Background
Palestine (Occupied Palestinian Territories) is an eastern Mediterranean country that seeks independence and freedom. The term "oPt" as a whole refers to the geographic region of the Palestinian territory occupied by Israel and in which this small region has attracted the world’s attention for a long time [
1]. Before the World War II, Palestine was under British mandate. In 1948, Palestine name was removed and replaced with a new nation (Israel). Britain was committed to support the established Zionist movement that sought to create “a national home for the Jewish people” in Palestine [
2]. While the Israelis considered it "liberation," the Palestinians considered the beginning of the "catastrophe" ‘Nakba’ [
3]. The violent birth of Israel led to a major displacement of the Arab population. According to the Palestinian Central Bureau of Statistics in the year 2012, 7.4 million (66%) of the global population of 11.2 million Palestinians have been displaced forcibly from their homeland [
4]. As a result, most of Palestinian people were evicted forcibly, displaced from their homes and became refugees into different neighborhood countries e.g. Jordan and Syria. The others remained in the occupied Palestine [
5].
In 2002, Israel started to build a physical barrier with parts of it isolating the Palestinians’ cities and villages. Israel called it a ‘fence’ and Palestinians called it a ‘Separation Wall’ [
6]. In the years 2008, 2012 and 2014, there was a prolonged siege that included movement restrictions on food and individuals, especially in the Gaza Strip [
7]. One of the many ways in which the Israeli government controls the Palestinian population–alongside theses: Separation Wall, water shortages, the appropriation of Palestinian land and the segregation of Palestinians living in different occupied areas–is through home demolition [
8]. Home has such a central meaning in Palestinian culture. It is not only a shelter, but also the heart of family life [
9]. Inside every Palestinian home there are mutual memories of pain and joy as well as attachment to familiar objects. Palestinians believe in the security of home since they consider being in place, as part of a family, and as a resident in their village and thus part of a broader nation. Moreover, the idea of security has a historical meaning, and this means that homes would be built for the express purpose of repelling invaders [
10].
The urban architecture of Palestine prior to 1850 was relatively elegant [
11]. Two types of house predominated in Palestine from the second millennium BCE through to the modern era: the simple house found commonly in rural areas and the courtyard house found mostly in urban centers [
11,
12]. The sense of "rootedness" and "unmediated connectedness" which characterized Palestinian Arab architecture was admired by many travelers [
13]. The majority of Palestinians live in the same house and neighborhood their entire life, and moving to another house or neighborhood is not done regularly because in many cases they maintain strong social ties with their families and neighbors [
10,
14]. Although the behaviors of races and cultures differ among people around the world, the basic needs they satisfy are very similar. According to the psychologist Abraham Maslow, the need for shelter is one of the first and most important human needs [
15]. In any given year approximately 750 000 people lose their housing through demolition worldwide. In many instances, those living in locations targeted by demolition have little say in the disposition of their neighborhood and often face difficulty in finding appropriate replacement housing [
16]. Although, thousands of Palestinian populations throughout the Occupied Palestinian Territories (oPt) and (Palestinians who are living in occupied land since 1948) has received humanitarian response to such practices through shelters, they were subject to the continuity of demolition or confiscation [
17]. According to Amnesty International reports, it highlighted Israeli missile attacks on the Gaza Strip, which destroyed entire families. Most of their homes were crowded with relatives, and they were attacked by large missals. For example, the organization examined eight cases, in which Israeli attacks targeting at least 111 people were killed and civilian homes destroyed. Survivors described the terrible destruction of their homes as they searched the bodies of children and loved ones and most of the West Bank residents were very concerned about their relatives in the Gaza Strip during the military operation [
18,
19].
The WHO has deemed housing as a preexisting condition of health, since it is a fundamental human right and a major social determinant of health [
20,
21]. Worldwide, approximately 60% of the population have severe and disabling mental health disorders, which are expected to rise to 75% after severe trauma or loss [
22]. According to WHO, an increase in the burden of mental and psycho-social disorders can be expected in a population experiencing prolonged occupation, lack of personal security, severe movement restrictions and human rights violations, including displacement in a post-conflict situation” [
23]. In general, silent ethnic cleansing practices in Palestine in the past seventy years, the impact on mental health is one of the most important consequences for the Palestinian population [
24]. Such of policy of house demolitions, along with settlements, restricted movement, exposure to threats or even killed, have left thousands of Palestinians subject to severe distress which could lead to major psychological and mental disorders [
19].
