Creating a Culture of Healing

Recovering from Trauma in War-Ravaged Gaza

Creating a Culture of Healing

This article originally published in the January/February 2007 issue.

Entering Palestinian Gaza at the Erez Crossing, we step into an open-air prison–cinder block walls, wire fences, locked gates, bunkers. Israeli Defense Force (IDF) soldiers with automatic weapons stand guard. Upon questioning, we explain that we’re a team of health professionals there to work with Palestinians who’ve been traumatized by war and its aftermath.

Some of the soldiers appear interested in our work. Others are curt, incurious. A few seem hostile: “Why go there, to be with them?” All are achingly young. They pore over our identification papers and passes, check names against lists, rummage through our suitcases. We move ahead. Metal doors click and clang. Announcements from loudspeakers punctuate our passage through a 300-yard-long metal shed.

It’s a harsh welcome, but we’re still excited to be here. Our group includes six U.S. psychotherapists and physicians, two staffers from the Center for Mind-Body Medicine in Washington, D.C., and two Kosovo psychiatrists. Our job in Gaza–as it was earlier in Bosnia, Macedonia, Kosovo, and most recently in Israel–is to help Palestinian health and mental health leaders cope with the psychological trauma of war themselves, and to teach them to integrate our approach into their own work. So far, we’ve trained some 2,000 doctors, nurses, psychologists, and teachers in the U.S. and around the world to use and teach our model, which integrates aspects of mind-body medicine (meditation, guided imagery, biofeedback, yoga) with self-expression and small-group support.

In Bosnia and Kosovo, as in post-9/11 New York City, most of our work took place after the worst of the destruction was over, with populations struggling to rebuild their lives. Here it’s different. We’re well aware, as Israeli shells scream overhead and we meet victims of bombs in Israel and tank fire in Gaza, that the conflict is ongoing–we aren’t in a “post” traumatic situation at all. So there’s a special urgency to our work with Israelis and Palestinians, a need to do our best to ensure that what we teach will become part of our trainees’ own lives and professional work.

Day 1: An Introduction to Gaza

We spend the first two days getting oriented. I tell Mahmoud (to preserve confidentiality, I’ve altered first names and, in some instances, job titles), our Palestinian coordinator, that we’d like to meet some families and see the refugee camps where Palestinians have lived since 1948, when they were expelled from their villages in what’s now Israel.

The next morning, we drive down Gaza’s Mediterranean coast. It’s Friday, the day of prayer, and the markets and mosques are crowded. The entire trip, with stops for trucks and donkey carts, takes just 45 minutes. The Gaza Strip, where more than 1.4 million people are jammed together, is only 25 miles long, stretching from the Erez Crossing at the north end of the strip to Rafah, which borders Egypt on the south.

As we walk around Rafah, in sight of Israeli settlements and gun towers–“don’t point your cameras toward them,” Mahmoud warns us–we gaze at dozens of broken buildings. Mahmoud explains that the buildings were bulldozed by Israeli forces. Some were the sites from which Qassam rockets (homemade weapons used by Hamas and other Palestinian militants) were fired at Israeli settlements. Israeli officials destroyed other blocks of homes to create an open space between themselves and Palestinians in which potential assailants could be detected and eliminated. A young Palestinian social worker leads us past several acres of stones, fragments of picture frames, and children’s shoes– the aftermath of Israeli destruction. Gesturing with a small, sad smile to a square of rubble indistinguishable from its neighbors, he says, “Welcome to my home.”

Later that day, we turn north to Khan Younis, Gaza’s second largest city, to visit Ahmed, a skilled electrician who is Mahmoud’s cousin. Getting out of the car, I walk among buildings packed so closely together that the alleys separating them are hardly wider than my shoulders. Standing on a hillside in Khan Younis, I can make out the red-roofed homes and well-tended gardens of Neve Dekalim, an Israeli settlement a few miles away. In just a month’s time, this settlement will be emptied and the buildings demolished by the Israeli army as part of the mandatory evacuation of all Israeli settlers in Gaza.

When I was last in Khan Younis, Ahmed could still cross the border at Erez to work in Israel. He lived in a spacious, comfortable home with his wife and six children. When the border closed in 2004, he lost his job and income. Not long afterward, his house became collateral damage in an Israeli demolition whose purpose he’s never fathomed. He and his family were forced to move to a small, run-down apartment not far from the border with Neve Dekalim. Some months later, on his way home from a nearby mosque where his family had taken refuge during an Israeli attack, Ahmed was shot in the leg by an Israeli sniper.

