Collective Trauma in Gaza Society After the 2023 Military Operation: A Meta-Analysis of Psychosocial Impacts

Authors

  • Nurzahara Sihombing SD Negeri 107396 Paluh Merbau
  • M. Agung Rahmadi Sekolah Tinggi Ilmu Kesehatan Sehati Medan
  • Winda Yulia Gitania Br Sembiring Universitas Islam Negeri Sumatera Utara
  • Nadia Saphira Universitas Islam Negeri Sumatera Utara
  • Naysila Prasetio Universitas Islam Negeri Sumatera Utara
  • Helsa Nasution Universitas Alwasliyah Medan
  • Luthfiah Mawar Sekolah Tinggi Ilmu Kesehatan Sehati Medan
  • Amanda Aulia Putri Universitas Islam Negeri Sumatera Utara
  • Nafiza Rizky Ramadhani Lubis Universitas Islam Negeri Sumatera Utara

DOI:

https://doi.org/10.59680/medika.v3i4.2236

Keywords:

Collective Trauma, Communal Resilience, Gaza, Psychosocial Impact, PTSD

Abstract

This meta-analysis evaluates the psychosocial impact of the 2023 military operation on Gaza society through a systematic review of 47 reports and online publications. Employing a mixed-method approach with a primary emphasis on quantitative analysis, the study integrates data from multiple credible sources collected between October 2023 and January 2024. The synthesized findings indicate a PTSD prevalence of 78.3% (95% CI: 75.2 to 81.4%) among the adult population and 84.6% (95% CI: 81.7 to 87.5%) among children. Logistic regression identifies the loss of family members as the strongest predictor of trauma (OR = 3.87, p < .001), followed by loss of housing (OR = 2.94, p < .001). Severe depressive symptoms are detected in 67.2% of adult respondents, while anxiety levels reach 71.5%. Social network analysis underscores the significant role of community support in mitigating traumatic impact (r = 0.64, p < .001). These findings extend the work of Altawil et al. (2020) and Greene et al. (2017) by revealing patterns of collective trauma that differ from previous conflicts, particularly in relation to communal resilience and group-based coping mechanisms. The study further identifies a phenomenon termed “accelerated transgenerational trauma” that has not been previously reported and provides an empirical foundation for community-based psychosocial interventions within contexts of protracted conflict.

References

Abudayya, A., Bruaset, G. T. F., Nyhus, H. B., Aburukba, R., & Tofthagen, R. (2023). Consequences of war-related traumatic stress among Palestinian young people in the Gaza Strip: A scoping review. Mental Health & Prevention, 32, 200305. https://doi.org/10.1016/j.mhp.2023.200305

Alexander, J. C. (2013). Trauma: A social theory. John Wiley & Sons.

Amsalem, D., Haim-Nachum, S., Lazarov, A., Levi-Belz, Y., Markowitz, J. C., Bergman, M., ... & Neria, Y. (2025). The effects of war-related experiences on mental health symptoms of individuals living in conflict zones: A longitudinal study. Scientific Reports, 15(1), 889. https://doi.org/10.1038/s41598-024-84410-3

Atallah, D. G. (2017). A community-based qualitative study of intergenerational resilience with Palestinian refugee families facing structural violence and historical trauma. Transcultural Psychiatry, 54(3), 357–383. https://doi.org/10.1177/1363461517706287

Betancourt, T. S., Gilman, S. E., Brennan, R. T., Zahn, I., & VanderWeele, T. J. (2015). Identifying priorities for mental health interventions in war-affected youth: A longitudinal study. Pediatrics, 136(2), e344–e350. https://doi.org/10.1542/peds.2014-1521

Betancourt, T. S., Meyers-Ohki, S. E., Charrow, A. P., & Tol, W. A. (2013). Interventions for children affected by war: An ecological perspective on psychosocial support and mental health care. Harvard Review of Psychiatry, 21(2), 70–91. https://doi.org/10.1097/HRP.0b013e318283bf8f

Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2017). Introduction to meta-analysis. Wiley. https://onlinelibrary.wiley.com/doi/book/10.1002/9781119186805

Buheji, M., & Hasan, A. (2024). Capitalising on the 'social capital' that would accelerate the collective wealth of Gaza. International Journal of Social Sciences, 6(1).

