Resilience under protracted conflict and siege: a new paradigm shift

ABSTRACT

This study sought to explore the relationship between resilience as perceived within the Palestinian context, and individual, contextual, and psychosocial factors among adults living in the Gaza Strip. Secondly, this study applies the Connor-Davidson Resilience Scale to the Palestinian population within the context of the challenges they are facing while living under extended sieges, in order to examine the generalizability of the resilience scale. Gender-specific bivariate analyses and multivariate linear regression were conducted to examine links between resilience, and diverse psychosocial and contextual factors. Males scored higher in resilience than females. Consistent predictors of higher resilience included, being male, employed, income, not living in a peaceful area, higher life satisfaction, and the Palestinian idea of resilience (Sumud). For the overall sample and males, hardiness was a positive predictor of higher resilience. For the overall sample and females, post-secondary education was a positive predictor of resilience. Psychosocial factors may act synergistically to foster resilience in the face of adversity, low socioeconomic status, and fear of living in a non-peaceful area. Our findings add to a limited body of literature calling for attention to contextual and psychosocial influences on gender differences in measuring and defining the dynamic nature of resilience.

KEYWORDS:

• Resilience
• Palestine
• dynamic
• contextual
• psychosocial
• gender

Introduction

The concept of resilience has been studied for decades, though the need for adaptation of the definition continues in pursuit of illustrating its interactive and complex processes, relative to various individual, contextual, social, cultural, and geo-political factors (Pooley and Cohen 2010; Vella and Pai 2019). Correspondingly, there remains a lack of consensus on the definition, conceptualization, and measurement of resilience (Giacaman 2020; Vella and Pai 2019). As an evolutionary mechanism, a widely used present view posits resilience as the active and dynamic process of recovering from adversity. For example, The American Psychological Association (2014) defines resilience as ‘the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of stress’ (Gao et al. 2019; Southwick, Douglas-Palumberi, and Pietrzak 2014). This definition is situated within the ‘Western’ perspective, which considers resilience as a concept that enables one to adapt to the changes of their environment and thrive in the face of adversity (Connor and Davidson 2003). However, beyond ‘normative’ developmental and environmental contexts, a dynamic definition of resilience that embodies the differences inherent in cultural dimensions is needed (Giacaman 2020; Southwick, Douglas-Palumberi, and Pietrzak 2014).

In contexts that do not share all the same challenges – namely peaceful compared to areas affected by protracted conflict – sources and determination of resilience which might vary remarkably are critical issues for research, humanitarian policy, and public health (Eggerman and Panter-Brick 2010). Specifically, among Palestinians living in The Occupied Palestinian Territories since 1967, an approach culturally embedded within the Palestinian reality of struggle, dispossession, exile, and occupation is known as Sumud – translating from Arabic as ‘steadfastness’ or ‘resilience’ (Ryan 2015). The Palestinian tactic of resilience differs from that of the widely used definition in the literature based on a predominantly Western discourse, by considering resilience as a way of changing the reality that they are embedded within, rather than adapting to the circumstances that are enforced upon them (Giacaman, 2020). The definition of steadfastness is to live a decent life in the context of the struggle for freedom and independence, which means the ability of the Palestinians to develop long-term strategies that ensure better ability to withstand internal and external shocks and improve their future within the framework of their national struggle (Kteily-Hawa, Khalifa, and Abuelaish 2020; Marie, Hannigan, and Jones 2018; Ryan 2015). According to Nguyen‐Gillham et al. (2008), resilience is exercised collectively rather than individually in Palestine, which is reflected in communal belonging, support, and care. They note that for Palestinian youth, resiliency hinges on the ability to normalize life within challenging circumstances (Nguyen‐Gillham et al. 2008, 296). This belief system also stems from the Palestinian faith and hope in ending and getting rid of the occupation and the settler colonialism.

Within this paper, we reference the concept of Sumud with an awareness of its complexity. Sumud is multifaceted, encapsulating various aspects of the Palestinian context, life, and national identity. It serves as a cornerstone in comprehending the steadfastness, rootedness, and unique resilience of the Palestinian people in confronting the prolonged Israeli occupation and its far-reaching implications (Giacaman 2020). This resilience encompasses the determination not only to survive but also to safeguard and uphold their identity, dignity, land, history, heritage, narratives, norms, language, arts, culture, and rights. Sumud further nurtures unity and fosters social and communal bonds (Ryan 2015). Additionally, it serves as a potent tool for raising global awareness and advocating internationally to support the Palestinian struggle for freedom and rights.

