Human (in)security and psychological well‐being in Palestinian children living amidst military violence: A qualitative participatory research using interactive maps

Abstract Background Research has widely evidenced the effects of war and political violence on the functioning of children, with a great accord in diagnosing children's psychological burdens related to their exposure to violence. Yet, within this literature, the influence of the chronic sense of insecurity on their psychological functioning during and after hostilities remains unexplored. Methods The present study aimed at exploring interrelated relationships between the perceived insecurity and the children's psychological well‐being and their adjustment to trauma. Based on drawings and walk‐along interviews with 75 Palestinian children, residents of both the West Bank and Gaza Strip, we offer an analysis of human security‐related risks and protective factors that contribute to either promoting or undermining the child's psychological functioning in a context characterized by chronic instability and political violence. Results A complex network of sources of security and insecurity emerged from the narratives depicting an ecological portrait encompassing the determinants of children's mental health and psychological functioning. The TCA led to the identification of eight main themes: school and associativism; social relations and house as a source of security/insecurity; military occupation as a source of insecurity; national and political identity as a source of safety; mosque and spirituality as a source of safety/unsafety; environment as a source of security/insecurity; and mental health. Discussion An approach encompassing human security as an explicative model can help in exhaustively portraying the complexity of the Palestinian children's suffering and their competence in adjusting to their traumatic reality. The study draws attention to social, political, environmental and economic determinants of children psychological well‐being.


| INTRODUCTION
Studies have reported psychological burdens as a long-term effect of children's exposure to armed conflicts and structural violence (Catani, 2018;Denov & Fennig, 2020). Most of the research associated the children's suffering during the war and their exposure to traumatic experiences with resultant trauma-related pathologies Karam et al., 2019), whereas social and political determinants of the war-affected children's psychological breakdown have been much less considered and under-analysed within the literature (Bloom, 2019;Dawes, 2020). In fact, the psychiatric discourse on war and violence is the dominant one in the mainstream clinical and health pathology (Summerfield, 1999(Summerfield, , 2000. A systematic review of 7920 children's mental conditions in the aftermath of war reported that post-traumatic stress disorder (PTSD) was the primary syndrome, whereas in fewer studies, both elevated levels of depression and anxiety disorders were reported (Attanayake et al., 2009). In Gaza, 535 out of 549 children were found to suffer from some trauma-related syndromes , whereas Syrian refugee children resettled in Jordan and Lebanon were diagnosed with PTSD associated with emotional dysregulation.
Hence, a massive corpus of research has certified that PTSD syndromes are an epidemic among war and systematic violence-affected children worldwide (Fazel & Stein, 2002;Khamis, 2012). Despite this, human rights-related issues and their effect on children continue to be more volatile and controversial topics in the scientific arena (Denov & Fennig, 2020;Kienzler, 2019).
However, several sources of human insecurity have been identified as risk factors for children experiencing war and political violence. is restricting access to primary resources and limiting freedom of movement within, across and outside the occupied territories (Batniji et al., 2009

| Instruments and procedures
All the children were asked to draw a map on an A3 white paper representing all of the significant places in their neighbourhoods, whether they perceived them as safe or unsafe, and describe them. Participants were given three colours: green to represent safe places, black for neutral ones and red to represent unsafe places (Blaut et al., 2003). Upon completion of the drawing task (all children participated), 40% of them (seven from Nablus City, six from the village of Fasayel, 10 from Dheisheh refugee camp, three from Gaza City and four from Jabalia refugee camp) were invited to continue the interview during a

Key messages
• Children in Palestine experience high degrees of human insecurity.
• Human insecurity affects children's mental health and psychological functioning.
• Individual and collective factors shape children's suffering in Palestine.
• Clinical work focused on adapting victims to abnormal living condition is ethically questionable and ineffective.
• Participative and community-oriented programmes can generate healing forces within the Palestinian children and population.
walk-around in their neighbourhood while showing the places they inhabit in their daily lives (Anderson, 2004;Carpiano, 2009). The remaining children (60%) did not participate due to previous commitments with their family, work or school commitments. The activity consisted of one child at a time leading the team on a tour of his/her neighbourhood, both among the places drawn and beyond them. This technique of 'talking while walking' (Anderson, 2004) has been described as a 'walk-around' (Carpiano, 2009), and it has been specifically used to study the interactions and implications of place on people's general health and well-being (Carpiano, 2009).
Participants were fully informed about the research aims, and all children and their families were asked to provide verbal informed consent. Children were free not to answer any of the researchers' questions or to withdraw themselves from the study at any moment. The research was conducted according to American Psychological Association (APA) ethical guidelines concerning child protection (APA, 2013) and approved by Milano-Bicocca's Institutional Review Board (N.368).
All children's narratives were recorded, transcribed and translated into English by a local bilingual researcher and analysed by two independent researchers (Lambert, 2019). A deductive, top-down content analysis approach was used to categorize data using NVivo12 Software. Inter-rater agreement was satisfactory at 72%. The main themes were selected via a consensus by discussion procedure.

