East Jerusalem is home to six specialized mental health centers, and four of them are Arab-run: The Palestinian Counseling Center, Spafford Children’s Center, Hadi Center for Support and Counseling, and Al-Majd for Psychological Counseling. These centers offer psychological therapy for children, couples, and families through individual and group therapeutic programs. They also engage in advocacy efforts to influence legislation and policies that promote the right to mental health in Palestine.1

Do Palestinian Jerusalemites, however, seek psychological support or visit mental health clinics? What exceptional pressures do they face that affect their mental health? Do treatments offered at these clinics help alleviate their distress, or does the reality in which they live render treatment futile?

To learn more, Jerusalem Story spoke with Dr. Mohammad al-Khawaja, a Palestinian psychiatrist who specializes in mental health and addiction treatment and works with the community. The interview took place on December 15, 2024 at his clinic at Makassed Hospital and has been edited for clarity.

Jerusalem Story (JS): Who is Dr. Mohammad al-Khawaja?

Dr. Mohammad al-Khawaja (MK): I come from the village of Ni’lin in the Ramallah Governorate, but I was born in the city of Tabuk, Saudi Arabia, in 1983. I lived there for only three years before my family returned to Palestine. I studied at al-Iman schools in Jerusalem from the first grade until high school. My father wanted me to study in Jerusalem, because schools in the West Bank were frequently disrupted during the First Intifada, so he moved me to Jerusalem to ensure my academic journey would not be jeopardized.

I pursued my medical degree at the Jordan University of Science and Technology, then I specialized in psychiatry after completing a five-year program. From 2013 to 2016, I worked with Syrian refugees in Jordan as the sole psychiatrist for about 100,000 refugees at the Zaatari camp.

[Smiling] And because I’m the only son in the family, I answered my father’s wish and returned to my homeland. In 2017, I began working in Jerusalem while also maintaining a private clinic in Ramallah.

Despite the difficulty of reaching Jerusalem, I insist on working here because it holds a special place in my heart. My connection to the city is emotional, and I deeply cherish being here consistently.

JS: We know that Palestinians across all parts of Palestine are exposed to severe pressures that often impact their mental health, but what are the unique challenges experienced in Jerusalem?

MK: It is important to note that Palestine can be divided into three regions when discussing mental health: Jerusalem, the West Bank, and Gaza. Jerusalem has distinct characteristics that set it apart from the other two. Firstly, Jerusalemites live side by side with Jews, which forces them to engage in daily interactions. They are also compelled to learn and use the Hebrew language to manage their daily lives. This results in significant pressures that impact psychological, cultural, cognitive, civilizational, and ideological aspects.

Additionally, numerous Israeli studies aim to devise methods that apply pressure on Palestinians in Jerusalem to coerce them to leave the city, either voluntarily or by force. For those who stay, the goal is to assimilate them and strip them of their national identity—in essence, to “break” those who decide to remain in the city.

Another issue unique to Jerusalem is the ease of access to prescription drugs classified as narcotics or other forms of drugs, often legally. This is a significant challenge I face as a psychiatrist working in the city where I encounter numerous cases of addiction. For example, an individual can visit a general practitioner and request medication classified as a narcotic, and the doctor has the authority to prescribe it. This does not happen in other areas, where such prescriptions require extensive documentation, such as reports for a terminal cancer patient suffering severe pain, to justify using such medication for palliative care.

It’s unfortunate that some types of legal cannabis are also widely spread in Jerusalem, and the sale and purchase of drugs are done openly in the neighborhoods that fall behind the Separation Wall in Jerusalem, such as the Shu’fat refugee camp, Anata, and Kufr ‘Aqab (see Neighborhoods beyond the Wall).

It must be noted that the Israeli legal system criminalizes certain cultural, religious, and societal practices and customs. For instance, parents are prevented from standing in the way of their children’s unacceptable wishes, and children can file complaints against their parents and have them arrested and punished by the police. This leads to the disintegration of many families and threatens the psychological resilience of their members.