Sumud, resilience, steadfastness, and rootedness represent distinct, yet interconnected concepts employed to confront the reality of prolonged occupation through various means. Embracing responsibility, Sumud involves enduring and resisting, while resistance itself is a multifaceted concept encompassing a range of strategies. Central to our discussion is the understanding that Sumud remains a fundamental attribute of Palestinian resistance, endurance, and narrative. It signifies an unwavering determination to persevere in the quest for justice and self-determination. Given the diverse interpretations of this idea, our paper aims to heighten awareness of the nuanced concept of resilience within the Palestinian context. Through an exploration of the determinants of resilience within this population, we seek to provide additional insights into its origins and manifestations.

Research exploring sources of resilience among Palestinians has identified tangible and intangible resources related to steadfastness (Sumud) such as academic and medical infrastructure (Marie, Hannigan, and Jones 2017), Islamic culture, supportive relationships, and personal capacity (Marie, Hannigan, and Jones 2016, 2018). The modest relationship between hope and resilience has been equivocally supported by research (Bellizzi and Blank 2004; Park and Fenster 2004) and others have indicated the link between hope and hardiness (Benight and Bandura 2004), wherein hope leads to hardiness and both correlate with one’s ability to prevail against the consequences and conditions of a potentially traumatic event.

Furthermore, exhibiting resilience in the context of repeated chronic traumatic exposure has been linked to greater economic and material resources, such as higher income and education levels (Wister et al. 2016), as well as the male gender (Hobfoll et al. 2011). A cultural perspective suggests that Palestinian women, as gatekeepers of the family, tend to rely more on the means of resilience to change their reality through their belief in Sumud and instilling that in their familial morals (Ryan 2015; Veronese, Sousa, and Cavazzoni 2021). Nonetheless, studies from Palestine suggest that women are disproportionately at risk for poor physical health, somatic disorders (Sousa 2013), mental health (Al-Krenawi Lev-Wiesel and Sehwail 2007) and overall present less resiliency (Hobfoll et al. 2011). However, the relationship between gender-specific differences, psychosocial, and contextual factors associated with resilience has not been well studied among adults in a protracted conflict zone, and in relation to the distinct idea of resilience within the Palestinian context (Gartland et al. 2019). Thus, there is a need for examining determinants of resilience in relation to gender while incorporating a social-ecological approach to help understand the critical needs that may foster resilience in each subpopulation.

The Connor and Davidson Resiliency Scale (CD-RSC-25) was developed with the aim of constructing a valid and reliable measure to quantify and assess psychological resilience, based on the operational definition as the ability to thrive in the face of adversity (Connor and Davidson 2003). Research shows high ratings for their psychometric properties in capturing resilience in an adult population (Windle, Bennett, and Noyes 2011); however, there remains no gold-standard, and limited studies have used the CD-RSC-25 to measure resilience in the Gaza strip in relation to a culturally rooted coping mechanism that has presumably fostered the development of resilience in this population. As such, generalizability of the scale based on complex multidimensional and culturally sensitive contexts is needed to capture the natural mechanisms and determinants that allow for preserving resilience and maintaining and promoting wellbeing among people living in areas of conflict and siege. Given many interpretations and meanings of resilience, researchers can benefit from examining this concept for people living under protracted conflict and siege, using a comprehensive social-ecological approach to capture the dynamic nature of resilience.

Objectives

This study sought to explore the relationship between resilience and individual, contextual (age, education, spousal education, marital status, income, employment, and perception of living conditions) and psychosocial factors (sumud, hardiness, and hope) in a large sample of adult Palestinians living in the Gaza Strip. Secondly, this study applies the CD-RSC-25 to the Palestinian population within the context of the challenges they are facing while living under extended sieges, in order to examine the generalizability of the resilience scale.

Methodology

This exploratory cross-sectional study included a large sample of Palestinian adults (18–60 years old) living in the Gaza Strip, across five Gouvernantes (Rafah, Khan Younis, Middle Area, Gaza, and North). Community mapping and enumeration of households in the Gaza Strip were first determined to create a schematic map of households with eligible participants (18–60 years old and literate in Arabic). Households with eligible participants in the Gaza Strip were listed in a sample frame, and a random number table was used to draw households from the sampling frame. The selected households were approached by the research team on the ground to explain the purpose of the study, request participation and to obtain consent. One participant per household (n = 1200) completed a self-administered questionnaire in Arabic. Research volunteers explained the different sections of the questionnaire and demonstrated how the responses should be inputted. Participants who could read and write were eligible. The questionnaire was designed to take 30–60 minutes to complete. This study received approval from the ethics board at the University of Toronto, the Dalla Lana School of Public Health [Protocol ID #32524].

