Study Eligibility

The abstract screening process was conducted using specific inclusion and exclusion criteria designed to evaluate the challenges of mental health rehabilitation in the Gaza Strip following the war that began on October 7, 2023. The inclusion criteria specified that studies must focus on the barriers individuals in Gaza encounter when seeking mental health services for rehabilitation, involve participants who require such support, and be conducted in various health care environments, including hospitals and community services. The exclusion criteria eliminated studies that fell outside the review’s scope, such as those focusing on non-Gaza residents or populations other than those seeking mental health support, articles published in languages other than English, and non-peer-reviewed works such as magazines, newsletters, and conference proceedings that lacked sufficient detail for analysis. This review accepted all primary research designs and included studies published from October 2023 to August 2024, as noted in Table 1.

Table 1.

Article eligibility criteria

Data Extraction

The author of this review, along with an eternal reviewer, conducted the data extraction process independently. They commenced by identifying and eliminating any duplicate records. In the second step, they assessed the studies based on their titles and abstracts. They reviewed the full texts during the third stage to verify that the studies met the inclusion criteria. If there were any disagreements between the researchers, a third independent researcher was brought in to evaluate the records and help resolve any discrepancies. The author of this review, along with the eternal reviewer, extracted critical information from each study, which included the authors, publication year, country of origin, study design and sample characteristics, research objectives, and key findings.

Ethical Considerations

This study does not need ethical approval because it relies solely on published research and does not involve human or animal interaction.

Quality Appraisal

The author of this study and one external researcher assessed the quality of the selected studies using the Critical Appraisal Skills Program (CASP), a widely recognized and user-friendly evaluation tool.Reference Long, French and Brooks ¹⁵ The CASP comprises 9 simple questions, with answers classified as “Yes,” “Might Tell,” or “No.” Each response was assigned a numerical value for a structured assessment of research quality, facilitating comparisons among reviewers: “Yes” was scored 2, “Might Tell” received a score of 1, and “No” was assigned a score of 0. If there was a discrepancy more significant than 25% between the total scores from the 2 reviewers after they individually reviewed each study, a third external reviewer was called in to perform an independent evaluation.

Data Synthesis

A narrative synthesis analysis explored “Mental Health Rehabilitation in the Gaza Strip: Understanding the Impact of War on Access and Barriers.” The theoretical framework underscored the urgent need to identify the challenges faced by individuals affected by the ongoing conflicts, particularly in the aftermath of October 7, 2023. Recognizing these obstacles is crucial for developing a safe and supportive health care environment that can improve mental well-being for those currently suffering in the Gaza Strip. Tackling these barriers may enhance reporting mechanisms and promote a culture of respect and professionalism among health care providers. The author examined whether the current literature indicates that these challenges significantly impact mental health rehabilitation for the affected population. This was followed by a comparative analysis of the included studies, focusing on their characteristics, findings, and relationships among relevant variables. The evaluation also considered the studies’ robustness and the synthesis’s methodological quality, while acknowledging any limitations and biases within the existing research.

Risk of Bias Assessment

The author of this study and one external reviewer independently evaluated the quality of the included articles using the revised Newcastle-Ottawa Scale (NOS), specifically designed for assessing nonrandomized studies.Reference Wells, Shea and O’Connell ¹⁶ When the reviewers disagreed, a third reviewer was brought in to help reach a consensus or provide a final decision. The NOS tool assesses potential bias in nonrandomized cohort studies based on 3 main categories: participant selection, group comparability, and outcome determination.Reference Wells, Shea and O’Connell ¹⁶ Each category is awarded “stars” to reflect the risk of bias, with a more significant number indicating a lower risk. A study can earn up to 1 star for each subcategory within the selection and outcome determination categories. At the same time, it may receive 2 stars in the comparability category if it considers one or more factors.

Characteristics of Included Studies

Table 2 summarizes the characteristics of the included studies: 1 mix methodology (12.5%), 1 systematic review (12.5%), 2 quantitative cross-sectional (25%), and 4 literature review (50%). These studies highlight significant challenges related to utilizing mental health services in Gaza during the ongoing conflict. Key challenges include damage to infrastructure, limited access to mental health resources, a shortage of trained professionals, and economic hardships, all of which impede the provision of adequate care.

Table 2.

Overview of studies examining challenges to mental health rehabilitation in Gaza during the ongoing war conflict

Quality Assessment of Included Studies

According to the CASP methodology, the quality ratings for the various studies ranged from 12 to 16 out of 18 points. Overall, the studies were of moderate quality, achieving an average score of 14.13 in the quality assessment. Each study clearly defined its objectives, employed appropriate methodologies, and presented well-documented results. However, they failed to acknowledge or address potential biases and confounding factors, which could have negatively impacted the quality of the evidence ratings. Consequently, despite the research’s intention to evaluate the current level of knowledge, all related activities persisted due to the quality assessment process.

