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Published online: 29 Aug 2018

Approximately one in four children lives in conflict-affected areas around the world and this results in many consequences for their physical and mental health. This paper first provides a brief history of the specific contexts of violence and resistance that children and youth engage with, and in, on a daily basis in Palestine. It then outlines the efforts of one functioning program in the West Bank, the United Nations Community Mental Health Project, which was designed not only to respond to, but mitigate, child and youth mental health problems in the midst of decades of such political violence.

 

INTRODUCTION

One in every four children in the world is living in a country affected by conflict or disaster (UNICEF, 2018UNICEF. (2018). UNICEF humanitarian action for children 2018 OverviewNew York, NYAuthor. [Google Scholar]). In prolonged armed conflicts such as those in Palestine, Iraq, Syria, Yemen, Libya, the Democratic Republic of Congo, and Myanmar, hundreds of thousands of people have been subjected to trauma and destruction where daily life is a nightmare (UNICEF, 2018UNICEF. (2018). UNICEF humanitarian action for children 2018 OverviewNew York, NYAuthor. [Google Scholar]). Evidence suggests that massive exposure to war has many negative effects on children. These are not only physical; armed conflict has direct effects on mental health and the well-being of the population. For example, childhood trauma associated with war violates children’s sense of safety and trust in the world in which they live, reducing their sense of worth. It also increases their levels of emotional distress, shame, and grief, and their tendency to engage in destructive behaviors (Atkinson, Nelson, Brooks, Atkinson, & Ryan, 2014Atkinson, J.Nelson, J.Brooks, R.Atkinson, C., & Ryan, K.(2014). Addressing individual and community transgenerational trauma. In P.DudgeonH. Milroy, & R. WalkerEds., Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (pp. 289307). Retrieved fromhttps://www.telethonkids.org.au/our-research/early-environment/developmental-origins-of-child-health/aboriginal-maternal-health-and-child-development/working-together-second-edition/ [Google Scholar]).

Not only are specific individuals affected by war, but communities suffer as well (Wessells, 2009Wessells, M. G. (2009). Do no harm: Toward contextually appropriate psychosocial support in international emergenciesAmerican Psychologist, 64(8), 842. doi:10.1037/0003-066X.64.8.842[Crossref][PubMed][Web of Science ®][Google Scholar]). Communities where long-term violence has crippled civil society are often more threatening to children in the long term than “distant trauma” itself (Lieberman, Van Horn, & Ozer, 2005Lieberman, A. F.Van Horn, P., & Ozer, E. J. (2005). Preschooler witnesses of marital violence: Predictors and mediators of child behavior problemsDevelopment and Psychopathology, 17(2), 385396.[Crossref][PubMed][Web of Science ®][Google Scholar]). As in the cases involving massive trauma, where all aspects of a community’s ecology have collapsed and left an absence of stability and rule of law, the lives of the population generally—and children in particular—are profoundly affected by the effects of the terror, which is part of the embedded systems in which they live. However, in such situations, the need to defend children and women is usually not perceived as a top priority (Gasseer, Dresden, Keeney, & Warren, 2004Gasseer, N. A.Dresden, E.Keeney, G. B., & Warren, N.(2004). Status of women and infants in complex humanitarian emergenciesJournal of Midwifery & Women’s Health, 49(S1), 713. doi:10.1016/j.jmwh.2004.05.001[Crossref][PubMed][Google Scholar]).

Exposure to adversity or trauma does not always necessarily lead to impairment and the development of psychopathology in children, however. Some still have the capacity to recover from trauma in the face of stressful life events and appear to develop healthy psychosocial functioning (Yehuda, Flory, Southwick, & Charney, 2006Yehuda, R.Flory, J. D.Southwick, S., & Charney, D. S.(2006). Developing an agenda for translational studies of resilience and vulnerability following trauma exposureAnnals of the New York Academy of Sciences, 1071(1), 379396. doi:10.1196/annals.1364.028[Crossref][PubMed][Google Scholar]). The identification of factors that may either protect children and youth from adverse effects of violence during war, or exacerbate these effects, is crucial for understanding human development and for designing effective intervention strategies to enhance protective factors for life-span development.

