Mental health and psychosocial support (MHPSS) needs among children in Gaza are high. Since 7th October 2023, most of the children in the Gaza Strip have been through traumatic events, including grief, widespread destruction, forced displacement, and severe shortages of food, water, and medicine. The absence of safe spaces and playgrounds and the closure of schools are also factors that cause mental health and psychosocial issues among children. They are reported to be suffering from anxiety, fear, emotional withdrawal, and nightmares. Israel has bombed Gaza’s only psychiatric hospital, and air strikes have suspended the operations of the other six community mental health clinics that work with thousands of patients across Gaza. Some doctors have tried to stay in contact with children via WhatsApp and identify those suffering from mass depression, mutism, bedwetting, and suicidal thoughts.
Children are likely to face long-term Mental health and psychosocial support (MHPSS) needs given the lack of immediate response. It has been demonstrated that children who experience strong, frequent, and prolonged adversity, such as exposure to violence, physical abuse, or neglect, are likely to experience a toxic stress response, which can disrupt the development of the brain architecture and other organ systems and increase the risk of stress-related disease and cognitive impairment.
The impact of the current hostilities on children’s mental health is incomparable to the pre-crisis situation, as the extent of hostilities and infrastructure destruction has been unprecedented. That said, prior to 7th October 2023, there was already a high burden of mental health issues in the Gaza Strip. A 2017 study found that approximately 54% of Palestinian boys and 46.5% of Palestinian girls aged 6–12 had emotional and behavioural disorders. In 2022, Save the Children found that 80% of the children in one study showed emotional distress symptoms. About half of them there reported having contemplated suicide, and three out of five kids were self-harming. Prior to 7th October 2023, access to mental health support in Gaza was limited and often socially stigmatised, resulting in families and community members not prioritising Mental health and psychosocial support(MHPSS). Children with pre-existing mental health issues can be expected to face aggravated impacts under the current context of hostilities.
As of now, an estimated 60% to 75% of housing units were destroyed or uninhabitable in Gaza and over 290,000 (approximately) were damaged, forcing people into displacement and to seek safety in United Nations Relief And Works Agency (UNRWA) facilities, relatives’ houses, or under the open sky in courtyards.
There are no safe spaces. The United Nations Relief And Works Agency (UNRWA) shelters are hosting more than four times the number of displaced people than their intended capacities. More than half of the population in Gaza currently live in UNRWA facilities, enduring dire and overcrowded conditions. These conditions create severe health (including mental health) and protection concerns for Intrusion Detection And Prevention System(IDPs), with a particular impact on children.
Despite UNRWA facilities being UN facilities, they are not protected from attacks. There is a lack of safe zones. On 1st December 2023, the Israel Defense Forces released a map of Gaza divided into 623 numbered blocks indicating areas they would imminently strike, accordingly with the intention to avoid civilian casualties and indicate areas to which civilians should go to receive humanitarian aid and protection from air strikes. That said, many residents in Gaza have had little electricity or internet service, making it difficult to access the map. Mawasi and neighbouring areas in southwestern Gaza, where thousands of Gazans live in challenging conditions with scattered farm fields and waterlogged dirt roads, were stipulated as safe zones for people fleeing hostilities. These areas lack basic services such as running water, sanitation facilities, and humanitarian response. The makeshift shacks and tents in the area also offer inadequate protection against the winter rain.
There is an increased risk of gender-based violence (GBV). There is limited current and pre-crisis GBV data disaggregated by age, making it difficult to analyse the extent of GBV needs among girls. Women and girls are likely facing increased risks of arbitrary detention and harassment. The Israel Defense Forces has been reported to have detained hundreds of Palestinians, including women taken to Yarmouk Stadium, where their veils are removed and they are searched by soldiers. Some of the women have reported enduring abuse, beatings, and harassment. As at December 2023, many of the women and girls detained remained in undisclosed locations.
As of now, huge percentage of the children in Gaza could not access their normal daily water intake, putting them at risk of dehydration. On average, children are estimated to access 1.5 Litres(L) of water or less each day, compared to the minimum standard of 3 Litres(L).
