Agency and activism in school-aged children as protective factors against ongoing war trauma and political violence in the Gaza Strip: a qualitative study

Background This exploratory qualitative study investigated self-perceived risk and protection factors that can determine the ability of children living in the Gaza Strip to adjust to a traumatic and risky life context characterised by loss and dispossession. Methods A cluster sampling procedure was used to represent refugee children from four areas of the Gaza Strip (North Gaza, Gaza, Dheir el-Balat, and Rafah). The sample comprised 200 Palestinian children recruited at primary schools in four refugee camps (Bureij, Gaza Beach Camp, Jabalia, and Rafah Camp) in the Gaza Strip in 2012. Of these children, 104 were boys (mean age 8·6 years [SD 2·3], range 6–11) and 96 girls (9·6 years [2·7], 6–11). The children were engaged in activities aimed at eliciting narratives of military violence and traumatic experiences, and individual, familial, and community-related resources that they had mobilised during the war to cope with traumas. Thematic content analysis was applied to written materials and narratives using Nvivo10 software. The main objective was to identify in detail the dimensions of wellbeing present in the narratives, and perceptions of risk and protective factors. The inter-rater agreement ranged from 74% to 95%. Findings Both boys (78%; 81 of 104) and girls (52%; 50 of 96) reported having directly experienced traumatic events related to war, episodes of political violence (39% of boys [41 of 104], 38% of girls [36 of 96]), domestic violence (31% of boys [32 of 104], 3% of girls [three of 96]), or community violence (6% of boys [six of 104], 2% of girls [two of 96]). Thematic content analysis led to the identification of ten main themes: relationship with peers, family, and other significant adults, affect balance, constraints on movement, play, health, school, personal satisfaction, and spirituality. In boys, the most severe self-reported risks were related to constraints on movement and affect balance, followed by relationship with family, and health. Play, personal resources, relationship with other significant adults, and school were perceived to be protective factors. The girls reported more sources of protection than risks, conversely, boys perceived themselves to be more at risk than protected. Interpretation Children deal with ongoing suffering and discomfort by means of subjective and intersubjective agency in multiple domains of their life, showing psychological adaptability.