Whither the “Children of the Stone”? An Entire Life under Occupation

This article summarizes a uniquely thorough study of the first generation of Palestinians to have lived the whole of their lives under occupation. Findings from group interviews and large, representative surveys of men and women from the West Bank, East Jerusalem, and the Gaza Strip in 2011 draw a complex portrait of day-to-day life both currently and historically, including: widespread political activism that they continue to prize; high levels of exposure to often demeaning political violence and restriction of movement; limited access to basic resources, low employment stability and poverty; high levels of social cohesion, but also of lack of safety, political instability, fear for the future, stress, and feeling broken. Most were not optimistic in 2011 about the peace process but remained, confident in their ability to manage what the future brings. The findings also show that each of the three territories has unique types and levels of challenges.


Brian K. Barber is a fellow at New America in Washington, the founding director of the Center for the Study of Youth and Political Conflict, and professor of child and family studies, at the University of Tennessee, Knoxville.


Clea McNeely is associate professor of public health and associate faculty of the Center for the Study of Youth and Political Conflict at the University of Tennessee, Knoxville.


Chenoa Allen is a doctoral student in public health at the University of Tennessee, Knoxville.


Rita Giacaman is professor of public health at the Institute of Community and Public Health at Birzeit University.


Cairo Arafat is a civil rights adviser to Save the Children UK.


Mahmoud Daher, PhD, is a public health expert and researcher from Gaza.


Eyad El Sarraj, MD, is now deceased and was the founding director of the Gaza Community Mental Health Programme.


Mohammed AbuMallouh, PhD, is former director of the Gaza office of the Qattan Centre for Educational Research and Development.


Robert F. Belli is professor of psychology at the University of Nebraska–Lincoln.

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The Context

PALESTINIANS in the West Bank, East Jerusalem, and the Gaza Strip have been under Israeli military, security, and/or police control since 1967. Unfortunately, attention to this population— which now has reached 4.68 million [1]—is discontinuous and narrow. The various forms of news media focus on Palestine primarily when there is spectacular drama. Thus, it has been the severe outbreaks of explicit, observable, and violent clashes with Israel which have drawn attention, such as the two intifadas (1987–93; 2000–2005) and major wars between Israel and Gaza (2008–9, 2012, 2014). [2] Although such coverage provides critical awareness of the raw tragedy of war when violence peaks, mainstream journalists and cameras quickly dispatch elsewhere when it ebbs. Too rarely do the media follow the lives of those who have just lived those crises and who must move forward and make life work.


Hundreds of nongovernmental and human rights organizations write regular reports highlighting the continuing challenges of certain segments of the population (for example, children, the wounded, prisoners) or certain conditions that are particularly vexing (for example, discriminatory planning policies, extrajudicial treatment of individuals). While such coverage is crucial and the work involved often heroic, it is necessarily limited by the precarious availability of funding and the specific and shifting interests of donors. For their part, academics—from anthropology, economics, geography, medicine, public health, psychiatry, psychology, social work, sociology, and so forth—have conducted hundreds of studies on Palestinians. Funding limitations, funder priorities, or the specific interests (and methodologies) of an academic discipline, however, necessarily render any given study narrow in scope. Also, the groups of people that are studied are often small or otherwise not representative of the larger population (for example, studies of Palestinians seeking psychotherapy) and, regardless, are typically not followed over the long-term.


A good case in point is the substantial body of research on Palestinian youth. There have been scores of studies conducted—especially of first intifada youth—but the large majority focus primarily or exclusively on conventional Western mental health measures such as depression or post-traumatic stress disorder (PTSD). The serious concerns with the very conception and measurement of mental health in many of these studies will be briefly mentioned later. For the moment, it suffices to highlight that any such narrow scope can inform neither on how young people are doing in the many other social, educational, and economic spheres of their lives, nor over time as they transition to adult roles and responsibilities.


The PAL Project

In this article we provide an overview of one research program that has explicitly sought to address many of these limitations. The full title of the project is The Impact of Political Conflict on Youth: Assessing Long-Term Wellbeing via an Event History–Resource Model, and will be referredto hereafter as the PAL project. [3] All data were collected in Arabic by trained, local fieldworkersfrom the Palestinian Center for Policy and Survey Research (PSR). [4] The project is a multistageeffort that has sought to thoroughly understand the youth of the first intifada as they have growninto adulthood. This article reviews how the methodology of the PAL project has enabled thediscernment of crucial information about the complexities of living under occupation throughyouth and adulthood, including unique insights into the nature of suffering under occupation. Bydesign, it examines lives holistically; that is, it concentrates on the full scope of everydayexperience, including the psychological, social, economic, and political. Further, because the PALproject engaged a relatively large number of participants (nearly 1,800) from all sectors of life inthe three territories, its findings are unprecedented in terms of illuminating what life is like for theeveryday Palestinian generally.



While Yasir Arafat’s affectionate term, “The Children of the Stone,” didn’t take hold in English, the young people who were at the forefront of the first intifada form arguably one of the most crucial generations of Palestinians ever. The images of skinny, kaffiyeh-masked young men throwing stones at mammoth Israeli tanks that flooded the world’s TV screens beginning in December 1987 drew global attention to the Palestinian situation in the occupied territories as never before. The sympathy was further fueled by the harshness of the Israeli military’s so-called Iron Fist response as Israel struggled to deal with the mounting public insurrection that would not end officially until 1993 when the Oslo Declaration of Principles was issued. While that accord has roundly failed to bring peace or other improvements in quality of life for Palestinians, there is no disputing that the youth of the first intifada were indispensable in forcing the world’s powers to address the Palestinian issue in explicit ways.


Beyond its central value to Palestinian history, the youth of the first intifada distinguished itself globally in its historically high engagement in the uprising. Typically across history—including in the recent conflicts throughout the Middle East—only a minority of youth (generally 25 percent or less) engage actively in social or political movements. In contrast, majorities of Palestinian youth participated actively in the struggle. One study of this generation revealed that over 80 percent of young men demonstrated, threw stones, burned tires, planted Palestinian flags, and provided supplies to those on the front lines at some time during the movement. [5] Moreover, despite a traditional culture in which women are generally less visible in the public sphere, over 50 percent of young women of the first intifada demonstrated, threw stones, protected someone from Israeli soldiers, and provided supplies. In short, the youth of the first intifada were exceptionally instrumental in resisting the occupation by actively participating in their people’s struggle for self-determination, dignity, and basic rights.


The vast majority of that generation survived the foundational period of their struggle inside historic Palestine and they are now the current generation of adult Palestinians (ages thirty to forty-five), who have formed families, raise children, fill jobs, take positions on political developments, and increasingly provide leadership in the still-occupied territories. The PAL project has been an earnest and scientifically rigorous attempt to understand how this pivotal generation of Palestinians is faring as adults, to find out how life has played out for them over the decades since the first intifada. The unprecedented data it has collected on a relatively large, nationally representative group is valuable not only to scholars, but crucially to policymakers and others who wish to contribute to improving the lives of Palestinians in the Israeli-occupied territories.



When preparing to assess quality of life for this generation of Palestinian adults, the most basic question is, literally, how should quality of life be measured? In other words, how do contemporary Palestinian adults think in terms of their well-being or quality of life? Often, researchers import existing measurement tools created in other (generally Western) societies, translate them, and interpret their findings as if those tools actually uncovered the local understandings of human functioning. Besides being inattentive to local culture—which actually strongly informs definitions of quality of life, suffering, and so forth—such an approach is typically also narrow in scope, often concentrating only or primarily on the bio-psycho-medical model of “mental health,” for example.


