Effect of a 12- year siege on the quality of life of among university students in the Gaza Strip

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This affected the general mental health and quality of life of the population significantly. This study aimed at assessing the impact of siege and quality of life among university students in the Gaza Strip. Method The study is a cross sectional study in which we have collected the data from 600 participants (274 men, 326 women) with average age 20.54 from four universities. We have collected demographic data, the impact of siege using Gaza Siege Checklist, and the quality of life using WHOQoL scale. Data was entered, cleared and analyzed using SPSS version 23 to assess the relationship between the impact of siege and quality of life. Results A total of 600 university students participated (45.6% men, 54.4% women; mean age 20.54 ± 1.69 years). Nearly half of the students (51.2% ± 21.8) reported moderate-to-severe negative impact from the 12-year siege, with significant gender differences (men: 58.3% ± 20.6; women: 45.1% ± 19.8; p < 0.05). The most affected domains of quality of life were general life satisfaction, social relationships, and environmental and financial resources, while health and mental well-being were less affected. Pearson correlation analysis showed significant negative associations between siege impact and life satisfaction (r = -0.195, p < 0.05), social relationships (r = -0.126, p < 0.05), and environmental/financial resources (r = -0.254, p < 0.05). Regression analysis confirmed that siege-related stressors significantly predicted lower overall quality of life (B = -0.107, p < 0.05). Conclusion Siege has impacted the lives of the participants significantly especially in their perspectives of the general satisfaction, the social life, and the environmental and financial resources. Gaza Strip University Students Quality of Life Siege Impact Psychosocial Stress INTRODUCTION The Gaza Strip is a narrow territory covering 360 sq. km along the coast of the Mediterranean Sea, characterized by a densely concentrated population in cities and refugee camps [ 1 ]. According to the Palestinian Central Bureau of Statistics, the estimated population of Palestine is 4,780,978, with 2,881,687 residing in the West Bank (5,655 sq. km) and 1,899,291 in the Gaza Strip (365 sq. km) [ 2 ]. The population distribution shows that 44.1% are under 14 years, 21.34% are 15–24 years, 28.5% are 25–54 years, 3.48% are 55–64 years, and 2.58% are older than 65 years [ 2 ]. The humanitarian situation in Gaza has been deteriorating since 2007, following the imposition of a siege on the population [ 3 ]. This blockade, coupled with ongoing human rights violations, has severely restricted movement and access to basic needs. The situation worsened after three major military offensives in 2008–2009, 2012, and 2014, which caused high casualties and placed enormous pressure on the already strained health system [ 4 ]. The siege and associated hardships have reduced the availability of essential resources and disrupted social support structures due to internal political divisions. These chronic stressors have contributed to the development of mental health problems such as depression, anxiety, post-traumatic stress disorder (PTSD), and substance use [ 5 ]. It is estimated that approximately one-third of Palestinians in the occupied territories require psychosocial and mental health interventions [ 6 ]. Quality of Life (QoL) is defined by the World Health Organization (WHO) as an individual’s perception of their position in life, within the context of culture, value systems, goals, expectations, standards, and concerns [ 7 ]. WHO developed a tool to assess QoL across four domains: physical health, mental health, social relationships, and environmental resources, along with two items measuring general satisfaction [ 7 ]. In Gaza, previous research has shown that only 11.8% of participants reported being satisfied with the general situation, which may reflect the cumulative effects of prolonged siege and continuous trauma [ 8 ]. This study aims to assess the impact of a 12-year siege on the quality of life of university students in the Gaza Strip and to explore the relationship between the siege and their perceived QoL. METHODS Study Design This study employed a cross-sectional analytical design using quantitative methods to examine the impact of the prolonged siege on the quality of life of university students in the Gaza Strip. The cross-sectional approach was chosen to allow assessment of exposure to siege-related stressors and their association with quality of life at a single point in time. Study Setting The study was conducted across four major universities in the Gaza Strip, which represent diverse geographic areas and student populations: Islamic University of Gaza Al-Azhar University Al-Quds University Al-Aqsa University These institutions collectively enroll a large number of undergraduate students, making them suitable for studying the impact of prolonged political and economic hardship on young adults. Study Population The target population consisted of undergraduate students enrolled in the selected universities during the study period. University students were chosen due to their heightened vulnerability to the psychosocial and economic stressors resulting from the long-term siege, which could affect academic performance, social interactions, and overall quality of life. Sample and Sampling Technique A convenience sampling technique was used to recruit participants from the four universities. A total of 800 students who met the eligibility criteria were invited to participate. Of these, 600 students completed the questionnaires adequately and were included in the final analysis, yielding a response rate of 75%. The final sample included 274 males (45.6%) and 326 females (54.4%), with a mean age of 20.54 years. Participants were recruited from various academic disciplines and educational levels to enhance sample heterogeneity. Eligibility Criteria Inclusion criteria: Enrolled as a student in one of the selected universities Aged 18 years or older Resident of the Gaza Strip during the 12-year siege Willing to participate and able to provide informed consent Exclusion criteria: Incomplete or poorly filled questionnaires Self-reported severe cognitive or psychiatric conditions that could impair questionnaire completion Instruments Socio-demographic Questionnaire A structured socio-demographic questionnaire was used to collect data on age, gender, marital status, area of residence, type of housing, residency status, monthly household income, family size, parental education and occupation, student employment status, university, college, and academic level. Gaza Siege Checklist (GSC) The GSC is a 21-item instrument assessing daily life stressors related to the Gaza siege, including family life, health, education, social relationships, and economic conditions. The scale was developed based on focus group discussions with 20 mental health professionals and has been previously validated in Gaza [ 7 ] on a community-based sample of 400 adults. The internal consistency of the scale was high (Cronbach’s alpha = 0.802). World Health Organization Quality of Life – BREF (WHOQOL-BREF) The WHOQOL-BREF, derived from the WHOQOL-100, is a cross-cultural instrument assessing subjective perceptions of quality of life. It includes 24 items covering six domains: general satisfaction, health satisfaction, physical health, mental state, social relationships, and environmental/financial resources, plus two items on overall general satisfaction. The instrument has been used previously in Gaza and demonstrated strong internal consistency (Cronbach’s alpha = 0.797) [ 7 – 8 ]. Data Collection Procedures Data were collected from October 2018 to April 2019. Prior to data collection, formal permissions were obtained from the participating universities and ethical approval was granted by the Helsinki Ethical Committee. Participants received written informed consent forms explaining the study objectives, procedures, voluntary nature of participation, and confidentiality measures. Questionnaires were self-administered in classroom or university settings under the supervision of trained research assistants. Statistical Analysis Data were coded, entered, and analyzed using SPSS version 23. