Strife

The Academic Blog of the Department of War Studies, King's College London

You are here: Home / Archives for women and children in conflict series

women and children in conflict series

Series on Women and Children’s Health in Conflict – Children with craniofacial anomalies in the Gaza Strip: treatment options and access to care.

by

The French medical mission screens the children after their arrival to Gaza Strip, Palestine.
Photo Credit: © 2019 Abdelazeez Noman, PCRF (used with permission).

This article is part of the Strife Series on Women and Children’s Health in Conflict. Read the Series Introduction at this link.

Craniofacial anomalies (CFAs) are deformities that affect a child’s head and facial bones. These disorders are typically present at birth (congenital) and can range from mild to severe, with the most extreme cases threatening the life of patients and requiring immediate intervention. CFAs are considered a major cause of infant mortality and childhood morbidity. In addition, children born with CFAs often suffer from social anxieties that result from their physical appearance, which ultimately negatively affect their quality of life and psychological well-being. CFAs are complicated and, most of the time, require comprehensive and multidisciplinary care by specialized teams to provide the proper care beginning from early childhood. The emotional and psychological well-being of children with CFAs are just as important as the child’s surgical and medical care. Moreover, families of those children have to cope with the surgical procedure and their child’s speech problems, appearance, and experience of bullying.

In Gaza Strip, protracted conflict has created many obstacles to treatment and to accessing care for children with CFAs and their families. Obstacles include: limited financial resources, travel restrictions, lack of local professional expertise, dependence on outside assistance and foreign surgical missions, and an absence of professional rehabilitation centres. All of these increase the physical and social suffering of patients and their families. Additionally, the protracted conflict and deteriorating economic conditions compound the suffering, which results from obstacles to treatment, through additional detrimental effects to the children’s quality of life and psychological well-being.

Research on CFA in the occupied Palestinian territories (oPt) is scarce and the incidence of CFA in the Gaza Strip is not reported. However, consanguinity, which is a common phenomenon in the Palestinian community, was found in a study of orofacial clefts (most common form of CFA) to have a high rate among parents of children with orofacial clefts in oPt. In fact, many international organizations made efforts to create projects addressing the lack of data. This sort of database would be useful in spotting demographic trends amongst Palestinian families with birth defects and in helping to detect environmental and behavioural factors implicated in the development of conditions like CFAs.

With a poverty rate exceeding 53 per cent among Palestinians living in the Gaza Strip, limited financial resources are the biggest challenge for the families of children with CFAs to pursue treatment abroad. Children with CFAs who need surgical interventions in their treatment plan rely heavily on the foreign surgical missions to operate on them. These missions come from the United States, and Europe (often from United Kingdom, Germany, France, and Switzerland). Most missions come to show solidarity with Palestinians, and often are of Palestinian descent. These professionals occasionally travel on their own, but more frequently they participate as part of organizations doing humanitarian work in Palestine. Most of these surgeons come sporadically, whilst some others work more consistently in Gaza.

The main philanthropic organization which provides free surgical care for children with CFAs in Gaza is the US-based Palestine Children’s Relief Fund (PCRF). PCRF’s system for healthcare delivery is bifurcated, either they provide funds for CFA professionals to travel to Palestine to operate on children, or they transport children with complex surgical conditions to the United States for surgery. The foreign missions are hosted by any one of the government hospitals for an average of 5 to 8 days. During their stay, both foreign and local professionals operate together on the patients. As for the cases that require complicated surgical interventions, they join Treatment Program Abroad, where they are sent abroad to receive proper treatment. Following completion of surgery abroad and, sometimes, appropriate rehabilitation, the patients return to Palestine and are followed up with by local professionals.

When the Covid-19 pandemic emerged in early 2020, the Palestinian Ministry of Health (MoH)decided to suspend all elective surgical interventions, except for emergency surgeries, to free up personnel and resources to respond to the pandemic and treat patients with Covid-19. Moreover, the borders of the Gaza Strip have been strictly closed and, concurrently, all planned foreign surgical missions have been postponed to mitigate the risk of virus transmission. This was further complicated by political disputes between the Palestinian Authority and Israel leading to a cessation of security coordination, which is needed for obtaining security permits that allow patients to travel abroad to receive treatment. All of these events have had a serious impact on children with CFAs.