Burgund Isakov, A., & Markovic, V. (2024). Systematic review of trauma-informed approaches and trauma-informed care for forced migrant families: Concepts and contexts. Trauma, Violence, & Abuse, 25(5), 3999–4015. https://doi.org/10.1177/15248380241266161

Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. The Lancet, 394(10194), 240–248. https://doi.org/10.1016/S0140-6736(19)30934-1

Cooper, H. (2017). Research synthesis and meta-analysis: A step-by-step approach (5th ed.). SAGE. https://doi.org/10.4135/9781071878644

Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). SAGE.

Cummings, E. M., Merrilees, C. E., Taylor, L. K., & Mondi, C. F. (2017). Developmental and social-ecological perspectives on children, political violence, and armed conflict. Development and Psychopathology, 29(1), 1–10. https://doi.org/10.1017/S0954579416001061

de Jong, K., Stickers, R., Orner, R., & Schnyder, U. (2003). Early psychosocial interventions for war-affected populations. In Reconstructing early intervention after trauma (pp. 184–192). https://doi.org/10.1093/oso/9780198508342.003.0017

Denkinger, J. K., Windthorst, P., Rometsch-Ogioun El Sount, C., Blume, M., Sedik, H., Kizilhan, J. I., ... & Junne, F. (2018). Secondary traumatization in caregivers working with women and children who suffered extreme violence by the "Islamic State". Frontiers in Psychiatry, 9, 234. https://doi.org/10.3389/fpsyt.2018.00234

El-Khodary, B., & Samara, M. (2020). The relationship between multiple exposures to violence and war trauma, and mental health and behavioural problems among Palestinian children and adolescents. European Child & Adolescent Psychiatry, 29(5), 719–731. https://doi.org/10.1007/s00787-019-01376-8

Frankova, I., & Sijbrandij, M. (2025). Preventing common mental health problems in war-affected populations: The role of digital interventions. Frontiers in Digital Health, 7, 1586030. https://doi.org/10.3389/fdgth.2025.1586030

Giacaman, R., Rabaia, Y., Nguyen-Gillham, V., Batniji, R., Punamäki, R. L., & Summerfield, D. (2011). Mental health, social distress and political oppression: The case of the occupied Palestinian territory. Global Public Health, 6(5), 547–559. https://doi.org/10.1080/17441692.2010.528443

Greene, M. C., Jordans, M. J., Kohrt, B. A., Ventevogel, P., Kirmayer, L. J., Hassan, G., & Tol, W. A. (2017). Addressing culture and context in humanitarian response: Preparing desk reviews to inform mental health and psychosocial support. Conflict and Health, 11(1), 21. https://doi.org/10.1186/s13031-017-0123-z

Hall, B. J., Tol, W. A., Jordans, M. J., Bass, J., & de Jong, J. T. (2014). Understanding resilience in armed conflict: Social resources and mental health of children in Burundi. Social Science & Medicine, 114, 121–128. https://doi.org/10.1016/j.socscimed.2014.05.042

Hein, F. A., Qouta, S., Thabet, A., & El Sarraj, E. (1993). Trauma and mental health of children in Gaza. BMJ: British Medical Journal, 306(6885), 1130. https://doi.org/10.1136/bmj.306.6885.1130-c

Higgins, J. P. T., & Thomas, J. (Eds.). (2022). Cochrane handbook for systematic reviews of interventions (version 6.3). Cochrane. https://training.cochrane.org/handbook

Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., & Ursano, R. J. (2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry: Interpersonal and Biological Processes, 70(4), 283–315. https://doi.org/10.1521/psyc.2007.70.4.283

Hurtado-de-Mendoza, A., Serrano, A., Gonzales, F. A., Fernandez, N. C., Cabling, M. L., & Kaltman, S. (2016). Trauma-exposed Latina immigrants' networks: A social network analysis approach. Journal of Latina/o Psychology, 4(4), 232. https://doi.org/10.1037/lat0000053

Isobel, S., Goodyear, M., Furness, T., & Foster, K. (2019). Preventing intergenerational trauma transmission: A critical interpretive synthesis. Journal of Clinical Nursing, 28(7-8), 1100–1113. https://doi.org/10.1111/jocn.14735

Jain, R. P., Meteke, S., Gaffey, M. F., Kamali, M., Munyuzangabo, M., Als, D., & Bhutta, Z. A. (2020). Delivering trauma and rehabilitation interventions to women and children in conflict settings: A systematic review. BMJ Global Health, 5(Suppl 1), e001980. https://doi.org/10.1136/bmjgh-2019-001980