One driving principle of the PAL project has been to listen carefully to local conceptions of all of the issues we intended to study. Accordingly, in the grounding phase of the project we interviewed in depth several dozen thirty- to forty-five-year-old Palestinians in groups of five participants. [6] Staff from PSR selected the groups to represent: the three territories; refugee status; and, in the Gaza Strip, adherents to Fatah and Hamas, so that we could hear as many perspectives as possible. Specifically, groups in the Gaza Strip consisted of: Fatah-affiliated refugee men; Fatah-affiliated non-refugee men; Hamas-affiliated refugee men; Hamas-affiliated non-refugee men; and the same constellation of groups of women. In the West Bank, groups consisted of refugee and non-refugee women and men. In East Jerusalem, there was one group of men and one of women.


The primary task for each person was to describe two individuals they knew well: one who they saw as doing relatively well in life and one who they saw as doing relatively poorly in life. Participants were left to define “doing well” however they wished. [7] They variously described friends, family members, or acquaintances.



As would be expected in any culture, descriptions of persons doing more- or less-well included economic conditions, employment, family relationships, personal problems, religion, and so forth. Most prominent in the participants’ descriptions, however, were political conditions. While the driving force of political conditions is self-evident to Palestinians, it is uncommon for relatively privileged people in other parts of the world—especially those who have not suffered persistent political conflicts—to think of their day-to-day well-being as directly impacted by political realities. Those who have not spent time with Palestinians also cannot appreciate from afar to what extent the Israeli occupation (and Palestinian interfactional political strife) virtually determines the quality of day-to-day life.


The prominence of the political domain of functioning in these participants’ accounts was evident in numerous ways, including literally invoking the word political or its derivatives in their answers. [8] When invoking the political in describing people’s lives, participants recounted a wide range of issues associated with the occupation, extending from specific actions of Israeli military or police to broad principles of freedom, justice, and dignity. Following are some illustrative excerpts from the interviews.


He lives under bad conditions because he was arrested by the occupation at an age when he was supposed to study . . . he was put in prison for several years . . . So, his life became a mess and he got older and this made his chances to pursue studying more difficult.


A few months after her marriage, the occupation planes shelled the car of her husband who was hit and injured and they had to cut off both his legs. So, at home, she became a physician, a wife, and a maid.


What does normal life mean? It means we have to remove all the abnormal conditions. The occupation is an abnormal condition. When I want go get a building permission, they should give me. When I apply for a job, they have to accept me because I have good qualities . . . there should be a system or an entity, which creates a sort of normal and dignified life and equality . . . a social affairs ministry . . . state that takes care of these poor people.


We need to have civil rights, where I can make a family and have a cultural, economic and political identity inside of my country, as well as the health rights.




While it is common knowledge that Palestinians suffer psychologically from these conditions—indeed, mental health has been studied more than any outcome in research on youth in Palestine—careful attention has not been paid before to local definitions of that suffering. In these grounding interviews, we discerned a type of suffering that is rarely measured in commonly used Western-informed tools. We, and others, have come to refer to it as contextualized mental suffering, because, unlike traditional concepts such as PTSD or depression, it sources the suffering in the oppressive context—that is, what any normal person would experience in situations of oppression and injustice—and not as a disorder of the individual. [9] The contextualized suffering expressed in these interviews was multilayered and included nuances such as fear, insecurity, lack of safety, and powerlessness. As examples: “constant fear of bombardments and shooting” that “we fear and that terrify us”; or arrests, and that “someone would come at 3:00 A.M. to arrest one of your kids or your husband”; and, “We are weak; we have nothing to defend ourselves, they have everything.”


Most profoundly, many participants from all three territories described themselves or their futures as broken or destroyed, as in: broken, crushed (muhattam), shaken up (mahzuz), destroyed (mudammar), and exhausted, tired (ta‘aban). Invariably, they linked this distressing feeling to the oppressive political and economic conditions and associated violations of dignity (at times using such severe expressions as “not living like humans”). In the words of a woman from East Jerusalem who enjoys some financial ease compared to Palestinians elsewhere in the occupied territories: “I always try to think positively and have determination and hope, but day after day I feel that I am losing that. I feel as if I am a different person. I feel that my character has changed. It’s true that the Israelis give us good money, but they break our souls and determination.”


Because the expression of such sentiments was unique in terms of the more traditional assessments of mental health, we wrote questionnaire items to reflect this form of suffering and validated the new tool in subsequent phases of the PAL project. [10] Full analyses are available elsewhere, [11] but in short the new assessment tool has proven reliable and valid, correlated with health and other indicators of well-being, [12] and it is more prevalently experienced by everyday Palestinians than traditional measures of depression and PTSD. It is now an important addition to research tools for populations experiencing oppression in that it uniquely sources the mental distress in the oppressive context. The straightforward implication of this is that this basic suffering can ultimately only be relieved when the political conditions change.



A benefit of listening carefully to Palestinians from all three regions was to hear the articulation of some uniquely impactful conditions in each of those areas. This should be especially helpful in drawing attention to the needs of Palestinians across the territories; that is, not just to the Gaza Strip, where it is commonly known how extraordinarily difficult life is. In Gaza, when identifying the political conditions that drive daily well-being, men and women often invoked the crippling siege. They also attributed suffering to the factional divides that have played out so brutally since 2006, and the subsequent absence of freedoms:


Those people in political factions, Fatah, Hamas, and I don’t know who else . . . not allowing [us] to participate in the [political] system of this country.


. . . to have freedom to get education, freedom of expression, of decision-making, freedom to participate in marches, in demonstrations, freedom to object to issues that I don’t like or don’t approve of in my society, freedom to work wherever I want, or to participate in anything I would like to participate in.



Of course, Palestinians in both the West Bank and East Jerusalem share this lack of freedom, but they also have particular difficulties that Gazans no longer face. One major issue, elaborated more fully later, is the pervasive restrictions on mobility due to closures, checkpoints, and other barriers. Another is land confiscation.


There are many people who lost their lands, in which they used to plant crops; the occupation confiscated their lands and hence now they are staying home jobless.



Life for residents of East Jerusalem is particularly burdensome due to building restrictions, fines, and taxes imposed by the Israeli authorities as well as the baffling and crippling identity complications.


. . . after he was kicked out of his house, he has had to pay fines for old building violations and a very high property tax although the house is no longer theirs.


I am working [in Ramallah] these days, but after a while they [the Israelis] may tell me, “You live in Jerusalem. . . .You can no longer work in Ramallah.” . . . They [the Israelis] can take my identity card.


The first thing a mother asks if a suitor comes to her daughter is if he has a blue ID or a green one. This has led to a lack of harmony in Palestinian cities. They have removed ties between Palestinian families. Right now people are not ready to give their daughters away to men who are [otherwise] compatible with their daughters because of IDs [color/type] . . . This has led to lack of harmony.


Saleh was kicked out of his house, and settlers took it and lived in it . . . He grew up in a hard environment where he lived with seven or eight brothers in a seventy square meter house, because the Israeli authorities do not allow building new houses in Jerusalem . . . they had no gardens or any place for playing even, because it is forbidden. He went to government schools because his father could not pay his tuition fees . . . Tuition fees in Jerusalem private schools are very expensive, and his father’s salary was low. His father’s money problem is related to the occupation, since they do not allow Palestinians to live normally or to have a good job with a good salary to meet their needs.



In summary, these illustrative statements underscore how dominant political conditions are in the day-to-day life of Palestinians, and likely so for any population or minority experiencing injustice and oppressive political control. The political conditions were so central in the renditions of well-being articulated in the interview phase of the PAL project that we gave extensive attention to them in the subsequent survey phases described below. Before proceeding, however, one final excerpt from the statement of an East Jerusalem man illustrates well how insidious, cumulative, and life-altering such conditions are.