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize demographic characteristics, siege-related stressors, and quality of life scores. Inferential analyses were conducted to examine the relationship between the impact of siege and quality of life. Pearson’s correlation coefficient was used to assess associations between GSC scores and WHOQOL-BREF domains. Multiple regression analysis was performed to predict quality of life (dependent variable) based on the impact of siege (independent variable). Statistical significance was set at p < 0.05. Ethical Considerations Ethical approval for the study was obtained from the research committee at the Faculty of Medicine – Islamic University of Gaza. Participation was entirely voluntary, and participants had the right to withdraw at any time without penalty. Written informed consent was obtained from all participants. Data were collected anonymously, and confidentiality was strictly maintained throughout the study. All procedures were conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. RESULTS Demographic Characteristics A total of 600 students completed the questionnaires, of which 274 (45.6%) were male and 326 (54.4%) were female. The mean age of participants was 20.54 years (SD = 1.69; range: 17–32). The majority were single (90.2%), followed by married (8.6%), divorced (0.7%), and widowed (0.5%). Participants were recruited from four universities in the Gaza Strip: Al Azhar University (34.1%), Al Aqsa University (26.4%), Islamic University (23.8%), and Al Quds University (15.6%). Secondary education tracks were mostly literary (70.9%) versus scientific (28.7%). Participants represented diverse academic levels and colleges, as shown in Table 1. Most participants were not employed (93.5%), while 4.9% worked alongside their studies. The majority lived in towns (69%), followed by camps (21.7%) and villages (9.3%). Family size varied: 49.8% had more than 8 members, 37.1% had 5–7 members, and 13.1% had fewer than four. Parental education and employment varied: fathers’ education ranged from primary (4.9%) to postgraduate (12.6%), and mothers’ education ranged from uneducated (5.4%) to university graduates (23.8%). Fathers were employed in various sectors (e.g., 19.1% salaried employees, 12.1% workers), and most mothers (82.6%) were housewives. Monthly family income ranged from 4000 NIS (9.9%). Table 1 presents demographic statistics of study participants Table 1 Demographic Characteristics of Participants (n = 600) Variable Category n (%) Gender Male 274 (45.6) Female 326 (54.4) Marital Status Single 541 (90.2) Married 52 (8.6) Divorced 4 (0.7) Widowed 3 (0.5) Secondary Education Track Literary 425 (70.9) Scientific 172 (28.7) University Al Azhar 205 (34.1) Al Aqsa 158 (26.4) Islamic 143 (23.8) Al Quds 94 (15.6) College Education 352 (58.7) Science 34 (5.6) Medicine 55 (9.1) Engineering 29 (4.9) Pharmacy 1 (0.2) Islamic Studies 38 (6.3) Law 14 (2.3) Economics & Political Science 77 (12.8) Employment Employed 29 (4.9) Not employed 561 (93.5) Residence Type Town 414 (69) Camp 130 (21.7) Village 56 (9.3) Family Members > 8 299 (49.8) 5–7 223 (37.1) < 4 78 (13.1) Refugee Status Refugee 392 (65.3) Citizen 208 (34.7) Impact of Siege The mean score of the Gaza Siege Checklist (GSC) was 51.24% (SD = 21.81), indicating moderate negative impact. Women reported significantly higher impact compared to men (mean = 58.34%, SD = 20.59 vs. 45.11%, SD = 19.76; p < 0.05). Participants reported various siege-related hardships, including difficulties in studying due to electricity shortages (82.9%), challenges in traveling abroad for studies (82.1%), and financial constraints in paying university fees (71.2%). Many felt “like living in a big prison” (67.8%) and reported barriers to accessing medical care outside Gaza (67.5%) (Table 2). Table 2 Frequency of Reported Impact of Siege (n = 600) No Item Yes n (%) 1 I feel that I live in a big prison 407 (67.8) 2 Difficulty completing house construction 330 (55) 3 Difficulty buying educational needs 392 (65.4) 4 Difficulty visiting friends/relatives 318 (53) 5 Daily family income not enough for transport 313 (52.1) 6 Study affected by electricity shortage 497 (82.9) 7 Difficulty finding transport to university 274 (45.7) 8 Difficulty studying abroad 493 (82.1) 9 Difficulty getting medical care outside Gaza 405 (67.5) 10 Visited associations for assistance 172 (28.6) 11 Difficulty paying university fees 427 (71.2) 12 Difficulty getting medical care due to lack of insurance 212 (35.3) 13 Stress due to father’s loss of job 301 (50.1) 14 Thinking of emigrating 350 (58.3) 15 Difficulty visiting family in West Bank 322 (53.6) 16 Considering leaving university to work 200 (33.4) 17 Family member died due to inability to travel for treatment 120 (20) 18 Prevented from visiting imprisoned family 79 (13.1) 19 Unable to find necessary items due to blockade 402 (67) 20 Started working on emigration procedures 137 (22.6) Quality of Life The overall mean quality of life score was 60.34% (SD = 9.5). Satisfaction with life averaged 55.77% (SD = 16.9), and satisfaction with health was 68.78% (SD = 18.3). Physical and mental health scores were 55.7% (SD = 10.19) and 65.16% (SD = 12.58), respectively. Social relationships averaged 63.75% (SD = 18.14), and environmental/financial resources 52.67% (SD = 12.68). Gender differences were significant only in health satisfaction (women: 66.86%, men: 70.94%) (Table 3). Relationship between Siege and Quality of Life Pearson correlation analysis showed a significant negative relationship between the impact of siege and three QoL domains: life satisfaction (r = − 0.195, p < 0.05), social relationships (r = − 0.126, p < 0.05), and environmental/financial resources (r = − 0.254, p 0.05) (Table 3). Table 3 Pearson Correlations between Siege Impact and QoL Domains QoL Domain r p-value General satisfaction –0.195 0.001* Satisfaction about health –0.072 0.091 Physical health –0.056 0.154 Mental health –0.048 0.202 Social relationships –0.126 0.004* Environmental & financial resources –0.254 0.000* Predictors of Quality of Life A linear regression model was conducted with total quality of life as the dependent variable and impact of siege as the independent variable. The model was statistically significant (p < 0.05), indicating that greater exposure to siege-related stressors predicted lower quality of life (B = − 0.107, p < 0.05). DISCUSSION The findings of this study indicate that the prolonged 12-year siege has had a substantial negative impact on the quality of life of university students in the Gaza Strip. Participants reported multiple hardships, including restricted access to education, healthcare, and financial resources, which were exacerbated by the lack of electricity, difficulty traveling abroad, and limitations on medical care. Nearly half of