The Mental Toll of War

The latest escalation in the Israel-Palestine conflict sheds light on the detrimental effect wars have on the mental health of everyone involved.

On Saturday, about 1,000 fighters of Hamas, the organization the United States considers terrorist, entered Israel's territory from the Gaza Strip and killed over 1,300 people, leaving many more wounded. Approximately 150 Israelis were taken hostage and are now held in the Gaza Strip, a Palestinian enclave under Israeli blockade.

Israel responded by conducting air strikes in Gaza that killed more than 1,300 people. According to the United Nations agency, more than 338,000 people have been displaced across the enclave, and the number is expected to increase.

The escalation has only deepened the wounds inflicted by the decades-long conflict. According to international law, Israel occupied Palestinian territories and continues to violate international conventions by transferring its citizens and establishing settlements in the West Bank. Amnesty International, the leading human rights organization, says Israeli authorities enforce apartheid against Palestinians.

Death is the 'tip of the iceberg'

Sara Freedman, a researcher and professor at Bar-Ilan University in Israel told Healthnews, "We know that war and ongoing political conflict are extremely detrimental to mental health, and can exacerbate existing issues. Often, families are separated and communities destroyed, removing much support. Women, children and the elderly are particularly affected."

One in five (22%) who have experienced war or other conflict in the previous 10 years will develop depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, or schizophrenia, the World Health Organization (WHO) estimates. Studies show that usually, women are more severely affected than men.

While conflicts cause more mortality and disability than any major disease, death as a result of wars is simply the "tip of the iceberg," according to a 2005 review.

"War destroys communities and families and often disrupts the development of the social and economic fabric of nations. The effects of war include long-term physical and psychological harm to children and adults, as well as the reduction in material and human capital," the authors wrote.

The Israel-Palestine conflict is not an exception. A Facebook-based survey conducted by the World Bank in 2021 found that almost 70% of Gazans and 57% of West Bank residents report symptoms of PTSD.

Meanwhile, a 2014 study associated high levels of exposure to rocket and terrorist attacks on Israelis with a double risk for depression, PTSD, and inflammation, which may lead to immune dysregulation.

John Crimmins, a consultant psychotherapist from Ireland, says PTSD can cause intrusive memories, recurring nightmares, and deeply distressing recollections of traumatic events, which can cause severe emotional turmoil and anxiety-related disorders.

"The persistent threat to safety induces hypervigilance, leaving people with a constant state of tension, easily startled and unable to keep their concentration. In addition, the circumstances of enduring this experience can lead to alcohol or substance abuse as a way of coping."

John Crimmins

During a 30-year-long conflict from 1968 to 1998 in Northern Ireland, also known as "The Troubles," 3,524 people were killed, and thousands of others were left with deep emotional scars.

Graeme McDonald, a consultant psychiatrist from Belfast, wrote in 2007 that people who have been active in violent conflict may cope well with the emotional consequences of what has been done to them and what they have done to others as long as "the struggle" seems reasonable and justified.

As the purpose of violent conflict becomes less clear, the rates of substance misuse, breakdown in relationships, and mood disorders increase, resulting in a higher risk of suicide.

Crimmins explains that while both soldiers and civilians will endure significant psychological distress, the nature and intensity of the trauma they experience can differ.

He says that soldiers will have to deal with combat-specific traumas characterized by a unique set of symptoms, such as flashbacks, distressing dreams, distorted blame or guilt, and feelings of anger and shame.

"On the other hand, civilians may experience a broader range of traumas, including displacement, loss of family members, destruction of homes, and lack of essential resources. They may suffer from a wider spectrum of mental health issues, including anxiety, depression, complex grief, and adjustment disorders," he adds.

Amani, a Palestinian who lives in the West Bank, tells Healthnews that while it is safer than the Gaza Strip, she feels stressed and scared all the time. As settlers have recently started attacking Palestinians on the roads, she no longer leaves her place.

"I don’t feel safe. Every time I leave my house to go to work, I have this feeling that I could get shot by a soldier at a military checkpoint. I always have this feeling. When I have to wait hours at a checkpoint, I feel angry. I can’t really control myself."

Amani from the West Bank

Amani says she feels angry about the occupation and silence of the world all the time.

"Especially now with the situation in Gaza. I have friends there, and I don’t know what happened to them. I can’t reach out to them to see if they are still alive. Seeing all these people getting killed and their homes destroyed makes me mad and helpless because I feel that I can’t do anything to make them feel better," she adds.

One does not necessarily need to be in a war zone to become a victim of tragic events, as the 9/11 attack had a profound impact on the well-being of Americans. Research indicates that patients who experienced a 9/11-related loss were twice as likely to be diagnosed with depression, anxiety, or PTSD. Moreover, having loved ones in danger on 9/11 or knowing someone involved in the rescue and recovery effort doubled the risk of anxiety disorder.

Spectators are also affected

In March 2022, Russia launched an unprovoked invasion of its neighboring country, Ukraine, which is still extensively covered by the media. Meanwhile, social media users can follow developments almost in real-time, including watching graphic scenes of killings and torture.

While nothing compares to the suffering of Ukrainians, research indicates that the fear and uncertainty created by the war may have lasting effects on the mental health of people not directly involved in the conflict. For instance, a recent study found the war in Ukraine increased stress and anxiety levels among Italians.

Andrius Jurgaitis, a Lithuania-based psychologist, says that the internet brings conflicts closer to us. It makes us feel scared because we are not used to watching disturbing scenes that are not just a movie but a reality.

It is important to keep yourself informed on current events. However, when it comes to following conflicts on social media, consider setting some healthy social media boundaries.

"Dedicate some time in the morning or evening to learn what is happening. However, it should be a matter of minutes, not several hours. Otherwise, it could lead to panic attacks, depression, and other serious disorders."

Andrius Jurgaitis

He emphasizes the importance of checking the quality of information sources, as misinformation and propaganda are unavoidable during a war. Spending time with friends and family can also help.

"If you see that someone close to you has difficulty dealing with emotions, talk to them, try to calm them down, spend some time with them," he adds.

Freedman suggests, "Keeping a normal routine is very important, especially with children. Doing everyday tasks may seem irrelevant but helps with coping. Anything that reduces stress — meditation, dancing, breathing — are helpful. Reducing exposure to media, particularly social media and specifically video clips, is essential."

There are currently 110 ongoing armed conflicts in the world, many of which may continue for years to come. They will undoubtedly have a devastating impact on the mental health of both civilians and fighters.