Your questions answered by Dr Mohammed Shaheen, Mental Health Doctor in Gaza

Mohammed Shaheen is a mental health doctor with Doctors of the World in Gaza. For the past seven months, he has lived in fear: will his children still be alive tomorrow? Where will the next strike fall? Now a refugee in the Middle Area, he continues his mission to help the population and bears witness to the horror people experience every day.

HAVE YOU HAD TO FLEE RAFAH SINCE THE BEGINNING OF THE ISRAELI MILITARY OPERATIONS? 

No, not me. But before that, I had to move twice. During the evacuation of Khan Younis 4 or 5 months ago, I had to leave the area where I was living for Rafah. Then in February, when the airstrikes started in eastern Rafah, I moved to the Middle Area, to Deir el-Balah where I now live. I am with my wife, my three children, my mother, my two younger brothers, and my little sister.

HOW LONG HAVE YOU BEEN WORKING FOR DOCTORS OF THE WORLD? 

I have been working for Doctors of the World since 2022, it will soon be two years. I am a general practitioner with a master’s degree in mental health. I studied the integration of mental health into general healthcare services, which is why I started working with Doctors of the World as a mental health doctor. This was in Gaza City, in our office which is now destroyed. We provided psychosocial services and support to institutions across the Gaza Strip.

Our work is not about treating headaches or physical conditions, while ignoring patients’ mental health.

WHAT MEDICAL SERVICES DOES DOCTORS OF THE WORLD PROVIDE IN GAZA TODAY? 

Everything has destroyed since the beginning of the war. There is no healthcare system left in Gaza, not enough medical services, medicines, or even places to give consultations and distribute medicines, no emergency services to help people. Doctors of the World started setting up medical points in Rafah in late January. Initially, we mainly provided emergency primary healthcare. Then we added sexual and reproductive health services, maternal and children health, and mental health support, meaning psychological consultations in individual or group sessions at each medical point. This way, we can care for patients who need mental health interventions or refer them elsewhere in Gaza. For this, we coordinate with other organisations or clinics from the Ministry of Health. But since May, everyone is fleeing Rafah too, so we have launched a new medical point in the Middle Area where we provide the same health services. With the evacuation of Rafah, we had to adapt to intervene where there are the most people, the most needs, to respond as best as we can.

HOW DO YOU MANAGE TO FIND MEDICAL SUPPLIES? 

The security situation is dire in Gaza. If people are suffering, we – as an international organisation offering health services and psychological support – also suffer from the insecurity. We have donations from the WHO, for example, and Doctors of the World has also been able to transport medicines to Gaza. But our stock was stolen from our office in Rafah. We are trying to manage the shortage and replenish our stock from other international organisations. But so far, we manage to meet the needs of the people who come to us.

WHAT ARE THE NEEDS OF THESE PEOPLE AND WHAT CAN YOU DO FOR THEM? 

My colleagues in the mental health service are psychologists and mental health workers who provide direct care to patients, organising support and counselling sessions, mental health interventions ranging from psychoeducation to advanced interventions for people who are stressed, depressed, severely suffering from psychosis due to their current living conditions. As a mental health doctor, I oversee the integration of mental health services with doctors, nurses, and psychologists. I help them identify mental health needs during medical exams, refer the most critical patients who need regular follow-up or medications that we do not have in stock to suitable facilities. We also produce training materials for medical staff to respond to this crisis, not only for Doctors of the World but also for other organisations in Gaza, to teach them how to address mental health needs. It is not about treating headaches or physical conditions, while ignoring patients’ mental health. We need to address it.

WHAT ARE THE MOST COMMON CASES YOU ENCOUNTER? 

There are many stress and grief-related disorders. These are normal reactions that become abnormal in certain situations. Like in Gaza, where the violence has been ongoing for too long. It is not just the grief of losing loved ones. It is the pain of losing children, homes, jobs. Everyone in Gaza today suffers from abnormal grief.

Stress symptoms reach extreme levels. We are starting to diagnose multi-traumatic stress disorders. Every day, we encounter significant stress cases, patients suffering from psychomotor agitation, patients with chronic mental disorders, psychotic patients, epileptic patients who need treatments that are unavailable due to shortages. Sometimes we are forced to change the treatment of these people, start from scratch with a new medication while they were being effectively treated for years and their condition was under control. Suddenly they collapse, and we have to find another medication, monitor this treatment, and watch for side effects.

And above all, there is depression. It is everywhere in Gaza at the moment. More than one in five patients we receive has mental disorders. We need to identify these patients and do our best for them. Thanks to our psychologists, we can offer psychological consultations, support sessions, or start short therapy, and prescribe medications. But I assure you there is a real shortage of mental health services in Gaza, and medical services in general. We need enormous help to overcome this situation.

