The brutal attacks by Hamas in Israel and the devastating bombing campaign that Israel has unleashed in response have killed more than 1400 Israelis and 6500 Palestinians – mostly civilians on both sides – and are causing intense distress and trauma to people living in the region and throughout the world, including people who are part of both the Palestinian and Jewish diasporas.

Last week, we presented an interview with Jack Saul, a New York-based psychologist who has worked in countries around the world developing community-based responses to trauma and disasters. “Collective trauma requires a collective response,” Saul notes. 

Today, we are publishing an interview with Dr. Iman Farajallah, a psychologist who was born and raised in Gaza and now lives in California. She did her undergraduate studies at Birzeit University in Palestine’s West Bank and Durham University in England. She migrated to San Francisco in 1997 as a refugee and later earned a master’s degree and a doctorate in psychology at Sofia University in Palo Alto, California. She has a large extended family in Gaza and visits there frequently. 

In 2016, she conducted interviews with children in Gaza to learn about how their conditions of life and the constant state of war – with frequent missile and drone attacks by the Israeli military into Gaza – has affected their mental health. She is working now to turn her research into a book.

I spoke with Dr. Farajallah last week in the aftermath of the October 7 attack by Hamas into southern Israel and the massive military response by Israel into the Gaza strip. She had recently learned that virtually her entire family had been displaced from their homes and that four members of her family – a mother and three children – had been killed in the bombing campaigns. Several days after this interview, Dr. Farajallah found out that 10 members of her family have now been killed in Gaza.

Rob Waters:  As a Palestinian who has done research on the impact of trauma on children in Gaza and has family there, I’m wondering, first of all, at a human level, how are you coping?

Dr. Iman Farajallah: When we talk about my personal experience, talking about coping is really hard. I was born and raised in Gaza. I came to the United States over 20 years ago. Most of my siblings live in Gaza. My father is alive, and still lives in Gaza. He’s 85 years old. My nephews, my nieces, my sisters, my dear ones live in Gaza. So, coping at the current moment is very difficult. I’m not even thinking about coping. I’m just thinking: Are they alive? Are they okay? Do they have food? Are they getting bombed? You are in continuous stress and anxiety that is endless, trying to find out if your family is OK or not. I cannot imagine how it is for them right now.

Palestinians search a house after an Israeli air strike in the city of Rafah in southern Gaza, on October 12 2023. Credit: Ana Mohammed/Shutterstock

What reports are you getting from them?

Israel has cut, unfortunately, internet, food, electricity, water, everything. I sent my family a message on WhatsApp saying, are you okay? After two or three days, I got a message from one of my siblings saying, ‘We are still alive.’ I was shocked the other day to learn on the news that four members of my family were bombed and killed — my cousin’s wife and three children who are babies. (Editor’s note: As mentioned above, several days after this interview, Dr. Farajallah reported that 10 members of her family have now been killed in Gaza.)

Coping was not even a word that I thought of. I went a whole week without taking a shower. I haven’t been cooking a proper meal for me and my children. The fact that I’m here safe in this country, my anxiety, my stress level, my PTSD is being activated. I feel wrong when I sit and eat because I know my sisters are starving.

Because you you’re not there.

Exactly. I say to myself, ‘How dare I can eat, and they don’t have food?’ It’s a constant battle to try to balance your own wellbeing and cope with what is happening.

Tell me about your family history.

My father and mother were both born and raised in Biʾr al-Sab (the city that Israel calls Be’er Sheva) and Yaffa. In 1948, they were kicked out of Palestine to the Gaza Strip. We were born in Gaza Strip. My mom passed away in 2012. My dad’s sister and her kids – they still live today on our land from before 1948, in Biʾr al-Sab. But we cannot see them; we cannot visit them. His sister died from cancer two years ago, and she was crying out to see him. Her kids still live there, but they are not allowed to build a home, they still live in a tent. When they build a bathroom, they come and demolish it because they are not allowed to build anything on that land. This is this is the way they live. And the way people live in Gaza is that we are getting bombed every day.

As I became a psychologist and researcher, I felt the obligation: Somebody has to voice children’s voices, tell their stories and experiences.”

Palestinians for 75 years have been experiencing wars. My 85-year-old Dad witnessed the 1939 war and the second world war as a child. He witnessed the 1967, the 1973 War, the Intifada, the Second Intifada. He witnessed wars in 2008, 2009, 2014. Poor guy.

Let’s talk about your research on the impact of trauma on children in Gaza.