I was a small kid during the first intifada, yet I was arrested several times and I spent four years in jail . . . You get out of jail to meet troubles in education (academics) and then overcome them in order to study and to obtain the certificate you want. In this case, you become an open person who witnessed a lot in his life, and learned [a lot about] myself.

However, what I actually feel nowadays is: “For which of my selves am I going to live? Do I live for myself as Nafez? Do I live for myself as a Palestinian? Or do I live for myself as a human being?” My Palestinian self is always stronger than the other two. I have not married. In fact, I am afraid to get married or to have a child in this country . . . There is a conflict between you and the life you dream of . . . This is the challenge and that is why I have fears. If you want to make your son live a dignified life, you need to have a good salary, but a good salary does not exist . . . This is our dilemma . . . I do not have the ability to say: “I don’t care about whatever happens in Palestine and leave the country, like Jordanians, Americans, Haitians, and Africans say.” It is not easy to emigrate. You commit slow suicide when you emigrate. As a result, you stay here.



After thoroughly studying the interviews of the first phase of the PAL project, we proceeded to create measurement tools to be used in further phases of the project. While the group interviews provided unparalleled depth and richness essential to understanding how Palestinians conceive their lives, that information came from relatively few people (n = 68). It was also critical to the project to be able to be confident that any findings we presented would also be representative of the population as a whole. To accomplish this, in 2011, PSR drew two representative samples of men and women, ages thirty-two to forty-three, across the three territories. As with those interviewed in the first phase of the project, this age range roughly covered individuals who would have been youths during the first intifada. The first sample consisted of 508 men and women, and the second of 1,778 men and women (including the 508 of the first sample). The household interviews of the first sample were conducted in June 2011 and of the second in October/November 2011. The response rates in both exceeded 90 percent.


These samples were drawn with conventional methods using a clustered stratified sampling strategy based on the most recent census for Palestine (2007). There were three stages to the sampling process: (1) randomly selecting population locations (clusters or blocs) using probability proportional to size (such a selection process ensured accurate representation of all Palestinian districts—sixteen in total—divided into urban/rural/refugee camp locations); (2) randomly selecting households from the population locations using updated census maps; and (3) selecting an individual between the ages of thirty and forty from among the persons in the household using the Kish table method. Selected individuals not present during the visit were contacted by cell phone to schedule an interview. If that person rejected the interview, a different household in the same location was selected using simple random sampling without replacement. This procedure ensured a representative sample when sampling weights are used in the analysis.


We used the first sample to pilot test the measurement tools that we had created based on the interviews in phase 1 (and some existing tools that were also culturally appropriate). The pilot interviews provided the first evidence that the measurement tools were reliable and valid, and how the measures of various domains of functioning were interrelated. [13] An overview of descriptive findings from the survey of the larger sample of 1,778 men and women from all three Palestinian territories is presented in appendices A–J (online only, at http://www.palestine-studies.org/jps). [14] The average age of the sample was thirty-seven, with 44 percent of respondents reporting being refugees. Twenty-two percent reported having completed education higher than high school, with males (26 percent) reporting significantly higher rates than females (18 percent). The large majority of the sample (91 percent) was married; participants had an average of four children.


PSR fieldworkers interviewed each participant in Arabic in his or her home. For every interview, a male and a female fieldworker were present to accommodate gender concerns. The interview consisted of a survey of the participants’ quality of life in 2011, which had been developed and tested in the earlier phases of the PAL project. Also, consistent with the intent of the project to provide a needed long-term look into how a population of youth experiencing political conflict develops over time into adulthood, this survey of the larger sample employed a unique method of collecting key historical data called an event history calendar (EHC). Much research has shown the EHC to be a particularly effective method of collecting historical data that overcomes many biases of memory. [15] Thus, we achieved both a thorough assessment of how life was experienced in 2011 and an historical account of the respondents’ lives since 1987.


Essentially, the EHC is a grid with columns—in our case, columns representing years from 1987–2011—and rows listing key events that individuals experienced as youths during the first intifada. Key events included basic demographic data such as education, employment, marriage, and birth of children. Based on information gained in the first phase of the project, and through consultation with key Palestinian advisors, the list also included crucial aspects of Palestinian life, such as political activism, exposure to multiple forms of political violence, movement restrictions, separation from family members due to the conflict, access to health care, and so forth. [16] Thus, for every year between 1987 and 2011, the survey gave an indication of whether the event occurred or not. PSR fieldworkers were trained rigorously in how to administer the EHC, a process in which the interviewer and the participant sit together and complete the EHC. The interviewers were trained in various procedures to check the completeness and consistency of the data.


We present the basic descriptive findings below, broken out by the three territories separately so as to highlight the comparability of experience across the distinct regions. Generally, findings proved comparable and we note in the text any cases in which the rates of experience differed significantly in any one particular region. [17] Also, analyses of data from men and women were conducted separately. Again, generally the findings did not differ significantly by gender. We identify significant differences in the text.


Consistent with the intent of the PAL project to provide a broad scope to view the functioning of this key generation of Palestinians, we report findings for multiple domains of their lives, including political, economic, community, family, and personal (psychological). We close with a summary of their perspectives on the peace process, such as it still appeared at the time, and their orientations toward the future.


Political Life

Here, we present findings from numerous aspects of the political conditions that participants have faced, beginning with a summary of their involvement in political activism and going on to their exposure to political violence, persistent humiliation, and political imprisonment.



The political activism questions were asked in the survey of the first sample only (n = 508) and they were phrased to adhere to the same formulation as was used in previous studies of this generation, conducted shortly after the end of the first intifada. [18] Numbers were too small to separate out East Jerusalem; instead, we combined answers from participants in East Jerusalem with those from the West Bank.


Participants were asked how often they “participated in the struggle against the occupation” (demonstrating, throwing stones, erecting barricades, and so forth) during the first intifada, the Oslo period, and during the second intifada and beyond. A summary of these findings, presented in figure 1 below, indicates the percentage of respondents who participated at any level (other than “never”) and the percentage of men who reported having participated “often” or “regularly” (second to last bar).



These findings confirm this generation’s substantial involvement in political activism. Levels of participation are generally similar across regions and, expectedly, they are higher for males than females. A large majority of males (75 percent) but also a substantial proportion of females (42 percent) reported participating at least once in some form of political activism during the first intifada. Noteworthy in these findings is that as many as 40 percent of men reported participating “often” or “regularly.”


Although it is common wisdom that fewer individuals participated in the second intifada than in the first, it is noteworthy that the study provides evidence that still nearly half of all men participated at least to some degree (and nearly 20 percent participated often or regularly) during this second major phase of the struggle, as well as 20 percent of women. Further, that 43 percent of men and 22 percent of women participated in some way even during the ostensibly more peaceful Oslo period is evidence of this generation’s commitment to the struggle against the Israeli occupation since their youth.



For the year 2011 and all of the years since 1987, participants indicated how often (from “never” to “frequently”) they experienced several forms of political violence at the hands of Israeli forces: being verbally abused; shot at; hit or kicked; detained or imprisoned; hearing or feeling the effects of a bomb; having their home raided; and witnessing someone close to them personally being humiliated.