Measures

Outcome variable

This study used the Arabic version of the self-administered, 25-item CD-RSC. Items of the scale are measured on a 5-point Likert scale (0 = not true at all to 4 = true nearly all the time). The scale is made up of five latent components that include items related to self-efficacy (8-items), sense of humour (7-items), optimism (5-items), personal or collective goals (3-items), and patience (2-items). Total resilience scores were computed using the study sample by taking an average score across the 25 items. This scale had high internal consistency (Cronbach’s alpha .91).

Explanatory variables

Individual and contextual characteristics included socioeconomic status (income, employment, education), age, gender (female, male), marital status, and area of residence (Gouvernantes: Rafah, Khan Younis, Middle Area, Gaza, North). Perceptions of living conditions included three questions; 1) ‘I reside in a peaceful area’; 2) ‘living area is characterized by social cohesion’; 3) ‘living area is characterized by support and lack of fear’. Four measures of psychosocial state indicators were collected: hardiness, hope, satisfaction, and perception of sumud.

The Hardiness scale consisted of 13 items measured on a 3-point scale (1 – never, 3 – always). Items were extracted from the Dispositional Resilience Scale (DRS-15) (Bartone 2007) and consisted of measurements related to resilience (3 items), sense of personal control (4 items), sense of meaning (3 items) and hope (3 items). Item examples include ‘I feel despair when conditions are against me’ and ‘I take (tolerate, bear) painful events that happen to me’. The internal consistency was calculated with a Cronbach’s α of 0.62. Using the items from the verified scales, items were modified to match the Palestinian context, relative to how each question is perceived by experts within the field and of Palestinian descent.

The Hope scale consisted of eight items measured on a 3-point Likert scale. Items were extracted from The Adult State Hope (Snyder et al. 1996) and Herth Hope Index (HHI) (Herth 1992). Examples include ‘I can achieve my goals no matter the difficulties I encountered’ and ‘I see a light at the end of the tunnel’. The internal consistency of the scale was first determined by Cronbach’s α 0.29. However, examination of the corrected item-total correlations showed that one item had a low relationship to the scale. After their removal, the calculated Cronbach’s α had improved to .51, but could not be further improved by removing other items. Total scores for the Hope scale were thus computed by averaging seven items. Life Satisfaction was based on 11-items, measured on a 5-point Likert scale, from strongly disagree = 1, to strongly agree = 5. The scale was made up of four latent components that included items related to, satisfaction with life as a whole (three items), optimism (four items), psychological wellbeing (three items), and hope (one item). Item examples include, ‘I feel security and peace of mind’. The Cronbach’s α for this was 0.88. Finally, perception of sumud was investigated in terms of its distinct Palestinian cultural idea of resilience, and as a threshold to facing challenges. This was measured based on the response to the question ‘what does sumud mean to you?’, i.e. ‘working towards changing reality’ (yes or no).

Statistical analyses

Data were analysed using SPSSv28. Statistical analyses examining bivariate associations between resiliency score and demographic characteristics, perceptions of living conditions, living with a chronic disease or disability, and Sumud as a means of working towards changing their reality involved conducting independent samples t-test, and one-way between-groups analysis of variance (ANOVA) to describe distributions of resilience in categorical demographic and clinical variables. Differences were considered significant if p < 0.05. Pearson correlations were conducted to examine associations between psychosocial variables: perceived hardiness, hope and satisfaction in relation to resiliency score. Multi-variate analyses involved conducting three linear regression models. All explanatory variables were entered into linear regression models to determine predictors of resilience for the overall sample, and for males and females separately. Gender-specific bivariate analyses (one-way ANOVA/t-test, and Pearson’s r) and multivariate linear regression were conducted to examine links between resilience as the dependent variable and diverse psychosocial (hope, hardiness, satisfaction, and sumud), individual and contextual factors (age, education, spousal education, marital status, income, employment, and perception of living conditions) as independent variables. Three linear regression models were conducted for the overall sample and stratified by gender. For each of the modelled outcomes, forward stepwise entry of variables was conducted using p ≤ 0.05. For the independent variables, one category was chosen to be the reference category, with each category of the variable then compared to the reference.

