This text was first revealed by Index on Censorship on 10 April 2025. It appeared in Quantity 54, Subject 1 of Index on Censorship’s print journal, titled: The forgotten sufferers: Misplaced voices within the world healthcare system. Learn extra in regards to the problem right here.
Most youngsters say their first phrase between the ages of 12 and 18 months. However Fatehy, a Palestinian boy residing in Jabalia Metropolis in Gaza, is 4 years previous and continues to be barely speaking.
When he does communicate, he says the identical phrases over and over – ‘scared’, ‘bomb’ and ‘fighters’. Whereas he used to say phrases akin to ‘mumma’ and ‘bubba’, his language development has reversed, and now he’s largely silent.
He has been displaced roughly 15 occasions and skilled a number of shut household deaths, together with these of his mom and sister. At one level, he was found on a pile of our bodies and was presumed lifeless. He was rescued purely by luck when a member of the family noticed that he was nonetheless gently respiration.
Gaza 2024. Picture: Jaber Jehad Badwan / Wikimedia Commons
His cousin, Nejam, is three years previous. His speech can be very restricted, and is usually reserved for the names of tanks, drones and rockets. He has been pulled from rubble a number of occasions. Neither youngster has entry to highschool, nursery or social actions with associates. Medical remedy is severely restricted, and so they have been unable to entry any of the few speech therapists obtainable. Meals shortage additionally means they’ve been unable to be taught primary vocabulary about components or meals.
Dalloul Neder, a 33-year-old Palestinian man residing within the UK since 2017, is their uncle. ‘The only thing they’ve been listening to is the bombing,’ he informed Index. ‘That’s why they’re traumatised. ‘They miss their families, grandparents, mums and family gatherings around the table. They realise something is not right but they can’t categorical their ache.’
Psychological trauma is extraordinarily widespread for youngsters residing in warzones. This may trigger psychological well being points akin to despair, anxiousness and panic assaults, but in addition communication issues, akin to shedding the flexibility to talk partially or totally, or growing a stammer. For youthful youngsters akin to Fatehy and Nejam, warfare trauma can impression cognitive growth, inflicting language delays and making it exhausting to be taught to talk within the first place.
In December, the Gaza-based psychosocial assist organisation Neighborhood Coaching Centre for Disaster Administration revealed a report based mostly on interviews it had carried out with greater than 500 youngsters, mother and father and caregivers. Almost all the kids interviewed (96%) stated they felt that dying was ‘imminent’ and 77% of them prevented speaking about traumatic occasions. Many confirmed indicators of withdrawal and extreme anxiousness. Roughly half the caregivers stated youngsters exhibited indicators of introversion, with some reporting that they spent quite a lot of time alone and didn’t prefer to work together with others.
Katrin Glatz Brubakk is a baby psychotherapist who has simply returned to Norway from Gaza, the place she was working as a psychological well being actions supervisor with Médecins Sans Frontières in Nasser Hospital, Khan Younis. Her crew gives psychological well being assist to adults and kids, however primarily to youngsters coping with burns and orthopaedic accidents, largely from bomb assaults.
Brubakk informed Index that youngsters tended to current with ‘acute trauma responses’, whereas the long-term impacts on their psychological wellbeing weren’t but seen. In her work, she usually sees two kinds of responses – both restlessness and being exhausting to settle down, or turning into uncommunicative and withdrawn.
She believes the latter is considerably tougher to identify and subsequently under-reported. ‘We have to take into account that it’s simpler to detect the acting-out children, and it’s simpler to miss the withdrawn children or simply suppose they’re a bit shy or quiet,’ she stated.
She generally noticed youngsters experiencing excessive panic assaults as a result of flashbacks, the place any small factor – akin to a door closing or their guardian leaving a room – might set off them. She famous they might usually let loose ‘intense screams’.
However some youngsters have turn out to be so withdrawn they don’t scream or cry in any respect. Some have even fallen into ‘resignation syndrome’, a decreased state of consciousness the place they will cease strolling, speaking and consuming solely.