For almost one year, and still, to this day, children with CFAs in the Gaza Strip, unless in a life-threatening condition, have not been able to receive adequate, timely healthcare services. They are left with no other choice but to wait while suffering from pain and dysfunction, which prevents them from living a normal life and practicing their daily activities. This will have serious consequences on their health such as dehydration, loss of appetite, and weight loss. What’s more, these children are at great risk of growing up with psychosocial problems, because their facial deformities expose them to higher rates of social and emotional problems. This has had a damaging effect on their lives and personalities.

Treatment options and access to care for children with CFAs in conflict-afflicted settings like the Gaza Strip is severely restricted and largely dependent on foreign missions. This limitation was clearly illustrated and accentuated during the Covid-19 pandemic when foreign missions stopped coming to Gaza. This one-year lack of all types of healthcare services and access to care, has caused untold negative impacts on the lives of children with CFAs. In order to avoid these impacts, children with CFA, and patients in general, should be spared from political disputes, their care should always be the first priority.

Series on Women and Children’s Health in Conflict – The hidden face of the blockade and wars: Palestinian children with psychological wounds

by

Two children playing in the Gaza Strip. Photo licensed under Creative Commons.

This article is part of the Strife Series on Women and Children’s Health in Conflict. Read the Series Introduction at this link.

In recent years, the urgent need to address the global burden of mental health disorders has grown exponentially. Huge efforts have been undertaken to investigate this in low and middle-income countries (LMIC), where many factors exist that are detrimental to mental health. These include political, economic, social and individual factors1,2. Moreover, the demographic distribution of LMICs, where on average 50% of population is under the age of 18, makes intervention all the more pressing3,4. This is supported by evidence that most mental health disorders emerge at younger ages, making it a global responsibility to cooperate and establish evidence-based strategies for Child and Adolescents Menta Health (CAMH) services in these countries5.

In this context, conflict zones have been of special interest, as it is evident that the burden of mental health in such settings is higher than in areas without conflict2,5. A well-established example is the devastating effects of the ongoing Israeli-Palestinian conflict on the Palestinian CAMH. Among Palestinian adolescents in Gaza Strip, 94.9% reported severe anxiety, 68.9% had post-traumatic stress disorder (PTSD), and 40% reported experiencing severe depression6.

Since the beginning of the second intifada, uprising, in 2000, there has been a constant increase in reported psychological and emotional symptoms among Palestinian children7. This is unsurprising as the occupied Palestinian territories (oPt), especially Gaza, have been through multiple military assaults and violent events. This has led some national and international organizations to argue that an epidemic of mental illness exists amongst Palestinians in the oPt, and that it is particularly harmful for children and young women.

Different factors need to be considered when speaking about Palestinian children’s mental health issues, which broadly fall into direct or indirect causes. Direct factors involve witnessing traumatic events experienced by people around them, such as a relative or a friend being killed, injured, targeted, or imprisoned. The effect of these factors is evident in the countless children who are lie awake at night, tormented by resistive nightmares, and mental images of mutilated bodies and buildings or houses being bombed7.

Indirect factors can be seen in the negative knock-on effects of the blockade and the subsequent lack of resources and opportunities for Palestinians. Unemployment, poverty, loss of hope and learned helplessness are major detrimental social factors that affect Palestinian families. Parents, especially fathers, experience high levels of anxiety, says Dr. Sami Oweida, a psychiatrist at Gaza Community Mental Health Program (GCMHP). Fathers in the Palestinian culture are the family leaders; therefore, they are expected to be the most resilient, and they have to complain less and show strength almost all of the time. He adds that parents take out this anxiety unwillingly on other family members, often including children. This situation aggravates the children’s already existing psychological difficulties because of the aforementioned conflict-related factors. Dr Oweida pointed to an example of one of his clients, who was already receiving treatment for PTSD related to the 2014 attacks on Gaza and was injured during the Great March of Return in 2018. ‘[H]e had not been fully treated, but he went to the border again, one of the explanations could be the release of anger in a socially proper way’.

More than 70% of Palestinian children show symptoms that qualify for the diagnosis of PTSD. These include reexperiencing traumatic events through flashbacks, nightmares, and compulsively recalling distressing images. Children also show symptoms of avoidance and withdrawal from their environment as well as hyperarousal and hyperactivity. Another endemic disorder is Separation Anxiety6. Children feel distressed, anxious and afraid when they separate from their families or parents. This has affected their academic performance, their social activities, and their self-confidence.

