Summary of Annual Report 2002

q       التعريــف

In September of 2000, the second Intifada, or uprising, began.  The 50 years of oppression, combined with the disappointment in the failed Oslo peace process to achieve a true and just peace, resulted in a massive popular movement to resist and reject the occupation.  This Intifada has seen even more brutal repression than was seen in the first Intifada.  More than 2,000 Palestinians have been killed, 388 of them children, more than 60% now live in poverty due to strict restrictions on movement, 20,000 have been detained, 860,000 dunums of land have been destroyed, 227,995 trees have been uprooted and roughly 1850 homes have been demolished.

The Gaza Strip has been particularly affected.  The land area of Gaza is about 360 km and 1.2 million Palestinians live in only 60% of that space.  With repeated and lengthy closures of the Strip, an already impoverished community is now economically decimated; add to that rampant home demolitions and occasional bombs dropped from war planes, the people of Gaza are highly traumatized.

The Gaza Community Mental Health Programme was established in 1990 to meet the extreme need for mental health care in the Gaza Strip that were presented in the first Intifada.  Our main objectives were, and continue to be, treatment and empowerment of all in need, and especially those who are most vulnerable- children, women and ex-detainees who have undergone torture.

Community Mental Health Services Department (CMHSD)

 The GCMHP was one of the first to offer mental health treatment in the Gaza Strip.  We seek to provide a system with standard procedures and a community-based approach to mental health services appropriate to the needs and demands of Palestinian society. Treatment plans routinely involve the family, and patients are often visited in their homes to ensure a supportive and relaxed environment and to emphasize the communal aspects of mental health therapy. From its establishment as a single clinic with three staff members, CMHSD has expanded to include four clinics with 33 professionals, an occupational therapy unit, an electro-encephalographic unit (EEG), a pharmacy, and a physiotherapy unit.                        

In addition to the work conducted regularly, the department’s work during the last two years has been influenced by the events of Al-Aqsa Intifada. New activities included visits to hospitals, homes of the injured, schools and places that were bombarded, shelled or bulldozed.  Also, the department launched a free telephone counseling service for people unable to reach the clinics due to closures, or those concerned with the potential stigma associated with issues of mental health. The Community Mental Health Services Department operates four clinics located throughout the Gaza Strip.  Clients, who include men (mostly victims of violence and torture), women, and children, are mainly self-referrals who come to obtain treatment. This includes individual psychotherapy, physiotherapy, occupational therapy, play and family therapy, and family counseling and parental guidance.  The emphasis is not on medication, but when needed psychopharmacological interventions are used.

In 2002, we saw 1188 new clients, 2313 follow-up clients and 1788 home visits.  We have three special projects with dedicated teams specializing in the mental health of the children of Gaza, empowerment of survivors of human rights violations and trauma counseling.

Mental Health of the Children of Gaza Project

During 2002, 178 children were killed. This represented 22.6% of the total number of Palestinian casualties, an increase of 191% over the number from the year before, in which 93 were killed. These numbers reflect the growing use of lethal force by Israelis against Palestinians.  The numbers also hint at the extent of suffering faced by children who are unable to cope with psychological problems that include anxiety, depression and post-traumatic stress disorder (PTSD), and behavioral problems including aggression, enuresis, nightmares, sleep disturbances and speech problems.

The Children's Project (CP) team has provided therapeutic, as well as preventive services, to reduce the level of mental health symptoms and problems. Their work has included community activities with parents, teachers, school counselors and other professionals working with children.

To help children cope with their circumstances, the team provided individual therapy, and preventive group sessions which took place in schools, at teenager meetings, and at summer camps. Therapy was offered at GCMHP clinics and in the context of home visits.

In 2002, we saw 531 new children in the clinic, we provided 488 home visits for children and saw 760 children in follow up visits.

We also believe it is important for the community surrounding the children to be able and ready to deal with issues particular to children's mental health.  To do this, we held teaching and discussion sessions in schools with educators and parents, carried out school visits, had parenting training sessions, had neighborhood meetings and  training sessions to educate religious leaders in matters of mental health of children.

The Empowerment of Survivors of Human Rights Violations Project

 GCMHP has established a special committee to deal with matters relating to violations of human rights in order to better serve the victims and their families. The Human Rights (HR) team intensified its efforts in order to confront the negative psychosocial consequences of imprisonment and torture and to reduce their impact on the victims, their families, and society at large.

The main objective of the HR project is to provide an effective contribution in alleviating the impact of torture and organized violence in the Gaza Strip. To fulfill this objective, the HR team has three main focal points: to aid those coping with traumatic experiences, to increase professionals' capacity to deal with the effects of internment and torture, and to work toward preventing human rights violations.

The Human Rights team was able to treat 618 new clients who had victims of torture, 2661 return clients, and were also able to carry out 1211 home visits to these men.

