Children in Crisis

Intifada-related symptoms in children
of the Nablus area Refugee Camps

After thirty months of Intifada, many children in West Bank refugee camps are showing symptoms of stress and depression. This report details the observations of more than two dozen teachers, doctors, social workers, psychologists, parents and children, interviewed in five West Bank refugee camps.

According to UNRWA staff members and parents, symptoms of stress and depression can be observed in the children’s general health, psychological state, academic performance and interpersonal relations.

For many children late bedwetting is the main symptom of their stress. A doctor in Balata Health Centre explained that although this condition had already existed, it has grown phenomenally in the last two years. He said that children as old as nine or 10 wet their beds; this in itself becomes an additional source of stress for children, due to parental and social pressures who may fail to see the reasons behind the child’s regressive bedwetting.

Doctors and health workers from Balata and Askar camps also said that visits to the clinic for psychosomatic disorders in children are becoming alarmingly regular, and have increased in the past year. Children come to clinics complaining of acute pain, usually in the stomach or chest, with no medical reason for it. This phenomenon, common to Post Traumatic Stress Disorders, also causes stress to parents, who think that their children are sick. A doctor from Askar Camp Health Clinic said that it is difficult to convince parents that their children are not suffering from a specific illness, even after a thorough medical checkup.

Both doctors and teachers said that children are suffering from sleeping disorders, in particular sleep deprivation. A teacher in Balata Basic Girls’ School said that sleep deprivation had a direct impact on the children’s behaviour, academic performance and interpersonal relationships. Many parents told UNRWA that children don’t get enough sleep because they watch the news until late or are woken up by night-time IDF incursions. Also, some children cannot sleep because of anxiety, which increasingly shows itself as hyperactivity. Many parents say that children are only getting six to seven hours of sleep because of the change in sleeping patterns. Teachers say that children become moody and forgetful in class because of sleep deprivation.

In addition to these new health indicators amiong chidlren, behavioural changes have been noticed. A Doctor from Askar Camp said that some children now start smoking at age 10 because they associate smoking with “releasing tension”. Although children might not experience any significant relief from tension, they will tend to continue smoking and even increase their daily nicotine intake because they are convinced that smoking will lessen their stress. A social worker told UNRWA that delinquency in schools has increased as a result of early smoking: children steal a couple of shekels from each other in order to buy individual cigarettes, now available in most camps and towns in the West Bank (a single cigarette costs one shekel).

Children are also nervous, restless, and anxious. Teachers from Balata, Askar, Tulkarm, Camp Number One and Kalandia schools said that lack of attention and focus is having a negative impact on the children’s academic performance. In Palestinian society, where high importance is placed on educational excellence, this is causing additional stress to the children and their families.

One teacher said that the children’s apathy and loss of initiative is due to the fear of any ‘change’ that might further alter their lives. She said that children’s phobia of change reflects their fear of the future, which they see as uncertain and unstable. As a camp service officer put it, “our children are in an intellectual coma but are physically overactive”.

One social worker from Balata’s School for Girls has even suggested: “Children do not know how to dream anymore. It is as if their imagination stopped at the boundaries of the camp”. When UNRWA asked some girls about what their wish would be if they found Aladdin’s magic lamp, most said “going to Nablus for the day”, or “not having to wash the dishes tonight”. The social worker said this reflected the reduction of the children’s horizons. A telling picture of this “confinement” was observed in Askar Camp on the second day of the Muslim religious festivity of the Eid. Children were taking a ride on a small carriage for half a shekel. We asked the children where they would go with their carriage. Children seemed not to understand the question, and said that there was ‘only’ the camp they could tour, as if nothing could exist outside the camp.

Increasingly it seems that children have lost the social references they grew up with. One health worker in Balata Camp said, “the traditional environments where children would feel secure have become a source of instability themselves: even schools, often considered safe havens for children, are increasingly perceived as dangerous”. This could be explained by the uncertainty that surrounds children’s lives: they often do not know whether schools will open, having to wait until morning to see what the “situation” is. They also do not know whether their teachers will be there. The “emergency” system adopted by many schools, where any available teacher will hold classes, has reduced school hours lost, but has increased the children’s feelings of uncertainty and disruption. Ironically, the only time when children feel secure is when a curfew is imposed, for only then they know what they can or cannot do, and the likelihood for surprises is low.

According to one doctor in Askar Camp, “the most serious symptoms of Post Traumatic Stress Disorders are the signs of mild to moderate paranoia exhibited by some children”. Some children show signs of suspicion, particularly towards strangers. Children see strangers as “undercover agents”. A social worker in Askar camp said that this symptom, is not limited to strangers, as she had seen children accuse some members of their own families of being Israeli “special forces”. On one occasion, children wrote “Israeli undercover agents” an UNRWA jeep. On another occasion, children gathered around UNRWA staff and shouted “collaborators”. As the word quickly spread around, tension mounted and children became openly hostile to the UNRWA team.

