GAZA CITY | Assistance to the Gaza Strip, where tens of thousands of displaced people are living in flimsy U.N. tents despite freezing winter temperatures and rain, will be "at the top of [the] agenda" when Secretary of State Hillary Rodham Clinton visits the region next week, a U.S. official in Jerusalem said Wednesday.
A month after a cease-fire ended Israel's military offensive in Gaza, many sleep on thin mats on the muddy ground and traumatized children burst into tears at any loud noise. Lots where they once played are littered with crushed concrete and other debris.
Mrs. Clinton, who flies to the Middle East Saturday, has privately expressed anger at Israel for steps that have interfered with the delivery of humanitarian aid to help the Gaza residents, the Israeli newspaper Ha'aretz reported Wednesday.
A U.S. official in Jerusalem, who spoke on the condition that he not be named, said not to read too much into the Ha'aretz article but added, "You can bet this will be an issue at the top of the secretary of state's agenda. ... We respect the Israelis' need for security, but there are genuine humanitarian needs in Gaza."
More than 1,300 Palestinians, many of them civilians and a third of them children, died in Israel´s 22-day military offensive last month. Thousands more were injured, some permanently disabled.
But the enduring damage is mental as well as physical, and it is most evident among the children such as 9-year-old Amir Musbah. His family of eight initially hid in their house in the border town of Beit Lahiya as Israeli F-16s flew overhead.
"Planes came and started bombing us. The attack forced us to flee our home and head to a nearby school," Amir said.
When Amir's father and uncle ran to try to rescue their brother, who had been hit by artillery, they were killed by a helicopter gunship hovering overhead, said Amir's grandfather, Khalil Musbah. He said Amir's house collapsed after a bomb landed on it.
"Initially we thought Amir's father had been arrested and taken away. It was later that we discovered that he had died," Mr. Musbah said. "I buried him, after the planes and the tanks left, under the big tree."
Mr. Musbah said the grief-stricken boy ran to the tree and dug in the dirt with his hands to find his father.
Israel said the offensive was necessary to halt rocket fire into southern Israeli towns from the militant group Hamas, which rules Gaza.
Mark Regev, a spokesman for outgoing Israeli Prime Minister Ehud Olmert, said conflict also has traumatized Israelis.
"To be fair, you have a whole generation in southern Israel who are growing up in constant fear and trauma," he said. "I went with my prime minister to a grade school in Sderot. There were kids who have known nothing else but sirens and running to bomb shelters because of rockets from Gaza. ... I know the conflict has caused pain and suffering to children on both sides. The goal of our operation was to bring about an end to the violence."
Meanwhile, psychologists, teachers and community workers are training caregivers and offering a variety of activities to help Gaza children cope.
At the Zahwa Rosary Catholic School in Gaza City, counselor Fadl Abu Hein said children are given balloons to vent stress while affording them a sense of control. But when a green balloon popped and then a red one, eliciting squeals from about three dozen 6-year-olds during a recent outing, one child clapped his hands over his ears.
"Most of the children cry when they hear an explosion or any loud noise," said Mr. Abu Hein. "Many are bed-wetting. They bite their nails or have nervous twitches. They become afraid, especially at night."
Mr. Abu Hein, a psychologist and consultant for UNICEF, said the therapy is a kind of "first aid" for the people of Gaza. Further stages of the program, which will span six months to one year, include behavior modification for cases of severe depression and violent anger.
"We have a large number of highly stressed and traumatized people. It's a big suffering," said Mr. Abu Hein, who heads the Community Training and Crisis Management Center in Gaza City.
A survey carried out by the center after the war among 3,000 children and 1,000 adults revealed that 97 percent of children are afraid of the dark and cling to their parents, 76 percent exhibit behavioral problems such as social withdrawal, 70 percent are depressed, and 71 percent have trouble sleeping.
Mr. Abu Hein said the support program is aimed to help more than 8,000 people, mainly schoolchildren. A Washington-based group, American Near East Refugee Aid, and Norwegian Aid are providing financial assistance, he said.
Mr. Abu Hein said that all of Gaza's inhabitants had been "psychologically injured" to some extent by the bombardment, even though Israel insisted that it sought to limit civilian casualties.
"Nowhere in Gaza was safe," he said.
Although initial reports of Israel targeting a U.N. school proved inaccurate, more than a half dozen schools were destroyed and about 175 damaged.
"The emotional problems children face result not just from three weeks of severe conflict, but prior to that, a year and a half of essentially being under siege," said Ashley Clements, a spokesman for the charity World Vision. "They have been unable to get out and do not live what most of us would regard as a normal childhood."
Mr. Clements said assessments made before the offensive showed "disturbing numbers" of children who were afraid of being separated from their parents and other family members.
"It was bad before the recent conflict, but now it's been exacerbated significantly," he said.
When you see your family killed in front of you and you're unable to save them, it's a big shock," said Almaza al-Sammouri, 12, as she and her classmates drew pictures during a therapy session at the An-Jalout Islamic Girls School in Gaza City.
"I want to draw about when the Israelis kicked us out of our house and how I found my family martyred when a missile hit the place where we sought shelter," she said of the air strike that killed her mother, four siblings and several uncles.
"I found them piled on each other. Some were dead. Others died a little later because we couldn't get an ambulance. It was a huge shock. I couldn't move or do anything," she said.
"I want to become a first-aid nurse because if this happens again, I would be able to treat them so they wouldn't die," she said.
Psychologists and aid officials expressed concern about the long-term impact of the offensive, warning that it could persuade more young people to turn to terrorism.
"One thing we'll have to be very aware of is how these children engage politically in the future," Mr. Clements said. "Certainly, I hope these children can be helped to confront these experiences so they can become a productive part of the Gaza life."
But when 6-year-old Aseel of the Rosary School was asked whether he could see a future peace with Israelis, he responded with a determined, "No." When asked why not, he said, "That's just how it is. They're afraid of us, but we're not afraid of them."
• Joshua Mitnick contributed to this report from Tel Aviv.