the participants reported moderate-to-severe impact from the siege, with women experiencing significantly higher burden than men. Overall, the quality of life among students was moderate, with the lowest scores observed in environmental and financial domains, reflecting the socioeconomic constraints imposed by the blockade. The negative correlations between siege impact and life satisfaction, social relationships, and environmental resources highlight the pervasive influence of chronic political and economic stressors on psychosocial well-being. Moreover, regression analysis confirmed that exposure to siege-related stressors is a significant predictor of reduced quality of life. These results align with previous research in Gaza, which demonstrated that ongoing political violence, economic hardship, and social disruption contribute to elevated psychosocial distress and lower life satisfaction among young adults. Collectively, the findings underscore the urgent need for targeted interventions to mitigate the psychological and social consequences of prolonged siege on university students in the region. The findings of the present study provide compelling evidence on the substantial impact of the prolonged 12-year siege on the quality of life of university students in the Gaza Strip and are consistent with previous research documenting the broader psychosocial consequences of chronic siege conditions [ 9 – 17 ]. The results reveal that students experience significant restrictions in multiple domains of daily life, including education, mobility, financial stability, and access to healthcare, which collectively contribute to lower overall quality of life. Nearly half of the participants reported moderate-to-severe impact from siege-related stressors, with women experiencing significantly higher burdens than men. The domains most affected were general life satisfaction, social relationships, and environmental and financial resources, reflecting the pervasive influence of chronic socioeconomic and political constraints on students’ well-being. These findings align with prior studies conducted in Gaza, which consistently demonstrated elevated levels of psychological distress and reduced well-being associated with prolonged exposure to political violence, economic hardship, and restricted mobility [ 13 – 17 ]. The significant negative correlations observed between the impact of the siege and several domains of quality of life highlight the siege as a form of continuous and pervasive stressor [ 18 ]. Unlike acute traumatic events, the prolonged blockade imposes persistent challenges that permeate daily life, including frequent electricity shortages, financial strain affecting tuition and living costs, barriers to traveling abroad for education or medical care, and a pervasive sense of confinement. The high proportion of students who reported feeling as though they “live in a big prison” underscores the psychological and social toll of long-term restrictions on autonomy and mobility. This pattern mirrors findings from conflict and post-conflict settings, where chronic socioeconomic deprivation, uncertainty about the future, and repeated exposure to stressors are strongly linked to diminished quality of life [ 18 – 19 ]. When contextualized within broader evidence from Gaza, the results suggest that the siege has created a baseline of chronic psychosocial vulnerability among university students [ 13 ]. While this study did not directly assess clinical mental health outcomes, the observed declines in life satisfaction, social functioning, and environmental well-being likely reflect the cumulative effects of prolonged siege-related stress. The consistent patterns across diverse demographic subgroups indicate that the siege exerts a broad and largely indiscriminate impact on students, with only modest gender differences in health satisfaction [ 13 ]. This universality underscores that all students, regardless of gender or academic background, are exposed to and affected by long-term siege conditions. The implications of these findings are particularly important given the critical developmental stage of university students [ 20 – 22 ]. Persistent reductions in quality of life during early adulthood may compromise academic achievement, social development, and future career prospects. Moreover, long-term exposure to chronic stress and deprivation can have enduring consequences on mental health and resilience, potentially influencing students’ ability to contribute to societal recovery and development in Gaza [ 23 – 26 ]. These results underscore the urgent need for comprehensive, context-sensitive interventions that address the multidimensional impacts of the siege, including educational support, financial assistance, psychosocial programs, and measures to facilitate mobility and access to essential services. Promoting protective factors such as social support, adaptive coping strategies, and culturally rooted resilience mechanisms (e.g., Sumud) may help buffer the adverse effects of prolonged siege conditions [ 18 , 24 – 26 ]. One of the important strength of this study that it is a leading study in assessing the relationship between the impact of siege and quality of life among a crucial category of the community; the university students. In addition, the sample size added a value to our study as it represents relatively the university students’ population in four main universities in the Gaza Strip. One of the limitations of our study is the potential mistrust of researchers in Gaza, as it is a conflict zone that is characterized by mistrust and suspicion of persons seeking information in the event that they are informants for the various political and military factions. We believe that the researchers have considerable respect in the community to offset any of such concerns. Moreover, our study was based on the quantitative measures only, so we recommend conducting future studies adopting the mixed method approach. CONCLUSION The findings of this study demonstrate that the 12-year siege has had a significant negative impact on the quality of life of university students in the Gaza Strip. Students reported substantial challenges in multiple domains, including general life satisfaction, social relationships, and access to environmental and financial resources, with nearly half experiencing moderate-to-severe effects of the siege. Women were particularly affected in comparison to men, and financial, educational, and healthcare-related constraints were among the most commonly reported stressors. The significant negative correlations between siege impact and key domains of quality of life, along with the predictive value of siege-related stressors in the regression analysis, highlight that prolonged political and socioeconomic restrictions are a primary determinant of diminished well-being among students. These results underscore the urgent need for targeted interventions to support the psychosocial, educational, and economic needs of university students, aiming to mitigate the long-term adverse consequences of sustained siege conditions on this vulnerable population. Abbreviations • GSC Gaza Siege Checklist • NIS New Israeli Shekel • PTSD Post–Traumatic Stress Disorder • QoL Quality of Life • SD Standard Deviation • SPSS Statistical Package for the Social Sciences • UNRWA United Nations Relief and Works Agency • WHO World Health Organization • WHOQOL BREF–World Health Organization Quality of Life–Brief Version Declarations Ethics approval and consent to participate Ethical approval for this study was obtained from the Research Committee of the Faculty of Medicine, Islamic University of Gaza. Participation was voluntary, and all participants had the right to withdraw at any time without penalty. Written informed consent was obtained from all participants prior to data collection. Data were collected anonymously, and confidentiality was strictly maintained. All procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials Data are available upon reasonable request Competing Interest Authors have no conflict of interest Funding None Authors’ contribution Khamis Elessi conceptualized and supervised the study. Tayseer Afifi analyzed the data and drafted the manuscript. Khalil Abu Naqera revised the manuscript and prepared it for submission. All authors reviewed and approved the final version of the manuscript. Acknowledgment Not applicable References Afana A. The assessment of mental disorders in primary health care clinics in the Gaza Strip. Primary Health Care Research and Development; 2003. Afana A, Qauta S, Sarraj E. Mental health needs in Palestine. Humanitarian Practice Network. 