Trials and tribulations of children in Gaza, as witnessed by health professionals Peter Smith and Catherine Thick.

Childhood in Gaza is scarred by oppression and distress. In 1991, Israel ratified the 1989 UN Convention on the Rights of the Child. Article 37 states: "No child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment, and no child shall be deprived of his or her liberty unlawfully or arbitrarily." But Israel shows no mercy to the children of Gaza.

More than 1,300 children have been killed as a result of repeated Israeli military offensives on Gaza. Given the current regime of collective punishment implemented through a 6-year-old blockade, targeted assassinations and regular military offensives, the situation for Gaza's children will continue to deteriorate. Following Operation Cast Lead in December 2008 to January 2009, which resulted in the death of over 350 children, the United Nations Fact-Finding Mission on the Gaza Conflict found Israel’s use of force to be disproportionate.

While both Israeli forces and Palestinian armed groups in Gaza unlawfully targeted civilians during the offensive, the use of drones in attacks on civilians, particularly children, is extremely troublesome. Last November saw Operation Pillar of Defense, an eight-day Israeli military offensive on the Gaza Strip. More than 30 Palestinian children were killed. Yet again there were well-documented evidence of war crimes and serious violations of internationalhumanitarian law. 

Although about 10,000 rockets have been fired into Israel by the largely uncontrolled jihadists in Gaza, the number of Israelis killed over 10 years has been 23 — compared with the thousands of Palestinians. Drones were used in only 5% of air strikes but accounted for 23% of the total deaths during Pillar of Defense. Civilians are the chief casualties of what Israel refers to as "surgical" strikes from drones. The ever-watching drones are a reminder that, whatever Israel and the international community claim, the occupation has not ended. Gazans live completely under Israeli control.

Living in Constant Fear

The sense of permanent exposure, coupled with the fear of being mistakenly targeted, has inflicted deep psychological scars on civilians, especially children. Children face increasing insecurity which traumatizes both them and their and parents; the latter feel they are failing in their most basic responsibility. It is probably impossible to separate the psychological toll inflicted by drones from other sources of damage to mental health, such as the air strikes by F-16s, or severe restrictions on movement and the economic insecurity caused by the blockade.

A survey in medical journal The Lancet following Operation Cast Lead, Israel's month-long attack on Gaza in 2008-09, found large percentages of children suffered from symptoms of psychological trauma: 58% permanently feared the dark; 43% reported regular nightmares; 37% wet the bed; and 42% had crying attacks.

Children should enjoy a happy and carefree childhood. They should not have to witness horrific events and live in fear or endure sleepless nights listening to drones and bombs. Yet this is the life of many children in Gaza. They are the innocent victims of Israel’s relentless siege and blockade, which is taking a huge toll on their wellbeing and psychological development.

It is no exaggeration to say that their childhood has been stolen. The governing party in Gaza bears some responsibility too; Hamas is struggling to retain the loyalty of an increasingly embittered and exhausted population. The situation in Gaza is at its worst since Hamas took over in 2007, the citizens showing signs of hopelessness and powerlessness. There have been recent efforts at rapprochement, however, the politically divisive split between Gaza and the West Bank leadership is at a low point, increasing Gaza’s political isolation. 

Gaza could collapse economically, socially and environmentally. The trauma on the children of Gaza is thus further compounded, besides the violence, by the consequences of the Israeli blockade. The Gaza Strip is destitute and overcrowded. Having been there several times now, it is hard not to believe Gaza is the victim of a deliberate Israeli campaign to strangulate its economy, with the express purpose of making its residents starve and suffer.

As medical professionals, we have seen the human face of the conflict, the ordinary people caught in an extraordinary situation. We have seen children who are inheriting the conflict from their great-grandparents and, as many expect, it will be handed down to future generations. Physical and psychological stress is also inherited.

The incidence of psychological trauma and post-traumatic stress disorder has more than doubled in Gaza since the November 2012 war. The United Nations agency for Palestinian refugees (UNRWA) reported that 42% of patients they treat for psychological trauma are under the age of 9. We have listened to parents reporting their children suffering sleep problems, flashbacks to the war, bedwetting and speech difficulties. Constant crying is common.

Impact of War on Gazan Children

The deterioration in well-being and psychological development manifests in the sleepless nights and nightmares, clinging behavior, depression, anxiety, and many become withdrawn and uncommunicative. At the other end of the spectrum some youth become aggressive, violent and speak of revenge. This cannot be condoned but is kindled by oppression, injustice and witnessing violence against their family and friends, and the destruction of their homes and infrastructure. Their health and development is also at risk by limited access to general health care, insufficient psycho-social care as well as by poor housing, polluted drinking water and malnutrition. The blockade extends to permits for urgent medical treatment and the UN estimates that 30-50% of drugs are at zero stock.

The clinics we ran were well-attended, giving us the opportunity to listen to the views of the many people who bear the physical and emotional scars of Israeli bombs and repression. A doctor at the clinic we work from told us: "Over 80% of Palestinian children suffer trauma at the sound of the Israeli F-16 fighter aircraft which frequently overfly the territory, and we have noticed an increase in the number of deformed babies as well as a sharp increase in the number of cancer patients, especially among children and women, following the 22-day war in 2008-2009." There are bomb strikes almost daily, the Israelis do not keep to ceasefires, and the violations are never reported.

A lovely family with three beautiful, bright daughters attended every clinic. The Palestinians highly value education and the girls spoke good English. The very shy and anxious 14-year-old daughter suffered breathing problems after inhaling noxious gases when an illegal phosphorous bomb exploded close to their home. She had become withdrawn with post-traumatic stress and experienced flashbacks, nightmares, insomnia and anxiety. We treated her almost every day for two weeks and it was wonderful to see her breathing improve and change from a frightened girl to a smiling teenager.