Results

Descriptive statistics and bivariate correlations

This paper is based on responses from a large random sample of adult Palestinians living in the Gaza Strip. This study included participants from the total sample (n = 1068) that answered all 25 questions of the CD-RSC-25. Overall, the final sub-sample in this study comprised 768 adults. Demographic characteristics and differences in relation to individual, contextual, and psychosocial factors associated with resilience are described in Table 1. Of the 768 complete responses, 333 identified as male (44%) and 422 as female (56%). Missing data in relation to identification based on gender accounted for 1.7% (n = 13). The mean resiliency score for the sample population was 75.9, standard deviation (SD) = 13.9, Median = 77, Q1 = 66, Q3 = 87. The total resilience score for Palestinian females living in the Gaza Strip was mean = 75.17, SD = 14.1, which is lower than the scale’s general population mean = 80.4, and lower in comparison, to males in this study (t = 1.89, p = 0.059).

Table 1. Overall sample and male and female bivariate associations in relation to resiliency score and demographic characteristics using the 25 CD-RSC.

Variables		Overall (n = 768)			Males (n = 333)			Females (n = 422)
	Classification	n (%) ^a	Mean (SD)	p-value	(%) ^a	Mean (SD)	p-value	(%) ^a	Mean (SD)	p-value
Gender				.059		-			-
	Male	333 (44.1)	77.1 (13.6)
	Female	422 (55.9)	75.1 (14.1)
Gouvernantes				0.38			0.50			0.24
	Rafah	58 (7.8)	78.6 (11.7)		30 (9.2)	79.0 (12.9)		28 (6.8)	78.1 (10.6)
	Khan Younis	57 (7.6)	76.2 (12.1)		18 (5.5)	73.4 (10.9)		38 (9.2)	77.8 (12.6)
	Middle area	204 (27.1)	74.5 (13.5)		97 (29.8)	76.4 (13.4)		102 (24.6)	73.1 (13.7)
	Gaza	141 (18.7)	76.1 (14.1)		54 (16.6)	75.9 (14.1)		84 (20.2)	75.9 (14.2)
	North	292 (38.8)	75.9 (14.7)		126 (38.8)	78.2 (14.2)		163 (39.2)	74.3 (14.9)
Age				0.31			0.94			0.12
	20–31	446 (58.4)	76.0 (13.1)		194 (58.4)	77.3 (12.7)		250 (59.7)	75.0 (13.3)
	32–43	180 (23.6)	74.8 (15.4)		76 (22.9)	76.8 (15.2)		100 (23.9)	73.4 (15.4)
	44+	138 (18.1)	77.3 (14.4)		62 (19.3)	76.8 (14.4)		69 (16.5)	77.9 (14.9)
Employment				0.02			0.33			0.07
	No	462 (61.2)	75.1 (14.1)		161(48.5)	76.3 (14.2)		294 (72.1)	74.3 (14.0)
	Yes	293 (38.8)	77.4 (13.4)		171 (51.5)	77.8 (13.0)		114 (27.9)	77.1 (14.0)
Income				0.11			<.001			0.21
	0	249 (42.2)	76.6 (13.9)		87 (30.1)	78.7 (12.9)		161 (55.3)	75.4 (14.2)
	<1000	89 (15.1)	74.2 (14.4)		61 (21.1)	73.2 (13.3)		27 (9.3)	76.2 (16.9)
	1000–2000	123 (20.8)	76.9 (12.2)		73 (25.3)	75.3 (11.9)		46 (15.8)	79.9 (12.2)
	>2001	129 (21.9)	78.7 (13.6)		68 (23.5)	82.6 (11.9)		57 (19.6)	74.4 (14.1)
Education level				0.01			0.02			0.33
	Primary/Middle School	109 (14.3)	72.6 (15.2)		49 (14.8)	72.8 (3.9)		58 (14.0)	72.6 (16.6)
	Highschool	239 (31.4)	75.8 (13.9)		106 (31.9)	76.3 (13.8)		130 (31.3)	75.4 (14.2)
	Post-secondary	412 (54.2)	77.0 (13.5)		177 (53.3)	78.8 (13.2)		227 (54.7)	75.7 (13.5)
Education level spouse				0.02			.001			0.47
	Primary/Middle School	85 (16.7)	74.5 (14.0)		43 (19.7)	72.7 (14.1)		38 (13.7)	76.5 (14.3)
	Highschool	150 (29.5)	74.5 (14.2)		75 (34.4)	75.3 (14.0)		73 (26.4)	73.9 (14.4)
	Post-secondary	273 (53.8)	77.9 (13.1)		100 (45.9)	80.7 (12.3)		166 (59.9)	76.2 (13.3)
Belief in Sumud as changing one’s reality				0.01			0.02			0.14
	No	416 (56.5)	74.8 (13.7)		181 (56.9)	75.8 (13.2)		227 (56.0)	74.2 (14.0)
	Yes	320 (43.5)	77.6 (13.7)		137 (43.1)	79.4 (13.5)		178 (64.0)	76.2 (13.9)
Perceptions of Living Conditions
Reside in peaceful area				0.36			.004			0.38
	No	259 (33.8)	76.7 (14.2)		107 (32.1)	80.1 (13.1)		147 (35.0)	74.4 (14.5)
	Yes	507 (66.2)	75.7 (13.7)		226 (67.9)	75.6 (13.7)		273 (65.0)	75.6 (13.9)
Living area characterized by social cohesion				0.64			0.09			0.41
	No	396 (51.8)	75.8 (14.4)		182 (54.8)	75.9 (14.2)		209 (49.8)	75.8 (14.5)
	Yes	369 (48.2)	76.3 (13.3)		150 (45.2)	78.5 (12.8)		211 (50.2)	74.7 (13.6)
Living area characterized by support and lack of fear				0.24			0.51			0.58
	No	672 (88.0)	76.3 (13.6)		295 (89.1)	77.3 (13.4)		366 (87.1)	75.4 (13.9)
	Yes	92 (12.0)	74.4 (15.3)		36 (10.9)	75.4 (15.9)		54 (12.9)	74.3 (14.9)

