The enduring political conflict and recurrent military escalations in the Occupied Palestinian Territories have created an environment of chronic stress and exposure to trauma, with profound implications for the mental health of the population.(1,2) The October 2023 war on the Gaza Strip, characterized by unprecedented intensity and devastation, sent shockwaves throughout the region, including the West Bank. The pervasive media coverage, personal losses, and the palpable atmosphere of collective grief and anxiety have acted as significant psychosocial stressors, even for those not in the immediate conflict zone.(3,4) Research consistently demonstrates that such exposures are strongly correlated with high rates of post-traumatic stress disorder (PTSD), depression, anxiety, and other psychological sequelae among Palestinians.(2,5)

Within this vulnerable population, healthcare workers and nursing students represent a critical subgroup. Nursing students are tasked with the dual challenge of managing the rigorous academic and clinical demands of their training while simultaneously navigating the same traumatic external environment as their communities.(6,7) This convergence of academic stress and external trauma places them at a heightened risk for psychological distress.(8) Studies conducted in similar contexts have shown that healthcare students report significant levels of anxiety, stress, and PTSD symptoms, which can adversely affect their academic performance, clinical competence, and overall well-being.(9,10) Furthermore, the nursing profession requires immense emotional resilience and stability, qualities that can be severely compromised by untreated trauma.(11)

Existing literature has begun to shed light on the mental health burdens faced by Palestinians. Research has explored PTSD among various groups, including nurses working in conflict settings,(12) university students in Gaza (13) and the general populace.(2,5) However, a focused investigation into the specific psychological impact on nursing students in the West Bank following major geopolitical events remains relatively underexplored. Most studies concentrate on Gaza's direct war zones or broader adult populations, creating a gap in understanding the ripple effects on future healthcare professionals in adjacent regions who experience the trauma vicariously and through personal and collective loss.

Therefore, this study aims to address this gap by assessing the psychological impact, specifically PTSD-related symptoms of intrusion, avoidance, and hyperarousal, among nursing students in the West Bank in the aftermath of the October Gaza War. By examining the prevalence and severity of these symptoms and exploring their variation across demographic factors such as gender, academic year, and place of residence, this research seeks to contribute a nuanced understanding of the war's extended psychological repercussions. The findings are critical for informing academic institutions, clinical training centers, and mental health policymakers to develop targeted support systems, psychological interventions, and resilience-building programs tailored to safeguard the mental health of the next generation of nurses, who are indispensable to the community's health and recovery.(14,15)

Table 1 presents the demographic characteristics of 195 participants. Most were female (71,3 %) with a mean age of 21 ± 1,84 years. Participants were fairly evenly distributed across academic years, with slightly more in the third (30,8 %) and fourth years (29,7 %). The majority were single (89,2 %), with few married (10,3 %) or divorced (0,5 %). Regarding residence, most lived in villages (68,2 %), followed by cities (21,5 %), out of the city (5,6 %), and campus housing (4,6 %). Overall, the sample is young, predominantly female, single, and mainly village residents.

Table 1. Demographic Data (n=195)

Table 2 presents the psychological impact scores of 195 participants. Among avoidance items, most students reported high levels of emotional suppression and efforts to avoid reminders, with means ranging from 1,73 to 1,94, while partial responses were noted for feeling numb or detached. Intrusion symptoms were prominent, especially regarding reminders and recurrent thoughts (means 1,75–2,21), with dreams showing diagnosed levels (1,52). Hyperarousal symptoms were also elevated, particularly irritability and concentration difficulties (1,90–2,07), whereas physical reactions were partial (1,20). Overall, participants exhibited moderate to high psychological impact, highlighting significant PTSD-related effects.

Table 2. Means and Standard Deviations of Psychological Impact (n = 195)

Table 3 illustrates differences in psychological impact scores across demographic variables among 195 participants. Female students (mean = 5,48) had slightly higher scores than males (5,21), but the difference was not statistically significant (p = 0,272). Second-year students reported the highest mean score (5,89), while fourth-year students had the lowest (5,05), though differences across academic years were marginal (p = 0,081). Mean scores were similar across place of residence and marital status, with no significant variations. Overall, demographic factors did not appear to substantially influence psychological impact in this sample.

