Mental Health Nightmare Brewing in Traumatized Kids of Israel-War, Experts Warn

For children in Gaza and Israel who experienced the unspeakable tragedies of the last two months, surviving the war is only the beginning of a long, painful, and unpredictable journey.

Israeli children who were rescued after being abducted by Hamas for several weeks are now working to recover from the trauma of their kidnapping. And although “the danger is now over,” some are already exhibiting telltale signs that they likely will be reeling from the captivity for years to come, Adi Shamia-Atzmon, a clinical psychologist and a member of the team who has treated some child hostages taken by Hamas, told The Daily Beast.

“We saw a lot of disorientation behaviors such as whispering and fears to speak up or speak loudly, which were directly related to the conditions they were held in,” Shamia-Atzmon told The Daily Beast. “The children were really frightened and withdrawn.”

“They looked really like the shadow of a child. They were very tired, very thin, and very hungry,” she added, describing the conditions of the children who arrived at Schneider Children’s Medical Center after being rescued. The facility received many of the women and children who were released as part of the hostage and prisoner exchanges that Israel arranged with Hamas during temporary ceasefires last month.

In Gaza, most children were already plagued with significant mental trauma long before the war began on Oct. 7, having lived through multiple bouts of Israeli bombardment. The U.N. had previously estimated that half a million children needed psychological support in Gaza.

But now, with approximately 85 percent of the population displaced—and living with a constant threat of attacks, a lack of safety and basic needs, and continued exposure to violence—the need for psychological support in Gaza is staggering.

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“We estimate right now that the entire child population is in need of some form of mental health or psychosocial support,” UNICEF consultant Tess Ingraham told The Daily Beast. “It’s definitely getting worse by the day.”

UNICEF staff members say that children in Gaza are exhibiting a range of traumatic stress responses, from children having nightmares to not speaking at all. “Humans are not built to experience this degree of fear and helplessness, repeatedly,” Ingram said.

The toll that the Israel-Hamas war is having on children will have long-term cascading effects, aid workers and psychological staff told The Daily Beast. But the violent horrors of war, including cases of Palestinian children who witnessed their entire families being killed in a heartbeat, are still a lived reality for thousands of Gazan children.

Unraveling

Meanwhile Israel, families and doctors are still unwinding the details of what happened to the hostages while Hamas held them in Gaza. Although Shamia-Atzmon and her team had prepared to receive children hostages—leaning on their previous work with children who have experienced trauma or traumatic injuries—there were no handbooks on what to expect from such a large group of former child hostages, Shamia-Atzmon said.

“It’s important to say that there’s no research or literature in the world on children who came back from captivity in those numbers like this. So we didn’t really know what to expect, we were facing a new territory,” Shamia-Atzmon said. “As professionals, we expected the worst. So we were prepared for the worst,” she added.

Depending on how old they are, some children might exhibit behavior that looks like a kind of regression to earlier developmental stages, according to Shamia-Atzmon. This can include difficulty going to sleep or problems with potty training. Eating issues and separation anxiety can crop up as well, particularly for young children, said Shamia-Atzmon, who specializes in working with children ages zero to 6.

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“Working with young children who have gone through trauma is challenging because some of the experiences are nonverbal and very hard to comprehend at any age, especially when their cognitive and emotional functioning is still developing,” Shamia-Atzmon told The Daily Beast.

That is part of why it is crucial for children of all ages to talk aloud about what happened in order to start processing the horrors of war.

“It’s so important to help children process the experience by addressing it directly at the level of understanding and development of the child,” Shamia-Atzmon said. “It is important always to talk to the child about what has happened, even if we think that he doesn’t understand because he does.”

The team at Schneider is focused on creating these kinds of spaces for children to connect their feelings with what has happened to them—through play, drawing, asking questions, or playing with dolls, all to allow space for children to spontaneously share their own thoughts and questions.

While working with the children who were just released from captivity, psychologists and the team at Schneider were careful to ask for permission before entering rooms, as establishing a sense of safety and stability is paramount in the days after liberation.

“Our main goal from a psychological perspective… was to reassure them and to help them know and feel that they were now safe, being taken care of, protected,” Shamia-Atzmon said.

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The Unspeakable

Parents and guardians in Gaza are also encouraged to talk with their children about the violence they are witnessing and their emotional reactions to it, rather than sidestepping these conversations as if children don’t understand what’s going on.

The focus is on “meeting children where they’re at and not trying to tell them to manage or minimize their feelings but to experience them basically,” Ingram told The Daily Beast. “We’re saying, ‘Right, OK, well you’re feeling angry, that’s fine… How do you want to express that?’”

UNICEF has a number of programs aimed at helping children in Gaza deal with their mental health right now, including those that allow children room for recreational activity, group play, drawing about their experiences and feelings, and individual conversations with service providers.

But providing psychological support in Gaza during Israel’s invasion has been extremely challenging. “It’s becoming harder and harder for service providers to engage… one, because it’s so crowded in the south… but also obviously because of the ongoing bombardment,” Ingram said.

Much remains unknown about how the war will impact children long-term, according to UNICEF. Their experience in this war is unique in that many children and their families can’t flee the conflict, which poses a very particular strain on children’s mental health, said Ingram.

“If you think about a conflict you might experience, maybe an attack on a village or something, you would be able to move away. And that’s not what’s happening in Gaza,” Ingram said. “What we know is that this is new, because there’s a prolonged period where children are being repeatedly exposed to traumatic events, and that really wears down the body’s ability to cope, so this is an unprecedented situation.”

But the psychological ripple effects of the sustained violence—and the children’s inability to escape—are not entirely clear just yet.

“In terms of the long-term impact of that, we don’t really know yet because until it ends, we won’t be able to get a good idea,” Ingram, who called for an immediate ceasefire to allow for an abatement in the violence and for healing, said.

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“Children are being pushed around at the moment with nowhere safe to go, no medicine and hospitals. I think that alone has a tremendous impact on mental mental health. You really can’t have mental health without basic safety and basic access to service.”

Referring to the compounding trauma of living through one war after another, Ingram added that “children in the region are very aware of either the threat to or the total breakdown of security and then live with this additional stress every day.”

John Franchi, a former CIA chief of station who worked in the Middle East, told The Daily Beast that the wartime horrors may very well create an entire generation primed for future cycles of violence.

“That’s gonna be one of the results of this: It’s going to make it that much harder to achieve peace,” Franchi said. “The anger and the rawness of this we’ll be dealing with for some time. There’s significant problems coming ahead of us.”

Although Gazan children have experienced many of the same traumas, responses will play out on a very individual basis over a long period of time, and the same applies to the group of former Israeli child hostages. Much of how children respond to traumatic events depends on what their life was like before the incident, and how it looks after, for instance. All recovery may not happen immediately, with triggers and symptoms emerging and dissipating for years to come.

“It will always be part of their story,” Shamia-Atzmon said.

Many former Israeli hostages are not going back to the houses they lived in, since their homes were destroyed on Oct. 7. Thousands of homes in Gaza have been damaged or completely destroyed in Israel’s attacks, too. And children across the board have lost their parents and other family members, hindering their recovery.

“We have to remember that most of the kids are not returning to their physical home. They have to start anew, go back to a new environment with new people,” Shamia-Atzmon said. “It’s really a long, long journey for them.”