^an may not add up due to missing data.

Missing data for overall sample: gender (n = 13), gouvernantes (n = 16), age (n = 4), employment (n = 15), income (n = 178), education level (n = 8), education level spouse (n = 260), Sumud (n = 32), reside in peaceful area (n = 2), living area characterized by social cohesion (n = 3), living area characterized by support and lack of fear (n = 8).

Overall and gender-specific bi-variate analyses revealed positive correlations between resilience and each of hardiness, hope, and satisfaction (p < .01) (Table 2). Overall resilience was significantly higher among participants having employment (t = −2.28, p < .05). Overall and for males only, resilience was positively associated with education, spousal education, and Sumud, perceived as working towards changing their reality (p < .05). For males only, income (p < .001) and not residing in a peaceful area were associated with higher resilience scores (p < .01).

Table 2. Correlations between resilience (25-item CD-RSC) and perceptions of hope, hardiness, and life satisfaction.

Variable	Overall (n = 768)			Males (n = 333)			Females (n = 422)
	n^a	r	p	n^a	r coefficient	p	n^a	r	p
Hope	729	.379	< .01	308	.328	<.01	408	.407	<.01
Hardiness	649	.436	< .01	293	.412	<.01	343	.459	<.01
Life Satisfaction	680	.686	< .01	292	.628	<.01	375	.728	<.01

^an may not add up due to missing data based on listwise deletion.

Multivariate regression analyses

Multivariate models showed that all variables entered explained 55% of the variability in resilience for the overall sample, 51% for males, and 61% for females (Table 3). Independent variables that were consistent predictors of higher resilience for the overall sample included being male (β = 3.27, p < 0.05), employed (β = 6.09, p < 0.05) and lower income or no income (β = 9.36, p < 0.05). For the overall sample and females, post-secondary and sumud were positive predictors of resilience (p < 0.05). For the overall sample and males, hardiness was a common positive predictor of higher resilience. For the overall sample, both males and females, not living in a peaceful area and higher life satisfaction were common positive predictors of higher resilience (p < 0.05). Higher education status, specifically post-secondary education level of a spouse, was negatively associated with resilience for females (β = −8.08, p < 0.05).

Table 3. Predictors of resilience and gender-specific results in relation to individual, contextual and psychosocial factors for adult Palestinians.