Additionally, military checkpoints around Jerusalem are another source of stress for Palestinian Jerusalemites in particular. The uncertainty surrounding these checkpoints greatly disrupts their lives, especially due to the varying and unpredictable wait times from one day to the next, which further affects their mental well-being.

JS: Is there any recent data on the prevalence of trauma among Palestinians living in Jerusalem? If so, how is trauma defined in these studies? Is it post-traumatic stress disorder (PTSD) or something more since trauma exposure is an ongoing process for Palestinians rather than a “past” or “post” event?

MK: Jerusalemites experience what is often referred to as “intergenerational trauma.” Unlike a one-time event, such as an earthquake or a sudden war, the trauma in Jerusalem is ongoing and spans multiple generations. Its impact is transmitted from grandparents to parents and from parents to their children. This cyclical trauma diminishes psychological resilience, perpetuating anxiety, fear, and stress. It significantly impacts individuals’ thought processes, decision-making, and relationships with others.

In such circumstances, it is common for disputes to arise within the home and between neighbors for trivial reasons because everyone suffers from pressures that are not properly released or treated.

JS: While research-based data might prove hard to obtain, some insights can be gained by treating cases in the clinic. So, let us discuss your observations: What are the most common mental health complaints in East Jerusalem?

MK: We can classify mental health disorders into two main categories. The first includes biological mental illnesses resulting from a specific chemical imbalance, genetic predispositions, or a certain upbringing, such as schizophrenia, bipolar disorder, and depression. The second includes psychological issues stemming from life problems and pressures.

In Jerusalem, I encounter numerous cases of drug addiction, marital and family problems, as well as issues arising from illicit relationships. All of these are avenues that Jerusalemites turn to as an escape from the pressures they face.

Depression, schizophrenia, and bipolar disorder are also prevalent. I should mention that bipolar disorder—a condition in which patients alternate between states of depression, lack of motivation, mania, and grandiosity—has driven many individuals to carry out attacks against the Israeli army and settlers. During their trials, no consideration was given to their mental condition, and they were treated as mentally sound individuals, which is extremely dangerous. A person suffering from schizophrenia or mania is legally incapacitated and should be treated immediately. This is often ignored in Israeli courts, causing families to lose their loved ones due to the lack of appropriate and timely treatment.

I have approached the courts about some of these cases, providing documentation and precise diagnoses, but the medical reports presented to the courts are seldom taken into consideration.

JS: Are there specific groups that visit your clinic more often for mental health support, such as released prisoners, children, or mothers?

MK: Mothers visit the clinic most frequently. Scientific studies suggest two primary reasons for this: the first is hormonal factors, which affect women more than men, and the second —and the one I find more convincing—is that women tend to be more willing to confide, express their struggles, and seek help compared to men.

I always emphasize to everyone that asking for help is a sign of strength, not weakness. Unfortunately, released prisoners and children under house arrest are often reluctant to visit psychiatric clinics. They believe that the suffering they endure as part of resisting the occupation must be silently borne and that showing weakness or fear is unacceptable. Anyone who has been subjected to arrest is expected to project an image of heroism, which is a profound misconception.

Several released prisoners have been seeking help at the clinic during the current war due to the hardships they endured in Israeli prisons. Many of them struggle with severe depression, high levels of trauma, and a tendency to isolate themselves.

“Panic disorder” also accounts for a significant portion of my patients’ issues. This condition stems from intense anxiety and fear, often triggered by specific situations, and presents with symptoms such as rapid breathing, a racing heartbeat, chest pain, and a sense of impending death. For example, some patients experience panic attacks as soon as they reach the notorious Qalandiya military checkpoint. In psychiatric terms, this condition is known as “agoraphobia,” which in Jerusalem is closely tied to the trauma of navigating military checkpoints.

Since the outbreak of the war on Gaza on October 7, 2023, I’ve seen a dramatic rise in cases of panic disorder due to heightened restrictions at these checkpoints. There has also been a significant increase in depression, stress, and anxiety among my patients during this period.