According to the WHO, mental health challenges” is "one of the most important public health challenges" in the OPT [
25]. In general, there are many factors, including economic, political, social and cultural factors that play a role in determining the state of mental health and providing services to residents [
26]. It is well established that there is a gap between the mental health needs of the Palestinian population and the provision of mental health services. For instance, the mental health system faces specific challenges related to occupation and political conflict. According to Marie et al. [
27] restrictions on freedom and movement greatly limit patients receiving care outside their area of residence, in addition to the cost of treatment, the inconsistent availability of medications on the WHO Essential Medicines List, as well as insufficient specialists and by absence of interdisciplinary teamwork.
Indeed, home demolitions can lead to multi-faceted negative consequences: family disruptions, loss of culture, loss of identity, mental health problems, et cetera. Given these challenges in light of policy of home demolitions, there is a pressing need to look around mental health condition for whom experienced their homes demolished. This paper aims to provide an overview of the literature and established studies related to the mental health consequences of home demolitions for Palestinian families who have actually experienced home demolition along with those who have experienced a constant threat of demolition to their homes.
Israeli home demolition policy
The roots of Israel's house demolition policy date back to British Mandate, which has always been the overwhelming weapon of colonialism. The home demolition policy was implemented under Article 119 of the "Defense of Law (Emergency)" regulations. Although the British claimed to repeal the law upon their departure, the Israeli regime continued to use it [
28]. The military government implements demolitions by either detonating the house with explosives or destroying it with bulldozers. When demolitions seem unattainable for technical reasons, the military government usually closes houses and closes their doors and windows using bricks or metal sheets. In cases of destruction and sealing, families are forbidden to rebuild their homes or use their lands in any way [
29]. For instance, during the first year of intifada in 1987, 125 houses were demolished and 41 were sealed; in the second year, 158 houses were demolished and 80 were sealed; in the third year, 88 houses were demolished and 96 were sealed; and in the fourth year, 47 houses were demolished and 48 were sealed. In the fifth year (beginning December 1991) 8 houses were demolished and 22 were sealed [
30].
Since the beginning of the second intifada in September 2000, the rate of house demolitions has risen significantly. According to the UN Office for Co-ordination of Humanitarian Affairs (UNOCHA) which monitors and maps house demolitions, East Jerusalem is experiencing an increasing number of demolitions and population displacement. In the ten years between 2004 and 2014, 516 housing units were demolished in East Jerusalem; 59 were carried out by the home owners to save the amount that Israel demands for demolition. As a result, more than 2000 Palestinians people have been made homeless. The vast majority of these homes belonged to Palestinians [
5]. The Destruction and confiscation of Palestinian houses in East Jerusalem by the Israeli authorities, led to displacement and expulsion of the inhabitants. Men, women, and children were left homeless, mentally scarred, and economically and socially ruined, all because they tried to improve their lives and provide themselves with a place to live [
31]. Recently, during the month of June 2019, at least 64 structures were demolished in the occupied Palestinian Territories (including East Jerusalem) by Israeli forces, displacing at least 60 people- including 27 children- and affecting a further 18,774 people [
32,
33]. During the month of January 2020, at least 44 structures were demolished in the occupied Palestinian Territories (including East Jerusalem) by Israeli forces, displacing at least 87 people- including 56 children- and affecting a further 205 people. Furthermore, in the Naqab desert, the entire Bedouin village of al-Aragib has been demolished three times during the month of January 2020 alone and more than 173 times all together in the past ten years [
34].
On the other hand, the possibility of Palestinian construction is restricted severely. For instance, building is limited to only 13 per cent of East Jerusalem and only one per cent of Area C (which is totally managed by Israeli military forces). Moreover, more than 94% of the 3,750 requests for planning permission made by Palestinians between 2010 and 2012 were rejected by the Israeli authorities. As a result, Palestinians wishing to extend their homes or expand their communities in order to accommodate family and population growth face impossible bureaucratic barriers and have no other option but to build without a military permit [
5].
According to Israeli authorities, Palestinian homes are demolished for various reasons: the land they own has been declared by Israel “open green space;” they have no building permit (which Israeli authorities rarely grant to Palestinians); the slope of their land is adjudged as “too steep;” their houses are too near settlements or Israeli only highways (although the houses were there first), out of collective punishment for some action the punished people had nothing to do with, the “clearing” of vast tracts of land for military/security purposes, destruction for the sake of expanding roads, settlements and the “Separation Barriers;” houses “cleared” to make passage safe for settlers or for other security purposes, homes representing “collateral damage,” and more of unjustified causes [
35].
