Background

Armed conflict causes tremendous challenges to the health of civilians, particularly vulnerable populations such as children. While the world’s attention in Gaza has focused on the unfolding conflict and the tragic loss of life in Israel and Palestine alike, another cohort of casualties has gone unaddressed: Gazan children born with congenital heart disease. 

Historically, these children have received special travel permissions to cross the Gaza-Israel border for treatment at an Israeli hospital for pediatric surgical and interventional cardiology care, or been operated on by teams in Gaza from non-governmental organizations (NGOs). Since the onset of armed conflict in October 2023, however, no child with congenital heart disease has been able to cross the border nor have any surgical teams entered the conflict zone. 

Prior studies have demonstrated a high incidence of congenital heart disease in Gaza (10 per 1000 population), estimating that approximately 360 children have been born with congenital heart disease in Gaza since the beginning of conflict. However, the impact of armed conflict on Gazan children, their families and healthcare providers is poorly defined. 

Capitalizing on long-standing partnerships with NGOs and Israeli medical centers, this team will define the impact of war on Gazan children with congenital heart disease and bring global awareness to this growing catastrophe. 

Project Description

This project team will measure and document the impact of the Israel-Hamas conflict on Gazan children with congenital heart disease, their families and the healthcare providers in Israel who previously cared for this population. The team will ultimately aim to make the case for emergency reinstatement of travel permissions for Gazan children to receive surgical care. 

To achieve these goals, team members will:

1. Measure the number of children with congenital heart disease in the Gaza Strip and estimate the impact of the Israel-Hamas conflict on the burden of untreated cardiac disease. Team members will collect data from local NGOs that have facilitated the movement of children from Gaza to Israel for cardiac care as well as data from three Israeli hospitals that provide cardiac care. Team members will review the medical records of all Gazan children undergoing congenital heart disease care at these sites over the five-year period prior to the armed conflict as well as since the onset of conflict (estimated total sample size of 1200 children). They will collect data on patient age, gender, diagnosis and surgical procedure performed. 
2. Explore the psychological and social impact of the Israel-Hamas conflict on the families of children with congenital heart disease in the Gaza Strip. The team will conduct focus group discussions with Gazan families of children with congenital heart disease and perform qualitative analysis. Team members will develop a semi-structured interview tool concentrating on family experiences, including access and barriers to care,  and experiences of powerlessness, grief, loss of control, gratitude, moral incongruity, survivor guilt, access to screening, medications, follow-up care and the impact of living with the fear of caring for a child within a conflict zone. The team will then perform qualitative thematic content analysis to identify the most frequent and significant codes to inform salient data categories.
3. Investigate the psychological and social impact of the Israel-Hamas conflict on healthcare providers who previously cared for Gazan children with congenital heart disease. The team will conduct focus groups and interviews with Israeli healthcare providers from each of the three medical centers in Israel. Using similar methods to the discussions with families, interviews and analysis will focus on cognitive dissonance, moral incongruity, anger, grief, guilt and hope.

Anticipated Outputs

Policy brief outlining the need for reinstatement of travel permissions for Gazan children with congenital heart disease; policy brief for Palestinian Health Authority detailing estimates of adjusted life years lost by cessation of provision of care; manuscripts with quantitative and qualitative findings; proof of concept for similar projects in conflict areas (e.g., Ukraine, Sudan, Yemen, Syria)

Student Opportunities

Ideally, this team will include 3 graduate/professional students and 6 undergraduate students with interests and/or experience in global health disparities, conflict studies, medicine and surgery, and international advocacy and policy.

The team will meet weekly to build cohesion, align vision and develop research tools and then will split into three subteams based on each research aim – 1) clinical data collection/analysis; 2) focus group discussions with Gazan families; and 3) focus group discussions with Israeli healthcare providers.

Team members will gain experiences in literature reviews, qualitative and quantitative data collection and analysis, survey and focus group design, manuscript drafting and editing, engagement with NGOs and coordination with international health ministries and hospitals.

In Fall 2024, the team will meet on Thursdays from 5:00-6:00. 

Timing

Fall 2024 – Summer 2025

• Fall 2024: Seek IRB approval; conduct literature review; identify focus group participants from Gazan families and Israeli doctors/healthcare providers; begin quantitative data collections
• Spring 2025: Complete quantitative data collection; conduct quantitative data analysis; model future projections; draft policy briefs; host focus groups 
• Summer 2025 (optional): Finalize and distribute policy briefs; conduct additional focus groups; complete qualitative data analysis; draft manuscripts

Crediting

Academic credit available for fall and spring semesters; summer funding available