Palestinian experience. Staff Publications: Faculty of Education, Islamic University of Gaza.
18. Baker, A. Shalhoub-Kevorkian, N (1999) Effects of Political and Military Traumas on Children: The Palestinian Case. Clinical Psychology Review, Vol. 19, No. 8, pp. 935–950
19. ‘The missing global in global mental health’ (2020) Hailemariam, M. Pathare, S. The Lancet Psychiatry, December 2020.
    and ‘There’s a revolution happening in global mental health ‘Goswami, T. (2020)The Correspondent (online) 25th November 2020.
20. Baker, A. Shalhoub-Kevorkian, N (1999) Effects of Political and Military Traumas on Children: The Palestinian Case. Clinical Psychology Review, Vol. 19, No. 8, pp. 935–950
21. Ibid.
22. Omar Dewachi ‘When Wounds Travel’ Medicine Anthropology Theory. Vol. 2 (3): 61-82. (2015), and ‘Towards a Regional Perspective on Health and Human Security’ in Jabbour et. al. Public Health in the Arab World, Cambridge University Press (2012).
23. Giacaman (2018) ‘Reframing Public Health in Wartime: From the Biomedical Model to the “Wounds Inside” Journal of Palestine StudiesVol. XLVII, No. 2 (Winter 2018).
24. Ibid.
25. Dr. Samah Jabr, Elizabeth Berger (2015) 'The Thinking Behind a Mental Health Workers Pledge for Palestine'Open Democracy (online) 2nd December 2015.
26. ‘Samah Jabr: The 'invisible damage' of life under the occupation’ (Dr Samah Jabr, interviewed by Emmanuela Eposti) MEMO Middle East Monitor (online) 19th December 2014.
27. Mental Health Needs in Palestine (2004)by Abdel Hamid Afana, Samir Qouta and Eyad El Sarraj, and Gaza Community Mental Health Programme, for Humanitarian Practice Network.
28. Ibid p.36.
29. Ibid. p.38.
30. BT'Selem, in Ibid p.47.
31. Ibid. p.32.
    32. Palestinian Counseling Centre (2009: 30)
    33.Palestinian Counseling Centre (2012, p.12) With Our Own Hands
32. The Sonic Booms in the Sky over Gaza (2016) B’Tselem 1st January 2016.
33. Mental Health Needs in Palestine (2004) by Abdel Hamid Afana, Samir Qouta and Eyad El Sarraj, and Gaza Community Mental Health Programme, for Humanitarian Practice Network.
34. Puar, J.K. (2017) The Right to Maim: Debility, Capacity, Disability Duke University Press: Durham.
35. As explored in psychiatric research with a post-colonial perspectives, including by Frantz Fanon (The Wretched of the Earth, 1961) and Roland Littlewood (Colonialism and Psychiatry, 2001). Please see Palestine: Mental Health Reading list in the Resources page.
36. China Mills (2015) Symptom, seduction, subversion: Reading resistance to psychiatry through a postcolonial lens Please see Transcultural Psychiatry Reading list in the Resources page.
37. 'Emerging Paradigms in the Mental Health Care of Refugees' (2001) Watters, C. in Social Science & Medicine Volume 52, Issue 11.
38. Yoa’d Ghanadry-Hakim, Palestine Counseling Centre (Beit Hanina branch) Café Palestine 4 30th May 2020 via UK-Palestine Mental Health Network (UKPMHN).
39. Ibid (30th May 2020).
40. Giacaman (2018) ‘Reframing Public Health in Wartime: From the Biomedical Model to the “Wounds Inside” Journal of Palestine StudiesVol. XLVII, No. 2 (Winter 2018).
