Today is World Health Day: a suitable opportunity to take time to consider the connection between mental health, prolonged occupation and human rights violations. This connection was explicitly drawn at the inaugural meeting of the UK/Palestine Mental Health Network, which took place last Wednesday 2 April 2014 at the Guild of Psychotherapists in London. The meeting opened with two significant questions which demand contemplation by anyone engaged with Israel/Palestine:
- Why are mental health issues and the political situation so intertwined?
- How does mental health fit into human rights and universal values?
Attending this event caused me to reflect upon the reality of the profound psychological damage human rights violations can cause to individuals under occupation and it strikes me that the time is ripe to explore further how human rights and mental health under occupation intersect.
The context of occupation
An overriding theme that came out of the meeting was the absolute necessity to have a focus on ‘context’ when considering the issue of mental health in the occupied Palestinian territory (oPt). Part of the context in question is the legal fact that the West Bank, including East Jerusalem, and the Gaza Strip remain under Israel’s occupation. At this point it is worth quickly defining what ‘occupation’ means in law and how it is applied to the situation of Israel/Palestine.
The legal fact of occupation
Under international law a territory is considered occupied if a state exercises an unconsented-to ‘effective control’ over it. Israel’s arguments that the oPt is not ‘occupied’ have been rejected by the international community. Israel does not possess sovereignty in the oPt as an occupying power; they should only be a temporary administrator. As a consequence, Israel’s annexation of East Jerusalem in 1980 is a serious breach of international law and is not recognised by the international community. The occupied status of the West Bank was confirmed by the International Court of Justice in the Wall advisory opinion in 2004. Israel’s disengagement from the Gaza Strip in 2005 did not constitute the end of occupation there because, despite the redeployment of its military ground forces from Gaza, it retains and exercises effective control over the territory.
In all of the oPt, Israel is therefore an ‘Occupying Power’ with attendant legal obligations to provide for the safety and welfare of the Palestinian people under the Fourth Geneva Convention and Hague Regulations (international humanitarian law), in addition to international human rights law.
The purported impact of prolonged occupation on mental health
Mohamed Altawil is a clinical psychologist and founder of the Palestine Trauma Centre (Gaza & UK) who gave a compelling presentation at last Wednesday’s meeting. He explained that the founding of the Palestine Trauma Centre in 2009 is directly connected to the political background of Israel’s prolonged occupation. He described the experience of occupation as ‘a fact which we [Palestinians] live day by day’ and then went on to reveal the marked impact it has particularly had on the mental health of Palestinian children in Gaza.
Mohamed Altawil informed the meeting that his research on chronic trauma of children in 2006 found 41 per cent of 10 to 18 year olds suffered from Post Traumatic Stress Disorder (PTSD). The prevalence of PTSD among Palestinian children in Gaza rose to an extremely high 88.2 per cent when he conducted follow-up research in 2012: this research taking place after the destruction caused by Israeli military Operation Cast Lead in 2008/2009.
Mohamed Altawil noted that following his research in 2006 he considered that Palestinian children in Gaza were suffering from more than PTSD: they were suffering from ‘ongoing PTSD’, meaning the trauma causing the condition was not as a result of a single event, but is on-going, exacerbating symptoms and inhibiting recovery. This ‘ongoing PTSD’ was closely connected to two significant contextual factors. First, is the legal fact that Palestinians have been under unremitting occupation since 1967. Second, is the egregious legal fact that the prolonged occupation has been characterised by pervasive human rights violations and intermittent heavy military assault.
This latter factor is the other particularly important aspect of context which must be focused upon when considering mental health issues affecting Palestinians: the context of continuing and pervasive human rights violations.
The context of human rights violations
During the meeting it was emphasised that any planned action to support the mental health of Palestinians has to focus upon the context of a ‘systematic and ongoing violation of human rights against a people who see no end to it’. The resonance of this statement can be underscored by reference to two of Israel’s occupation policies which violate basic human rights of Palestinians and furthermore are recognised as having a deleterious effect on mental health:
- House demolitions,
- Child detainees in the Israeli military detention system.
