War in Gaza and settler violence are taking a toll on mental health in the West Bank

SATEH AL BAHAR, West Bank — The bright pink mobile medical clinic rolls down a dirt road in a hilly area outside Jericho for its weekly visit to a Bedouin outpost.

It stops in a clearing with a few tents and shacks that look almost abandoned. But as soon as Samir Sbieh, the driver, rolls out the awning over the van and throws open the door, women and children start emerging from the hills and tents, seeking medical help.

Increasingly, those treatments include mental health consultations.

Since the start of the war between Israel and Hamas, anxiety and depression have sky-rocketed among members of this community — one of several semi-nomadic herder communities that tend to live off the land — especially the children.

The war is not in the occupied West Bank, but even here, perched in these serene hills among their sheep under what looks like an endlessly open sky, the conflict in Gaza feels close.

The war started on Oct. 7, after Hamas attacked southern Israel, killing 1,200 people and kidnapping 240, according to Israeli officials. Israel's military response has killed at least 30,320 people, according to the Gaza Health Ministry, many of them women and children.

The images of dead children permeate the news here, and the youngest of viewers have noticed.

A woman who gives her name only as Khitam walks up to the van, which is run by the British charity Medical Aid for Palestinians (MAP). She holds two babies, with a little boy running behind her.

Her 4-year-old son, Ahmad, needs to see the psychologist.

"He's been talking to his grandfather about the war. 'Look, look,' he says, 'children and soldiers. They are killing children,'" says Khitam, as she bounces one-and-a-half year old Aya on her right hip.

Aya has a sore throat that Khitam wants looked at. But she says she's worried about Ahmad and her older daughter, Ayat.

She says the 7-year-old couldn't come because she was at school, but Khitam says she's anxious about the war and is increasingly scared of interacting with Israeli settlers on her way to and from school.

According to a November report from the International Crisis Group, settler violence against Bedouins has increased in recent months "and especially since 07 October," with at least 800 people being driven from 15 Bedouin communities in that time.

Redah Hussin, a psychologist with MAP, says she's seen an increase in the need for mental health care since the start of the war. She says she's seeing a lot of "stress, panic and worry" in everyone, including in children, who don't know how to speak about it.

Along with Hussin, the van, which is stocked with medication and equipment, including an ultrasound machine, is staffed with a doctor, practical nurse, lab technician and a medical assistant. The team treats patients for everything from chronic illnesses to ear infections.

"Mainly, these people don't have the money to go to specialists," says Hussin.

She says since the war, she has seen an increase in stress and anxiety, so much so that "children are soiling themselves ... We've even started putting them on medical treatment for anxiety since the start of the war."

She ducks into a large tent lined with colorful pillows and cushions and is instantly surrounded by children eagerly grabbing the coloring pencils and activity books.

Nahidah Dashd, a physician with the mobile clinic, says she has noticed an uptick in stress-related ailments from adults too.

"First and foremost, they need psychological treatment," says Dashd.

"I will hear 'my back hurts,' or 'my neck is suddenly so sore,' but after testing them and not finding anything physical wrong with them, I ask them about their mental health and I hear that they are in fact very anxious, or very stressed out," she says.

"That's when we refer them for psychological care."

The children's mothers sit at the entrance of the tent, looking on. They too are anxious.

"Last week, was feeling very tense. I couldn't stop crying. I didn't know what was wrong with me," says Amneh Khalil. She talks about how her mental health suffers when her children refuse to eat because they hear that children in Gaza are starving.

She says she took Hussin, the therapist, to her home and spoke to her there.

"She talked to me and gave me some breathing exercises and ways to think. After sitting with the psychologist, believe me, I felt better" says Khalil.

Growing hopelessness and despair

The war has increased stress all around, taking a toll on the mental health of Israelis and Palestinians alike.

For some, the challenges are new. For others, they go back further.

Even before the war, Palestinians in both the occupied West Bank and Gaza struggled with mental health issues — specifically, anxiety and depression.

According to a June 2023 World Bank mental health report on Gaza and the West Bank, some 71% of Gaza residents struggled with depression, compared to 50% of Palestinians living in the West Bank.

Dr. Fathi Fleifel, a psychotherapist with a clinic in Ramallah, says Palestinians in the West Bank and Gaza have always had issues with "depression and cumulative stress."

But now, he says, the numbers are rising.

"It's really difficult to say how much, exactly, but there's at least 25% increase," he estimates, noting that many of the patients range in age from 20 to 35.

That number probably doesn't represent the full extent of the need for therapy, according to Fleifel, who says cultural stigmas about seeking help and uncertainty that it would even work means the demand is probably even greater.

Fleifel says there aren't enough psychiatrists, psychotherapists or counselors to meet the needs of those in need of therapy. He knows of maybe 40 people practicing in the West Bank, because although more professionals registered with the health ministry, Fleifel says many of them don't practice. Instead, they work as consultants or for organizations.

And right now, the need is acute — with all of his patients talking about the war.

"All of them are talking about it, even the small children, they are following what's going on in social media and television ... people are really afraid of what will happen in the West Bank. They don't know how this situation will end," he says.

But it's not just the war. An increase in clashes with Israeli settlers, as well as delays at checkpoints and road closures imposed by the Israeli military, are all adding to stress and aggravation felt by Palestinians here. Fleifel said it recently took him three-and-a-half hours to travel 27 miles between Nablus to where he was going in Ramallah.

The strain on children

Fleifel says he's hearing about a variety of symptoms from his patients: Sleeplessness, fights within families, eating disorders and more.

"There's a fear of losing everything, they are talking about hopelessness and despair, for themselves as well as their loved ones," says Fleifel.

He worries about the long-term effects of stress and trauma on children in particular.

"Some of them definitely will be affected seriously," he says, adding that some will certainly need specialized care.

Back in Sateh al Bahar, Khadrah Salameh is already seeing the effects of the war on her children.

She says they have panic attacks when they hear an airplane overhead. They've also grown increasingly scared of the dark. As she talks, Nawal, 5, is busy coloring with a gaggle around psychologist Hussin.

"My children now are afraid of the war," says Salameh. "They are always saying, 'Look mama look, how they kill these children, how they hurt these children,' they are always looking for images of children like them, and I have no answer for them when they say these things," she says, with 10-month-old Mizen bouncing on her lap.

"I just say, 'May God be with them.'"