Land Day

Land Day is approaching tomorrow (Friday 30 March). It is an annual day of commemoration for Palestinians of an event in 1976. In response to the Israeli government's plan to expropriate thousands of acres of land for "security and settlement purposes", a strike and marches were organized in Palestinian towns throughout the West Bank. In the ensuing confrontations with the Israeli army and police, six Palestinians were killed, about one hundred were wounded, and hundreds of others arrested. For this year's Land Day, Palestinian activists are organizing a Global March to Jerusalem intended to bring attention to the situation here and to recognize Jerusalem as a vital and controversial site for both Palestinians and Israelis. The March will engage people from all over the world, who will show their support for Palestinians by marching as close to Jerusalem as they can get considering existing country borders and political barriers.

Two days out of the past week, I have heard gunfire in the distance. I have not been able to pinpoint exactly where the gunfire is coming from. But, like the Israeli military jets continually flying over Nablus, it is a reminder that the occupation is ubiquitous. For example, the following happened in the past week in Nablus:

• last Friday, an 8-year-old boy was injured by an explosion in the village of Qaryut; apparently, the devise was set there by the Israeli army during training exercises.
• on Monday, the Israeli army detained three men for unknown reasons in the Nablus city center.
• on Tuesday, a 24-year-old farmer from the Nablus village of Iraq Burin sustained head injuries when settlers from the nearby Yizhar settlement threw rocks at him.
• and, yesterday, settlers blocked the entrance of the village of Beit Dajan, protesting the reopening of a road to Nablus city.
  

These events were tempered by a unity rally held in Nablus City center last week, which called for an end to the division between the political parties in the West Bank in Gaza, to more effectively resist the occupation. Of course, this is controversial, because the Palestinian division is between Fatah and Hamas, the latter which has been recognized as a terrorist organization by the EU, US, Canada, Israel, and Japan.

In terms of my research with children and families, things are going slowly but surely. I have finished three interviews in Balata Refugee Camp. The interviews have been extremely interesting. Each interview was supposed to be the parent and two children (older and younger), but the whole family is there for the whole interview. So it's usually Mom and her 10 children, and maybe a sister-in-law or a bunch of young cousins as well. It's definitely a different kind of methodology (more like a family focus group) using a collaborative process, with every member of the household contributing a piece, which is more culturally representative of how families operate here. I can distract the kids with some mapping and drawing exercises and then talk to the adult. But I also try to spend more than half of the interview speaking with the children to get their views. Parents have commented on how great it is that the research cares about what children think.

Some of the families' stories are difficult to hear. Two separate families told me about how the Israeli army has entered their homes and broken down the wall between their wall and their neighbor in order to arrest their neighbors. (The image to the right is of one family's wall that was broken down and is now repaired with cement.) This practice, known in Israeli army parlance as "walking through walls", is the action in which soldiers create holes in the walls of Palestinian homes in order to avoid the streets, roads, alleys, and courtyards of the community, where they fear being attacked by militants. Though an effective military strategy, the “penetration of war into the private domain of the home” is described by Weizman (2007) as “ the most profound form of trauma and humiliation” (p. 194). My study participants have called it "insulting". In another house I went to, the 6-year-old son was asleep on a mat on the floor near where we were conducting the interview. The mother told me that the Israeli army had been in the refugee camp a few days ago, and when the boy saw them, he involuntarily urinated and has been incontinent since then. This is a common symptom in school-age children who have experienced traumatic stress. These cases are not the majority, though, and there are plenty of happy, bright, and energetic children who "seem" impervious to the effects of occupation.

Mind-Body Skills Intervention Decreases Symptoms of Post-Traumatic Stress Disorder in Postwar Kosovar Adolescents

Incidence of post-traumatic stress disorder (PTSD) has been reported among war-affected children and adolescents. Yet few studies have evaluated the effectiveness of PTSD treatment programs for this population. Gordon, et al. (2009) conducted a randomized control trial to determine the effectiveness of an intervention aimed at ameliorating the effects of PTSD in adolescents. All children in Jeta e Re (“New Life”) High School in Kosovo were screened to participate in the study. Eighty-two students met the criteria for PTSD and were randomly assigned to two groups: (a) intervention group and (b) delayed intervention group. The intervention group participated in a comprehensive mind-body skills group program, a 12-session program consisting of meditation, guided imagery, breathing exercises, relaxation activities, therapeutic discussion, and art therapy. The delayed intervention group received the same intervention once the intervention group had completed the program, approximately 6 weeks later. The study shows that students receiving the mind-body skills group program had significantly reduced levels of PTSD symptoms as compared to the delayed intervention control group.