2004. Castellino J, Canavan K. Minority rights in the Middle East. Oxford: Oxford University Press; 2013. p. 150. Dunning T, Hamas. Jihad and popular legitimacy: Reinterpreting resistance in Palestine. London: Routledge; 2016. Jomaa A, Thabet A. 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Resilience under protracted conflict and siege: a new paradigm shift. Med Confl Surviv. 2023;39:369–88. Hammad J, Tribe R. Culturally informed resilience in conflict settings: a literature review of sumud in the occupied Palestinian territories. Int Rev Psychiatry. 2021;33:132–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8592382","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":588753602,"identity":"676a8877-9b98-49a7-8539-cc185c5a4d10","order_by":0,"name":"Khamis Elessi","email":"","orcid":"","institution":"Islamic University of Gaza","correspondingAuthor":false,"prefix":"","firstName":"Khamis","middleName":"","lastName":"Elessi","suffix":""},{"id":588753603,"identity":"79d89e29-d57e-4613-99df-c33a012c1b95","order_by":1,"name":"Tayseer Afifi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYDAC5oMNHxLgvAqQCHMDfi1siY0zEhgMoLwzIC2MhLQkMM5ggGlhbAOT+LXwtzE3Njxg+CNvcP7wwceV82qj+duBWn5UbMOpReIYY2MD0GGGG26kJRue3XY8d8ZhxgbGnjO3cVtzv7H9AVAL44YbPGaSjduO5TYAtTAztuHWIg+1xX7D+fPffzbOOZY7n5AWA6iWxA0HctiAzJrcDYS0GIK1GBgnz7yRZizZcOxA7kagloP4/CJ3jP1h448KOdu+84cffmyoqcudBwy6Bz8q8Hgf4jwGBoUDYNZhMHmAgHoIkG8AU3VEKR4Fo2AUjIKRBQB9LWL+H0Y3ogAAAABJRU5ErkJggg==","orcid":"","institution":"Islamic University of Gaza","correspondingAuthor":true,"prefix":"","firstName":"Tayseer","middleName":"","lastName":"Afifi","suffix":""},{"id":588753604,"identity":"41e53945-80af-46c1-9212-521f33b02844","order_by":2,"name":"Khalil Abu Naqera","email":"","orcid":"","institution":"United Nations Relief and Works Agency for Palestine Refugees in the Near East","correspondingAuthor":false,"prefix":"","firstName":"Khalil","middleName":"Abu","lastName":"Naqera","suffix":""}],"badges":[],"createdAt":"2026-01-13 13:08:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8592382/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8592382/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104284439,"identity":"d9340be1-d921-4a70-b0fa-7e3464a2bd72","added_by":"auto","created_at":"2026-03-10 04:25:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":524676,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8592382/v1/4aa1a8e8-d06c-47e3-ba3e-a6e86da69ef1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of a 12- year siege on the quality of life of among university students in the Gaza Strip","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe Gaza Strip is a narrow territory covering 360 sq. km along the coast of the Mediterranean Sea, characterized by a densely concentrated population in cities and refugee camps [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to the Palestinian Central Bureau of Statistics, the estimated population of Palestine is 4,780,978, with 2,881,687 residing in the West Bank (5,655 sq. km) and 1,899,291 in the Gaza Strip (365 sq. km) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The population distribution shows that 44.1% are under 14 years, 21.34% are 15\u0026ndash;24 years, 28.5% are 25\u0026ndash;54 years, 3.48% are 55\u0026ndash;64 years, and 2.58% are older than 65 years [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe humanitarian situation in Gaza has been deteriorating since 2007, following the imposition of a siege on the population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This blockade, coupled with ongoing human rights violations, has severely restricted movement and access to basic needs. The situation worsened after three major military offensives in 2008\u0026ndash;2009, 2012, and 2014, which caused high casualties and placed enormous pressure on the already strained health system [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe siege and associated hardships have reduced the availability of essential resources and disrupted social support structures due to internal political divisions. These chronic stressors have contributed to the development of mental health problems such as depression, anxiety, post-traumatic stress disorder (PTSD), and substance use [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It is estimated that approximately one-third of Palestinians in the occupied territories require psychosocial and mental health interventions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eQuality of Life (QoL) is defined by the World Health Organization (WHO) as an individual\u0026rsquo;s perception of their position in life, within the context of culture, value systems, goals, expectations, standards, and concerns [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. WHO developed a tool to assess QoL across four domains: physical health, mental health, social relationships, and environmental resources, along with two items measuring general satisfaction [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Gaza, previous research has shown that only 11.8% of participants reported being satisfied with the general situation, which may reflect the cumulative effects of prolonged siege and continuous trauma [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This study aims to assess the impact of a 12-year siege on the quality of life of university students in the Gaza Strip and to explore the relationship between the siege and their perceived QoL.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003eThis study employed a cross-sectional analytical design using quantitative methods to examine the impact of the prolonged siege on the quality of life of university students in the Gaza Strip. The cross-sectional approach was chosen to allow assessment of exposure to siege-related stressors and their association with quality of life at a single point in time.\u003c/p\u003e \u003cp\u003eStudy Setting\u003c/p\u003e \u003cp\u003eThe study was conducted across four major universities in the Gaza Strip, which represent diverse geographic areas and student populations:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eIslamic University of Gaza\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAl-Azhar University\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAl-Quds University\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAl-Aqsa University\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThese institutions collectively enroll a large number of undergraduate students, making them suitable for studying the impact of prolonged political and economic hardship on young adults.