Hazem Suleiman lost nearly a quarter of his body weight as he and his family repeatedly fled Israeli airstrikes in Gaza. But what really worries him is the invisible damage that cannot be seen - the invisible trauma that will mark him forever.
“I will never forget the screams of children and women... I have nightmares about charred bodies. Horror movies don't show something like this, but it happened."
The 26-year-old now lives in a tent in the devastated southern city of Khan Yunis, along with his wife, mother and eight children. They are alive, unlike many of their neighbors and friends, but that does not mean they have passed without consequences, according to a report by the Thomson Reuters Foundation (TRF).
"My mental state is very bad, and my children are constantly scared," he said.
Mona Abu Amer did not sleep for months for fear that bombs could hit the fragile tent where she lives with her husband and three children, also in Khan Yunis. She is so stressed that her hair is falling out. She recently gave birth and is not even able to feed her hungry child.
"My milk suddenly stopped flowing due to stress and I can no longer breastfeed," she told TRF. "My four-month-old son, Mahmud, is constantly crying and I can't do anything to help him."
A year after the start of the Israeli offensive on Gaza, more than two million people out of a total of about 2,3 million inhabitants of this enclave "have either experienced or witnessed violent and traumatic events," said Muhammad Abu Shawish, head of the mental support program of Medical Aid to the Palestinians. in this area.
"Mothers in particular face high levels of anxiety as they balance the responsibility to protect their children with the fear of violence," said Abu Shawish.
Most Gazans have been displaced - some up to 10 times - since the Israeli offensive began on October 7, after Hamas militants invaded southern Israel, killing 1.200 people and taking around 250 hostages.
Since then, Israeli air and artillery strikes have reduced much of the Gaza Strip to rubble, and according to the Gaza Health Ministry, more than 41.600 people have been killed. At least 90.000 people were wounded.
Mothers in particular face high levels of anxiety as they balance the responsibility to protect their children with the fear of violence
TRF points out that bare figures cannot convey the depth of the trauma of the people who survived the destruction. The mental scars, especially among children, are deep, humanitarian workers say.
The United Nations children's agency, UNICEF, estimates that nearly all of Gaza's 1,2 million children need mental health support.
"They have lost the sense of belonging to their family, siblings, parents, because neither their mother nor their father, nor anyone else can provide them with that sense of security," said Isra Al-Kahvadzi, the organization's mental health and psychosocial support coordinator. "Let's save the children" in Gaza.
"No one can protect them".
The organization said in June that up to 21.000 children were missing in Gaza - including 17.000 unaccompanied or separated from their families and 4.000 children buried under rubble. An unknown number are believed to be buried in mass graves.
Others have been forcibly disappeared, including an unknown number of children detained and transferred outside Gaza amid reports of abuse and torture, the organization said.
Those who survived are especially susceptible to developing mental and psychosocial problems, said Abu Šaviš.
The trauma children experience can mark their lives and contribute to a long list of mental illnesses, ranging from cognitive and educational challenges to behavioral problems and chronic health disorders, he added.
TRF writes that injured children feel the psychological pressure the most.
In April, UNICEF cited data from the Palestinian Ministry of Health showing that more than 12.000 children, or nearly 70 children each day, had been injured in Gaza since October.
Al-Kahvaji says that the most important thing for a child's mental health is a sense of security. That feeling "completely disappeared" when the children lost their homes during the conflict, she added.
To combat prolonged and intense exposure to trauma, she provides mental health support sessions, known as grounding, and works with children to prevent them from distancing themselves from reality so they can face the challenges of surviving in a war zone.
However, Al-Kahwaji wonders if anything can stand up to the brutality of war and the harsh life it imposes on people. She and her colleagues try, but they too suffer mental and physical difficulties. Small advances are often all they can hope for.
"We see things that may seem simple, but mean a lot to us," she said.
A few weeks ago, a woman burst into tears while holding her child during a support session led by Al-Kahvadzi. It was the first time the woman had hugged her child since the war began.
"She loves her child, but she doesn't have time to think about him," Al-Kahvaji said. "She is only worried about how to keep him alive: how to bring him water, how to get him food, and that not only takes her day, but also the whole family's day".
Sulejman, who used to be the captain of the cycling team, feels the same burden. Now he cycles long distances every day just to get water and food for his children.
Abu Amer is also focused on survival, but she knows that a difficult confrontation is coming.
"Right now I'm just thinking about surviving," she said. "But even if we survive, we will be haunted by the terrible memories of this war".
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