Palestine: Providing dignity through mental health support

Jennifer Craig, from Perth, is the project coordinator in Nablus.

“The city of Nablus is nestled in a valley between two steep hills – most of the time it is quiet, and when you are inside the city you can forget there is a military occupation. Go outside of the city, however, and you immediately see the Israeli army checkpoints. Sometimes there are army raids on the city at night. The people here live between moments of normality and moments of stress, and there is a constant sense of uncertainty. It is this situation that places an extra burden on some people’s mental health.

In the West Bank, MSF is working to support people experiencing trauma, grief and loss, as well as mental health diagnoses such as anxiety, depression and post-traumatic stress disorder. The ongoing occupation, poor economic situation and social pressures in this region contribute to high levels of these conditions among the people.

In Nablus, our mental health team is providing psychotherapy – where patients talk through their issues with a psychologist – as well as medication when necessary and social support. We have also partnered with a local university to provide practical training for clinical psychology Masters students. Through this partnership, we aim to contribute to the sustainability of mental health programs in the region by empowering Palestinian people to gain experience and skills in mental health care.

As project coordinator, I analyse the context in which we work to determine how we can best respond to the developing situation, and monitor the security of our team. I work closely with the community, authorities and other actors in the region to ensure our acceptance and continued ability to deliver mental health services.

As project coordinator, I analyse the context in which we work to determine how we can best respond to the developing situation, and monitor the security of our team. I work closely with the community, authorities and other actors in the region to ensure our acceptance and continued ability to deliver mental health services.

Mental health is heavily stigmatised in some parts of Palestinian society, with people who experience it sometimes seen as ‘crazy’. This makes it extremely difficult for people to seek help. We are working to change this by running awareness activities in the towns and villages of the region, as well as using local radio to inform the community of the services we offer.”

Sydney psychologist Yvette Aiello recently returned from working in the West Bank

“People living in the West Bank experience a lack of freedom and control over their lives. In addition to immediate trauma and stress, the prolonged conflict and tense situation has likely led to intergenerational trauma, which can have impacts on an individual’s sense of self, self-regulation and attachment patterns – and has ripple effects for society.

In this region, people are commonly medicated without receiving treatment for the cause of their problems, or establishing more sustainable means of coping with their situation. A lack of general knowledge of mental health in the community also means many people do not understand what they are experiencing and do not know they can seek care.

Our service provides a safe place where people of all ages can freely discuss their difficulties. Being able to process their feelings in therapy can help relieve some of the distress people experience and help them develop new ways of coping with stress, increasing their resilience.

While I was in Nablus, we developed a group program in collaboration with Tomorrow’s Youth Organization for vulnerable mothers from the refugee camps. These women were struggling to raise their children in an environment rife with violence, with few resources to support them. They were often facing domestic violence and poverty and reported feeling they had little control of their relationship with their children. As a result, there were patterns of violence being passed from one generation to the next.

Over eight weeks, we met as a group and the women were able to express thoughts they had never been able to share openly before. By the end, the women had developed a strong supportive bond and were committed to continuing to support each other. They told us how important the group had been for them in regaining a sense of self-worth and helping them find new pathways for their relationships with their children.

Living in a safe and stable environment is an important factor for mental health, though this is not possible in conflict situations. Knowledge and understanding can be powerful tools in creating a sense of control and dignity within oneself, even within uncontrollable circumstances. Through our mental health services, MSF is empowering individuals and communities to live with dignity within an environment of oppression. It was extremely gratifying to witness the people we treated go on to live meaningful lives, filled with enjoyment and purpose.”