Commentary: Gaza remains a crisis of children's mental health

As a psychologist in the occupied West Bank, I have spent my career sitting across from children carrying burdens no child should ever know — lives shaped not by playgrounds or classrooms, but by constant fear.

I recognize that fear because I lived it myself. I remember when I was less than 5 years old, Israeli soldiers stormed our home in the middle of the night and took my father from his bed. The pounding on the door, the shouting, the terror — those memories are still vivid.

Children who wake from nightmares convinced Israeli soldiers are coming for their families.

Children who flinch at the slam of a door.

Children who can recognize the sound of drones and fighter jets before they can multiply or divide.

I have helped them process arrests, home demolitions, settler violence, humiliation at checkpoints and the grinding, quiet stress of growing up without ever feeling safe.

I joined the Palestine Red Crescent Society in 2021 because I knew it was one of the few relief organizations willing to go where the need was greatest — into red zones, near the separation wall, close to illegal settlements and even in active conflict areas. Mental health services are scarce and often inaccessible for Palestinians. If children were hurting in the hardest-to-reach places, I wanted to be there with them.

I thought I understood trauma.

I thought I knew how to guide children through fear.

I thought I had the tools.

Then, on Jan. 29, 2024, the phone rang. It was a call from Gaza.

Five-year-old Hind Rajab was trapped in a small car, surrounded by the bodies of her six relatives, who had just been killed. Israeli tanks were closing in. Gunfire crackled in the background. She was whispering into the phone so no one nearby would hear her.

“I’m scared. They’re shooting at us. … Please come get me,” she repeated again and again.

For hours, we tried to reach her. Our ambulance was minutes away, but it needed clearance from Israeli authorities to enter the area. We waited for permission that came hours later, only to be ignored.

Inside our operations room in Ramallah, time slowed to something unbearable. With every passing minute, the frustration and helplessness grew heavier.

All I could do was talk to her.

How do I keep a child hopeful when she’s trapped alone among her dead family members?

How do I make her feel safe when tanks surround her?

How do I keep her conscious and focused on anything but the immediate trauma?

I kept reminding her to breathe. To keep talking. To stay awake.

Above all, one thought kept repeating in my mind: She is 5. Just 5 years old. Barely old enough to tie her shoes. Barely old enough to read on her own. And yet she was alone, asking strangers to come save her.

Near the end, her voice grew faint. She told me she was bleeding. “From where,” I asked. “My mouth, my tummy, my legs — everywhere,” she whispered. I tried to stay calm and told her to use her blouse to wipe off the blood. Then she said something I will never forget: “I don’t want to. My mother will get tired from washing my clothes.”

Even then — alone, terrified, wounded and hungry — she was thinking about her mother who would have extra laundry to wash. Those were the last words I heard.

We lost Hind that day. We also lost two of my brave colleagues, Yousef Zeino and Ahmad Almadhoun, when their ambulance was struck after they received clearance. They were just minutes away.

Hind’s story is not an exception. It is one of tens of thousands of children in Gaza.

For more than two years now, children in Gaza have opened their eyes each morning to displacement, loss, violence and little access to even the most basic needs. At least 20,000 children have been killed since October 2023, an average of at least 24 children killed each day, the equivalent of an entire classroom. And we recognize this is a gross undercount as so many children remain buried under rubble. Tens of thousands have been forced from their homes. Schools have collapsed. Hospitals have been destroyed and doctors and medical personnel detained and targeted.

This is not only a man-made humanitarian catastrophe. It is also a mental health crisis.

Children in Gaza are not only surviving bombs and displacement; they are carrying an overwhelming psychological burden that grows heavier each day. Nearly every child is at risk of famine or getting sick from preventable diseases. More than 650,000 have no access to school, and more than 1.2 million children need immediate psychological support. Reports on the ground show that more than 39,300 children have lost one or both parents, including about 17,000 who have become orphaned. Hundreds of thousands are trapped with nowhere safe to go, living in a world defined by fear and instability.

Healing is impossible when the threat never stops and when schools and healthcare systems have collapsed. Trauma doesn’t fade under these unbearable conditions; it accumulates. The consequences could be irreversible.

We are witnessing the psychological injury of an entire generation.

Immediate action is imperative. A real, permanent ceasefire is the first step toward stability, but it must be followed by the rapid restoration of healthcare and education, with sustained investment in psychosocial and mental health support. Mental health cannot be an afterthought in a humanitarian response but must be central from the beginning. Without these interventions, the psychological toll will only deepen, shaping an entire generation with long-term consequences for their well-being and for the future of the Palestinian people.

And above all, children must be protected from continued violence, because no therapy can compete with ongoing trauma.

Hind’s last words will haunt me forever. The world failed her. It has failed the children of Palestine. But there’s still time to save the ones who remain. Through the film “ The Voice of Hind Rajab,” her voice will continue to travel across borders, carrying the truth of what children in Gaza and the West Bank endure day after day.

It is not just another story. It is a call we must answer.

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Nisreen Qawas is a psychologist with the Palestine Red Crescent Society.