Functional and psychiatric consequences of war-related amputation in Gaza and the burden on caregivers: a cross-sectional comparative study

BACKGROUND: The war in Gaza since October 2023 has resulted in unprecedented rates of traumatic limb loss. Local evidence on the functional and psychiatric consequences for survivors and caregivers remains limited. METHODS: We conducted a cross-sectional comparative study across three rehabilitation centers in Gaza, recruiting 96 adults with war-related limb amputations, 53 primary caregivers, and 95 community-based controls matched for age, sex, and education. Functional disability was assessed using WHODAS 2.0, and psychiatric symptoms with PHQ-9, GAD-7, and PC-PTSD-5. Predictors of disability were examined using multivariable ordinal logistic regression. RESULTS: < 0.001) with large effect sizes across domains. Psychiatric symptoms were markedly elevated among amputees, and 74% screened positive for two or more disorders versus 52.8% of caregivers and 16.9% of controls. In adjusted models, belonging to the amputee group (OR 48.1), higher depressive symptom severity (OR 1.38 per point), and older age (OR 1.06 per year) were independently associated with greater disability, while income, sex, education, and other sociodemographics were not. CONCLUSIONS: Integrated interventions combining functional rehabilitation with sustained mental-health and psychosocial support are urgently needed to address the impacts of war-related amputation in Gaza.