In 2011, a large majority in the Gaza Strip (83 percent) reported hearing or feeling the effects of a bomb, with much lower rates reported in East Jerusalem (10 percent) and the West Bank (12 percent). Respondents in East Jerusalem and the West Bank, however, experienced personally targeted forms of political violence significantly more, no doubt reflecting the higher rates of contact between Palestinians and Israeli forces in those two territories. Thus, for example, as many as one-quarter of respondents in East Jerusalem (27 percent) and in the West Bank (24 percent) witnessed their father or other person close to them humiliated, compared to 2 percent in the Gaza Strip. Similarly, 17 percent in East Jerusalem and 13 percent in the West Bank reported being verbally abused, compared to less than 1 percent in the Gaza Strip; 9 percent in East Jerusalem and 4 percent in the West Bank reported their homes raided, compared to less than 1 percent in the Gaza Strip. Fewer than 3 percent of participants in any of the territories reported being shot at, hit or kicked, or detained or imprisoned for political reasons in 2011. Significantly more women reported hearing or feeling the effects of a bomb than did men, and more men reported being verbally abused than did women.


These 2011 findings are valuable in and of themselves because they provide a uniquely broad documentation of the types of violence experienced by this generation, which, together with the findings to follow, paints a picture of daily life in Palestine at a time of relative calm—that is, two full years after Operation Cast Lead (2008–9) and a year before Operation Pillar of Defense (2012).


But as noteworthy as these figures are—particularly that one in four adults saw a family member or friend humiliated in 2011—the clearer story of the role of political violence becomes evident in figure 2 below that documents the percentage of Palestinian adults who have experienced such forms of political violence over the course of their lives since the outbreak of the first intifada (1987).



In the almost twenty-five years between 1987 and 2011, majorities of all respondents (ranging from 56 percent to 90 percent) reported having been verbally abused, witnessing someone close to them personally be humiliated, having had their home raided, and hearing or feeling the effects of a bomb at some point in that time span. That more than one in three reported being hit or kicked and one in four reported being detained or imprisoned (primarily men) complete the picture of a generation that has experienced widespread violence and assault. Psychologists and psychiatrists consider any one of these types of exposure as a potentially traumatic event. Such pervasive exposure would be considered severe by any measure, and likely unprecedented.



When attending to political violence, researchers and practitioners typically focus on the more objective, physically inflicted, and observable types of political violence (that is, the most dramatic) and regard humiliation as a “low-level stressor.” We and others argue that humiliation should rather be considered a major stressor, the effects of which are acute because it is an intentional use of abusive power that purposefully degrades identity and dignity, and denies justice. [19] The findings of the PAL project provide new evidence for this contention.


Specifically, we wanted to know just how participants experienced this range of exposures to political violence over the prior twenty-five years of life and its association with their current (2011) quality of life. [20] Predictably, most of the participants experienced medium to high levels of such types of violence primarily during the first intifada and somewhat less so during the second intifada, with much less exposure during the Oslo period or after the second intifada. But, a significant minority—12 percent of both men and women—reported high exposure to being verbally abused and to witnessing others humiliated across all twenty-five years (that is, not just during the intifadas). Notably, it was this group of persistently humiliated respondents that was having the hardest time as adults. That is, compared to their peers who experienced more dramatic violence periodically, those who were persistently humiliated reported higher levels of a range of economic, political, and psychological difficulty in 2011. Interestingly, these persistently humiliated men and women also reported higher social cohesion, as they likely bind together to preserve their families and communities in the face of such consistent assaults.


Beyond the considerable value of documenting the history of humiliation in this generation of Palestinians and its effects on current day-to-day life, the data go farther in documenting key regional differences. It turns out that the bulk of these persistently humiliated individuals live primarily in three distinct areas: Hebron, East Jerusalem, and the Jordan Valley—all locations where residents frequently encounter checkpoints or other barriers as they go about their daily lives. This is an important finding in that it documents how some aspects of the occupation are experienced most acutely in certain parts of Palestine and that its effects are profound. It should be no surprise, therefore, that the current outbreak of violence (at the time of writing) is occurring primarily in Hebron and East Jerusalem.



Political imprisonment is a hallmark issue for Palestinians. Many agencies issue regular reports about the numbers of Palestinians who are or have been imprisoned. [21] But data collected from individuals about their imprisonment experience is rare, especially when using a large, representative sample such as that of the PAL study. Further, unlike others, we were able to compare prisoners with nonprisoners to actually test if having been imprisoned had had any lasting effects. [22]


The findings show that fully 26 percent of male participants have been imprisoned, with those imprisoned early in life (that is, during the first intifada and the Oslo period) functioning currently very much the same as those who were never imprisoned. Thus, in our data, there is no evidence of long-term effects from having been imprisoned when younger. Rather, it is the group of men who were imprisoned most recently (that is, 2006–11) whose lives appear significantly more difficult psychologically, politically, and socially. Once again, such findings have useful policy and practice implications, in this case signaling that attempts to care for the former prisoners should focus on those with the most recent experience.



The Israeli checkpoints prevent us from visiting and socializing . . . my parents live in Jerusalem but I can’t reach them the way my friends reach their parents. I might see them only once a month . . . I feel that the checkpoints have cut family ties and connections.


Now, we have the siege and the wall . . . there are no permits nowadays so we cannot reach Israel to work.


If you send your son to study in Hebron, because of the checkpoints, he’ll come [and visit] only every month, but if there are no checkpoints, he’ll come every day.



These excerpts from the interviews conducted in the first phase of the PAL project reveal another vexing strategy of political control: restrictions on movement, which are widely and regularly documented by human rights organizations. The PAL project data, however, provide a unique window into the proportion of people who actually face such restrictions and how those restrictions impact their lives. For all twenty-five years that the study covered, we asked both about being barred from and delayed in traveling for four key reasons: to visit family, for medical care, in pursuit of employment, and for the purpose of education.


Being Barred from Travel

For the year 2011, 16 to 22 percent of the participants reported needing to travel for the various reasons enumerated above, with the highest proportions needing to travel for medical care and to visit family. For the sample as a whole, the proportions ranged from 22 percent (education) to 46 percent (medical care) reporting ever needing to travel in at least one year since 1987.


Figure 3 illustrates the patterns of being barred from traveling. [23] It is clear that in 2011 more participants in the Gaza Strip were barred than in the other territories, particularly with respect to traveling in pursuit of work, from which two in three Gazans (66 percent) were barred. Over the course of their lives, however, the figure makes clear that those in the West Bank who have needed to travel have had the highest prevalence of being barred, with fully half being barred from travel for medical care and to visit family in at least one year since 1987. Also, between 30 and 40 percent of respondents in the West Bank and in the Gaza Strip reported being barred from travel for work in the same period.



Being Delayed When Traveling

In terms of being delayed when traveling for these same reasons, figure 4 shows the same pattern of primary burden for those in theWest Bank. The percentages are higher, however, with nearly two in three reporting being delayed in at least one year since 1987 for three of the four purposes for traveling. Similarly to the figures for being barred altogether, approximately one in three of the participants from the Gaza Strip also reported having being delayed since 1987 when traveling for multiple reasons.



Checkpoints and Closures

We also asked about experience with checkpoints in 2011, specifically if the participants were “delayed, refused or humiliated” at a checkpoint or experienced a closure during the month prior to the interview. The rates were highest for participants in East Jerusalem with one in three reporting being delayed, refused, or humiliated at a checkpoint (37 percent), or experiencing a closure (34 percent). Since for the twenty-five-year period, 1987–2011, East Jerusalem respondents did not report high levels of being delayed or barred from travel compared to their peers in the West Bank and Gaza (figures 3 and 4), it is likely that this variable therefore most accurately reflects the humiliated component of this question. This would be consistent with the findings on persistent humiliation referred to earlier, in which rates of persistent humiliation were high in East Jerusalem. Rates were closer to one in five for those in the West Bank, and close to zero for those in the Gaza Strip (consistent with the absence of checkpoints within the Gaza Strip in recent years). Were it not for averaging Hebron and towns and villages in the Jordan Valley—the other regions where we found high levels of persistent humiliation—with the rest of the West Bank as we did in the study, we likely would have seen much high proportions having been reported.


