Letter to the Editor

This letter addresses the article by Lipskaya-Velikovsky et al. (2025), which examined mental health and contributing factors among Hebrew-speaking higher education students in Israel during the onset of the Swords of Iron war. Their study’s focus on the population-level impacts of trauma and factors that influence mental health offers valuable insights for occupational therapy practitioners. The authors’ methodology and analysis highlight occupational therapy’s role in supporting mental health at individual, community, and population levels. However, methodological and contextual limitations bound the study’s findings, reducing its applicability to gaining an understanding of the broader occupational and mental health impacts.

Although the authors provide worthwhile insights, the omission of Palestinian perspectives is a substantial limitation. The study does not mention Palestinian students in higher education in Israel, who have been deeply affected by what the International Court of Justice (2025) described as genocide against Palestinians. This exclusion skews the findings, offering a narrow view of the war’s impact. The authors’ comparison with refugee populations is especially notable given that Palestinians, not Israelis, have been displaced. In addition, the small number of participants directly involved in the October 7 attack further highlights the omission of Palestinian experiences.

The study relies on participants’ self-reported mental health before the war and compares it with their current state, one month after the October 7 attack. This method is subjective and prone to recall bias. Without a control group or prewar baseline data, the study cannot establish clear cause-and-effect relationships between the conflict and mental health outcomes. Selection bias further weakens the study’s validity. Recruiting participants through platforms like WhatsApp excluded those without access, likely marginalizing Arab Israeli students facing systemic barriers. Such exclusion skews the findings and perpetuates the erasure of Palestinian experiences in occupational therapy research. The study also lacks sufficient demographic and contextual detail. Although it mentions variables like religious status and geographic diversity, it overlooks the unique experiences of Arab Israelis and Palestinians. Treating the Israeli student population as a whole ignores important differences in how various groups experience and respond to trauma.

The framing of trauma in the study is problematic. Although the authors acknowledge the impact of armed conflict on mental health, they focus exclusively on Israeli experiences, neglecting the systemic violence endured by Palestinians. For instance, the destruction of Gaza’s last remaining university in January 2024 (Euro-Med Human Rights Monitor, 2024) highlights the occupational deprivation faced by Palestinian students. This erasure of Palestinian realities represents a significant ethical oversight and weakens the relevance of the study’s findings.

The study attributes changes in occupational patterns primarily to environmental factors like war-related restrictions. However, it fails to consider the broader context of occupational apartheid—a term used to describe the systemic exclusion and marginalization of Palestinians in various areas, including education and employment (Kronenberg et al., 2005). This omission limits the study’s ability to address the structural factors affecting occupational engagement and mental health.

Future research must be inclusive, reflecting the diverse experiences of all groups affected by the war, including Palestinian participants. Mixed-methods designs should combine quantitative and qualitative data to enable us to understand lived experiences holistically. Researchers must account for confounding variables, such as prior trauma and socioeconomic status. Studies should also explore broader systems affecting mental health and occupational engagement, such as living under a government and military engaged in genocide and the impact of occupational apartheid on Palestinians (Simaan, 2021).

The authors address trauma and resilience but overlook Palestinian perspectives and systemic oppression, resulting in a biased understanding of the conflict’s occupational and mental health impacts. We stand with Palestinian colleagues in and outside of Israel addressing their communities’ needs amid systemic violence, displacement, and infrastructure destruction, exemplifying occupational therapy’s resilience and adaptability. Future research must prioritize inclusivity, ethical responsibility, and the addressing of occupational apartheid to advance the field and provide a more equitable understanding of trauma and resilience.