an interview from 2001 with Palestinian psychiatrist Dr Eyad El-Sarraj

I was very sorry to hear tonight of the death of the remarkable Palestinian psychiatrist Dr Eyad El-Sarraj. This is an interview I conducted with him in 2001, in which he spoke of the dire state of mental health in Gaza and on his training and experiences as a psychiatrist and how he came to found the Gaza Community Mental Health Programme (GCMHP).

Dr Eyad El-Sarraj

Dealing with Palestine's Traumatized People
by Susannah Tarbush
Saudi Gazette, 28 April 2001

The internationally-renowned Palestinian psychiatrist and human rights activist Dr Eyad El-Sarraj is deeply troubled at the impact Israeli actions in Gaza since October are having on the mental health of Palestinian women, men and above all children.

“In Gaza now every single person, adult or child, is traumatised to a different degree”, El-Sarraj told Saudi Gazette in an interview during a recent visit to London. “Do you know what the children’s preoccupation is now? Guns, terror, violence – nothing else – and they are very jumpy.”

Around half of Gaza’s 1 million inhabitants are less than 16 years old. The widespread feelings of fear and terror among children are causing numerous problems. There is a big increase in the number of children who suffer from bedwetting and insomnia, while in school children are finding it hard to concentrate and are showing rebellious attitudes.

For Dr El-Sarraj the current traumas of the younger generation are all too familiar. It was to help child victims of Israeli violence during the first intifada that he founded the Gaza Community Mental Heath Programme (GCMHP) in 1990.

“We have already lost a generation in the first intifada,” Dr El-Sarraj says. “That generation is poorly educated, even illiterate, and now a second generation is suffering from the same things – overcrowded schools, a backward curriculum, traumatised teachers, violence and hopelessness.”

In the first intifada many children were arrested, beaten, shot, exposed to tear gas and physically abused. They were left with lasting psychological damage, including anxiety, depression, post-traumatic stress disorders, night terrors and sleep walking.

Many children witnessed their fathers being beaten by the Israelis and most of the Palestinians who were imprisoned were tortured. Unfortunately, some of the Palestinians who were tortured inflicted torture on others after their release.

 “We have what is called ‘identification with the aggressor’”, Dr El-Sarraj says. “When people come out of prison it is not only they who suffer, they make everyone around them suffer. They are isolated, paranoid, suspicious and aggressive and may be violent to women. When we started to treat children we found we could not treat them in isolation but must deal with the family as a whole.”

After the second intifada erupted GCMHP launched a Crisis Intervention Project to help victims cope with the traumas of being injured or witnessing relatives and friends being killed and injured, having their homes destroyed and being attacked by Israeli helicopter gun ships. Britain’s Department for International Development, the Canadian government and UNDP are among the foreign donors of the Crisis Intervention Project.

The project includes a free telephone hotline. “As Israel dissected the Gaza strip we could not move between clinics and centres and so we developed this hotline,” Dr El-Sarraj says. “A typical call to the hotline is from a mother suffering fear over her children –she may complain that her children’s behaviour has become violent and rebellious and that she cannot control them.” The hotline provides counselling and may arrange for therapy.

There are plans for GCMHP’s video department to produce a film, with the help of the Palestinian-British writer, film maker and producer Karl Sabbagh, on the current situation in Gaza and how GCMHP has responded to it. It is hoped that a version will be screened on British television.

As well as receiving international recognition for his pioneering work with GCMHP, El-Sarraj has been attracting much interest in recent weeks with his well-publicised call for Palestinians to adopt the path of non-violent resistance.

He sees non-violent resistance as a movement that would “liberate people in Palestine from fear, and liberate the Israelis from racism.” It would “start a peaceful dialogue with the people of Israel and would at the same time improve the situation for the Palestinians internally by advocating freedom of speech, the law, democracy, elections and so on.”

The most optimistic scenario he can see for the future is for such a movement “to join hands with the Israeli peace movement and friends everywhere in the world, so as to put pressure on Israel to withdraw from occupied land and recognise a sovereign Palestinian state”.

Through non-violent resistance the Palestinians could escape the trap they have been in for the past 50 years. “This trap always links the Palestinians with violence and portrays Israel as the one party that is seeking peace. Palestinian violence can be taken as an excuse to impose what the Israelis call ‘security’ – which means grabbing more Palestinian land.”

There are reports that a growing number of people in Gaza and the West Bank share this vision and there have been several large peaceful demonstrations, although the Israelis have responded with brutality, using for example stun grenades and tear gas against the demonstration by 600 Palestinian women near Ramallah in March. Palestinian politician Hanan Ashrawi was among the injured.