Brubakk recalled one ‘extreme case’ of a five-year-old boy who was the sufferer of a bomb assault and witnessed his father die. He fell fully silent and didn’t need to see anyone, and likewise hardly ate.
‘When children experience severe or multiple trauma, it’s as if the physique goes into an overload state,’ she stated. ‘In order to protect themselves from more negative experiences and stress, they totally withdraw from the world.’
Dwelling in a warzone may also imply that youngsters’s ‘neural development totally stops’, she stated, as they lose the chance to play, be taught new abilities, be taught language and perceive social guidelines. ‘The body and mind use all their energy to protect the child from more harm,’ she stated. ‘That doesn’t have an effect on the kid solely there after which, it’ll have long-term penalties.’
That is made worse by an absence of ‘societal structures’, akin to colleges. ‘[These offer a] social arena, where they can feel success – there’s no normality, there’s no predictability.’
Remedy can be utilized to encourage youngsters to talk once more, notably with inventive strategies akin to play and drawing remedy. Brubakk defined how by way of ‘playful activities’ and ‘small steps’, her crew had been capable of encourage youngsters to speak.
Not too long ago, she managed this by way of the creation of a makeshift dolls home. A younger lady had been burnt in a bomb assault. Her two brothers had been killed and her two sisters injured, with one in all them in a vital state. It was unsure whether or not her sister would survive.
The lady wasn’t in a position to talk about her experiences till Brubakk helped her create a dolls home utilizing an previous field, some colouring pens and tape, plus two small dolls the lady had stored from her residence. She named the dolls after herself and her sister, and was capable of begin expressing her grief and fears, in addition to her hopes for the longer term.
‘So through a very different type of communication, she was able to express how worried she was about her sister, but also process some of the experiences she had,’ stated Brubakk.
A report revealed by the non-profit Gaza Neighborhood Psychological Well being Programme (GCMHP) contains success tales of kids who’ve benefited from inventive communication. Alaa, a 12-year-old boy who sustained facial accidents after a bombardment after which later skilled pressured evacuation by Israeli forces from Al-Shifa hospital, developed recurring nightmares, verbal violence, reminiscence loss and an aversion to speaking about his accidents. A remedy plan of drawing remedy and written narrations of the occasions helped him to turn out to be extra sociable, and now he visits different injured youngsters to share his story with them and hearken to theirs.
Sarah, in the meantime, is a 13-year-old lady who developed post-traumatic stress dysfunction and traumatic mutism after having an operation on her leg following a shell assault. She didn’t communicate for 3 months and would use solely indicators or write on items of paper. The GCMHP labored along with her on a gradual psychotherapy plan, together with drawing and play remedy. After three weeks, she began saying a couple of phrases, and he or she was ultimately capable of begin discussing her trauma with therapists.
Trauma-related speech points are advanced issues that may be identified as each psychological well being points and communication problems, in order that they usually profit from intervention from each psychotherapists and speech and language therapists.
Alongside growing speech points as a result of warfare, residing in a warzone can worsen speech issues in youngsters with pre-existing circumstances. For instance, these with developmental disabilities akin to autism might have already got selective mutism (speaking solely in sure settings or circumstances), and this will turn out to be extra pronounced.
Then there may be behaviour that may turn out to be ‘entrenched’ as a result of their environments, Ryann Sowden informed Index. Sowden is a UK-based well being researcher and speech and language therapist who has beforehand labored with bilingual youngsters, together with refugees who developed selective mutism in warzones.
‘Sometimes, [in warzones,] it’s not all the time protected to speak,’ she stated. ‘One family I worked with had to be quiet to keep safe. So, I can imagine things like that become more entrenched, as it’s a manner of dealing with seeing some actually horrific issues.’
She described a ‘two-pronged’ impact, with warfare trauma inflicting or exacerbating speech points, and an absence of healthcare companies that means that early intervention for these with present communication problems or very younger youngsters can’t occur.
There’s an comprehensible must deal with survival somewhat than rehabilitation in warzones, she stated, and quite a lot of allied well being professionals, akin to occupational therapists, physiotherapists and psychotherapists, are diverted to emergency companies.