The Effects of Being Barred and Delayed from Traveling

Our ongoing analyses are looking into determining the effect of these movement restrictions on the life of the participants, and currently focusing on access to medical care. [24] The findings show that participants across all three regions were barred for 28 percent of the time (in the twenty-five years 1987–2011) from traveling for medical care and were delayed when traveling for medical care for 35 percent of that time (rates were highest for West Bankers).



Loss of key personal and material resources is a further burden caused by political conflict. We asked about separation from family members due to death, deportation, or imprisonment. As shown in figure 5, relatively few participants reported losing or being separated from a parent, spouse or child since 1987 but an average of 14 percent reported the loss of a sibling through death, deportation, or imprisonment.




As for material loss, relatively few lost their home or land in 2011 specifically. Historically, however, as evident in figure 6, nearly one-third of participants in East Jerusalem (31 percent) and just short of half of those in the West Bank (46 percent) and the Gaza Strip (44 percent) have lost a home or land since 1987.



Finally, we also asked about individuals’ perspectives in 2011 relative to political freedom and government stability. As shown in figure 7, only about one-quarter of the participants indicated that they felt “completely” free or “a lot” of freedom to express themselves. Figure 8 shows that perceptions of the Palestinian government’s political stability are even lower. While only a quarter (26 percent) of those in the West Bank perceived it to be “stable” or “very stable,” significantly fewer still in East Jerusalem (11 percent) and in the Gaza Strip (16 percent) judged it to be stable.




In summary, the findings confirm that this generation of Palestinian men and women were extensively involved in efforts to resist or remove the Israeli occupation—especially during the first intifada, but substantially thereafter as well. Life under occupation has been oppressive, with extraordinarily high percentages of them having experienced multiple forms of violence and assault, particularly various forms of intrusion (for example, home raids) and humiliation. Significant proportions—even majorities of those in the West Bank—have been constrained or forbidden when trying to move around for their needs. A substantial minority have lost a sibling due to the conflict, and between one-third and nearly one-half have lost a home or land since 1987. Relative to their own government, barely one in four or 25 percent felt free to express themselves and few—particularly in East Jerusalem and the Gaza Strip—felt that the Palestinian government was stable.


Economic Life

The PAL project included numerous questions about the economic life of its participants, ranging from family income to being able to provide resources for children.



On average across the territories, only one-third of the sample reported family income above the poverty level. [25] As evident in figure 9 below, this average is balanced by relatively higher rates in East Jerusalem, where nearly six in ten reported income above the poverty level, and lower rates in Gaza, where only one in four reported this level of economic well-being.




In 2011, over 80 percent of women across the territories reported not working or wanting to work outside the home. Of those women who did work outside the home in 2011, most were in the West Bank (8 percent working part of the year) and East Jerusalem (11 percent working the full year). For the years that they were not in school since 1987, women in the West Bank reported the highest levels of work outside the home (part of the year: 5 percent; year-round: 8 percent; see appendix D at http://www.palestine-studies.org/jps).


The employment histories of men are shown in figure 10. Overall, men in the Gaza Strip reported the lowest labor force participation. In terms of full-time employment (that is, working year-round), East Jerusalem men fared the best, with 70 percent reporting being employed for the full year in 2011, and in three out every five years (63 percent) that they were not in school since 1987. Only 40 percent of Gazan men reported working the full year for 2011; their full-year employment stability since 1987 was equally low at only two out of every five years (39 percent) that they were not in school.


In all three regions, a large proportion of men were underemployed, working just part of the year. The highest rates of underemployment were reported in the West Bank, where approximately half the male participants (49 percent) worked for part of the year in 2011, and for a comparable time only half (49 percent) of the years since 1987 that they were not in school. Finally, although we cannot know for certain from these data, the 13 percent of men in the Gaza Strip—a relatively elevated proportion compared to the other regions—who reported “not working/not wanting to work” may have been due to the fact that since Hamas’s 2006–7 takeover of the Gaza Strip from the Palestinian Authority (PA), civil servants previously in the employ of the PA were instructed not to report to work as a show of PA resistance to Hamas (even though the PA kept them on its payroll).




We asked several questions about individuals’ access to basic resources. Since education is such a priority in Palestinian culture, we asked first about respondents’ ability to provide their children with education in 2011. As shown in figure 11, on average 60 percent of those who had children reported that they were “satisfied” or “very satisfied” with this ability. Although the question did not specify what level of education, due to the age group of those taking part in this study, it is safe to say that participants were likely thinking in terms of primary and secondary education rather than college education.



We next asked about the adequacy of participants’ access to food, water, and income for the year 2011 and across the previous twenty-five years. As evident in figure 12, half (51 percent in East Jerusalem) or less reported having adequate access to those resources in 2011. Historically, one third (36 percent in East Jerusalem) or less reported adequate access to all three resources in every one of the twenty-five years since 1987. Finer breakdowns of the findings are presented in appendix D online. Focusing specifically on the widely known problem of water, for example, while two in three in East Jerusalem reported adequate access to water every year since 1987, less than half in the West Bank (46 percent) and in the Gaza Strip (44 percent) reported adequate access to water during all of the twenty-five years.




Finally, since respondents mentioned crowded housing a number of times in the initial interview phase of the project, we asked a single question about how crowded their homes felt in 2011. As might be expected, the rates were higher in the Gaza Strip than in the other territories, with one in three Gazans reporting that their homes were “very crowded,” compared to one in five in the other areas (figure 13).



In summary, depending on the territory, a maximum of half the participants reported income above the poverty line, with better rates of income highest in East Jerusalem. Less than half of the men worked full-time in 2011 and had, otherwise, a very unstable history of employment since 1987. Half or less reported adequate access to resources in 2011 and only a third reported stable access to resources since 1987. Up to one-third (Gaza) reported living in homes that they perceived as overcrowded up through 2011.


Physical Health

Generally, this young adult age group is relatively healthy across the world. We asked three questions regarding health: (1) self-rated health; (2) the degree to which health limited functioning in other domains of life; and (3) access to health care.



Approximately two-thirds of the participants rated their health as “good” or “very good.” Males reported somewhat higher rates than females. Otherwise, on average, only 13 percent reported that their health “often” or “regularly” limited their functioning in other areas of their lives (figure 14).




For 2011, fully three-quarters of the participants in East Jerusalem reported adequate access to medical care for themselves when they needed it, reflecting their relatively higher economic well-being, but only half of them reported adequate access to health care for their families that year (figure 15). And approximately half of respondents in the West Bank and the Gaza Strip reported adequate access to medical care for both themselves and their families in 2011. Across the territories generally, women reported greater access to medical care than did men.



Shown in figure 15 is the history of adequate access to medical care. Regarding care for self, participants reported adequate access for half (Gaza) to three-quarters (East Jerusalem) for the years since 1987. Regarding medical care for their families, adequate access was somewhat less consistent, with between half (Gaza) and two-thirds (East Jerusalem) of respondents having had adequate access to medical care since 1987.


In summary, consistent with their age, significant majorities of the participants reported having good health and that their health did not significantly disrupt their lives. Smaller majorities—and only half of all respondents in the Gaza Strip—reported adequate access to medical care for themselves and their families in 2011 and across time. Typically, rates of access were highest in East Jerusalem.


