Deep breathing helps kids ease 'Gaza trauma'

GAZA CITY — When the Israeli missile landed at the foot of her building during the Hamas-Israel conflict this May, spraying bits of glass from the surrounding apartments into the room where she huddled with her family, 15-year-old Sama Ahel did what any other teenager might do. She took out her phone and started filming.

The video lasts about seven minutes. You see her in socks, running down a darkened stairwell and across a rubble-strewn street. You see a charred car flipped on its back, and flames in front of a Hamas government office on the ground floor, and her 17-year-old sister Tasneem covering her bloody face with her headscarf.

You hear rapid-fire explosions, and Sama's shrieks, as she crouches with her family behind a metal dumpster next to a United Nations compound across from her apartment building. A wailing ambulance collects them, and her father, a psychologist, tells her to stop filming, fearing Israel could pick up the cell phone signal and target them.

Not captured on video is what Ismael Ahel did next. He led his family in a deep breathing exercise. The idea, he says, is to ease yourself out of the shock and into the present, to make yourself recognize that the traumatic event is over.

"You just need to close your eyes and start to inhale," Sama, now 16, demonstrates. She draws a quiet breath and holds it for a few moments. "You will start to feel it going through you."

Her entire apartment building needed help.

A week after the war, Ahel and a group of therapists went to all 120 apartments in the building, making house calls. They referred some to therapy. With others, they taught deep breathing and other coping mechanisms, like shaking out your limbs to release stress.

"We have a hard time treating" Gazans, said Ahel, sitting on his couch at home. "We can't just deal with the first trauma or the second trauma. It's a complexity of trauma together."

The deadly 11-day conflict in May scarred Palestinians and Israelis both. But in the small Gaza Strip, where Palestinians faced heavy bombardment without the bomb shelters and missile defense systems that protect Israelis, the psychological wounds are deep.

Ahel and his colleagues diagnose it as "Gaza trauma"

It's the accumulation of trauma upon trauma from four punishing wars over the last decade and a half, fought between Gaza's Hamas rulers and their foe Israel.

"I maintain that the biggest damage that happened in May is psychological," said Matthias Schmale, who this summer finished his tenure as Gaza director of UNRWA, the U.N. agency that provides food, health care and schooling in Gaza.

About half of Gaza's two million residents are under 18 years old, and in the last six months, many have received mass therapy. The United Nations put 150,000 children through counseling and summer activities.

"If you look objectively at the numbers, people killed, buildings destroyed, et cetera, this was maybe not as heavy as the 2014 [war]. But I didn't meet any Palestinian who didn't describe this as worse, and that had to do with the heaviness [of the Israeli strikes] and the psychological impact," Schmale said.

Some children after the war had knee and ankle pain and difficulty walking. The Gaza Community Mental Health Programme, a local clinic supported by European donors, diagnosed it as trauma-induced, and referred them to traditional folk practitioners who perform a olive-oil body massage known as gata'at il-khofa, Arabic for "cutting the fear."

It improves "blood circulation, lymphatic circulation, and puts an end to some of those pains," said psychologist Yasser Abu Jamei, who directs the mental health organization.

Kids who don't communicate or collaborate

The mental health clinic still runs group psychodrama workshops, which Abu Jamei said is a cost-effective way to treat many kids at once.

"Ooooh! Oooooh!" psychologist Aida Kassab howls, flapping a window drape to simulate a storm, as kids huddle in a plastic playhouse during one group psychodrama session. Kassab wants the children to learn to find love and protection from others when their home feels threatened. The kids in the session barely speak to each other.

"Those children are from the same school and the same neighborhood. But there is no communication between them. No collaboration, no teamwork," Kassab said. "They have a behavior disorder, and trauma."

Helping traumatized families find their 'strength points'

It's hard to treat trauma in Gaza, where people don't feel the war is truly behind them. Israel and Hamas are still negotiating the terms of their ceasefire, and most destroyed homes have not been rebuilt.

Abu Jamei offers parents advice. "Sometimes the best thing which you can give the family is to make them identify their strength points in their life," he said. "You know, a strength point could be that you survived. A strength point could be that your home is still there. A strength by point could be that your school is a good one."

The Ahel family has those strength points: They survived the attack near their building. Their home is still there. Tasneem graduated with high marks on her matriculation exam shortly after the war and is searching for a scholarship to study medicine abroad. Sama is back in school.

But Sama finds it difficult to move on. Friends keep commenting on her video of the attack she posted on Facebook, and every other day or so, she goes back and watches those seven terrifying minutes. Her father says their apartment building is now tilting a few degrees. At school, when she looks out the window, she sees a bombed building.

Still, before she does her homework or takes a test, Sama sits on a comfortable chair, rests her hands on her legs, shuts her eyes, takes five or six deep breaths, and visualizes.

She pictures the Mediterranean Sea. Or Capital Mall, a shopping center with a bustling food court. Or her friend Yasmine's house. Or the Qattan children's library, her second home.

She has some happy places she can go to in her mind.

Fatima Shbair contributed to this story from Gaza City.

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