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Siege and Mental Health: Walls vs. Bridges.

Siege and Mental Health: Walls vs. Bridges. VI International Conference GCMHP and WHO, Gaza City and Ramallah, Palestine, 27-29 October, 2008. The Siege of Gaza in History: Mental Health and Behavioural Implications. By Federico Allodi, MD.

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Siege and Mental Health: Walls vs. Bridges.

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  1. Siege and Mental Health: Walls vs. Bridges. VI International Conference GCMHP and WHO, Gaza City and Ramallah, Palestine, 27-29 October, 2008

  2. The Siege of Gaza in History: Mental Health and Behavioural Implications. By Federico Allodi, MD. Near East Cultural and Educational Foundation Canada. Email: < fallodi@pobox.com >

  3. Outline of the paper • Quotations on history • Some definitions, model and parameters of analysis: (Military, material strength and supplies Psychological preparation Strategy: attackers and defenders Group psychology: cohesiveness and divisions. Mental health and behavioural aspects Stress disorders Stress responses in defenders and attackers. Positive outcomes.) 3. Historical review of sieges: Antiquity, Modern and Police sieges 4. The siege of Gaza 5. Conclusions.

  4. History is: • An explanation of changes in a society (Eric Hobsbaum, 1997) • History is a teacher (Herodotus, 440 BC) • History repeats itself (Popular) • History is bunk (Henry Ford, 1916) • History does not repeat itself, but it does rhyme (Mark Twain, 1835-1910)

  5. Definitions • Health is a state of harmony between the biological, psychological and social components of man. (WHO) • Medicine is politics (Rudolf Virchow, 1821-1902) • Public health is politics to the nth power (Rudolf Virchow)

  6. Sieges in antiquity

  7. Siege of Megiddo, 15th Century BC

  8. Siege of Jerusalem by Sennacherib, 701 BC

  9. Babylonians carrying prisoners to exile, 597 BC

  10. Nabuchadnezzar II (the Great) in his city of Babylon. He took Jerusalem in 987 and destroyed it in 597 BC.

  11. Nebukadnezzar, (c 630-562 BC), ruler of Babylon, by William Blake

  12. Flavius Josephus (37-94?), Historian. The Jewish Wars

  13. Flavius Josephus, 70 AD, pleading before Jerusalem

  14. The destruction of Jerusalem by the Romans, 70 AD

  15. Siege of Jerusalem by the Romans, 70 AD. Roman triumphal arch panel showing spoils of Jerusalem temple.

  16. Siege of Ma’arrat by the Crusaders, 1098 AD

  17. Siege of Ma’arrat, 12 December- 5 January,1098-9. Crusaders Throwing Heads Of Muslims Over Ramparts

  18. Siege of Jerusalem by First Crusaders, 1099

  19. The Siege of Jerusalem by the crusaders, 1099. Drawing by Gustav Adolf Dore

  20. Godfrey of Bouillon takes Jerusalem, 1009

  21. Saladin (Salah al-Din), 1138-1193

  22. Statue to Saladin in Damascus

  23. Siege of Acre, 1281

  24. Final surrender of Acre to the Muslims, 1281

  25. Modern Sieges

  26. Surrender of Granada, 1492

  27. Siege of Gibraltar by the French and Spanish June 24, 1779 - February 7, 1783 The Defeat of the Floating Batteries at Gibraltar,, by John Singleton Copley

  28. Siege of El Alamo, Texas,February 23- to March 6, 1836

  29. Siege of Madrid, T-26 republican tank,1936-1939

  30. Savoia Bomber and Fiat fighter planes over Madrid, 1936-1939

  31. Telephone exchange building, Madrid 1936

  32. Siege of Leningrad, 1942

  33. Siege of Leningrad by the German army, 1942

  34. Kreditbanken at Norrmalmstorg Siege, August 23-28, 1973 Stockholm, Sweden.

  35. Swiss Bank Robbery Hostages,1974

  36. Patricia Hearst, 1974. As Nadia in a Symbionese Liberation Army poster.

  37. London Spaghetti House Siege, 1975

  38. Siege of Sarajevo, 1992 to 1996. People under Serb snipers’ fire. (It claimed 12,000 lives)

  39. Motives for the Siege(Sarajevo, 1992-996) • Land appropriation • Property grabbing • Removal of the Other people (Ethnic Cleansing) • Elimination of the Other (Genocide)

  40. Damage to understructure and supplies by Serbian Army (Siege of Sarajevo, 1992-1996) • Five main hospitals • Electric plants, university, transportation • TV towers, banks • Flour mills, bakeries, candy factories, • Theological schools, mosque. • Blocking off humanitarian aid

  41. Traumas to children. (N: 65-60 000 children. Percentages)Siege of Sarajevo, June 1992-Feb 1996. • Saw some one shot by sniper --------- 40 • Saw someone killed ------------- 51 • Saw family member killed ----------- 39 • Saw house occupied by some else -- 48 • Had house attacked by soldiers ----- 73

  42. Gaza, 2007. Destruction of hydroelectric plant.

  43. Gaza Siege, 2007. Father carrying body of his dead child. Erez check point.

  44. Health determinants Siege of Gaza, 2066-2008 • Population density: --------- 3823 /sq. km. • Pop. Child 17yrs./adult proportion --------- 50% • Income per capita: ----------- $2.00 day • Unemployment: ----------------------- 60-77% • People without sufficient food: ---------- 70 • Pop. depending on UNRWA basic food ----- 80 • Pop. without access to water: (over 2/3) 70 • Pop. suffering from malnutrition ----------- 48 • Houses not connected to sewers ----------- 22 • Houses in OT demolished by IDF(2000-2007):4170

  45. Health care services determinantsSiege of Gaza, 2006-2008 • Pop. without medicines medicines --- 8% • Pop. Without medical services ------ 38% • Availability of drugs for med. trea’t --- 31% • Availability for essential drugs ------- 0.% • State health empl’es without reg. pay-90% • Patients with emerg/chronic illness requiring trea’t denied exit fr. Gaza--17.5%

  46. Children’s physical health and illness statusGaza, 200-2007 • Malnutrition ----------- 50% • Increase diarrhoea/dysentery -- 150% • Anaemia ----------------------- 70% • Rate protein supplies exhausted--100% • Change in weight at birth ----- • Infant mortality -------------

  47. Children’s mental health statusPeriod prevalence.Gaza, 2006-2008 • Anxiety disorders and fear symptoms • Social withdrawal • Regressive and clinging behaviour • Enuresis • PTSD • Other trauma related disorders Overall rates child population --- 68-90%

  48. Violence turned inwards.West Bank and Gaza, 2004-2006 Women physically abused. W. Bank ----- 24% Gaza ---- 23% Women Sexually abused. W. Bank ----- 12% Gaza ----- 23% Increased rate since 2006 to 2007 ------- 400% Collaborationism and Spying. (No data) Factionalism and splitting. (No data) Tortured becoming torturer (Clinical vignettes)

  49. Casualties and harm to attackers • Physical Deaths • Injuries and mutilations • Psychological Anxiety, fears • Moral blunting, callousness • PTSD (Beware: Criterion A) • “Moral degeneration” • Social refusenicks • Witness soldiers of the “dirty war” • Factionalism and splitting • Soldiers and veterans: Increased suicides Increased homicides. Family and social violence (Vignettes)

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