A clinical psychologist in Nablus

Loraine Anderson is a Clinical Psychologist. In 2016, she spent seven months working in Médecins Sans Frontières’ (MSF) mental health program in Nablus, in the north of the West Bank, Palestine. She describes her experience.

“I was based in the Nablus office for seven months. I was treating patients, training staff, and supervising students from Al-Najah University. It’s the first Palestinian university to teach clinical psychology, and MSF offered three-month student placements so they could practice their skills and apply their knowledge in a clinical setting. In total they had eight students in this first year cohort.

Mental health and in particular psychology is not very developed in Palestine. There is only one psychiatric hospital, in Bethlehem, and the WHO[1] with the Palestinian Authority Ministry of Health are developing community health centers to also include mental health. That’s why MSF’s support in training students in clinical psychology is important. 

All Palestinian scientific courses including clinical psychology are conducted in English. This made it easy for me to communicate with the students. It was more difficult in clinical sessions as my translator would have to interpret both what the students and patients were saying in Arabic. In Nablus, our translators were great, very professional and dedicated, and they often acted like facilitators, especially with large family groups.

As well as supervising two students one day a week each, I had a case load with a mix of children and adults, individuals and families.  I would conduct about 10 to 15 weekly sessions. I was directly supervising one of our Palestinian psychologists. I was also involved in providing psychological services and training for the staff in one orphanage in Qalqilya, a city about 30 km west from Nablus.

We were mainly dealing with the consequences of the occupation

In terms of needs, we were mainly dealing with the consequences of the occupation like trauma, grief, and loss as well as general mental health diagnoses, like depression and anxiety.

For example, we had cases of relatives and friends of people killed by Israelis, who needed support for grief and loss.  Obviously, it’s not a normal death, and it’s hard dealing with the aftermath. We also treated children who had been traumatized by the army coming into their houses, searching at night, using weapons including gas bombs, or by the settlers entering villages and being destructive.

In terms of patients, quite surprisingly, I think we had more or less the same proportion of the population in need of mental health services as in Australia. That is possibly for several reasons: people are very resilient, they rely very much on their community, and because they have dealt with occupation for a very long time and they just have to cope.

There is still cultural resistance to mental health. In our societies, we have done a lot of education. It’s more about wellbeing, and you’re not so much stigmatized. The Palestinians have not had the exposure to mental health services, let alone funding for education.

The main problem is that Palestinians don’t have access to enough services. If someone in Australia has depression or anxiety, it’s very easy to receive treatment. You just have to be referred by your doctor to a psychologist. In Palestine, it’s difficult to find services and even more difficult in rural, remote, or conservative areas like in Qalqilya. This town is difficult to access. If you look at a map it’s like a key hole, a city surrounded by the separation wall, and there are fewer resources or NGOs than in Nablus.

Supervising the students was the most rewarding

The most challenging thing was scheduling the training, and being responsible for organizing the week and the days with the students, the translators, and the supervising staff. The most rewarding thing was supervising the students. The relationship with the patients was also rewarding thanks to the translation of our interpreters.

We had a team of three national psychologists and two international psychologists each with their own interpreter, two social workers, and a medical doctor. The initial information would be taken by a social worker, then the referral would be provided to the psychologists.  We received referrals from other organizations and we also had a toll-free number. The allocated psychologist would either go to their home, invite them to attend the clinic, or in a consultation room outside of Nablus to do the initial assessment. The psychologists managed the case, and we decided if the social worker or the doctor was needed, creating a multi-disciplinary treatment approach.

This experience will affect my practice in Australia. It made me more confident in my clinical skills and in training future psychologists. It makes me want to work more with people with a refugee background.”

In 2016 MSF’s mental health programs in Hebron, Nablus and Qalqilya governorates, and East Jerusalem, provided psychological and social support to victims of political violence. MSF also provided training for medical staff, teachers and counsellors. Last year, MSF commemorated 10 years of working in Nablus.

To find more about MSF activities in Palestine: http://activityreport2015.msf.org/country/palestine/

[1] World Health Organisation