Nuri Mustafa a Research Associate at the Ayaan Institute highlights the lifelong trauma that Palestinian survivors of genocide face.

Beyond PTSD: Recognising the Chronic Trauma of Palestinian Children Amid Ongoing Displacement and Genocide.

The genocide of Gaza has murdered, injured, and destroyed Palestinians and their land causing an unspeakable amount of trauma. However, the trauma experienced by Palestinians has been ongoing since 1948 (United Nations, 2023a). It has been half a century since Israel occupied the West Bank, East Jerusalem, and the Gaza Strip (Global Centre for the Responsibility to Protect, 2024). Israeli policies are designed to maintain Jewish Israeli control over Palestinians (Zhou, 2023). According to Levine and Cheyfitz (2017), the term “apartheid” is now often used to describe Israeli control over the Occupied Territories. Considering the collection of laws and policies enacted by Israel to consolidate its rule over Palestinians, the Israeli regime has been characterised as an apartheid regime (B’Tselem, 2021). Israeli Apartheid privileges settlers while deliberately oppressing Palestinians (United Nations, 2022; Zhou, 2023). Even worse in terms of international law is the Israeli persecution which includes the systematic and institutionalised regime of oppression and domination that extends beyond apartheid (Amnesty International, 2022). Israel’s war crimes and crimes against humanity include persecution on political, racial, and religious grounds, racism, the denial of education, collective punishment, detention without trial, home demolitions, extrajudicial executions, torture, kidnapping, theft (of land, money, and resources), and a massive settlement complex, to name a few (Levine & Cheyfitz, 2017). According to Amnesty International, Israel imposes tyranny and dominance on Palestinians in every place it controls. Examples include forced transfers, denial of resident rights, travel restrictions, territorial fragmentation, and wrongful deaths (Amnesty International, 2022). The persecution extends beyond the traditional understanding of apartheid, encompassing a broader range of human rights violations and oppressive practices that violate international law (Human Rights Watch, 2023).

The ongoing genocide in Gaza, as recognised by the International Court of Justice (ICJ, 2023), can be seen as an escalation of this long-standing persecution. South Africa’s submission to the International Court of Justice (ICJ) on Israel’s activities in Gaza states that Israel breached the Genocide Convention by committing and continuing to commit genocide against Palestinians in the Gaza Strip (United Nations, 2023b). The ICJ deemed it plausible that Israel’s conduct in Gaza may be classified as genocide in 2024, marking a turning point in Israel’s occupation (United Nations, 2024). The ICJ issued provisional measures in January 2024 directing Israel to stop crimes of genocide and guarantee that humanitarian aid reaches Palestinians in Gaza (International Court of Justice, 2023; Amnesty International, 2024). Human rights groups report that Israel has disregarded the ICJ’s directives despite this decision, thereby continuing their genocidal acts (Human Rights Watch, 2024). In recent years, Israeli police have used live fire to shoot and murder Palestinian children along the Gaza border. A report by Defence for Children (2024) showed that 20% of all Palestinian children killed in the occupied West Bank, including East Jerusalem, since 2000, have been killed since 7^th October 2023 at a rate of one child every two days (Defence for Children, 2024).

Currently, humanitarian aid to Gaza has never been more urgently needed. Airstrikes within authorised humanitarian zones demonstrate that there are no safe zones for Palestinians (Moran, 2025). Between October 7, 2023 and August 31, 2024, 84% of Gaza was under evacuation orders (Forensic Architecture, 2024). About 1.1 million Palestinians in northern Gaza were given barely 24 hours to move to the southern portion of the Gaza Strip when the Israeli military issued an unprecedented evacuation order on October 13, 2023 (OCHA, 2024). Given the relatively short timescale, the sheer number of individuals involved, and the inadequate infrastructure available for such a major relocation, this order was widely criticised as being impossible to accomplish and potentially having disastrous humanitarian effects (Guterres, 2023). The International Committee of the Red Cross (ICRC) also released a strong statement, warning that the evacuation order and the full siege of Gaza were in violation of international humanitarian law. The ICRC also emphasised that Gaza is a closed area with limited resources, making it nearly impossible for many residents, particularly vulnerable groups like the elderly and disabled, to evacuate safely (ICRC, 2023).

