With millions of children worldwide affected by past and ongoing wars and conflicts, there is an urgent and growing need for research to inform efforts aimed at understanding, preventing, and mitigating the potential consequences of this violence for children, families, and communities, for both present and future generations. Political violence and armed conflicts put people of all ages at risk, but developing children are especially vulnerable to the long-lasting negative psychosocial consequences of these situations (Nemeth and Glozman, 2020; Joma et al., 2022). Over the past 20 years, Palestinians have endured four wars that have resulted in many casualties and widespread psychological trauma, particularly among children (El-Khodary et al., 2020; Shaheen et al., 2025).

Since 2018, thousands of Palestinians have participated in weekly protests that have had significant repercussions on the well-being of young people, resulting in considerable impacts on children’s education (UNRWA, 2019; Migdad et al., 2021). As a result, there have been calls for improved psychosocial support and resources from educators and parents, both within and outside of the school environment, to better assist children in dealing with the aftermath of this political violence. Abo Hamza et al. (2019) estimated that 51% of children in the Gaza Strip experience Post-Traumatic Stress Disorder (PTSD). Additionally, a significant proportion of these children suffer from chronic stress, anxiety and depression, emotional regulation disorders, and sleep disorders. This situation significantly impedes their ability to access quality education and engage in uninterrupted learning without disturbance due to the crisis. Moreover, the Global Monitoring Report on Education for All prioritized education in conflict contexts and stressed the significance of psychosocial interventions in counteracting the destructive effects of conflicts, such as depression, trauma, shame, and dropouts, which can significantly impede learning (UNESCO, 2011). As per the UNRWA report in 2019, teachers frequently express apprehensions regarding the impact of such circumstances on their students’ emotional and psychosocial wellness. They view these factors as influential in low academic achievement and behavioral problems in the classroom, especially for male students. These obstacles, combined with political instability and socioeconomic barriers, result in a highly complex learning environment for the children.

This case study was conducted in a refugee camp, located in the Occupied Palestinian Territories (OPT). This camp holds a strategic geographical position, near the main checkpoint between Ramallah and Jerusalem. Violent confrontations between Israeli forces and Palestinians occur frequently, resulting in injuries and deaths among residents. In addition to political and military conflicts, the camp also endures significant socio-economic challenges. With a high unemployment rate, considerable overcrowding, and frequent incursions by Israeli forces, the camp’s social fabric is severely disrupted. Moreover, deteriorating economic conditions have led to a surge in violence and illicit behaviors in recent years (UNRWA, 2019).

Numerous studies suggest a dynamic link between education and psychosocial support (Afana et al., 2020; Tol et al., 2011). Research indicates that offering children structured, relevant, and creative activities in educational settings can contribute to enhancing their emotional and behavioral well-being (Ager et al., 2011; Berger and Gelkopf, 2009; Kostelny and Wessells, 2008). Moreover, although additional research is required, certain psychosocial support programs also appear to have a positive impact on classroom results (Betancourt et al., 2014; Layne et al., 2008; Woodside et al., 1999). Nevertheless, the mechanisms that promote stronger resilience capacity in children in emergency settings remain largely unknown, and future studies are needed to gain a more detailed understanding of the efficacy of various psychosocial programs (Burde et al., 2017).

Scientific literature emphasizes that research on children exposed to political violence and armed conflicts is crucial to (1) promote healthy child development; (2) enhance the resilience and human capital of affected communities; and (3) foster positive long-term outcomes, particularly in preventing the recurrence of violent conflicts (Cavazzoni et al., 2020; Cahill and Foa, 2007). To inform interventions and policies aimed at improving the lives of vulnerable children, it is essential to focus research programs not only on documenting outcomes in children exposed to political violence and armed conflicts but also on identifying the pathways and processes through which exposure leads to specific problems over time (Cairns and Dawes, 1996; Cicchetti and Cohen, 2006; Sroufe, 2013). Unfortunately, process-focused research studying children, political violence, and armed conflicts remain scant to date. Therefore, our study aims to fill that gap related to lack of sufficient knowledge about how stress exposure affects children’s executive functions and academic trajectories and which protective factors may mitigate these effects in conflict-affected settings.

This study is based on recent advances in two fields: (1) developmental psychopathology in children residing in areas affected by political violence and (2) education in situations of armed conflict. It contributes to a deeper comprehension of the relationship between stressors intensity, chronic stress, well-being, psychological resilience, executive function skills, and learning among primary school students in the West Bank. The study aims to develop a better understanding of the interactions between variables in the vulnerability-stress model (REF). Additionally, we aim to test the present methodology, which is commonly used in stable and developed contexts, with vulnerable populations affected by armed conflict to outline all logistical, methodological, and ethical challenges involved.

As part of a multiple case holistic study (Yin, 2009), we examined six cases that we consider representative of a typical situation among primary school students in refugee camps around the city of Ramallah in the occupied Palestinian territories. This pilot study strives to establish a methodology that will ease the production of knowledge valuable for conducting statistically generalizable studies in the future (Cadario et al., 2020; Yin, 2003).