We pray and hope that the fires will cease, that the deaths with stop, that the destruction of what remains will end.

HOW MANY PATIENTS DO YOU SEE EACH DAY? 

When we started with two medical points in Rafah, we could receive 600 to 700 patients per day.

HOW DO YOU MANAGE TO WORK UNDER THESE CONDITIONS, DESPITE THE INSECURITY AFFECTING YOU AS WELL? 

What I want to say here is that even our team suffers from multiple traumas every day. Many of us have lost a loved one, a friend, a family member, we all have lost our homes. And the severe repeated trauma we endure is having to regularly flee from one place to another. Over the past eight months, some of my colleagues have had to move five or six times. So yes, we do our best to help people. We suffer, but we can still help others. We understand what they are going through because we are going through the same thing. We understand their situation, and sometimes this helps to find solutions together. Daily solutions: how to find food, transportation, solve overcrowding problems, hygiene issues, pests that proliferate because there is no wastewater treatment. But we also need help. Our team needs help.

WHAT IS THE CURRENT HEALTH SITUATION IN THE MIDDLE AREA? 

When the Israeli army ordered the evacuation of Rafah, people fled to Deir el-Balah. There is only about fifteen kilometers between Rafah and the Middle Area, but the only road considered safe is the one along the sea, and it is completely packed with cars and carts. It takes two hours to make the journey. The Middle Area has started to become overcrowded. However, the wastewater treatment system, which runs on diesel or fuel, cannot pump the water to the sea due to shortages. The streets are full of sewage. We expect to see outbreaks of diseases, cases of hepatitis A, infectious diseases, skin diseases. Hepatitis A cases, for example, were common among our patients in Rafah. We distributed hygiene guidelines on how to care for the sick, how to break the chain of infection. I believe we will soon have the same cases in the Middle Area because of overcrowding, tent life, and close quarters in the camps.

IS THE MIDDLE AREA STILL THE SAFEST PLACE IN GAZA TODAY? 

According to the evacuation order of Rafah given by the Israeli army, yes, it is the safest area. In reality, we still face indiscriminate bombings, especially in eastern Deir el-Balah. And nothing is entering Gaza. No food, no medicines, no tents. The shortages of everything are starting again. The price of food doubles or triples. Due to the fuel shortage, for example, bakeries cannot operate, and it is impossible to find bread. Everything we still find comes from supplies that entered Gaza in the past months. At the Deir el-Balah market, you will find canned food: white beans, fava beans, canned meat. There is a shortage of fresh food, groceries, vegetables, rice, meat, milk, eggs. I have three children, the oldest is six years old. They have not eaten eggs for two months. We are always looking for solutions to feed them. We try to store some beans. We keep a kilo of rice. But we expect the worst because there is no solution. So many things have been tried. We are losing hope. It is like an infectious disease, everyone in Gaza is losing hope. The Middle Area is not suited for such an influx of population. There is no drinkable water. Even the saltwater used for some hygiene needs, hand washing, and showers is not enough given the number of people in the area. It arrives in homes about once a week to fill containers. People fight for this water. If you can afford to buy it, a thousand liters will cost you 100 shekels, about 25 euros.

WHAT DO THE PEOPLE OF GAZA HOPE FOR TODAY? 

We do not look too far ahead. We try to see the days to come. We pray and hope that the fire will cease, that the deaths will stop, that the destruction of what remains will end. These days, we do not have much faith in the future. We all plan to leave Gaza. Maybe not now, maybe tomorrow, later, in years. Because the lesser destruction caused by previous military escalations ten years ago has not yet been repaired. With what is happening today, we expect it will take a hundred years to solve the problems, rebuild people’s lives, repair homes, shelters, sanitation facilities, wastewater treatment. It is going to take a long time. That is why we are losing hope.

We just want the bombings to stop, to be able to walk in the street, not constantly think that we will die in the next five minutes. There is no school for the children. In the camps, people try to gather the children to play with them, to offer them some support or respite. One of our mental health team members participates in this. But I do not want to send my children there. Nowhere is safe. Even the evacuation orders that say one area is safe and another is not. But it is not just a matter of tanks or ground operations. There are airstrikes and bombings that can happen anywhere, anytime. I am sorry to say this, but I would rather die with my children than have one of them die away from me. My father was ill when the Israeli army conducted its operations in Khan Younis. I had to take him to Al-Aqsa hospital in Deir al-Balah. The only doctor who cared for my father, who treated him, who administered his IV, was me. There was no doctor. No medicine. Nothing. He died in three days. This is not my story. This is the story of all families in Gaza.