41. Integration of Mental Health-care with Primary Health-care Services in the Occupied Palestinian Territory: a Cross-sectional Study (2013) Mustafa El Masri, Dyaa Saymah, Mahmoud Daher,Fuad Al Aisawi
42. A.J. Afana, J. Tremblay, J. Ghana, H. Ronsbo, G. Veronese (2018) ‘Coping with Trauma and Adversity among Palestinians in the Gaza Strip: A Qualitative, Culture-informed Analysis’ Journal of Health Psychology, Vol 25, Issue 12, 2020.
43. Mohammed Abouelleil Rashed (2015) ‘Islamic Perspectives on Psychiatric Ethics’ Chapter in Oxford Handbook of Psychiatric Ethics. OUP: 2015.
44. A.J. Afana, J. Tremblay, J. Ghana, H. Ronsbo, G. Veronese (2018) ‘Coping with Trauma and Adversity among Palestinians in the Gaza Strip: A Qualitative, Culture-informed Analysis’ Journal of Health Psychology, Vol 25, Issue 12, 2020. and L. Abu Nahleh (2006) 'Six Families: Survival and Mobility in Times of Crisis' in Ed. Lisa Taraki. Living Palestine: Family, Survival, Resistance and Mobility under Occupation. Syracuse, N.Y. : Syracuse University Press, 2006.
45. A.J. Afana, J. Tremblay, J. Ghana, H. Ronsbo, G. Veronese (2018) ‘Coping with Trauma and Adversity among Palestinians in the Gaza Strip: A Qualitative, Culture-informed Analysis’ Journal of Health Psychology, Vol 25, Issue 12, 2020.
46. Baker, A. Shalhoub-Kevorkian, N (1999) Effects of Political and Military Traumas on Children: The Palestinian Case. Clinical Psychology Review, Vol. 19, No. 8, pp. 935–950
47. ‘“We must cooperate with one another against the Enemy”: Agency and Activism in School-aged Children as Protective Factors against Ongoing War Trauma and Political Violence in the Gaza Strip’ (2017) by Veronese, G. Alessandro, P. Jaradah, A. Murannak, F. Hamdouna, H. in Child Abuse & Neglect (Journal) 70:pp. 364-376. July 2017.
48. Meari, L. (2015) Reconsidering Trauma: Towards a Palestinian Community Psychology Journal of Community Psychology Vol. 43, No. 1, 76–86
49. Ibid.
50. Ibid.
51. Ibid.
52. L. Abu Nahleh (2006) 'Six Families: Survival and Mobility in Times of Crisis' in Ed. Lisa Taraki. Living Palestine: Family, Survival, Resistance and Mobility under Occupation. Syracuse, N.Y. : Syracuse University Press, 2006.
53. Shalhoub-Kervorkian, N. (2014) ‘Living Death, Recovering Life: Psychosocial Resistance and the Power of the Dead in East Jerusalem’ Intervention 2014, Volume 12, No. 1.
54. Baker, A. Shalhoub-Kevorkian, N (1999) Effects of Political and Military Traumas on Children: The Palestinian Case. Clinical Psychology Review, Vol. 19, No. 8, pp. 935–950
55. Palestinian Ministry of Health in Diana Alghoul (2019)'Israel, social stigmas, patriarchy and Palestine's growing suicide epidemic' for AlAraby (online) 18th September 2019.
56. Giacaman (2018) ‘Reframing Public Health in Wartime: From the Biomedical Model to the “Wounds Inside” Journal of Palestine StudiesVol. XLVII, No. 2 (Winter 2018).
57. Ibid.
58. Shalhoub-Kervorkian, N. (2014) ‘Living Death, Recovering Life: Psychosocial Resistance and the Power of the Dead in East Jerusalem’ Intervention 2014, Volume 12, No. 1.
59. Giacaman (2018) ‘Reframing Public Health in Wartime: From the Biomedical Model to the “Wounds Inside” Journal of Palestine Studies Vol. XLVII, No. 2 (Winter 2018).
60. E. Weizman (2006: 9) Hollow Land: Israel’s Architecture of Occupation. Verso Books: London.