The same people, measured three times — psychological distress in Gaza, 2020 to 2025

Most of the numbers quoted about mental health in Gaza come from separate cross-sectional surveys, which means a hostile reader can always say the samples were not comparable. This study closes that door. It is a longitudinal population-based cohort — the same adults, asked the same questions, three times.

The paper is “Changes in psychological distress during conflict escalation in an adult population-based cohort in the Gaza Strip (2020–2025): a longitudinal analysis”, published in eClinicalMedicine on 24 November 2025 (DOI 10.1016/j.eclinm.2025.103647). The authors are Curdin Brugger, Jan Hattendorf, Mirko S Winkler and Nicole Probst-Hensch of the Swiss Tropical and Public Health Institute at the University of Basel, with Bassam Abu Hamad of Al-Quds University in Gaza City.

The method matters, so it is worth stating exactly. Household surveys were conducted across the Gaza, North Gaza and Rafah governorates in three waves — 18 March to 15 July 2020, 24 January to 7 March 2023, and 12 to 28 January 2025. Distress was measured with the 12-item General Health Questionnaire (GHQ-12), scored dichotomously, with a score above 6 taken as high distress. 677 participants completed all three surveys. The cohort is adults aged 40 and over (70% aged 40–59; 51% female), which is a real limit on what it can say about the young.

The finding: “High psychological distress increased from 19.5% in 2020 and 17.4% in 2023 to 67.2% in 2025.” Adjusted models showed twelve times higher odds of psychological distress in 2025 than in 2020. Two things follow, and the second is the one usually missed. The first is the scale of the rise. The second is the baseline — roughly one adult in five was in high psychological distress in 2020, before this war, under blockade. The war did not create the condition. It multiplied it.

The authors’ conclusion is deliberately unglamorous: the findings “underscore the relevance of providing long-term psychosocial and mental health services.” Read alongside the Palestinian clinical literature — which argues that services delivered into continuing danger cannot do what services do in safety — the number is best read not as a treatment target but as a measurement of what is being done to people.

Why it matters

• A within-person comparison, which is the strongest design available in these conditions and the hardest to dismiss.
• It establishes the pre-war baseline as well as the wartime figure, which is what makes the blockade years legible rather than being erased by the enormity of what followed.
• Co-authored from inside Gaza, at Al-Quds University, during the war.

Key resources

• Changes in psychological distress during conflict escalation in an adult population-based cohort in the Gaza Strip (2020–2025) — full text