Since 2001, Palestinian militants have launched thousands of mortar and missile attacks directed against the southern part of Israel, particularly the Gaza area. Most of the attacks have been directed against urban centres, including the town of Sderot, and the smaller agricultural communities such as kibbutzim and moshavim. While these communities are intended to be self-supporting with a high level standard of living for residents, the damage from the attacks, as well as political uncertainty, has overshadowed life in Gaza.
As of 2014, there have been fifty fatalities and more than 1900 people injured from the rocket attacks. Still, the greatest damage from comes from the widespread disruption of life in Gaza as well as the uncertainty surrounding future attacks. Medical studies of people living in Sderot and neighbouring centres have found that almost half of all young people experience posttraumatic stress disorder (PTSD) as well as elevated rates of depression and medical conditions linked to stress.
In describing the emotional problems linked to living in areas affected by chronic violence, including Gaza, psychologists have referred to this as continuous traumatic stress (CTS). Though many people experiencing the repeated traumas linked to war will have enough resilience to avoid developing full-blown trauma symptoms, coping with CTS often depends on how or where the trauma takes place. This includes war zones where the threat of physical attack remains very real and a state of "permanent emergency" exists. Soldiers, U.N. peacekeepers, relief agency workers, people in refugee camps, and even civilians living in these war zones often experience CTS on a daily basis with no relief in sight.
There are different resources that people can draw on to cope with this kind of continuous stress. Along with personal resources like self-esteem, family support, and money saved up for emergencies, they can also draw on national and community resources, including that sense of belonging to a community or a country that can help with coping. After 9/11, the collective trauma that Americans felt over what happened was followed by the sense of all Americans pulling together to cope with tragedy. With natural or man-made disasters, having entire communities mobilize to help survivors can have a powerful factor in promoting recovery afterward.
How effective have these national and community resources been for Gaza residents coping with continuing missile attacks? A new research study published in the journal Psychological Trauma: Theory, Research, Practice, and Policy attempts to answer this question. Written by a team of researchers from Sapir College near Gaza, the study examined nearly three hundred Gaza residents, half of whom were living in Sderot and the other half in kibbutzim. Virtually all of the people studied had been either directly exposed to the attacks (their home had been damaged by a Qassam rocket, or a rocket had fallen right next to them) or reported a high level of exposure (a missile striking their neighbourhood).
What the researchers found was that 40.5 percent of the older residents of Sderot and 27.5 percent of younger residents reported PTSD symptoms though these numbers were substantially lower for kibbutzim residents. One effect that seemed particularly striking was that people who had a sense of belonging to their community, especially people living in kibbutzim, were more protected against the effect of traumatic stress. For people living in Sderot and other urban areas, posttraumatic stress was directly linked to low income.
Since Sderot was the target of most of the missile attacks, it is probably not surprising that residents reported the highest level of PTSD symptoms. Still, according to lead researcher, Orit Nuttman-Shwartz, people living on kibbutzim have the family and community support that makes it easier for them to cope effectively with the continuous threat posed by the missile attacks. Perhaps surprisingly, age doesn't appear to be a significant factor in terms of ability to cope with this kind of chronic threat. Elderly adults who were part of the study did not appear any more vulnerable to chronic stress than younger people despite other life traumas that might have occurred over the years.
These results also relate to the "shared traumatic reality" described by Nuttman-Shwartz in traumatic stress workshops around the world. For both clients and therapists living in places such as Gaza, coping with trauma is part of regular living and therapy often involves sharing different experiences and helping one another rather than in the traditional therapist-patient relationship found in most places.
Considering the mass trauma that can occur following widescale disasters, including Hurricane Katrina, the 2004 Indian Ocean tsunami and 9/11, recognizing that this kind of trauma can affect caregivers as well as people directly affected can be vital in providing treatment. It is also important to recognize the importance of ties to the community to help survivors cope and to help entire communities develop the resources that might be needed in a future disaster.
For people living under the continuous threat of violence or injury, knowing that their community is waiting to help may make all the difference in moving on after the unthinkable happens.