Disaster and Resiliency in Palestine

Transcription

1 School of Psychology Disaster and Resiliency in Palestine By Dr. Mohamed Altawil, PhD University of Hertfordshire, School of Psychology Milan-Bicocca University, Italy 22 nd June,

2 Overview of Presentation Introduction Background The Aims of Study (Quantitative and Qualitative) Methods Results Conclusion Current and Future Research Project Resiliency Exercise

3 Occupation & War (1948 up to the present day) War 1948 (Massacres, Destroyed villages, Refugees) War 1956 War 1967 Palestinian refugees increased from 1 million in 1950 to more than 8 millions in 2010 (UNRWA,2011). War 1973 War 1982 Intifada I: Intifada II: War 2006 Blockade on Gaza onwards War on Gaza 2008/2009

4 Daily life in Gaza

5 A silent killer in Gaza Since the blockade started in 2007 till June 2011, 369 people are known to have died while waiting to be allowed to get to a hospital outside (Maan-Palestinian News Agency, June,2010).

6 A silent killer in Gaza An average of hours of electricity has been cut every day for the last month. Palestinian children playing near Gaza's only power plant. It has no fuel. Oil lamps are lit at night in houses or tents.

7 Lives at risk from Gaza Fuel Cuts Since the beginning of 2008 till now, about 155 Palestinians have been burned to the death because of using power generators at home. (Maan-Palestinian News Agency, June,2010).

8 Lack of the fuel for cooking

9 Gaza Death Trade. The people in Gaza are forced to use tunnels to survive and feed their children and families since the blockade started 4 years ago. About 25,000 Palestinians used to work in the tunnels. The estimated number of tunnels was 2000 in Since the Egyptians started building the concrete/metal wall to stop the smuggling between Gaza and Egypt, this number has gone down by half. About 150 Palestinians have died in the tunnels. (Maan-Palestinian News Agency, June,2010).

10 Introduction Trauma has a greater effect on children (e.g., Dinan et al., 2004; Soysa,2002) Children living in war torn areas show high levels of PTSD (Cambodia, South Africa, Bosnia, Iraq, Iran, Northern Ireland, Lebanon, Palestine. (Husain, 2005; Mohlen et al., 2005) Trauma in Gaza : high risk of suffering from PTSD (e.g., Thabet & Vostanis,2004; Kanninen et al., 2003) What is Chronic Trauma? Sudden & unaccepted events + Duration (>6 months) + Frequency of Traumatic events (>3 times) = PTSD / OTSD Most children and their families in Gaza who suffer from PTSD are not being provided with adequate mental health services (GCMHP & WHO, 2008)

11 Quantitative Study A larger study (Altawil, 2008) about the effects of chronic traumatic experiences on Palestinian children in the Gaza Strip.

12 Aims of the study? The overall aims of the present study are: 1. To examine the chronic traumatic experiences of children living in the Gaza Strip; 2. To explore the factors which best explain why some children exposed to chronic trauma in Gaza do not develop significant PTSD symptoms. Why this study? The disastrous life of the Palestinians is carrying on. Most of these previous studies were conducted during the first Intifada ( ) and not in the second Intifada ( ) in which the amount of violence and suffering has gradually increased. The studies conducted in the Gaza Strip were only focused on a small number of traumatic experiences (12 traumas or less).

13 Why this study? (cont...) Most of these previous studies used a small sample, but the present study examined a large sample (1,137) of the Palestinian children from 10 to 18 years. Most studies conducted in the Gaza Strip used quantitative studies, and few of them used qualitative studies. Most of the previous studies investigated prevalence of the traumatic events, levels of PTSD and the relation between exposure to traumatic events and symptoms of PTSD without enough consideration for the moderating factors. The current study comes to help psychologists in clinics, schools and psychiatric hospitals to develop relevant, effective programmes which provide four fundamental aspects (prevention, counselling, rehabilitation and therapeutic treatment).

