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'Agencies need to prepare staff for trauma of war zone work'

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There is substantial evidence on the impact of war conflict on children’s and adults’ physical and mental wellbeing, in particular the recurrent conflict in the Gaza Strip

We have completed a number of studies that demonstrated high rates of emotional disorders such as post-traumatic stress disorder and depression associated with direct exposure to trauma and the exacerbating effect of extreme socioeconomic deprivation in this area (Thabet and Vostanis, 2012; Thabet et al 2008).

Research on the impact of this extreme cycle of violence on health professionals is limited, even though nurses and other staff from the UK and international health community offer assistance to the Gaza population.

Two years after the previous war on Gaza in January 2009, which lasted 23 days, we studied the traumatic experiences and mental health of 274 nurses, aged 20-47 years, who had worked in local ministry of health, military, UN and private health settings. Participants completed measures of experience of traumatic events, PTSD and post-traumatic growth.

We found ongoing trauma exposure related to both civilian and professional identities. The most commonly reported traumatic events were: watching pictures of dead and injured people on TV; caring for severely injured patients, including those who died; and witnessing the demolition of neighbours’ homes by tanks. Nearly 20% of nurses experienced post-traumatic stress disorders which, consistently with the literature, were significantly associated with trauma exposure. Nursing staff reported a range of strategies to deal with stressors, namely spiritual change, personal strengths, interpersonal relations and appreciation of life.

It is obviously difficult to disentangle personal, professional and collective experiences of a health workforce living in a continuously traumatised society and apply it to other groups. Similar problems may be experienced to some extent by nurses deployed in hospital and community health settings for short periods during times of conflict. This raises a number of issues for all organisations involved in humanitarian situations.

Substantial effort is required to support staff beyond catering for their physical or educational needs. International agencies also need to train and prepare their voluntary or employed workers to cope with trauma first hand, as well as monitoring and protecting their welfare during and after their placement in a conflict zone.

Nader Ashraf Shamia is staff nurse at Ministry of Health and Shiva Hospital, Gaza; Abdel Aziz Mousa Thabet is associate professor of psychiatry, School of Public Health at Al Quds University, Jerusalem; Panos Vostanis is professor of child psychiatry at the University of Leicester.

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