Objectives: To investigate the influence of exposure to humiliation in war-like conditions on health status in 10th- and 11th-grade students living in the Ramallah District, West Bank, Occupied Palestinian Territory. Study design: A stratified single-stage cluster sample of 3415 students from cities, towns, villages and refugee camps of the Ramallah District. Methods: Survey questions were derived from the World Health Organization's Health Behaviour in School-aged Children Survey, the Gaza Community Mental Health Programme Traumatic Event Checklist, and focus group discussions with young people. The survey questionnaire was completed by students in their classrooms, under the supervision of a trained field worker. Results: There was a significant association between a high number of subjective health complaints and demographic variables, particularly for females compared with males, and refugee camp dwellers compared with village dwellers. In addition, exposure to humiliation was significantly associated with an increased number of subjective health complaints. Students experiencing three forms of humiliation were found to be 2.5 times more likely to report a high number of subjective health complaints compared with those who had never been exposed to humiliation (52% vs 21%), while those experiencing four forms of humiliation were three times more likely to report a high number of subjective health complaints (62% vs 21%). A multiple logistic regression model revealed that humiliation was significantly associated with a high number of subjective health complaints, even after adjusting for sex, residence and other measures of exposure to violent events. The odds ratio of reporting a high number of subjective health complaints increased as the number of forms of humiliation increased, with values of 1.69, 2.67, 4.43 and 7.49 for reporting a high number of subjective health complaints when exposed to one, two, three or four forms of humiliation, respectively, compared with those who had never been exposed to humiliation. Conclusions: The results of this study demonstrate that humiliation induced by conflict and war-like conditions constitutes an independent traumatic event that is associated with negative health outcomes in its own right, regardless of exposure to other violent/traumatic events. Based on these findings, it is proposed that humiliation should be included as an indicator of mental health status in research that investigates the consequences of war and conflict on the health of populations. © 2007 The Royal Institute of Public Health.

Health outcomes War and conflict Palestinian youth Humiliation

Eurasia questionnaire survey refugee adolescent disease demography Emotions conflict Adolescent Psychology mental health human risk assessment Health Behavior sex difference Asia war violence Middle East controlled study life event health status Arabs human rights abuse Palestine cluster analysis student Humans health impact Adolescent male female young population risk factor environmental exposure population research Occupied Territories West Bank Article major clinical study Child Abuse adult posttraumatic stress disorder Sex Factors Stress Disorders, Post-Traumatic health hazard health survey