The Family

It is well-known that family is a crucial social institution for Palestinians, not alone for cultural and religious reasons, but also as the first barrier against the impact of occupation. Therefore, we asked some key questions about family life for the participants in 2011 based on issues they had highlighted in the initial interviews. Specifically, we asked about their satisfaction with their own and their spouse’s family, and about the quality of their marriages. As is evident in figure 16, equally across the three territories, the very large majority of participants reported being “satisfied” or “very satisfied” with their own families. Large majorities also reported virtually equally high levels of satisfaction with their spouse’s family. Further, essentially eight in ten “agreed” or “strongly agreed” with statements reflecting positive marital relations that we defined as happy, harmonious, understanding, and allowing independence from comments made by participants in the initial group interviews. For all of these questions, on average across the territories, men reported higher levels than women.



Community Life

We assessed community life by asking the participants to indicate their level of satisfaction with the sense of community belonging and the sense of safety.



Figure 17 shows that just over half of the participants reported feeling “satisfied” or “very satisfied” with the sense of community belonging. On average across the territories, men reported higher levels than women.



We asked about participants’ sense of safety in their neighborhoods for 2011 as well the consistency of feeling safe across the twenty-five-year period. The latter question referred to safety generally, not with specific reference to the neighborhood. As evident in figure 18, again only approximately one-half of men and women reported feeling “somewhat” or “very” safe in their neighborhoods in 2011. Historically, participants reported feeling safe generally just over half of the twenty-five years since 1987.


Mental Suffering and Perspectives on Both Past and Future

Finally, we asked participants to answer several questions about their personal feelings in 2011. These questions tapped the psychological state of the participants in several ways. They also included the individuals’ current perceptions about the first intifada and some perspectives on the future.




Findings regarding four types of mental suffering are presented in figure 19 and are summarized briefly below.



This construct was developed within the PAL project, and is, therefore, a uniquely contemporary and genuine reflection of how Palestinians in 2011 suffered psychologically: for example, feeling that their lives and/or futures were broken or destroyed, as well as feeling emotionally exhausted.


Participants were asked to reflect on the past two weeks and indicate how often they felt this way, using a scale from “never” to “regularly.” In figure 19, we record those who reported feeling broken or destroyed “often” or “regularly” during the previous two weeks. These ranged from 29 percent (East Jerusalem) to 40 percent (West Bank). Thus, on average across the territories, more than one in three men and women (37 percent) were suffering to this extent. A finer breakdown of these findings, as well as those below, is recorded in appendix H online. It shows, for example, that few participants across the territories reported “never” feeling this way during the prior two weeks, with as few as 6 percent of Gazans never feeling broken or destroyed, compared 12 percent of participants in the West Bank and 17 percent in East Jerusalem.




Participants also rated their feelings of depression, such as having trouble falling asleep, feeling tired or having little energy, poor appetite or overeating, trouble concentrating, and so forth, again referring to the previous two weeks. On average across the territories, one in four (26 percent) of participants reported such feelings “more than half the days” or “nearly every day” during the period in question. The highest proportion of participants in East Jerusalem (34 percent of total) and 29 percent of men compared to 20 percent of women reported “not at all” when asked about such feelings in the previous two weeks (see appendix H, at http://www.palestine-studies.org/jps).



The participants also rated the following indicators of trauma-related stress: recurrent or intrusive thoughts; sudden reliving of the event(s); being emotionally upset when reminded of the event(s); persistently making efforts to avoid thoughts or feelings associated with the event(s); and persistently making efforts to avoid activities, situations, or places that reminded them of the event(s). On average across the territories, 39 percent of the participants indicated that they had engaged in such processes “more than half the days” or “nearly every day” during the prior two weeks. As to the “not at all” response with respect to engaging in these processes, participants in East Jerusalem reported the highest level with 43 percent indicating that they did not engage in these processes, compared to 31 percent in each of the West Bank and the Gaza Strip.



Levels of insecurity were assessed using several questions concerning the participants’ fear for or worry about: themselves and their families currently and in the future; displacement or loss of home or land; chaos in Palestinian society; and the extent to which events in Palestine make children feel frightened. Consistent with how this tool has been used before, we made no reference to a time period that the participants should consider when answering the questions. We found that on average across the territories nearly two in three (64 percent) participants reported having these fears “very much” or “an extreme amount.” Very few reported “never” having these feelings, with the highest proportion of those (4 percent) being from East Jerusalem.



As a final view into this generation of Palestinians, we provide some of their perspectives on life relative to both the past and the future. First, since the first intifada was such a formative period of their lives, we asked several questions about how they—now as adults—view the value and effects of that initial struggle against the Israeli occupation. Second, we asked a few questions about their view of the future of the political situation and their sense of how well they think they will manage the future. For all questions in tables 1 and 2 below, we report the percentages who indicated “agree” or “totally agree” with the statements. Since more of these questions were included in the first survey of 508 adults and not in the larger survey that has been the focus of most of this report, we report data from the smaller, but still representative, survey (as we did for political activism items earlier). One consequence of this is that numbers were too small to separate out East Jerusalem; instead, we combined answers from participants in East Jerusalem with those from the West Bank.



Evident in table 1 is that over 90 percent of the participants still consider the first intifada to have been worth the effort, and that very few (less than 10 percent) regret having participated in it. Large majorities also judged that formative period to have improved their identities and feelings of usefulness, and that they had “made history” (that is, participated in history). About half indicated that they were more politically active in society because of their earlier involvement, with significantly more men (59 percent) reporting that activity than women (37 percent).


In terms of negative effects, about two-thirds felt that they had lost their childhood because of their involvement in the first intifada. Significantly more (54 percent) of those in the West Bank and East Jerusalem reported regretting that loss than those in the Gaza Strip (40 percent). Relative to feeling that their participation in the first intifada hurt their education, again rates were significantly higher in the West Bank and East Jerusalem (61 percent) than in the Gaza Strip (39 percent), and for men (66 percent) than for women (42 percent).



Perspectives on the political process and the future are summarized in table 2. Not surprisingly given the failure of political efforts to achieve meaningful change over the course of their lives, fewer than half the participants reported being hopeful about the peace process, except for women who reported significantly higher rates of hope (56 percent) compared to men (34 percent). Even fewer men and women (between one-third and one-quarter) judged that they would participate in another intifada, with a significantly higher rate reported by respondents in the Gaza Strip (42 percent) than those in the West Bank and East Jerusalem (27 percent). That said, this lack of endorsement of the political process and disinclination for another popular movement notwithstanding, attitudes toward the future were less bleak. Around half of the respondents reported being pessimistic about the future—with the highest level of pessimism registered in the West Bank and East Jerusalem (53 percent) compared to the Gaza Strip (34 percent). And perhaps reflecting the steadfastness (sumud) that has been so prominent historically in narratives about Palestinian experience, on average as many as 70 percent indicated that they felt confident in their ability to manage whatever the future brings.



Summary and Implications

In this article, we provided an overview of a uniquely thorough study of the contemporary generation of Palestinians who were young adults in 2011 (ages thirty to forty-five). Theirs is the first generation of Palestinians to live the whole of their lives under occupation, and they distinguished themselves as the youth of the first intifada by their historically high commitment to resisting and removing the occupation. The multiphase study used multiple methods, all of which were grounded carefully in local understandings and informed by numerous key Palestinian advisors. All data were collected in Arabic by trained, experienced local fieldworkers. The size of the samples and the methods used for their selection make the findings generalizable to the entire population of this generation of Palestinians in the West Bank, East Jerusalem, and the Gaza Strip.


