Mental Health and Social Justice Are Inseparable – An Ethical Statement Regarding the Events in Gaza

Our Statement is addressed to members of the mental health and welfare community in Israel, and to our representatives in professional associations, to all those who remain silent in the face of the destruction, starvation, and ongoing genocidal war in Gaza.

Against the fear of taking a political stance, it must be stated clearly: silence is itself a political act!

This document calls for breaking the silence and acting according to the ethical codes that are the core of our work.

The events of October 7, 2023, struck the community in Israel with shock. The encounter with boundless cruelty and violence shook our world. The mental health and welfare community in Israel was also severely impacted on that dreadful day. Some of us were affected personally and within the family. As a result, we too, as professionals, are subject to the difficult emotions experienced by trauma victims— rage, a desire for revenge, harm to one's self-perception and worldview, and the undermining of fundamental human values.

However, our professional commitment requires us to observe what is happening with deep thought and a broad perspective and offer an alternative to the urge for revenge. Our commitment requires us to be aware of how our personal and social identity affects our judgment and professional functioning, to separate ourselves from the position of the collective victim, and to be aware of our collective moral injury and our own ability to perpetrate injustice.

The Ethical Codes of Mental Health and Welfare Professions

When war is used as a political tool, the silence of mental health professionals is inexcusable. This is the moment when our ethical codes obligate us not only to consider individual circumstances, but to acknowledge the complex ethical conflict we face.

The Code of Ethics of Psychologists in Israel states that the profession's purpose is to "promote the psychological well-being… and minimize the suffering" of the client, and emphasizes the "social commitment" of professionals to act for the well-being of people and the community. This commitment does not differentiate between people and should not stop at a border.

The Code of Ethics of Social Workers defines the promotion of well-being and equality as the profession's purpose. It explicitly calls for action "to promote social justice" and to fight against "discrimination and other forms of injustice." It also obliges us to act "to ensure that every person has access to the resources, services, and opportunities they need."

Art therapists are obligated to "the care and commitment to the welfare of every person who seeks help, without distinction of race, gender, religion, nationality, or origin."

The International Federation of Social Workers (IFSW) rebuked the Israeli Association of Social Workers for failing to act for peace, emphasizing that social workers are obligated to act for human rights as part of their professional work.

The Testimonies Refuse to Be Silent, the Psyche Is Collapsing

The testimonies presented below, from Palestinians on the ground, illuminate the incomprehensible scale of human suffering and mental distress, and emphasize the urgent need for action.

Sabreen Al-Massani, an MSF (Doctors Without Borders) psychotherapist: "This time I don’t want to pack. No bags, no papers, nothing. I don’t know why—maybe my mindset is wrong, but I just cannot mentally process the idea of leaving home again … We are in a constant state of alert; we can receive a notification to flee at any time. We cannot sleep at night thinking we might be the next."

Dr. Mohammad Qishta, an MSF doctor: "The emergency in Nasser Hospital was very disastrous:  We received many bodies and body parts, most of them children and women. The bodies were everywhere in the emergency room, with complete confusion … At that moment, everyone was praying to God that none of their relatives would be present among the dead and the injured. The situation was very tense, and the doctors in the emergency room fell down and collapsed. They were crying due to the intensity and the difficulty of the situation."

Edward Antone, an MSF driver: "… I went to the place where we heard the gunfire. I found my mother injured. I asked if she could hear me or if she could speak to me. Then she died in my arms"

Dr. Samah Jabr, a Palestinian psychiatrist: "People suffer distress, rather than depression. So they don’t need treatments, they need better life circumstances."

First, Do No Harm

The central ethical principle of our professions is to cause no harm. The psychologists' code states that we must do "all we can to avoid harming our clients," while the APA's ethical code requires us to "respect and protect human and civil rights, and not participate in or condone discriminatory practices."

