Mental Health Burdens of the Israel-Hamas-Gaza War

Mansoor Malik; Gary Belkin; Ravi Chandra; Patricia Gerbarg; Robin Cooper; Austina Cho; Yassar Kanawati; James Fleming; Rahn Bailey

doi:10.37871/jbres2141

ISSN: 2766-2276

2025 July 09;6(7):876-879. doi: 10.37871/jbres2141.

Subject area(s)

| | |

Review Article

Mental Health Burdens of the Israel-Hamas-Gaza War

Mansoor Malik^1*, Gary Belkin², Ravi Chandra³, Patricia Gerbarg⁴, Robin Cooper³, Austina Cho⁵, Yassar Kanawati⁶, James Fleming⁷ and Rahn Bailey⁸

¹Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore
²Department of Psychiatry, Department of Psychiatry. NYU Grossman School of Medicine
³Department of Psychiatry, University of California, San Francisco
⁴Department of Psychiatry, Columbia University, New York
⁵Department of Psychiatry, Advanced Research Center, Anaheim CA
⁶The Child and Adolescent Psychiatry Trials Network, Atlanta
⁷Department of Psychiatry, Medical College of Wisconsin
⁸Department of Psychiatry, Louisiana State University, New Orleans

*Corresponding authors: Mansoor Malik, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, USA E-mail:

Received: 09 June 2025 | Accepted: 15 July 2025 | Published: 16 July 2025

How to cite this article: Malik M, Belkin G, Chandra R, Gerbarg P, Cooper R, Cho A, Kanawati Y, Fleming J, Bailey R. Mental Health Burdens of the Israel-Hamas-Gaza War. J Biomed Res Environ Sci. 2025 Jul 16; 6(7): 876-879. doi: 10.37871/jbres2141, Article ID: jbres1757

Find and get this Article from other databases

Export Citation CrossMark Publons Harvard Library HOLLIS GrowKudos Search IT Google Scholar Academic Microsoft Scilit Semantic Scholar Universite de Paris UW Libraries SJSU King Library NUS Library McGill DET KGL BIBLiOTEK JCU Discovery Universidad De Lima WorldCat DTU VU on WorldCat ResearchGate

Abstract

Wars have enormous negative mental health consequences for the civilians involved. This is particularly true for the recent Israel-Hamas war in Gaza. We present an analysis of the current humanitarian situation in Gaza, its dire mental health impact, and highlight the critical silence of medical and mental health professional organizations on this public health disaster.

Introduction

Wars in the Middle East, Ukraine, and many other regions of the world remind us of the costs of unresolved human conflict, paired with aggressive drives to dominate and destroy others. Over two billion people (quarter of global population) currently live in one of the roughly 27 global war zones [1]. During the 20th century, armed conflicts caused 190 million deaths, mostly civilians [2], and widespread suffering and destruction to many millions more. Armed conflicts trigger a multitude of social and emotional consequences for the people who survive, all of which have dire effects on their lives. Beyond direct and immediate casualties, armed conflicts can produce enduring political instability, destroy welfare systems including health systems, and increase homelessness, unemployment, and poverty and contribute to climate change [3] which have widespread implications for population health. Conflict related mental health disorders are well-characterized for soldiers, but it is generally acknowledged that the most significant mental health burden of war is endured by non-combatant civilians [4]. The psychological, social and economic costs of war-related trauma are staggering and must be addressed not only in the immediate aftermath of war but also for the long-term post-war recovery.

Post‐Traumatic Stress Disorder (PTSD) and depression are the most common mental disorders in the aftermath of war for both adults and children, affecting from one third to half of the surviving population [5]. Children generally are more severely affected with a significantly higher lifetime risk of both major depression and anxiety disorder as well as suicide and violence [6]. In addition to the direct harm, they experience secondary trauma as a result of the impact on their caregivers and social support systems, creating a vicious cycle of adverse outcomes. For example, studies in conflict areas in Sri Lanka and Uganda show that maltreatment of children was associated with the parents’ exposure to war trauma and their PTSD symptom severity [7].