From October 7, 2023, to February 3, 2025, Al Jazeera reported that the death toll in Gaza had reached 61,709, which includes 14,222 individuals who are missing or presumed dead under rubble (Al-Jazeera, 2025). Even after a temporary pause in hostilities in Gaza, the bloodshed continues; bombings and military activities have killed individuals, including babies (Save The Children, 2025). Rather than being the consequence of isolated incidents, this represents a persistent and unbroken cycle of violence. Palestine is the world’s deadliest country for children and UNICEF (2023) describes Gaza as a “graveyard” for children. According to the March 6, 2024, ICJ application instituting proceedings against Israel, more Palestinian children were killed in the first three weeks in Gaza alone (a total of 3,195) than the total number of children killed in all conflict zones worldwide since 2019 (United Nations, 2024b). Case studies of children in Gaza who lose sleep because of hearing aircrafts or seeing murders reinforce a sense of dread and hyperarousal (Farajallah, 2024). Israeli drones, known locally as “Zanana,” continuously hover overhead, according to Gaza residents. People link the sound with impending violence, which causes them great fear and anxiety (Solaimane, 2025). Israeli soldiers in Gaza have used the unnerving psychological warfare method of luring Palestinians outside with drones that simulate the sounds of a wailing baby before shooting them (NDTV, 2024). According to Staff (2024), Israeli snipers and drones targeted locals who went outside to assist or investigate.

The Trauma of Genocide

In addition to the death toll of Palestinians, the survivors are left to deal with significant and lifelong trauma. Palestinian children and adolescents are more likely to develop Post-Traumatic Stress Disorder (PTSD) because of persistent exposure to political violence and protracted war (Marie et al., 2020). MSF psychiatrist Dr. Juan Paris underlined the widespread psychological toll on Gaza’s population, stating that 60-70% of young Gazans suffer from PTSD, 90% from other stress-related diseases, and around 40% from mood disorders. He also highlighted the increasing number of suicides and suicide attempts, which go unreported since mental health is stigmatised in Palestinian society (Hanona, 2021). This is consistent with broader findings that the persistent violence, displacement, and scarcity of safe spaces in Gaza lead to a stigmatised and ubiquitous mental health environment that exacerbates the issues faced by both adults and children (Qutishat, 2025).

According to Qouta and Odeh (2005), young people in Palestine had major mental health issues even before the genocide began, with 33% suffering from acute PTSD, 49% from moderate PTSD, and 15.6% from low PTSD. As for recent years, El-Khodary et al (2020) state that 53.5% of youth suffer from PTSD. Furthermore, El-Khodary and Samara (2019) discovered that a significant proportion of the sample’s children—64.5% at home, 48.2% in the neighbourhood, and 78.2% at school—were subjected to violence. 53.5% of patients experienced PTSD, as defined by DSM-5 criteria. Exposure to bombing had the strongest predictive effect on children’s responses to PTSD, which is a constant action in a battle zone. Thabet et al (2002) found that children who experienced home bombardment and demolition had a much higher prevalence of PTSD symptoms (59%) than controls (25%). A study by the United Nations (2003) found that nine out of ten parents saw symptoms of traumatic behaviour in their children, such as hyperactivity, nightmares, bedwetting, and increased aggression.

Beyond PTSD: from “Post” to “Continuous”

The Head of the Palestinian Ministry of Health’s mental health unit challenged western definitions of trauma and the clinical diagnosis of PTSD for not reflecting this reality of Gaza (McKernan, 2024). It is vital to acknowledge the reality of continuous trauma which extends beyond PTSD. Complex PTSD (CPTSD) can affect both adults and children (Jones et al, 2024). CPTSD differs from PTSD in that it is permanent and caused by recurring bombings, loss of loved ones, and systemic oppression (Cleveland Clinic, 2023). Cumulative childhood trauma was found to be more closely connected to CPTSD than PTSD. According to Dr. Samah Jabr, chair of the Palestinian Ministry of Health’s mental health branch, there is no “post” for Palestinians because the trauma is recurrent and continuing (Bosqui et al., 2024). This term refers to repeated and prolonged exposure to several traumatic events or situations, which often begin in early childhood and last for an extended period. The Palestinians’ ongoing psychological pain is more akin to Complex Continuous Trauma (CCT) or Continuous Traumatic Stress (CTS) than PTSD (Cloitre, 2020). It is vital to acknowledge the continuous nature of the trauma that Palestinian children experience to understand the psychological effects of genocide, siege, apartheid, and expulsion on Palestinian children. Instead of having a single traumatic experience, Palestinian children are constantly exposed to violence, displacement, and instability. CPTSD symptoms include emotional dysregulation, relationship problems, negative self-perception, self-identity disturbances, hypervigilance, avoidance behaviours, flashbacks, physical symptoms, intimacy and trust issues, and feelings of helplessness and hopelessness (Farajallah, 2024). They are continuously stressed due to trauma. Victims who are regularly exposed to danger without appropriate support to understand what is going on are imprisoned in a world where re-victimisation is routine, as opposed to PTSD victims, whose anxiety is anchored in previous experiences with little to no chance of repeat.

