Contributor: Gaza remains a crisis of children’s mental health

As a psychologist in the occupied West Bank, I spent my career working with children carrying burdens that no child should ever experience – lives shaped not by playgrounds or classrooms, but by constant fear.

I recognize this fear because I have experienced it myself. I remember when I was less than 5 years old, Israeli soldiers stormed our house in the middle of the night and dragged my father out of his bed. The knock on the door, the screams, the terror: these memories are still vivid.

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

Children who jump at the slam of a door.

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

I helped them deal with arrests, house demolitions, settler violence, humiliation at checkpoints, and the quiet, agonizing 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 humanitarian organizations ready to go where the needs were greatest: in the red zones, near the separation wall, near illegal settlements and even in active conflict zones. Mental health services are scarce and often inaccessible to Palestinians. If children were suffering in the hardest-to-reach places, I wanted to be there with them.

I thought I understood the trauma.

I thought I knew how to guide children through fear.

I thought I had the tools.

Then, on January 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 loved ones who had just been killed. Israeli tanks were getting closer. Gunshots crackled in the background. She whispered into the phone so no one nearby would hear her.

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

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

In our operations room in Ramallah, time slowed to an unbearable pace. With each passing minute, the frustration and helplessness grew heavier and heavier.

All I could do was talk to him.

How can I maintain hope for a child when he is stuck alone among his deceased family members?

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

How can I keep her conscious and focused on something other than the immediate trauma?

I kept reminding him to breathe. To continue talking. To stay awake.

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

Towards the end, his voice grew weaker. She told me she was bleeding. “From where,” I asked. “My mouth, my stomach, my legs, everywhere,” she whispered. I tried to stay calm and told her to use her blouse to wipe the blood. Then she said something I’ll never forget: “I don’t want to. My mom will be tired from washing my clothes.”

Even then – alone, terrified, hurt and hungry – she thought of 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 hit while they were waiting for permission to reach it. They were only a few minutes away.

Hind’s story is no exception. He is one of tens of thousands of children in Gaza.

For more than two years now, children in Gaza have opened their eyes every morning to displacement, loss, violence and lack of access to the most basic needs. At least 20,000 children have been killed since October 2023, an average of at least 24 children killed every day, the equivalent of an entire classroom. And we recognize that this is a vastly underestimated figure, as many children remain buried under the rubble. Tens of thousands of people have been forced to leave their homes. Schools collapsed. Hospitals were destroyed and doctors and medical staff were arrested and targeted.

This is not just a man-made humanitarian disaster. It’s also a mental health crisis.

Gaza’s children don’t just survive bombs and displacement; they carry a crushing psychological burden that grows heavier every day. Almost all children are at risk of starvation or illness from preventable diseases. More than 650,000 do not have access to school and more than 1.2 million children need immediate psychological support. Field reports show that more than 39,300 children have lost one or both parents, including around 17,000 who have become orphans. Hundreds of thousands of people are trapped, with nowhere to go safely, living in a world defined by fear and instability.

Healing is impossible when the threat never ends and when schools and health systems have collapsed. The trauma does not disappear in these unbearable conditions; it accumulates. The consequences could be irreversible.

We are witnessing the psychological wounding of an entire generation.

Immediate action is imperative. A real and permanent ceasefire is the first step towards stability, but it must be followed by a rapid restoration of health care 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 start. Without these interventions, the psychological toll will only grow, shaping an entire generation with long-term consequences for its well-being and the future of the Palestinian people.

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

Hind’s last words will haunt me forever. The world has failed him. This has failed the children of Palestine. But there is still time to save those who remain. Through the film “Hind Rajab’s voice“, his voice will continue to cross borders, carrying the truth about what the children of Gaza and the West Bank endure day after day.

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

Nisreen Qawas is a psychologist at the Palestine Red Crescent.