Background

This chapter, a part of Part Five (see Figure 1.1), explores the dynamics of professional and interprofessional ethics when working across countries with significant cultural differences. It uses the case study of a trauma recovery programme delivered by UK professionals in Palestine to illustrate the potential tensions and dilemmas. The chapter then takes an ethical decision making (EDM) approach to suggest ways of resolving any issues inherent in such work.

The occupied Palestinian territories (oPt) are a dangerous place for children and adolescents. A recent survey found that children in Nablus experience on average at least 13 different types of war event (Barron et al, 2013). These events include witnessing the death, injury, detention and torture and/or abuse of someone close to them, be it family member or friend, or experiencing similar events themselves. Similar to other studies, higher levels of domestic violence were found, as compared to non-war contexts (Al-Krenawi et al, 2009). Srour (2005) observes that children in Palestine live in a multi-traumatic environment that includes not only the events of violent military occupation but also the impact of trauma on the adults who care for them. In short, trauma is fracturing the protective shield of childhood in this part of the world (Punamäki et al, 2001).

The consequences for children and adolescents are many, complex and enduring. Along with a high rate of post-traumatic stress disorder (PTSD) – as high as 65% – high numbers of children experience depression and traumatic grief. Children display difficulties in school, including motivation and concentration problems and relational difficulties with parents, peers and teachers. Zakrison et al (2004) conclude that children under occupation in Palestine display complex symptoms more akin to developmental trauma than PTSD.

In addition to war events, children's lives are negatively impacted by the deteriorating economic, social and health conditions of the occupied territories. Shortages of water, food and medical supplies; intermittent electricity; restrictions on movement; and the creation of imprisoned towns all add to the stress and trauma of living on a day-to-day basis (UNWRA, 2009). High levels of adults are unemployed (UNICEF, 2011), and those in work do not always have the guarantee of being paid; for example, prior to the current project starting, teachers in schools had not received salaries for a six-month period.