In the Gaza Strip, and after fourteen years of continuous blockade, it was unsurprising to hear the senior health advisor of Save the Children say, ‘A whole generation of children in Gaza is balancing on a knife edge where one more shock could have devastating life-long consequences’. But what can be done? Three major problems stand in the way of the delivery of therapy to affected children.

First, mental health professionals in Gaza agree that children do not suffer from just PTSD, where a single traumatic event results in the symptoms of PTSD. Instead, they are afflicted by ongoing traumatic stress syndrome, that it is, the continuous and multi-origin experience of trauma among Palestinians, especially the children. A leading clinical Psychologist at GCMHP said that the children do not have sufficient time to recover from previous traumatic experiences before they encounter a new one. In Gaza there were four major violent escalations between Palestinians and Israelis in less than eight years from 2006 to 2014. This has led to a near constant experience of trauma, which results in an aggravated and a cumulative effect on Palestinian children.

The second problem exacerbating the situation is that those helping are themselves not protected from the effects of traumatic life events in Gaza. Professionals who work with children are also suffering and trying to cope with their traumatic experiences. Once clinical psychologist, who is a leading professional at GCMHP and focuses on PTSD patients, lost six immediate members of his family in 2014. Mohammed Mansour, a trauma specialist at Physicians for Human Rights has said ‘mental health specialists in Gaza have no other option than to digest their emotional and traumatic difficulties before they go to treat their clients’.

Finally, mental health infrastructure, resources, and staff are extremely limited in Gaza. For the two million residents of the strip, there is only one certified child psychiatrist, despite the fact that half of the population is below the age of 18. Additionally, less than 2% of the Ministry of Health’s budget goes towards mental health services6.

In the oPt, whole generations of children have known nothing but war, blockade, poverty, and unemployment. This has resulted in unprecedentedly high levels of mental health illness and psychological afflictions for this population. A lack of resources, continuity of trauma and the helpers themselves being exposed to the situation have exacerbated the situation. However, people and children have never lost hope, and they continue to dream of a better, more peaceful, future.

References

  1. Chisholm, D., A. J. Flisher, C. Lund, V. Patel, S. Saxena, G. Thornicroft, and M. Tomlinson. 2007. “Scale up services for mental disorders: a call for action.” Lancet 370 (9594): 1241-52. https://doi.org/10.1016/s0140-6736(07)61242-2.
  2. Eaton, J., L. McCay, M. Semrau, S. Chatterjee, F. Baingana, R. Araya, C. Ntulo, G. Thornicroft, and S. Saxena. “Scale up of services for mental health in low-income and middle-income countries.” Lancet 378 (9802): 1592-603. https://doi.org/10.1016/s0140-6736(11)60891-x.
  3. de Jong, J. T., I. H. Komproe, and M. Van Ommeren. “Common mental disorders in postconflict settings.” Lancet 361 (9375): 2128-30. https://doi.org/10.1016/s0140-6736(03)13692-6.
  4. Steel, Z., T. Chey, D. Silove, C. Marnane, R. A. Bryant, and M. van Ommeren. 2009. “Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis.” Jama 302 (5): 537-49. https://doi.org/10.1001/jama.2009.1132.
  5. World Health, Organization. 2009. Mental health systems in selected low- and middle-income countries: a WHO-AIMS cross-national analysis. Geneva: World Health Organization.
  6. Elbedour, S., A. J. Onwuegbuzie, J. Ghannam, J. A. Whitcome, and F. Abu Hein. 2007. “Post-traumatic stress disorder, depression, and anxiety among Gaza Strip adolescents in the wake of the second Uprising (Intifada).” Child Abuse Negl 31 (7): 719-29. https://doi.org/10.1016/j.chiabu.2005.09.006.
  7. Vostanis, Panos. 2003. “Impact of trauma on Palestinian children’s mental health: lessons from the Gaza studies.” International Psychiatry 1: 5-6. https://doi.org/10.1192/S174936760000641X.

 

 

Series on Women and Children’s Health in Conflict - The Voice of Gender: Shedding Light on the Impact of Emergencies and Armed Conflicts on the Health and Safety of Women and Girls

by

A Syrian refugee and her newborn baby at a clinic in Ramtha, Jordan. Photo Credit: UK DFID, licensed under Creative Commons

This article is part of the Strife Series on Women and Children’s Health in Conflict. Read the Series Introduction at this link.