\u003c/p\u003e \u003cp\u003eStudy Population\u003c/p\u003e \u003cp\u003eThe target population consisted of undergraduate students enrolled in the selected universities during the study period. University students were chosen due to their heightened vulnerability to the psychosocial and economic stressors resulting from the long-term siege, which could affect academic performance, social interactions, and overall quality of life.\u003c/p\u003e \u003cp\u003eSample and Sampling Technique\u003c/p\u003e \u003cp\u003e A convenience sampling technique was used to recruit participants from the four universities. A total of 800 students who met the eligibility criteria were invited to participate. Of these, 600 students completed the questionnaires adequately and were included in the final analysis, yielding a response rate of 75%. The final sample included 274 males (45.6%) and 326 females (54.4%), with a mean age of 20.54 years. Participants were recruited from various academic disciplines and educational levels to enhance sample heterogeneity.\u003c/p\u003e \u003cp\u003eEligibility Criteria\u003c/p\u003e \u003cp\u003eInclusion criteria:\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eEnrolled as a student in one of the selected universities\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAged 18 years or older\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eResident of the Gaza Strip during the 12-year siege\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e Willing to participate and able to provide informed consent\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003eExclusion criteria:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eIncomplete or poorly filled questionnaires\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSelf-reported severe cognitive or psychiatric conditions that could impair questionnaire completion\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eInstruments\u003c/p\u003e \u003cp\u003eSocio-demographic Questionnaire\u003c/p\u003e \u003cp\u003eA structured socio-demographic questionnaire was used to collect data on age, gender, marital status, area of residence, type of housing, residency status, monthly household income, family size, parental education and occupation, student employment status, university, college, and academic level.\u003c/p\u003e \u003cp\u003eGaza Siege Checklist (GSC)\u003c/p\u003e \u003cp\u003eThe GSC is a 21-item instrument assessing daily life stressors related to the Gaza siege, including family life, health, education, social relationships, and economic conditions. The scale was developed based on focus group discussions with 20 mental health professionals and has been previously validated in Gaza [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] on a community-based sample of 400 adults. The internal consistency of the scale was high (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.802).\u003c/p\u003e \u003cp\u003eWorld Health Organization Quality of Life \u0026ndash; BREF (WHOQOL-BREF)\u003c/p\u003e \u003cp\u003eThe WHOQOL-BREF, derived from the WHOQOL-100, is a cross-cultural instrument assessing subjective perceptions of quality of life. It includes 24 items covering six domains: general satisfaction, health satisfaction, physical health, mental state, social relationships, and environmental/financial resources, plus two items on overall general satisfaction. The instrument has been used previously in Gaza and demonstrated strong internal consistency (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.797) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eData Collection Procedures\u003c/p\u003e \u003cp\u003eData were collected from October 2018 to April 2019. Prior to data collection, formal permissions were obtained from the participating universities and ethical approval was granted by the Helsinki Ethical Committee. Participants received written informed consent forms explaining the study objectives, procedures, voluntary nature of participation, and confidentiality measures. Questionnaires were self-administered in classroom or university settings under the supervision of trained research assistants.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were coded, entered, and analyzed using SPSS version 23. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize demographic characteristics, siege-related stressors, and quality of life scores. Inferential analyses were conducted to examine the relationship between the impact of siege and quality of life. Pearson\u0026rsquo;s correlation coefficient was used to assess associations between GSC scores and WHOQOL-BREF domains. Multiple regression analysis was performed to predict quality of life (dependent variable) based on the impact of siege (independent variable). Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eEthical Considerations\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for the study was obtained from the research committee at the Faculty of Medicine \u0026ndash; Islamic University of Gaza. Participation was entirely voluntary, and participants had the right to withdraw at any time without penalty. Written informed consent was obtained from all participants. Data were collected anonymously, and confidentiality was strictly maintained throughout the study. All procedures were conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDemographic Characteristics\u003c/p\u003e\n\u003cp\u003eA total of 600 students completed the questionnaires, of which 274 (45.6%) were male and 326 (54.4%) were female. The mean age of participants was 20.54 years (SD = 1.69; range: 17–32). The majority were single (90.2%), followed by married (8.6%), divorced (0.7%), and widowed (0.5%). Participants were recruited from four universities in the Gaza Strip: Al Azhar University (34.1%), Al Aqsa University (26.4%), Islamic University (23.8%), and Al Quds University (15.6%). Secondary education tracks were mostly literary (70.9%) versus scientific (28.7%). Participants represented diverse academic levels and colleges, as shown in Table 1. Most participants were not employed (93.5%), while 4.9% worked alongside their studies. The majority lived in towns (69%), followed by camps (21.7%) and villages (9.3%). Family size varied: 49.8% had more than 8 members, 37.1% had 5–7 members, and 13.1% had fewer than four. Parental education and employment varied: fathers’ education ranged from primary (4.9%) to postgraduate (12.6%), and mothers’ education ranged from uneducated (5.4%) to university graduates (23.8%). Fathers were employed in various sectors (e.g., 19.1% salaried employees, 12.1% workers), and most mothers (82.6%) were housewives. Monthly family income ranged from \u0026lt; 1000 NIS (37.4%) to \u0026gt; 4000 NIS (9.9%). Table 1 presents demographic statistics of study participants\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDemographic Characteristics of Participants (n = 600)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e274 (45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e326 (54.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e541 (90.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSecondary Education Track\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiterary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e425 (70.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScientific\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e172 (28.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAl Azhar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e205 (34.