Ola Ashkantana stares at her mobile phone screen looking at the pictures of her only sister and her four children who were killed in an Israeli Occupation raid in the Gaza Strip.

"I was hoping we would find her alive under the rubble," she says, trying to hold back her tears.

Then Ola, 30, puts the phone aside and wipes her tear-weary eyes as she welcomes a psychologist who works in a local association seeking to help her and other Gaza residents psychologically after the recent "eleven days war" between the Israeli Occupation and the Gaza Strip, which killed 260 Palestinians. 

On a bloody night in Gaza City, Israeli Occupation warplanes destroyed the house of Abeer, Ola's sister, in the Rimal neighborhood, which was subjected to more than 200 Israeli Occupation air strikes. Ten hours later, civil defense crews were able to rescue Riad Ashkinna, 35, and his daughter Suzy, 8, from under the rubble, while his wife Abeer and four of their children did not survive.

Ola, a mother of three, says, "I can't stop imagining how my sister and her sons feel alive for hours under the rubble. I feel shocked and afraid of losing my sons."

The young woman refuses the specialist's offer of sedative drugs, and says, "I'm afraid of addiction to sedatives."

In an adjoining room, Suzy is sitting on her father's lap, who is encouraged by psychiatrist Hassan al-Khawaja, also an activist in the association, to undergo psychotherapy sessions.

"I feel suffocated," the father replies.

"I thought of moving to live next to them in the cemetery," says Riad, who has avoided talking to anyone since the incident, according to his family.

He continues, skeptical of the ability of psychotherapy to help him, "I am very shocked, how will my feelings and thoughts change? I can't go back to the way I was."

- setback -

Ola and Riad are two of the many traumatized residents of the Gaza Strip. The recent escalation led to the destruction of more than a thousand housing units, according to the authorities of the Gaza Strip, which has fought four 'wars' with the Israeli Occupation since 2008. 

Doctors and psychologists who live in the impoverished coastal enclave, home to some two million people, know that rebuilding the Gaza Strip goes beyond building buildings.

"This is not the first war in Gaza, a large number of people suffer from post-traumatic stress disorder. With every war, there are new traumas," says Dr. Al-Khawaja.

"I anticipate the PTSD crisis in the coming months," he continues, stressing that frequent conflicts put patients in the face of relapses such as acute stress disorder, with symptoms including shock and denial.

Al-Khawaja also explains that delays in therapeutic intervention can develop, which poses a challenge to psychiatrists in the sector as they have to cope with the “explosion” of cases.

He stresses the need for there to be specialized teams on the ground, saying, "After the war, we go to the ground, but we cannot simply assess the suffering of people, and then say goodbye to them. (...) We must be able to help them."

- denial -

In Al-Awda Hospital in Jabalia, north of Gaza, Bilal Al-Day, 24, is lying on the Shifa bed after he was wounded in an Israeli Occupation raid east of Gaza City.

"I was drinking tea at the door of my house at ten in the evening when I heard the sound of shelling in front of our house," said my father, whose left leg was cast.

"I saw our neighbor wounded and crying. I went to help him, but as soon as I picked him up, another missile hit me."

"Bodies and body parts were everywhere and smoke covered the area. I crawled 15 meters back, so that someone might be able to see me and help me...until my brother came and carried me to the hospital."

Next to his bed, MSF psychologist Mahmoud Awad is watching Bilal and explaining that he is going through a period of severe anxiety.

Awad explains how the young man "suffers from shock and denial, as he tends to generalize everything without talking about himself."

"We're trying to get him to talk, we want to avoid developing PTSD," he says.

- No safe place -

Although the last war on the Gaza Strip was shorter than the previous one in 2014 and caused fewer deaths, its “psychological repercussions will be more severe,” according to the director of the Gaza Mental Health Program, Dr. Yasser Abu Jameh.

"How can you reassure your child when the bombing continues for more than half an hour?" asked Abu Jamea.

"It's impossible, we tell people that they need to live in a safe place to feel safe, but in Gaza there was no safe place for 11 days," he says.

The mental health services available in the Gaza Strip are unable to meet the demand for psychiatric treatment, especially in light of the shortage of psychiatrists and the unavailability of studying psychiatry in the Gaza Strip universities.

Some specialists question the concept of post-traumatic stress disorder in the Gaza Strip. "There is no post-traumatic stress disorder, because it is a continuous trauma," says psychologist Samir Zaqout.

"Healing from trauma means living in a safe place, but in Gaza there is no safe place," he explains.

According to Zaqout, "You can talk about adaptation and resilience, but you can't really cure."