El-Sarraj is critical of both of the Israelis and the Palestinian Authority (PA). “The Israelis have made the very serious mistake of not apologising to the Palestinians for everything they have done, from uprooting to occupation. Only once they apologise can there be a process of reconciliation. What is needed is a courageous Israeli leader to say we hurt the Palestinians and we are sorry, please forgive us and let us live together.” As for the PA, people have felt almost alienated by its conduct over the past seven years, and the intifada has shown clearly that it has no clear strategy or policy.

“In the first intifada we knew what we wanted, but this time we don’t know if we’re working for peace or for war. There has been no direction from the leadership. There is confusion and chaos at the level of the masses and we don’t know where we’re heading.” Dr El-Sarraj and Haider Abdel Shafi applied to the PA to found a new political party called the Movement for Democratic Change, but the PA refused to grant them a licence.

Dr El-Sarraj’s dual passion for psychiatry and human rights goes back to his days of studying medicine in Alexandria, Egypt. He spent four months during his medical training working in a psychiatric hospital, “and this was my introduction not only psychiatry but to human rights. The patients there were treated worse than dogs. It was a terrible experience but I learned so much from it, and it was enough for me to decide I was going to be a psychiatrist.”

El-Sarraj spent five years training and working at the famous Maudsley Hospital in London, and then went back to Gaza where he was the only psychiatrist for what must be one of the most stressed and traumatised populations in the world. He started a government psychiatric hospital in Gaza, although it had only 32 beds, and in his private clinic were a further eight beds.

Six months after the beginning of the first intifada the Israelis got him ejected as he had started to speak out on the impact of Israeli oppression on children and had made contact with sympathetic Israeli psychiatrists who went to Gaza and spoke out against the Israeli occupation.

At a conference in Berlin in 1988 he happened to meet Barbara Harrell-Bond, then the director of the Refugee Studies Programme at Oxford University, and with her encouragement he went to Oxford and drew up the plans for GCMHP, which he founded two years later.

GCMHP is a non-profit non-governmental organisation which now has eight clinics, dealing with children, women and torture victims. The clinics give counselling, cognitive therapy and, where appropriate, medication. GCMHP includes an Empowering Women programme which helps women develop their economic independence and enhance their skills.

GCMHP has also tried to overcome the stigma against mental illness that is common in Palestinian (and wider Arab) society and which may deter people from admitting they have a mental symptom and from seeking help.

The work of GCMHP is of relevance not only to Gaza, but to the Middle East and beyond. Its two-year diploma course in community mental health, taught in conjunction with several foreign universities, is the only course of its kind in the Middle East. GCMHP has drawn up a five-year plan which is due to start this year and which needs around $3 million a year. This year there is a deficit of between $200,000 and $300,000 and for next year they are assured of only around half the funds. Funds come most from Scandinavian countries and the European Union. In the future GCMHP hopes to set up a Trust Fund or Waqf to meet its financial needs.

The five-year plan would develop the services to reach more people, would upgrade the staff and would train more people. It would also strengthen links within the region in areas such as human rights, women’s rights, children, torture and rehabilitation. Countries such as Algeria, Iraq, Kuwait, Sudan and Lebanon have serious problems in some of these areas, El-Sarraj notes.

In Britain GCMHP has a small support organisation which is funded by Lord Sainsbury’s Linbury Trust. “Lord Sainsbury told me ‘part of my heart is in Gaza’” El-Sarraj recalls. “He served with the British Army there and saw the whole tragedy of the Palestinians and the uprooting and the refugees.”

El-Sarraj points out that the GCMHP has itself been democratised. “Over the past year we have restructured it and we now have very efficient and active board of directors from Gaza plus an international advisory board of around 21 members”.

GCMHP has also delegated authority to staff in the different departments. “This takes time because in our tribal culture, where the boss or father figure who decides everything, people have to get used to the idea that it is their responsibility and their right to take decisions.”

Every two years GCMHP holds an international conference. The fourth one, in November 1999, was on women in Palestine. “We were planning that our conference this November should be on democracy and the Arab mind, but we decided to change the topic to reconciliation, trauma and peace,” Dr El-Sarraj says.

Unemployment is one of the most serious problems facing Gaza, and Dr El-Sarraj hopes that a software training and production project could provide employment. He points out that Israel and India are the second largest producers of software after India and thinks that Gaza has potential in this field.

“We don’t have any industry or agriculture to speak of. What we have is people and we could train their brains to produce software in this hi-tech age. I’ve already received promises from some quarters that they will support this and will help get us contracts with IBM Microsoft and other big companies.”

Although Dr El-Sarraj ardently hopes for peace, yet “in so many ways I fear peace when it comes, because all the energy of the Palestinians that is now directed against the common outside enemy will be directed against the internal enemy and if there is no internal enemy we will create it.” He worries that there will be a lot of violence within the community itself.