João Ferreira, M., & Marcelino, P. F. (2011). Politics in trauma times: Of subjectivity, war, and humanitarian intervention. Ethics & Global Politics, 4(2), 135–145. https://doi.org/10.3402/egp.v4i2.5984

Lev-Wiesel, R. (2007). Intergenerational transmission of trauma across three generations: A preliminary study. Qualitative Social Work, 6(1), 75–94. https://doi.org/10.1177/1473325007074167

Mabil-Atem, J. M., Gumuskaya, O., & Wilson, R. L. (2024). Digital mental health interventions for the mental health care of refugees and asylum seekers: Integrative literature review. International Journal of Mental Health Nursing, 33(4), 760–780. https://doi.org/10.1111/inm.13283

Mahamid, F. A., & Berte, D. Z. (2020). Portrayals of violence and at-risk populations: Symptoms of trauma in adolescents with high utilization of social media. International Journal of Mental Health and Addiction, 18(4), 980-992. https://doi.org/10.1007/s11469-018-9999-0

Masten, A. S. (2021). Resilience in developmental systems. In Multisystemic resilience (pp. 113-134). https://doi.org/10.1093/oso/9780190095888.003.0007

Matanov, A., Giacco, D., Bogic, M., Ajdukovic, D., Franciskovic, T., Galeazzi, G. M., ... & Priebe, S. (2013). Subjective quality of life in war-affected populations. BMC Public Health, 13(1), 624. https://doi.org/10.1186/1471-2458-13-624

Miller, K. E., Kulkarni, M., & Kushner, H. (2006). Beyond trauma-focused psychiatric epidemiology: Bridging research and practice with war-affected populations. American Journal of Orthopsychiatry, 76(4), 409-422. https://doi.org/10.1037/0002-9432.76.4.409

Mollica, R. F., Cardozo, B. L., Osofsky, H. J., Raphael, B., Ager, A., & Salama, P. (2004). Mental health in complex emergencies. The Lancet, 364(9450), 2058-2067. https://doi.org/10.1016/S0140-6736(04)17519-3

Nasution, H., Rahmadi, M. A., Mawar, L., & Sihombing, N. (2025). Analysis of the role of social media in the collective trauma of Middle Eastern societies: A digital analysis. Medical Laboratory Journal, 3(3), 26-46. https://doi.org/10.57213/caloryjournal.v1i3.793

Neria, Y., Nandi, A., & Galea, S. (2008). Post-traumatic stress disorder following disasters: a systematic review. Psychological Medicine, 38(4), 467-480. https://doi.org/10.1017/S0033291707001353

Nocon, A., Eberle-Sejari, R., Unterhitzenberger, J., & Rosner, R. (2017). The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis. European Journal of Psychotraumatology, 8(sup2), 1388709. https://doi.org/10.1080/20008198.2017.1388709

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., … & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71

Parson, E. R. (2000). Understanding children with war-zone traumatic stress exposed to the world's violent environments. Journal of Contemporary Psychotherapy, 30(4), 325-340. https://doi.org/10.1023/A:1010281818958

Peltonen, K., Qouta, S., Diab, M., & Punamäki, R. L. (2014). Resilience among children in war: The role of multilevel social factors. Traumatology, 20(4), 232. https://doi.org/10.1037/h0099830

Pope, C., Mays, N., & Popay, J. (2007). Synthesising qualitative and quantitative health evidence: A guide to methods. McGraw-Hill Education.

Purgato, M., Gross, A. L., Betancourt, T., Bolton, P., Bonetto, C., Gastaldon, C., ... & Barbui, C. (2018). Focused psychosocial interventions for children in low-resource humanitarian settings: a systematic review and individual participant data meta-analysis. The Lancet Global Health, 6(4), e390-e400. https://doi.org/10.1016/S2214-109X(18)30046-9

Qutishat, M. (2025). Mental health rehabilitation in Gaza: Addressing the impact of ongoing war conflict on access and challenges, a systematic review. Disaster Medicine and Public Health Preparedness, 19, e33. https://doi.org/10.1017/dmp.2025.34

Saldaña, J. (2021). The coding manual for qualitative researchers (4th ed.). SAGE.