The devastating effects of armed conflict on non-combatant civilians are particularly apparent during the recent Israel-Hamas war. During the October 7 attacks by Hamas, nearly 1200 Israeli civilians, soldiers and foreign guest workers, were murdered and another 240 kidnapped and held hostage (including babies and the elderly). During these attacks, a large number of civilians were exposed to atrocities [8]. This national trauma is likely to have a significantly negative effect on the mental health of the whole population. Although Israel has a well-developed mental health system, there is evidence that it is being overwhelmed [9].

The situation for civilians in Gaza is horrifying. The tiny Gaza strip is home to 2.3 million Palestinians and has come under constant bombardment for nearly ten months, resulting in near total destruction of civilian infrastructure and deaths of at least 60,000 Palestinians, mostly women and children [10]. However, this number seems to be an underestimate and the actual number of deaths in Gaza is likely to be much higher [11]. Almost 95 % have been internally displaced and 93 % of the population is facing famine, according to the UN reports [12]. The health system in Gaza has collapsed with destruction of nearly all the major hospitals and killing of over 1500 health professionals and thousands of humanitarian workers [13]. The constant bombardment in Gaza has made it impossible to find a safe place anywhere and the lack of food, water, fuel, and electricity precludes the meeting of basic human needs.

Even before the recent war, very high rates of mental health disorders had been documented in Gaza. Palestinians’ Psychological Conditions Survey (PPCS) in 2021 showed that 71 % of the population in Gaza screened positive for depression and 25 % for PTSD [14]. Gaza has been under a complete blockade since 2007 and developing mental health infrastructure has not been a priority. The 40-bed Gaza City Hospital was the only psychiatric facility for more than two million people, which was destroyed by bombing early on in the conflict [15]. Similarly, all six mental health centers have been forced to close due to the fighting [16]. Tele-psychiatry support programs have shut down due to the blockade of electricity and internet services. The blockade has also severely restricted the supply of vital psychiatric medications.

The war has created a tide of mental health needs and the effects of this trauma are likely to be felt for many generations. The situation is particularly horrific for children in Gaza. Tens of thousands of them have suffered injuries, resulting in amputations, scars, complications, and chronic pain. Doctors have been forced to perform surgical procedures including abortions and C sections without anesthesia in unsanitary conditions. Many children in Gaza have lost not only both their parents but all their relatives, giving rise to the acronym WCNSF (Wounded Child, No Surviving Family). These children have seen their relatives killed in explosions or die slowly and painfully under the rubble. Many have witnessed horrific hospital scenes as they themselves have lain waiting for care [17]. There are reports from multiple US physicians that worked in Gaza during this war that children have been targeted by IDF snipers [18]. These terrible memories will burden them as they grow up and harm their mental health. Dr. Fozia Alvi, founder of the U.S. based charity Humanity Auxilium said to The Guardian, “This is not a normal war. The war in Ukraine has killed 500 children in two years and the war in Gaza has killed over 10,000 in less than five months. We have seen wars before but this is something that is a dark stain on our shared humanity [19].

The mental health impact on Israeli soldiers involved in killing of civilians is also significant. Reportedly at least 30,000 IDF soldiers have been treated for mental health issues since the start of the war [20]. A recent study in Israel found that PTSD in Israeli soldiers alone can cost Israeli economy more than 50 billion dollars over the next five years [21]. Additionally, both Israelis and Palestinians are likely to be affected through trans-generational trauma and the war is rekindling the memories of holocaust and nakba in second generation survivors. Jews worldwide have collectively experienced the amplification and exemplification of excruciatingly specific wounds and historical traumas. They harbor understandable and real existential fears based on the exacerbation of antisemitic bigotry. Palestinians have experienced a terrifying escalation of underlying conflict and historical trauma, and justifiably feel devalued and dehumanized by the lopsided devastation of Israel’s war efforts, and the as-yet unrealized short-term goal of ceasefire, and long-term goal of a peaceful, just, lasting resolution of the underlying conflict.