Almost two decades of a blockade coupled with regular Israeli assaults on Gaza has had a cumulative effect on Gaza’s children, causing continuous mental trauma (Farajallah, 2024).  According to Jason Lee from Save the Children’s Country Director, children are in shock and anguish, and this conflict is “further eroding their resilience,” adding to the trauma they have already undergone from almost two decades of blockade and cruelty (Save the Children, 2024). The fact that many studies on Palestinian trauma do not use the term CPTSD directly but do describe experiences and symptoms that are more compatible with CPTSD than regular PTSD emphasises the importance of context-specific understanding and measurement of trauma in this population (Ahmead et al., 2024). For example, a context-specific trauma scale for Palestinians produced by Mahamid et al (2023) found five trauma dimensions: physical symptoms, psychological symptoms, avoidance/numbing, hyperarousal, and re-experienced trauma. These findings are consistent with the broader symptomatology of CPTSD because they address persistent and cumulative stresses unique to the Palestinian context (Mahamid et al., 2023). Another study on Palestinian children in Gaza found that 53.5% met the DSM-V PTSD criteria, and 88.4% had experienced personal trauma; nevertheless, due to their severity and chronicity, many of the symptoms were like those of CPTSD (El-Khodary et al., 2020). Sarhan et al. (2024) also found that Palestinians whose homes were destroyed had much higher rates of PTSD, with many of the participants expressing distress and emotional dysregulation symptoms consistent with CPTSD. It highlights how long-term military brutality affects mental health in ways that differ from traditional PTSD theories. Even though PTSD has been extensively studied, these studies indicate that CPTSD is more likely to be the source of the reported symptoms, which are produced by chronic and repetitive trauma. It can be difficult to use Western-centric diagnostic approaches to detect trauma experienced by Palestinians because their ability to capture the systemic and chronic character of trauma in regions like Gaza is limited given its ongoing nature (Agbaria et al., 2021). This could explain why the CPTSD diagnosis has been misrepresented as PTSD.

Misrepresenting Palestinian Suffering

Media portrayals of Palestinian trauma have often been misleading and may have also contributed to the misdiagnosis, highlighting the diagnosis of PTSD as an immediate reaction to the violence rather than acknowledging the persistent and generational character of the suffering. Ahmed’s (2023; 2024) work on Western media complicity in the suffering of Gaza shows how the Western media routinely downplays Palestinian trauma. As Edwards (2023) argues, Palestinians are objectified as victims of humanitarian crises rather than as people living under long-term, chronic oppression, and they highlight the media’s proclivity to sensationalise Palestinian suffering by focusing on pain and loss, often without historical context or accountability. For instance, an article from The Telegraph demonstrates the focus on the immediate crisis, such as hospitals caught in crossfire (Ostrovsky, 2023), without holding anyone accountable or offering a comprehensive grasp of the systemic oppression Palestinians endure. Instead of tackling the underlying reasons for Palestinian misery, this kind of Western reporting runs the risk of dehumanising them and making them a spectacle. Furthermore, a report on British news media coverage found emotive terms such as “atrocities”, “slaughter”, and “massacre” were 11 times more likely to be used when describing Israeli victims compared to Palestinians, despite the significantly higher Palestinian death toll during the period examined (Sjöbeck, 2025).

Western media usually minimises Palestinian suffering by stressing short-term wounds or unhappiness without taking the long-term psychological impacts into account (Zeidan, 2024). Instead, they characterise Israeli actions as “responses” and downplay their gravity (Nashed, 2023). News outlets regularly fail to offer critical context on the occupation, blockade, and systemic violence that preceded events like 7^th October 2023 (Mir, 2024). This recurring trend, which has been seen for over a year in the genocide, demonstrates how the media continues to under-represent the chronic nature and depth of Palestinian trauma, lowering public knowledge of the conflict’s long-term psychological consequences.

This media pattern mirrors a larger political logic in which the discourse is continuously biased in favour of Israel by omitting the historical and structural background of the occupation (Falah, 2023). Israeli violence is depoliticised and decontextualised when it is presented as a “response” to Palestinian aggression rather than as a component of a long-standing system of blockade, dispossession, and apartheid (Darojat & Widhiatama, 2025). This narrative framework portrays Israel as a state that is only protecting itself and Palestinians as provocateurs (Kareem & Najm, 2024). In the context of the ongoing genocide, this framing implies that the story begins with the events of 7^th October 2023, rather than the decades of systematic violence that came before it (Aksunger, 2024). As a result, the public’s perception of Palestinian suffering is skewed, making it more acceptable, abstract, and eventually unimportant (Ali et al., 2021).