We find Ahmed sitting against the wall of his brother’s home, the purple end of his amputated leg angling toward us. He tells us, grimacing with present and remembered pain, the story of his many surgeries, infections, and amputations, first below and then above the knee. As he speaks, he begins to cry and then apologizes for his tears. His children–they surround us now, sweet and slightly bewildered–were once good students. Now, Ahmed says, they struggle in school by day and have bad dreams at night.

Day 2: The Training Begins

The following morning, we gather for the training at the Gaza City’s Commodore Hotel, a six-story, utilitarian, sand-colored structure overlooking the Mediterranean in an area that’s been largely sheltered from conflict. In the hotel ballroom are 90 Palestinian health and mental health professionals (two thirds of them men), a dozen interpreters, a local film crew, and our training team.

The participants we’ve selected are already quite skilled in conventional psychology and/or medicine, but, as I’ve learned on previous visits, they’re overwhelmed by the breadth and depth of the suffering around them. Many of the techniques we’ll teach–meditation, drawing, focused breathing, guided imagery, free writing, biofeedback, and various forms of movement–are unfamiliar to them. But most are intrigued by the idea of self-care, group support, and a mind-body model of working with traumatized people who continue to live with severe, unrelenting stress.

After introductions, I go over our daily format: a mix of lectures, experiential exercises, and small-group meetings, which are the heart of our work. In these small groups, participants will have an opportunity to learn and practice the techniques we teach, and share their experiences with one another. The groups, I explain, are essentially meditative, encouraging participants to become aware of thoughts, feelings, and bodily sensations as they arise during exercises and while others share their feelings. In fact, I say, the entire training is built on various forms of meditation, which will help create a relaxed, moment-to-moment awareness.

I review the house rules. Attendance at all the small groups is required. Ditto the lectures. I see a few wrinkled foreheads. Confidentiality is expected, I continue. People should come on time and turn off their cell phones. (Some laughter erupts here–the cell, bringing warnings of danger or bad news or just plain news, is all but grafted onto our colleagues in Gaza.)

I begin with “Soft Belly,” a simple breathing exercise. “Breathe deeply,” I say, “in through your nose and out through your mouth. Relax your belly as you do so.” I explain that Soft Belly calms the hair-trigger “fight or flight” response to danger “that, in all likelihood, is as ever-present in you as the conflict between the Israelis and the Palestinians.” They nod. I tell them that each day will begin and end with “Soft Belly.” I see a few smiles.

After lunch, participants are assigned to their small groups. The group I facilitate includes nine men, two women, and my translator, a Palestinian named Susan who’s blessedly good at her job. She’s a schoolteacher now, but previously, while living in Egypt, she translated for Yasser Arafat and Hosni Mubarak. The other two women, Nadia and Khadija, are psychologists and wear hijabs, or headscarves, ankle-length skirts, and, even in the summer heat, light overcoats. In this first group meeting, the women sit together and speak softly.

The men, ranging in age from their early thirties to late sixties, alternately raise and lower their voices in questions, responses, mini-lectures, asides, and many jokes. Hassan, a physician who’s the most senior member of our group, announces that he’s here “only to observe” and decide whether the hundreds of employees he supervises at one of Gaza’s major health organizations should be trained in our model. “Observation is fine,” I respond, “but you can’t know this work unless you participate. It’s not like learning to do gallbladder surgery.” There are some chuckles. “To do this work of self-awareness and self-care, you have to practice on yourself–first here in the group, and then at home, in the weeks and months ahead.”

Hassan smiles politely and moves to his next objection. “I don’t believe these small groups of yours will work as well here as perhaps they do in other places,” he says with an air of authority. “Talking about feelings isn’t done in public here.” After a pause, he adds, “And women will not speak frankly in front of men.” Nadia and Khadija are noncommittal. “We’ll see,” I say.

After a few moments of “Soft Belly,” I ask the group to make three drawings–“Yourself,” “Yourself with Your Biggest Problem,” and “Yourself with Your Problem Solved.” We supply crayons and paper, and everyone bends over their work. The men sneak elaborate glances at each other’s creations, laughing and elbowing. The women look briefly at one another and return to the task at hand.

