War's invisible wounds: prevalence and determinants of post-traumatic stress disorder among Gaza women amidst the war: a mixed-method study.

backgroundThe war of 2023-2025 has brought unprecedented devastation to the Gaza Strip, intensifying the psychological toll on the Gazan population. Families were torn apart, and millions were forced to flee their homes. Women in Gaza often carry substantial caregiving responsibilities during war and displacement, which may increase their vulnerability to psychological distress. This study aimed to assess the burden and severity of post-traumatic stress symptoms among displaced women in Gaza and to examine their association with food insecurity, displacement-related conditions, and socioeconomic vulnerability during the ongoing war.

methodsThis mixed-methods study assessed the burden of post-traumatic stress symptoms in a convenience sample of displaced women in Gaza during the war. For the quantitative part, data were collected using a structured survey in Google Forms, which included sociodemographic and socioeconomic characteristics, displacement-related experiences, food insecurity, traumatic events, and post-traumatic stress symptoms. For the qualitative part, semi-structured, face-to-face interviews were carried out in Arabic by trained researchers with field experience.

resultsThe study included 503 displaced Gaza women (29.4 ± 7.3 years); most were married, unemployed, and living below the deep poverty line. The average duration of displacement was nearly one year, and most participants resided in tents under severe overcrowding and food shortages. Almost all women included in this study (98.2%) had severe PTSD symptom scores on the IES-R, with a mean score of 61.5 ± 9.5. Severe food insecurity affected about 71% of participants and was significantly associated with higher post-traumatic stress disorder (PTSD) symptom severity scores (p < 0.001). Higher PTSD symptom scores were also significantly associated with marital status (being divorced or widowed), family structure (having extended family), living conditions (living in a tent or shelters) during displacement, and food unavailability. Qualitative findings based on interviews with 34 women revealed five overarching themes: poverty and inequity, food as a luxury, wounds you cannot see, on the move, nowhere to belong, and small acts of resilience.

conclusionsThe findings highlight the profound psychological burden experienced by displaced women in this study during the ongoing war. Continuous exposure to violence, loss, displacement, hunger, and deprivation we closely interwind with severe post-traumatic stress symptoms and boarder psychological distress among women included in this study. Given that PTSD symptoms were assessed using a screening instrument rather than a diagnostic clinical interview, these findings should be interpreted as indicating a high burden of trauma-related distress within the study sample. They nevertheless underscore the urgent need for comprehensive humanitarian and psychosocial support for affected women.