My interest in working on trauma comes from the fact that I was born in Gaza. I was a teenager when the second intifada broke out. I was injured by the Israelis. I bear this injury for the rest of my life. I was jailed by the Israelis. With the help from a Jewish lawyer, I was released, and then I came here as a refugee. When I was a child, nobody ever wrote or researched or gave the chance to Palestinian children to tell their stories. So as I became a psychologist and researcher, I felt the obligation: Somebody has to voice their voices, tell their stories and experiences. I decided to start researching the trauma, and how the war affected children in war zones. I have also published about trauma and war in Ukraine. I believe war is a vicious animal that has taken a toll on us as human beings. As a result, we dismiss our humanity and our conscience. This is wrong. Our humanity should come first.

I wanted to research how that impacted these children. It was shocking to see how traumatized these children are, the mental health illnesses that they are experiencing.”

I started my research in 2016. I was surprised that there hasn’t been any research on Palestinian children and how the war impacts them. I went to Gaza and interviewed people, talking to children. Some psychologists and psychiatrists helped me. I also interviewed women to see the how the war impacted them and how they are coping because a lot of women lost their husbands and support system and breadwinner. I haven’t written about that yet but I’m hoping I will.

2014 was the most horrifying war, with the most intense impact on children. Most of the people killed were children. I wanted to research how that impacted these children. it was shocking to see how traumatized these children are, the mental health illnesses that they are experiencing. Little did I know that 2023 would be even more intense.

Tell us more about what you learned.

I categorize it into four categories: the behavior signs or symptoms these kids have, the cognitive signs or symptoms, the emotional signs or symptoms and the physical signs that you can witness. With behavioral signs, these kids are crying constantly and it’s difficult for them to stay still and in one place. They have experienced recklessness and difficulties complying with house rules or home rules. Also daydreaming, social withdrawal, fear of darkness, flashbacks, nightmares, avoidant behavior, difficulty sleeping and recollection of trauma.

These kids experience confusion, lack of concentration, inattention, incoherent speech, and deterioration in their ability to achieve in school. Imagine waking up at 6 in the morning to a drone buzzing over your head, not knowing if they’re going to bomb. I cannot describe that feeling.”

I will tell you an example about one boy. In 2014, he was 8 years old and was injured in his stomach and back from the shrapnel of the missiles or bombs that Israel dropped on their home. When he hears the drones buzzing on the top of the house, he gets very scared and frightened. He runs into the room, turn off the light and hides under his blanket. I asked him why, and he said, I don’t want them to see me and bomb me. I want to hide. These kids are in constant fear because these drones are on top of the people of Gaza 24/7, buzzing over their head.

People gather near a destroyed building following an Israeli air strike in Deir el-Balah, central Gaza, on May 12, 2023. Credit/Ana-Mohammed/Shutterstock

I went last summer to Gaza because my dad had a heart attack and I wanted to take care of him. While we were there, they bombed twice. I already had the anxiety from the drones. I jumped out of bed and run to where my dad is, trying to protect him and he’s like, ‘Why are you putting yourself in jeopardy? Do you think if they bomb, you’re going to protect me?’

I noticed that my born-and-raised San Franciso girl, she told me every time we pack our stuff, I get traumatized because I know we are going to Gaza, and we have to deal with the borders, with the Egyptians, with the Israelis. This is how she described it to me. But this is their family, and I want them to know they have a family.

In terms of cognitive signs and symptoms these kids experience confusion, lack of concentration, inattention, incoherent speech, and deterioration in their ability to achieve in school. When I met with some Palestinian women in Gaza, a lot of them complain that my kid goes to school, but he’s not learning much. And when they come back from school, we have to reteach them everything. The reason is the child’s lack of concentration, his ability to learn in school is deteriorating. Imagine you wake up at 6 o’clock in the morning to a drone buzzing over your head, not knowing if they’re going to bomb. Then you’re walking to school to learn. I cannot describe that feeling.

As far as emotional signs, a lot of them experienced anxiety, sadness, fear and worry, stress, depression, they are easily irritated. If two boys fight, they are sometimes aggressive with each other. They wake up a lot of times, screaming and crying in the night. They wet their beds. They are scared of the future. Another example: These two little girls who live in Khan Yunis. One is 14 years old; the other is 4. An Israeli bombing killed her brother and killed her mother. And here’s the 14-year-old sitting in this interview, her 4-year-old on her lap, and she says to me: “I keep thinking over and over again, “When is another war going to erupt and how I’m going to take care of my baby sister.”

She’s taking the role of the mother.