Variables		Overall sample		Males		Females
		β	95% CI	β	95% CI	β	95% CI
Individual and contextual factors
Gender
	Female (ref)			-	-	-	-
	Male	3.27*	.675, 5.86	-	-	-	-
Age
	20–31 (ref)
	32–43	.639	−2.17, 3.45	1.04	−2.99, 5.08	.203	− 3.92, 4.32
	44+	.026	−3.47, 3.53	−1.52	−6.29, 3.26	.632	−5.09, 6.35
Employment
	No (ref)
	Yes	6.09*	1.14, 11.05	4.29	−1.98, 10.56	9.71	−.972, 20.39
Income
	>2001 (ref)
	1000–2000	2.25	−1.26, 5.75	−1.03	−6.05, 3.99	5.23*	.013, 10.45
	<1000	1.45	−3.62, 6.51	−.060	−6.85, 6.73	−2.91	−12.24, 6.42
	0	9.36*	2.96, 15.76	7.21	−2.04, 16.46	12.17*	.911,23.42
Education level
	Primary and Middle School (ref)
	Highschool	2.01	−2.14, 6.15	2.06	−4.17, 8.29	1.94	−4.13, 8.00
	Post-secondary	5.03*	.724, 9.34	2.43	−4.28, 9.14	7.78*	1.41, 14.15
Education level spouse
	Primary and Middle School (ref)
	Highschool	−1.67	−5.59, 2.26	1.27	−4.23, 6.76	−4.59	11.34, 2.16
	Post-secondary	−.876	−4.98, 3.23	3.71	−2.06, 9.48	−8.08*	−14.68, −1.48
Perceptions of Living Conditions
Residing in peaceful area
	Yes (ref)
	No	5.63**	2.98, 8.29	4.08*	.247, 7.91	4.71*	.735, 8.69
Living area characterized by social cohesion
	Yes (ref)
	No	2.05	−.429, 4.53	.083	−3.50, 3.67	2.88	−.864, 6.64
Living area characterized by support and lack of fear
	Yes (ref)
	No	−.381	−4.34, 3.58	−3.36	−9.42, 2.69	.737	−4.84, 6.31
Psychosocial factors
Belief in Sumud as changing one’s reality
	Yes (ref)
	No	−3.46*	−5.95, −.966	−2.77	−6.34, .810	−3.92*	−7.58, −.255
Hope		.049	−.641, .738	.416	−.534, 1.37	−.267	−1.35, .813
Life Satisfaction		1.02**	.862, 1.18	.881**	.641, 1.12	1.11**	.876, 1.34
Hardiness		.874**	.431, 1.32	.978*	.365, 1.59	.578	−.117, 1.27
Variance and F		Adj R^2 = .552, F = 17.42, p < .001		Adj R^2 = .510, F = 8.78, p < .001		Adj R^2 = .612, F = 11.40, p < .001

*p < 0.05; **p < 0.001; β = Unstandardized.

Employment and income variable demonstrated high collinearity (VIF >10).

Discussion

In this study, we investigated the interactive association of individual, contextual, and psychosocial variables that contribute to resilience among male and female adults in the Gaza Strip and found that a common factor of higher resilience was related to the distinct Palestinian idea of Sumud. Sumud is an important characteristic, function and belief related to fostering resilience in the Palestinian population (Marie, Hannigan, and Jones 2018). This is different from the widely used definition of resilience, which means adapting to circumstances (American Psychological Association 2014). Systematic research into resilience has shown that despite living in chronic war zones, most people prevail against these challenges, in contradiction to what most traditional theorists may expect (Shoshani and Slone 2016). Perhaps, this notion may be transferable and is an important indicator of shifting the connotation of resilience to a dynamic concept, and as a collective process upheld by the surrounding cultural context, which advocates for the need to change the reality one is presented rather than adapting to it.

In this study, for females in particular, results showed that those who perceived Sumud as working towards changing their reality, were more resilient than females who did not believe in this concept. Resilience has been conceptualized theoretically as ‘a dynamic process which, in the Palestinian setting, is embedded in agency, everyday practices and relatedness/connectedness to context’ (Giacaman 2020). The fact that Palestinians manage to stay connected, steadfast, and rooted to their land despite facing daily threats may help explain why not living in a peaceful area was identified as a significant predictor of resilience for the overall population in this study. However, it is important to consider the long-term mental and physical health impacts that may manifest because of the high stress intensity and persistent effort of sustaining resilience. Prolonged exposure to this increasingly harsh environment manifests in intense hopelessness, fear, and grief (Albrecht et al. 2007; Sousa, Kemp, and El-Zuhairi 2014). Even if people do not encounter violence directly, its threat is constantly felt (Sousa, Kemp, and El-Zuhairi 2014). Indeed, studies have stressed that in the Gaza Strip, lower resilience and hope were linked to the consistent siege that affected their living conditions and that this compounded the mental distress, including anxiety, traumatic stress, and depression that they experienced (Thabet et al. 2015; Veronese et al. 2021).

Our findings also indicate the link between psychosocial factors, satisfaction, hope, and hardiness, which showed significant positive correlations with resilience. However, in the adjusted regression model, only hardiness and satisfaction were significant predictors. In addition, whereas satisfaction was a common predictor of resilience for both males and females, hardiness was significant for males. This may explain the association between higher resilience and males found in this study. Hardiness is considered a personality trait reflective of a person with resilience (Omeri, Lennings, and Raymond 2004) and is suggested to bolster people’s ability to handle the demands of traumatic events, as well as strengthen resilience to adversity (Benight and Bandura 2004).

