Sitting with eight other women at a stress clinic, Jamalat Wadi, 28, tried to listen to the mental health worker. But she could not contain herself. She has eight children, and her unemployed husband spends his days on sedatives.

“Our husbands don’t work, my kids are not in school, I get nervous, I yell at them, I cry, I fight with my husband,” she blurted. “My husband starts fighting with us and then he cries: ‘What am I going to do? What can I do?’ ”

The others knew exactly what she meant.

The Palestinians of Gaza, most of them descended from refugees of the 1948 war that created Israel, have lived through decades of conflict and confrontation. Their scars have accumulated like layers of sedimentary rock, each marking a different crisis — homelessness, occupation, war, dependency.

Today, however, two developments have conspired to turn a difficult life into a new torment: a three-year blockade by Israel and Egypt that has locked them in the small enclave and crushed what there was of a formal local economy; and the bitter rivalry between Palestinian factions, which has undermined identity and purpose, divided families and caused a severe shortage of electricity in the middle of summer.

There are plenty of things to buy in Gaza; goods are brought over the border or smuggled through the tunnels with Egypt. That is not the problem.

In fact, talk about food and people here get angry because it implies that their struggle is over subsistence rather than quality of life. The issue is not hunger. It is idleness, uncertainty and despair.