Despite significant improvements over the past two decades in life expectancy, child mortality rates and health status, there has been a marked increase in mental health disorders in the MENA region.
Conflict, violence and political instability lead to high levels of psychological distress, with a clearly established link between trauma and deteriorating mental health.
Nearly every country in the region has a higher rate of mental disorders compared with the global average, according to a new study entitled The Burden of Mental Disorders in the Eastern Mediterranean Region 1990-2013.
In Palestine, chronic exposure to trauma and violence over a 50-year period has led to a crisis in mental health.
Palestine leads the MENA region in depression and anxiety disorders, with some estimates suggesting that more than forty percent of Palestinians suffer clinical depression, making it the highest rate in the world.
The prevalence of young people, genetic homogeneity and the environmental stressors of conflict over multiple generations are all contributing factors.
According to the study, 54 percent of Palestinian boys and 46.5 percent of Palestinian girls aged 6-12 years old are estimated to have emotional and behavioural disorders.
In Gaza, the crisis is particularly acute, with the besieged enclave witnessing three Israeli military offensives within six years. Poverty, mass unemployment, and physical entrapment severely exacerbate the crisis.
A study of adolescents in the besieged territory after the 2008-9 Israeli offensive found that 30 percent reported symptoms meeting the criteria for Post Traumatic Stress Disorder, according to a report by Medical Aid for Palestinians (MAP) investigating the health impact of 50 years of military occupation.
Among areas heavily bombarded during the 2014 war on Gaza, 54 percent of children were recorded as suffering from severe PTSD, whose symptoms include flashbacks, nightmares, avoidance behaviour, difficulty sleeping, and intrusive distressing recollections of traumatic experiences.
Following the 52-day war, which killed more than 2,200 Palestinians, the World Health Organization (WHO) estimated that more than 20 percent of the Gazan population may have developed mental health conditions which required psychosocial care.
The culmination of a decade of an Israeli-Egyptian blockade and routine violence means there is often no possibility to recover from severe psychological disorders, MAP says.
In the first five years of the Israeli blockade, the Gaza Community Mental Health Programme reported an 18 percent rise in depression. Drug addiction and suicides, once unheard of in Gaza, have increased as a result, with coping mechanisms for Gazans all but exhausted.
While exposure to direct violence is a major driver of mental health conditions, restrictions on movement, home demolitions, checkpoints, and abuse by Israeli soldiers in the West Bank all contribute to pervasive experiences of humiliation, which exacerbate psychological stress.
Around 78 percent of Palestinians report having experienced military raids on their homes, 62 percent have been verbally abused, and 43 percent physically abused between 1987 and 2011, the MAP report says.
Most adolescents have witnessed a stranger humiliated by Israeli forces in the preceding year, while 29 percent have witnessed a family member humiliated, a 2007 Journal of the Royal Institute of Public health report says.
The arrest of children by Israeli military forces is another common driver of mental health disorders in young people, leading to high rates of anxiety, depression, and attentional and educational difficulties. It can also lead to higher rates of suicide and self harm.
Defence for Children International - Palestine (DCIP) found that 75 percent of children detained between 2012 and 2015 endured some form of violence during their arrest by Israeli soldiers. Over 70 said they experienced verbal abuse, intimidation and humiliation, while 70 percent also underwent strip searches.
"Palestinians' right to health cannot be realised under perpetual occupation, which poses constant threats not only to physical safety, but also psychological and emotional wellbeing," MAP says.
"As the occupying power with effective control over Gaza and the West Bank, including East Jerusalem, Israel has an international legal obligation to respect, protect and progressively realise the right to health for Palestinians residing there."
By Charlie Hoyle
Copyright @ 2019 The New Arab.