More than anyone, children bear the brunt of regular Israeli military assaults on the Gaza Strip. During the 51-day war in the summer of 2014, 551 children were killed and 3,436 were injured. But these gruesome figures say little about the psychological state of the nearly 800,000 children who have survived the periodic bombing campaigns.

After the final cease-fire that ended Israel’s Operation Protective Edge on August 26 of last year, UNICEF estimated that at least 425,000 Palestinian children in the besieged Gaza Strip require “immediate psychosocial and child protection support.”

“Data from our community centers shows that about 50 percent of children referred to us have developed post-traumatic stress disorder,” said Dr. Yasser Abujamei, the executive director of the Gaza Community Mental Health Programme, “and another 10 percent have problems with bedwetting.”

The eight-year Israeli siege and repeated Israeli attacks on medical facilities have rendered Gaza’s healthcare system incapable of treating such widespread trauma. Severe restrictions on freedom of movement leave Gaza isolated and unable to send children abroad, or to import experts to assist in alleviating this perpetual crisis.

In perhaps the most infamous event of the war, the Israeli military launched a mid-day attack on one of the most popular beaches in the Gaza Strip. Though the military later released a statement claiming that, under real-time visual surveillance, it had detected Hamas naval commandos in the area and that a civilian presence had been ruled out—which was contradicted by journalists who witnessed the attack—missiles hit eight boys from the Bakr family as they played soccer on the beach, instantly killing four.

Rescuers and journalists nearby rushed to the scene, finding the lifeless bodies of Mohammad, Ahed, Ismail and Zakariah Bakr—all between 7 and 11 years old. The survivors, Yunis, 11; Hamada, 15; Sayed, 14; and Muntasir, 12, were badly wounded and rushed to Al-Shifa hospital. They received emergency surgery but have pieces of shrapnel lodged throughout their bodies.

While their physical wounds have since healed, they live with enduring psychological trauma. The soft-spoken Yunis Bakr rarely speaks since his cousins were killed. Both Sayed and Muntasir Bakr live with intense psychosomatic symptoms of post-traumatic stress disorder, causing them to get severe cramps. Muntasir’s case is even more dire, as he becomes tense before losing consciousness and collapsing. Once a happy and well-liked boy, Muntasir has become aggressive toward his family members and has repeatedly attempted suicide. Like many boys who saw family members killed in front of them, he now aspires to join the ranks of Hamas’s Al-Qassam Brigades, Gaza’s largest armed resistance faction.

Already impoverished by the Israeli/Egyptian siege and naval blockade, the family of refugees can no longer afford even the most basic treatment to alleviate Muntasir’s immediate symptoms. As Israeli politicians threaten the next round of “mowing the lawn”—a euphemism for periodic military campaigns—the Bakr family is left to cope with the psychological trauma of the beach massacre and the burden Muntasir carries as a survivor.