After a crisis, women face abuse in many shades and colours. Such abuse includes intimate partner violence, which is occurring at a shockingly high rate in many countries. Moreover, some women and girls who rely on aid are exposed to sexual exploitation by aid workers who withhold support until sexual demands are met. It is important to highlight that the mentioned types of abuse, and many others concerning health and safety of women, do not only affect individuals. They also have a long lasting impact on societies as numerous studies have shown that children growing up with violence are more likely to being abused or becoming abusers themselves in the future. Categorically, sexual violence, child marriage, female genital mutilation, trafficking for sexual exploitation, female infanticide, and ‘honour’ crimes remain common in many societies.

Working as a medical referrals’ coordinator for refugees, I still recall being struck by the number of underaged girls leaving school and getting married. Often before the age of 18, they endured numerous preventable health complications as a result of giving birth to their first, second and sometimes third child before they reached adulthood. And this problem did not end there, one woman I met had had more than 9 pregnancies before reaching the age of 35. This was because, as she told me while laying on her hospital bed, “a woman in her culture cannot say no to her husband”, and that hers “does not approve of using contraceptives or any family planning method”, even though she has been continuously warned that further pregnancies may jeopardise her own life.

These are just snapshots of many life stories that women and girls experience when they are deprived of access to basic services such as sexual and reproductive health. The inability to access such essential services puts women at a greater risk of unplanned pregnancy, maternal mortality and morbidity, severe sexual and reproductive injuries, and contracting sexually transmitted infections. In addition, emergencies cause scarcity of basic feminine hygiene products, which causes girls to experience cultural shame. This, in turn, can negatively affect their mental health and exposes them to physical health risks as low menstrual hygiene has been linked to reproductive and urinary tract infections.

As the COVID-19 global pandemic further worsens the suffering of communities especially in the Eastern Mediterranean region, where many countries are already experiencing conflict or are undergoing post-conflict transitions, many organisations and governments have reported a dramatic increase in GBV. This increase can largely be attributed to factors such as disruption of social and protective networks and decreased access to services.

The risk of GBV was exacerbated during the COVID-19 pandemic as many females were trapped in long lockdowns with their abusers. This put them at increased risk of various types of abuse, while isolating them from access to support systems. Simultaneously, governmental support was reduced as resources were diverted to the enforcement of Covid-19 measures and precautions. This has meant that law enforcement is stretched thin and is unable to address reports of GBV in a timely manner. For example, the World Health Organization (WHO) Eastern Mediterranean Region Office’s (EMRO) initial information from two countries in the Eastern Mediterranean Region, reported an increase of 50-60% in cases of violence against women, based on survivors’ calls for help to women’s organisations’ hotlines.

Even though many international and local organisations are working on issues related to women and girls, as one of the most vulnerable groups in post-conflict and emergency settings, I believe that there is still a very long road to go in order to achieve protection and meet women and girl’s needs. In order to alleviate suffering, UN organisations need to advocate for ending sexual violence against women and meeting the needs of women and girls, through raising awareness, increasing accessibility to healthcare including sexual and reproductive health services, and enforcing regulations that serve and protect females.

To support that, I believe that governmental and non-governmental organisations should prioritise including women in planning for and responding to emergencies, ensuring they are active participants in both formal and informal processes. The inclusion of women will shift the situation from women and girls being perceived solely as vulnerable or as victims, to being able to plan for and support their own needs. Many organizations supporting women’s involvement state that women are often strong influencers and dynamic leaders of change. Empowering women to participate in decision making ensures that women and girls’ issues are prioritised in any formal actions and, I believe, would be a major step towards better serving the needs of women and girls. As a woman who has studied and worked in emergency management, I believe that women in decision-making positions are able to give back a voice to those females who need it the most.

Series on Women and Children’s Health in Conflict - Maternal and Reproductive Health in the Gaza Strip: the impact of years of blockade and conflict

by

A Palestinian woman holds her baby in one of the UNRWA school shelters in the Gaza Strip during Operation Protective Edge in the summer of 2014, Photo by UNRWA.

This article is part of the Strife Series on Women and Children’s Health in Conflict. Read the Series Introduction at this link.

