In a small smoked-filled café in Cairo six months after the start of the latest Israeli-Gaza war, I sat with Dr. Yasser Abu-Jamei, a soft-spoken man whose suit jacket hung loosely on his light frame. He had escaped Gaza eleven days earlier and had the physique of a man who had not eaten enough for months. When I asked him what the first night out of Gaza felt like, he described how strange it was to wake up and realize he was surrounded by walls and a roof rather than the flapping of a tent. He, his wife and their six children, along with 15 other families, had spent the past three months in a makeshift encampment in Rafah, in the southern Gaza Strip.
As early as the afternoon of October 7th, when word first broke of Hamas’s attack on Israel, Abu-Jamei had a troubling sense of what might follow. His house sits not far from the Israeli border, and he and his family fled on that very day with little more than the clothes they were wearing. After a short stay in a school in Rafah, they went in search of a better place to live. They ended up dropping their belongings on a piece of empty land near a bit of running water. Under the circumstances, this amounted to a luxury.
Despite Israel’s monthslong attacks on Gaza, the house that Abu-Jamei and his family left behind remained untouched all through the long months they stayed in the tents. The home was still standing the day they arrived safely in Egypt, the war far behind them.
But as Abu-Jamei knows better than most people, one cannot simply leave a war behind, and attempting to will away its psychic effects is an illusory trick. He has spent his career studying trauma, war, and the psychological damage caused by violence. As a psychiatrist, he began working with patients scarred by Israel’s 2014 war with Gaza. For the past decade, he has been the director of the Gaza Community Mental Health Program, a mental health service provider in Palestine that affords counseling and resources to countless patients in the region.
During his first night in Cairo, sleeping quietly in a bed far from the cold night air and the flapping of the tent, the fact that he was safe provided only so much comfort. He could not help but think of his uncles and cousins who were still in tents. “I could not split both feelings,” he said. “I felt ashamed that I was out. I still feel guilty. There is survivor guilt. And that is a very uncomfortable feeling, you know?”
Abu-Jamei’s own work taught him not to be surprised by the intrusion of such thoughts. Over the years of conflict in Palestine, he’d spent many hours working with children and adults who were traumatized. Adults, he explained, could talk through their feelings and thoughts, but children often didn’t have the language or understanding for such conversations, even if they had the very real need. So, he and his colleagues would use puppets for them to act out their emotions. When words failed, they used toy planes and tanks to allow the children to construct physical scenarios. At times, however, during the most recent bombings it was almost impossible to find toys for this work.
Abu-Jamei explained how, paradoxically, it was often when the worst bombing was over that people began reacting to the trauma. In moments like this, there was time to reflect rather than simply revert to survival instincts. That is when Abu-Jamei’s work was most important and most sought. Now that he is in Egypt, he plans to implement a telephone help line that his center has run for years but was routinely rendered useless during the war by a lack of electricity and Wi-Fi. The hope is to establish a secure phone line to psychiatrists outside of Gaza who can answer calls and work with patients stuck in the war zone.
Most people in Gaza have not been as fortunate as Abu-Jamei in finding the means to flee the war. He is the first person to recognize his privilege in being able to pay the steep price to leave, and although he is better off than many, it was still a considerable burden for him. During the ongoing bombardment of Palestine, the Rafah border crossing has emerged as the sole route out of the country. But only the fortunate few with money, foreign passports, or approved medical reasons have managed to cross this border into Egypt. The fees to cross are roughly $5,000 per adult and $2,500 per child—a sum that is out of reach for most. The “travel bureau” tasked with facilitating crossing is Hala Consulting and Tourism, an Egyptian company with reputed ties to the Egyptian security services. Once the fee is paid, a name is added to a list. Every night, those who have paid check the list on Facebook pages and Telegram channels to see who will be able to cross into Egypt the following day. If you’re lucky, you’ll be among the hundreds that cross the border every morning at Rafah.
It wasn’t until he arrived in Cairo that Abu-Jamei learned that his house had, in fact, just recently been destroyed. He and his wife spent 17 years carefully building and decorating their home. Whenever they had a bit of extra money, they put it toward a new improvement on the building—a second bathroom, a new sofa, a special refrigerator. Like many other Gazans, he kept tabs on his neighborhood during the war by looking at videos that Israeli soldiers posted on TikTok. He pulled out his phone as we talked and showed me a TikTok posted by a member of the Israel Defense Forces. It shows a truck barreling down a dirt road, empty lots and homes on either side. “See, there,” he says, pausing the video. “That’s our house.” On that day, at least, he knew because of the timestamp of the video that his home was still standing.
But the next series of photos he shows me are of rubble. His cousins can be seen walking across a pile of cinder blocks that had once been his house. “They went to search to see if they could find anything worth salvaging,” he said. But all they were able to find were one or two mismatched earrings and a brooch—“presents I’d bought for my daughters over the years” when he’d traveled abroad to give a lecture or attend a conference. “I traveled often for a Gazan, maybe twice a year, and I always brought them back gifts.”