| FINDINGS
The TCA led to the identification of eight main themes. Up to seven of the themes were declined regarding self-perceived security and insecurity among the interviewed children. The remaining thememental health-was made of two subcomponents (negative emotions and perceived insecurity tied to ongoing hardships and fear and traumatic memories), explaining children's mental distress exposed to systematic violence and political oppression.

| School and associativism as a source of security/insecurity
Education is an asset for people living under oppression, and school is also a privileged arena for establishing social connections and struggling for collective liberation (Reynolds, 2007;Todd, 2011;Vollhardt et al., 2020). As a consequence of the ongoing colonial and military violence, the school can be either protective or unsafe when disrupted by highly traumatic events (Marie et al., 2018).
School can be perceived as one of the few safe places to play and spend time socializing and learning in an occupied landscape. It is a shelter for an activity that can restore a sense of efficacy and endurance despite the surrounding uncertainty and instability .
If there is bombing while we are in school, we do not get afraid. I feel safe at school. We are inside, and I am not afraid since I am with my friends. (Gaza, Y, 11 years old, male) Paulo Freire explains in Pedagogy of the Oppressed (Giroux, 2010) that school is the privileged place for liberatory education. Accordingly, education is a practice of freedom and resistance in the face of despair and hopelessness that can allow children to perceive a sense of competence and endurance in a dangerous and disruptive environment. Education is a means to understand and resist oppressive and to colonize structures of power that dehumanize the Palestinian community and subjugate any attempt of a critical and anti-colonial interpretation of historical facts in the region, ultimately creating a system of repression and surveillance that undermines people's well-being and functioning . On the contrary, school and associative places can be perceived as unsafe or dangerous spaces exposed to military incursions, intracommunity violence and aggression. Furthermore, there is a risk of school being negatively perceived as an oppressive institution where pupils feel overwhelmed by their duties (e.g. school assignments and institutional pressures) and frightened by unhealthy relationships with teachers and adults (Elbedour et al., 1997;Kortam, 2018

| Social relations as a source of security/ insecurity
Sociality in a collectivistic society can be counted as a protective factor from hardships and violence (Afana et al., 2018). Sharing experiences and emotions within the family circle, both nuclear and extended, can provide children with adjustment and coping strategies and reduce their sense of isolation and despair due to the unstable and disrupted living environment (Srour & Srour, 2006 On the other hand, strict social control within the family creates a sense of social suffocation that prevents individuation, especially among the young generation, including children (Akesson & Grinberg, 2020). A lack of individual freedom is a consequence of being controlled and judged by family members, both at a nuclear and extended level (Kortam, 2018).
In those houses, there is a relative who fought with my

| House as a source of security/insecurity
A house can be considered the most quintessential site of protection and safety for children, especially when we analyse a society organized and shaped by familial norms (Kulwicki, 2020). can also generate many conflicting meanings. For example, children can also experience the home as a source of uncertainty and anxiety (Akesson, 2014

| Military occupation as a source of insecurity
The Palestinian landscape is marked by signs of structural and organized violence (Weitzman, 2007). Living within this traumatic reality endangers childhood growth and development as they must constantly adjust to abnormal living conditions, comprising soldiers' harassment, settler violence, humiliating checkpoints, a separation wall and fences and barriers that jeopardize the Palestinian territory.
This sense of social suffocation and hopelessness among Palestinian children is the direct psychological consequence of Israeli military surveillance (Khamis, 2020

