Hazem Suleiman, 26, lost almost a quarter of his body weight as he and his family fled time and again from Israeli airstrikes in Gaza.
But what really worries him is the damage people can't see: the invisible trauma that will mark him forever.
"I won't forget the screams of children and women ... I have nightmares about charred bodies. Horror films do not show this, but it is what happened."
Suleiman now lives in a tent in the devastated southern city of Khan Younis, alongside his wife, mother and eight children.
Mona Abu Amer hasn't slept in months for fear of bombs crashing into the flimsy tent where she lives with her husband and three children.
A new mother, she also cannot feed her hungry child.
"My milk has stopped flowing well because of stress and I can no longer breastfeed.
"My 4-month-old son, Mahmoud, is always crying and I cannot do anything to help him."
A year into the Israeli offensive in Gaza, over two million people out of around 2.3 million in the enclave have "either experienced or witnessed violent and traumatic events", said Mohammed Abu Shawish, who leads Medical Aid for Palestinians' mental health support work in the strip.
Most of Gaza's people have been displaced — some up to 10 times — since the Israeli assault was triggered on Oct 7 when Hamas attacked southern Israel, killing 1,200 people and taking around 250 hostage.
Since then, Israeli air and artillery strikes have reduced much of the strip to rubble and more than 41,600 people have been killed, according to the Gaza Health Ministry. At least 90,000 people have been wounded.
The bald numbers do little to convey the depth of trauma for people who have lived through the destruction.
The mental scars, especially for children, are profound, relief workers say.
The United Nations children's agency Unicef estimates that almost all of Gaza's 1.2 million children need mental health support.
"They have lost their sense of belonging to their family, to their siblings, to their parents, because neither their mother nor their father or anyone else can provide them with that feeling of safety," said Israa Al-Qahwaji, a Gaza-based mental health and psychosocial support coordinator with Save the Children.
"No one can protect them."
In June, Save the Children said up to 21,000 children were believed to be missing in Gaza, including 17,000 unaccompanied and separated children and 4,000 buried under the rubble.
An unknown number is believed to be interred in mass graves.
Those that have survived are vulnerable to developing mental health and psychosocial problems, Abu Shawish said.
The trauma children are experiencing may come to define their lives and contribute to mental illnesses ranging from cognitive and educational challenges to behavioural issues and chronic health disorders, he added.
The mental toll weighs particularly heavy on wounded children.
In April, Unicef cited data from the Palestinian Health Ministry showing that more than 12,000 children, or almost 70 children every day, had been injured in Gaza since October.
Al-Qahwaji said the most important thing for a child's mental health is a sense of safety. That feeling "completely collapsed", when children lost their homes during the conflict, she said.
Small wins are often all they can hope for.
"We see things that might be simple, but for us they mean a lot."
For example, recently, a woman burst into tears as she held her child during a support session Al-Qahwaji was leading. It was the first time the women had hugged her child since the war began.
"She loves her child but she doesn't have time to think about him," Al-Qahwaji said.
"She is only worried about keeping him alive: getting him water, getting him food, and that does not only take up all of your day, but that of the entire family as well."
The writers are from Reuters
The views expressed in this article are the author's own and do not necessarily reflect those of the New Straits Times