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In Gaza, where displaced children play a game called “air strike” and act out death, the lack of mental-health resources has become another emergency.

By Mohammed R. Mhawish

The line outside Dr. Bahzad al-Akhras’s clinic starts to assemble before sunrise, a ripple of bodies in the half-light standing barefoot or in frayed sandals, waiting for a turn at what now passes for care. His clinic is wherever it needs to be: in a corner at a shelter compound, on the move during a walk around the yard, or behind the makeshift screen of a bedsheet pulled between two poles, if the wind allows. Often, Akhras sees patients in a tented space, tucked among hundreds of other such tents in the dense sprawl of Al-Mawasi, in the southern end of the Gaza Strip.

Akhras, a child and adolescent psychiatrist, lost his home to an Israeli strike, in early 2024. He and his family have been displaced multiple times, living in tents where the canvas sweats from too many bodies pressed into too little space. He no longer sits in a white-walled office or wears a badge. But he continues to work, seeing some fifty patients a day, most of them children. One of his regular patients is a young girl, no older than fourteen, who survived a strike that killed her entire family. She woke up in an I.C.U., alone, unable to understand where everyone had gone. Now she sits in front of Akhras in silence, until she asks, again and again, if he can bring them back. He has no answer, only a pencil stub and a coloring book, which he hopes she can use to express and process her emotions.

With barely functioning systems and almost no resources, practitioners such as Akhras rely on the few tools they have left: psychosocial support, cognitive behavioral therapy (C.B.T.), and improvised coping strategies. They teach breathing exercises, emotional regulation, and techniques to manage intrusive thoughts. When possible, they coördinate with overwhelmed medical staff to access limited psychotropic medication for patients with severe depression, psychosis, or suicidal ideation. But, as Akhras told me, most professional support has shrunk to voice notes between colleagues that ask just one question: “Are you still alive?”

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