JABALYA, Gaza Strip, Nov 8 (Reuters) - If ever there was a little corner of the world where trauma therapists hanging out their shingle should do a boom business, it has to be Gaza.
Take, for example, Samira, a 43-year-old schoolteacher and mother of five who lived too close to a Hamas security complex bombed repeatedly during Israel's December 2008-January 2009 cross-border offensive.
"I could not sleep for months -- no, for a year. I used to have dreams and even while awake I used to hear the sound of explosions when there was really nothing happening," said the woman, who did not want to be named.
"One of my children also wet his bed for several months," she added.
A trauma therapist should have been on the case -- and in this instance, was. But in Gaza, despite decades of Israeli incursions, economic blockades, deadly internal infighting among Palestinians and grinding poverty, dealing with trauma is something brand new -- and not a total success, either.
Experts estimate that up to 15 percent of Gazans suffer from post-traumatic stress disorder (PTSD), but Western-style psychotherapy is a relatively recent arrival.
Gazans, for whom therapy comes after scraping a living, also are culturally wary of seeking outside help with emotional and mental problems. The Israeli blockade ensures the enclave remains dirt poor, and not in a position to pay for new health services.
"We need specialists to deal with children, others to deal with adults, and specialists who can deal with specific and complicated psychological disorders," psychologist Hassan Zeyada, of the Gaza Mental Health Program, said.
"Gaza lacks qualified psychiatrists who meet regional criteria for the profession," he said. Experts say many of those practising in Gaza at the moment were self-taught.
PSYCHO DRUGS ABUSED
On top of that, the minute psychotropic drugs were introduced to help deal with stress, drug abuse cropped up.
During its 2008-2009 offensive, Israel attacked Gaza to shut down the firing of short-range rockets fired at southern Israel. About 1,400 Palestinians were killed and over 4,000 injured.
In the aftermath, with psychotherapy a relatively unknown option, Gazans began taking the opiate Tramadol, self-medicating to calm jangled nerves and recurring panic attacks.
Gaza's drug craze is gradually coming under control. Tramadol is now officially available by prescription only, but its use as a recreational drug remains a serious problem.
"I've stopped ordering it, even for legal uses," one local pharmacist said. "I know the devastating effect that abuse of this drug can have on youngsters."
For sufferers of post-traumatic stress disorder, depression and other psychological ailments, more promising therapies are now on offer.
"NOT A STIGMA"
Dyaa Saymah, a mental health officer with the World Health Organisation in Gaza, said the WHO was "trying to include psychological services in primary health care clinics and we have so far trained 300 doctors and nurses" in 56 clinics.
"Many people still view seeing a psychiatrist as a stigma," he said. "But people do go to primary health clinics and there a trained doctor can see what they really need."
Gaza also needed a Code of Practice to regulate a profession in which many practitioners are self-taught, experts said.
Zeyada said there was no official figure for the incidence of PTSD in Gaza, but he endorsed a recent study by a colleague who estimated it at 10-to-14 percent among the 1.5 million people living in a 40-km by 12-km (25-mile by 8-mile) enclave smaller than an Australian sheep ranch.
"We are talking about people who fit the full criteria of psychological disorder. We are not talking about the many people who suffer reactions because of certain pressure in their daily lives and certain difficulties and problems," Zeyada said.
Deputy Minister of Health Hassan Khalaf said Gaza's incidence of PTSD was not above 15 percent, and maintained it was not the most prevalent psychological problem.
"Our most pressing (mental health) problem is depression, and the causes are several, including the ongoing blockade, last year's war and its continued consequences, the bad economic situation and the lack of vision for the future," he said.
Gaza's problems are compounded by a climate of suspicion rooted in the intractable dispute between Hamas and Fatah, the dominant Palestinian movement which favours negotiation with Israel and was driven out of Gaza in 2007.
Gaza's patients with psychological problems therefore are not referred to Israel. And while Palestinians today are more ready to accept psychotherapy than in the past, there is a reluctance to discuss mental or emotional problems, doctors say.
"Awareness is higher but still limited, and many people still regard the topic as taboo," Zeyada said.
As long as Hamas holds control and remains hostile, there is little chance of Israel lifting its quarantine, but at least some of the new services, including help lines and advice over the Internet, are beginning to take hold -- and have an impact, even if violence is never far away.
"It is was hard for me to see a doctor, but a friend of mine convinced me it was not a stigma to see one. So I finally visited a doctor with my boy," the schoolteacher and mother-of-five said.
"After several weeks I began to feel better and my son stopped wetting his bed. I think I have recovered and I hope the violence is over. But maybe it's not."