Yes, and totally dismissing her own feelings and her childhood. As far as physical symptoms: Most of these children I have interviewed have experienced bombing, a lot of them were injured in their stomach, in their chest. A lot of them lost their limbs, lost their eyesight. I will never forget the scene of this father and his son, who tried with the mother and his siblings to run away from home to another safe area, because they are about to bomb the house. They bombed them while they are walking. The mother, his brothers and some of his cousins passed away. The father lost one leg, the son lost a leg and one of his hands. As they were walking towards me for the interview, each one is hopping on one leg.

A lot of the children in Gaza are walking with splinters and fragments in their bodies from the bombs. They cannot afford to go for treatment to be removed. Some carry 10 or 20 shrapnel pieces in their body. They experienced muscle pain, fatigue, headache, blurred vision, pain in the chest, hypersensitivity for heart rates. Some have lumps in their throats, vomiting, diarrhea, inability to breathe, they’re easily triggered and have anger. These are some of the symptoms I found.

One data point I recall that 95% of the children had signs of mental distress or mental health symptoms. Is that correct?

Absolutely. And with this war today, I would say 100% of Gaza residents experienced mental health problems. A lot of people refer to the trauma of children in war zones, particularly in Gaza, and they talk about PTSD. I want all mental health professionals to be careful labeling it as PTSD, because it’s not. It is what I call complex continuous traumatic stress. The diverse and long-lasting effects of extended and recurring trauma are distinctly different from the consequences of a single traumatic incident. Palestinian children are continuously experiencing prolonged and repetitive trauma over and over again, 24/7. They are confined, stuck, and under the blockade with nowhere to go getting subjected to Israel’s unjust polices, bombing and drones.

It’s very important to understand. The first step in healing from a trauma is to remove the person from the trauma. These kids live in a concentration camp with nowhere to go. Israel has the key for one door for that concentration camp. Egyptians have the key for the other, and neither one is allowing them to leave. They have nowhere to go. We cannot talk about PTSD because the drones are bombing them all year long. We cannot talk about PTSD because even when Israel was allowing food to Gaza, they were not allowing healthy, proper food. Middle eastern food is the healthiest – hummus, falafel, tomatoes, eggs. Now (prior to the current moment) what they allow in is Pepsi, chips and noodles — the most unhealthy food.

Are you working with Palestinians here in the US, and what would you say are their needs right now?  How are they responding to what’s happening in in Gaza, as well as violence here, like the stabbing of the 6-year old Palestinian boy outside Chicago?

I work in the Bay Area with underserved communities. Currently, I work with the Hyde Street clinic serving the homeless and low-income population. I work with the Arab population because I’m the only psychologist who speaks Arabic in the Bay Area. A lot of them come from war zones, like Yemen. San Francisco, especially the Tenderloin. has the highest population of Yemeni people. A lot of them are running from the civil war there. I work with them, I work with Syrians, I work with all kinds of refugees who speak Arabic, in addition to minorities and Americans who we consider underprivileged and underserved. On a personal level, I do work with some Palestinians.

Among Palestinians and the Middle Eastern population, everybody is outraged about what happened to that child. A lot of them are now scared for their kids to go to school. I have a group for Middle Eastern women – I help them with their depression, I provide free services. I started it with the pandemic, because we noticed the high rise of anxiety and depression among parents and children. Now their anxiety and stress and fear are rising again. A lot of them they are debating whether they should send their kids to school, and, if they were attacked, how they should defend themselves.

Is this group with Middle Eastern women in person or by zoom?

We do it in zoom and in person. Since the pandemic, I do it in Zoom, every week. I do some meditation, we talk about issues, sometimes we open the mic for everybody to express their feelings and how we can work through that. Sometimes we meet in a park, where we can sit in a circle and do meditation.

I got a small grant from the city of San Francisco to open an office for the Iman network in San Francisco in the Tenderloin area, to support Middle Eastern youth who are struggling, you know, academically, emotionally, mentally, and we are on the verge of opening the office. We were supposed to open it this week.

As far as emotional signs, a lot of [children] experienced anxiety, sadness, fear and worry, stress, depression, they are easily irritated. They wake up a lot of times, screaming and crying in the night. They wet their beds. They are scared of the future.

San Francisco is dear to me. When I came from Palestine it’s the place where I lived. Later we moved out of the city and are now in a place where my children can learn Arabic as a second language in school. I have a passion for San Francisco, but after the pandemic, the city is not the city we knew. I can see the homeless population rising, our teenagers are falling to drugs and gangs, and I feel the obligation to do something about that.