Mohamed Atawil explained that his research had identified the highest level of trauma felt by children was when a house was destroyed. He explained this is because a home is seen as ‘a centre of safety’. Jeff Halper of The Israeli Committee Against House Demolitions echoed this explanation by describing house demolitions as a ‘policy of despair’ for Palestinians and that it is ‘a very powerful issue from the perspective of mental health’.
Mr Halper stated that there has been an estimated 29,000 homes demolished in the OPT since 1967. He then outlined Israel’s policy of largely refusing the grant of building permits for Palestinian housing (figures from the Israeli NGO Bimkom show that 95 percent of Palestinian applications for a building permit are rejected) which leaves the vast majority of built housing liable to a demolition order. He noted how further Palestinians homes have been targeted by Israeli authorities as collateral damage – as vividly reported in the Breaking the Silence testimonies of Israeli soldiers coming out of Operation Cast Lead. He ended his presentation by stating that men, women and children respond in very different ways to home demolitions. Mohamed Atawil elaborated by explaining that it is the ‘worst feeling to feel helpless as a human to protect yourself and your family’.
Child detainees in Israel’s military detention system
When planning LPHR’s “Know Your Rights” campaign in partnership with Defence for Children Palestine International, I came across the expert psychiatric opinion of Dr Graciela Carmon on the emotional and developmental factors that lead children to make false confessions during interrogations, and the implications of these confessions for the lives of these children and those around them. I repeat her concluding summary in full here because it is powerful required reading for anyone interested in the apparent connection between mental health, prolonged occupation and human rights violations:
The violent arrest process and psychological interrogation methods mentioned above lead to the breaking of the ability of the child or adolescent to withstand the interrogation and flagrantly violate his or her rights. These interrogation methods, when applied to children and adolescents, are equivalent to torture. These methods deeply undermine the dignity and personality of the child or adolescent, and inflict pain and severe mental suffering. Uncertainty and helplessness are situations that can too easily lead a child or adolescent to provide the requested confession out of impulsiveness, fear or submission. It is a decision that is far from free and rational choice.
The social and mental consequences of the use of the aforementioned methods of detention and interrogation by the investigating and/or detaining authority for the life of the child or adolescent are difficult to remedy and damaging. They can cause serious mental suffering to a child or adolescent and cause psychological and psychiatric problem, as well as post-traumatic stress disorder (PTSD), psychosomatic diseases, fits of anger, difficulties in learning and concentration, memory problems, fears and anxieties, sleep disorders, eating disorders, regressive symptoms, and bedwetting. Such outcomes are devastating to the normative development of the child or adolescent, especially when he or she is innocent.
These detention and interrogation methods ultimately create a system that breaks down, exhausts and permeates the personality of the child or adolescent and robs him or her of hope. These methods are particularly harmful to children and adolescents who live in poor, isolated populations, in a state of conflict, political tension, and/or severe social stress, such as the occupied Palestinian population. The harmful effects on children can also harm the society to which they belong. Every child has the right to be a child, to his or her dignity, and to protection from all forms of violence.
Conclusion: A significant role for international humanitarian and human rights law?
If it is accepted that there is a direct link between mental health and the dual context of prolonged occupation and human rights violations, the question then arises as to whether applying the rule of law to the issue of mental health harm for Palestinians – especially prevalent for Palestinian children – could provide a measure of amelioration.
From a rule of law perspective, the short and positive answer is yes. A transformative change of policy by Israel to adhere to their obligations under international humanitarian and human rights law so that Palestinian rights are fully respected would go a long way to removing the primary cause of the adverse mental health effects described in this blog. The importance of respecting the rule of law from both a human rights and mental health perspective is critically clear. On World Health Day, this is a message well worth amplifying.