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Struggle to help Gaza's traumatised

Hala Awersha (left) and her mother Wafa, in their tent in al-Atatra, northern Gaza
Hala, 7, has stopped speaking since her brother's death, and covers her head when he is mentioned

By Heather Sharp
BBC News, Gaza

Omsyat, 12, has become nervous and aggressive, Hala, 7, has completely stopped speaking and Sobhy, 11, burned the toys he was brought with a candle, says their mother, Wafa Awersha.

Psychiatric nurse Rowiya Hamam nods as she sits on a thin mattress on floor of the tent in al-Atatra in northern Gaza.

In what is now their home, Mrs Awersha updates her on how the five children are coping with their brother's death in the recent conflict.

Sobhy Awersha, 11, in tent in al-Atatra, Gaza
Sobhy stares at the floor fiddling with a toy as he is asked about his loss
Ibrahim, 9, was hit by Israeli bullets on 4 January and died before his siblings' eyes, with their injured parents barely conscious nearby, the family say.

His body lay for four days outside their house before the fighting waned enough for neighbours to take it away on a donkey cart.

Israel blames civilian casualties on militants' practice of operating from populated areas and says Palestinian fighters fired at its forces during the daily unilateral three-hour ceasefire it instituted to allow emergency workers to reach the dead and injured.

Several hundred of the 1,300 Palestinian deaths were children and some accounts of civilian deaths have raised concerns of war crimes.

After Ibrahim's death, Sobhy began behaving like his sibling and asking to be called Ibrahim, Ms Hamam says.

"School's fine," he says, when asked. "I like maths." But he stares at the ground and tears soon well in his eyes.

Drawing by Shahed, 5, Jabaliya, Gaza

Mrs Awersha says he used to be top in his class, but he struggles to concentrate now.

Hala covers her head with a blanket whenever Ibrahim is mentioned, while Diya, 3, beheaded the soft toys he was given, Ms Hamam says.

'For my kids'

Ms Hamam is one of a team of mental health workers in Gaza that say they have been "overwhelmed" by the scale of the needs since the conflict.

She has visited the Awersha family several times, bringing toys and games, trying to help the children express their feelings and teaching them deep breathing exercises.

Mrs Awersha smiles and teases the children as she scrapes the girls' matted hair into pony tails and helps them put on the school smocks rescued from the rubble of their home. The tent buzzes with fat, black flies.

Mrs Awersha exhales hard when asked how she is coping. And then the tears flow.

Wafa' Awersha and her son Sobhy, al-Atatra, Gaza
Wafa says she jokes with her children, but cries when she is alone
"Maybe you found me making people laugh, but honestly I'm doing this just for my kids," she says.

Whenever she goes back to her bulldozed home and stands in the spot where Ibrahim was killed, she weeps and weeps, she says.

Gaza's mental health professionals have been working flat out in schools, kindergartens, clinics, homes and tents to try to help similar cases.

Hassan Zeyada, who heads the Gaza Community Mental Health Programme's centre in Gaza City, and his colleague, psychiatrist Sami Owaida, say they are exhausted.

"Many of our colleagues lost relatives. We have to give support, but sometimes we feel that we need support," says Dr Oweida.

Dr Zeyada also points out the difficulty of treating "ongoing and continuous trauma" in a place where a long-term political solution remains elusive.

"Sometimes you feel you are wasting your efforts. Another invasion, another war, another attack will happen - you feel they will demolish or destroy all your efforts," he says.

Anxiety

Ongoing trauma too plagues the residents of Israel's southern towns, who live under the constant threat of Palestinian rocket fire, with about 8,000 rockets and mortars fired since 2001.

At least 18 people have been killed in that time. Children under eight have known little else but a constantly heightened state of anxiety.

Girl examines rocket damage in Sderot, 05.01.09

And even after the recent fighting, which Israel said was aimed at reducing the rocket fire, a steady flow of rockets and mortars has continued.

But while mental health workers on both sides say at least 20-30% of the population suffers symptoms of trauma, the Israeli south is clearly better equipped to tackle the problems than Gaza.

GCMHP say there are only five clinical psychiatrists in Gaza trained to international standards, and no clinical psychologists.

'Basics for life'

John Jenkins, the World Health Organization's mental health project manager for the West Bank and Gaza , says that, as well as difficulties in getting people with the right skills into Gaza , shortages of drugs such as tranquilisers and antidepressants are a constant problem.

He says it is too early to assess the scale of the mental health needs from the recent conflict, as the impact of trauma takes time to emerge.

Wafa Awersha, outside the tent where she is living with her husband and five children
Living in a tent makes it harder for children to regain a sense of normality

But human beings' ability to deal with stress is "quite remarkable", he says, and the majority of people do not need specialist treatment.

"What people really need are the basic things in life," he says, such as reliable food supplies, a secure place to live and prospects for work. This should "absolutely" be the priority, he says.

But as Ms Hamam traipses away past the rows of tents, while children in flip-flops clamour at her to bring them shoes, she says that for the Awersha children, the conditions will make recovery harder.

"Before the war, they had their routine - come home, watch TV, write their homework, but in the tent it's very difficult."

"It will take too much time for them to recover," she says shaking her head sadly.

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