Today, tens of thousands of Palestinians carry demolition orders with their hands and live-in fear, and they wonder when bulldozers will arrive to demolish their homes. The hidden message of the bulldozers is clear: "Get out." We uprooted you from your homes in 1948 and prevented you from returning, and now we will force you to leave from all of the Land of ‘Israel’ [
36].
Discussion
Home demolitions are a miserable and frequent reality of life for large part of Palestinian people. As a result, the social, economic, and psychological impact on individuals, families, and societies was clearly affected negatively [
5]. In general, many theories have been suggested over the years to explain the developmental changes that people undergo over the course of their lives [
53]. For example, the loss has been linked to symptoms of depression, the threat of anxiety, and frustration of aggression [
54]. For Palestinians, the severe stress caused by losing a family home, and in fact the risk of its destruction, can’t only have just immediate, but long-term effects on the health of family members [
31]. Moreover, threatened demolition and risk for displacement in the future might result in a situation in which "people live in constant fear and anxiety", with many essential items packed in case of demolition "happening suddenly, and they have to evacuate the home immediately." The probability of demolition itself, long before the soldiers arrived to destroy a house, is an affective form of violence against the residents of Palestine, as life under threat of demolition becomes loaded with fears and anxieties about the disturbing future and the violence that it carries, because such a policy of affective demolition actually works by making it easier to anticipate fear and anxiety [
55]. It was clear from previous studies presented in Palestine that depression, anxiety, fear and lack of hope in the future were common themes running through interviews, for example, among women and their families in East Jerusalem and Arab Bedouin villages, especially since they are responsible for the struggle and protecting their children [
31,
45]. In the Palestinian context, efforts to assert the right to home and place can be understood as an ongoing defense of the rights of residents to safety, identity, and well-being for not only themselves, but also for their children, families and communities [
56]. Therefore, there is a pressing need to look around mental health condition for whom experienced their homes demolished along with those who have experienced a constant threat of demolition to their homes.
In general, parents, especially the mother, are the first to build a relationship with the child, thus they play the most important role in developing the child's mental and emotional characteristics and contribute crucially to the child's health or illness. It is well established that behavioral disorders among children reflect the psychological problems of parents, as the mental illness of either parent will increase the possibility of a child's mental disorder [
57]. For example, a descriptive study showed that primary school children whose parents suffer from poor mental health also have more severe behavioral and emotional problems [
58]. From previous studies presented in Palestine, it was clear that the period following the demolition of the home was very stressful for the parents and had a reflection on their children. For example, parents reported behavioral changes and children deteriorated in school. They also started sucking thumbs, wetting their beds or stopped allowing breastfeeding. Children were sad, more nervous and scared [
49]. In general, a proper understanding of such a process and awareness of their own problems, along with developing parenting skills of coping can help parents reduce behavioral problems in children.
According to WHO, “The quality of housing has major implications for people’s health [
59]. Research has shown that exposing to poor housing conditions, such as moisture, leakage and insufficient heating, increases the risk of respiratory infections and asthma, and to more serious conditions such as tuberculosis [
60]. From previous studies presented in Palestine, families who were threatened with demolition, along with families who had been displaced, were living in poor housing conditions. These findings suggest a strong, long-term impact of persistent poor housing on health and mental health particularly. Studies have shown that people who live constantly in poor housing conditions today are more likely to develop poor housing conditions in the future. Moreover, the stress and anxiety of poor housing may last for a long time after the housing problems of individuals have improved [
61]. Therefore, health services need to pay attention to these housing conditions, develop a clearer understanding and considering their implications throughout several aspects particularly mental health status as soon as possible.
Ordinarily, when a family has to move because of the home demolition, people lose their social network in their neighborhood. It was clear that suffering from the effect of military occupation and its aggression that caused the loss of the home, and the social consequences of such loss, turned them into vulnerable individuals in their own societies. When children were asked about the most painful incident that had happened to them, they all talked about losing their homes and becoming refugees in their own neighborhood [
52]. Overall, neighbors in Palestine are seen as a fundamental cornerstone of society and neighborhoods consist of a lot of family members and being a ‘good’ neighbor is seen as an important duty [
14,
14]. This may justify why younger children who had lost their homes reacted to their losses by trying to normalize their day-to-day activities by directing their energies toward helping others and helped them to cope with their losses [
52]. Therefore, positive social support can play a crucial role in lowering psychological consequences. The social support for both families and neighborhoods helps individuals to cope with some of the problems [
46].