14 Study 1: Quantitative Method Participants 1,137 Palestinian children (498 male and 639 female) with a mean age of years (SD = 1.79; Range = years) Random cluster selection of participants from all parts of the Gaza Strip (N=226 / Elem. School); (N=540 /Prep. School); (N=370/ Sec. School) Measures Checklist of Traumatic Experiences (*) PTSD Symptom Scale (*) Network of Psycho-Social Support (*) Personality Assessment Questionnaire (Rohner, 1968) All scales were tested prior to administration to ensure reliability and validity (including a pilot study), and available in English and Arabic (* validated by Altawil, 2006) School of Psychology

15 Results Exposure to Trauma All children in the Gaza are likely to have been exposed to at least 3 types of trauma. Exposure to chronic traumatic experiences increases symptoms of PTSD PTSD symptoms 41% of participants in this study suffered from PTSD symptoms This finding means that 305,195 (out of 742,200) Palestinian children are likely to suffer from PTSD symptoms

16 The Impact of Exposure to Traumatic Events The most prevalent symptoms of PTSD: (a) 25% Cognitive symptoms (e.g., a child might take a long time to get to sleep, or cannot stop thinking about the trauma he was exposed to, or feels everything around him is not safe) (b) 22% Emotional symptoms (e.g, the child feeling alone, suffering from nightmares, easily getting tense and nervous, feeling sad and fearful, bedwetting) (c) 22% Social behavioural problems (e.g., aggressive and rude behaviour, rejecting a teacher s or parent s authority, having difficulty enjoying games and hobbies) 3 0 % 2 5 % 2 0 % 1 5 % 1 0 % 5 % 0 % D im e n s i o n s o f P T S D S o m a t i c S y m p to m s C o g n i t i v e S y m p t o m s E m o t i o n a l S y m p to m s S o c i a l P r o b le m s (d) 17% Dysfunction and academic performance (e.g., difficulty in concentrating on study, increasingly bad academic performance, difficulties in paying attention during school lessons, disruptive behaviour at school) (e) 14% Psycho-somatic symptoms (e.g., headaches, stomach-ache, hypochondriasis, somatization) A c a d e m i c P r o b le m s

17 Results Levels of PTSD symptoms F i g u r e 2 : P e r c e t a g e s o f t h e l e v e l o f P T S D s y m p t o m o l o g y 7 0 % 6 0 % 5 8 % P e r c e n ta g e 5 0 % 4 0 % 3 0 % 2 0 % 1 0 % 2 0 % 2 2 % A c u t e le v e l C h ild r e n M o d e r a t e l e v e l C h ild r e n M i ld l e v e l C h ild r e n 0 % 1 T h e n u m b e r o f T r a u m a t i z e d c h i l d r e n School of Psychology

18 Results Types of traumatic events experienced School of Psychology

19 Results Traumatic experiences that influenced the development of PTSD symptoms most are: (a) complete or partial destruction of the home; (b) injuries to the degree of losing consciousness; (c) family members killed or direct eye witnessing of killing (d) experiencing shelling by occupying forces Personality Traits (Resiliency): Symptoms of PTSD decrease when positive personality aspects (such as positive self-esteem; independence; positive selfadequacy; emotional responsiveness; emotional stability; positive world view) are high Psycho-social support (Resiliency) : Symptoms also decrease whenever the level of psycho-social support increases. In particular: (a) family support; (b) level of spiritual-religious support; and (c) national pride Income: Children who belong to families with low incomes suffer more than others. Parent s Educational Level: Children whose parents have low standards of education suffer from PTSD more than other categories.

20 Discussion 41% (305195) of Palestinian children is likely to suffer from PTSD symptoms Worrying effects of ongoing, chronic exposure to traumatic events In addition, over crowdedness, poverty and high unemployment, irregular electricity, lack of medication, and lack of appropriate playgrounds might be compounding the effects of PTSD symptoms and hinder the possibilities for intervention and recovery Most children do not receive any treatment for their symptoms What interventions should be offered to these children and by whom? School of Psychology

21 The Many Faces of Chronic Trauma in Gaza

22 The Qualitative Study (conducted between March to June 2007) Aim: To explore, in depth, some of the moderating factors relating to Palestinian children in the Gaza Strip who have been exposed to chronic traumatic experiences, particularly the children who are doing well or show low levels of PTSD. Participants: The sample consisted of six children interviewed by using a semistructured interview. They were aged between years. These children had all been exposed to at least 15 traumatic events which for some of them should have been severe, yet they showed low level symptoms of PTSD. They had all been living in clashing areas in the Gaza Strip. Method: The measurements were made using a semistructured interview. The participants were interviewed in Arabic and the interview schedule was also translated into English. Data analysis was conducted through Thematic Content Analysis (Braun & Clarke, 2006).