These mass, cumulative, psychological damages yield not only population-wide epidemics of mental illness but a massive social toll as well with disintegration and poisoning of social fabric, capital, and trust. Any discussion of post-war reconstruction, stability or peace, has to include these realities and so needs to reimagine what community mental health can be and should look like. Unfortunately, the American Psychiatric Association (APA), like other major medical organizations, has been relatively silent and absent from this transformation in what’s possible for community mental health, stuck in models form 50 years ago. This narrowing of scope is evident as well in how far psychiatric practice is from the kinds of responses needed to imagine what that means; to psychologically rehabilitate whole populations and communities. Here again is laid bare how far the psychiatric practice has moved away from purposes of community level psychological strengthening, promotion, and managing mass-level forms of care and recovery. Such an effort can lean on a now deep bench of evidence, global networks and multilateral organizations, and tools, methods and experience form the field of global mental health in how to do treatment, prevention, and promotion through equipping entire communities and other sectors and lay workers with skills and capacity, with mental health clinicians as back up and coaches, as well as in enabling other “care” work, from child care to income security, part of a mosaic of community mental health and rehabilitation [22].

Rebuilding lives in Gaza and Israel will take decades. First, and right now, mental health communities locally and across the globe must advocate for an end to hostilities and to not only address the growing mental health needs in the region but to forcefully condemn medical war crimes, deliberate killing of medical personnel, destruction of medical infrastructure and using starvation as warfare. The courage and dedication of health workers in Gaza, despite extreme hardship, is a powerful reminder of the value of humanitarian assistance and principles. Raising awareness among the public and political decision-makers about the mental health consequences caused by armed conflicts should be a required social responsibility for all mental health professionals and associations regardless of their political beliefs.

It is in times like these that the role of healing professionals as a thin line of conscience and voice to value all life, to be part of the solution rather than a mere observer of the decisive role of social determinants for mental health and of mental health for social health and peace, are most sorely tested. So far, it seems like those commitments gauged in terms of APA action and voice, are in danger. Members of this Caucus were told by APA leadership that we should not get 'political.' However, advocating for the reinforcement of humanitarian law and an end to violence, by leveraging our expertise to encourage investment in violence prevention and highlighting its toxic effects, which often perpetuate further violence, is a fundamental professional requirement for healthcare professionals. If our professional organizations don’t see that then the scope of professional purpose has become as small as to be irrelevant to the polycrises of the world today. Indeed, psychiatrists are uniquely trained in an interdisciplinary model with skills and knowledge for contributing to both the science and practice of non-violent conflict resolution and APA took an active role in Arab-Israel peace process by convening Egyptian, Israeli, and Palestinian psychiatrists, psychologists, and diplomats for Track II negotiations from 1979 to 1984 [23].

As a global leader in psychiatry, the APA must take a lead on the psychiatric “Marshall Plan” for the region. APA’s Caucus on Global Health is launching an effort to compile mental health resources, make connections with both international humanitarian organizations and planning underway, as well as local anchor organizations and leaders needed to develop capacity to put those tools to work as soon as the war ends. That especially means getting to know and be in dialogue with the Palestinian diaspora, which is well educated and has significant number of motivated healthcare workers, is uniquely positioned to accelerate medical relief efforts in Gaza. However, the Israeli government is currently blocking entry of any healthcare workers of Palestinian descent from entering Gaza, even those from the West Bank [24]. This situation puts significant restrictions on an already diminished and constrained healthcare workforce in Gaza [25].

In conclusion, the silence of the APA over the Gaza genocide is unacceptable. The APA took a very forceful stand against the October 7 attacks, stating that “the innocent civilians should never have to endure the violence and chaos that happened” on Oct 7 [26]. In the light of this statement, why has the APA remained silent on the vastly more violent and chaotic conduct in Gaza by the Israeli government, a situation that has been described as a genocide by virtually all human rights organizations as well as the International Court of Justice and International Criminal Court? The attacks on Israel on October 7th were an undeniable atrocity. However, Israel’s subsequent genocidal campaign has unduly and disproportionately impacted all Palestinians. In the midst of great and lasting harm, the need for active, engaged, compassion and advocacy has never been higher. The authors wish for all psychiatrists to further educate themselves about genocide and war crimes and become more involved in caring for a world of increasingly consequential violence, divisiveness, and need. We see this effort as also jump-starting the APA learning curve as to where as an organization its muscle and expertise can be best put to use to realize such transformations in what mental health systems can do not only in the conflict areas but also here at home.