The bare minimum intake should be:
• 1.2 Litres(L) of water daily for children between four and eight years old
• 1.2–1.4 Litres(L) daily for children aged 9–13
• 1.4–1.9 Litres(L) daily for adolescents aged 14–18
The effects of dehydration are vomiting and diarrhoea, and it could have more serious consequences, such as multi-system failure and death. Some people have resorted to drinking brackish water from agricultural wells. This practice increases pesticide and chemical exposure, affecting the health of all Gazans, including unborn and newborn infants, children, women, and men. Water contamination and poor sanitation are increasing the prevalence of waterborne diseases, such as cholera, diarrhoea, dysentery, hepatitis A, typhoid, and polio, the leading causes of death among children under five.
The sanitation and hygiene situation in shelters is precarious. There was one toilet per 372 people or more and one shower per 4,500 people or more in the Gaza Strip. This issue particularly affects girls managing their menstrual cycles, who require adequate WASH facilities, sanitary products, and pain medication. Many of them have resorted to taking pills that delay menstruation. These factors can result in a higher risk of bacterial and fungal infections, including those affecting the urinary tract and vagina. Water access has long been limited in the Gaza Strip even before 7th October 2023. As of now, over 30% of the 2.2 million Gazans population had limited WASH access.
Hunger has become the most pressing issue for people in Gaza. On present situation, at least one in four households (more than half a million people) in the Gaza Strip were facing Integrated Food Security Phase Classification (IPC) scale 5 food insecurity conditions characterised by extreme food gaps and a collapse of their livelihood. About 80% of the population in the strip were experiencing IPC 4 or IPC 5 levels characterised by extreme food gaps. As present situation, around 93% of the population was facing acute food insecurity – i.e. Crisis (IPC Phase 3) or worse levels. The current hostilities have destroyed crops, food warehouses, and bakeries. The Israeli siege of Gaza has interrupted food and fuel imports, limiting the availability of essential staple foods.
Four out of five households in the northern governorates and half the displaced households in the southern governorates have reported going entire days and nights without eating, and many adults are skipping meals so children can eat. Children have lost weight and have reported cases of dizziness from a lack of food.
Since the end of the humanitarian pause on 30 November 2023, only an average food trucks have been allowed to access the Gaza Strip daily, compared to between 150–180 food trucks (out of an average of 500 humanitarian aid trucks) entering Gaza daily prior to 7th October 2023. The food supply level is far below the food and nutritional requirements of the whole population based on the potential kilocalories delivered in the current shipments. Frequent communication disruptions, damage to infrastructure such as roads and vehicles, fuel shortages, and a lack of safety and security for aid workers have also constrained the delivery of the already limited food.
Famine thresholds for both acute malnutrition and non-trauma mortality may also be breached by 4th February 2024. As of all under-five children (around 3,35,000) were at high risk of severe malnutrition as the risk of famine conditions continued to increase. Around more than 7,700 children in Gaza were experiencing acute malnutrition. Acute malnutrition, the most life-threatening form of malnutrition in children, was estimated to increase by 30% from pre-crisis conditions, affecting up to more than 10,000 children in Gaza. Acute malnutrition can be fatal or have long-term consequences if left untreated. Reported malnutrition cases are likely to be underreported because of access and communication constraints.
The presence of long-term food insecurity also creates a risk for an entire generation to suffer from chronic malnutrition and for the occurrence of disease outbreaks. Malnutrition enhances children’s vulnerability to mortality resulting from diseases such as diarrhoea, pneumonia, and measles, particularly in dire environments where they lack access to essential healthcare services. Children who experience malnutrition are at a heightened risk of developing disabilities. Children who already live with disabilities are likely to experience a further deterioration in their mobility and developmental abilities. Malnutrition is also likely to increase among non-breastfed infants, who need access to formula alongside sufficient access to safe drinking water if preparation is required. Currently, children lack sufficient complementary foods and micronutrient supplements.
In 2021, global acute malnutrition prevalence in under-five children was low at 0.8%. 10% of the staff present before 7th October 2023. The maternity unit at Al-Aqsa Hospital is not operational and is referring all pregnant women to Al-Awda Hospital, which is further away in Gaza governorate, putting patients at risk during travel time. Prior to 7th October 2023, there was already a shortage of medical staff, doctors provided a daily average of 113 medical consultations, and there were only 1,016 health staff in the Gaza Strip.