Afterward, we share our drawings. Ali, a surgeon, quick-moving and humorous, begins. In his first drawing, he’s alone and looks confused. In the second, his four children stand in front of an Israeli soldier, who’s pointing his gun at them. “I live near an Israeli settlement,” he says, “and, every day, when I leave the house, I worry that something will happen to my children before I come home. Two years ago,” he adds matter-of-factly, “my house was bombed.” In the final picture, the one that shows the “problem solved,” he’s joyfully playing with his children. The occupation is over and the Israeli soldiers have gone home. “I’m thankful to God,” he concludes.

Several others hold up their own pictures of endangered children, assuring me that they didn’t have to copy from each other. “This is our biggest concern,” Mahmoud says. “Everyone worries about their children, every single morning when we leave for the hospital or clinic.” They share memories of homes vacated on Israeli orders and destroyed, of bombs shaking their houses, of children bleeding in hospital emergency rooms. Later I think of the recent training we led in Israel, where health professionals drew their own pictures of vulnerable children traveling on buses or sitting in malls that might be attacked.

Day 3: Fight or Flight

Today, following early-morning yoga, we meet as a large group and discuss the physiological basis for our mind-body approach. The fight-or-flight response, I explain, is a survival mechanism in which the sympathetic part of the autonomic nervous system secretes adrenaline and prepares all vertebrates to combat or flee from a predator. The muscles tensed for action, and the elevated blood pressure and heart rate that result, serve our survival. When this response continues over long periods of time in situations of chronic stress, it may lead to persistently high levels of the stress hormone cortisol, which raises blood sugar and decreases immunity, as well as adrenaline. Chronic stress–the kind that’s all but universal in Gaza–can produce or contribute to chronic physical and emotional problems, among them hypertension, muscle pain, anxiety and depression, diabetes, and disorders of the immune system.

“There’s a constant dialogue going on,” I say, “among the brain and the autonomic nervous system–which produces the fight-or-flight response–and the endocrine and immune systems. The good news is that we have the power to alter this conversation–transform agitation into calm, decrease blood pressure and blood sugar, improve endocrine functioning, and strengthen the immune system–through such techniques as Soft Belly, guided imagery, self-expression in words and drawings, movement, and yoga.”

Later, in our small group, I discover that several people have already been sharing what they’ve learned with family members and friends. Ibrahim, a middle-aged psychiatrist who works in an emergency room, taught the Soft Belly technique to a suicidal man during a midnight shift. Walid, a physician, found himself slowing and deepening his breath during a family crisis the evening before. It’s already clear to participants that, unlike the techniques of psychotherapy they’ve previously learned, this mind-body work can be available, and useful, just about anywhere, anytime.

We share the remaining pictures. In the “Biggest Problem” drawings, several people have drawn bold lines dividing their papers. Some lines are red; others, black. They show the participant separated from the outside world–from family members who are dispersed in other countries, from villages destroyed by the Israelis in 1948, and from homes bombed out during the last four years of the intifada. “The wall is inside us, also,” notes Ismail, a reflective psychologist who’s a senior staff member in one of Gaza’s major mental health organizations. “It’s a wall of fear and suspicion and anger, a wall of sadness that cannot be expressed because it may disturb our families. It’s a wall that stops us from even hoping for a safe, secure future.”

Nadia draws a mountain with a figure inside. “Before the intifada, we had a good economic situation,” she says. “But my husband went to jail, and now he’s unemployed. I’m carrying the financial burden myself. The money is too little.” Her voice drops to a whisper. “I’m atop a volcano that’s about to erupt.” Toward the end of our meeting, Hassan shares his drawing. “Here I am, with a rope tight around my neck. I cannot move. I can hardly look left or right without being strangled.”

That afternoon, Jerrol, a nurse on our faculty, gives a lecture on guided imagery, the use of mental images to enhance physiological and emotional functioning. She explains that imagery can be used to prepare for painful medical procedures, to strengthen the immune response, and to find answers to personal concerns. It’s been particularly useful, I add, in helping children and adults traumatized by war to explore the forgotten–really, repressed–sources of their current stress, and to create moments of calm.

Later, in our small group, we practice guided imagery ourselves. I guide participants in a brief Soft Belly exercise, and then, with their eyes closed, I ask them to imagine a place that’s comfortable and safe. Later most will tell me they traveled far from the fear and tension that now preoccupy them. Some imagined playing in the back yards of their childhoods; others strolled on quiet beaches. Still others were snug in homes long since occupied by Israelis, but now magically restored to them.