There is also evidence that children now use an increasingly violent vocabulary, permeated by expressions of bloodshed and killing. A social worker in Nur Shams Camp said that children are adopting a “culture of death” where martyrdom is idealized. “Death becomes their reality and fantasy at the same time… Children write their own ‘martyrdom’ leaflets, and distribute them to their friends at school… they also build small cemeteries, with tombs bearing their names and their ‘date of martyrdom’”.

Social workers and psychologists said that children exhibit aggressive and anti-social behavior. Many teachers said that they have observed a higher incidence of aggressive behavior, such as fist fighting, and bullying in children, even among girls, who traditionally do not use physical violence as an outlet for anxiety and stress.

These changes in health and behaviour are of seriously schoolwork. Teachers and head teachers said academic performance has declined due to school days lost and the psychological effects of the Intifada and the occupation.

Incidents of school delinquency such as stealing have increased. Educational staff attribute this to the deteriorating socio-economic conditions in the children’s families.

Teachers themselves are under stress, depressed and tired. They said they are often impatient with children. Teachers are transmitting their own personal feelings of rejection and disenchantment to children - who detect the teachers’ distress and occasional disinterest. While UNRWA’s hard-working teachers are committed to teaching and their efforts have enabled UNRWA schools to minimize the impact of the Intifada on children, they cannot help but be frustrated and stressed by overcrowded classes and their communities’ economic hardships.

Teachers and parents said that frustration, economic deprivation, and unemployment are affecting family life in general and children in particular. The young suffer from the same hopelessness and frustration experienced by their parents. One camp service officer told UNRWA that “children are profoundly distressed by the feeling that they have no outlets, and that their future perspectives are much more limited”.

Many parents said that they do not have the patience to spend quality time with their children and talk to them. Although unemployment is high, and many fathers stay at home during the day, they are not inclined to establish dialogue with their children. A doctor who mentioned this phenomenon and started by saying “parents do not have patience”, “parents do not communicate with their children”, concluded by saying “I do not talk to my son anymore”. He showed obvious signs of distress and grief as he spoke.

A camp resident stated that “family values are becoming fragmented and individualistic”. Every member of the family is now expected to fend for himself. The concept of fathers as the breadwinners has been shattered. Children show increased rebellious behavior against their parents as a result of the loss of respect for an unemployed father, and the feeling of being left to themselves. A psychologist attributed the loss of respect for authority to the “Mohammed El Durra syndrome” (the widely circulated news picture of the young boy killed by Israeli gunfire in October 2000 while trying to hide next to his father), and said that this has had a lasting impact on Palestinian children.

The Occupation and the Intifada are affecting the entire Palestinian social and political culture. There is less time for communication and dialogue, and children are growing up in an individualistic and fragmented society.

All the persons interviewed said that socioeconomic hardship is the most harmful factor affecting children’s psychological well-being. A doctor said that the increasing hardship is as destructive as physical or military violence. Almost all teachers used examples of children who do not have enough money to buy school materials, or children coming to class with no coat in winter. Poverty has a direct impact on the children’s emotional stability and further fosters stress and depression.

Closures and curfews are leading to acute feelings of claustrophobia and apathy.

Children are paying the price of the first Intifada as well. A doctor said that children are taught by the “products” of the first Intifada, who suffered the devastating effects of that period and have not overcome it.

Unlike the first Intifada, the IDF is showing less “restraint”. It is as if there were no more “rules of the game”, which is increasing the children’s feeling that “anything can happen”.

According to a doctor in Balata Health Centre, the problem is not only about the children’s symptoms, but also about the lack of psychological follow-up. The lack of the necessary “infrastructure” to deal with these types of symptoms, and the taboos still associated with mental illness will hamper the treatment of these symptoms, he said.

Doctors said that these problems, if left unattended, could degenerate into mental illnesses. The more time children’s symptoms are left untreated, the more difficult they will be to treat. All teachers and head teachers interviewed said that more psychologists and social workers are needed to deal with the children’s problems. Long term rehabilitation programs will be needed. As a doctor said, “the current crisis is about the minds we are creating. We are running towards our own destruction if these alarming signs are left untreated”.

A nurse said that the real effects of the traumas will not fully appear until the current political situation is over, and that the first Intifada abounds with examples of late post-traumatic stress disorders among children.

As a doctor put it: “the coming generation will want to destroy everything, because it will have lost everything, unless we do something to change it”.