Assessing the mental health impacts of Israeli occupation infrastructure in the West Bank by combining geospatial data with a representative survey of Palestinian youth

Veronese G., Bdier D., Obaid H., Mahamid F., Crugnola C.R., Cavazzoni F.

Children exposed political violence deploy resources to maintain functioning, hope and life satisfaction. We sought to explore whether or not children promote hope and life satisfaction trough agency, psychological difficulties, potentially traumatic experiences and symptoms in Palestine. 965 children (494 males and 471 females) in multiple geographical contexts, and areas were involved. We administered the War Child Agency Assessment Scale, Child Hope Scale, Multilevel Students'Life Satisfaction Scale-Bref, the Strength and difficulties scale, the Child Revised Impact of events Scale, and Trauma Checklist, and performed regression analysis; hope and life satisfaction were dependent and agency, strength and difficulties, trauma symptoms and traumatic events independent variables. Specific forms of agency predicted life satisfaction (β = 0.219; ** p < .01, social agency; β = 0.11; ** p < .01, with agency in education) and hope (β = 0.07; ** p < .05, agency on free movement), while mental difficulties (conduct problems, β = −0.09; ** p < .01; hyperactivity, β = −0.07; ** p < .05; β = −0.15; ** p < .01 with life satisfaction) (conduct problems, β = −0.06; ** p < .05, and difficulties in pro-social behaviour, β = −0.21; ** p < .01 with hope), traumatic events (β = −0.16; ** p < .01, with life satisfaction; β = −0.15; ** p < .01, with hope) and trauma symptoms (β = −0.09; ** p < .05, with hope) were negatively associated with the dependents variables. We found a positive role of social, educational, and freedom of movement agentic behaviours in fostering hope and life satisfaction.

Hammoudeh W., Mitwalli S., Kafri R., Lin T.K., Giacaman R., Leone T.

Building on the literatures examining the impacts of deprivation and war and conflict on mental health, in this study, we investigate the impact of different forms of deprivation on mental health within a context of prolonged conflict in the occupied Palestinian territory(oPt). We expand the operationalization go deprivation while accounting for more acute exposures to conflict and political violence and spatial variations. We use multilevel modelling of data from the Socio-Economic & Food Security Survey 2014 conducted by the Palestinian Central Bureau of Statistics, which included a sample size of 7827 households in the West Bank(WB) and Gaza Strip(GS). We conduct the analysis for the combined sample, as for the WB and GS separately. We use a General Health Questionnaire-12 (GHQ12) score as our main outcome measure of poor health. We used various measures of deprivation including subjective deprivation, material deprivation, food deprivation, and political deprivation. In addition to the different measures of deprivation, we included acute political, health, and economic shocks in our analysis along with background socio-demographic characteristics. The results indicate significant variance at the locality level. We find a significant association between poor mental health and subjective, economic, political, and food deprivation; health, economic, and political stressors; age, and being a woman. Post-secondary education and wealth have a significant inverse association with poor mental health. Subjective deprivation is the strongest predictor of GHQ12 score in the models whereby people who feel very deprived have GHQ12 scores that are almost 4-points higher than people who do not feel deprived. Economic conditions, particularly subjective measures, are significant predictors of mental health status. Our findings confirm that political and social factors are determinants of health. Feeling deprived is an important determinant of mental health. The community effect suggests that spatial characteristics are influencing mental health, and warrant further investigation.

Giacaman R., Hammoudeh W., Mitwalli S.M., Khallawi H., Kienzler H.

