Trauma and mental health burden of Gaza's displaced children during war: a cross-sectional study

The ongoing war in Gaza since 2023 has caused unprecedented trauma and widespread displacement, with nearly 200,000 casualties and over 90% of the population displaced into crowded shelters and makeshift tents. Evidence on the mental health effects on children during this crisis remains scarce.

A cross-sectional study was conducted in May 2025 among displaced children aged 3-12 years living in shelters and tented communities across the inhabited areas of the Gaza Strip. The study used a multistage purposive and convenience sampling strategy. Caregivers filled out questionnaires assessing sociodemographic characteristics, war exposures, forced migrations, and caregiver PTSD, as well as the caregiver-reported versions of the Child and Adolescent Trauma Screen (CATS) for PTSD symptoms and the Strengths and Difficulties Questionnaire (SDQ) for psychosocial functioning. Multivariable logistic regression analyses were conducted to examine associations between sociodemographic factors, war exposures, and child PTSD.

The final sample included 933 children (50.4% boys, 49.6% girls), with an average age of 7.6 years (SD = 2.8). Caregivers reported that children experienced an average of 6.7 forced displacements and 6.6 out of 10 surveyed war-related exposures. Nearly all experienced hunger (98%) and house destruction (95%). Based on age-appropriate CATS cutoffs, 57.8% of children met criteria for probable PTSD. SDQ results showed high rates of emotional and behavioral problems, with over 46.3% classified as abnormal on the Total Difficulties score. Boys were significantly more likely than girls to have experienced the loss of a close family member (57.0% vs. 49.9%, p = 0.035), although no other significant sex differences were found in the average number of traumas experienced or in the rates of other surveyed war exposures. Additionally, boys were significantly more likely to have more conduct problems and to score lower on prosocial behaviors (p < 0.001). In regression analyses, greater psychosocial difficulties (SDQ; OR = 1.18, 95% CI: 1.14-1.22), higher trauma exposure (OR = 1.17, 95% CI: 1.09-1.26), and more severe parental PTSD symptoms (OR = 1.26, 95% CI: 1.12-1.41) were consistently associated with increased odds of child PTSD. Non-marital parental status (OR = 1.62, 95% CI: 1.04-2.51) and non-maternal caregiving (OR = 2.61, 95% CI: 1.40-4.88) were also associated with higher odds. In the backward elimination model, older age showed a modest protective effect (OR = 0.95, 95% CI: 0.90-1.00), while female sex was associated with higher odds of PTSD (OR = 1.36, 95% CI: 1.02-1.82).

Displaced children in Gaza are experiencing extraordinarily high levels of trauma exposure, PTSD symptoms, and psychosocial difficulties. The findings highlight both the acute and generational mental health burden of war on children and underscore the urgent need for scalable, context-sensitive psychosocial interventions.