As would be expected, the findings reveal a complex portrait of a generation of Palestinians who have sacrificed much to the struggle against the occupation, especially during the first intifada, but notably thereafter as well. At the time of the survey, the very large majority still valued their political activism now that they were adults and found that it had enhanced them personally. Their lives have included persistent adversity, including extraordinary levels of exposure to political violence, often of a degrading and humiliating nature. Significant proportions have been barred or restricted from travel to meet basic needs, and many have lost homes, lands, and family members. Half or less have adequate access to food, water, and income, most live below the poverty level, and employment has been very low and unstable since leaving school. This generation reported generally good health and are very satisfied with their families and marriages, and about half are satisfied with the sense of belonging in their communities. But also more than half feel very unsafe and fear considerably for themselves, their families, and the future. Up to 40 percent often felt broken or destroyed by the unrelenting and increasingly forbidding pressures and also reported feeling trauma-related stress. Most did not feel free to express themselves publicly and few had confidence in the stability of the Palestinian government. Not surprisingly, relatively few were hopeful about the success of the peace process and few indicated that they would participate in a new intifada. Yet, most were not highly pessimistic about the future in 2011 and the large majority felt confident in their ability to manage whatever came their way.


In terms of regional differences, the findings show much similarity in the experiences of this generation of Palestinians, but also some key differences. As expected, participants in the Gaza Strip reported the worst economic conditions, with the highest levels of poverty, crowding, and limited access to resources. However, those in the West Bank have had the highest history of constraints on movement for basic personal and social needs, and, perhaps in part because of this, the highest levels of trauma-related stress. For Hebron and the Jordan Valley—both in the West Bank—participants reported the highest levels of being persistently humiliated across their lives. While participants in East Jerusalem reported higher levels of economic well-being overall than the other territories, they also reported high levels of persistent humiliation, likely related to the onerous complexity of identity documentation, and of movement and building restrictions.


The story that these findings tell is valuable at several levels. First, like any other group, Palestinian society warrants thorough documentation of the way and quality of life of its people. The findings presented here support and complement the wealth of related information being provided by Palestinian researchers and varied institutions. The main contributions of the PAL study are its unusual breadth of coverage of Palestinian lives and the mapping of those lives over a twenty-five-year period. Further, in many cases, the study has provided needed estimates of the proportion of the population that experiences well-known burdens, such as movement restrictions, imprisonment, and forms of violence exposure. The data should, therefore, serve as an important source of documented, credible evidence of life in the occupied territories in 2011 and before.


Life has only become harder since—with settlement expansion in the West Bank, home demolitions in East Jerusalem, increased violence, and two more wars with Gaza, to name only some of the most visible and dramatic developments—such that one could confidently expect that the types of adversity documented here would only have increased in severity. And, given the historic steadfastness of Palestinians, who in some ways seem to cohere even more tightly in the face of adversity, whether as a mechanism of survival or as a form of resistance, one might also expect their resilience to have firmed yet further since 2011. Of course, this expectation needs to be assessed given the magnitude of destruction and constraint that has occurred in recent years.


Second, these strengths of the data allow the identification of targets or entry points for policymakers, practitioners, and educators who wish either for evidence of the severity of conditions to advocate for political change, or to focus on specific sectors of society, regions, or issues in most need of attention. The data are all the more valuable to these ends because the selection of topics of focus in the project was guided fully by what Palestinians themselves articulated as the key elements of their lives. In other words, we know more now about what actually matters to everyday Palestinians and how these issues have been experienced throughout their lives under occupation.


Third, while the Israeli occupation is unique in its longevity and the harshness of some of its practices, the core of the adversity that Palestinians face—the violation of basic rights and dignity—is known in many places in the world where indigenous or minority populations are systematically discriminated against. Thus, the array and specific forms of adversity and strengths described here, as well as the ongoing analyses of their effects that are also introduced, should be useful in helping to understand the experience of the subjugated in other parts of the world.


Fourth, as primarily academics, we note the value of these data in encouraging more and better research on Palestinians as well as other groups. Most fundamentally, we recommend that any project targeted to understanding individuals who live complex lives begin by carefully listening to and being guided by the people being studied. Much of the richness of what we have learned to date from this project comes from articulations made during the grounding interview phase, particularly the utter domination of political realities in daily life and personal well-being, and that the massiveness and longevity of the demeaning political control is responsible for the mental distress and sense of brokenness and fear reported. We also recommend the value of specificity; that is, measuring and testing the unique effects of multiple, specific types of experiences, such as exposure to political violence and movement restrictions. As a method, we also recommend the event history calendar, which when administered by carefully trained fieldworkers, appears to be an effective method of collecting historical data.


Finally, the project and its findings have value in addressing what might be Palestinians’ most long-lived and still urgent ambition: to be acknowledged as fully worthy human beings who have sacrificed much personally and collectively, endured endlessly, and retained impressive strength. Particularly given the increasing insularity within Palestine itself—Gaza cut off more completely than ever before, Jerusalem nearly completely surrounded by settlements, the West Bank riddled with movement barriers and building restrictions, the Jordan Valley at risk of yet further militarization, and so forth—Palestinians’ plea that their story be told is all the more intense. It is a story full of deep physical and emotional bruises, a stubborn insistence on living with dignity, and severely challenged hopes. We hope that the earnest effort of the PAL project to document and understand the lives of this crucial generation of Palestinians in some way meets this plea.



Beyond the Jacobs Foundation, we express sincere gratitude to key Palestinian advisors: Khalil Shikaki, Olfat Hammad, and Waleed Ladadweh; to the Palestinian fieldworkers from PSR; and most profoundly to the nearly 1,800 Palestinian participants who gave so much of themselves for this project. We also acknowledge the important contributions of several students, including Carolyn Spellings, Samuel Benjamin Doty, and William Barnes.


Statement of Ethics

All phases of the research reported here were approved by the Institutional Review Boards of the University of Tennessee and the Palestinian Center for Policy and Survey Research.


About the Authors

Brian K. Barber is a fellow at New America in Washington, the founding director of the Center for the Study of Youth and Political Conflict, and professor of child and family studies, at the University of Tennessee, Knoxville.


Clea McNeely is associate professor of public health and associate faculty of the Center for the Study of Youth and Political Conflict at the University of Tennessee, Knoxville.


Chenoa Allen is a doctoral student in public health at the University of Tennessee, Knoxville.


Rita Giacaman is professor of public health at the Institute of Community and Public Health at Birzeit University.


Cairo Arafat is a civil rights adviser to Save the Children UK.


Mahmoud Daher, PhD, is a public health expert and researcher from Gaza.


Eyad El Sarraj, MD, is now deceased and was the founding director of the Gaza Community Mental Health Programme.


Mohammed AbuMallouh, PhD, is former director of the Gaza office of the Qattan Centre for Educational Research and Development.


Robert F. Belli is professor of psychology at the University of Nebraska–Lincoln.



1 Palestinian Central Bureau of Statistics (PCBS) and National Population Committee statement, PCBS, 9 July 2015, http://www.pcbs.gov.ps/site/512/default.aspx?tabID=512&lang=en&ItemID=14... 3171&wversion=Staging.

2 We use the word “war” here, in favor of, for example, attack, onslaught, offensive, bombardment, and so forth. This is because war is the word that many Gazans use to describe these episodes of severely imbalanced battles. For many, this is likely because they do not wish to be seen simply as victims of Israeli aggression, but, rather as a people who are engaged, however poorly equipped, in a fight for rights and self-determination.

3 The project has been funded by the Jacobs Foundation, Switzerland, one of the world’s leading charitable foundations dedicated to research and facilitating innovations for children and youth.

4 The Palestinian Center for Policy and Survey Research (PSR) is an independent nonprofit institution and think tank, specializing in policy analysis and academic research, which is based in Ramallah.

