• Shiraz Nasr, Ahmad Heneiti, and Weeam Hammoudeh.
• Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory. Electronic address: shnasr@birzeit.edu.
• Lancet. 2021 Jul 1; 398 Suppl 1: S41.

BackgroundPalestinians have been exposed to long-term violence, displacement, and conflict since the 1940s. Continued expropriation and fragmentation of the region has affected people's quality of life. The Biddu Enclave communities, located northwest of Jerusalem, are behind a barrier wall that detaches them from Jerusalem and the rest of the West Bank other than by access through a tunnel controlled by the Israeli authorities. The enclave is fully or partially under Israeli administration. We explored the effects of socioeconomic and geographical transformations and isolation on the quality of life of these communities, specifically on daily uncertainty, stress, and overall wellbeing of residents.MethodsWe included four communities-Beit Iksa, Qatanna, Biddu, and Beit A'nan-that have varied characteristics and circumstances. Between early October, 2018, and the end of November, 2019, we did in-depth interviews with 20 key informants, such as mayors, village council members, municipality employees, and teachers, and 16 residents older than 20 years and from a range backgrounds, including activists, retirees, and housewives. We also did two focus groups involving young adults from all four communities. Questions were asked about living conditions and consequences of the socioeconomic and geographic transformations in the study area. We analysed the data by repeated readings to identify patterns and themes.FindingsWe found poor overall quality of life, characterised by chronic daily uncertainty, insecurity and heightened vulnerability, leading to stress and reduced wellbeing. The main negative determinants of quality of life were poor infrastructure, dependence on work in the Israeli labour market, a precarious permit system, increasing land expropriation and expansion of Israeli settlements, separation from Jerusalem, and marginalisation by the Palestinian National Authority. Community characteristics, such as social solidarity and active community organisations were important in mediating some of these effects. Other variations in the characteristics of the communities, such as topography, having relatives living in the USA, levels of education, unemployment rate, and proximity to Israeli settlements seemed to play a role in the abilities of residents to endure conditions.InterpretationOur findings highlight the importance of political and socioeconomic transformations in the wellbeing of residents in the Biddu Enclave. Sustained insecurity and uncertainty, marginalisation, and isolation of the communities have negative effects on quality of life. More research focusing on these communities is needed to better understand the mechanisms by which these factors affect health and how they may lead to ill health and disease in the long term.FundingArab Council for Social Sciences.Copyright © 2021 Elsevier Ltd. All rights reserved.

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