Background: Public health research suggests that multiple factors contribute to the mental health sequalae of political violence, but the daily experiences and ongoing strategies of psychological survival during active warfare are not clearly understood. We analysed retrospective chronological diaries from Palestinian women in Gaza, occupied Palestinian territory, to explore their lives during Operation Protective Edge in 2014, when a series of aerial bombardments killed over 2000 Palestinians and left around 500 000 displaced from their homes.
Methods: 20 Palestinian female teachers in Gaza were recruited via an intervention for trauma recovery 1 month after the end of Operation Protective Edge, in September, 2014. Following the experience sampling method, women were asked to chronicle specific memories and affective responses associated with their experiences. Data were imported into qualitative data analysis software, coded line by line, and analysed using content analysis, with special attention to the causes of mental distress associated with political violence.
Findings: The women's narratives included memories of exposure to bombings, injuries, death, and destruction of vital infrastructure and systems. Their experiences of flight were described as exhausting and demoralising. Their temporary shelters lacked their basic needs for sanitation, food, and privacy. These experiences resulted in intense terror, grief, exhaustion, hopelessness, and isolation. Strategies of psychological survival included reframing; trying to appreciate "being able to escape death", a sense of solidarity within families and neighbourhoods, and pride and satisfaction found in a context of resistance and global attention to the suffering in Gaza.
Interpretation: Our results reveal the importance of tracing the events of warfare, its psychosocial consequences, and the distinct patterns of emotional and logistical survival in Gaza. This study was limited by the representativeness of our study population and the small sample size. Future studies should explore this topic in larger populations. Limitations notwithstanding, in drawing out the unique contribution of reflective narratives of women survivors of war, our study highlights the need to solicit and analyse reflective and chronologically grounded narratives within global mental health epidemiology.
Funding: None.
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