It’s late, and Abu-Jamei and I have been speaking for several hours. The café had filled with young people clustered around tables, talking animatedly. Downtown Cairo was full of life: strolling shoppers, fashionable women walking next to young religious scholars, exuberant soccer fans watching the latest match at packed sidewalk cafes. We stepped outside to say our goodbyes on the street. Abu-Jamei stood still as the traffic of Cairo swerved by and the florescent lights of downtown shops blinked behind him. A calm man amid the noise. He stayed there on the sidewalk, talking as if he were in no hurry to say goodbye, even though I imagine he had a hundred obligations, a thousand things to do. Among them were things to buy: basic household items and new clothing for his wife and children, who were still wearing clothes from the tents. And there were people back in Gaza relying on him for assistance. Finally, he shrugged, smiled gently and stepped out into the street to walk home. Or, what serves as home for now.
IN HIS OWN WORDS
Yasser Abu-Jamei as told to Kira Brunner Don
Most of the population is severely affected psychologically and have physical ailments, but their main concerns at the moment are their basic needs. It’s reported now that in the Gaza Strip one third of the population faces level three famine—this means that there is an urgent need for food support. No one can sleep without food, but now everyone in the north of Gaza—600,000 people—are basically starving.
I lived in a shelter for three weeks, and then moved to a tent, where I stayed with my children and my family for about three months. Tents do not have privacy. Whenever you talk, everyone listens. We were in a place with tents for my uncles and my cousins, we were all next to each other—maybe 15 families together. There is no variety of food; no fruit, for example, and vegetables are very rare and expensive. In December and January we managed to buy chicken only once; fruit only once. One chicken was about 70 shekels or $20. Who can afford that? Since there was no variety of food items, I saw that my kids were losing weight. The whole Gaza Strip was losing weight. You could see it in your friends when you meet them after two or three weeks. And it was a problem, especially for the kids.
During war time, people rarely get mental health services, unless there is a clear instance of trauma. Everyone is preoccupied with safety and finding food. But a couple of weeks after a ceasefire takes place, people notice something is wrong with their kids or themselves, and then they would start to seek mental health intervention. That’s why we usually see an influx of patients or clients two or three weeks after a ceasefire.
I’ll give you a very clear example. A lot of people are always trying to hear news about their loved ones, about their homes, their houses, their neighborhoods—whether people that are missing have been killed, whether they have been detained, whether they are in the rubble. And they hope for the best, of course. So people are between frustration and hope all the time. When a ceasefire takes place, everyone starts to move around and go back to their homes to find out what happened, then they start to face the reality. They lost their house. They lost their loved one. You end up not only homeless but also broken. There is no place to go to. Aid takes ages to come. What can you do? And then people start to show symptoms and they start to come and visit us.
One of the main services we offer is telephone counseling. It’s a toll free line. We were not sure that our colleagues would be able to answer the phones because of the lack of power, so that’s why we have partner organizations in the West Bank we forward our telephone line to so that their psychologist can help our people. It’s a relief.
For the last two months, we sent our psychologist to provide psychological first aid. They go to the shelters, they identify the main issues. The issues that adults and children have are a little bit different—at the moment, adults show anxiety about the future; what might happen at any moment; the bombardment, tanks. They are between desperation and depression. Others feel that there is no way out or that an end is coming close. There are a lot of family quarrels and social issues because of the pressure and the stresses and the lack of resources. A lot of disputes happen in the community. And then there are also sleep difficulties.
Children have different symptoms. Their main thing is fear. They’re just afraid and they long for their normal life. They ask when are we going to go back to school, their neighborhoods, their homes. And there is no answer to that. Then there are behavioral changes. A lot of children, especially the younger ones, become more irritable, more hypervigilant. They are more worried and agitated. They can’t stand still. And they start to be disobedient. They fight more, they become more angry, they become more aggressive. And with the night terrors and nightmares, they wake up in the middle of the night screaming.
My youngest child is two and a half. She used to scream in the middle of the night. The conditions were really terrible. But when we moved to Rafah, the bombardment was less frequent and the nights were calmer, but it was still terrible. The good thing is that there were a lot of children in the community in those fifteen tents where we stayed. So children were spending a lot of time together playing with the sand. My wife used to joke and say that during the day, the tent was like an incubator, and sometimes she called it a greenhouse. It was extremely hot so it was good the kids could stay outside. And in the night, the tents were freezing cold.
And who are the most affected? It’s the vulnerable groups—women, children, disabled people, people with chronic illnesses. As a mental health professional, my eyes are always on the most vulnerable groups because they are more impacted and the psychological implications are more apparent. My team and I try to do our best.
If a ceasefire happens tomorrow, it will take two or three months for caravans to come. And then the authorities, whether local or national organizations—will they prioritize mental health, or are they going to prioritize housing? We are in this struggle all the time. We feel that mental health is not prioritized compared to other health issues like emergency health.
I do think there will be a ceasefire, but look. We live in the least transparent area in the world. You never know what’s happening. You never know what’s on the table. What’s below the table? You never know what the negotiations are really about. And even when a ceasefire is reached, you don’t know what the deal is. That’s historically what I feel. I lead one of the main civil society organizations in Gaza Strip, we’re quite known locally, internationally, quite respected for our work, and we never know what’s happening. So given that, what we have is just hope. And we do have hope, sometimes it’s stupid hope, but what else is there to do? That’s the thing that keeps you running. There is no other way.
