Hidden costs of war: Middle East violence and its effect on children

April 18, 2012

Wars have obvious victims. The dead, the injured. Those left behind. But there is another class of victims that often goes unnoticed: children. Not kids who are abducted or killed, but those who simply witness acts of ethnic or political violence, and whose lives and behavior are changed forever.

“Violence is really like a contagious disease,” says Rowell Huesmann, director of the Research Center on Group Dynamics at the Institute for Social Research (ISR). “Except in one sense, it’s worse. With contagious diseases, you have to be near the person in order to get it. Violence is contagious even at a distance.”

A Palestinian girl stands next to a home destroyed

A Palestinian girl stands next to a home destroyed in the 22-day war on Gaza in Jabaliya refugee camp, February 2, 2009, Gaza Strip, Palestinian Territories. (Photo by Warrick Page/Getty Images)

Huesmann has studied the impact of violence on children in a number of contexts. Most well known is his research showing that kids who watch lots of violent TV programs or movies, or who often play violent video games, become more aggressive. He has also studied how community and peer violence affect kids in inner city neighborhoods.

But Huesmann wanted to take it a step further, to go to a part of the world where he could study how regular exposure to ethnic or political violence affects aggressive behavior and post-traumatic stress (PTS) symptoms—such as nightmares, emotional numbness, and irritability—among young people.

Palestinian Bedouin boys from a marginal community outside Gaza City play as they look out of their courtyard gate Nov. 3, 2008, in Malalha in the Gaza Strip. Photo credit: Abid Katib/Getty Images

Given the world’s state of turmoil, there were plenty of locations to consider. But Huesmann also wanted a crackerjack team with collaborators who would know the territory. He found those collaborators in the Middle East, a region rife with incidents of political violence. At least 4,860 Palestinians ,731 Israeli civilians, and 332 Israeli soldiers were killed in political violence from the beginning of the second intifada—or Palestinian uprising—in September 2000 until the start of the Gaza War on Dec. 26, 2008, according to B’Tselem, the Israeli Information Center for Human Rights in the Occupied Territories.

With funding in 2005 from the National Institutes of Health (NIH), Huesmann and six other researchers set to work. In the US were Paul Boxer of Rutgers University, Jeremy Ginges of the New School for Social Research, and fellow ISR researcher Eric Dubow. In Israel, Simha Landau and Shira Dvir Gvirsman of Hebrew University of Jerusalem would oversee operations. Khalil Shikaki, director of the Palestinian Center for Policy and Survey Research in Ramallah, led efforts in the Palestinian Territories.

The team started in 2007 with 1,500 kids—600 Palestinians, 450 Israeli Jewish, and 450 Israeli Arabs, split evenly among 8-, 11- and 14-year-olds. The researchers also interviewed a parent of each child or teen. Interviewers approached the same kids and parents every year for three years, asking questions covering 24 indicators of exposure to ethnic-political conflict and violence. These ranged from watching political violence on TV news, to spending hours in a security shelter, to witnessing actual violence or dealing with the death of a family member or friend.

It was critical to frame the questions so as not to place respondents in legal jeopardy, or, for that matter, to encourage false answers. “We couldn’t ask a Palestinian, ‘Have you thrown a rock at an Israeli soldier?’ which would be the most common way you would aggress against the Israelis,” Huesmann explains. “But we could ask, ‘Have you been in a demonstration where rocks have been thrown against Israeli soldiers?’ It’s a subtle difference, but legally an important one.”

Table: Mediators of the Relation Between Exposure to Violence and Aggression in Israeli and Palestinian Youths

And to successfully do research in Israel and the Palestinian Territories, Israeli and Palestinian researchers had to take the lead, Huesmann says. Only they would know the best way to build a representative sample, to elicit cooperation, to maintain the trust of authorities, and even to know what questions you can and can’t ask.

Having said that, operating in Israel in many ways was not that different from doing research in the United States. Simha Landau of Hebrew University engaged a survey research company that contacted respondents by phone and then sent interviewers across the country to do face-to-face interviews. Polls and surveys are common in Israel, and the standard of living too high for the 100-shekel participant incentive provided by NIH—equal to about $25—to mean much. Thus, many respondents were somewhat jaded, Landau says. That, combined with Israeli residents’ easy mobility, contributed to a significant falloff in the sample; only about 63 percent participated in the second and third waves of the survey.

