The Impact of War Exposure on Early Childhood Mental Health in the Gaza Strip: A Systematic Review

Armed conflict is a well-established risk factor for children’s mental health, yet young children remain underrepresented in research on mental health among children affected by conflict in the Gaza Strip. This systematic review synthesized evidence on the relationship between war exposure and mental health outcomes among children aged 0–8 years in the Gaza Strip, drawing on studies published between 2000 and 2026 to compare findings across conflicts preceding and following the October 2023 escalation. Following PRISMA 2020 guidelines, five databases (Scopus, Web of Science, ERIC, PubMed, and PsycINFO) were searched, yielding 220 records. After screening and full-text assessment, seven reports representing six independent samples (N = 309–11,646) met the eligibility criteria; all included studies were conducted in the Gaza Strip, and no eligible studies from the West Bank or East Jerusalem were identified. Methodological quality, assessed using the JBI Critical Appraisal Checklist, ranged from low to high. Across the outcomes examined, including post-traumatic stress, anxiety, depression, and broader psychosocial and behavioral functioning, greater trauma exposure was generally associated with poorer outcomes. Reported PTSD estimates varied substantially across studies and assessment approaches, ranging from 6% in a preschool sample to 57.8% in a broader sample, with the latter estimate decreasing to 15.6% under a stricter DSM-5 diagnostic algorithm. These differences likely reflect, at least in part, variation in age range, assessment instruments, and diagnostic thresholds. Caregiver mental health was consistently associated with child outcomes and, in some studies, showed stronger associations than children’s reported trauma exposure. Household socioeconomic disadvantage was also associated with poorer outcomes, while findings regarding sex differences in internalizing symptoms were inconsistent; boys were more frequently reported to exhibit externalizing problems. All included studies were cross-sectional and conducted in Gaza, limiting causal inference and geographic generalizability. These findings indicate that supporting children’s mental health in the context of war cannot be separated from supporting the caregivers who raise them and underscore the urgent need for longitudinal and intervention-focused research addressing the ongoing consequences of the 2023–2025 war.