TEHRAN - So far, Israel has killed over 4,650 people in Gaza, including nearly 2,000 Palestinian children, leveling residential buildings, hospitals, mosques, churches, etc. 

It means children make up around 40 percent of those who have lost their lives to the bombardment so far. That is an average of almost 111 children a day. Thousands more have been injured. 
"More than 4,600 children are injured as hospitals run out of fuel, electricity, and medical supplies," rights group Defence for Children International – Palestine said in a post on social media platform X on Sunday. 

Children in Gaza are developing severe trauma symptoms alongside the risk of death and injury, according to a Palestinian psychiatrist. 

The psychological impact of the war on children was showing, said Fadel Abu Heen, a psychiatrist in Gaza. Children had “started to develop serious trauma symptoms such as convulsions, bed-wetting, fear, aggressive behavior, nervousness, and not leaving their parents’ sides.” 

The “lack of any safe place has created a general sense of fear and horror among the entire population and children are most impacted,” he said. 

“Some of them reacted directly and expressed their fears. Although they may need immediate intervention, they may be in a better state than the other kids who kept the horror and trauma inside them.” 

About half of Gaza’s 2.3 million population are children. Since 7 October, they have lived under near-constant bombardment, with many packed into temporary shelters in UN-run schools after fleeing their homes with little access to food or clean water. 

Studies conducted after earlier conflicts have shown a majority of children in Gaza exhibit symptoms of post-traumatic stress disorder (PTSD). 

After Operation Pillar of Defence in 2012, UNICEF, the UN children’s agency, found that 82% of children were either continuously or usually in fear of imminent death. 

Among UNICEF’s other findings were: 91% of children reported sleeping disturbances during the conflict; 94% said they slept with their parents; 85% reported appetite changes; 82% felt angry; 97% felt insecure; 38% felt guilty; 47% were biting their nails; 76% reported itching or feeling ill. 

After Operation Cast Lead, the three-week war in 2008-09, a study by the Gaza Community Mental Health Programme (GCMHP) found that 75% of children over the age of six were suffering from one or more symptoms of post-traumatic stress disorder, with almost one in 10 ticking off every criterion. 

At the time, Hasan Zeyada, a psychologist with the GCMHP, told the Guardian: “The majority of children suffer many psychological and social consequences. Insecurity and feelings of helplessness and powerlessness are overwhelming. 

“We observed children becoming more anxious – sleep disturbances, nightmares, night terror, regressive behavior such as clinging to parents, bed wetting, becoming more restless and hyperactive, refusal to sleep alone, all the time wanting to be with their parents, overwhelmed by fears and worries. Some start to be more aggressive.” 

Experts also noted a spike in psychosomatic symptoms, such as a high fever without a biological reason, or a rash over the body. 

A report last year by Save the Children on the impact of 15 years of blockade and repeated conflicts on the mental health of children in Gaza found their psycho-social wellbeing had “declined dramatically to alarming levels”. 

Children that the aid agency interviewed “spoke of fear, nervousness, anxiety, stress and anger, and listed family problems, violence, death, nightmares, poverty, war and the occupation, including the blockade, as the things they liked least in their lives”. 

The report quoted António Guterres, the secretary general of the UN, describing the lives of children in Gaza as “hell on earth”.