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAl Aqsa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e158 (26.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIslamic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e143 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAl Quds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003eCollege\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e352 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEngineering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePharmacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIslamic Studies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaw\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEconomics \u0026amp; Political Science\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77 (12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e561 (93.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eResidence Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e414 (69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCamp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130 (21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVillage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eFamily Members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e299 (49.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5–7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e223 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (13.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eRefugee Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRefugee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e392 (65.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCitizen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e208 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\u003c/tfoot\u003e\n\u003c/table\u003eImpact of Siege\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eThe mean score of the Gaza Siege Checklist (GSC) was 51.24% (SD = 21.81), indicating moderate negative impact. Women reported significantly higher impact compared to men (mean = 58.34%, SD = 20.59 vs. 45.11%, SD = 19.76; p \u0026lt; 0.05). Participants reported various siege-related hardships, including difficulties in studying due to electricity shortages (82.9%), challenges in traveling abroad for studies (82.1%), and financial constraints in paying university fees (71.2%). Many felt “like living in a big prison” (67.8%) and reported barriers to accessing medical care outside Gaza (67.5%) (Table\u0026nbsp;2).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eFrequency of Reported Impact of Siege (n = 600)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI feel that I live in a big prison\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e407 (67.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifficulty completing house construction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e330 (55)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifficulty buying educational needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e392 (65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifficulty visiting friends/relatives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e318 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDaily family income not enough for transport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e313 (52.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudy affected by electricity shortage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e497 (82.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifficulty finding transport to university\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e274 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifficulty studying abroad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e493 (82.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifficulty getting medical care outside Gaza\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e405 (67.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVisited associations for assistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e172 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifficulty paying university fees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e427 (71.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifficulty getting medical care due to lack of insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e212 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStress due to father’s loss of job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e301 (50.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThinking of emigrating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e350 (58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifficulty visiting family in West Bank\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e322 (53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConsidering leaving university to work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e200 (33.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily member died due to inability to travel for treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrevented from visiting imprisoned family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79 (13.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnable to find necessary items due to blockade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e402 (67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStarted working on emigration procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eQuality of Life\u003c/p\u003e\n\u003cp\u003eThe overall mean quality of life score was 60.34% (SD = 9.5). Satisfaction with life averaged 55.77% (SD = 16.9), and satisfaction with health was 68.78% (SD = 18.3). Physical and mental health scores were 55.7% (SD = 10.19) and 65.16% (SD = 12.58), respectively. Social relationships averaged 63.75% (SD = 18.14), and environmental/financial resources 52.67% (SD = 12.68). Gender differences were significant only in health satisfaction (women: 66.86%, men: 70.94%) (Table\u0026nbsp;3).\u003c/p\u003e\n\u003cp\u003eRelationship between Siege and Quality of Life\u003c/p\u003e\n\u003cp\u003ePearson correlation analysis showed a significant negative relationship between the impact of siege and three QoL domains: life satisfaction (r = − 0.195, p \u0026lt; 0.05), social relationships (r = − 0.126, p \u0026lt; 0.05), and environmental/financial resources (r = − 0.254, p \u0026lt; 0.05). No significant correlations were observed for health satisfaction, physical health, or mental health (p \u0026gt; 0.05) (Table\u0026nbsp;3).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePearson Correlations between Siege Impact and QoL Domains\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eQoL Domain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeneral satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSatisfaction about health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMental health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial relationships\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnvironmental \u0026amp; financial resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ePredictors of Quality of Life\u003c/p\u003e\n\u003cp\u003eA linear regression model was conducted with total quality of life as the dependent variable and impact of siege as the independent variable. The model was statistically significant (p \u0026lt; 0.05), indicating that greater exposure to siege-related stressors predicted lower quality of life (B = − 0.107, p \u0026lt; 0.05).