Israel, social stigmas, patriarchy and Palestine’s growing suicide epidemic

For decades, Palestinians have been at the face of violence in the Middle East. They endured being expelled and murdered during a mass exodus in the late 1940s, to being subject to brutal occupations, sieges and forced into refugee camps under abhorrent conditions. It's no secret that the creation of Israel has stunted and even deteriorated Palestinian development.

First hand violence isn't the only form of aggression Palestinians face – as conditions for Palestinians worsen, more people in the occupied territories are resorting to taking their own lives.

Last week, the Palestinian Ministry of Health published a report saying suicide cases have increased by 14 percent in the space of just one year, with depression being one of the driving factors behind the sharp rise.

Statistics from Palestine's Police Research and Planning Department, the overall number of suicides increased from 22 people in 2017 to 25 people the following year in 2018.

More females killed themselves than males, with the number of girls and women killing themselves last year being 15, compared to male suicide numbers standing at 10.  

Seventeen of those who committed suicide were single and eight married. The highest percentage of those who committed suicide were in the age group of 25 and 28 years – standing at a 32 percent of the total cases. According to the study, 44 percent of those who committed suicide had completed high school.

Mental health stigma

In the Middle East, the topic of mental health remains a taboo. At best, the topic is ignored, whereas at worst, it's seen as a discussion for the weak and even Western infiltration on the resilient Arab persona.

In some ways, Palestine does relatively well compared to other countries. According to a paper written in 2012, health expenditure estimated as a percentage of gross domestic product is highest in Palestine, standing at 13.5 percent.

However, mental health provisions are difficult for Palestinians to obtain, especially considering the high levels of the population suffering as a result of their mental health.

According to a study from 2017, Palestinians have the highest levels of depression in the Easter Mediterranean Region. About 54 percent of Palestinian boys and 46.5 percent of Palestinian girls aged 6-12 years old are estimated to suffer from emotional and behavioural disorders.

The study, The Burden of Mental Disorders in the Eastern Mediterranean Region 1990-2013, said out of the whole region, Palestinians suffer the most from mental health disorders, despite all of the countries in the region, except Egypt, having higher mental disorder level in comparison to the global average.

Another study from 2014 showed a quarter of Palestinian teenagers have at some point in their lives attempted suicide, which is attributed to "living in continuous turmoil and in a violent region attributed to political instability, combined with poverty and unemployment, closure and war, which may result in post-traumatic stress disorder, including disrupted patterns of eating and sleeping, difficulties in controlling attention and relating to others, anxiety responses, fear and recurring experiences of the violent episodes they have witnessed."

The study also found that despite high levels of mental health disorder and a society that has an underlying suicide problem, not much is done because of a taboo in Middle Eastern culture surrounding the topic.

"Unfortunately, in Arab countries and due to the combination of the stigma, familial, religious and social taboo affiliated with suicide; previous studies have focused solely on suicide ideation and /or thoughts of killing oneself, but not on attempted or completed suicide", the study said, adding that the phenomenon has been under-researched in the region.

Product of Israeli brutality

Recently, a high ranking official in the Palestinian ministry of health and one of just dozens of the country's psychiatrists said the way mental health conditions are defined are unsuitable for Palestinians.

Samah Jabr, chair of Palestine's mental health unit in the country's Ministry of Health and one of just 32 psychiatrists inside Palestine recently made the argument that mental illnesses such as post-traumatic stress disorder (PTSD) cannot be used in the context of Palestinians because trauma is ongoing.

"What is sick, the context or the person? In Palestine, we see many people whose symptoms – unusual emotional reaction or a behaviours – are a normal reaction to a pathogenic context", she said in January. 

In terms of the use of PTSD, she claimed the use of the illness is used to relate to Western audiences.

"We describe our psychological experience in terms that we hope to be understood in the West, so we talk a lot about PTSD. But I see patients with PTSD after a car accident. Not after imprisonment, not after bombardment or being labelled as a person against the law and having a relationship with prison like revolving door. The effect is more profound. It changes the personality, it changes the belief system, and it doesn't look like PTSD."

Read also: Mental health in Palestine among world's worst

By definition, however, PTSD is a reaction to a traumatic event, without distinguishing whether the trauma is ongoing or a one-off. 

Last year, Doctors Without Borders interviewed a group of Palestinians suffering from severe mental health crisis – all of whom attributing their disorders to the conditions Israel's occupation has forced them under.

Noura, 46, who lives in a refugee camp in occupied Hebron, described the state of her mental health after having her young sons taken away from her by Israeli police:

"I cannot sleep anymore. I am wrecked with worry. I have developed an obsession that they are coming for me every day. Even if a breeze slightly moves the door, I expect them to be there. I cry all the time. I am not crying for my sons, but for all children. I don't want anyone to grow up and experience the same things my sons did."

In the West Bank, which Israel has occupied since 1967, Palestinians are subject to being humiliated and dehumanised by occupation forces as they encounter traumatising raids, random acts of violence by Israeli settlers and forces and are forced to endure mind-numbing checkpoints.

As Israel continues its annexation process of the occupied territory, Palestinians are at fear of being left homeless in areas of settlement expansion projects – sometimes even being forced by Israel to destroy their own homes and businesses.

Patriarchy kills

There are many potential reasons behind the suicide rate in Palestine being higher for females than males. One of them is living under the collective trauma of being a Palestinian suffering under the hands of Israel and under the hands of patriarchy. 

For girls and women, the trauma is also coupled with patriarchy. In her book Anxiety of Erasure: Trauma Authorship and the Diaspora in Arab Women's Writings, Hanadi al-Samman explores how the concept of collective feminine trauma has affected women.

In pre-Islamic Arabia, burying baby girls alive was a common phenomenon when families, especially fathers, found out their baby is not a boy. Girls were seen as a liability and even a dishonour on families.

In her book, al-Samman consistently argues that female infanticide, known as wa'ad al banat in Arabic, was a deliberate attempt to devalue and bury women in the soils of society. Whilst that is no longer a common phenomenon, burying women in the modern world has manifested in a metaphorical sense by silencing women with patriarchy.

Along with the pressures of living under the violent occupation, Palestinian girls and women have to deal with the pressure of living under a heavily patriarchal society where they are put under pressure to dress and act according to society's demands of what a respectable woman is.

If not, many would be either alienated or mocked by their communities, or worse: subject to a vicious murder in the name of honour.