“No safe place”: An exploration of the lived realities and mental health consequences of the 2014 assaults on Gaza

Background: The 2014 Israeli attacks on Gaza, known as Operation Protective Edge, was a massive series of aerial bombardments that killed over 2,000 Palestinians, left almost a half a million displaced, and destroyed over 20,000 homes. Journalists and humanitarian agencies repeatedly asserted that during these attacks there was absolutely no safe place in Gaza. Increasingly, global public health scholarship is building the case for understanding the health ramifications of war, yet we have little on the ground exploration of the events and 113 psychological responses that contribute to the mental health sequalae resulting from such totalizing experiences of war and terror. Methods: In this study, we examine the written narratives of 20 Palestinian women in Gaza, recruited via an intervention for teachers in Gaza. Women were asked by researchers to create a retrospective chronological diary of their life during Operation Protective Edge, and to describe the events, and negative feelings resulting from these experiences. Women were also asked to record the positive events, emotions, relationships or thought patterns that allowed them to survive or resist during this time. Data were imported into qualitative data analysis software, coded line by line, and analyzed using content analysis, with special attention to the etiology of mental distress within political violence. Results: Women’s descriptions of living through Operation Protective Edge included being exposed to bombings, injuries and death, as well as interruptions to infrastructure that threatened their abilities to meet the basic needs of their families. Women also described the exhausting and demoralizing experience of flight, as they were compelled to move in with other families or endure temporary shelters that were inadequate in terms of basic needs or privacy. Our findings draw attention to how these experiences directly contributed to exhaustion, hopelessness, isolation, feelings of intense terror and grief. At the same time, women described resilient patterns of coping, including simply trying to appreciate “being able to escape death,” as well as the experience and coping pattern of togetherness and closeness within their families, as they worked together to survive. Women also described the political context surrounding the events as a positive force, including a context of resistance among Palestinians and more global awareness of the Israeli actions in Gaza. Implications: Findings reveal the importance of tracing the events of warfare, its psycho-social consequences, and the distinct patterns of emotional and logistical survival in Gaza. Our results highlight the unique contribution of reflective narratives in contributing to the growing field of epidemiology of war.