In relation to the role of gender, findings are mixed in determining differences in resilience levels, and some literature suggests that gender-differences may not be a reliable predictor of resilience (Gao et al. 2019; Sambu and Mhongo 2019; Hamama-Raz 2012). However, our results are in line with a study by Sambu and Mhongo (2019), who found that, among traumatized internally displaced persons in Kiambaa Village, Uasin Gishu County, Kenya, males exhibited higher resilience levels than females, as determined by the CD-RSC-25. Discrepancies in findings related to gender may be due to differences in social and cultural norms, as well as the context in which they are able to develop resilience. Women tend to utilize familial and community protective factors, while men confide in individual protective factors (Sambu and Mhongo 2019). Furthermore, in one study among Muslim women in America, resilience stemmed from the cultural perception they were instilled with, fostered by the security and protection provided by men (Marie, Hannigan, and Jones 2018; Hamama-Raz 2012). An expectation of the dominantly conservative culture and fear of the occupational context in Palestine, is that girls are expected to stay within the home due to greater concern for safety and are provided fewer opportunities for movement beyond the domestic sphere (Cavazzoni et al. 2022; Giacaman et al. 2007). This notion is suggested to influence where resilience is derived from for boys and girls in Palestine. For example, a study found that sources for boys were friends, families, and sports activities, while for girls they were found to include reading, writing, and drawing, in addition to the pursuit of education (Nguyen‐Gillham et al. 2008). These findings corroborate our research, suggesting education to be a significant predictor of higher resilience for females. Although employment was only significant for females in the bi-variate analysis, the fact that they were found to have the highest unemployment rates in this study, suggests that this group may be disproportionately vulnerable, since the desire for acquiring employment after post-secondary education may be limited or not accessible. Hence, ensuring the accessibility of infrastructure resources is crucial to aid in facilitating the educational and vocational pursuits of girls and women in regions of conflict.

Additionally, the findings indicate an intriguing association wherein higher educational attainment of a spouse appears to exert a counterproductive effect on the resilience of females. This counterintuitive relationship might stem from the correlated experience of frustration linked to the inability to secure employment opportunities. This unexpected pattern could potentially be attributed to the prevailing assumption that superior educational accomplishments generally enhance the likelihood of attaining future economic prosperity.

Despite the high level of education status found in this population (Kteily-Hawa, Khalifa, and Abuelaish 2020), there is a lack of accessible and available employment opportunities to build financial security. Our findings suggest that, despite employment status being a significant predictor of resilience for the overall sample, an individual reporting lower income reported higher resilience compared to someone with a higher income. The role of socioeconomic status (SES) in the development of psychological resilience is contradictory. Research on the mediating role of SES in contributing to resilience is conflicted. Some evidence suggests a positive correlation between greater SES measured by social and economic resources (Qiu et al. 2021; Wister et al. 2016). On the other hand, theorists have hypothesized that the consistent high-effort coping behaviour that may accompany emotional stress related to low SES may be linked to higher resilience (Qiu et al. 2021). For Palestinians, their notion of resilience (Sumud) is the product of an ingrained cultural process, which relies on intangible sources for daily coping, such as religion and social and family support (Marie, Hannigan, and Jones 2018). Thus, psychosocial factors influencing resilience may be linked to cultural practices, such as the unique idea of the Palestinian method of promoting resilience. This suggests that resilience may manifest based on various intersecting factors. Such perspectives support the need for a paradigm shift to an alternative and dynamic way of thinking about what resilience is, and in which contexts it may function differently (Ryan 2015). Specifically, the perception of steadfastness supports the prominence of a cultural and social underpinning of resilience, which depends on who you are and where you are.