This qualitative study explores lived experiences of Palestinians in the West Bank during the COVID-19 pandemic intersecting with life under Israeli military occupation, structural violence, and racism. Insight is provided into the pandemic's effect on daily life and health and into coping and support mechanisms employed under apartheid conditions. Forty-three semi-structured interviews were conducted among a stratified sample of Palestinian adults. Interviews were digitally recorded, transcribed, and analyzed using thematic analysis. During the pandemic, Palestinian social lives were interrupted, jobs were lost, and incomes declined. Families fell into social and financial crises, with strife, insecurity, uncertainty, and fear negatively affecting physical and mental health. Pandemic effects were compounded by the Palestinian Authority's shortcomings and policies not taking into account citizens’ rights and social protection and by Israel's continued colonization of Palestinian land and violation of Palestinian human rights. Social solidarity was instrumental for coping during the pandemic just as it was during intensified political violence. One key feature that helped Palestinians survive promoting their cause for freedom, sovereignty, and self-determination is their social solidarity in times of strife. This has proven to be a crucial component in overcoming threats to the survival of a people during the twentieth century and into the twenty-first century.

Veronese G., Cavazzoni F., Russo S., Ayoub H.

Cavazzoni F., Fiorini A., Shoman H., Diab M., Veronese G.

Through a mixed-method design, the study investigated gender and context differences within the domains of agency, life satisfaction, affectivity, and symptoms of trauma. Two-hundred-fifty Palestin...

Alang S., McAlpine D., McClain M.

Stress researchers have emphasized the relationship between social stress and mental health. However, research investigating police brutality as a stressor is scarce. The authors conceptualize police brutality as a stressor, examining racial variation in its effects on mental health. Data came from the Survey of the Health of Urban Residents in the United States ( n = 4,389). Negative encounters with the police were found to be associated with depressed mood and anxiety. The relationship between encounters with the police and depressed mood was stronger among Black respondents and Latinxs compared with Whites. Regardless of personal encounters with the police, the anticipatory stress of police brutality—concern that one might become a victim of police brutality—was associated with depression and anxiety. These findings highlight police brutality as an anticipatory stressor and have implications for whiteness as a resource that protects from the stress of negative police encounters.

Veronese G., Sousa C., Cavazzoni F., Shoman H.

Research has widely documented the effects of war and political violence on the functioning and well-being of children. Yet, children's agency in the face of political violence remains underexplored. The present study aimed at exploring the sources of spatial agency that children draw on to counteract the harmful consequences of ongoing exposure to trauma. Based on drawings and walk-along interviews with 29 Palestinian children from Dheisheh refugee camp, we offer an analysis on how children use domestic and social spaces to actively maintain positive function and subjective well-being. Five themes were identified: the mosque as a place of spiritual resistance, the school as a source of happiness and personal improvement, internal spaces as a safe place for growing and developing, community spaces as places where children have fun and play an active role, and inhabiting the outdoor spaces in the camp despite environmental dangers and the Occupation. The study draws attention to spatial activities as forms of embodied resistance through which children promote their subjective well-being and maintain positive functioning.

Wagner G., Glick P., Khammash U.

The Lancet

Fahoum K., Abuelaish I.

A contentious issue in the Israel-Palestine conflict is the ongoing construction of settlements in the occupied West Bank along with its related policies, both of which have had impacts on the lives of resident Palestinians. These impacts have been documented by various UN and non-governmental agencies yet have been insufficiently studied in the academic literature. This article aims to review the literature on the social determinants of health for West Bank Palestinians and understand how settlement construction and policy influence these determinants. To accomplish these aims, the article first includes an analysis of how military infrastructure, resource allocation, land appropriation and house demolition related to the settlements influence the lives of West Bank Palestinians. The article then proceeds to review available literature on the social determinants of health in the West Bank, most notably: access to healthcare, exposure to political violence, economic conditions and water contamination, with the goal of understanding how settlement-related policies are related to these social determinants of health.

Sadeq T., Lubrano M.

Calì M., Miaari S.H.