Resilience frameworks (e.g., Cyrulnik, 2005Cyrulnik, B. (2005). The whispering of ghosts: Trauma and resilienceNew York, NY: Other Press. [Google Scholar]) are one way to identify and amplify how children and youth may recover from trauma or develop healthy psychosocial functioning in the face of stressful life events (Shastri, 2013Shastri, P. C. (2013). Resilience: Building immunity in psychiatryIndian Journal of Psychiatry, 55(3), 224. doi:10.4103/0019-5545.117134[Crossref][PubMed][Web of Science ®][Google Scholar]). Such models understand resilience as the outcome of a long-term interaction between children and surroundings during development—family, schools, and the community, for example, all play a crucial role in the development of resilience (Olah, 2013Olah, A. (2013). Psychological immunity: A new concept of coping and resilience. Retrieved fromhttps://www.psychevisual.com/Video_by_Attila_Olah_on_Psychological_immunity_A_new_concept_of_coping_and_resilience.html [Google Scholar]). Consequently, these models also argue that it is important to utilize these resources to promote secure early bonding between children and adults to enhance cognitive development and self-esteem, and to strengthen family relations, affiliations and a sense of belonging to their community (Sudmeier-Rieux, 2014Sudmeier-Rieux, K. I. (2014). Resilience–An emerging paradigm of danger or of hope?Disaster Prevention and Management, 23(1), 6780. doi:10.1108/DPM-12-2012-0143[Crossref][Web of Science ®][Google Scholar]).

This article first provides a brief history of the specific contexts of political violence and resistance that children and youth engage with, and in, on a daily basis in Palestine. It then outlines the efforts of one functioning program in the West Bank—the United Nations Community Mental Health Project (CMHP)—that was designed not just to identify or respond to— but prevent—child and youth mental health problems in the midst of decades of such political violence. It also discusses three important considerations regarding resilience to come out of this program for engaging with children and youth in conflict zones: (1) the value of shifting from vulnerability to resilience paradigms, (2) the need to think critically about resilience paradigms once they are adopted, and (3) the promise of leveraging community strengths as part of resilience paradigms. Identifying and analyzing such trends in the context of one successful Palestinian mental healthcare program may demonstrate the importance of more creatively rethinking resilience as a central part of similar programs that promote well-being for children and youth in other conflict zones.

THE PALESTINIAN POPULATION AND ITS EXPOSURE TO POLITICAL VIOLENCE

Palestine is located in the Middle East and is made up of two areas: the West Bank, which borders Jordan, and the Gaza Strip, which borders Egypt and the Mediterranean Sea. There are approximately five million people who live in Palestine; just over three million people live in the West Bank and almost two million live in the Gaza Strip. As of 2017, 39% of the Palestinian population was younger than age 15 years; 37% of these children/youth live in the West Bank and 43% live in the Gaza Strip (Palestinian Central Bureau of Statistics [PCBS], 2017aPalestinian Central Bureau of Statistics. (2017a). The international population day 11/ 07/2017. Retrieved fromhttp://www.pcbs.gov.ps/site/512/default.aspx?lang=en&ItemID=1975 [Google Scholar]).

The 1948 Palestinian exodus—also known as Al Nakba—occurred when the then-emerging Israeli state drove out approximately 800,000 Palestinians from their homeland. The first uprising (intifada), which occurred from 1987 to 1993, represented the zenith of Palestinian popular resistance against decades-long Israeli military occupation. In the course of the First Intifada, more than 1,500 civilians were killed, 25% of them children, with many thousands injured (Giacaman et al., 2011Giacaman, R.Rabaia, Y.Nguyen-Gillham, V.Batniji, R.Punamäki, R.-L., & Summerfield, D. (2011). Mental health, social distress and political oppression: The case of the occupied Palestinian territoryGlobal Public Health, 6(5), 547559. doi:10.1080/17441692.2010.528443[Taylor & Francis Online][Web of Science ®][Google Scholar]). Since then, the violent Israeli response to the second Palestinian intifada in September 2000 has led to even more difficult, precarious, and insecure living conditions for Palestinians. Israeli military actions have killed more than 4,800 people, including more than 950 children, between September 2000 and June 2008 (B’Tselem, 2008aB’Tselem. (2008a). Human rights in the occupied territories: Annual report 2007: B’tselem. Retrieved fromhttp://www.btselem.org/download/200712_annual_report_eng.pdf [Google Scholar]).

In June 2007, Israel tightened its control over the Gaza Strip, barring almost all Palestinians from entering or leaving the area. This has effectively turned the area into an open-air prison in which 1.5 million Palestinians must learn to live (B’Tselem, 2008bB’Tselem. (2008b). Fatalities before Operation “Cast Lead”. Retrieved fromhttp://www.btselem.org/statistics/fatalities/before-cast-lead/by-date-of-event [Google Scholar]). During three Israeli sieges on the Gaza Strip between 2008 and 2014, Israeli soldiers have killed 3,756 Palestinians. In addition, over 100,000 Palestinians have been left homeless, losing all they hold dear (B’Tselem, 2016B’Tselem. (2016). Whitewash Protocol: The So-Called Investigation of Operation Protective Edge: B’Tselem. Retrieved fromhttp://www.btselem.org/publications/summaries/201609_whitewash_protocol [Google Scholar]).

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