Helping to relieve the suffering of children is profoundly humbling and rewarding; their gratitude never fails to move us but what we can provide is a drop in an ocean of need.

Their mother is a nurse and we treated her for stress-related migraines. She said: "The chief victims of the conflict are women and children. Anemia affects most children in Gaza and one third of pregnant women. Ten percent of children under 5 suffer from stunting, the effects of which are lifelong." 

More than half of the households in Gaza eat poorly or are short of food, even though UN food distributions provide to almost 1.1 million people. Eighty percent of households receive some form of assistance and nearly 33% are jobless.

The situation there is already intolerable and recent events are making it even worse. Recently international bodies, including the UN and Oxfam, have warned of a worsening humanitarian crisis as the Palestinian territory and the foreign aid agencies who work with it struggle to offer basic services. Fuel and power cuts are disrupting water, sanitation and medical care. According to Gaza’s Coastal Municipalities Water Utility, 40% of the population receives water for only four to six hours, every five days.

Outgoing Commissioner General of UNRWA Filippo Grandi warned last month that the impoverished Gaza Strip was getting quickly unsuitable for human life as a result of the blockade. UNRWA just reported it has again cut or halted food aid to thousands of Palestinians as it struggles to keep up with the rising poverty rate. The Syrian crisis that has left millions of people dependent on international aid has caused the reduction of funds to assist Palestinians. "We are doing better in obtaining resources for Syria’s emergency than we are for Gaza," said Grandi.

Further, an airstrike last week, the third against a specific militant in Gaza in three weeks, was a return to the practice known in Israel as "targeted killing" that had all but halted after a ceasefire began more than 14 months ago, ending a round of fierce cross-border fighting. Gaza militants have launched 33 rockets at Israel since the beginning of this year, according to the Israeli military. About 60 rockets were fired at southern Israel in all of 2013.

A Dark Future

In recent months, fuel and electricity shortages in Gaza have worsened as the Egyptian military has blocked supply tunnels leading into the region. The underground tunnels serve as a lifeline for Gazans, especially for fuel. Blackouts are now lasting  8-16 hours a day, according to Oxfam. Garbage is mounting up. Raw sewage has flooded streets in some areas of Gaza City following the closure of Gaza's only power plant in November 2013, which made pump stations inoperative. Before the current crisis, some 90 million liters of raw or partially-treated sewage were being dumped into the sea off Gaza every day.

Since the power plant shut down, more raw sewage is being dumped into the sea. For years, more than 90% of the water extracted from the Gaza aquifer has been polluted and unfit for human consumption, due to the infiltration of sewage and seawater and prolonged over-extraction because of Israel’s disproportionate use of water resources. By 2016, the UN estimates there will be no potable water left in Gaza’s main aquifer.

Eighty percent of the factories in Gaza are fully or partially closed due to the continued siege, leading to layoffs, while hospitals are running on emergency reserves. Hospitals and other health facilities throughout the Gaza Strip have been relying on their own generators during the lengthy power outages. But the generators are also affected by fuel shortages, jeopardizing essential services like kidney dialysis, operating theaters,, blood banks, intensive care units, neo-natal care, and laboratories, putting patients' lives at risk. Only 40% of Gaza's fuel needs were being met and consumer prices for petrol and diesel had doubled.

Less than 400,000 liters of fuel a day enter Gaza through official crossings, compared with 1 million liters a day that were smuggled through the tunnels. Students study by candlelight and women cook by flashlight. More than 80% of Gaza's 1.7 million inhabitants are now in need of humanitarian aid and 65% of families are expected to be food insecure by the end of the year. The closures of the tunnels by the Egyptian military has also led to a near total collapse of private sector constructions, resulting in even greater unemployment.

Israel only permits farmers to export abroad, not to Israel or the West Bank, Gaza’s main markets. Gaza’s current export level is about 1% of what it was before 2007 when the territory traded in a wide variety of goods.

Palestinian fishermen are only allowed to venture three nautical miles from Gaza's shore, though official Israeli-Palestinian agreements previously settled on 20 nautical miles. Israeli naval forces frequently harass Palestinian fishermen who near the three-mile limit, as well as those inside the zone. There are some 4,000 fishermen in Gaza. According to a 2011 report by the International Committee of the Red Cross, 90% are poor, a 40% increase from 2008 resulting from Israeli limits on the fishing industry.

So this is the lives of children in Gaza. Imprisonment, war,  malnutrition and poverty. Early adversity can put children on a lifelong trajectory of ill-health and poor development and social functioning. Bad experiences in childhood can have terrible effects mentally and physically, effects that can reverberate through generations. Inequity, poverty and powerlessness beget violence. Is this the world we want? 

In December 2013, over 200 children, ages 4 to 15 years, including 25 orphans, assembled at the Gaza Port. The children launched mini-arks into the sea to symbolically challenge the illegal and immoral Israeli blockade. The mini-arks were sponsored by people across the world. Like messages in a bottle, they carry the children’s cry for help to the outside world. Trapped in the small stretch of land that is the Gaza Strip, the children there want freedom. They want the brutal siege of their land to end. If what is happening in Gaza by Israel were happening to any other nation, the whole world would be up in arms. The UN states clearly that "collective punishment of the civilian population of Gaza is not lawful in any circumstances." We can only hope the world begins to listen and to act.

The views expressed in this article are the authors' own and do not necessarily reflect Fair Observer’s editorial policy.