The Occupied Palestinian Territories - Focus on the psychological care of the children
July 6, 2011
Last April 24 to 28, training took place in Amman, Jordan on the specific psychological care of children and adolescents, intended for teams of psychologists, national and expatriate, from Gaza and Nablus. Hélène Thomas, MSF Program Coordinator for Mental Health Care in the Palestinian Territories, participated in this seminar.
Why did you decide to begin this focused reflection on children and adolescents?
"This follows a request by psychologists from the two areas, Gaza and Nablus, where 30 to 50% of the patients are under 16 years of age. The psychological consequences for an adult and a child who would have faced the same trauma are problematic for everyone, of course, regardless of their age, but children and adolescents have symptoms of psychological distress that are very particular and specific. For example, bedwetting is very common yet it is rare in adults; there are also learning difficulties (reading, speech), concentration, memory and therefore academic failure, or even aggressive behaviour toward others (brothers, sisters, friends, comrades), nightmares...
Not all psychologists are necessarily specialized in developmental psychology and they are often more familiar with the psychopathology of adults than of children. So our teams wanted training specific to the care of younger people, to learn how to better meet their needs and also to be able to exchange with psychologists working in the field in other MSF regions, about their work context - similarities, differences - their approach etc.
What are the psychological issues specific to the Occupied Palestinian Territories?
The young patients that we follow in Gaza and Nablus have a close relative that is imprisoned, have been part of violent scenes, including between the Palestinians, often with rocket fire, have seen people injured or killed before their eyes, experienced the bombings, the demolition of their house, been subject to settler attacks or raids, in the middle of the night, by the Israeli army.
Many suffer from anxiety disorders, chronic post-traumatic stress disorder syndromes or more acute and specific stress disorders, nightmares, flashbacks, phobias such as phobias of dogs, for example, because they often accompany the Israeli soldiers ...
The child's difficulties often result in family dysfunction. When the child is doing better, the family does better. Often, when the parents consult for their child and they witness rapid progress, they ask in turn to be taken into care. I remember one 33 year old mother, who had brought her enuretic child for care. After a few sessions, given the results obtained, she asked to also be supported for bedwetting, a problem she had never dared to admit to because she was ashamed. So the child sometimes becomes a gateway to treatment for the adults too.
What kind of psychological support is offered to the young people?
Several types of support are possible: individual therapy starting at 4/5 years of age; as a mother-child duo for younger children; or family therapy if the problem persists and the child's condition could improve further if the whole family’s situation were supported.
We don’t use the same therapeutic tools as for adults. A child is supposed to play so we use dolls, figurines etc., staged scenes, drawing, and role playing. Similarly, the psychologist must adapt their way of addressing the patient, according to their age. We must also discuss and interact with the parents, even if they don’t necessarily participate in the session.
Because a child depends on his parents and reacts to their anxieties, any disruption in his environment may be likely to cause manifestations of psychological suffering. Thus, in the context of mother-child therapy, by working with the one who spends the most time caring for the child - the mother in general, but it can also be the father, uncle, aunt, the grandparents - we are able to care for infants/babies that are anxious, refusing to eat, sleep, refusing any emotional contact, suffering from somatic symptoms such as vomiting or regurgitation.
We will get results more quickly with the children because they are more receptive, more open, less encumbered by prejudices or with the accumulation of traumas over the years. By the second session we can already see an improvement in the younger ones."
Opening in Qalqilya
Because of their proximity to some colonies, and because the Israeli army regularly carries out operations there, the villages of the Qalqilya district, next to that of Nablus, are particularly exposed to violence. The evaluations conducted by MSF over the last two years have concluded that there are real needs there in terms of psychological assistance. This is why, in 2010, MSF decided to launch a program of psychological care in the area.
Psychological Care at MSF
Considering that the individual is a mental, physical and social whole, MSF tries whenever possible to provide a response on all three levels. As for psychological support, we use brief therapy (between 10 and 15 consultations on average), focusing on certain goals to be attained and using specific techniques based on speech, cognitive behavioural therapy, relaxation, play, drawing, modelling clay etc. From a medical point of view, certain diseases (depression, anxiety ...) require medical treatment which must be carried out at the same time as the psychological therapy. Finally, it is important to help the person to (re)create a social network, to carry on with activities, to follow through with some administrative processes. This is the role of our social workers: to put the patient in contact with the structures involved, whether it is for paperwork, follow-up with a speech therapist, an assistance organization, etc.