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While the deadly has come to an end, the psychological trauma lives on.

At least 234 Palestinians, including 66 children, were killed in the most recent , with 450 children wounded. Eleven of the children who died were receiving mental health support to tackle trauma from previous wars.

According to Save the Children, are suffering from fear and anxiety, sleep deprivation, and are exhibiting worrying signs of distress, including continuous shaking and bedwetting.

The Israeli military assault completely destroyed in Gaza and partially demolished at least 14,300 others. Fifty-one schools were damaged by airstrikes, impacting 41,897 children, with schools being forced to close and used as shelters.

"The definition of PTSD does not apply to Palestinians in Gaza. We experience continuous stress and trauma all of the time so there isn’t really a 'post'"

The intensity of the recent bombardments, which Palestinians say were the worst they have seen, will have a devastating impact on children and their families for generations to come.

At least 90 per cent of Palestinian residents are in need of mental health support and treatment as a result of repeated Israeli military attacks and dire humanitarian conditions in Gaza.

Dr Khaled Yousef Melad, a Palestinian psychiatrist from the besieged territory, said that Gaza experienced what amounts to a psychological war.

“Psychological wars have more of a long-lasting effect than widespread destruction. In fact, psychological disability is more harmful than physical disability,” Dr Melad told ������.

Recent studies show that in a population of approximately - where more than 40 per cent are under 14 years old – around 60 per cent suffer from post-traumatic stress disorder (PTSD). More than 55 per cent of children suffer from anxiety.

“In the last 20 years, children in Gaza have been subjected to recurrent wars, violence and aggression by the Israeli army. This exposure to war has resulted in catastrophic disorders in children including depression, anxiety, acute stress disorder and PTSD,” said Dr Melad.

According to a study published last year in the Swiss scientific journal , 90 per cent of Palestinian children and adolescents in the Gaza Strip had experienced personal trauma, and more than 80 per cent had witnessed the trauma of others.

Children who experience the immediate trauma of war in Gaza exhibit behavioural disorders which take many forms, such as extreme anxiety, fear of the unknown, insecurity, isolation, bedwetting, and aggressive behaviour.

“Children who face psychosomatic symptoms, psychological problems, social problems and functional problems will regress back to their earlier stage of development,” said Dr Melad.

Earlier research by Save the Children after the war in 2014 found that after a year, seven out of ten children in the worst-hit areas in Gaza continue to suffer from nightmares, and 75 per cent were still bedwetting regularly.

"I am only 10 years old, and I have been through three wars. I still feel scared and fear that they will start bombing us again"

Research in 2019 found that 63 per cent of children regularly experienced nightmares and 42 per cent of children lost the ability to speak.

“The definition of PTSD does not apply to Palestinians in Gaza. We experience continuous stress and trauma all of the time so there isn’t really a ‘post’,” said Dr Melad.

“What we are witnessing in Gaza is what we call complex PTSD which is a form of PTSD diagnosed in adults or children who have repeatedly experienced traumatic events,” he added.

“The continuous exposure to wars and unresolved trauma from previous wars leads to many symptoms such as difficulty in concentration, problems with self-perception such as feelings of shame, guilt, helplessness, stigma and a sense of being completely different to other human beings.”

It has always been difficult for children in Gaza, even before the most recent . Indeed, for many children, this is the fourth war that they have experienced in their short lifetimes.��

Nadine Abdel-Latif, whose emotional video during the war was widely shared on social media, is one of them.

“I am only 10 years old, and I have been through three wars. I still feel scared and fear that they will start bombing us again,” she told ������.

“I still hear the sounds of bombs and airstrikes in my head. Sometimes I can’t even sleep. I wake up in the morning wondering if I am dead or alive.”

“As a child, I shouldn’t have to think about death but because of what we went through and what we are still going through, us children have no option but to think about death and losing our loved ones,” said Abdel-Latif.

… The 10-year-old girl, Nadine Abdel-Latif, from , talks about the suffering of her generation in Gaza, after the occupation's bombing of her home .. She said:

— سعيد بشارات Saaed Bsharat (@saaed_bsharat)

Playing is important to the development and well-being of children in any context. The for children to play and feel safe impedes their social emotional interaction with peers, thus leading to a detrimental impact on their mental and physical well-being.

Nadine Abdel-Latif said that although there is a ceasefire, she and her friends continue to experience persistent fear and cannot enjoy a normal childhood.

“My friends and I don’t want to leave our houses. We are scared to leave the house even now. I am scared to play outside, and I’m scared to stay inside and play,” said Abdel-Latif.

The prolonged adversity which children in Gaza have been exposed to in the last decade, as well as unresolved psychological and emotional trauma, has had a severe impact on their cognitive development, learning and memory.

“It is important to note the impact that these wars have on the foetus in the mother’s womb. Many psychological disorders are a result of the exposure of mothers to stress,” Dr Melad says.

“The greatest stress that they are suffering from in Gaza is a result from the recent war as well as previous wars, this will increase the incidence of many psychological disorders in children such as autism, intellectual disability and attachment disorder,” he adds.

“The next few months will see an increase in psychological disorders amongst newborns and this will have serious effects on their development”.

There is a mental health crisis among children in Gaza, reflected by the alarming demand for psychosocial support for children and their families.

"I still hear the sounds of bombs and airstrikes in my head. Sometimes I can't even sleep. I wake up in the morning wondering if I am dead or alive"

The daily hardships of electricity cuts, a lack of water, medicine shortages, in addition to the destruction of homes, create an immense fear of the future for children.

According to the Norwegian Refugee Council (NRC), children who survived the offensive are very likely to relive the experience of bombing almost every day.

But the blockade on Gaza means that young people are unable to access appropriate treatment and support for underlying mental health issues.

Unable to enjoy a normal childhood, Palestinian children in Gaza live in constant fear. They can’t enjoy the basic freedoms taken for granted elsewhere, such as playing safely with friends or going to a park.

When asked about what it would take for her to feel like a child again, Nadine responded: “it is impossible to have an answer for this question in Gaza.”

Razan Shamallakh is a freelance journalist and holds an MA in Conflict Resolution in Divided Societies from King's College London

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