In this section, we present the empirical findings from the six participants, identified by aliases (Abdel, Hamza, Nassim, Mehdi, Youssef, and Omar). For each case, we report exposure to potentially traumatic events, perceived stress, physiological stress markers, well-being, resilience, executive functioning, and school-related indicators.

Table 1 presents the interplay between traumatic experiences and all psychological and physiological indicators collected. The table elucidates individual participant scores in each category.

As shown in Table 2, we assessed participants’ school perceptions across several constructs, including absenteeism, emotions experienced when attending school, their view of the school environment, their teacher’s perception, and academic performance.

Looking at the results, the first thing that stands out is the high exposure to potentially traumatic events in the last 3 months (Table 1). Half of our participants had experienced seven events. With this level of exposure, we could expect an impact on participants’ mental health.

Physiological data from the stress biomarker show that all participants have a non-typical cortisol awakening response (CAR). Our interpretation is based on the study from Chung et al. (2023). In this research, the CAR and potential determinants were evaluated for 69 healthy children aged 6 to 12 years. The objective was to address the gap in knowledge about CAR in children below the age of 10. This study showed that CAR occurs in about 75% of healthy individuals. Furthermore, these findings—particularly prevalent in males—shed light on CAR parameters within a healthy pediatric sample. According to this study, the typical CAR for a healthy child aged 6 to 12 is between 50 and 75%. As reported by Chung et al. (2023). The stability of the CAR is well established in healthy children and adolescents (Bäumler et al., 2013; Platje et al., 2013). Exposure to acute stress is generally associated with an increase in CAR, and chronic, prolonged, uncontrollable, or traumatic stress is associated with an attenuation of CAR (Filaire et al., 2013).

After interpreting our data according to these parameters, only one participant (Abdel) out of six has a cortisol awakening response (CAR) close to the typical threshold (88% for a boy of his age). He is also the least exposed to potentially traumatic events (N = 3) in the period studied. On the other hand, he appears to have lower psychological resilience, lower well-being, and the lowest academic achievement. Being the youngest and the only one experiencing academic challenges may be contributing factors.

Abdel and three other cases under study—Hamza, Nassim and Youssef—appear to be under chronic stress according to their CAR. In contrast, Mehdi and Omar are potentially in a state of stress-related exhaustion. It is noteworthy that both do not show a CAR at all, instead displaying negative values. Based on the parent logbooks and daily verification phone calls, there is no indication that the saliva timing deviated from the required protocol. The self-reported perceived stress data align perfectly with their CAR values, reinforcing this interpretation: both report extremely low perceived stress (5/39).

Our hypothesis is that these two individuals may have difficulty perceiving stress due to reduced cortisol secretion, potentially caused by chronic exposure to the stressors generated by political violence. The alignment between perceived stress and the stress biomarker is consistent across all cases except for Abdel. Regarding the resilience and well-being results, these two indicators correspond seamlessly with one another. It appears that these constructs are comparable or at least progress in a similar manner.

As shown in Table 2, participants generally hold a positive perception of school. They express favorable views of the school environment, feel safe, and evaluate their teachers positively. All students except Abdel have high grades. Abdel again stands apart: he reports more negative emotions when attending school, more frequent absences, lower well-being, lower resilience, and lower academic achievement. The study of his case suggests a strong link between his level of well-being and resilience and the fact that school does not seem to be serving its protective role for him.

Turning to the cortisol secretion patterns, each participant displays unique variations from the typical curve. The absence of a pronounced CAR in most participants, as well as elevated levels in the late afternoon or evening in several cases, may be related to recurring stressful experiences such as encountering soldiers on the way home or hearing almost daily violent clashes, gunfire, and stun grenades in the camp.

According to Rotenberg et al. (2012), typically developing boys aged 9 to 12 should have a diurnal AUC-G around 2.23 (1.18) μg/dL. Nassim, Omar, and Youssef show AUC-G values within the expected range. Hamza and Abdel show higher values, while Mehdi’s is substantially below. Chronic stress, anxiety, or depression are often associated with elevated AUC values (Sapolsky et al., 2000; McEwen, 2008; Ulrich-Lai and Herman, 2009). Research has shown heightened cortisol levels in individuals with major depressive disorder, leading to increased AUC values (Pariante and Lightman, 2008; Stetler and Miller, 2011). Conversely, low AUC may indicate an adaptive response to prolonged stress (Miller et al., 2007; McEwen, 1998; Fries et al., 2005). In acute stress, cortisol typically spikes; with chronic stress, the system may become dysregulated. Over time, the body may adapt by suppressing cortisol production. Overall, cortisol levels in our participants were well below pediatric norms (Griffing, 2020), reinforcing the impression of chronic HPA-axis dysregulation.