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe findings of this study indicate that the prolonged 12-year siege has had a substantial negative impact on the quality of life of university students in the Gaza Strip. Participants reported multiple hardships, including restricted access to education, healthcare, and financial resources, which were exacerbated by the lack of electricity, difficulty traveling abroad, and limitations on medical care. Nearly half of the participants reported moderate-to-severe impact from the siege, with women experiencing significantly higher burden than men. Overall, the quality of life among students was moderate, with the lowest scores observed in environmental and financial domains, reflecting the socioeconomic constraints imposed by the blockade. The negative correlations between siege impact and life satisfaction, social relationships, and environmental resources highlight the pervasive influence of chronic political and economic stressors on psychosocial well-being. Moreover, regression analysis confirmed that exposure to siege-related stressors is a significant predictor of reduced quality of life. These results align with previous research in Gaza, which demonstrated that ongoing political violence, economic hardship, and social disruption contribute to elevated psychosocial distress and lower life satisfaction among young adults. Collectively, the findings underscore the urgent need for targeted interventions to mitigate the psychological and social consequences of prolonged siege on university students in the region.\u003c/p\u003e \u003cp\u003eThe findings of the present study provide compelling evidence on the substantial impact of the prolonged 12-year siege on the quality of life of university students in the Gaza Strip and are consistent with previous research documenting the broader psychosocial consequences of chronic siege conditions [\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14 CR15 CR16\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The results reveal that students experience significant restrictions in multiple domains of daily life, including education, mobility, financial stability, and access to healthcare, which collectively contribute to lower overall quality of life. Nearly half of the participants reported moderate-to-severe impact from siege-related stressors, with women experiencing significantly higher burdens than men. The domains most affected were general life satisfaction, social relationships, and environmental and financial resources, reflecting the pervasive influence of chronic socioeconomic and political constraints on students\u0026rsquo; well-being. These findings align with prior studies conducted in Gaza, which consistently demonstrated elevated levels of psychological distress and reduced well-being associated with prolonged exposure to political violence, economic hardship, and restricted mobility [\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe significant negative correlations observed between the impact of the siege and several domains of quality of life highlight the siege as a form of continuous and pervasive stressor [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Unlike acute traumatic events, the prolonged blockade imposes persistent challenges that permeate daily life, including frequent electricity shortages, financial strain affecting tuition and living costs, barriers to traveling abroad for education or medical care, and a pervasive sense of confinement. The high proportion of students who reported feeling as though they \u0026ldquo;live in a big prison\u0026rdquo; underscores the psychological and social toll of long-term restrictions on autonomy and mobility. This pattern mirrors findings from conflict and post-conflict settings, where chronic socioeconomic deprivation, uncertainty about the future, and repeated exposure to stressors are strongly linked to diminished quality of life [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen contextualized within broader evidence from Gaza, the results suggest that the siege has created a baseline of chronic psychosocial vulnerability among university students [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. While this study did not directly assess clinical mental health outcomes, the observed declines in life satisfaction, social functioning, and environmental well-being likely reflect the cumulative effects of prolonged siege-related stress. The consistent patterns across diverse demographic subgroups indicate that the siege exerts a broad and largely indiscriminate impact on students, with only modest gender differences in health satisfaction [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This universality underscores that all students, regardless of gender or academic background, are exposed to and affected by long-term siege conditions.\u003c/p\u003e \u003cp\u003eThe implications of these findings are particularly important given the critical developmental stage of university students [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Persistent reductions in quality of life during early adulthood may compromise academic achievement, social development, and future career prospects. Moreover, long-term exposure to chronic stress and deprivation can have enduring consequences on mental health and resilience, potentially influencing students\u0026rsquo; ability to contribute to societal recovery and development in Gaza [\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These results underscore the urgent need for comprehensive, context-sensitive interventions that address the multidimensional impacts of the siege, including educational support, financial assistance, psychosocial programs, and measures to facilitate mobility and access to essential services. Promoting protective factors such as social support, adaptive coping strategies, and culturally rooted resilience mechanisms (e.g., Sumud) may help buffer the adverse effects of prolonged siege conditions [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the important strength of this study that it is a leading study in assessing the relationship between the impact of siege and quality of life among a crucial category of the community; the university students. In addition, the sample size added a value to our study as it represents relatively the university students\u0026rsquo; population in four main universities in the Gaza Strip.\u003c/p\u003e \u003cp\u003eOne of the limitations of our study is the potential mistrust of researchers in Gaza, as it is a conflict zone that is characterized by mistrust and suspicion of persons seeking information in the event that they are informants for the various political and military factions. We believe that the researchers have considerable respect in the community to offset any of such concerns. Moreover, our study was based on the quantitative measures only, so we recommend conducting future studies adopting the mixed method approach.