Using data on Israeli closures inside the West Bank, this paper provides new evidence on the labor market effects of conflict-induced restrictions to mobility. To identify the effects, the analysis exploits the fact that the placement of physical barriers by Israel was exogenous to local labor market conditions and uses a measure of conflict intensity to control for the likely spurious correlation between local unrest, labor market conditions, and the placement of barriers. The study finds that these barriers to mobility have a significant negative effect on employment, wages, and days worked per month. The barriers had a positive impact on the number of hours per working day. These effects are driven mainly by checkpoints while other barriers, such as roadblocks and earth mounds, have a much more limited impact. Only a tiny portion of the effects is due to direct restrictions on workers' mobility, suggesting that these restrictions affect the labor market mainly by depressing firms' production and labor demand. Despite being an underestimation of the actual effects, the overall costs of the barriers on the West Bank labor market are substantial: in 2007, for example, these costs amounted to 6 percent of gross domestic product. Most of these costs are due to lower wages, thus suggesting that the labor market has adjusted to the restrictions more through prices than quantities.

Glick P., Al Khammash U., Shaheen M., Brown R., Goutam P., Karam R., Linnemayr S., Massad S.

Barber B.K., McNeely C., Olsen J.A., Belli R.F., Doty S.B.

This study assessed the association between exposure to political violence over a 25-year period and adult functioning among a population that has experienced protracted and severe political conflict. Instead of aggregating exposure to political violence across time and type of exposure, as is commonly done, the event history calendar pioneered in this study assessed exposure to five forms of political violence annually from 1987 to 2011 in a representative sample of 1788 adults, aged 37 on average, in the occupied Palestinian territories (West Bank, East Jerusalem, and the Gaza Strip). This method allowed for the identification of trajectories of exposure to political violence from childhood to adulthood using latent profile analysis. We then correlated the trajectories of exposure to measures of economic, political, community, family, psychological, and health functioning. As expected, being shot at, having one's home raided, being hit or kicked, being verbally abused, and witnessing someone close being humiliated were all elevated during periods of heightened political conflict (the first intifada (1987-1993) and, less so, the second intifada (2000-2005)). In addition, 12% of women and men reported high and persistent levels of exposure to humiliation (being verbally abused and/or witnessing someone close being humiliated) across the entire 25-year period. These individuals lived predominantly in neighborhoods with a high Israeli military presence. Compared to those who experienced periodic exposure to political violence, persistently humiliated men and women reported significantly lower health, economic, political, and psychological functioning, as well as higher social cohesion and political expression. Relevant literatures are reviewed when concluding that persistent humiliation is a neglected form of political violence that is best represented as a direct (versus structural), acute (versus chronic), macro (versus micro), and high-grade (versus low-grade) stressor whose particular injury is due to the violation of individual and collective identity, rights, justice and dignity.

Maguire A., French D., O'Reilly D.

Background Neighbourhood segregation has been described as a fundamental determinant of physical health, but literature on its effect on mental health is less clear. While most previous research has relied on conceptualised measures of segregation, Northern Ireland is unique as it contains physical manifestations of segregation in the form of segregation barriers (or ‘peacelines’) which can be used to accurately identify residential segregation.Methods We used population-wide health record data on over 1.3 million individuals, to analyse the effect of residential segregation, measured by both the formal Dissimilarity Index and by proximity to a segregation barrier, on the likelihood of poor mental health.Results Using multilevel logistic regression models, we found residential segregation measured by the Dissimilarity Index poses no additional risk to the likelihood of poor mental health after adjustment for area-level deprivation. However, residence in an area segregated by a ‘peaceline’ increases the likelihood of antidepressant medication by 19% (OR=1.19, 95% CI 1.14 to 1.23) and anxiolytic medication by 39% (OR=1.39, 95% CI 1.32 to 1.48), even after adjustment for gender, age, conurbation, deprivation and crime.Conclusions Living in an area segregated by a ‘peaceline’ is detrimental to mental health suggesting segregated areas characterised by a heightened sense of ‘other’ pose a greater risk to mental health. The difference in results based on segregation measure highlights the importance of choice of measure when studying segregation.