In the N-Back task, accuracy decreases in the more demanding 2-Back condition, with an increase in omission errors. Reaction times do not consistently follow the expected pattern of longer latencies in the harder condition. Between sequences 1 and 4, there appears to be a habituation effect followed by a learning or training effect. Comparisons with Spanish normative data (Pelegrina et al., 2015) indicate no statistically significant differences in targets detected or false alarms. None of the tests yielded p-values below 0.05, and our directional hypothesis that the sample would perform below the norm is not supported.

For the Stroop task, accuracy was high across all conditions, though reaction times increased as expected in more complex conditions. Comparisons with normative data from several countries (Moradi et al., 1999; Roy et al., 2018; Guerra et al., 2021; Roukoz et al., 2021; Er-Rafiqi et al., 2022) reveal comparable or slightly better performance. Negative interference scores in some participants (Youssef, Abdel) are unusual and may reflect specific task strategies or low automaticity in reading. The range of interference scores (−1.0 to 9.0) suggests diverse cognitive profiles. Some of these patterns, particularly negative values, warrant further investigation. The small sample size limits statistical power, but the variation nonetheless underscores the need for a nuanced understanding of executive functions among Palestinian children living in contexts of political violence.

The Wisconsin Card Sorting Test (WCST) reveals the greatest difficulty for participants. A large number of errors (55–80%) were observed, and perseverative errors were frequent (44% of the group). Comparisons with Brazilian norms (Coelho et al., 2012) show significantly higher perseverative errors, even though total errors were not significantly different. Perseverative errors are a well-known indicator of impaired cognitive flexibility. This supports the hypothesis that Palestinian children living in chronic instability may face more pronounced challenges in cognitive flexibility than in other executive functions.

Cognitive flexibility plays a pivotal role in learning, problem solving, adjusting to changing task demands, and interpreting social cues (Borst and Houdé, 2014). It influences empathy, conflict resolution, and general social functioning. Our findings suggest that participants may be trapped in a self-perpetuating cycle: the conflict environment diminishes cognitive flexibility, which in turn reduces the ability to resolve conflict, both in school contexts and in daily life. Living in a conflict-ridden environment appears to impair not only the moral capacity to resolve conflicts but also the cognitive capacity to do so.

To the best of our knowledge, no studies have tested the impact of chronic stress, psychological exhaustion, or different types of trauma on children’s executive functions. However, existing literature has consistently suggested that chronic stress have a negative impact on executive functioning. Only a few studies have recently considered the possibility that these states or experiences might improve one or more executive functions. This pertains to Kira et al.’s (2022) study on an adult population and Eren-Koçak and Kiliç’s (2014) pilot study, which suggests that trauma correlates with enhanced executive functioning. For our part, as shown in Table 11, it appears that some of the cases we have studied exhibit cognitive flexibility significantly lower than the average, but slightly above-average working memory, and most notably, cognitive inhibition significantly above the average. Overall, our participants seem to be in a state where they are less easily alarmed and in which it may be easier to inhibit.

In conclusion, let us take a step back and examine the overall situation for each cases. Over the past 3 months, the six children under study exhibited varying levels of exposure to potential traumatic events. Abdel demonstrated the least exposure (3 reported events in the last 3 months) while Mehdi, Youssef, and Omar exhibited the most (7 reported events in the last 3 months). Despite their varying degrees of potential trauma exposure, these children displayed high levels of well-being and resilience, even in the face of chronic stress. Measurements of the CAR revealed that certain children demonstrated increased stress responses, whereas others exhibited indicators of stress-related depletion. Importantly, discrepancies between self-reported stress scores and physiological measurements were observed, underscoring the need for a multifaceted approach to comprehending children’s stress experiences. Indeed, our objective data (physiological & performance measures) tell a very different story than self-reported data apart from a single participant. Indeed, Abdel seems to be the only one where all data aligns. We could hypothesize that he’s the one most in touch with his emotions and most able to share how he’s feeling. The participants demonstrated a varied level of performance in executive functions. The results indicated that cognitive inhibition, assessed through the Stroop interference error score, was generally strong. However, performance in working memory and cognitive flexibility showed significant variations. In particular, numerous children exhibited signs of struggling with cognitive flexibility, as revealed by Wisconsin persistence errors. Youssef’s performance in all three executive functions was exceptional, surpassing the normative data. In contrast, Hamza and Mehdi faced distinct cognitive challenges in certain areas. The study sheds light on different facets of children’s responses to trauma, highlighting that perceived resilience and well-being are still high even in the face of challenges. The variation in cognitive abilities highlights the necessity of personalized strategies for meeting the unique requirements and abilities of students who are regularly exposed to political violence. The present study is a multi-case pilot research and further research, with larger sample, is necessary to examine the impact of exposure to political violence or armed conflict on students’ learning abilities in various contexts. Nevertheless, the study allowed us to test a methodological approach and highlight challenges of conducting research in unstable context. Qualitative data could provide valuable insights into culturally informed methodologies, tools, and practices. Moreover, additional research should explore the impact of this exposure on the global health and academic performance of affected populations. Finally, our findings suggest that the effectiveness of pedagogical interventions tailored to the individual needs of students should be evaluated.