Carolyn Spellings

Human insecurity, chronic economic constraints and health in the occupied Palestinian territory.

Research on the effects of political conflict has focused predominantly on the association between violence exposure and psychological trauma. This paper expands that focus. We broaden the assessment of health beyond the conventional spotlight on trauma-related stress to include culturally derived measures of health, and we assess the association between a broad array of political and economic conditions and health. Household interviews were conducted in 2011 with a representative sample of 508 30–40 year olds in the occupied Palestinian territory (oPt; response rate = 97%). The four dependent variables were limits on functioning due to health, feeling broken or destroyed (both culturally derived measures of health), feelings of depression and trauma-related stress. Twenty-four predictor variables assessed multiple dimensions of political conflict and background characteristics. All four measures of health and suffering were associated with human insecurity and resource adequacy. Exposure to political violence was associated only with trauma-related stress. These findings support the increasing recognition that human insecurity and chronic economic constraints in the oPt broadly threaten health, perhaps more so than direct exposure to violence. Ultimately, a political solution is required, but in the meantime, efforts to reduce insecurity and improve economic conditions may improve health and reduce suffering in the oPt.

Politics drives human functioning, dignity, and quality of life.

Too little is known about human functioning amidst chronic adversity. We addressed that need by studying adult Palestinians in the occupied Palestinian territories (oPt), a population that has experienced longstanding economic and political hardships. Fourteen group interviews were conducted in February, 2010 in Arabic by local fieldworkers with 68 participants representing the main stratifications of Palestinian society: gender, region, refugee status, and political affiliation. Interview tasks included each participant: describing someone doing well and not well, free listing domains of functioning, and prioritizing domains to the three most important. Thematic analyses highlighted the dominating role of the political domain of functioning (e.g., political structures, constraints, effects, identity, and activism) and the degree to which political conditions impacted all other realms of functioning (economic, education, family, psychological, etc.). The discussion links the findings to relevant theory and empirical work that has called attention to the need to include the political in frameworks of quality of life. It also emphasized that values, such as justice, rights, dignity and self-determination, that underlie political structures and policies, are key elements of human functioning. This is the case not only in the oPt, but in any society where power imbalances marginalize segments of the population.

Effect of chronic exposure to humiliation on wellbeing in the occupied Palestinian territory: an event-history analysis

Background Investigation of the long-term effects of political violence is needed. Patterns of past exposure to political violence since the first intifada were identified in a large sample of adults in the occupied Palestinian territory (oPt) and assessed for associations with current adult functioning. Methods In 2011, fieldworkers from the Palestinian Center for Policy and Survey Research, Ramallah, West Bank, oPt, undertook household interviews in Arabic of a representative sample of 1800 individuals (aged 30–40 years; 50% men) in the oPt. The interviews consisted of a culturally-grounded inventory of current wellbeing or quality of life along with an event-history calendar, which through its design and mode of administration has been shown to enhance memory. For every year from 1987 to 2011, participants indicated the degree from 0 (never) to 3 (frequently) to which they had been shot at, hit or kicked, verbally abused, saw other individuals humiliated, and had their homes raided. Latent profile (MPlus, version 7.0) and general linear regression analyses (SPSS, 21.0) were used for the statistical analyses. All participants provided written informed consent. The Palestinian Center for Policy and Survey Research and the University of Tennessee, Knoxville, TN, USA, provided institutional review board approval for the study. Findings Data were evaluable for 1758 people. For analyses, yearly scores for violence exposure were averaged within four periods: first intifada, Oslo period, second intifada, and post-second intifada. For men, there were three patterns of past exposure to political violence: 519 (60%) of 872 men reported moderate exposure during the first and second intifadas and very little or no exposure between the intifadas and after the second intifada (group 1); 250 (29%) had the same periodic pattern but with higher exposure during the intifadas (group 2) than did group 1; and 103 (12%) indicated chronic exposure to humiliation (verbal abuse and observing others being humiliated) for all the periods (group 3). For women, there were two patterns of exposure: 745 (84%) of 886 women had the same pattern of low, periodic exposure as did the men in group 1; and 141 (16%) reported high exposure to observing others being humiliated for all the periods, similar to that reported by the men in group 3. Results from the general linear regression models showed that chronically humiliated men and women, compared with other patterns of exposure, had less access to basic resources; higher insecurity or fear; higher feelings of depression; higher feelings of being broken or destroyed; higher trauma-related stress; higher community belonging; and higher marital quality. Chronically humiliated women also reported less personal freedom and poorer health. Post-hoc analyses showed that most of the chronically humiliated participants (85 [83%] of 103 men and 93 [66%] of 141 women) were living in distinct neighbourhoods in East Jerusalem and Hebron—two oPt cities that have a particularly strong presence of Israeli forces, and have frequent and several constraints (including checkpoints and barriers) on the Palestinian populations mobility. Interpretation The results of this study show that, methodologically, the assessment of the patterns of exposure over time (instead of commonly aggregating exposure) is a useful way to capture the long-term effect of political violence exposure. Substantively, they show the particular risks to long-term wellbeing of individuals with chronic exposure to humiliation. Funding Jacobs Foundation, Zurich, Switzerland.

