The impact of war, work, and daily life stressors on the mental health of nurses in Gaza during the 2023–2025 war

Systematic attacks on Gaza’s health system, including the direct targeting of healthcare infrastructure, healthcare workers, and evacuations, have brought the Gazan health system to the brink. As resources become increasingly constrained, individuals face cumulative and compounding stressors associated with exposure to war and the chronic adversities of daily life, including repeated displacement, overcrowded and unsafe living conditions, and persistent food insecurity. While several studies have examined the differential effects of war exposure and daily stressors, limited evidence exists regarding the additional contribution of work-related stressors to psychological distress among frontline healthcare workers. This study therefore aimed to examine the relative contributions of war exposure, daily stressors, and work-related stressors to mental health outcomes among nurses working in Gaza. A cross-sectional quantitative study was conducted among nurses working in Gaza during the 2023–2025 war. Data were collected between April and June 2025 from a convenient sample of n = 108 nurses using an electronic structured questionnaire distributed through professional nursing networks. The survey assessed war- exposure, work, and daily-life stressors and measured psychological distress using the validated Arabic version of the Depression Anxiety Stress Scales (DASS-21). Descriptive and hierarchical regression were performed to examine the additional contribution of work-related stressors to psychological distress among frontline healthcare workers. Most participants reported high exposure to conflict-related events, with 95% experiencing bombardment and 92% forced displacement. Daily living hardships were widespread, particularly rising food prices (97%) and lack of safety. Mean DASS-21 scores indicated elevated levels of psychological distress symptoms, with mean scores of 15.1 (SD = 4.1) for stress, 14.6 (SD = 4.5) for depression, and 13.0 (SD = 5.0) for anxiety. Hierarchical regression analysis showed that daily-life stressors and work-related stressors were significantly associated with higher levels of psychological distress symptoms. Daily-life stressors explained an additional 17.2% of the variance in psychological distress (ΔR² = 0.172, p < .001), while work-related stressors explained a further 9.3% (ΔR² = 0.093, p < .001). War-related exposure was not significantly associated with psychological distress symptoms in the final model. Nurses working in Gaza during the ongoing conflict reported elevated levels of psychological distress symptoms. These findings highlight the importance of addressing occupational and daily-life challenges, alongside conflict-related conditions, when developing psychosocial support strategies for healthcare workers in humanitarian and conflict settings.