Double Burden of COVID-19 Pandemic and Military Occupation: Mental Health Among a Palestinian University Community in the West Bank

Background: The Covid-19 pandemic created major global health crises, with serious effects on all aspects of life. The pandemic reached the Israeli occupied West Bank of Palestine in early March 2020, and lockdown immediately ensued. Objectives: To assess the prevalence and predictors of distress and insecurity among Birzeit University's community during the COVID-19 pandemic and lockdown. Methods: An online survey completed in March-April 2020 using standardized and previously validated distress and insecurity scales. The survey was placed on the University portal accessed by students, faculty and employees, and was sent by email to faculty and employees. Data were weighted to reflect the University community's distribution. Findings: There were 1,851 participants in the study: 84% were undergraduate students, 10% graduate students, and 6% faculty and employees. Sixty two percent were women. Ages ranged from 17 to 70 years (mean 24 +/- 9.7). Prevalence of moderate/high distress and insecurity were 40% and 48% respectively. Multiple logistic regression revealed that women, those under 35 years old and those with worse reported income, had significantly higher odds of distress and insecurity compared to their counterparts. Undergraduate students or living with a person at home with high risk of illness with COVID-19 were associated with higher odds of distress compared to their counterparts (OR = 1.56, 95%CI[1.13-2.15]) and (OR = 1.34, 95%CI[1.11-1.62]) respectively. A COVID-19 worry score was significantly associated with higher odds of distress and insecurity (OR = 1.77, 95%CI[1.46-2.14]) and (OR = 4.3, 95%CI[3.53-5.23]) respectively. Conclusion: This study emphasizes the need to pay attention not only to physical health but also to mental health during the COVID-19 pandemic, especially among young people, women, those with lower economic status, and those living with high risk persons during the pandemic. We hope that this study will inform the policies and interventions of the Palestinian Authority, local non-governmental organization, international groups working in the occupied Palestinian territory, and beyond.