Once everyone has imagined himself or herself in a peaceful place, I ask them to invite a guide to appear–a wise being who might be someone they know, a figure from scripture, or an image from folklore. This guide, I tell them, is a symbol of their own intuition, their unconscious knowing. I ask participants to introduce themselves to their guides, exchange names, and then, if they like, ask a question.

Many see their own fathers; a few see their small children. Afterward we talk about our experiences. “Share feelings,” the inner guides urge some. “Pray,” advised another. “Appreciate the sun during the day and the moon at night,” was the message Ali received. “The sun and moon, they care for us like a woman does for her children.” The group ends quietly. “Hold hands, if you’re comfortable doing that,” I say. Men take each other’s hands. Nadia and Khadija stand close together, clasping hands, but not touching the men, as their religion doesn’t permit it. We all stand quietly in a circle, breathing together.

Day 4: Shaking Things Up

This morning’s topic is emotion. “The problem isn’t any particular emotion,” I say, “but becoming stuck in it.” I tell them that when emotions get congested, “active meditation” is a powerful way to loosen up the system. Certain intensely physical exercises–fast deep breathing, dancing, and shaking–have been used for millennia by indigenous healers and shamans to work through emotional distress.

I explain that we’ll shake first, in the process loosening up the fixed thoughts and emotions that keep us stuck in depression, anxiety, and chronic illness. “After we shake, we’ll let our bodies simply move to music, each in our own unique way.” There are a few anxious and skeptical glances, but everybody laughs with me when I demonstrate the proper shaking regimen, knees bent and eyes closed, wildly jerking and jouncing in place. It has the intended effect: If I’m willing to look utterly foolish, well, then, what’s stopping them?

As in Israel and Kosovo, Macedonia and Bosnia, we do our best to create an environment that’s culturally appropriate. Here, men will shake and dance at their desks and in the aisles and up front near me. Women will move behind a large wooden screen at the back of the room, where there’s ample space and privacy. Mahmoud assured us earlier that the music we’d chosen for movement, Jimmy Cliff’s reggae song, “You Can Get It If You Really Want It,” would work. Some strict Muslim people are concerned about moving to music with words, but after conferring with colleagues, Mahmoud concluded that Cliff’s upbeat, encouraging message might well be helpful.

The shaking begins. A few young male psychologists shuffle around, pointing at each other and laughing. But soon they, too, begin to shake. So do the women. We go on for six or seven minutes.

Then the reggae song starts, signaling the transition from shaking to dancing. Some of the men begin to rock gently, while others gleefully stomp and jump. Through the slats in the wooden screen, I see the women in their scarves and long skirts, swaying to the music. Everything seems to be going well.

Suddenly, Salim, my young translator for this large-group session, is saying something loudly and urgently in Arabic. I don’t understand his words, but I hear the strident tone of absolutism in his voice. I feel a shadow of constraint pass over our training. “What’s he saying, Mahmoud?”

“He says that this dancing isn’t appropriate for our culture,” Mahmoud replies softly. I wonder for an anxious moment if we should stop, but know that we need to continue, to move through this moment of confrontation–and talk about it later. I ask Mahmoud to tell people to keep dancing. They do. Meanwhile, I ask the translator to move to the side.

When the music stops, everyone sits down. For a few moments, people talk about their experience of the shaking and dancing–how it made them feel younger, less serious, more in the present moment. Then an older physician stands up. “The translator’s behavior was unacceptable,” he declares, and a dozen hands shoot up. “What you did was not a problem,” Khadija tells me. “It’s like you’re offering us a great banquet with many different dishes. It’s up to us whether we’ll try every dish.” Many people nod and add postscripts. “I feel pain and regret,” says another physician, “but in these difficult conditions, many unacceptable things happen.”

I reply that I had no problem with the translator’s opinions, but only that he expressed them in the midst of an exercise when we were depending on him to translate. “It’s up to us to learn from you as well,” I say. “We want to create dishes that are most appropriate to your palate. Did any of you have trouble with the exercise?”

“The shaking is fine,” one man replies, “and the moving, too. But the drums were disturbing.”

“Do others share this feeling?” I ask. Two others, a tall, earnest young man and an older one with a commanding presence and a long, white beard, nod. “Would you be willing to bring us some music that’s more appropriate?” I ask the older man. He nods again.