Table 3. Differences in Psychological by Demographic Variables

This study aimed to assess the psychological impact of the October Gaza War on nursing students in the West Bank, a population navigating the dual pressures of academic training and exposure to collective trauma. The findings reveal a significant psychological burden among participants, characterized by pronounced symptoms of PTSD across the domains of intrusion, avoidance, and hyperarousal.

The most salient finding of this research is the high prevalence of PTSD-related symptoms among the sampled nursing students. The mean scores across all IES-R subscales indicate a moderate to high level of psychological impact. Notably, intrusion symptoms, particularly the experience of strong feelings being brought back by reminders (Mean=2,21) and recurrent, unwanted thoughts about the event (Mean=2,02), were among the highest reported. This suggests that students were persistently and involuntarily preoccupied with the traumatic events, a core feature of PTSD.(16) Similarly, avoidance behaviors, such as consciously trying not to think or talk about the war (Means=1,94 and 1,76, respectively), were highly prevalent. This indicates a pattern of cognitive and behavioral efforts to avoid distressing memories and emotions, which is a common coping mechanism that can paradoxically maintain PTSD symptoms over the long term.(17)

The elevated hyperarousal symptoms, especially irritability (Mean=2,07) and difficulty concentrating (Mean=1,95), are particularly concerning for a student population. These symptoms can directly impair academic performance, clinical learning, and the ability to engage in theoretical and practical training.(9,10,18) The high level of concentration difficulties aligns with previous research on academic functioning in traumatized students (9) and underscores the potential for the conflict to undermine the educational pipeline for future nurses in the region.

Contrary to some existing literature that often shows gender differences in trauma response.(2,19) this study found no statistically significant variation in psychological impact scores based on gender, academic year, place of residence, or marital status. The absence of significant demographic predictors suggests that the traumatic impact of the October war was pervasive and cut across traditional demographic divides within this sample. The collective nature of the trauma, amplified by constant media coverage and shared national grief, may have created a homogenizing effect on psychological distress, making individual or group characteristics less relevant to the overall level of impact.(3,4) The slightly higher, though non-significant, scores among second-year students warrant further investigation but could be linked to their specific stage of academic and clinical exposure, where they are no longer newcomers but not yet advanced practitioners with more developed coping mechanisms.

These results resonate with and extend the existing body of work on mental health in Palestine. The findings confirm the high levels of psychological distress documented among Palestinians living under prolonged occupation and conflict.(1,2,5) However, they specifically highlight that this distress extends to future healthcare professionals in the West Bank who experienced the war vicariously. This aligns with research on the broader impacts of war on health professionals (11,20) and students (8,10) emphasizing that physical distance from the epicenter of conflict does not confer immunity from its psychological consequences.

Despite these limitations, this study provides crucial empirical evidence of the significant psychological toll exacted by the October Gaza War on nursing students in the West Bank. The pervasive symptoms of intrusion, avoidance, and hyperarousal indicate a clear need for institutional and policy-level interventions.

Based on these findings, the following recommendations are proposed:

University-Based Support: Nursing programs and universities should integrate mandatory, routine mental health screenings and provide accessible, confidential psychological support services and counseling tailored to trauma.

Resilience Training: Curricula should incorporate modules on trauma-informed care, stress management, and resilience-building techniques, such as progressive muscle relaxation, which has shown efficacy in reducing anxiety among nursing students in similar settings.

Faculty Development: Educators and clinical supervisors should be trained to recognize signs of psychological distress in students and to foster a supportive, rather than overly demanding, academic environment during times of collective crisis.

Further Research: Longitudinal studies are needed to track the progression of symptoms over time. Qualitative research would be valuable to gain a deeper understanding of the students' lived experiences and coping mechanisms.

Investing in the mental health of nursing students is not merely an academic concern; it is a critical public health imperative. safeguarding their well-being is essential to ensuring a competent, resilient, and compassionate future nursing workforce capable of meeting the healthcare needs of the Palestinian people.