Letters to the Editor
Reply: The Prevalence of Psychological Morbidity in West Bank Palestinian Children
Dear Editor: We respond here to the letter from Scholars for Peace in the Middle East concerning our paper revealing that, in July 2000, more than 42% of Palestinian children in the West Bank exhibited psychological morbidity (1).
Several criticisms were raised concerning the Discussion section of our descriptive study. Principal among these was the assertion that we should have tested the hypotheses generated in our study. According to basic statistics, a descriptive study attempts to reveal patterns associated with a specific disease or phenomenon without relying on a prespecified hypothesis. Thus ours is not a hypothesis-testing or proving but, rather, a hypothesis-generating investigation. To suggest that we test hypotheses generated from our Discussion reveals a serious lack of understanding of research methods.
Exception was taken to our use of “settlement encroachment” as a possible cause of psychological morbidity and to our use of a reference by Noam Chomsky describing this phenomenon. According to first-hand observation and serious historical scholarship, our statement is a valid, supported hypothesis properly placed in the Discussion section of the paper. Further, we stand by Prof Chomsky’s thorough, well-researched work and recommend further recent works by Israeli scholars describing the same phenomenon (2).
The correspondents question our anecdotal evidence concerning the fear that Palestinian children have of settlements, contending that acts of violence were not verified. We did not state that acts of violence occurred, nor was our descriptive study designed to verify interviewee statements. We point out that violence against Palestinian children has been well described in the literature and by regional and international human rights organizations. We agree with the correspondents that Palestinian children may be subjected to a campaign of incitement to violence. This incitement (as mentioned in our paper) may include the significant presence of the Israeli Defence Forces (IDF) in the occupied territories; illegal settlement encroachment; and ongoing, violent displacement of the Palestinian population.
Objection was raised concerning our statement that Palestinian children under investigation were living in a “period of relative calm.” This objection is at odds with the extremely violent conditions imposed by the IDF directly following the period of our investigations: Over 600 Palestinian children have been killed (see www.btselem.org/ english/Statistics/Casualties.as) and more than 7000 wounded (3) since September 2000. During the previous period (1987–1992), 1533 Palestinians were killed during the first Intifada (www.btselem.org/English/ Statistics/First_Intifada_Tables.asp).
The correspondents mention no criticism of our methodology or statistical analysis. The Rutter Scales (A2 and B2) were used in the Gaza Strip in 2000 (after validation) (4), but we agree that they are employed less often in recent studies. Researchers no longer attempt to flag Palestinian children with evidence of psychological morbidity, since it is well established that many Palestinian children require formal psychiatric assessment on a large scale. Research now largely focuses on screening for DSM-IV criteria for depression or posttraumatic stress disorder, common among populations living with war and highly prevalent in the West Bank and Gaza (5–7).
Thus our brief communication remains one of countless studies revealing that Palestinian children are not thriving under occupation (8,9). Finally, we conclude that the criticisms directed toward the Canadian Journal of Psychiatry editorial process and authors are vacuous and unfounded.
References
1. Zakrison TL, Shahen A, Mortaja M, Hamel PA. The prevalence of psychological morbidity in west bank Palestinian children. Can J Psychiatry 2004;49:60–3.
2. Pappe I. A history of modern Palestine. In: Shlaim A, editor. War for Palestine: rewriting the history of 1948. Cambridge (UK): Cambridge University Press; 2001.
3. Report of the Special Rapporteur of the Commission on Human Rights. New York: United Nations; 2002. E/CN.4/2002/32. Available: http://domino.un.org/UNISPAL.NSF/0/48b2a380133d484085256b87005e1081?OpenDocument. Accessed 2005 June 6.
4. Thabet AA, Vostanis P. Post traumatic stress disorder reactions in children of war: a longitudinal study. Child Abuse Negl 2000;24:291–8.
5. Khamis V. Post-traumatic stress disorder among school age Palestinian children. Child Abuse Negl 2005;29:81–95.
6. Thabet AA, Abed Y, Vostanis P. Emotional problems in Palestinian children living in a war zone: a cross-sectional study. Lancet 2002;359:1801–4
7. Thabet AA, Abed Y, Vostanis P. Comorbidity of PTSD and depression among refugee children during war conflict. J Child Psychol Psychiatry 2004;45:533–42.
8. Giacaman R, Husseini A, Gordon NH, Awartani F. Imprints on the consciousness: the impact on Palestinian civilians of the Israeli Army invasion of West Bank towns. Eur J Public Health 2004;14:286–90.
9. Qouta S, Odeb J. The impact of conflict on children: the Palestinian experience. J Ambul Care Manage 2005;28(1):75–9.
Paul A Hamel, PhD
Tanya Zakrison, MD
Toronto, Ontario
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