At supervision that evening, I learn that the other translators and a number of participants feel that while the translator Salim was “wrong,” he deserved another chance. The consensus is that “it would be disloyal not to support him.” We decide to invite him back, and are acknowledged for it. “Americans can be different from what we thought, what we are told . . . they can respect our point of view,” says an older physician. “You have shown us,” adds Ismail, the psychologist, “that one fundamentalism doesn’t have to provoke another.”

Interlude: Evenings with Fadel’s Family

On two of our evenings, we visit with Fadel’s family in Gaza City. Fadel, one of our participants, is the head of the psychology department at Al-Aqsa University and runs a nongovernmental organization that works with those traumatized by violence. He greets us warmly, wearing the jalabiya, a traditional, ankle-length, white gown. Underneath it, he moves with the ease and solidity of a soccer halfback.

Fadel introduces us to the head of the family, “the Mokhtar,” a dignified, relaxed, 60-year-old man wearing an immaculate, white burnoose. The Mokhtar is surrounded by several of the family’s elders. They mediate disputes, find jobs for young people, and direct the families’ many activities. The Mokhtar’s “big family,” as it turns out, is actually a tribe of some 10,000 people.

We shake hands with the Mokhtar and each of the elders, as we file into a large, stone-floored room, where we sit on a row of plastic chairs. The Mokhtar, Fadel, and the elders sit across from us on their own plastic chairs. As we chat, I notice a huge photocopy of an elegant garden hanging on the wall behind the Mokhtar. When I comment on it, Fadel tells me that green is the color of healing, and, according to Quran, “of the clothes we’ll wear in paradise.” He says he came to love the Quran during his 18 months in an Israeli prison. Someone asks why he was in prison. Fadel smiles. “There were no charges,” he says. “No trial, no convictions.”

Evening comes, and we walk in the neighborhood. We pass a shed housing a couple of cows, some chickens, and goats. The marks of Israeli tanks and shells are everywhere. In the midst of the rubble of an empty lot, tomato plants are, improbably, growing. A 7-year-old girl in a worn, white dress comes by. Fadel explains that this is a young cousin and introduces us. At his request, she removes a glass eye and shows us the empty, white, scarred socket. “A sniper’s bullet,” says Fadel.

Evening meals with Fadel’s family, served on the cool rooftop of the house, are a welcome respite. I think again of the little girl who lost her eye, and of other children, Israeli as well as Palestinian, who’ve suffered so much. I remember speaking on an earlier visit to a 9-year-old Israeli boy in Neve DeKalim. He had a star-shaped scar on his cheek–a memento of an exploded Qassam missile. “I’m afraid every day now,” he told me. “I’m afraid to go to school. I’m afraid to come home from school. I’m afraid to go to bed at night.”

I think, too, of children ready to embrace killing: fresh-faced, school-uniformed, teenage Palestinian boys who, on a previous visit, proudly told me that “the best way to serve our people is to become a martyr”; Israeli teenagers defending the Gaza settlements, explaining that their God is indifferent to Palestinian deaths.

Day 5: Going Deeper

This morning, we talk about the power of breath and physical exercise in the healing process. I explain that exercise can raise levels of neurotransmitters, such as serotonin and norepinephrine, and lower high levels of blood sugar and cortisol. I go over some of the research, and then tell them that it’s time for all of us to do another experiment, this time, “chaotic breathing.”

Chaotic breathing is an active meditation that requires fast, deep breathing in and out through the nose, with arms pumping up and down like a bellows to increase the lung capacity. As with the shaking exercise, chaotic breathing is followed by a period of free movement. I’ve found this exercise particularly powerful for those whose bodies have been frozen by terrible trauma–rape, physical injury, the sight of family members’ murders–and whose emotions are suppressed and clotted.

There’s an air of anticipation as the men spread out up front and the women move behind the screen. I also sense a bit of apprehension. But as the rhythmic electronic music for the first part starts, everyone begins to breathe deeply and pump his or her arms earnestly. I urge them on: “Breathe faster and deeper! Yes! Yes! Faster and deeper!” I feel our communal urgency to push beyond the walls we’ve all put up in ourselves. After about eight minutes, I shout: “Stop!”

We then go on to free movement. This time, we’ve selected traditional Arabic music without words. Flutes weave in and out of drum rhythms as the tempo picks up. Everyone moves now, swaying and dancing.