We believe that by creating networks of organizations that deal with victims of torture, the treatment and support provided to these people will be better.  We have coordinated with local and international organizations to this aim.   . Some of the local organizations were Al-Mezan Center for Human Rights, the Palestinian Independent Commission for Citizens’ Rights, and the Ministries of Health, Detainees Affairs, and Social Affairs. Other institutions were the Union of Palestine Medical Relief Committees, UN Centers for Women’s Activities, and Governmental Psychiatric Hospital.

To generate increased knowledge of the subject we carried out research studies dealing with a number of topics related to trauma and human rights violations.  In addition, we worked toward educating the public regarding our clinically gained knowledge, as well as the information gleaned from our research.  We visited prisons and trained law enforcement officials as well.

We hope to continue to increase our ability to provide treatment, education and training on measures to prevent human rights violations from ever occurring.

Trauma Counseling Project

 This Trauma Counseling (TC) project is comprised of a team of professionals specializing in trauma, who have concentrated their efforts on counseling, treatment, and awareness, and making direct connections with victims of Israeli aggression wherever they may be found, whether at points of clashes, in demolished homes, at schools, or hospitals

Continuing their work through 2002, goals of the crisis team professionals were:

1-       To strengthen the mental health of individuals affected by the Intifada.

2-       To protect affected persons against psychological harm.

3-       To inform caretakers, teachers, and all interested professionals on their part in this crisis, and to train them on how to deal with children and patients during the current circumstance.

4-       To treat those who suffer from psychological problems as a result of the events, and to refer them to the clinics of the Programme when necessary.

 Among other services, the Trauma Counseling Team provides immediate crisis intervention, short-term crisis intervention, individual treatment, public awareness, training and education, and telephone counseling.  These activities were funded by the British International Development Department, the Canadian representative to the Palestinian National Authority, and United Nations Development Programme (UNDP).

In an effort to provide immediate short term care the TC team carried out 63 hospital visits in which 114 injured people and 81 of their relatives were met and counseled.  The TC team also conducted 417 home visits, in these visits 1.402 victims of home demolition or shelling were seen.  The team also carried out school visits, individual treatment and public awareness measures.  A free telephone counseling service was established by the team.  In 2002, 1221 telephone calls were received from individuals inquiring about problems that they or their children are facing due to the current situation, including depression, anxiety, and other problems of psycho-social nature. Additionally, a number of these cases were referred to the Programme clinics for further assistance and intervention following the initial telephone consultation.

Women’s Empowerment Project

The Women’s Empowerment Project (WEP) of the GCMHP was established in 1995. Its overall aim is to improve the quality of life of women victims of domestic, social and political violence, and to improve the lives of their families and community. This is achieved through educating the public on women's issues and providing educational opportunities and training facilities for women victims. The majority of women who utilize WEP have experienced personal trauma, dysfunctional family life and social disruption.

Currently, WEP comprises four centers: the main branch in Gaza City and three other centers in Rafah, Beach Camp and Deir El Balah.  The distribution of centers allows WEP to serve the southern, northern and middle areas of the Gaza Strip.  All centers offer individual and family services, psychosocial and legal counseling, psychotherapy, court representation, vocational training, and health, social, psychological and legal awareness. The staff of all of our centers work actively in the local community, conducting home visits, as well as organizing regular workshops and public meetings regarding issues of concern within each community.

Vocational training provided different courses to participants, such as sewing, embroidery, beauty care, English-language classes and computer training.

In addition to the vocational activities, lectures in psychological, social, legal and health issues were arranged by the training unit and implemented by professional staff members. Some of these lectures were arranged by different organizations. During 2002, 263 lectures were conducted on different issues they included an introduction to the concept of mental health and crisis intervention with children and the effects of the Intifada on women and Palestinian people.  402 different public meetings were held, as were 17 workshops all on issues regarding women as individuals and in society.

During 2002, WEP staff provided counseling sessions about psychological, social, legal and health issues.  During 2002, WEP conducted 1270 counseling sessions.

WEP has provided a number of women from the community as well as participants of training programs with financial and material support. This was in co-ordination with many organizations and individuals. Among the participating organizations were: Ministry of Social Affairs, Ministry of Supplies, Qatar Benevolent Association, the European Ophthalmology Center, El-Zakat Committee, Blossoms of Love and Hope Association, and Al-Aqsa Hospital. 

WEP social workers provided 72 job opportunities for women, especially participants in the vocational training programs, in sewing factories, kindergartens, beauty care salons, offices, embroidery factories, and marketing.

Training and Education Department

 The Training and Education Department has a specific philosophy of community development and promotion. It provides advanced education and relevant skills to psychologists, physicians, nurses, social workers, teachers, primary health workers, law enforcement officers, and a wide range of other helping persons and organizations interested in social services, community intervention, human rights and mental health.