A mother and her young child in a Gaza hospital in Palestine, October 20th 2023. Credit: A-1 Rowan/Shuterstock

To me, understanding what is happening now requires an understanding about the collective trauma that both Palestinians and Israelis have experienced historically, and that form each of their identities and their psychology. How do you see this?

First, I am a mental health professional, who tries to see human beings as human beings despite their culture, religion, or background. I’m a firm believer of what has been stated in the Quran — that if you save a human being’s life, it’s as if you save the whole of humanity. That’s my approach to life. I cannot speak on behalf of the Israeli children’s experience. I would have loved when I did my research to be able and interview Israeli children. But I can’t; I have a Gaza ID.

My dad and my mom always talked about their neighbors who were Jewish, before the 1948 War, and how they ate together, celebrated together, how they used to enjoy life together. At that time, I was saying to myself, ‘Whatever, maybe you’re not telling us the truth.’ But then I had the privilege to experience it myself. I was in Palestine, I went to Bir Zeit University and met with a lot of Palestinian Jewish people like Women in Black, who would demonstrate every day against the Israeli government. I demonstrated one time to support my friend’s son who was jailed because he refused to serve in the Army. The person who helped me sneak out of Palestine and come here was a Persian Jewish friend.

A good mental health professional can have an impact if they gave us a voice to speak. But unfortunately, right now, nobody’s giving us that choice. Nobody is giving us the mic. Politicians are holding on the mic while killing thousands of people.

I’m not going to dive too much into politics. But how is this war going to take a toll on Palestinians and Israelis? War is war, and it’s going to affect everybody. It’s affecting us here in the U.S. We are affected by the images we see and the death toll. It’s a very sad reality, but that is the situation. And this is why I quote this psychologist who works in Palestine, his words stick with me all the time. He said:

‘Children are smart, we can try to remedy their mental health, and teach them some resilience and teach them some coping skills. But when he sits with you in the session, and asks: ‘Are you able to prevent another war coming? Are you able to protect my parents? Are you able to protect me?’, my answer to them is no. It’s in the hands of the politicians.” As psychologists, we can do as much as we can to help alleviate the pain and suffering of people and try to help them make sense of their experiences. But in the end, we cannot control the political environment.

Can mental health practitioners and advocates play a role in informing the public and changing policy and having an impact on creating greater empathy for others?

Absolutely. But are we allowed to do so? I didn’t know. Sometimes our theories and our thinking is used by governments to abuse others. A good mental health professional can have an impact if they gave us a voice to speak. But unfortunately, right now, nobody’s giving us that choice. Nobody is giving us the mic. Politicians are holding on the mic while killing thousands of people.

From your perspective, what is the way forward now? Is there any way to move out of this gridlock, born of so much trauma?

I have three steps that really can solve this problem. First, stop the war. Second, give shelter, food and safety to people. Then we can talk about mental health. Any human being who thinks that by abusing another human being, they’re going to get what they want, I want to tell them, You’re wrong. Because the more you abuse that individual, the more they’re going to be angry, the more they want revenge, the more they’re going to have a bad backlash.

Think about this: If Gaza was not a concentration camp, if people were able to work, able to conduct a normal life, able to travel when they want, to develop the skills the way they want, to have jobs after university. If they were able to see their kids grow up in front of their eyes – these are all things that any human being wants in life. What would push them to what is happening right now?

We need to stop pouring money into bombs and wars and arms. And, above all, that we need to learn humanity, that there isn’t someone better than the other. We all are human beings; we all deserve to live as humans. Palestinians are not animals. They are human beings who can love, smile, marry, have kids and live like any other people. I am one of these Palestinians who was born and grew up in Gaza. And here I am carrying this passion of serving underserved people, because of my experience in Gaza. It’s because that’s what I learned in Gaza. I learned to put my love before my hate. And I think it’s time for the Israeli government to recognize that we are human beings who strive to live as any other human beings want to.

Is there anything else you would like to add?

The only thing I want to add, is to say to our [U.S.] government to stop supplying war and pouring money to fuel wars that are not necessary. Let’s invest that money in our community here, in our homeless population, in shelter, in mental health, in helping underserved populations. We need that money. We need it for here, not to drop bombs on people.

Type of work:

Opinion Advocates for ideas and draws conclusions based on the author/producer’s interpretation of facts and data.

Rob Waters, the founding editor of MindSite News, is an award-winning health and mental health journalist. He was a contributing writer to Health Affairs and has worked as a staff reporter or editor at...