JS: As a treating physician in such an environment, do you find that you can offer treatments to alleviate the symptoms? Or is the reality that people live in overwhelming and resistant to treatment?

MK: No, of course we can help. Just one word can change a person’s life, and a proper diagnosis is crucial.

Mental illnesses are extremely impactful on people’s lives and relationships, and many of them are easy to treat. We make a huge difference in someone’s life by helping them distinguish between external pressures that they can’t control and those within their responsibility and ability to manage.

I always tell my patients that we can’t control the triggers, but we can control our response to them. There is nothing fixed. In psychiatry, our interventions lead to positive results, and the cases are very few where we can’t make an improvement.

JS: For a Palestinian patient suffering from mental health issues in Jerusalem, are resources easily available to seek support or are they scarce and difficult to obtain?

MK: The problem in East Jerusalem is that health institutions are under the Israeli health umbrella. In Jerusalem, there is a good framework for mental health care in general, but the performance is weak due to the shortage of Arab psychiatrists. A Jewish doctor cannot offer much help to a Palestinian because of cultural differences and simply because they do not live with the pressures that Palestinians experience.

On the other hand, there is a stigma attached to mental illness in Israel. When I first started working at Makassed Hospital, I was surprised by the reluctance of some patients to include details of their mental health diagnoses in their records with the Israeli health insurance system. Over time, I discovered that this hesitation stems from the real impact such disclosures can have on their employment prospects and how various institutions treat them. This also explains why many patients insist that their visits to my clinic remain strictly confidential. They seek care in a space of discretion rather than in the public eye.

JS: How does societal stigma surrounding mental health issues affect access to care for those who need it? Has this stigma decreased over time?

MK: The stigma has indeed decreased and continues to decrease. It’s worth noting that the stigma associated with mental illness originated in Europe. Historically, the Fatimids in Egypt established the first psychiatric hospital, and the Abbasids in Iraq opened the first psychiatric department within a general hospital to normalize and destigmatize mental health care. In contrast, in Europe, mentally ill individuals were once treated alongside animals. Through cultural dominance, we inherited this European stigma, although ironically, Europe is now leading efforts to combat it.

Studies in this field reveal that the numbers of patients visiting psychiatric clinics are similar in Arab countries and Europe. The key difference lies in societal attitudes: in Eastern societies, people are generally open about physical illnesses or surgeries but remain extremely reluctant to disclose mental health issues. They often prefer not to discuss these matters at all.

JS: Do Jerusalemites experience “Jerusalem Syndrome,” where those who live in Jerusalem feel they can’t live anywhere else?

MK: This syndrome may resonate with anyone who feels that the place they live in is their home, and they can’t bear to leave it. However, Jerusalem holds something truly unique and special due to its ancient civilization and religious landmarks. The al-Aqsa Mosque, in particular, carries tremendous historical significance—a value deeply cherished by every Jerusalemite.

JS: What are the positive aspects of Jerusalem that strengthen a person’s psychological resilience?

MK: [Answered quickly and without hesitation] Al-Aqsa . . . al-Aqsa provides us with psychological resilience. It serves as our sanctuary in times of suffering, much like the Church of the Holy Sepulchre gives us purpose and strength to stand firm in the face of hardship.

In my work, I consider “meaning-centered therapy” to be the most effective approach. We endure immense suffering, and each of us must find a tangible meaning that helps us persevere. In Jerusalem, there is an abundance of such meaning.

Another positive aspect of Jerusalem is the strong family bonds and communal unity that persist despite decades of efforts to break them. This unity undoubtedly contributes to the psychological resilience of the city’s residents.

JS: Is there anything else you would like to add?

MK: Yes, there is a saying about war: “Everyone knows how a war begins, but no one knows how it will end.” I would add that while we can’t predict our psychological state when this war ends, I am optimistic that it will ultimately lead to a better state, not a worse one. The suffering we are enduring is forging resilience and building character. Although the war is in a painful phase now, it may pave the way for a positive birth—a new beginning.