In 2002 the Training and Education Department provided human rights and mental health education to 70 police officers and representatives of the General Intelligence Department. A combined total of 328 physicians, nurses, psychologists, social workers, counselors, teachers and others participated in various training courses in 2002.

Department Goals

1-       To improve skills and increase knowledge among GCMHP team members and staff through comprehensive, concentrated training programs.

2-       To increase community awareness about mental health and human rights concepts and related subjects.

3-       To inform, educate, and train personnel and professionals working in other institutions and disciplines about GCMHP and  fundamental concepts, techniques, and practices in community mental health and human rights.

4-       To provide certificates of course completion to highly educated professionals who participate in various GCMHP courses or workshops on mental health and human rights.

A post graduate diploma in community mental health

 The idea of a Post Graduate Diploma Program in Community Mental Health at GCMHP in partnership with Gaza Islamic University was first formulated in 1994.

The stated goals of this diploma program are to prepare professionals from other disciplines to work in community mental health and to enhance the knowledge and skills of community mental health professionals in Palestine, already working in the field.

Today, there are continuing efforts toward developing such an accredited institute. Educators and experts from the Netherlands are actively engaged in formulating plans and coordinating with international and local universities and educational institutions to be involved. Eighty nine students have registered in the post graduate diploma in Community Mental Health since classes began in 1997. Thirty eight have graduated from the two year program.

GCMHP diploma program

The diploma program requires 48 credits, combining theory and practice.  Theoretical study is comprised of twelve (12) modules, with three (3) credits given for each module.  The practical training provides 12 credits of carefully supervised and documented fieldwork or clinical practice. Grades given in the practicum are considered a part of the student's accumulated grade point average.

It has been agreed with the Islamic University, Gaza, and Flinders University, Australia, that all 48 credits of the post graduate diploma in Community Mental Health may be applied toward a Master's degree in Educational Psychology at The Islamic University, or may be applied toward a Master's degree in Disability Studies from Flinders University.

1-       Graduating Classes

   a. Class 2001-2003

A total of 12 students men and women, participated in the diploma program during 2001 – 2003. Their specialties were as follows: 1 physiotherapist, 1 rehabilitation specialist, 6 nurses and 4 physicians.

   b. Class 2002-2004

During February 2002, interviews were conducted of applicants for 2002-2004. Nineteen (19) were selected from different health and social fields including: 9 physicians, 7 nurses and 3 sociologists. Classes began March, 2002, and 4 students have since withdrawn from the program.

Training and professional courses outside of the Programme

In addition to the diploma program we provide training to the rest of the community as well.  We conducted courses in Loss Psychology, Mental Health and Counseling, Professional Abilities of Social

Workers, Mental Health and Human Rights, School Counseling, and a course for midwives in Psychological Counseling.

Resource Center

The year 2002 saw the creation of a GCMHP Resources Center. It includes a specialized library in mental health and human rights, which is electronically connected with its counterparts throughout the world in order to serve various needs of professionals, students and researchers in mental health and human rights.

It was agreed that the Resource Center would develop in two phases:

-          First, short-term development reflected by immediate local use.

-          Second, connecting the Resource Center at the regional and international levels as intermediate and long-term goals. 

The Resource Center is striving to increase the number of leadership of community members and to create an electronic GCMHP

  Resources Center web page which will carry GCMHP generated articles, research data, books, and Amwaj magazine, as well as material drawn from other resources on mental health, human rights and related subjects.

Research Department

 In keeping with the mission of GCMHP to deal hands-on with the issues of psychological trauma facing the Gaza community, the Research Department was established immediately following the inception of the Programme.  The Research department (RD) investigates and distributes information about pertinent issues in Palestinian society and provides the vital link between the work that the Programme does and the global academic community. By investigating and analyzing issues of crucial importance to the Palestinian community including human rights, violence, children, and family relationships, the research team provides a broad picture of the mental health of the Gaza community. The Department also shares responsibility for the development and standardization of tools and tests for professional use. In doing so, the Department allows the Programme to communicate that picture to a larger audience both locally and globally, thus drawing attention to the situation of Palestinians. The information provided by the R.D. also allows GCMHP to train teachers, graduate students, and inform consulting clinicians.

Research completed during 2002

1-       Prevalence and determinants of PTSD among Palestinian children exposed to bombardment and loss of home (accepted, European Journal of Child and Adolescent Psychiatry).

2-       Prevalence of PTSD among Palestinian mothers and children exposed to shelling and loss of home (submitted)

3-       Stress and coping among Palestinian people.

4-       The Relationship between trauma and bedwetting among Palestinian children.