This study is the first randomized control study to examine the effects of a therapeutic intervention on war-affected adolescents. The study design overcomes the ethical dilemma of withholding promising treatment from the control group by providing treatment to the control group after the intervention group has completed post-intervention interviews. Nevertheless, expectation bias poses a threat to the study’s internal validity, because the results of the improved outcomes may be due to the participants’ expectations that the intervention would be effective. This threat to internal validity is supported by the fact that the intervention was piloted in the school prior to the study, building even more anticipation, as students are bound to share their experiences with other students. This is also be related to the process of testing, which could be a threat to internal validity, because students may become familiar with the measures being used. Because teachers both facilitated the intervention and administered the measures, unintentional expectancy effects pose a threat to the study’s construct validity. In this case, teachers may have subconsciously expected students to show fewer PTSD symptoms in the post-test. Similarly, the students may have wanted to please the facilitators by showing improvements in the post-test. Despite the authors’ explanation that these students would only be comfortable speaking with a familiar adult, future studies should utilize external experimenters to administer the pre- and post-test, because they will be naïve to which students received the intervention and will have no vested interest in the outcome of the intervention.


Reference:
Gordon, J.S., Staples, J.K., Blyta, A., Bytyqi, M., and Wilson, A.T. (2008). Treatment of posttraumatic stress disorder in postwar Kosovar adolescents using mind-body skills groups: A randomized controlled trial. Journal of Clinical Psychiatry, 69(9), 1469-1476.

Combination of Education and Trauma Healing Activities Decreases Trauma Symptoms in War-Affected Children in Sierra Leone

Though research indicates that higher levels of traumatic events among war-affected children leads to greater incidence of negative mental health outcomes, there is little evidence about the effectiveness of psychosocial interventions to mitigate these consequences. Gupta and Zimmer (2008) focus on determining the effectiveness of a psychosocial intervention study among children affected by the conflict in Sierra Leone. The sample was randomly drawn from school registration lists provided by the Ministry of Education, which contains all school-age children residing in the Grafton and Trade Center camps for internally displaced persons. The sample focused on an equal number of boys and girls ages 8-17, for a total sample size of 315 children. The Rapid-Ed intervention consisted of an education module enhanced with eight sessions of structured trauma healing activities and unstructured recreation activities. Children were interviewed for the pre- and post-test by trained camp teachers using a semi-structured questionnaire, which was translated and back-translated into the local language (Creole). The pre-test was administered approximately 9-12 months after the start of armed conflict, and the post-test was administered 4-6 weeks after participants completed the intervention. Results show that 96% of children reported a significant reductions in concentration problems, sleep disturbances, bad dreams, and intrusive images after participating in the Rapid-Ed intervention. The study also found that there was a slight increase in avoidance symptoms after the intervention.

The study addresses selection bias by randomly selecting children from the target communities. Also, the low attrition rate (3%) was a strength, and most likely due to the accessibility and reliability of finding the students in formal schooling programs. However, the results of this study would be strengthened with the addition of a control group. Use of a control group would indicate whether it was the intervention that caused the decreased psychological distress or whether other factors were responsible. Firstly, maturation poses a threat to the internal validity, because the study is unable to discern whether the intervention was the cause of improved psychosocial outcomes or whether it was due to the subjects’ internal healing processes. Secondly, statistical regression may pose a threat to the internal validity, because the change due to the intervention cannot be distinguished from the effect of scores reverting toward the mean. A control group would have addressed these concerns and greatly improved the study’s internal reliability. However, the sensitive context creates ethical challenges in regards to whether one group can receive the intervention and the other one doesn’t.

Reference:
Gupta, L. and Zimmer, C. (2008). Psychosocial intervention for war-affected children in Sierra Leone. The British Journal of Psychiatry, 192, 212-216.