Over two million Palestinians in the Gaza Strip live in degrading conditions of poverty, food insecurity, and high unemployment. In June 2007, Israel imposed a land, sea, and air blockade on the Gaza Strip, and since 2008, Israeli military forces have mounted several operations against the Strip. Years of blockage compounded by military interventions have led to ruinous consequences on the healthcare system. While reports by health organizations and media outlets focus disproportionately on the numbers of casualties, deaths, and long-term disabilities, much less attention is paid to the conflict’s impact on maternal and reproductive health services.

Since the start of the blockage, the healthcare system in the Gaza Strip has been suffering from a significant shortage of essential services, with maternal and child healthcare services being affected the worst. Mothers and their babies are often discharged early (within 2-3 hours) due to the limited capacity and high demands for healthcare facilities. The quality of maternal services is also compromised due to the high number of deliveries and increasing rates of caesarean section, which further increase the burden on healthcare workers in the field. While the total fertility rate has declined in the occupied Palestinian Territory, it is still one of the highest in the region. At any given time, there are about 45,000 pregnant women in the Gaza Strip.

The large number of pregnancies in Gaza can be attributed to the uneven and relatively poor access to family planning services. Indeed, women in lower socioeconomic brackets who live in remote and disadvantaged regions are less likely to benefit from them. The unmet need for family planning increases the number of unwanted pregnancies, and therefore, increases the risk of unsafe abortions and maternal complications. According to a family health survey in 2010, high unmet needs for family planning was associated with 30% of unwanted pregnancies. In 2019, two out of the five essential family planning methods (male condoms and progesterone-only pills) have been at zero stock level (available for less than a month) at the United Nations Relief and Works Agency (UNRWA) and Ministry of Health (MoH) clinics in the Gaza Strip.

Maternal pharmaceuticals have also been affected by the blockade. For example, iron (a drug used to treat anaemia) and folic acid (a drug used to prevent a certain type of congenital defects) have been severely limited. In 2018, according to the MoH in Gaza, nearly 40% of pregnant women were anaemic. Although several organisations have supported the provision of life-saving maternal health drugs, 70% of essential maternal and child health drugs remain at zero stock in the MoH. In a mapping study done by the United Nations International Children’s Emergency Fund (UNICEF), all assessed primary healthcare (PHC) facilities reported that essential pharmaceuticals and life-saving drugs were either unavailable or had been experiencing interrupted supply for the last six months. These include iron, folic acid, antibiotics, and methyldopa (a drug used to treat high blood pressure during pregnancy).

Year on year, maternal and reproductive health in Gaza becomes increasingly concerning. A 2019 situation report by the World Health Organisation (WHO) showed that maternal deaths increased by 122% between 2017-2018 (from 8.6 to 19.1 per 100,000 live births), and of these, 63% occurred before childbirth. Several factors can be attributed to this increase. One of these is poor PHC. PHC staff have limited training, and according to the UNICEF report, preconception care (care before the pregnancy) guidelines were not available at any of the assessed PHC centres. The same report also showed that all the interviewed pregnant women were not aware of danger signs during pregnancy.

There is no doubt that the decline in healthcare standards is more significant during and following major military operations: women become unable to access maternal and reproductive healthcare services, and medical resources become incredibly scarce. In July 2014, the Gaza Strip experienced a 51-day military operation (Protective Edge) by the Israeli military, one of four major military operations since 2009. Nearly the entire population in Gaza was involved in the conflict and was affected by the concurrent destruction of infrastructure. The impact of Protective Edge on women specifically was huge. The UN-Human Rights Council (UNHRC) reported that 299 women were killed and 3,540 others were injured. The UN Office for the Coordination of Humanitarian Affairs (OCHA) reported that over 40,000 pregnant women were unable to access essential maternal healthcare, and accordingly, the neonatal mortality rate doubled from 7% to 14%.

The inability to access healthcare services can be attributed to two main factors. First, many healthcare facilities were damaged, and the remainder were overwhelmed. During the crisis, only 50% of PHC centres were operating, leading to a significant decline in accessing family planning services. Moreover, 17 hospitals were put out of action, and six maternity wards were closed. The high number of casualties meant some remaining wards (including maternity units) were adapted into surgical wards. Thus, women were subject to low levels of care and were discharged early after delivery, resulting in a massive deterioration of their health.