Challenges to Mental Health Rehabilitation in Gaza During the Ongoing Conflict

A summary of findings related Challenges to Mental Health Rehabilitation in Gaza During the Ongoing Conflict is outlined in Table 3. An analysis of this table reveals 6 significant themes: 1) limited access and availability of services; 2) economic hardship and poverty; 3) ongoing trauma and fear; 4) distrust in health care institutions; 5) mobility restrictions; and 6) disruption of social support networks.

Table 3.

Challenges Themes in Mental Health Rehabilitation in Gaza During the Ongoing Conflict: Findings from Research Analysis

Disruption of Social Support Networks

The conflict has shattered social support networks in Gaza, leading to isolation and a feeling of hopelessness among affected individuals. Reestablishing community bonds through initiatives like group therapy is essential for fostering resilience and emotional support in an increasingly challenging environment.Reference Abudayya, Bruaset and Nyhus ^{17 ,} Reference Unit ^{19 ,} Reference Ahmed, Alhajeeli and Badheeb ^{22 ,} Reference Taha, Sabet and Nada ^{24 ,} Reference D’Andrea, Aboagye and Lee ²⁵

Implication for Health Care Systems and Policymakers

The ongoing conflict in Gaza has underscored the critical need for integrated mental health services within humanitarian responses. As the psychological distress resulting from prolonged conflict continues to escalate, it is essential to adopt a comprehensive approach that prioritizes mental health alongside physical health care. This involves recognizing that the trauma experienced by individuals and communities is not just a secondary consequence of physical injuries, but a profound and pervasive issue that requires immediate attention. Addressing basic human needs—food, clean water, shelter, and safety—is fundamental for establishing a stable foundation for psychological rehabilitation. Moreover, special attention must be given to vulnerable groups, particularly children, women, and those who have lost family members or homes, to ensure that their specific challenges are adequately addressed. These groups often face unique psychological burdens, including grief, anxiety, and a sense of loss, which necessitate tailored interventions that resonate with their experiences.

In the immediate term, crisis response efforts must integrate mental health support as a core component of humanitarian aid. This means focusing on trauma-informed care for individuals affected by the conflict, providing them with the resources and support needed to process their experiences. Ensuring access to basic needs like food, clean water, and shelter will help stabilize the affected populations, allowing them to regain a sense of security. Additionally, targeted interventions should be implemented for vulnerable groups, including safe spaces for children to express their emotions and receive support, as well as specialized services for women who may face heightened risks of violence and trauma. Furthermore, it is crucial to provide support for those grieving the loss of family members or homes, offering counseling and community support to help them navigate their grief. Engaging local organizations to facilitate grassroots efforts will foster community support networks that promote resilience and healing, allowing individuals to connect and share their experiences in a supportive environment.

For long-term recovery, it is vital to invest in training programs for local mental health practitioners, ensuring that they are equipped with the skills necessary to address the complex psychological needs of the population. Establishing telehealth services can further enhance access to mental health support, particularly in areas where traditional health care infrastructure has been severely disrupted. Economic assistance and job training initiatives can help alleviate stressors contributing to mental health issues, enabling individuals to prioritize their well-being and rebuild their lives. Ongoing research is necessary to understand the evolving psychological needs of the population, informing future strategies for recovery and ensuring that interventions remain relevant and practical. Finally, developing inclusive support systems that specifically address the needs of children, women, and those who have lost loved ones will be essential for fostering a more resilient and cohesive community over time. By prioritizing these elements, we can create a comprehensive psychological rehabilitation framework that addresses immediate needs and lays the groundwork for sustained healing and recovery in the face of ongoing challenges.

Limitations and Future Recommendation

Despite the comprehensive insights provided by this systematic review, several limitations warrant consideration. The review includes only 8 studies, a notably small number, which may limit the generalizability and robustness of the findings. Furthermore, the majority of included studies are literature reviews and cross-sectional analyses, resulting in a scarcity of quantitative data due to the ongoing conflict in Gaza. This lack of quantitative research diminishes the applicability of the conclusions drawn to dynamic, real-time contexts, particularly in crisis situations. Additionally, the variability in research methodologies and quality may impact the consistency of the results.

Future research should focus on longitudinal studies that explore the long-term mental health effects of conflict, employing rigorous quantitative methods to assess the efficacy of specific interventions in diverse subpopulations. Qualitative studies investigating individual experiences and perceptions of mental health services in Gaza can provide a nuanced understanding necessary for tailoring interventions. Engaging local stakeholders in the research design and implementation will enhance the contextual relevance and sustainability of mental health interventions. Finally, enhancing collaborative efforts between international organizations and local entities will be critical in developing effective frameworks to address the complex and evolving mental health needs of affected populations.