A child born in Gaza in 2007 is now “six wars old.” That phrase, buried in an academic paper published this month in the International Review of Psychiatry, should stop you cold. It distills, in four words, what pages of clinical data struggle to convey: that for an entire generation, the interval between one catastrophe and the next has been shorter than a childhood.
The paper, authored by a team spanning Gaza, Beirut, Dubai, Bern, and Montréal, synthesizes decades of research on Palestinian mental health and marshals a single, uncomfortable argument: the international humanitarian system’s approach to psychological suffering in Gaza may be making things worse.
Here is the data that underwrites that claim.
Before the most recent escalation, War Child found that 96 percent of children in Gaza felt death was imminent.
Eighty-seven percent displayed severe fear.
Forty-nine percent expressed a wish to die.
Save the Children had already reported that 80 percent of Gazan children experienced high levels of emotional distress, with 79 percent exhibiting bedwetting, a body’s mute protest against conditions the mind cannot metabolize.
At least 19,000 children were orphaned or left without a caregiver by mid-2024.
These are not outlier statistics from a failed state.
They are the predictable output of a decades-long blockade imposed on a population half of whom are under eighteen.
The diagnosis problem
The dominant response to such numbers has been to scale up mental health and psychosocial support – MHPSS, in the humanitarian acronym – deploying international practitioners armed with Western diagnostic frameworks.
The article’s authors argue this gets something fundamental wrong.
Not because therapy is useless, but because the frameworks treat distress as an individual pathology rather than a rational response to structural violence.
Consider what Palestinian mental health workers in Gaza told researchers in 2023, before the current hostilities began.
They described their patients’ suffering not in DSM terminology but through local idioms: مخنوقين(makhnogeen, suffocation), مسجونين (masjoneen, imprisonment), معزولين (maa’zoleen, isolation), فش أمل (fesh amal, hopelessness).
These are not symptoms awaiting a proper clinical label.
They are precise descriptions of life under blockade.
When international organizations arrive with trauma checklists translated into Arabic but never culturally adapted, they commit what the anthropologist Arthur Kleinman called a “category fallacy”. They force living experience into boxes built for different lives. These scales reduce politically grounded anger, humiliation, and collective grief to individual symptom scores.
Occupation is not context, it is cause
The article’s sharpest line draws a distinction most humanitarian programming still refuses to make: “Occupation is not merely a context. It is a cause”. The destruction of hospitals, restrictions on patient movement, Israeli control over fuel, water, and medicines are not background conditions that complicate treatment delivery.
They are the primary determinants of mental suffering.
You cannot prescribe resilience to someone whose home has been demolished for the third time.
Parallel evidence from Ukraine underscores the pattern.
The Certificate peer learning programme on Psychological First Aid (PFA) in support of children affected by the humanitarian crisis in Ukraine was developed by the Geneva Learning Foundation with the International Federation of Red Cross and Red Crescent Societies (IFRC) and a network of over 300 Ukrainian and European organizations. Participants who were primarily frontline education, social work, and health workers described children who had stopped speaking, teenagers with suicidal ideation, parents too shattered to recognize their children’s distress. The most effective interventions shared by practitioners were peer support networks, locally adapted art therapy, and the patient work of facilitators who understood the context because they were living inside it.
Sumud and the limits of imported resilience
The Palestinian concept of sumud – steadfastness – runs through the article like a counter-melody to the clinical literature.
It is both a value and an action: the determination to remain on the land, to protect family and community survival, to maintain dignity and identity under prolonged oppression.
Researchers describe it as “a meta-cognitive framework which Palestinians use to interpret, cope and respond to ongoing injustice”.
Sumud does not appear in Western diagnostic manuals. Neither does the communal mobilization, intergenerational storytelling, or faith-based coping that studies consistently identify as protective factors. The humanitarian sector’s dominant models – focused on individual symptom reduction and short-term psychosocial support – have no instrument for measuring what a community preserves by simply continuing to exist.
What decolonization actually looks like
The authors do not stop at critique.
They describe their own collaboration during the past year of hostilities: co-designing interventions, co-authoring training materials, and embedding supervision sessions led by Palestinian clinicians – not as “beneficiaries” of capacity building, but as “equal producers of knowledge”. They propose replacing the logic of capacity building, which assumes asymmetry, with “capacity exchange,” which acknowledges that Palestinian mental health professionals have been innovating under siege for decades.
Their practical demands are specific: local teams should determine funding allocations and training content.
Evaluations should measure community agency and social cohesion, not just clinical outcomes.
Supervision must be politically aware, acknowledging that practitioners live under the same violence as their patients.
And international actors must replace institutional expertise with what the authors call “international humility”.
These recommendations resonate well beyond Palestine.
In Bosnia, the most effective post-war mental health recovery emerged when rebuilding was embedded within broader social reconstruction.
In Rwanda, community-based healing worked when rooted in local meaning-making.
Across Indigenous settings globally, healing is bound to identity, land, and collective memory.
The invitation
The article closes with the words of Salsabeel Al-Khatib, a Gazan mental health professional and one of the paper’s co-authors: “So Dear World, we as Gazan people invite all scientists and researchers from every field to come to Gaza, the ideal place to learn everything new, to write new books, and to throw away what you currently have into the abyss”.
It is an extraordinary sentence, generous and devastating in equal measure.
It says: your frameworks failed here.
Come see what we built instead.
References
Mc Mahon, A., Merchant, H., Alkhatib, S., Khanyari, S., Alami, T., Sader, E., Nachabe, J., El-Khoury, J., Jabr, S., 2026. Gaza: rethinking and decolonizing mental health responses in humanitarian emergencies. International Review of Psychiatry 1–12. https://doi.org/10.1080/09540261.2026.2627503
Kari Eller, n.d. Mixed Methods Findings of a Psychological First Aid Digital Peer Learning Program for Child-Supporting Professionals. IJFAE X, 1–19. https://doi.org/10.25894/ijfae.2835
Reda Sadki (2025). Beyond outputs, a scalable model for documenting child MHPSS outcomes in a crisis: remarks by Reda Sadki at the 18th European Public Health Conference. Reda Sadki: Learning to make a difference. https://doi.org/10.59350/wkac3-cs332
The Geneva Learning Foundation, & International Federation of Red Cross and Red Crescent Societies. (2024). Перша психологічна допомога дітям, які постраждали внаслідок гуманітарної кризи в Україні – Досвід дітей, опікунів та помічників (1.0). https://doi.org/10.5281/zenodo.13730132
The Geneva Learning Foundation, & International Federation of Red Cross and Red Crescent Societies. (2024). Psychological first aid in support of children affected by the humanitarian crisis in Ukraine: Experiences of children, caregivers, and helpers (1.0). https://doi.org/10.5281/zenodo.13618862
The Geneva Learning Foundation, & International Federation of Red Cross and Red Crescent Societies. (2025). Children in Crisis, Communities of Care – Psychological first aid for children affected by the humanitarian crisis in Ukraine (1.0).https://doi.org/10.5281/zenodo.14732092
The Geneva Learning Foundation, & International Federation of Red Cross and Red Crescent Societies. (2025). Діти у кризових ситуаціях, спільноти підтримки – Застосування першої психологічної допомоги для підтримки дітей, які постраждали від гуманітарної кризи в україні (1.0). https://doi.org/10.5281/zenodo.14901474