NORWAC received funding for a new project in Gaza last year in May. The aim of the project is to improve the quality of mental health services and provide patients with mental health conditions access to the appropriate medication.  A large part of the project is to conduct training for mental health staff. This has not been possible because of strict COVID-19 travel restrictions, but finally the first mission took place in the beginning of March. The picture shows the two NORWAC’s consultants, Peter Mc Govern and Thanos Tsapas together with some of the participants at the training.

The 6^th-10^th of March the first NORWAC team finally reached Gaza after two years of absent. As part of the team were two psychiatrist consultants.  During the mission, they delivered a two-day training to staff members from across the mental health sector focusing on promoting recovery and person-centred approaches to mental health as well as capacity building of core psychotherapy skills, which the team in Gaza had identified as a major deficit area. The consultants also had the opportunity to join the clinical staff on ward rounds, provide individual case supervision, actively participate in case base discussions, and meet with staff across the mental health sector.

In Gaza the Mental Health Directorate (MHD) and the Ministry of Health (MoH) are responsible for all public mental health services for the over 2 million people. The governmental services are provided through six Primary Health Clinics (PHC) and one psychiatric hospital (40 beds) for the whole population. Numbers from MoH show that these seven institutions receive over 1500 cases and provide about 80 000 follow up sessions annually.

There is a dire need for more qualified and skilled mental health workers in Gaza, and this shortage affects the MoH´s ability to provide effective and high-quality services to cover the population’s needs. In line with previous and on-going capacity building programs, NORWAC aims to improve mental health services in Gaza by building capacity within the mental health staff. The starting point is therefore to facilitate short courses for doctors, nurses, psychologists, and social workers already working at the psychiatric hospital and the PHCs. The first courses took place in March, the next one is planned for the end of April, and the courses will continue in the next project period, with the assistance of local experts and by psychiatrists and psychiatric scholars from Norway and the UK. Topics requested by local staff include Child and adolescent Psychiatry, Recovery, Advanced communication skills and Core skills in psychotherapy.

The supervision and case-based discussion will be based on real world clinical case studies and rooted in recovery and rights orientated approaches to mental healthcare. In addition the consultants will promote reflective practice and encouraging therapeutic holistic interactions with all people using services. The consultants also plan to have digital case discussion groups in between visits.

UNOCHA published in October 2020 an article outlining the further deterioration of the mental health situation in Gaza emphasizing the lack of proper resources, including human resources, and chronic shortage of drugs. More recently, the widespread COVID-19 restrictions, and the resulting economic deterioration, have exacerbated the situation.

This lack of time, resources, and available facilities to make diagnostic formulations, leads to unnecessary use of medication. Often, medication is used to deal with disruptive behaviour on the wards. This is against the patients’ core human rights afforded to them under the UN CRPD and other human rights conventions. It also amounts to poor and ineffective treatment and a systemic failure to address underlying and contextual causes of emotional distress and mental health problems. Task shifting and further training with the focus on less biomedical approaches can help to address these challenges and create a more recovery orientated service that promote people’s right to health.

Even if there is unnecessary use of medicines, there is also lack of specific types of medication. NORWAC does also cover procurement of vital and highly needed medication that identified by MoH as lacking or not available in Gaza for patients suffering from mental health conditions.