Secondly, there was a near lack of capacity and preparedness to respond to the needs of internally displaced persons (IDPs). OCHA reported that half a million people (28% of the population) were internally displaced in schools and informal shelters which were not equipped to provide maternal and reproductive health services. Throughout the military operation, women who needed these services were instead referred to outside facilities during a time when transportation was severely restricted and highly dangerous even to ambulances. Furthermore, pregnant and lactating women had reduced access to special dietary support and vitamin supplements. The overcrowded shelters, where multiple families had to stay in the same room, were particularly challenging for women due to the lack of privacy and female hygiene products.

In addition to the effect of the blockade and the repetitive military operations on providing essential healthcare services for women, the Great March of Return (GMR) also had significant impacts. The GMR, which catalysed on March 30th 2018, sought to end the Israeli’s illegal blockade on the Gaza Strip. In doing so, however, it has added extra pressure on the already overwhelmed healthcare system. The massive influx of casualties led to the suspension of elective surgeries and the reallocation of hospital beds to serve the injured patients.

About six months after the start of the GMR, the US Trump administration decided to cut off the American financial assistance to the UNRWA. UNRWA plays a vital role in the Gaza Strip’s health sector, delivering free PHC services through 22 facilities. UNRWA clinics serve about 70% of the Palestinian population in the Gaza Strip, providing them with essential antenatal and postnatal healthcare services. In 2018, 39,709 pregnant women attended PHC facilities at the UNRWA. This reflects the tremendous effect of the withdrawal of US financial support on the quality of maternal and reproductive health services in the Gaza Strip.

Maternal and reproductive health in the Gaza Strip is on the edge of the abyss. There is an urgent and immediate need to ease the blockade and improve maternal healthcare infrastructure, both by opening new facilities and increasing medical staff’s capacity. A holistic emergency plan, which prioritises womens’ needs and rights, is indispensable and should be adopted. Every woman has the right to receive full and high-quality maternal and reproductive health services, even during emergencies. Good womens’ healthcare is critical to maintaining a healthy life for every Palestinian in the Gaza Strip. The Palestinian society will not be safe unless Palestinian women are safe.

Series on Women and Children’s Health in Conflict: Introduction

by

MedGlobal Volunteer Performs Surgery at Al-Shifa Hospital in the Gaza Strip. Photo credit: MedGlobal, licensed under Creative Commons.

While conflict’s direct effects – deaths and injuries – often take the limelight, its indirect effects, including population displacement, infrastructure destruction and human insecurity commonly cause prolonged suffering that is greatly exacerbated by the length of conflict and persists long after direct hostilities cease. Though men tend to be affected more by the direct effects of a conflict, women and children, often held to be ‘vulnerable’ in context of conflict, are at much greater risk of suffering its indirect effects.[1]

This series seeks to promote the accounts of healthcare professionals who have first-hand experience dealing with medical and health issues related to women and children in protracted conflicts in the Eastern Mediterranean region. In doing so, it addresses a gap often found in scholarship of health in conflict seen from a top-down perspective, and instead foregrounds the micro-level picture. The four pieces included in the series, therefore, highlight issues which are neither routinely discussed nor prioritized.

The first article discusses maternal, sexual, and reproductive health in the Gaza Strip, and the differential levels of healthcare accessible dependent upon whether an attack is ongoing or has recently ended. In the second piece, the author shares her experience working in refugee camps in Jordan, where gender-based violence and discrimination against women are prevalent. The third article sheds light on child development in Gaza and how it is exacerbated by continual psychological trauma inflicted because of the protracted conflict and blockade. The final piece describes difficulties children with craniofacial anomalies and their families experience in accessing the care their children need in the midst of conflict and political disputes.

Publication Schedule

Part I: Maternal and Reproductive Health in the Gaza Strip: the impact of years of blockade and conflict by Maisara Alrayyes

Part II: The Voice of Gender: Shedding Light on the Impact of Emergencies and Armed Conflicts on the Health and Safety of Women and Girls by Asmaa Essa

Part III: The hidden face of the blockade and wars: Palestinian children with psychological wounds by Bahzad Alakhras

Part IV: Children with craniofacial anomalies in the Gaza Strip: treatment options and access to care by Wafaa Alzaanin

[1] Craig, Sophia. “Effects of Conflict on Societies.” In Conflict and Health, 14–24. Berkshire: McGraw-Hill Education, 2012.