War causes direct and unprecedented harm. It creates mental distress, existential anxiety, and mass traumatic patterns. The current war erupted against a backdrop of years of prolonged Israeli closure of Gaza with a devastating impact on every aspect of life. "The closure is like a drop of ink in a pool of water, spreading everywhere, touching everything." (Nedaa Murtaja, psychologist, Gaza). Hassan Zeyada, a psychologist from Gaza, says, "The depression experienced by residents of Gaza is not depression in its classic, conventional sense, Palestinian depression is different. Gaza’s entire society is in a constant state of high level of chronic stress and ongoing trauma. The Israeli closure and travel restrictions on Gaza affect everyone, without exception. The prevailing feeling among Gaza’s population is one of helplessness and hopelessness. This situation did not appear out of thin air: It is the result of a deliberate process designed to induce a state of helplessness to weaken the resilience of both individuals and society in Gaza." Dr. Samah Jabr explains: “The development of the construct of PTSD came from the experience of soldiers who do their work and go back to the safety of their homes. They still feel a threat that is not reality…This construct doesn’t work for the people of Gaza, because the threat is very real; it is surrounding every aspect of their life.”

To remain silent in the face of this reality is passive complicity in the continuation of suffering. We, as professionals, have a duty to acknowledge this harsh reality, because as Dr. Jabr says "it validates the Palestinian experience, it tells us that we are seen and that our pain is felt."

In a place and time where the threat is tangible and daily, in the absence of basic existential security—in a reality of killing, starvation, destruction of homes and infrastructure, and repeated displacements—our tools as therapists almost completely lose their meaning. At the same time, we must not fall into despair and helplessness. We have courses of action available to us.

Silence is an Ethical Failure at this Time

A historical perspective can assist us at this time, offering a view beyond the bloody reality of war—a reality that attacks the body, mind and thought. Therefore, we suggest reflecting upon other times or places where a bloody military conflict occurred, in which many innocent people were harmed by the actions of their State and to consider the mental health and welfare professionals in those places:

What is our ethical expectation of mental health and welfare professionals in those regions?

How do we feel about professionals like ourselves who remained silent in the face of injustices perpetrated by their own people?

In conrast, how do we view those who raised their voices, even at the cost of professional risk and even danger to their lives?

How does history judge them in the eyes of generations to come?

Call to Action

The reality in Gaza requires us to recognize that there are no therapeutic solutions for a state of continuous and total suffering, and that instead of therapy the people there need "better living circumstances," in the words of Dr. Samah Jabr. In this context, a clear statement against Israel's actions in Gaza has significant potential in stopping the ongoing harm to an innocent population.

We call on all mental health professionals in Israel and around the world to:

Raise your voices against the killing and starvation in Gaza. The best medicine for collective trauma is solidarity.

Push for an immediate ceasefire. This is the most basic and necessary condition for preventing further mental suffering.

Condemn the silence of professional institutions and remind them of their ethical obligation to act for justice and equality, without distinction of religion, race, or nationality.

Remember your fundamental commitment: not only to treat the psyche, but to protect it.

Do not remain silent any longer!

Our Responsibility as a Professional Community

Our ethical commitment is not limited to the clinic. It obligates us to fight for humanity, mental well-being, and justice, sometimes even in the face of opposition of our own affiliation groups.

As Levinas said, our infinite responsibility is toward the Other, before any commitment to any law or social institution.

Our practice is not detached from the social and political context. Our lives in Israel and the lives of the residents of Gaza are intertwined—we will not be able to live here in peace and mental health as long as there is indescribable physical and mental suffering across the border. Our ethical and moral commitment to act is also toward our own society, to the life contexts of our clients.

Remove Your Hands from Your Eyes, Ears, and Mouth:

The very fact that you are reading this document now may indicate that this issue touches your heart. We encourage you to open your eyes.

Look—learn and understand what is happening in Gaza (do not be content with the mainstream, mobilized media channels in Israel; there are far more independent and reliable sources of information both in Israel and abroad).

Speak—do not be silent in your workplaces and professional spaces. Share information about the disaster we have wrought upon the civilian population in Gaza.

Join existing initiatives and raise the important, professional, and ethical voice of a mental health or welfare professional.

You are welcome to contact us here.