23 Results What are the Possible Reasons for Different Re-actions to Chronic Trauma? p e r c e n t a g e 120% 100% 80% 60% 40% 20% 0% Moderating Factors Personality Traits & Idological commitment Psycho-Social Support Entertainment Adaptation/Acclim atization Further Moderating Factors

24 Results Moderating and resiliency factors which seem to play a role in protecting children in Gaza from developing PTSD are: 1- Positive personality traits (e.g., a patriotic sense, ambition and hope, religion and faith, courage and boldness, sociability, determination and a strong will, dilligence). 2- Ideological commitment (e.g., culture of challenge, a strong belief in obligatory resistance to the occupation and the patience to do so). 3- Network of psychosocial support (e.g., family, friend, relatives, neighbours, teachers and community support). 4-Entertainment (e.g., sport and hobbies, sense of freedom gained from healthy activity, or following recreational programs like drama). 5- Adaptation or acclimatization (e.g., not thinking constantly about traumas or difficulties, usually facing up to traumas and difficulties and a collective sharing of grief and anxiety). Activities like painting or talking which give opportunities for emotional debriefing also helped children adapt.

25 Conclusion Although some children in Gaza who have been exposed to traumatic experiences seem to be doing reasonably well at present, there is a significant risk that they will continue to be exposed to further traumatic experiences. If these and other less fortunate children in Gaza do not get adequate help (both preventative and reactive), we might face the prospect of a lost generation of Palestinian children.

26 The Impact of Exposure to Chronic Traumatic Events ( 2006 & 2009)

27 The Current Health and Psycho-Social Well-being of Children.

28 The Current Health and Psycho-Social Well-being of Children.

29 The Current Health and Psycho-Social Well-being of Children.

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32 Gaza during the war (Dec.2008-Jan.2009) Emergency & Rapid Response Program during the war on Gaza The project duration was from 31/12/2008 and ended on 31/07/2009. The project was implemented in northern Gaza and the middle zone. This project includes three domainintegrated parts: A-Emergency and Rapid Response Project for the victims of war (during the war). B-The psychosocial rehabilitations. C- The therapeutic and councelling unit with PTC providing regular, ongoing services to the victims. 60,005 traumatised children and families benefited from the above services. This project was funded ( 50,000) by Muslim Aid (UK).

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40 The psychosocial rehabilitation programme

41 Breaking the sadness circle

42 Art Therapist from PTC(UK) visiting PTC(Gaza) in January 2010

43 Current Projects 1-Bringing Hope to Gaza: Wellness and Focusing Project for children & families A joint initiative of the Palestine Trauma Centre and The Focusing Institute (USA)

44 Focusing Project Summary -Reduce stress levels in children and parents by developing coping strategies and listening skills. The programme is based on the wellness concept of resiliency -Establish a Training Programme for a core group of nonprofessional Palestinian practitioners in Focusing Therapy to work with other children and families in psychosocial awareness. Train family groups and teacher groups in Focusing and Psychosocial Wellness to share with neighbours and extended families.

45 2- Family Therapy Project For the treatment of severely traumatised Palestinian children and their families. by University of Hertfordshire (UK) & Palestine Trauma Centre (PTC) Funded by Muslim Aid & Interpal

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47 Resiliency Resiliency is like a green stick, it does not break when it is bent

48 The Team: psychiatrists, clinical psychologists, psychologists, social workers and animators.

49 Organising the teams to work with families.

50 A psychologist and animator helping a family to deal with disability.

51 Making a psychosocial assessment of the family in the home.

52 Problem-solving work with children in the family. The parents observe.

53 Psychologist and animator start activities with children in extended family.

54 Drama work in the school

55 Organised trips for 40 families from all parts of Gaza

56 Therapy activities are part of the trip.

57 Helping some children to relax and have fun.

58 Overcoming the stigma of Mental Health.

59 The cost of accumulated, on-going trauma.

60 Focusing on the situation in Palestine How can you help!

61 جزیلا شكرا Thank you