The Humanitarian Emergency in the Gaza Strip: Urgent Actions for Advocacy in Mental Healthcare Management

The Israel–Gaza conflict traces back to the 1948 Arab-Israeli War, which left Gaza under Egyptian control and home to many Palestinian refugees. In 1967, Israel captured Gaza during the Six-Day War, initiating decades of occupation. The Oslo Accords of the 1990s granted limited Palestinian self-governance, but tensions escalated after Hamas took control of Gaza in 2007, leading to Israeli blockades and recurring cycles of violence. Recent attacks stem from longstanding grievances, including Gaza’s blockade, disputes over Jerusalem, and Israeli settlements in the West Bank, coupled with Hamas’ militant actions and Israel’s retaliatory strikes. These events highlight unresolved territorial, political, and humanitarian issues fueling the conflict.

The death toll resulting from Israeli attacks on the Gaza Strip since October 7, 2023, has been steadily rising. Continuous airstrikes and bombardments from air, land, and sea have resulted in over 43,665 Palestinian civilian deaths, with more than 1,037,650 wounded and disabled. ¹ Thousands of victims remain trapped beneath the rubble and scattered across the streets, as the Israeli Occupation Forces (IOF) have been obstructing ambulance and civil defense teams from reaching them.^2–5 Additionally, over 1.5 million Palestinians are being displaced, either migrating within the country or seeking refuge in neighboring nations.^2–3 The general population in Gaza is remarkably young, with nearly half of its residents being under the age of 18. Consequently, when civilians are inadvertently harmed during military operations or are deliberately and cynically employed as human shields, a substantial proportion of the casualties are anticipated to be children. The Gaza Strip is one of the most densely populated regions in the world, home to over 2.2 million people who have been living under a blockade since 2007.^2–3

Essential supplies, including food, water, medicine, and electricity, are critically depleted. The collapse of water and sanitation services, coupled with the shutdown of Gaza’s last seawater desalination plant, has exacerbated concerns over dehydration and the spread of waterborne diseases. ¹ Israeli airstrikes have inflicted severe damage on universities, schools, and 205 additional educational facilities, leading to the displacement of over 1.5 million people to neighboring countries. Around 70% of those affected are children, women, and elderly individuals, and 50% of families are now confronting food shortages.^2–5

The prolonged blockade of Gaza has led to a severe food shortage and nutritional crisis among Palestinian refugees, disproportionately affecting vulnerable groups such as infants, children, women, and the elderly.^1,4 This situation in Gaza underscores the urgent need for humanitarian support and healthcare.

Since October 7, 2024, extensive damage has been inflicted on healthcare facilities. ¹ Israeli airstrike have destroyed 35 hospitals, including the recently hit Al-Ahli hospital, 69 medical centers, 32 primary care health centers, 24 ambulances, and 11 water sanitation facilities. ¹

Unfortunately, 46 healthcare professionals have lost their lives in the ongoing military conflict.^3–7 Health registries in Gaza indicate that over 350,000 patients are affected by co-morbidities and chronic conditions, including coronary heart disease, stroke, hypertension, cancer, diabetes, and chronic renal failure. Furthermore, nearly 50,000 pregnant women are being denied essential healthcare services.^2,3–7 The absence of clean drinking water and the spread of pollution through waterways, resulting from infrastructural failures, have led to an increase in infections such as cholera, plague, malaria, typhus, amoebiasis, trachoma, acute fever, and scabies.^2,3–7 The damage to transportation infrastructure currently impedes the availability of medical supplies and restricts access to healthcare services for those in need.^4–5 Israel has also implemented restrictive measures in Gaza, which complicate Palestinians’ ability to obtain permits for work and travel within Palestine.

Israeli attacks in Gaza have resulted in a significant rise in severe mental health disorders, including an elevated risk of long-term post-traumatic stress disorder (PTSD).^2–3,8–12 Vulnerable populations, such as children, the elderly, and pregnant women, are particularly susceptible to both health and mental health repercussions. A recent study has highlighted a marked increase in children’s mental illness, exacerbating fear, anxiety, disordered eating, bedwetting, sleep disturbances, and notable behavioral changes.^11–13 Children’s cognitive and emotional development in captivity is impaired, rendering them particularly vulnerable. ¹¹ Repeated and prolonged attacks have perpetuated widespread psychological trauma, early life stress among children, and significant depression and anxiety among the general population, with many individuals enduring profound grief. Alarmingly, more than 75% of Gaza residents are afflicted by depression.^3,9–10 Furthermore, it is imperative to acknowledge that specific mental disorders, such as PTSD, are linked with an elevated risk of developing clinical illnesses, including cardiovascular diseases. ¹⁴ This association significantly exacerbates the overall health burden shouldered by survivors of the conflict. ¹¹

