Fifteen-year-old Nour Aidi has hardly spoken in seven years since Israeli soldiers bulldozed the olive trees around his home, barricaded his family in a room and turned the house into a base, fortified with sandbags, camouflage netting, barbed wire and machine guns.
The soldiers stayed 12 months and then moved into barracks next door where, for another four years, they continued to control when Nour and his family could leave and enter the house.
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Israel withdrew its army and settlers from Gaza in 2005, but the soldiers still occupy Nour's life. Nour is introverted, angry, sometimes violent, and without friends.
Nearly four miles away, on the other side of Gaza's deadly perimeter, similar behaviour has also taken root.
In the Israeli border town of Sderot Raziel Sasson, 13, sleeps huddled next to his mother and father. Raziel retreated to his parents' bed four years ago after a rocket fired by Palestinian militants in Gaza exploded in a playing field, knocking him from a tree. He eventually returned to his own bed only to later move with the entire family into the lounge downstairs where they have slept for the past year, sheltering from the escalating attacks.
Raziel has watched rockets fired into his front yard and seen explosions cause serious injury. He has nightmares about the rockets and lately he has taken to sleeping in the reinforced steel box that his brother built in the living room for added protection.
Fits of aggression
Sleeping problems, fears, and fits of aggression are just some of the many symptoms of severe stress affecting the majority of children in Gaza and Sderot.
They live on the frontline of the world's oldest conflict, which in the past eight years has killed 5,848 people, wounded thousands more and traumatised countless families. Raziel has spent four years in therapy; Nour has been seeing counsellors for six months.
But Israeli and Palestinian researchers suspect the toll is worse than either the number of deaths or psychological symptoms of this protracted conflict suggest.
Alon Friedman, a biology professor and neurologist at Israel's Ben-Gurion University, who has been studying the effect of stress on the brain for 10 years, is now planning a study of the children of Gaza and Sderot.
Limited research on adults and more extensive testing on animals shows that stressful events, especially life-threatening situations, can cause long-term neurological and biological damage. When stressed the brain secretes powerful hormones such as cortisone which, in big or prolonged doses, can change the brain's structure, resulting in an inability to process intense emotions or form new memories. Such hormones can also induce epileptic seizures and attention deficit and hyperactive disorders.
"The connections between brain cells are very sensitive to stressful stimuli or experiences," Friedman said. "These change the way your brain cells interact and when that happens your thoughts and the way you express them also change."
Hormones such as cortisone can also damage internal organs, including the kidneys, heart and muscles.
The distress of living under military rule in Gaza caused Nour's younger sister to stop eating. Now 12, she has the body of a six-year-old. His mother developed a stomach disorder that activates when she is nervous, and his eldest brother is clinically depressed.
In Sderot Raziel's mother has been diagnosed with diabetes, which the doctor said she developed because she "has no quiet".
If psychological symptoms are any indication, Gaza and Sderot could be in the throes of an emerging epidemiological disaster.
A study of children and their families in Sderot last October revealed an epidemic of severe stress.
Twenty-eight per cent of adults, three times the national average, and an even higher proportion of children, suffered post traumatic stress disorder. Children aged seven to 12 suffered most, with 74% experiencing extreme fear, 67% refusing to talk or visit places that remind them of an attack, and 57% enduring nightmares and other sleep difficulties.
Ninety per cent of residents had seen or heard a rocket fly overhead, 92% had experienced a rocket falling nearby, 56% had experienced shrapnel hitting their home, and 65% knew someone who had been injured.
Dr Ronny Berger, who conducted the Sderot study for the Israel Trauma Centre for the Victims of Terror and War, says the statistics fail to show the true extent of the damage.
"People don't want to leave their homes, their kids cry and refuse to go to school. Their kids wake up in the middle of the night and can't be calmed down and the red alert [siren warning of incoming rocket attacks] makes them cry hysterically."
The results of a survey of children in Gaza last August were as traumatic.
Nearly 60% suffered post traumatic stress disorder, around 20% suffered anxiety and 51% were depressed.
The study of 251 children aged six to 16, conducted by Gaza's only child psychiatrist, Dr Abdel Aziz Mousa Thabet, showed they had suffered multiple severe shocks.
As a result of Israeli army ground invasions and air raids the average child had experienced 13 traumatic events. Thirty-four per cent had been threatened with a gun, 30% had witnessed a close relative die and 62% had seen someone killed by a missile. Many had seen their homes demolished, suffered injuries or witnessed the kidnapping of a friend or relative.
Conducted in the wake of fierce street clashes in which Hamas seized control of Gaza, the survey showed that the internal Palestinian fighting exposed children to even more violence, with each exposed to an average of 20 similarly shocking events.
Even when the children were not first hand witnesses they were highly exposed to violence via the media. Seventy-five per cent saw mutilated bodies on television caused by internal Palestinian fighting and Israeli army invasions.
"This is a trauma culture, all of us are traumatised," said Thabet.
According to Friedman, "what we see now in the Gaza strip, the violence especially, is partly the result of a generation of young people who have grown up under severe stress."
While the violence in Sderot is less extreme, the widespread exposure to trauma means the consequences will also be felt for generations to come.
Berger has "strong concerns" about the ability of either side to make peace in the future.
"Children need a calm environment to develop, they need security, they need parents who are available and sensitive, and if they don't have it it changes the way in which they see reality and the way in which they protect themselves," he said.
In a rare utterance, tears rolling down his cheeks, and with the logo of a militant group adorning his shirt, Nour contemplates his future. "I don't think that much about it because I'm afraid as to whether I will be alive or not."
Over the border in Sderot, Raziel, who has not thought about what he wants to do when he leaves school, fears a similar fate. "You can never know what will be in another year. You can never know if you can survive this day, or the day after, or the next week."
© 2008 The Guardian