There is a clear media bias in the coverage of the genocide in Gaza with a disproportionate lean towards pro-Israeli framing and narratives (Javed, 2024). The passive voice is widely used by Western media to describe Palestinian victims, dehumanising them and denying them agency.  In contrast, the active voice is usually used to describe Israel, giving Western readers a sense of justification for their activities (Osman, 2023). Israelis are frequently portrayed as victims of massacres and atrocities, while Palestinians are simply described as having “died” (Cathcart, 2024). The tendency of the media to report violent stories sensationally reinforces the belief that using force to defend oneself is justified (Gannot, 2014). Some western media coverage often exaggerates events without providing the necessary historical context or addressing the root causes of the conflict. This approach, as noted by Gilboa and Sigan (2024), can lead to false or misleading reports that fail to capture the full complexity of the situation. This selective narrative upholds a racially unequal value of human life while disregarding the long-term psychological toll on Palestinians (Arash Javanbakht, 2024). By creating support for Israel’s activities, Western media has essentially joined the genocidal apparatus and contributed to the escalation of Islamophobic views (Al-Jazeera Staff, 2024).

Global perceptions of Palestinian trauma are strongly impacted by this media framing, which isolates violent occurrences and deprives them of their larger historical context (Matar, 2025). Rather than acknowledging the ongoing, generational nature of Palestinian suffering rooted in decades of displacement, occupation, and systemic violence, such coverage reduces the trauma to isolated incidents (Warshagha et al., 2024). This narrative disregards the chronic, compounded psychological effects on Palestinian children, who live in a state of constant fear, instability, and loss (Abudayya et al., 2023). The result is that the trauma of Palestinian children is framed as an episodic, reactive condition rather than a continual, deep-seated wound shaped by years of oppression (Vostanis, 2003). The media’s selective representation therefore generates a cycle of neglect that ignores the long-term psychological effects of living under occupation and displacement (Barron et al., 2016) and leads to a global misperception of the extent of Palestinian trauma (Allan & Bishara, 2024).

Trump’s Gaza Proposal: Echoes of Ethnic Cleansing

Given recent events and the ongoing risks to Palestinian stability and well-being, it is critical to identify the trauma they have experienced as CPTSD rather than PTSD. Their pain continues, despite a recent ceasefire accord that provided some relief. Furthermore, Trump and Netanyahu’s plans to relocate Gazans are congruent with previous and ongoing Palestinian displacement patterns reminiscent of the 1948 Nakba (B’Tselem, 2025).Their ongoing trauma and displacement will be exacerbated by Trump’s plan to relocate Palestinians (Kent, 2025), emphasising how complex and long-lasting their suffering is. Such a plan, involving forcible displacement, would add to the continual cycle of dislocation and instability experienced by Palestinian children, exacerbating CPTSD symptoms, such as difficulty managing emotions and maintaining a sense of security (Jones et al., 2024). A study of Palestinian refugees in Jordan discovered that living conditions in refugee camps, such as exposure to violence, poverty, and overcrowding, have a significant influence on mental health, equal to the consequences of direct combat exposure (McKell et al., 2017). This demonstrates that political leaders ought to consider the mental health effects of their policies regarding Palestinian land use and relocation.

Strengthening Mental Health Support in Palestine

Even before the genocide in Gaza began, there was a chronic shortage of mental health services in Palestine. The prevalence of mental illness has increased in Gaza due to the genocide. Nonetheless, mental health services are still inadequate and thinly distributed (Medical Aid for Palestinians). In 2024, nearly all of Gaza’s estimated 1.2 million children required psychosocial and mental health support (ACAPS, 2024). The World Health Organisation (2024) estimated that in 2025, 452,600 people (22.1%) in the Gaza Strip would have mental health disorders, according to prevailing estimates of mental disorders in war settings. Globally, advocacy and awareness of Palestine’s mental health services are essential. Organisations such as the Palestine-Global Mental Health Network are working to highlight psychological lessons from Palestinian colonial traumas by establishing a global alliance for mental health advocacy (Khouri, 2024). Since the problem has existed for decades, well before the genocide even began (Afana et al., 2004), international efforts should concentrate on assisting organisations that provide mental health training and consultation in Palestine and keep pushing for the inclusion of mental health services in public healthcare in Palestine (Akita et al., 2021).

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