Humiliation: the invisible trauma of war for Palestinian youth.
Author: Giacaman R, Abu Rmeileh NM, Husseini A, Saab H, Boyce W
Source:
Public health, 121(8), 563-571.
OBJECTIVES: To investigate the influence of exposure to humiliation in war-like
conditions on health status in 10th- and 11th-grade students living in the
Ramallah District, West Bank, Occupied Palestinian Territory. STUDY DESIGN: A
stratified single-stage cluster sample of 3415 students from cities, towns,
villages and refugee camps of the Ramallah District. METHODS: Survey questions
were derived from the World Health Organization's Health Behaviour in School-aged
Children Survey, the Gaza Community Mental Health Programme Traumatic Event
Checklist, and focus group discussions with young people. The survey
questionnaire was completed by students in their classrooms, under the
supervision of a trained field worker. RESULTS: There was a significant
association between a high number of subjective health complaints and demographic
variables, particularly for females compared with males, and refugee camp
dwellers compared with village dwellers. In addition, exposure to humiliation was
significantly associated with an increased number of subjective health
complaints. Students experiencing three forms of humiliation were found to be 2.5
times more likely to report a high number of subjective health complaints
compared with those who had never been exposed to humiliation (52% vs 21%), while
those experiencing four forms of humiliation were three times more likely to
report a high number of subjective health complaints (62% vs 21%). A multiple
logistic regression model revealed that humiliation was significantly associated
with a high number of subjective health complaints, even after adjusting for sex,
residence and other measures of exposure to violent events. The odds ratio of
reporting a high number of subjective health complaints increased as the number
of forms of humiliation increased, with values of 1.69, 2.67, 4.43 and 7.49 for
reporting a high number of subjective health complaints when exposed to one, two,
three or four forms of humiliation, respectively, compared with those who had
never been exposed to humiliation. CONCLUSIONS: The results of this study
demonstrate that humiliation induced by conflict and war-like conditions
constitutes an independent traumatic event that is associated with negative
health outcomes in its own right, regardless of exposure to other
violent/traumatic events. Based on these findings, it is proposed that
humiliation should be included as an indicator of mental health status in
research that investigates the consequences of war and conflict on the health of
populations.