Ongoing research includes studies on the cost-effectiveness of therapy in GCMHP as part of a collaborative effort organized and coordinated by the trans-cultural Psychosocial Organization (TPO), a Dutch NGO working with developing countries.  The relation between the different variables in the different countries will be compared to determine the most effective therapeutic techniques for each country.  In addition we are studying the prevalence of PTSD in the Palestinian Community.  This study will identify the prevalence of PTSD, and other psychological trauma among Palestinians who have been living under severe conditions during the last two years of the Intifada.   A third study is being conducted in the Role of Play and Dreams as method of intervention. 

Public Awareness and Documentation Unit

 The Public Awareness and Documentation Unit has produced many television documentaries, and series of programs, addressing issues or phenomena relevant to Palestinian society.

The Public Awareness and Documentation team created three television shows about Palestinian children.  The first discussed about the political pressure the Palestinian people have been going through in the last two years and its impact on the academic achievement of students.   The specialists provided advice to the parents and teachers on ways of dealing with children, and how to cope with their children's problems in these difficult circumstances.   The second show featured Dr. Khaled Dahlan and a psychiatric nurse, Bushra Abu-Laiyla. The interview concentrated on the impact of the deteriorating Palestinian economic situation and the psychological development of children whose parents have lost their income, either inside Gaza or within Israel proper. Children's aggressive behavior was the topic of the third show.  This behavior has become something of a phenomenon and is worthy of attention.  It seems to be due to the difficult circumstances and the atmosphere full of aggression that the Palestinian children live in. In this program, advice and guidance was given to the parents about different ways of dealing with their children in relation to the problem of aggressive behavior.

The team also made three documentaries regarding Palestinian Human Rights issues.   One was entitled Israeli Violations Rights to Health in Palestine.  The program discussed the ongoing Israeli violations of international agreements and laws, especially those related to health situation during war. They also discussed the causes behind the international silence in response to such violations.  In a 30 minute program, The Psychosocial Impact of Torture, various torture techniques used against Palestinian prisoners were discussed as well as the ramifications of torture on the individual, family and society. Lastly, the issue of The Psychosocial Impact of Unemployment was covered. The program was focused on the psychosocial impact of unemployment and the problems that are directly influenced by unemployment such as divorce, aggression, and other important issues in the Palestinian community.

Information Technology Unit

 The Information Technology (IT) unit is considered one of the core groups of the Programme. The IT unit works to enhance the Programme’s work by improving communication and internal exchange of information among the staff. Additionally, IT provides the Programme with the most recent technological advancement and connects the Programme with local and international friends and professionals.  Our website also falls under the IT unit and can be found at http://www.gcmhp.net.

Public Relations Department

 In order to educate the local public and the international community on the Intifada and the psychological effects resulting from it, the Public Relations (PR) department increased its efforts.  The PR team continued to issue leaflets and other printed materials and they welcomed visitors, journalists, and international solidarity groups. In addition, the PR team worked to increase its networking and coordination with other organizations.  

The Public Relations Department is responsible for the publication of GCMHP's bi-monthly magazine, Amwaj, in addition to the Annual Report, press releases and appeals, and GCMHP monthly reports.

The PR department also hosts all visitors that come to the program.  Due to the danger and restrictions imposed during this Intifada, the number of visitors from different countries was much decreased as compared to years prior.  The number of visitors in the year 2002 was 365 local and international visitors, which is actually quite a noticeable increase compared with the year 2001 (156 visitors). 

The Programme's media activities are also coordinated by the PR department.  The PR department continued to meet with local and international media in order to provide them with news and explain the activities of the Programme. In the local media, 226 stories on the Programme were shown and advertisements about the Programme’s activities were published. Also, a number of appearances in local media such as TV and Radio were performed.   In total, 130 media activities were conducted including interviews, TV and Radio appearances, and documentary films.

We believe that in order to better serve our community, we need to form strong partnerships with local and international organizations.  The Public Relations Department continued to expand and solidify ties with different local organizations working in the area of psychological, social, and general human services. Of particular importance is the Palestinian Non-Governmental Organizations Network (PNGO), an umbrella organization that coordinates and connects NGO's in Palestine.

The GCMHP welcomes international volunteers.  Due to current security measures enforced by the Israelis, the number of volunteers visiting GCMHP has reduced drastically.  There were three volunteers for the year 2002.  The first was Bergetta Bockman from Germany who conducted a number of field visits and documented cases of those exposed to human rights violation.  In addition, she wrote many articles about the stories she heard and cases from her field work. The second volunteer was Dr. James Crossen, a Canadian Psychotherapist who conducted a number of professional supervision courses to specialists from the Programme and students from the post-graduate diploma program. He also gave lectures about trauma and addiction.  The third volunteer was Dr. Henry Bang, an Australian who visited the Programme for one and half months. In this period, he became acquainted with the unique experiences of the traumatized Palestinian children.