After we sit down, Ismail says, “It reminds me of Zikhr,” a traditional, Muslim form of moving meditation. “It brings a feeling of great joy that I had forgotten.” Fadel nods, adding, “For the first time in years, the knots in my shoulders are loosening.” Then Khadiya speaks up, her voice newly strong and vital. “I’ll do this with the children and the women who have suffered violence,” she says. “They’ll enjoy it, and it’s most necessary for them to feel again.”

In the small groups, we hear how our colleagues are bringing their new skills home. “Everyone in my family–especially the women–are interested,” Nadia says. Both she and Khadiya have shown family members the yoga postures they’ve learned, as well as the Soft Belly breathing. Then Ali, the busy hospital surgeon, speaks up. “Last evening I watered my trees in a meditative way, breathing deeply,” he says. “I feel like I’ve done something important.”

Afterward, in group, we do “Dialogue with a Symptom,” a written exercise that draws from Gestalt Therapy, psychodrama, and free writing. You imagine your symptom or problem sitting opposite you in a chair, and you “talk” to it via a written conversation. The idea is to write swiftly, without conscious thought or censorship. “First thought, best thought,” I say, citing a Zen motto.

For the next few minutes, the only sound is that of pens scratching on paper. Afterward people are eager to share what they’ve discovered. “My chest is telling me I must breathe more deeply,” says Ibrahim, reading from his notebook. “Relax more fully, your heart as well as your mind.” Ali goes next: “Read the Quran to find the forgiveness that will heal your rage.” Others speak of dialogues with chronic headaches and back pain and digestive problems. I have seen this process unfold numerous times. Almost always the personified problem begins to inform and gently advise the person who’s suffering from it.

In the afternoon, Bob and John, a social worker and a family physician from our team, introduce genograms, symbolic maps of four generations of family history. The approach here, as in everything we do, is meditative. As each person shows his or her genogram, the other group members sit quietly, absorbing the information and noting what comes up for them. Ibrahim, the psychiatrist who works in an ER, is first. “There are so many people on this page,” he begins, “that if I brought them here, they’d fill the hotel.” We learn that both his mother’s and father’s parents were expelled from their villages in 1948. Returning home for food, his mother’s parents were blown up by land mines. Their children buried them and moved on.

For a rare moment, our group is quiet. “What’s coming up in you?” I ask. They speak in turn of relatives dying young, often at Israeli hands, of a father carrying a dying grandfather from their village in 1948, of growing up with parents who cried every day with “loss and humiliation.” And then, unexpectedly, group members begin to wonder out loud why the Israelis behave as they do. They speculate about their psychology, citing the work of the philosopher and sociologist Theodor Adorno and wondering if the Israelis are indeed “identifying with the oppressors.”

Ibrahim retorts: “Explanation is no excuse.” Still, everyone assures me that they don’t hate individual Jews; many, in fact, feel a palpable bond with them. They speak of dear Jewish friends with whom they remain in weekly contact, and of their hope for coming together to work with Israeli mental health professionals, perhaps with our help in this mind-body program. Ismail concludes softly, “We share the same trauma.”

Day 6: Assessment and Celebration

This is the last full day, a time of reflection and taking responsibility, and, whenever we offer this training, of integration as well. Now my group members focus less on the damage that Israelis have caused and more on their own struggles to come together, across the bitter divides of profession, political party, and religion. Already the techniques they’re learning have had a direct, felt effect on their levels of stress, lowering their sympathetic arousal and anxiety, improving their mood, as we learn from the data we’ll compile later. For the first time, they tell us, they have some sense of control over their physiological functioning and its emotional consequences, greater perspective on the trauma that’s deformed their lives, and a sense that vulnerability as well as strength can be shared.

This is the night of our party. There are more guests than we’ve anticipated, more than 200 of us in all. Women have brought their husbands; men, their wives. The buffet has two types of fish, countless side dishes, no alcohol, but cigarettes of many kinds. The men are courtly, bringing their wives plates piled high with food. Mahmoud has invited musicians who play traditional stringed instruments, flutes, and drums. Everyone talks at once, and circulates from table to table.

As desserts are served, several young, male psychologists begin a traditional line dance, the Debka. The music picks up; they move faster. Laughing and sweating, they pull several of us trainers out onto the floor. With arms clasped around us and around each other, they move smartly, confidently. We stumble along.

