BETHLEHEM (Ma'an) -- Israel's ongoing military assault in the Gaza Strip is exacerbating a mental health crisis in the besieged enclave as Gazans struggle to sustain coping mechanisms under the constant fear of death.
Aside from the huge physical death toll -- over 160 have been killed and at least 1,000 injured since the assault began -- 1.8 million Gazans live in a state of permanent anxiety as families are unable to find refuge from airstrikes, drones, and naval bombings in the densely populated enclave.
Rana Nashashibi, a psychologist with the Palestinian Counseling Center, told Ma'an that not knowing when, or how, you could die amid widespread carnage has a deliberate dis-empowering effect on Gazans, part of the psychological warfare used by Israel to weaken the population.
"It is always parallel to the conventional warfare of military power, using psychological warfare on people. The main aim is to make people feel helpless and debilitated, a way of saying: 'We are powerful and we are doing this to you.'"
The Israeli blockade on Gaza, imposed in 2007, has depleted the resources and energy of Gazans in facing the severe challenges of military attacks, she says.
"Just surviving and being able to cope with every day challenges is fatiguing people."
Adults and children in the Gaza Strip suffer from high levels of psychological trauma which inevitably increase during periods of intense violent conflict, medical professionals say.
Following Israel's war on Gaza in Nov. 2012, the incidence of psychological trauma and post-traumatic stress disorder rose by 100 percent, according to UNRWA.
UNICEF released findings following the conflict which showed a 91 percent increase in sleep disturbances among children, with 85 percent of adults reporting a loss of appetite.
There was also a notable increase in the incidence of miscarriage among pregnant women, UNRWA said.
Sleep disorders, bed-wetting, anxiety, and psychosomatic symptoms such as heart problems, high blood pressure, and even cancer, are a result of living in continuous fear, Nashashibi says.
The ability of people to function in the workplace is also impeded and severe anxiety causes children to have gaps in concentration which obstructs their emotional and intellectual capacities.
"When you fire missiles at someone while they are sleeping it is a way of saying 'you cannot run.' Even if you want to run, where can you go? Gaza is a big prison."
"Israel aims to make people feel helpless, they are hoping that people don't move to a higher level of functioning. In order to feel you can fulfill your dreams you need to feel safe and sheltered, if you don't feel that it makes people feel that they have no future."
'Gazans show what it means to be human'
Palestinian families seek shelter after evacuating their homes near the border in Gaza City on July 13, 2014.(AFP/Mahmud Hams)
Around 10 percent of Gazans will have clinical symptoms and children usually suffer bed-wetting and severe anxiety for three to six months following Israeli attacks, Norwegian doctor Mads Gilbert told Ma'an from Gaza, with most children witnesses to death and trauma in their young lives.
"There's a very simple way of stopping children from being traumatized; just stop the bombing. There's a very simple way to ease mental health; end the blockade," Gilbert says.
Despite the huge psychological burden of living in a war zone, Dr. Gilbert says the family structure of Palestinian society, a sense of community, and religion, are tools used by Gazans to develop a remarkable sense of resilience in the face of constant hardship.
"I have been here in 2006, 2008, and 2012 and every time I have the same experience. The most impressive sense you get is this coping capacity, that they are not cracking under pressure, they are bowed but not reshaped, they re-find their human shape."
Despite the medical necessities of attending to the physically and psychologically wounded in Gaza, Gilbert is adamant that only a political solution based on equity and an end to Israel's discriminatory system can bring relief to the besieged population.
"The abnormal becomes normal in Gaza after seven years of a siege in which no-one should be forced to live in. The world has to understand that the people of Gaza are like any other, they want to live in peace and have dignity and equity."
The huge military disparities give Israel an automatic advantage in terms of force, but Gilbert says Israel is confronted with a people who will not yield.
"Bomb them as much as you like, people will never surrender. Gazans show what it means to be human in extremely dire conditions. They don't behave like the animals they are treated as by Israel."
Nashashibi agrees that the level of resilience shown by Gazans in the face of such atrocities is remarkable.
The motivation among her colleagues in Gaza is higher than those in the West Bank and East Jerusalem, she says, a testament to how much Gazans "love life and want to do well for themselves."
"We as Palestinians, and not only Gazans, have no option but to resist, because for our mental well-being our only option is to resist. Our motivation, our will to resist, is what is keeping us going, and I think this is very important."'Value of life'
Despite the vast human toll in Gaza, Israel's media and military spokespersons have largely chosen to ignore the impact of its large-scale military action on civilians, referring to them in terms of accessories to Hamas' military tactics, or simply victims of being in the wrong place at the wrong time.
Online images of Israeli civilians in Sderot eating popcorn while cheering bombs landing in Gaza add to the sense that Gazan lives are simply worth less than Israelis.
"For one moment let's sit in the mirror and ask ourselves what would have happen if, God forbid, 18 members of an Israeli family had been killed in a Palestinian attack. Or what would happen if 100 Israelis died," Gilbert asks.
"In that simple question lies the problem Palestinians are so well aware; the value of their lives."
Nashashibi agrees that the level of violence used by Israel, and its support among some sectors of the population, is a trend that their society should be worried about.
"As a psychologist I want to say that Israel has to be very afraid about how these acts affect their community, because they are full of hatred. Those soldiers full of hate will not only hate Palestinians but will cause harm in their own lives.
"If the Israeli community doesn't do anything to help them, they will suffer from all this hatred building up in their society."