could have been a birthday party, but it was a play therapy session in one of Gaza City's schools. a of six-year-olds played on a huge canvas on the ground, grabbing multi-coloured balloons and popping them, not all of them were squealing with delight. One child, Omar, clapped his hands over his ears. The blasts reminded him of recent explosions in Gaza City. Omar said he does not go to school unless his mother is with him and holds his hand. And he doesn't feel secure if his teacher isn't around. Omar and others in Gaza are involved in play, art and music therapy in their schools as part of efforts by psychologists, teachers and community workers to help them cope with having lived through Israel's three-week offensive launched on 27 December 2008 and its aftermath. One such programme, implemented by Gaza psychologist Fadel Abu Hein at the Zahwa Rosary Catholic School, helps children express the anxiety, anger and fear they felt over the loss of family members and the destruction of their homes. Most of the children cry when they hear an explosion or any loud noise. Many are bedwetting. They bite their nails or have nervous twitches. They become afraid, especially at night, he said. The World Health Organization (WHO) has worked with the Palestinian ministry of health and community-based organizations since 2002 to improve mental health services in the Gaza Strip and the West Bank. A recent WHO assessment of Gaza views children and adolescents as a particularly at-risk group for the psychosocial consequences they may face during and after the crisis. Tens of thousands of people were displaced. Children's play areas became littered with crushed concrete and debris. Some children and adults were permanently disabled. WHO estimates that between 70% and 75% of a population develop mild to moderate post-traumatic reactions after a large-scale crisis, such as the one in Gaza, while it estimates that 5% to 10% of people in Gaza may need professional mental health support to address more long-term problems, such as depression, trauma, anxiety and panic attacks. About 1300 people died and more than 5000 were injured in Israel's military offensive in the coastal strip. Children made up about one-third of these casualties. Israel said the attacks were necessary to stop the militant Hamas, who rule Gaza, from firing rockets into southern Israel. Many in Gaza said they were deeply affected by the attack. Nowhere in Gaza was safe, said Abu Hein, who heads the Community Training and Crisis Management Center in Gaza City. [ILLUSTRATION OMITTED] When you see your family killed in front of you and you're unable to save them, it's a big shock, said 12-year-old Almaza al-Sammouri, as she and her classmates drew pictures during a therapy session at the An-Jalout Islamic Girls School in Gaza City. found them piled on each other. Some were dead. Others died a little later because we couldn't get an ambulance, al-Sammouri said of the airstrike that killed her mother, four siblings and several uncles. It was a huge shock. I couldn't move or do anything. want to become a first-aid nurse because if this happens again, I would be able to treat them so they wouldn't die, al-Sammouri said. The mental health needs of such survivors of conflicts and other disasters have come under the spotlight of late. New guidelines were adopted last September by WHO along with other UN organizations and their nongovernmental organization (NGO) partners to include mental health and psychosocial support as part of their emergency response. In a statement, these groups underscored the need to coordinate multiple agencies offering such support and, while doing so, to ensure that the affected populations are not overwhelmed by outsiders and local contributions to mental health and psychosocial support are not easily marginalized or undermined. …