World Health Organization (WHO) had reported more than 1,58,000 diarrhoea cases in Gaza since 7th October 2023. As at December 2023, cases among under-five children had increased from 48,000 to 71,000 in just one week. Approximately 3,200 new diarrhoea cases among under-five children have been reported daily. Before the conflict, around 2,000 diarrhoea cases in under-five children were recorded per month. This recent climb represents an increase of about 2,000% in diarrhoea cases among under-five children. There were no updated figures on the number of diarrhoea cases among children.
Thousands of people are living in extremely overcrowded conditions in shelters, increasing the risk of disease outbreaks. International Development Program (IDP) collective sites have recorded over 3,60,000 cases of infectious diseases, such as acute respiratory infections, meningitis, jaundice, impetigo, chickenpox, and hepatitis A. Obtaining an accurate count is extremely difficult given access and communication constraints, meaning the number could be much higher. In general, disease outbreaks in Gaza pose a significant threat to children, as their weakened immune systems and lack of food render them highly vulnerable.
The winter season in the Gaza Strip is between December–March, with temperatures dropping as low as 9° C. Temperatures may drop further during low-pressure fronts. There is a high need for mattresses, blankets, sleeping bags, winter clothing, and other winter items. Some individuals in shelters sleep directly on the floor without any mattresses or blankets. The cold in the shelters facilitates the spread of various diseases, including respiratory diseases (such as pneumonia), and hypothermia.
During winter, there is only an average of about two to three hours of sun, sometimes less, affecting solar-powered water stations that require at least five hours of proper sun to operate all day. Winter reduces these stations’ outputs and makes it more difficult for people to get water. Solar-powered water pumps convert sunlight into electricity to power them. Solar panels collect photons from sunlight to generate direct current for the motor to pump water out.
On 8th October 2023, the Israeli Government implemented a comprehensive blockade on the Gaza Strip, which involved severing water and electricity connections and shutting down all border crossings, effectively restricting movement in and out of Gaza. As a result, all entry points to Gaza have been blocked, allowing only a limited number of humanitarian trucks to enter from the Rafah Crossing with Egypt. The number of trucks carrying aid has been significantly inadequate in relation to the needs and overall humanitarian situation. At present, the border crossings connecting Egypt and the Gaza Strip, Rafah and Kerem Shalom, were mostly closed for the movement of people, with only the exit of wounded people and the entry of a limited number of humanitarian trucks being allowed. Intense ground operations and fighting, frequent communication disruptions, insecurity, blocked roads, and fuel scarcity pose significant challenges to humanitarian operations.
On 23 November 2023, a humanitarian truce was initiated, initially planned for four days and extended for seven days, suspending fighting and allowing for aid to flow in the Gaza Strip until 30th November 2023 These pauses aimed to relocate civilians from northern Gaza to the south and allow the entry of humanitarian aid. Specifically, during these pauses, UN agencies and other stakeholders increased the amount of aid entering the Gaza Strip via the Rafah Crossing. Despite these plans, no substantial progress was made during this period. According to humanitarian organisations, pauses and corridors are not sufficient to ensure humanitarian aid delivery to the people in need in Gaza.
The security situation significantly constrained organisations working alongside children, which were unable to reach and respond to the severity of their needs. Many international humanitarian organisations cannot enter the enclave because of security constraints and are working in partnership with local responders. Only few operational organisations are present in the area, including United Nations Relief And Work Agency (UNRWA), the Red Cross and Red Crescent, Al-Haq, Al Mezan, and the Palestinian Centre for Human Rights, which have had long-term presence in Gaza. On 28th January 2024, however, at least 12 countries (including their main government donors U.S. and Germany) had cut their funding to UNRWA following allegations by Israel that 12 UNRWA staff were involved in the 7th October 2023 attacks. Defunding UNRWA will likely reduce its operational capacity further, risking the suspension of its humanitarian response in the Gaza Strip. UNRWA is currently the main responder in Gaza, and over two million people depend on the agency for survival. UNRWA runs shelters for over one million people and provides food and primary healthcare even at the height of the hostilities.
The child protection organisations had reached more than 93,000 boys and girls mostly with awareness-raising initiatives, Mental health and psychosocial support (MHPSS) for children and caregivers, and registration and alternative care for Unaccompanied Asylum-Seeking Children(UASC).
Copyrights ©️
OBSERVERTIMES GLOBAL NEWSNETWORK PRIVATE LIMITED reserves the rights to all content contained within its official website https://observertimes.in/ Online Magazine/ Publications