Predictors of Traumatic Stress Symptoms and Posttraumatic Growth Among Humanitarian Workers In Palestine

Background: Armed conflict places humanitarian workers at increased risk of physical danger and psychological stress. In Palestine, prolonged conflict and ongoing genocide have intensified trauma exposure and strained systems across diverse sectors. Humanitarian workers may experience direct and indirect trauma exposure with both positive and negative impacts. This study examined predictors of traumatic stress symptoms (TSS), and posttraumatic growth (PTG) among Palestinian humanitarian workers.

Methods: Data were collected using an online cross-sectional quantitative survey of the Global Humanitarian Initiative (GHI) administered via Qualtrics. The sample consisted of aid workers who served the Palestinian population at NGOs. Data collection took place between August and December 2025. Demographic variables included age, sex, education, economic status, and primary work location (i.e., West Bank, Jerusalem, and Gaza). Trauma exposure was assessed through weekly hours of trauma-related work, living in the same conflict zone as clients, and the percentage of in-person client interactions. Traumatic stress symptoms were assessed via the Harvard Trauma Questionnaire (HTQ), whereas posttraumatic growth was assessed via the Post-Traumatic Growth Inventory–Short Form (PTGI-SF).

Results: The sample comprised 198 humanitarian aid workers operating in the West Bank (51.4%), Jerusalem (7.2%), and Gaza (38.7%). Two regression models were estimated; both were statistically significant. The HTQ model explained 19% of the variance, with greater weekly hours of trauma-related work (β = .004, p = .049) and working in Gaza (β = .20, p = .047) associated with higher traumatic stress. The PTG model explained 24% of the variance and identified distinct predictors. Greater in-person interaction was associated with higher PTG (β = .082, p = .001), while individuals not living in the same conflict zone reported significantly lower PTG compared to those who were (β = −4.20, p = .003). Higher educational attainment was also associated with lower PTG, with significant reductions observed for for high school graduates (β = −7.52, p = .013), bachelor’s (β = −4.96, p = .012), master’s (β = −6.07, p = .006), and doctoral degrees (β = −6.32, p = .023), while other education levels were not statistically significant.

Conclusions and Implications: These findings indicate that work-related trauma exposure and conflict intensity, rather than demographic characteristics, were associated with both traumatic stress symptoms and posttraumatic growth. Given the severity of trauma exposure, the observed HTQ patterns did not fully align with expectations and may reflect the effects of ongoing conflict and continuous exposure on psychological responses. Greater in-person interaction was associated with higher posttraumatic growth, suggesting that direct engagement may support meaning-making and coping with extreme violence. In contrast, the negative association between higher educational attainment and posttraumatic growth indicates that education alone may not serve as a protective factor. Posttraumatic growth may not emerge during ongoing conflict and may require time and supportive conditions for recovery and meaning-making. Overall, these findings underscore the complexity of psychological responses to trauma and highlight the need for context-sensitive frameworks that account for continuous exposure and the limitations of traditional PTSD and posttraumatic growth models in protracted conflict settings