Shaheen, M., Schindler, L., Saar-Ashkenazy, R., Bani Odeh, K., Soreq, H., Friedman, A., & Kirschbaum, C. (2020). Victims of war-psychoendocrine evidence for the impact of traumatic stress on psychological well-being of adolescents growing up during the Israeli-Palestinian conflict. Psychophysiology, 57(1), e13271. https://doi.org/10.1111/psyp.13271

Somasundaram, D. (2014). Addressing collective trauma: Conceptualizations and interventions. Intervention Journal of Mental Health and Psychosocial Support in Conflict Affected Areas, 12(4), 43-60. https://doi.org/10.1097/WTF.0000000000000068

Tol, W. A., Barbui, C., Galappatti, A., Silove, D., Betancourt, T. S., Souza, R., ... & Van Ommeren, M. (2011). Mental health and psychosocial support in humanitarian settings: linking practice and research. The Lancet, 378(9802), 1581-1591. https://doi.org/10.1016/S0140-6736(11)61094-5

Uludag, K. (2024). The impact of collateral damage: Unravelling psychological mechanisms in the context of war and conflict; A literature review. Scientific Studios on Social and Political Psychology, 30(1), 90-94. https://doi.org/10.61727/sssppj/1.2024.90

UNICEF. (2024). UNICEF in the State of Palestine - Humanitarian situation report. United Nations Children's Fund. https://www.unicef.org/sop/reports/unicef-state-palestine-humanitarian-situation-update

United Nations Office for the Coordination of Humanitarian Affairs. (2025). Humanitarian situation update - Gaza Strip (Update No. X). https://www.unocha.org/publications/report/occupied-palestinian-territory/humanitarian-situation-update-286-gaza-strip-enar

Vivekananda, J., Schilling, J., & Smith, D. (2014). Climate resilience in fragile and conflict-affected societies: concepts and approaches. Development in Practice, 24(4), 487-501. https://doi.org/10.1080/09614524.2014.909384

Vostanis, P. (2003). Impact of trauma on Palestinian children's mental health: lessons from the Gaza studies. International Psychiatry, 1(2), 5-6. https://doi.org/10.1192/S174936760000641X

Werner, E. E. (2012). Children and war: Risk, resilience, and recovery. Development and Psychopathology, 24(2), 553-558. https://doi.org/10.1017/S0954579412000156

Williams, M. E., & Thompson, S. C. (2011). The use of community-based interventions in reducing morbidity from the psychological impact of conflict-related trauma among refugee populations: a systematic review of the literature. Journal of Immigrant and Minority Health, 13(4), 780-794. https://doi.org/10.1007/s10903-010-9417-6

World Health Organization, United Nations Children's Fund, United Nations Relief and Works Agency for Palestine Refugees in the Near East, & United Nations Population Fund. (2023). Women and newborns bearing the brunt of the conflict in Gaza, UN agencies warn. WHO. https://www.who.int/news/item/03-11-2023-women-and-newborns-bearing-the-brunt-of-the-conflict-in-gaza-un-agencies-warn

World Health Organization. (2013). Mental health action plan 2013-2020. WHO. https://www.who.int/publications/i/item/9789241506021

World Health Organization. (2021). Mental health in emergencies: WHO guidance for mental health and psychosocial support in emergency settings. WHO. https://www.who.int/publications/i/item/9789240035115

Yule, K., Houston, J., & Grych, J. (2019). Resilience in children exposed to violence: A meta-analysis of protective factors across ecological contexts. Clinical Child and Family Psychology Review, 22(3), 406-431. https://doi.org/10.1007/s10567-019-00293-1

Zaghrout-Hodali, M., Alissa, F., & Dodgson, P. W. (2008). Building resilience and dismantling fear: EMDR group protocol with children in an area of ongoing trauma. Journal of EMDR Practice and Research, 2(2), 106-113. https://doi.org/10.1891/1933-3196.2.2.106

Zalta, A. K., Tirone, V., Orlowska, D., Blais, R. K., Lofgreen, A., Klassen, B., ... & Dent, A. L. (2021). Examining moderators of the relationship between social support and self-reported PTSD symptoms: A meta-analysis. Psychological Bulletin, 147(1), 33. https://doi.org/10.1037/bul0000316

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Published

2025-11-30

How to Cite

Nurzahara Sihombing, Rahmadi, M. A., Winda Yulia Gitania Br Sembiring, Nadia Saphira, Naysila Prasetio, Helsa Nasution, … Nafiza Rizky Ramadhani Lubis. (2025). Collective Trauma in Gaza Society After the 2023 Military Operation: A Meta-Analysis of Psychosocial Impacts. Jurnal Medika Nusantara, 3(4), 74–94. https://doi.org/10.59680/medika.v3i4.2236

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