The dancing goes faster and faster. There are now two lines, now three, now we’re all in a circle. Men move into the center to dance freestyle, some individually, some in pairs. Ali takes my hand and we whirl, kicking our legs as high and far as we can. Soon several women join us. The circle widens again and again, as we whirl around, stepping, kicking, making sounds to match the music, looking with wonder and laughter at one another.

Day 7: Tears and Hope

The next morning begins with our final small group. We talk about how this is only a beginning–how, after the training is over, we’ll organize small groups throughout Gaza, in which participants can continue to meet, practice what they’ve learned, and share what they’re feeling and doing.

Still, this is the last time we’ll meet as this group. By now, trust and intimacy run deep. Many allow themselves to feel what had been concealed behind those red and black lines drawn in the first group. “Some days,” Ismail tells us, “I debrief as many as 50 people who’ve witnessed killings. This is the first time I’ve allowed myself to cry.” The women, too, now speak clearly and without embarrassment. “I’m always anxious when I leave the house,” Nadia confides, “because my husband often mistreats my children. He was in an Israeli prison for three years. Since then, he has no job.” She looks down, closes her eyes. Khadiya covers Nadia’s hand with hers.

We move on to our last exercise, another set of three drawings: “Where are you now?” “Where would you like to be?” “How will you get there?” Afterward, I ask Hassan–the physician initially so doubtful about our approach–to show his drawings. On the first day, he reminds us, a noose was pulled tightly around his neck. In that drawing, his head was large, his body small and stiff. Today, the figure representing him wears a patchwork of lively, colorful clothing. His arms and legs are in motion, and, he emphasizes, “There’s no head.” We all laugh.

We go around the room and check in one last time. “Perhaps you won’t believe it,” says Ali, “but I’ve never danced before, not even at my own wedding. Last night is the first time.” Ibrahim goes next. “What I’ve gotten is a little peace. I’ve experienced that I can change, and that the situation, the struggle . . . .” He pauses, lowers his head slightly. “Maybe, it can also change.”

Back in Israel

Two days later, in Jerusalem, we meet with some of the Israelis who’ve already participated in our training. This is a time to catch up and share what we’ve all been doing. We talk about our plan to select an Israeli leadership team to conduct further trainings; under our supervision, they’ll train hundreds more health, mental health, and education professionals. We plan to focus clinical work on the settlers who’ll soon leave Gaza and be scattered across the country. We’ll also work with the Israeli soldiers and police who’ll remove them.

The week we’ve just spent in Gaza is on the minds of our Israeli colleagues. “How was it?” they ask, eager for news of this Palestinian land that’s so close, yet so remote. They listen with undisguised wonder to our stories about the training–“Oh, they did the shaking and dancing, too? And Soft Belly? What about the genograms?” They want more stories and, as we tell them, I sense them recognizing, acknowledging, some it seems for the first time, the commonality of the struggles that Israelis and Palestinians face. And then comes a chorus of questions with a single melody: “When will we work together?!”

Postscript: Gaza, Winter 2006

Last summer, several months after the surprise Hamas electoral victory and the severe restriction of international funds that followed it, a Palestinian faction killed two Israeli soldiers and kidnapped one. The Israeli army retaliated with massive force, killing more than 250 Palestinians to date (at least half civilians), largely destroying the local power and water supply, and terrifying, on a daily basis, the entire population of Gaza.

Amidst the devastation, our work is even more desperately needed. And, like the tomatoes in that rubble-strewn lot near the Mokhtar’s home, it’s flourishing. Graduates of our program–Ali, Ibrahim, Nadia, Ismail, and 30 others–are leading 40 mind-body groups each week, for children who’ve lost homes and parents, teenagers plagued by violent memories and fantasies, women struggling to hold families together, and men like Ahmed, who’ve been mutilated by the conflict.

Each week, 70 of the participants come together under Mahmoud’s leadership with members of our new Palestinian leadership team. In these small groups, they share the work they’re doing, learn from one another, and find comfort and hope–and even laughter and joy–in a very dark time.

James Gordon

James S. Gordon, MD, is a psychiatrist, the founder and CEO of The Center for Mind-Body Medicine, and the author of Transforming Trauma: The Path to Hope and Healing. He is a Clinical Professor of Psychiatry and Family Medicine at Georgetown Medical School and chaired the White House Commission on Complementary and Alternative Medicine Policy. His work with war-traumatized children in Gaza and Israel, both of which he has visited 20 times, has been featured on 60 Minutes in 2015, as well as in The New York Times and The Washington Post.