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Ahmad Al Shaer is still adjusting to life away from war. After leaving Gaza last year and entering Egypt, he found it hard to fall asleep, the disbelief of being outside the enclave for the first time in his life keeping him awake. Everything was new. Everything was difficult.
At the age of 25, he has experienced several wars, including Israel's continuing bombardment of the enclave. "I've suffered," he said. "The smell of death is something I've known since I was child."
He left Gaza in May last year, paying about $8,000 to a private company to take him across the border. That was a standard practice for many who could afford it at the time, before the Rafah border crossing between Gaza and Egypt was closed, effectively trapping 2.1 million people in the enclave.
The rest of his family could not afford to cross the border. Some refused to leave.
He now lives in safety, without killer drones flying overhead or the threat of an air strike. But he is haunted by his experiences in Gaza.
Mr Al Shaer studied to become a chef and was supposed to graduate in June 2024, nine months after Israel's war on the enclave began and when the death toll was at about 37,000. More than 46,000 people have now been killed by Israeli attacks, with at least 109,000 injured, the enclave's Health Ministry said.
Famine, cholera and hypothermia also cast a deadly shadow over Gaza. Humanitarian aid is only trickling into the enclave when a "waterfall" of assistance is needed, the International Committee of the Red Cross said previously.
Mr Al Shaer faced challenges adjusting to his new life and he sought help. "I forgot that I could take a shower at any time. I forgot I could go eat whenever I wanted," he said. "Filling a form was difficult. Seeking out help and finding organisations that offer assistance seemed impossible to do."
Eventually, he began to receive therapy online, through a UN mental health programme. At first, it seemed to be working. "Until it didn't," he explained. "Already in Gaza we feel like we're numbers, and talking to someone virtually and not face-to-face furthers that perception we have of ourselves."
He called for Gazans who escaped the war to be given more integrated mental health assistance. "We just have ourselves to rely on, and many of us who leave are still in survival mode," he added.
The situation was grave a few months ago, when he contemplated ending his life. He says many others did, too.
Accountability and healing
Mr Al Shaer said his pain and anger has only been exacerbated by the failures of the international community and the Palestinian Authority in the occupied West Bank. The PA has recently cracked down on what it says are "outlaws", referring to militants from groups including Hamas and Palestinian Islamic Jihad.
Such a sense of betrayal and disillusionment will prolong the suffering of Gazans after the war, consultant psychiatrist in Ramallah, Dr Samah Jabr, told The National.
"There are 'out of the self' aspects when it comes to healing justice," she said. "This includes whether there's going to be justice for the people who endured great losses."
A case filed by South Africa at the International Court of Justice accuses Israel of committing genocide in Gaza. In July 2024, the court issued an advisory opinion that found Israel responsible for racial segregation and apartheid against Palestinians. The administration of US President Joe Biden has also warned repeatedly it could limit military assistance to Israel if it failed to provide more adequate aid to Gaza, but Washington has not yet done so.
Dr Jabr also warned Palestinian resilience was being weakened by the events in the West Bank's Jenin refugee camp, which the PA has besieged for more than a month, cutting off electricity and water from many areas. At least 12 people have been killed there, including 21-year-old journalist Shatha Sabbagh. Her family has accused Palestinian security forces of killing her, an allegation that the PA denies.
The PA's popularity has dwindled in recent years amid accusations of corruption, inefficiency and co-operation with Israeli forces. "The Palestinian Authority is exterminating its own people, so we can't rely on them to take care of us," Mr Al Shaer said. "We need to face that fact that we have a government and an occupation that works against us."
Dr Jabr said there is still hope for people such as Mr Al Shaer, even if they face challenges. "Some people bounce back and grow," she added. "Some people have depression and a change in their world view. Not everyone's reaction is the same."
Some are able to thrive, despite the trauma they carry. "The 1948 Nakba is the biggest proof of that," she said, referring to the killing of hundreds of Palestinian civilians and expulsion of more than 750,000 from their homes.
