Accessibility of day–night emergency alert systems for Deaf and hard-of-hearing adults during armed conflict

BACKGROUND: People with disabilities, including Deaf and hard-of-hearing (DHH) individuals, face disproportionate disaster risks due to communication barriers. Emergency alert systems are predominantly auditory-based, limiting their effectiveness for DHH populations. This gap is especially critical during armed conflict, where timely alerts can be life-saving. OBJECTIVE: This study examined emergency alert system accessibility and associated psychological distress among DHH adults during active armed conflict. METHODS: A cross-sectional online survey was conducted in Israel (October-November 2023) during the early phase of the Israel-Hamas War among DHH adults (N = 167), assessing daytime and nighttime alert accessibility and psychological distress. Analyses included McNemar's test, repeated-measures ANOVA with Bonferroni correction, independent-samples t-tests, and one- and two-way ANOVA. Effect sizes were reported throughout. RESULTS: Participants included 87 Deaf (52.1%), 73 hard-of-hearing (43.7%), and 7 (4.2%) identifying as "other," with a mean age of 55.3 years (SD = 16.4). While 69.5% received alerts via the national application during daytime, only 32.3% did so at night, indicating a substantial nighttime accessibility gap. Alert accessibility was only partially associated with psychological distress. Women reported significantly higher distress than men (p < .019). No significant differences emerged between Deaf and hard-of-hearing participants in alert use or distress levels. Education level did not predict alert accessibility, suggesting structural rather than user-dependent barriers. CONCLUSIONS: DHH individuals face systematic barriers to accessing emergency alerts, particularly at night. Equitable disaster preparedness requires multimodal systems incorporating visual, vibration, and text-based channels. Culturally accessible mental health support should be integrated into emergency response protocols.