In the Palestinian Territories, it was a different story. The Palestinian Center for Policy and Survey Research (PSR), like ISR, does its own survey work, and is deeply embedded in the communities where it operates. “Because of Israeli checkpoints, because we are concerned about the mobility of our data collectors and our field workers, we’ve built local capacity,” Khalil Shikaki says. “In any single geographic location, we have teams of interviewers and field workers. It is their responsibility to make sure throughout the year that we remain in touch with the families.”

Shikaki says it was easier to recruit survey participants in Palestine than in Israel or the US, where pollsters call on the phone and residents routinely beg off or don’t answer at all. By contrast, all PSR’s contacts were face to face. “It’s more difficult for someone to turn away two young data collectors who knock at their doors,” he says. The 100-shekel incentive also meant much more to poor Palestinians in Gaza and the West Bank than to a typical Israeli. The fact that many Palestinians can’t move freely also likely contributed to PSR’s remarkable 95 percent retention rate over the three years of the survey.

“The most important finding is that simple exposure to violence results in very substantial increases in both the risk of behaving aggressively against your peers in the in-group, and a significant increase in the risk for developing PTS symptoms.”

Data collection ended in 2010, and the results, now appearing in a series of articles, have been illuminating, Huesmann says. “The most important finding is that simple exposure to violence results in very substantial increases in both the risk of behaving aggressively against your peers in the in-group, and a significant increase in the risk for developing PTS symptoms—anxiety, depression, and so on,” he says. “We expected we’d find some effects, but they’re really quite substantial. We were particularly surprised by how much war violence leads to increased aggression by youth directed at their own peers.” The team also found that ethnic political violence has a cascading effect, stimulating violence within ever-smaller social spheres—the community, schools, peers, and families, all of which increase the violence of the individual.

Part of the value of the research was getting to look more carefully at why observing violence increases aggression by the observer. Many children who routinely witness political violence begin to see it as normal, Huesmann says; they become convinced that the world is a hostile place, and eventually become desensitized to the point that a violent act may produce little emotional reaction at all. “What we’re talking about are very fundamental rules of how the nervous system, the brain, the mind works,” Huesmann says. “I believe what we found here in just two cultures is probably generalizable to anyplace.”

For team member Eric Dubow, a clinical psychologist by training, the study was also a chance to investigate the factors that protect kids from negative outcomes. “One of the things we’re finding is that self-esteem seems to be a protective factor for these kids, and so is positive parenting—parenting that’s non punitive,” Dubow says. “Some of these kids are exposed to pretty chronic violence, and often that erodes those potential protective factors. But that’s not what’s happening here.” Perhaps not surprisingly, children whose parents punish them harshly are more likely to be aggressive themselves, or to suffer PTS symptoms.

All of this has policy implications; the researchers plan to recommend approaches both to protect kids from bad effects and to help those already affected. Educating adults about parenting approaches and placing adequate social and therapeutic resources in schools and communities would be important first steps. “We think that every school should have more than one social worker, and that they should be trained to address these specific issues that we find to be very troubling,” Shikaki says.

Indeed, for Shikaki, the policy implications are the crux of the entire survey. Palestinians reported the most incidents of political violence, and showed the highest levels of aggression and PTS symptoms. In fact, about a quarter of the Palestinian kids could probably be diagnosed with full-blown PTSD, Dubow says, compared to about 6 percent of Israeli Jews and Israeli Arabs. As Shikaki notes: “Our children, in particular, are at much greater risk, which means we really need a much greater intervention at the policy level to address these issues. If this is not addressed, we’re planting the seeds for the next conflict.”

The researchers agree that the ultimate solution would be to stop this and other conflicts. But given the reality, world leaders must, at a minimum, understand that all wars inflict collateral damage on youth. “Children are at a critical period where their personalities are being molded,” Huesmann says. “We’re talking about how their beliefs, their social cognitions, their emotional reactions are changed. And once these cognitions become crystallized, it’s very difficult to dissolve them.”

From left: Simha Landau and Rowell Huesmann in Israel. Photo courtesy of the researchers.

From left: Jeremy Ginges, Khalil Shikaki and Eric Dubow at the Palestinian Center for Policy and Survey Research in Ramallah. Photo courtesy of the researchers.










Other ISR studies in the Middle East:

Arab Barometer

Directed by Mark Tessler of U-M and Amaney Jamal of Princeton University, and coordinated by an international team composed primarily of Arab scholars, these surveys involve face-to-face interviews with representative, probability-based national samples in 11 Arab nations.

Middle Eastern Values Study

Directed by Mansoor Moaddel of ISR and Eastern Michigan University, this systematic, comparative study probes the values and attitudes of the population in Egypt, Saudi Arabia, Lebanon, Iraq and other Islamic countries.