This was echoed by Julie Marshall, emerita professor of communication incapacity at Manchester Metropolitan College and previously a speech and language therapist working with refugees in Rwanda. Her educational analysis has famous an absence of speech and language therapists in low and middle-income international locations (LMICs) typically.
‘In many LMICs, communication professionals are rare, resulting in reliance on community members or a community-based rehabilitation workforce underprepared to work with people with communication disorders,’ she wrote in a co-authored paper in British Medical Journal International Well being.
For kids who have already got speech or language difficulties, shedding relations who’re attuned to their different strategies of communication, akin to gestures or pointing, could make the difficulty worse.
‘If you are non-verbal, you may well have a family member who understands an awful lot of what we would call “non-intentional communication”,’ stated Marshall. ‘If you lose the person who knows you and reads you really well, that’s large.’
In warzones, Marshall and Sowden each imagine that speech and language remedy is extra more likely to be integrated alongside medical disciplines coping with bodily harm, akin to head or neck trauma or dysphagia (an lack of ability to swallow accurately). This perception was mirrored by the work of Brubakk, whose psychological well being crew at Nasser Hospital labored largely with sufferers who had been seen within the burns and orthopaedics departments.
One of the crucial priceless issues that may be carried out is to coach communities in easy methods to assist youngsters who could also be residing with a speech or language issue, Marshall believes, shifting away from treating a single particular person to attempting to alter the final setting.
‘There are lots of attitudes around communication disabilities that could be changed,’ she stated. For instance, it’s usually misjudged that youngsters with muteness might not need to discuss, and they’re subsequently ignored somewhat than patiently and gently interacted with.
Regardless of an absence of healthcare provision, there are some professionals on the bottom in Gaza. In 2024, the UN interviewed Amina al-Dahdouh, a speech and language therapist working in a tent west of Al-Zawaida. She stated that for each 10 youngsters she noticed, six suffered from speech issues akin to stammering. In a video report, al-Dahdouh held a mirror as much as youngsters’s faces as she tried to show them primary Arabic vocabulary and present them find out how to formulate the sounds of their mouths.
However the destruction of medical amenities akin to hospitals and an absence of apparatus have made it tough for professionals to do their jobs. Mohammed el-Hayek is a 36-year-old Palestinian speech and language therapist based mostly in Gaza Metropolis who beforehand labored with Syrian youngster refugees in Turkey.
‘Currently, there are no clinics or centres to treat children, and there are many cases that I cannot treat because of the war, destruction and lack of necessary tools – the most important of which is soundproof rooms,’ he informed Index. ‘Before the war, I used to treat children in their homes.’
Soundproof rooms can be utilized by speech and language therapists to create extra non-public, quiet and managed areas that scale back distracting exterior noises together with triggering sounds akin to gunfire or bombs. The most typical problem he has encountered is stammering, which he says turns into tougher to sort out the longer it’s left untreated.
‘Children are never supported in terms of speech and language,’ he added. ‘[It is] considered ‘not essential’ however it’s a very powerful factor in order that the kid can talk with all their household and associates and never trigger [them] psychological issues.’
For a lot of of those youngsters, the highway to restoration will likely be lengthy. Mona el-Farra, a health care provider and director of Gaza tasks for the Center East Kids’s Alliance, informed Index that the ‘accumulation of trauma’ attributable to a number of bombardments meant that even these receiving psychological assist had been supplied little respite to heal.
One glimmer of hope is that cultural boundaries round trauma seem like lifting, which has inspired folks to cease self-censoring round their very own psychological well being.
‘There is no stigma now [around mental health],’ stated el-Farra. ‘The culture used to be like this, but not anymore. You can see that 99% of the population has been subjected to trauma. [People] have started to express themselves and not deny it.’
On the time of writing, the ceasefire between Israel and Hamas had damaged down and bombardment had restarted. When a everlasting ceasefire is lastly established and healthcare provision in Gaza may be rebuilt, there’ll have to be a concerted effort to assist youngsters with their psychological and social rehabilitation in addition to their bodily well being. Hopefully then they will begin to come to phrases with their experiences and inform their tales – in any other case, they could possibly be misplaced endlessly.
