One Year of War in Gaza: Mental scars that will last a lifetime

• War is inflicting lifelong trauma on Gazans
• Almost all 1.2 million children need mental health support
• Adults suffer extreme stress, sleep loss

BEIRUT - Hazem Suleiman lost almost a quarter of his body weight as he and his family fled time and again from Israeli airstrikes in Gaza. But what really worries him is the damage you can't see - the invisible trauma that will mark him forever.

"I won't forget the screams of children and women ... I have nightmares of charred bodies. Horror films do not show this, but it is what happened."

The 26-year-old now lives in a tent in the devastated southern city of Khan Younis, alongside his wife, mother and eight children. They are alive, unlike many neighbours and friends, but that doesn't mean they are unscathed.

"My mental state is very bad, and my children are constantly afraid," he said.

Mona Abu Amer hasn't slept in months for fear of bombs crashing into the flimsy tent where she lives with her husband and three children, also in Khan Younis.

She is so stressed all the time that her hair is falling out. A new mother, she also cannot feed her hungry child.

"My milk has suddenly stopped flowing well because of stress and I can no longer breastfeed," she told Context. "My four-month-old son, Mahmoud, is always crying and I cannot do anything to help him."

A year into the Israeli offensive on Gaza, more than two million people out of a total population of around 2.3 million in the enclave have "either experienced or witnessed violent and traumatic events," said Mohammed Abu Shawish, who leads Medical Aid for Palestinians' mental health support work in the strip.

"Mothers in particular face high levels of anxiety as they are balancing the responsibility of protecting their children with the fear of violence," Abu Shawish said in an emailed response to questions.

Most of Gaza's people have been displaced - some up to 10 times - since the Israeli assault was triggered on Oct. 7 when Hamas militants attacked southern Israel, killing 1,200 people and taking around 250 hostage.

Since then Israeli air and artillery strikes have reduced much of the strip to rubble and more than 41,600 people have been killed, according to the Gaza health ministry. At least 90,000 people have been wounded.

The bald numbers do little to convey the depth of trauma for people who have lived through the destruction. The mental scars, especially for children, are profound, relief workers say.

The U.N. children's agency UNICEF estimates that almost all of Gaza's 1.2 million children need mental health support.

"They have lost their sense of belonging to their family, to their siblings to their parents because neither their mother nor their father or anyone else can provide them with that feeling of safety," said Israa Al-Qahwaji, a Gaza-based mental health and psychosocial support coordinator with Save the Children.

"No one can protect them."

Litany of mental health needs

In June, Save the Children said up to 21,000 children were believed to be missing in Gaza - this includes 17,000 unaccompanied and separated children and 4,000 children buried under the rubble. An unknown number are believed to be interred in mass graves.

Others have been forcibly disappeared, including an unknown number detained and transferred out of Gaza amid reports of ill-treatment and torture, the agency said.

Those that have survived are particularly vulnerable to developing mental health and psychosocial problems, Abu Shawish said.

The trauma children are experiencing may come to define their lives and contribute to a litany of mental illnesses ranging from cognitive and educational challenges to behavioural issues and chronic health disorders, he added.

The mental toll weighs particularly heavy on wounded children.

In April, UNICEF cited data from the Palestinian Ministry of Health showing that more than 12,000 children – or almost 70 children every day – had been injured in Gaza since October.

No time for hugs

Al-Qahwaji said the most important thing for a child's mental health is a sense of safety. That feeling "completely collapsed," when children lost their homes during the conflict, she said.

To combat the extensive and extended exposure to trauma, she provides mental health support sessions, called grounding sessions, and works with children to stop them from dissociating so they can cope with the demands of surviving in a war zone.

But Al-Qahwaji wonders if anything can combat the brutality of the war and the savage existence it is imposing on people. She and her colleagues try, but they too are enduring the same mental and physical hardships.

Small wins are often all they can hope for.

"We see things that might be simple, but for us they mean a lot," she said.

For example, a few weeks ago, a woman burst into tears as she held her child during a support session Al-Qahwaji was leading. It was the first time she had hugged her child since the war began.

"She loves her child dearly but she doesn't have time to think about him," Al-Qahwaji said. "She is only worried about keeping him alive: getting him water, getting him food, and that does not only take up all of your day, but that of the entire family as well."

Suleiman, who used to captain a cycling team, feels the same burden. He now rides his bicycle over long distances every day just to get water and food for his children.

Abu Amer is also intent on surviving but she knows a harsh reckoning is coming.

"What I can think about right now is hoping that we survive," she said. "But even if we survive, we will be haunted by the terrifying memories of this war."

(Reporting by Nazih Osseiran and Menna Farouk; Editing by Clar Ni Chonghaile.)