Moreover, coping resources can be significant in reducing emotional responses because it helps in mediating the relationship between exposure to stress and psychological outcomes. Most models of coping assume that individuals who cope more effectively with stressful life events show lower levels of anxiety or depression [
62]. Whereas several studies found that during acute violent situations (with political background) emotional coping strategies of denial and distancing were used more frequently [
63]. It was clear in both groups of adolescents who participated in the study mentioned above [
50,
51] that emotional coping strategies were linked to more anxiety, anger and psychological distress. Moreover, adolescents are at the stage of developing personal styles of coping. This developmental period also introduces abilities to deal with sources of conflict or stressful events in a variety of contexts [
64]. Therefore, intervention and prevention programs should target facilitating coping strategies, which can help adolescents adjust in such a crisis.
Home demolition is a traumatic and difficult event for all the members of the family [
65]. Interviewing traumatized people about traumatic events is difficult and might lead to additional problems [
66]. For instance, respondents can endure extra stress because of retelling traumatic events. From the previous presented studies in Palestine, it was clear most of the researchers have used focus groups methods. It could be because these groups allow victims to share their suffering and tell their stories in their own environment while learning about each other’s ordeals, acknowledging their pains and hardships, sharing their own techniques of coping with loss, and even planning future supportive actions [
52]. Those participants especially children who were silenced by fear and trauma may be able to speak up and share their ordeals, while being encouraged by the voices of the other children that spoke, wrote and resisted oppression even before any intervention. Therefore, as an interviewer, it is necessary to understand the impact of trauma on the brain, adjust the interview technique accordingly, and focus on empowering the interviewee. This would enhance their ability to recover from trauma.
Although many Palestinians have lost their security and stability after being demolished, more are still in place, competing on a daily basis with threats to the safety, quality and safety of their home environments [
49]. Studies have shown value of both physical and psychological support in reducing the effects of war-related trauma, as well as the role of religion and cultural practices as methods of dealing with conflict situations [
66]. Several factors seemed to lower the consequences of home demolition and seemed to work as a type of a coping mechanism among Palestinian population. Religion seemed to be a great supporter to cope with the consequences. For instance, Palestinians indicated that they would be rewarded and were able to find peace with their home demolition [
50]. In addition, the faith and religious practices have positive effects for Islamic Palestinian population in reducing anxiety level such as praying and reading The Holly Quran. It enhances their resilience and ability to recover from continuous adversities and traumas. In addition to “Sumud Culture” which developed by Palestinians as a resilient response to the history of continuous traumas and threat to their existent on their homeland [
67].
Overall, it is widely recognized that homes are critical sites for safety, meaning, belonging, and refuge, in addition to their important role in the formation and fortification of individual and collective identity and the nourishment of families and relationships [
68]. As a result, losing one’s home can lead to a loss of identity, because the physical home is an important part of an individual’s identity [
32]. As a result, home demolitions can alter, destroy Palestinians’ entire persona, and create different experience for each of men, women and children [
36]. Personal identity must be protected under human rights law from deterioration and destruction. Because such of these inhuman and degrading handling affects a person's sense of identity. Violations the group's full identity through war crimes against humanity can kill lives, which necessarily means our individual identities. On a large context, it could lead to genocide or ethnic cleansing so that their identity no longer exists [
69]. Therefore, there is a need to develop a comprehensive and coordinated response between human rights organizations and mental health services to prevent displacement and home demolition through providing a protection for those who have been displaced or at risk of displacement with a special focus on their specific needs and vulnerabilities [
47].
In summary, it seems from above presented studies in Palestine that the psychological problems and mental consequences always follow the process of demolition or even the threat of demolition. Children, adolescents and women were a particularly vulnerable target group. Psychological problems were associated with different traumatic experiences and difficult events for all the members of the family. In some cases, trauma decrease children resilience since they became sad, more nervous and scared. Moreover, women may be particularly affected and significantly suffered of depression because they are a more vulnerable group in society for example: Arab Bedouin women, especially while they are working as the main caregivers in their families. Incidentally, while men are traditionally seen as family providers, there are no specific studies exploring their experience as husbands or parents and how they’ll cope. Therefore, to investigate the mental health of them, there is a need for drawing attention to the importance of providing an updated database in order to deal with several aspects of scientific research in Palestine and enhance the collaboration between all researchers.
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