BEIT LAHIA, Gaza Strip -- Shahed Quishta was curled up in an armchair one late afternoon during the Gaza war when a shell slammed into her living room. Shrapnel pierced the 8-year-old's head and neck, and she died minutes after arriving at a hospital.
Her funeral was held before nightfall, in line with Muslim tradition. Her family couldn't host a customary three-day wake, typically attended by hundreds of people, because streets remained dangerous during ongoing fighting between Israel and Gaza militants.
Almost a month after her death from what her father says was an Israeli tank shell, her family remains paralyzed by grief.
Sister Rojina, 14, can't sleep in the room they shared, spending nights on a mattress in the hallway. Her mother Nisreen, 38, takes clothes from Shahed's closet from time to time, crying as she inhales the lingering scent.
The Quishtas are among thousands who suffered a loss during the current Israel-Hamas war, the third in Gaza in just over five years. The emotional wounds, though sometimes hidden, can be seen in the grim statistics of the conflict.
Close to 2,000 Palestinians were killed, including 459 children, and more than 10,000 people were wounded since fighting began July 8, according to UN figures. About 20 per cent of Gaza's population of 1.8 million people has been displaced, including about 100,000 whose homes were destroyed or damaged beyond repair.
Based on these numbers, "the psychological effects (in this war) will be much higher than in the previous ones," said Dr. Iyad Zaqout, who runs the community mental health program of Gaza's main aid group, the UN Relief and Works Agency.
Children are especially vulnerable because they can't put their experiences into context yet, he said.
The UN estimates that about 373,000 children in Gaza need direct psychological intervention because they've witnessed violence, lost a relative or have been displaced. Such children often display one or more of a range of symptoms, including bed-wetting, nightmares, irritability or clinging to parents.
In the last major round of fighting in Gaza in the winter of 2008-2009, about 18,000 of some 190,000 children attending UN-run schools required counselling, Zaqout said. Several hundred still haven't recovered, he said, adding that repeated exposure to trauma -- a given in Gaza -- compounds the problem.
Some 100 UN trauma counsellors now visit several dozen crowded UN schools that have been turned into shelters for those who fled or were made homeless by the fighting. Several private groups providing trauma relief have also sprung up in recent years, though the demand continues to outstrip available treatment.
The counsellors offer psychological "first aid" to those at the shelters. Children are usually accessible, eagerly joining playgroups in school courtyards or picking up crayons to draw what they saw in the war. At least 30 per cent of the children at the shelters will need longer-term treatment, Zaqout estimated.
Adults are often reluctant -- especially men.
On a recent morning, counsellor Kamel Kahlout from the Gaza branch of a U.S.-based group, the Center for Mind-Body Medicine, persuaded about a dozen men to join him in therapy session at the Abu Hussein school, a shelter in the Jebaliya refugee camp.
Kahlout led them through a simple breathing exercise and asked them to close their eyes. Many found it difficult to sit still, with the noise from the crowded courtyard outside. When asked to share their concerns, the men stuck to politics, avoiding the personal. The men need more time to open up, he said.
Those at the Abu Hussein school have gone through particularly rough times. On July 30, three Israeli artillery shells slammed into the school crowded with some 3,300 people, many of them sleeping. The shells, which Israel says came in response to mortar fire nearby, killed 17 people.
Among those who witnessed the attack was 11-year-old Moath Sweilem. Asked later to describe the shelling, Moath talked about dead donkeys near the main gate, also killed in the attack, and wounded children brought to his family's sleeping area by his mother.
"I was scared when it happened," Moath said.
Moath has become more aggressive, said his mother, standing on the edge of the courtyard filled with noisy children waiting to have their faces painted by aid group volunteers. Those near the front started pushing and shoving as adults tried to separate them.
Moath emerged from the scuffle with a triumphant smile. He had a goatee and the word Gaza, in Arabic, drawn on his face.
Shahed Quishta was the middle child of five. Shahed and her sister Rojina shared a room that now stands empty because Rojina can't bear to sleep there alone.
Shahed's school bag is still filled with notebooks from third grade, including those from English class with vocabulary lists written in a neat script. Her report card notes that she was third in her class.
During the war, Shahed was scared, like the others. Her aunt Dareen, who lives on the ground floor, designated a "war room" away from windows and doors to reassure the children. They often stayed there when they heard shelling from Israeli tanks.
Israel has fired thousands of tank and artillery shells toward what it said were targets linked to militants during the war, though a majority of those killed were civilians, according to Gaza health officials. Hardest hit were towns near the border with Israel, including here in Beit Lahiya. Gaza militants have fired more than 3,000 rockets and mortar shells at Israel in the same period.
Two weeks into the war, on July 22, Shahed was playing with her cousins downstairs. Around mid-afternoon, she returned to her family apartment on the second floor. She settled into the armchair with her tablet computer.
Her father, Mouin, was napping on a mattress nearby in the living room.
The shell hit at 4:15 p.m., her father said. He awoke to a huge cloud of dust and smoke that obstructed his view of Shahed critically wounded on the armchair. He grabbed his wife and children and ran downstairs, only to find that Shahed had not been accounted for. He raced back upstairs and found her. She still was breathing faintly, but died less than half an hour later.
Almost a month later, the living room remains almost unchanged. There's no back wall. The other walls and the armchair are peppered with holes from shrapnel and debris covers the floor. The family keeps it locked most of the time.
Shahed's parents find comfort in their faith, saying every death is preordained and that they will meet their daughter in heaven. Still, Shahed's mother can't shake off her sadness. She cries when she holds Shahed's clothes or watches a video of her prancing in a white dress for her kindergarten graduation. Rojina said she tries to stay strong to avoid burdening her mother.
On Saturday, Shahed's younger brother Mohammed and several cousins attended a playgroup with some three dozen neighbourhood children put on by World Vision, an international Christian aid organization.
As a warm-up, they sang a version of "If You're Happy and You Know It," finishing each verse with clapping, fist pumping or stomping.
Mohammed, who had witnessed the explosion that killed his sister, was reserved at first, but eventually got swept by the enthusiasm.
Majd, an 11-year-old cousin, said he enjoys going to the group, but misses Shahed. "She was our leader," he said.