Political Imprisonment and Adult Functioning: A Life Event History Analysis of Palestinians

Political imprisonment is a traumatic event, often accompanied by torture and deprivation. This study explores the association of political imprisonment between 1987 and 2011 with political, economic, community, psychological, physical, and family functioning in a population-based sample of Palestinian men ages 32-43 years (N = 884) derived from a dataset collected in 2011. Twenty-six percent (n = 233) had been politically imprisoned. Men imprisoned between 1987 and 2005 reported functioning as well as never-imprisoned men in most domains, suggesting that men imprisoned as youth have moved forward with their lives in ways similar to their nonimprisoned counterparts. In an exception to this pattern, men imprisoned during the Oslo Accords period (1994-1999) reported higher levels of trauma-related stress (B = 0.24, p = .027) compared to never-imprisoned men. Men imprisoned since 2006 reported lower functioning in multiple domains: human insecurity (B = 0.33, p = .023), freedom of public expression (B = -0.48, p = .017), perceived government stability (B = -0.38, p = .009), feeling broken or destroyed (B = 0.59, p = .001), physical limitations (B = 0.55, p = .002), and community belonging (B = -0.33, p = .048). Findings pointed to the value of examining the effects of imprisonment on functioning in multiple domains.

Prediction of health with human insecurity and chronic economic constraints in the occupied Palestinian territory: a cross-sectional survey

Background Research into the effects of political conflict has focused predominantly on the association between exposure to violence and psychological trauma. This focus was expanded by investigation of the association of a broad array of political and economic factors with four health outcomes in the occupied Palestinian territory (oPt). Methods The Palestinian Center for Policy and Survey Research, Ramallah, West Bank, oPt, undertook household interviews in 2011 with a representative sample of 508 people aged 30–40 years. Interviews included culturally-informed questions about current wellbeing and past political and economic experiences. Health outcomes were assessed as limitations on functioning due to health (one item, 1 [never] to 5 [regularly]); feeling broken or destroyed (six items, α=0·81, range 1–5) such as the extent to which respondents felt emotionally exhausted or their spirits broken; feelings of depression (eight items, α=0·84, 0–3); and trauma-related stress (17 items on the Post-Traumatic Stress Disorder Checklist, α=0·92, 0–3). Political and economic conditions were assessed as 34 outcomes, including human insecurity (five items, α=0·80, 1–5) such as the extent to which respondents felt fear for themselves or their family in their daily life and the extent to which they worry or fear for their and their familys future; resource inadequacy (six items, α=0·84, 1–5); heard or felt effects of a bomb (one item, 0–1); or was hit, kicked, shot at, or verbally abused (three items, α=0·83, 1–5). Data were analysed with ordered logit and ordinary least-squares regression models using Stata (version 12.1). The study was approved by the institutional review board of the University of Tennessee, Knoxville, TN, USA. All participants provided written informed consent. Findings 508 (97%) of 524 households took part in the interviews. When other covariates were controlled for, human insecurity and inadequacy of economic resources were positively associated with all four health outcomes: functional limitations (odds ratio 1·29, p=0·029, and 1·43, p Interpretation These findings support the increasing recognition that human insecurity and chronic economic constraints in the oPt threaten health, perhaps more so than does direct exposure to violence. Funding Jacobs Foundation.

Contextual and individual factors influencing the implementation effectiveness of sport for development and peace programmes: a comparative case study of conflict relief in Lebanon and Ukraine

Abstract Gaining insight into how sport for development and peace (SDP) programmes thrive amid social and political conflict is crucial for understanding how to better educate and equip individuals working to improve communities worldwide. After participating in an international exchange programme, two women, one from Lebanon and one from Ukraine, developed and implemented SDP programmes in conflict settings. Using comparative case study methodology, their cases were analysed to better understand what contextual factors and individual factors influenced the implementation effectiveness of their SDP programmes. Four themes, two within the domain of contextual factors and two within the domain of individual factors, emerged from analysis of their interviews and programme tracking sheets. Findings illustrate the importance of considering the strength of a support network and the nature of the political environment, two factors outside of personal control. Findings also illustrate the importance of streamlining programme development and engaging in intentional programme marketing, two factors within personal control.