Regarding mental health, the region suffers from a severe shortage of psychiatrists, psychotherapists, and counselors, insufficient to address the growing demand for mental health care prompted by the ongoing conflict in Gaza.^11–13 In this challenging context, it is imperative to explore effective strategies for supporting the affected population. An immediate ceasefire in the Gaza Strip is crucial, along with the provision of essential resources such as food, clean water, and other necessities to meet basic human needs.^15–19

One notable initiative is the Tarkiz program, a mental healthcare approach that has been culturally adopted in Turkey for over 15 years. Originally grounded in Eugene Gendlin’s metacognitive method known as “Focusing,” this program places a strong emphasis on community engagement and the development of collaborative partnerships. ²⁰ The program aims to reduce stigma, improve accessibility to mental health services, and foster integration into society for individuals with mental disorders. Key objectives are decentralization of mental health services, development of a patient-centered care model, stigma reduction, and integration with general health services. Reasons for implementations were to promote the over-reliance on institutional care, rising mental health challenges regarding the burden of mental illness on families and society, and alignment of national mental healthcare with global policies for deinstitutionalization and community-based care. ²⁰

Rockowitz et al. ²⁰ explored the efficacy of the Tarkiz program, highlighting its success in promoting cultural resilience and addressing the multifaceted nature of PTSD within the Gaza Strip. The research emphasized the significance of capacity-building opportunities for local practitioners and advocated for a collaborative approach to global public health. This model illustrates how culturally tailored interventions can be effectively executed in conflict-affected areas, offering a valuable framework for analogous initiatives around the world.

Other holistic programs provide essential care, including the United Nations Relief and Works Agency (UNRWA, providing health, education, and relief services), The World Health Organization (WHO) Gaza Health, the International Committee of the Red Cross (ICRC offers trauma care and psychosocial support), and the Gaza Community Mental Health Programme (GCMHP), focusing on mental health services. Other organizations like Save the Children and Médecins Sans Frontières (MSF) are also promoting aid initiatives.^18,21–26

A Call to Action

Despite the potential for providing meaningful assistance, the acknowledgment of the true realities of Gaza’s population remains a significant obstacle. On Tuesday, July 9, 2024, Secretary General Jens Stoltenberg commemorated the 75th anniversary of the North Atlantic Treaty Organization (NATO) in Washington, D.C., alongside U.S. President Joe Biden and other Allied leaders. During the event, Biden and Stoltenberg underscored that “The moment to defend freedom and democracy is now; the location is Ukraine,” rather than Gaza. ²⁰

It is imperative that humanitarian aid, including food, medications, and vaccines, be permitted to enter Gaza in adequate quantities under the oversight of the World Health Organization (WHO) and the United Nations (UN). International aid organizations, such as the Palestine/Gaza iHH Humanitarian Relief Foundation from Turkey, must ensure that this assistance is specifically directed toward the children in Gaza.^5–8,20 United States, United Nations, Arab States, and European Union partners should significantly enhance and improve the coordination of aid and rehabilitation efforts. An urgent ceasefire in the Gaza Strip is critically necessary, accompanied by the provision of food, clean water, medications, medical equipment, and other essential resources for basic human needs. Concurrently, it is vital to document the extent and nature of the suffering caused by this conflict and to fully acknowledge the comprehensive cost of the war.

The interim measures established by the International Court of Justice in January 2024 mandate that Israel “take effective measures to prevent the destruction and ensure the preservation of evidence related to allegations of acts within the scope of the Genocide Convention.”^13–15 Specifically in terms of mental healthcare management, we propose that actions should focus on: (a) monitoring and addressing the rising prevalence of psychological disorders (e.g., acute and PTSDs); (b) prioritizing the mental health of children and youth, who are particularly vulnerable to the impacts of war, displacement, and loss of family members; (c) improving access to mental health first aid services; (d) implementing large-scale interventions to address stress and trauma; (e) monitoring suicide risk and delivering targeted preventive interventions; (f) promoting psychosocial interventions within schools; (g) increasing international funding for mental health initiatives; (h) strengthening the support provided by nongovernmental organizations in mental healthcare; (i) implementing targeted interventions for the elderly and women, particularly in response to gender-based violence; and (l) implementing the number of psychiatrists, clinical psychologists, psychiatrist nurses, and other mental health professionals in Gaza. Thus, the involved countries might adopt conflict resolution strategies and promote community-level reconciliation programs. This would be supported by trauma-informed mental health services, where trained professionals address the psychological effects of violence and displacement through culturally sensitive therapy and family-centered approaches. Additionally, bilateral collaborative initiatives, facilitated by international mediation and supported by organizations like the WHO and UN, could play a key role in fostering peace and providing resources for mental healthcare. Furthermore, international efforts are urgently needed to address the critical shortage of hospitals and care facilities that have been destroyed or blocked due to the ongoing conflict.