A study focusing on Israelis residing in areas targeted by Hamas missile strikes during the May 2021 conflict revealed that wellbeing indicators fluctuated during the missile strikes and throughout the duration of the war. However, these indicators returned to their pre-war values shortly afterwards, with almost all participants showing a return to baseline levels. The study was published in Nature Communications Medicine.
Wars can take a heavy toll on individuals involved in them. It is the one of the very few conditions when it can become both socially acceptable and legal to wound or kill other humans, destroy their property, and infringe on personal liberties of individuals who have not broken any laws.
Additionally, with changes in the technology of warfare in the past 200 years, wars started affecting civilians even more than in earlier times. While intentional targeting and massacring of civilians and looting of their property were quite common in wars of previous centuries, this tended to mainly affect civilians living in areas where wars took place.
In contrast, modern warfare allows for the targeting of civilians even far from frontlines through aerial bombardments, artillery, and missile strikes. Today’s conflicts are fought across extensive lines, often involving civilian settlements for fortifications, shelter, and concealment of military equipment. This has resulted in a decrease in safe areas due to the increased range of weapons.
These developments cause both bodily and psychological damage to civilians exposed to war. Additionally, easy access to media, and particularly social media, was shown to additionally increase levels of fear in individuals living in areas affected by war. Researchers have long studied effects of living in conditions of war on psychological well-being of civilians. However, most of those studies were retrospective in nature i.e., conducted after the war ended and based on reported memories of survivors.
Study author Merav Mofaz and his colleagues wanted to examine the effects of war on civilians in real-time. They planned to utilize the capabilities of smartphones and smartwatches to observe both objective and subjective changes in individuals experiencing wartime conditions. Their focus was on the changes that occurred during the 2021 Israel-Hamas conflict in Gaza.
In April-May 2021, after a series of incidents, massive Palestinian protests erupted. Amid these tensions, Hamas, which governs the Gaza Strip, began firing rockets at Israeli settlements. In response, Israel initiated air strikes on Gaza. Over the course of the hostilities, over 4300 rockets and missiles were launched towards Israeli cities, while Israel conducted 1500 aerial, land, and sea strikes towards 16,500 targets in the Gaza Strip.
The study included 954 Israeli participants, all over 40 years of age, with a median age of 59. Of these, 549 were women, and 50% had incomes above the median level. They resided in regions targeted by Hamas missiles from Gaza. Among them, 74% lived in areas at medium risk of rocket and missile attacks, 7% in high-risk areas, and the remaining 19% in areas not exposed to missile attacks.
The study started on April 26, 2021, two weeks prior to the onset of the full-scale war. This period was marked by escalating hostilities, although the war had not officially begun. The study concluded shortly after a ceasefire was established in early June 2021.
Participants were instructed to install two applications on their smartphones: the Garmin Connect app, which gathered data from their smartwatches, and a specialized app created for this study. This second app collected GPS-based data on their locations and enabled them to complete daily questionnaires.
Participants wore Garmin smartwatches, which recorded data such as daily step counts, average heart rate, sleep onset time, and the percentage of awake time during the night. Their smartphones’ sensors captured the total duration the screen was active each day, a metric closely linked to stress, and the amount of time the phone remained stationary. They also filled out daily questionnaires reporting their mood (ranging from awful to excellent), sleep duration, sleep quality (also on an awful-to-excellent scale), time spent engaging in sports, and the number of social interactions they had.
Results showed that participants’ heart rates considerably increased after they heard an air-raid siren. From an average 50 beats per minute before the siren, the number of heartbeats would increase to 76 beats per minute an hour after the siren. During the war, Israeli authorities used air raid sirens to warn civilians that missiles and rockets were detected flying towards the area they live in. The heart rates returned to baseline values 20 minutes after the missile strike alert ended.
The war adversely affected all the wellbeing indicators. These effects were significantly larger in areas with a higher risk of exposure to missile attacks. More specifically, the daily time that smartphone screen was turned on was 38 minutes longer on average during the war. The reported mood decreased; stress increased.
The number of social encounters, as well as the number of steps taken in a day were also lower during the war. Sleep time was delayed by 9 minutes on average during the war, sleep duration decreased by 10 minutes, and the quality of sleep worsened somewhat. However, these changes largely reversed within two weeks after the war’s conclusion.
“The main findings of our study are that Israelis showed an acute and robust reaction to the war situation,” the study authors concluded. “The reaction was demonstrated in sharp responses in both objective and subjective measures related to three axes, mental, energy expenditure, and sleep. All these measures worsened during the war.
“Interestingly, our data suggest the resilience (the ability of the individual to ‘bounce back’ after the war) of the Israeli civilian population: as quick as the effects of the war were, so was the recovery, with all the measures that were altered during the war period returning approximately back to normal within 2 weeks after the cease-fire date.”
The study presents a novel way to study the psychological effects of war on civilians. However, it’s important to note that the Israeli-Palestinian conflict has persisted for decades. Consequently, the Israeli population may have become accustomed to these war conditions.
Additionally, Hamas missile strikes tend to be imprecise, using mainly low-payload rockets, while Israeli anti-missile defenses are among the best in the world. Due to this, these missile strikes result in very few casualties and limited damage to property. Findings might not be the same if the study was conducted on a population without prior experience of war, protected by weaker defenses, and subjected to heavy aerial bombardment or missile strikes, in which risks of death, bodily harm or destruction of the living surroundings were much higher.
The paper, “Real-time sensing of war’s effects on wellbeing with smartphones and smartwatches”, was authored by Merav Mofaz, Matan Yechezkel, Haim Einat, Noga Kronfeld-Schor, Dan Yamin, and Erez Shmueli.