Understanding wellness in a context of harm: Gaza's Pandemic mental health success and the Palestine Trauma Center.

Mental health interventions in contexts of ongoing violence are challenged with supporting psychological well-being in the absence of external safety or stability. In such contexts of harm, trauma is often persistent rather than time-limited, necessitating approaches that emphasize adaptation, an internal notion of safety, and resilience rather than symptom elimination alone. This mixed-methods study investigates changes in PTSD indicators associated with Tarkiz, a culturally adapted community-based PTSD intervention delivered in Gaza before and during the first wave of the COVID-19 pandemic. Quantitative data from 419 participants were analyzed to assess changes in trauma symptoms following participation in the intervention and to examine whether symptom change differed by time period of intervention administration (pre- vs. during COVID-19). A mixed design 2x2 ANOVA revealed a statistically significant decrease in mean trauma scores after the intervention in both time periods, with a Mann-Whitney test confirming a larger reduction in mean trauma scores for individuals who participated in the intervention during the COVID-19 period. Participant and practitioner interviews constituted the qualitative section, highlighting what was understood in the community as reasons for the perceived success of Tarkiz. This included the emphasizing of communal support, and tools to function meaningfully amid pervasive instability, such as projective externalization and creation of an internal safe space. Overall, these findings suggest that participation in Tarkiz was related to reductions in trauma symptoms potentially due to its understanding of an ongoing context of harm and focus on re-orienting individuals to address these harms as a community and in a continuous capacity. This study also offers insights for extended implementation of mental health interventions in Gaza and similarly constrained settings.