Whenever a door slams, 10 year-old Bissan al-Mansi mistakes it for a bomb dropping. More than a week has passed since the latest round of fighting with Israel in Gaza but al-Mansi says she still has nightmares.
Local psychiatrists said al-Mansi's symptoms were common among many children living in the enclave, who were experiencing lack of sleep, anxiety, bedwetting, as well as a tendency to stay glued to their parents and avoid going outdoors.
Palestinians have lived through several wars with Israel since 2008, which have made healing almost impossible as the causes remain unchanged, say local and international experts. They put the number of children needing mental health help at nearly a quarter of the enclave's 2.3 million population that lives under a crippling blockade enforced by Israel and Egypt, which both control and restrict the Gaza Strip's borders.
Previous studies in Israel also find that Israeli children under continuous exposure to rocket fire in areas near Gaza experience high levels of stress, aggression and anxiety.
The latest bout of cross-border fire, which lasted five days, began with Israeli air strikes against alleged Islamic Jihad commanders in Gaza. Israeli officials alleged more than 1,000 rockets were fired at Israel. In all, 33 Palestinians were killed in Gaza, including children as well as six alleged armed group commanders, while an Israeli and a Palestinian worker were killed in Israel.
There are no safe bomb shelters in Gaza, where over 50% of Palestinians live in poverty and have no other place to take shelter than in their homes. Palestinian officials and international humanitarian organisations have warned that the healthcare system is on the brink of collapse. Access to health services is limited, movement is severely restricted, and the psychological scars run deep, aid groups have said.
"My dreams have changed, they were nicer before," said al-Mansi, who has seen a psychiatrist since the fighting ended. "I have a lot of fear. I can no longer sleep at night."
The girl's house, in Deir al-Balah in central Gaza, was among several homes that had been damaged or destroyed when Israel bombed their neighbourhood after giving residents about 30 minutes to evacuate.
Al-Mansi, one of five siblings, said she was now too afraid to go outside, even if to play with her friends. Before the fighting, she would wake up early eager to go to school, where her favourite subjects are Arabic and history, but since the fighting ended she hasn't returned.
"If someone slams the door, I imagine it is an air strike," she said.
'THEY BOMBED THE WHOLE SQUARE'
According to Hamas officials, the Islamist political party in Gaza, the latest round of Israeli air strikes, which began on May 9, destroyed 100 housing units and damaged 2,000 buildings. The U.N Special Coordinator for the Middle East Process Tor Wennesland condemned the Israeli air strikes that killed civilians, while Israel denied it targets civilians. Wennesland also condemned the "indiscriminate" firing of rockets toward Israel.
Social activists, medics with the Palestinian Red Crescent, and psychiatrists toured areas affected and met with the children and their families to offer guidance on recovery.
"I came here to distract myself from the pressure," said Joudy Harb, 11, as volunteers in cartoon costumes painted the children's faces, played and danced. "They said they wanted to bomb two houses and instead, they bombed the whole square."
According to officials from the UN's Children's Fund (UNICEF), half of the young people in Gaza - around 500,000 children - could be in need of psychological support after 11 days of fighting in 2021 between Gaza's Hamas rulers and Israel.
UN officials and Palestinian mental health experts said that for the sake of all children's well-being and their future, a long-term peaceful solution to the Israeli military occupation is needed, one that prevents a repetition of wars and is sustainable.
Following another round of fighting, Palestinian families said the traumatic symptoms their children endured have worsened.
"Unfortunately, the fear remains planted in their hearts," said Mazeyouna al-Mansi, the girl's aunt.