5 Brian K. Barber, “What Has Become of the ‘Children of the Stone’?,” Palestine-Israel Journal 6, no. 4 (2000), pp. 7–15; Brian K. Barber and Joseph A. Olsen, “Positive and Negative Psychosocial Functioning after Political Conflict: Examining Adolescents of the First Palestinian Intifada,” in Adolescents and War: How Youth Deal with Political Violence, ed. B. K. Barber (New York: Oxford University Press, 2009), pp. 207–37.

6 The interviews were conducted in Arabic by trained field workers from PSR. The subsequent questionnaires were administered in Arabic after careful back-translations and pilot testing.

7 Interviewers used various renditions of doing more- or less-well, such as: “life is good” (al-hayat mniha) or “not good” (mish mniha al-hayat); “happy” (sa’da) or “unhappy” (mish sa’da); “succeeding” (najiha) or “not succeeding” (mish najiha); and so forth. For full details of the interview method and findings see Brian K. Barber et al., “Politics Drives Human Functioning, Dignity, and Quality of Life,” Social Science and Medicine 122 (2014): pp. 90–102, doi:10.1016/j.socscimed.2014.09.055.

8 Participants often referred to the political situation (al-wada al-siyasi) or political circumstances (alzuruf al-siyasiya), political environment (al-bi’a al-siyasiya), political stability (al-istaqrar al-siyasi), (a stable) political life (hayat siyasiya), political security (’amn siyasi), and safety (al-aman).

9 Rita Giacaman et al., “Mental Health, Social Distress and Political Oppression: The Case of the Occupied Palestinian Territory,” Global Public Health 6 (2011): pp. 1–13, doi:10.1080/17441692.2010.528443; Allan V. Horwitz and Jerome C. Wakefield, The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder (New York: Oxford University Press, 2007); Isaac Prilleltensky, “Wellness as Fairness,” American Journal of Community Psychology 49, no. 1–2 (2012): pp. 1–21, doi:10.1007/s10464-011-9448-8.

10 How often have you: 1) “Felt that your spirit or morale is broken or destroyed?” (Kam marra ahsast bi’anna nafsiyataka wa ma’nawiyataka muhattama?); 2) “Felt that your ambitions and hopes for the future are destroyed?” (Kam marra ah: sast bi’anna amalaka aw tumuhatak bin-nisba lil-mustaqbal muhattama?); 3) “Felt emotionally or psychologically exhausted?” (Kam marra ahsast bi’annaka murhaq ‘atifiyyan aw nafsiyyan?)

11 Brian K. Barber et al., “Feeling Broken or Destroyed: A Mixed-Methods Study of Contextualized Suffering in the oPt,” Lancet (forthcoming); Brian K. Barber et al., “Identifying Mental Suffering in Context: Feeling Broken or Destroyed,” under review for publication at PLOS ONE.

12 Clea McNeely et al., “Human Insecurity, Chronic Economic Constraints and Health in the Occupied Palestinian Territory,” Global Public Health 9, no. 5 (2014): pp. 495–515, doi:10.1080/17441692.2014.903427.

13 McNeely et al., “Human Insecurity.”

14 Full details on the measurement tools and the findings can be found in appendices A–J published online at http://www.palestine-studies.org/jps.

15 Robert F. Belli, “Autobiographical Memory Dynamics in Survey Research,” in SAGE Handbook of Applied Memory, ed. T. J. Perfect and D. S. Lindsay (Los Angeles: Sage, 2014), pp. 366–84; Robert F. Belli, William L. Shay, and Frank P. Stafford, “Event History Calendars and Question List Surveys: A Direct Comparison of Interviewing Methods,” Public Opinion Quarterly 65, no. 1 (2001): p. 45–74; Robert F. Belli, Frank P. Stafford, and Duane F. Alwin, Calendar and Time Diary: Methods in Life Course Research (Los Angeles: Sage, 2009).

16 For details on the EHC, see Brian K. Barber, “Political Conflict and Youth: Assessing the Longer-Term Impact,” in Emerging Trends in the Social and Behavioral Sciences: An Interdisciplinary, Searchable, and Linkable Resource, ed. Robert A. Scott and Stephen M. Kosslyn (Hoboken, NJ: John Wiley and Sons, 2015–).

17 Note: the reader should avoid making conclusions of differences based visually on the height of the bars. For complex statistical reasons, visually observed differences are not necessarily significant; hence, we identify any statistically different results in the text.

18 Barber, “What Has Become of the ‘Children of the Stone’?”; Barber and Olsen, “Positive and Negative Psychosocial Functioning.”

19 Rita Giacaman et al., “Humiliation: The Invisible Trauma of War for Palestinian Youth,” Public Health 121 (2007): pp. 563–71, doi:10.1016/j.puhe.2006.10.021.

20 Brian K. Barber et al., “Long-Term Exposure to Political Violence: The Particular Injury of Persistent Humiliation,” Social Science & Medicine (in press), doi:10.1016/j.socscimed.2016.03.011; Brian K. Barber et al., “Effect of Chronic Exposure to Humiliation on Wellbeing in the Occupied Palestinian Territory: An Event-History Analysis,” Lancet 382, supp. 4, (2013): p. S7, doi:http://dx.doi.org/10.1016/S0140-6736(13)62579-9.

21 “Statistics on Palestinians in the Custody of Israeli Security Forces,” B’Tselem, updated 3 February 2016, http://www.btselem.org/statistics/detainees_and_prisoners; “Statistics,” Addameer: Prisoner Support and Human Rights Association, http://www.addameer.org/statistics.

22 Clea McNeely et al., “Political Imprisonment and Adult Functioning: A Life Event History Analysis of Palestinians,” Journal of Traumatic Stress 28, no. 3 (2015): pp. 223–31.

23 For figures 3 (barred) and 4 (delayed), numbers represent percentages of those that needed to travel. Since the number of those needing to travel varies substantially between the one year 2011 and the span of years 1987–2011, percentages of being barred or delayed cannot be reasonably compared across the time periods. For example, this explains why 66 percent of participants in the Gaza Strip reported being barred from travel to work in 2011, but only 36 percent of Gazans reported being barred from travel to work between 1987–2011; simply, more people needed to travel across that twenty-five–year period than in 2011.

24 Clea McNeely, Brian K. Barber, Robert F. Belli, R. Giacaman, M. Daher, C. Arafat, and Abu Mallouh. Paper presented at the 7th Lancet-Palestinian Health Alliance Conference, Amman, Jordan, March 2016.

25 We asked the following question: “Today, the poverty line in Palestine is NIS 1800 [approximately $460] for the family. Tell us if the income of your family is less or more than that (using a response scale from 1, much less, to 5, much more).

26 Note that these figures will not correspond to other employment data, for example, from PCBS, because those data typically consider ages twelve years plus, not the specific adult age cohort we have studied here.

27 See Kurt Kroenke and Robert L. Spitzer, “The PHQ-9: A New Depression Diagnostic and Severity Measure,” Psychiatric Annals 32, no. 9 (2002): pp. 509–15.

28 See Edna B. Foa et al., “Reliability and Validity of a Brief Instrument for Assessing Post-traumatic Stress Disorder,” Journal of Traumatic Stress 6, no. 4 (1993): pp. 459–73, doi:10.1002/jts.2490060405.


29 See Rita Giacaman et al., “Health Status and Health Services in the Occupied Palestinian Territory,” Lancet 373, no. 9666 (2009): pp. 837–49, doi:10.1016/S0140-6736(09)60107-0; Niveen M.E. Abu-Rmeileh et al., “Health-Related Quality of Life of Gaza Palestinians in the Aftermath of the Winter 2008–09 Israeli Attack on the Strip,” European Journal of Public Health 22 (2011): pp. 732–37, doi:10.1093/eurpub/ckr131; McNeely et al., “Human Insecurity.”

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