Published on Arab Voices

The importance of measuring mental health in trauma-exposed populations: The case of West Bank & Gaza

The burden of poor mental health is significant for this trauma exposed population. The burden of poor mental health is significant for this trauma exposed population.

A Palestinian adolescent turning 14 years old this year will have lived through a period of Gaza’s history that has seen the loss of hundreds of lives and livelihoods, as well as the physical destruction of neighborhoods and infrastructure. After living through four wars — the most recent in May 2021 — a 14-year-old will have been exposed to such a high level of violence that is likely to have long lasting and traumatizing effects. The burden of poor mental health is significant for this trauma exposed population, and there are also crippling effects on the rest of the economy and society. Poor mental health is bad for productivity, impedes decision making, and reduces social engagements. A recent study using data from rural Kenya has shown evidence for the existence of a psychological poverty trap, where poverty perpetuates itself through stress and depression. 

After the May 2021 conflict, the World Bank team conducted a Facebook-based survey to assess the immediate needs of Palestinians living in the West Bank and Gaza. Using innovative techniques, the team reduced the risk of bias by using targeted advertisements and sampling weights to calibrate the data to known population characteristics. Within three weeks of the survey launch, more than 3,000 Facebook users responded. One of the starkest findings was related to post-traumatic stress disorder (PTSD). 70% of Gazans and 57% of West Bank residents surveyed reported symptoms consistent with PTSD, with the prevalence higher for women and those who had been displaced. Many of the comments that respondents posted on the survey’s Facebook page were related to trauma experienced by Palestinian children, as many children were unable to sleep well at night. 



While the Facebook survey brought to light the short-term needs caused by the May 2021 conflict, more research is needed to understand the extent and severity of the trauma, as well as its long-term and knock-on effects on livelihoods and human capital. To expand this body of research, the World Bank is supporting the Palestinian Central Bureau of Statistics (PCBS) to carry out its first nationally representative survey of mental health. This follows international trends, as mental health has begun to be incorporated in official statistics (see for example the UK’s Office of National Statistics and Statistics Netherlands). 

Funded by the State and Peace Building Trust Fund, and in partnership with the International Security and Development Center and Zentrum Überleben, PCBS is developing a survey that captures some of the most important aspects of mental health. It includes modules capturing signs of aggressive tendencies, symptoms of depression using the World Health Organization-5 Well-being index, as well as symptoms of PTSD and complex PTSD using the international trauma questionnaire. This survey will give a voice to an extremely traumatized population, providing a platform for expressing the toll taken on mental health. The results of the survey will help design programs to address the long-term effects of conflict, providing recommendations to address mental health barriers for Palestinians and starting a conversation about a subject that remains highly stigmatized.

[1] This blog is part of a three-part series that documents a mental health survey conducted in the West Bank and Gaza. Part 2 will highlight some of the key lessons learned from planning and implementing a large household survey focused on mental health, while Part 3 will outline some key findings from the survey itself.

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