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe findings of this study demonstrate that the 12-year siege has had a significant negative impact on the quality of life of university students in the Gaza Strip. Students reported substantial challenges in multiple domains, including general life satisfaction, social relationships, and access to environmental and financial resources, with nearly half experiencing moderate-to-severe effects of the siege. Women were particularly affected in comparison to men, and financial, educational, and healthcare-related constraints were among the most commonly reported stressors. The significant negative correlations between siege impact and key domains of quality of life, along with the predictive value of siege-related stressors in the regression analysis, highlight that prolonged political and socioeconomic restrictions are a primary determinant of diminished well-being among students. These results underscore the urgent need for targeted interventions to support the psychosocial, educational, and economic needs of university students, aiming to mitigate the long-term adverse consequences of sustained siege conditions on this vulnerable population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; GSC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGaza Siege Checklist\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; NIS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNew Israeli Shekel\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; PTSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePost\u0026ndash;Traumatic Stress Disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; QoL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eQuality of Life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; SD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; SPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; UNRWA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited Nations Relief and Works Agency\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; WHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; WHOQOL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBREF\u0026ndash;World Health Organization Quality of Life\u0026ndash;Brief Version\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Research Committee of the Faculty of Medicine, Islamic University of Gaza. Participation was voluntary, and all participants had the right to withdraw at any time without penalty. Written informed consent was obtained from all participants prior to data collection. Data were collected anonymously, and confidentiality was strictly maintained. All procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available upon reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors have no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKhamis Elessi conceptualized and supervised the study. Tayseer Afifi analyzed the data and drafted the manuscript. Khalil Abu Naqera revised the manuscript and prepared it for submission. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cstrong\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAfana A. The assessment of mental disorders in primary health care clinics in the Gaza Strip. Primary Health Care Research and Development; 2003.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAfana A, Qauta S, Sarraj E. Mental health needs in Palestine. Humanitarian Practice Network. 2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCastellino J, Canavan K. Minority rights in the Middle East. Oxford: Oxford University Press; 2013. p. 150.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDunning T, Hamas. Jihad and popular legitimacy: Reinterpreting resistance in Palestine. 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BMC Psychol. 2024;12:696.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamdan-Mansour AM, Albalishi IZ, Rayani A et al. The moderation effect of resilience on the relationship between PTSD, depression, and life satisfaction among on-duty healthcare professionals in Gaza. Psychiatr Q. 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDashorst P, Mooren TM, Kleber RJ, et al. Intergenerational consequences of the holocaust on offspring mental health: a systematic review of associated factors and mechanisms. Eur J Psychotraumatol. 2019;10:1654065.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJavanbakht A. Gaza's hidden crisis: adults, children, and generations of psychological torment to come. Eur J Psychotraumatol. 2024;15:2416824.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbuelaish I, Yousufzai S. Resilience under protracted conflict and siege: a new paradigm shift. Med Confl Surviv. 2023;39:369\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHammad J, Tribe R. Culturally informed resilience in conflict settings: a literature review of sumud in the occupied Palestinian territories. Int Rev Psychiatry. 2021;33:132\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Gaza Strip, University Students, Quality of Life, Siege Impact, Psychosocial Stress","lastPublishedDoi":"10.21203/rs.3.rs-8592382/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8592382/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSince the siege was imposed on the Gaza strip, the humanitarian situation was deteriorated to reach unprecedented level of poverty, economic hardship and social problems. This affected the general mental health and quality of life of the population significantly. This study aimed at assessing the impact of siege and quality of life among university students in the Gaza Strip.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003e The study is a cross sectional study in which we have collected the data from 600 participants (274 men, 326 women) with average age 20.54 from four universities. We have collected demographic data, the impact of siege using Gaza Siege Checklist, and the quality of life using WHOQoL scale. Data was entered, cleared and analyzed using SPSS version 23 to assess the relationship between the impact of siege and quality of life.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 600 university students participated (45.6% men, 54.4% women; mean age 20.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69 years). Nearly half of the students (51.2% \u0026plusmn; 21.8) reported moderate-to-severe negative impact from the 12-year siege, with significant gender differences (men: 58.3% \u0026plusmn; 20.6; women: 45.1% \u0026plusmn; 19.8; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The most affected domains of quality of life were general life satisfaction, social relationships, and environmental and financial resources, while health and mental well-being were less affected. Pearson correlation analysis showed significant negative associations between siege impact and life satisfaction (r = -0.195, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), social relationships (r = -0.126, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and environmental/financial resources (r = -0.254, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Regression analysis confirmed that siege-related stressors significantly predicted lower overall quality of life (B = -0.107, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSiege has impacted the lives of the participants significantly especially in their perspectives of the general satisfaction, the social life, and the environmental and financial resources.\u003c/p\u003e","manuscriptTitle":"Effect of a 12- year siege on the quality of life of among university students in the Gaza Strip","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-11 16:42:18","doi":"10.21203/rs.3.rs-8592382/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e1487583-2d26-4ede-a5c3-2d336af6f27d","owner":[],"postedDate":"February 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-10T04:25:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-11 16:42:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8592382","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8592382","identity":"rs-8592382","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}