Clinical psychologist Sylvia Wamser has been treating people suffering from emotional trauma in the Palestinian Territories for the last five months. “I have the advantage of being a foreigner", she says. "Gaza is a small place and everybody knows everything about everybody. It is easier for patients to speak openly to a stranger“. Sylvia tells us about her work in the region.
MSF clinical psychologist Sylvia Wamser talks to a patient. Palestinian Territories, 2008.
Valerie Babize / MSF
What is the focus of the programme in Gaza?
The population in Gaza lives in a state of siege
due to the inter-Palestinian conflicts and the conflict with Israel. The violence hits the civilian population hardest.
MSF started setting up post-operative clinics in June 2007. A paediatric project started last
March in Beit Lahiya, in the northern Gaza Strip,
to treat children under 12. MSF has also opened
a psychosocial-medical programme to alleviate
the psychological suffering following exposure
to violence.
What are the symptoms of the trauma?
Seven years of intifada and decades of
occupation have brought what we could call
‘multi-wave’ traumas for the population, which can impact individual, social, family and professional lives.
People suffer from acute stress reactions and post-traumatic stress disorder, which can result in symptoms like insomnia, loss of appetite, shock reactions, and fear of going outside. With children there can also be bedwetting, loss of concentration and learning difficulties. There is often no medical explanation for the physical discomfort which patients experience.
Psycho-trauma is made worse by: loss of relatives, loss of psychological and physical integrity, loss of one's home and belongings, loss of professional and social roles. This can lead to deep and persistent episodes of depression. People may also exhibit behaviour like withdrawal and self-harm.
What kind of treatment do you use?
With behavioural therapy, the focus is on encouraging self-help. In Gaza it was about teaching patients methods to overcome stress. This begins with learning a breathing technique that lowers the heart rate and the electrical resistance of the skin, thus relaxing the body. Athletes do the same before a competition.
Having reached a state of relaxation, the patient works on regaining resources, finding a positive outlook and converting bad memories. A patient who was shot at a specific corner might still be afraid to go there, even when there is no further danger. When the patient is relaxed in a session, he can return in his mind to that corner, free of fear, and imagine how the place felt before it took on a negative connotation. Then the same is done while picturing the place in the future.
Therapy can also help to treat the mental aspect of a physical disorder. I once had a young widow in the clinic. Her husband had died as a “martyr” and her brother-in-law died a violent death as well. Then her father got sick and eventually died with a broken heart. The widow came to me complaining of insomnia. It was triggered by a number of causes: she lived in constant fear of attacks, and she was afraid that her son might want to become a “martyr” as well. She wasn’t able to process the loss of her husband. I taught her how to use breathing and imagination techniques whenever a stressful situation arises. After a while she was able to sleep again.
How did you perceive the general situation in Gaza?
The situation is appalling. Next to violence and isolation there are also electricity shortages. There is a lack of everything. This makes it even more amazing that people deal so well with physical and emotional threats over many years.
MSF has been working in the Palestinian Territories since 1988.