The unexplored assumption and phenomenon of resilience within the Palestinian context sheds light on a unique and paradoxical situation. This population, besieged and facing numerous challenges, displays remarkable resilience despite the battering they endure. This duality of resilience amid adversity holds significant potential for shaping intervention programmes that could systematically and effectively bolster their resilience, ultimately leading to an improved quality of life. Thus, universal efforts and research exploring factors of resilience need to be context-based and culturally orientated to support the concept of resilience as determined by specific ideologies. Moreover, it is necessary to present a practical, applied measure of national resilience and immunity closely related to context, threats, and social capital, which enables it to capture all the elements of its psycho-social-political dimensions, and its link to patriotism, faith, national integration, political confidence, and general optimism. This would enable us to better understand the relationship between various factors that promote resilience and shift emphasis away from a purely psychological measure to one that calls for analysing and engineering the components of a dynamic definition of resilience based on the impact of political, economic, and social changes on the context. This will parallel the complexities of reality and the changes that developments have brought about. Better evidence as to what promotes resilient outcomes in children and adults in Palestine exposed to trauma or adversity is essential for effective interventions to prevent or ameliorate the immediate and lifelong impacts of prolonged and protracted conflict.

Prior research has advised prospective scholars to examine protective factors and methods of acquiring and enhancing these factors, particularly when conceptualizing resilience as a multi-level phenomenon (Vella and Pai 2019). Additionally, there is a call for research that delves into the intricate nature of resilience through multi-dimensional research frameworks, aiming to inform preventative and intervention strategies at multiple levels for fostering resilience among diverse groups or individuals facing varying challenges (Vella and Pai 2019). This study marks an initial stride towards comprehending the determinants of resilience, as observed within a population that employs a distinctive and unified communal approach to endure adversities. It stands as a foundational exploration that has the potential for further investigation, contributing to the conceptualization of resilience and enriching multi-dimensional research models.

Some limitations of this study are important to note. The cross-sectional design did not allow for examining causation, but associations indicate future research directions. As with most self-report measures, respondents may have been influenced by social desirability bias. Furthermore, although the questionnaire was administered to this population in their native language (Arabic), the study included participants based on their ability to read and write, although this effect would be small as literacy in the Gaza Strip is very high for both men and women. In addition to measurement tool contents, several concerns and cautions have been raised regarding the use of instruments in general in the assessment and research of resilience. For example, various authors have emphasized that, as a process, resilience is not a stable construct that can be measured with a static instrument (Bonanno and Mancini 2012; Catherine and Leckman 2013). That being said, this study employed instruments with high internal consistency (Cronbach’s alpha). Future studies can look into developing a measure for resilience that integrates an intersectional approach and would include community and contextual aspects of resilience as applied to areas of conflict. Longitudinal qualitative and quantitative studies could address this concern and help further explore correlates of resilience and how it may be transferable between different regions facing political conflict and adversity.

Author contributors

IA was responsible for the conceptualization of the research, formulating the methods for the study, and data collection. IA, CB and SY analysed the data. All authors contributed to the literature review and writing of the paper.

Ethical approval

This study was approved by the University of Toronto Ethics Research Office (REB#).

Acknowledgments

This work would not have happened without the help of the team that was involved with the data collection, and the participants.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Notes on contributors

Izzeldin Abuelaish

Izzeldin Abuelaish is a Palestinian Canadian physician and an internationally recognized author, human rights and inspirational peace activist devoted to advancing health and education opportunities for women and girls in the Middle East. Despite all odds, he has succeeded remarkably; aided by a great determination of spirit, strong faith, and a belief in hope and family. He is Prof. at the Dalla Lana School of Public Health, division of Clinical Public Health and Global Health at the University of Toronto. Prof. Abuelaish’ s book, I Shall Not Hate: A Gaza Doctor’s Journey on the Road to Peace and Human Dignity, a national and international best seller, an autobiography has achieved worldwide critical acclaim (currently in 23 different languages). Prof. Abuelaish’ s extensive list of awards and honors include countless national and international awards including 18 honorary doctorate degrees, The order of Ontario, The Meritorious Service Cross, and the Queen Elizabeth II Diamond Jubilee Medal, The Governor General’s Medallion, Prof. Abuelaish has been nominated five times for Nobel peace Prize, and he is fondly known as Nelson Mandela, Mahatma Ghandi and the “Martin Luther King of the Middle East”, having dedicated his life to using health as a vehicle for peace.

Susan Yousufzai

Susan Yousufzai (BSc, MHSc) is currently a research assistant at the Dalla Lana School of Public Health and in the Faculty of Health Sciences at Ontario Tech University. She completed a Bachelor of Science (Honours) majoring in Biology, and a Master of Health Sciences in Public Health at Ontario Tech University. For her Masters Thesis, Ms. Yousufzai effectively recruited more than 300 participants from social media platforms to examine changes in relation to cannabis consumption among young adults. Her research interests focus on social determinants of health, contextual factors influencing health, epidemiology in public health, and health behaviours related to substance use. She has published multiple papers in reputable Journals, and was nominated for the outstanding thesis award.