Emotional problems in Palestinian children living in a war zone: a cross-sectional study

BACKGROUND Children living in war zones are at high risk of developing post-traumatic stress and other emotional disorders, but little is known about the effect of traumatic events during war. We aimed to assess the nature and severity of emotional problems in Palestinian children whose homes had been bombarded and demolished during the crisis in Palestine, compared with children living in other parts of the Gaza strip. METHODS 91 children exposed to home bombardment and demolition during Al Aqsa Intifada and 89 controls who had been exposed to other types of traumatic events related to political violence completed self-report measures of post-traumatic stress, anxiety, and fears. FINDINGS Significantly more children exposed to bombardment and home demolition reported symptoms of post-traumatic stress (p=0.0008) and fear (p=0.002) than controls. 54 (59%) of 91 exposed children and 22 (25%) of 89 controls reported post-traumatic stress reactions of clinical importance. Exposure to bombardment was the strongest socioeconomic predictor of post-traumatic stress reactions (odds ratio 0.25 [95% CI 0.12-0.53], p=0.0008). By contrast, children exposed to other events, mainly through the media and adults, reported more anticipatory anxiety and cognitive expressions of distress (p=0.001) than children who were directly exposed. INTERPRETATION Children living in war zones can express acute distress from various traumatic events through emotional problems that are not usually recognised. Health professionals and other agencies coming in contact with children who have been affected by war and political violence need to be trained in detection and treatment of such presentations.