| National and political identity as a source of safety
Security can be perceived at a macro level through the national sense of belonging, fostering feelings of protection and self-esteem among children. National identity can be considered a source of security and political well-being (Veronese, Pepe, et al., 2020). In fact, active participation in the struggle to end the occupation provides children with a sense of social competence and agency within an otherwise hostile and constraining environment.
Here 3.7 | Environment as a source of security/ insecurity On the other hand, well-known places contribute to fostering children's self-confidence and sense of security.
I feel safe here because I was born here, I know this place. It is nice to explore places outside, but the best place is the place where you were born. Here I feel safe. (A, 13 years old, female, Nablus) Parks and the few other available green areas also improve the children's perception of well-being and satisfaction with their own lives as it helps them overcome the sense as mentioned above of social suffocation. Sadness and fear undermine the psychological development of children exposed to multiple traumatic experiences, and it generates traumatic memories and acute stress (Peltonen et al., 2017). Trauma is widespread among children in Palestine (Espié et al., 2009). The peculiarity of the complex trauma affecting the Palestinian population, including children, is marked by the absence of a 'post' condition. In fact, children are enmeshed in a distressing reality where the trauma is ongoing, multiple, multigenerational and historical (Mahamid, 2020;Mahamid & Veronese, 2020 (Meari, 2015). Children perceive themselves as part of a community struggling for recognition and survival, overwhelmed by decades of oppressive colonial domination, dispossession and human insecurity (Figure 1).
Regarding the demographic variables, some gaps between living contexts and gender differences emerged from the analysis. Children living in refugee camps and villages were more exposed to the burdens of the Israeli military occupation than children living in the cities.
Environmental barriers, greater exposure to military and settler violence bared those children as living a greater sense of insecurity than those living in urban areas (Cavazzoni et al., 2021;Mahamid & Veronese, 2020). Moreover, boys were more at risk of traumatic experiences than girls, most often more protected in the domestic sphere. However, girls seemed to perceive other forms of insecurity, more related to a form of patriarchal marginalization and relegation to the margin of the Palestinian community (Mahamid, 2020). We acknowledge that engendered forms of insecurity must be further studied and deeper discussed in future research.
A holistic approach to analysing Palestinian children's social suffering and their ability to adjust to their traumatic reality must encompass human security as an explicative model (Cavazzoni et al., , 2021. The social, political, environmental and economic determinants of children's psychological well-being must be taken into consideration in approaching the assessment, diagnosis and therapeutic intervention, especially when we are confronted with environments characterized by structural violence and severe violations of human rights (Batniji et al., 2009;Ziadni et al., 2011). In Palestine, approaches exclusively oriented at alleviating the psychological burdens of the victims of systematic violence, as well as fostering resilience within such battered communities, must simultaneously be oriented at subverting and changing the underlying conditions that contribute to the maintenance of systems of oppression and violence (McNeely et al., 2014;Veronese & Castiglioni, 2015). On the other hand, clinical workoriented solely at reducing symptoms or adapting victims to abnormal living conditions, although ethically questionable, could reveal its inefficacy, if not its iatrogenic effects (Giacaman, 2014;Kienzler, 2008).
In contrast, participatory programmes can help Palestinian children challenge and subvert dominant power structures that oppress them. These programmes enable them to transform their surrounding environments and increase their resistance and endurance to traumatic circumstances, as well as restore a sense of security that has been undermined by decades of oppression and structural violence (Rabaia et al., 2014). Community-oriented programs can generate healing forces within the Palestinian population that utilize political well-being, a sense of collective belonging, and participation as protective dimensions to control human insecurity (Hammoudeh et al., 2013) and foster agentic behaviours in children.
A sensitive approach to human security frameworks must also consider children's mental health as a holistic and multifaceted dynamic process. Thus, psychological well-being is made of interlocked domains and dimensions involving micro (individual's reactions to adverse conditions), miso (economic, political and environmental F I G U R E 1 Sources of human (in)security emerging from children narratives conditions affecting systems and acting within and between communities) and macro levels (spirituality, national identity and sense of belonging) (Gostin, 2001) that are promoting or impeding the sense of personal security of children affected by systematic violence and political oppression (Batniji et al., 2009).
Finally, some limitations to this study must be acknowledged and discussed. Firstly, the researchers engaged in this exploratory research were trained in a Western context and Westerners. This could have affected both the interaction and dialogue with indigenous children and the interpretation of the results. However, the diversity of the research team could have controlled such kinds of biases. Besides, and this could be considered a second limitation, short phase data collection could reduce the richness of the information and reflective elaboration of the participants' perspectives. For future research, ethnographic approaches and multicultural research teams are strongly recommended.

ACKNOWLEDGMENT
Open Access Funding provided by Universita degli Studi di Milano-Bicocca within the CRUI-CARE Agreement.

DATA AVAILABILITY STATEMENT
Due to the sensitivity of the topics and potential risks for children, data are available only on request to authors and after careful consideration of the research team.