Gazan women’s struggle for menstrual health and dignity during genocide

Abstract

Background

During the Israeli genocide against the Gaza Strip, Gazan women faced significant challenges related to menstrual health, exacerbated by a lack of sanitary products, absence of privacy, and water shortages. These conditions were further intensified by immense social pressure, increasing the psychological stress women were already experiencing due to the war.

Aims

The study used a qualitative approach to explore the menstrual health challenges faced by women during the Israeli war on the Gaza Strip.

Methods

Thirty-two Gazan refugee females, aged 20 to 60 years (mean age = 32.13, SD = 11.10), were selected from internally displaced Palestinian camps in Rafah during the recent Gaza conflict.

Results

Thematic analysis identified six themes: psychological impact of menstrual challenges in Gaza; economic and physical barriers to menstrual hygiene; social stigma and loss of privacy; health consequences of inadequate menstrual hygiene; emotional and physical strain from limited medical services; and socio-cultural aspects of menstrual hygiene in Gaza.

Conclusions

The study highlighted the severe challenges Palestinian women faced regarding menstrual health during the Gaza war, compounded by social pressure, lack of privacy, and inadequate sanitary products. It highlights the urgent need for global assistance to Gaza refugees and immediate therapeutic interventions, including psychological and healthcare support.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-025-03973-z.

Introduction

Cultural stigma surrounding menstruation perpetuates silence and marginalization, rendering it a taboo subject even in humanitarian crises. In broader terms, menstruation is linked to impurity (danasa, in Arabic), alienating women and girls from critical discussions about their health and well-being [1–4] and leaving women ill-equipped to manage their menstruation during emergencies where access to resources and education is already severely restricted [5, 6]. Adolescent girls, who often encounter menarche without sufficient preparation or guidance, face heightened psychological distress [1]. Because menstruation is stigmatized, women internalize feelings of shame and inadequacy Goffman [7].

The Israeli genocidal assault against Gaza has devastated infrastructure critical to Menstrual hygiene management (MHM). MHM refers to women and adolescent girls’ use of clean materials to absorb or collect menstrual blood changing them in private as often as needed during their period, maintaining personal hygiene with soap and water, and having access to safe and appropriate disposal facilities for used materials. This genocide compels over 700,000 women and girls to traverse their menstrual cycles without access to menstrual products, clean water, or private sanitation facilities [8–10]. This crisis has, however, forced women to resort to makeshift alternatives—torn clothing, fabric scraps and tent materials—which significantly heighten their vulnerability to infections, including bacterial vaginosis, urinary tract infections and toxic shock syndrome [11–13]. Infections that remain untreated because of the collapse of Gaza’s healthcare system can lead to more severe complications: secondary infertility, chronic pelvic pain and long-term reproductive health issues [14]. Water scarcity exacerbates these challenges, as Gaza’s infrastructure remains crippled by repeated bombings and the blockade. Gazans have access to less than two liters of water per day—far below global standard required for basic hygiene [15]. Women often go weeks without bathing, further elevating their risk of skin infections and exacerbating feelings of humiliation and distress. In overcrowded shelters, where hundreds share single bathroom, menstruating women face long queues, lack of privacy and unsanitary conditions [16–18]. Such circumstances strip women and girls of their dignity,however, they are forced to prioritize survival over basic hygiene. The UN estimates that some shelters host up to 400 individuals per bathroom, highlighting the gross inadequacy of existing sanitation infrastructure [16]. Adolescent girls, who frequently encounter menarche during displacement, face additional emotional distress because they traverse the challenges of menstruation without access to proper resources or guidance [8].

A prevalent coping mechanism among women in Gaza involves the utilization of menstruation-delaying pills—norethisterone, for instance. Although these medications can temporarily halt menstruation, they present significant health risks when employed without medical guidance. Prolonged use of these pills may result in hormonal imbalances, mood disorders, irregular bleeding and nausea [13, 19]. The inconsistent availability of these medications complicates their application, because women are often compelled to cease and restart treatment abruptly, thereby increasing the likelihood of adverse effects.

Despite the burgeoning acknowledgment of menstrual hygiene management (MHM) in emergencies, implementation in Gaza remains woefully inadequate. Reports indicate that fewer than half of the menstrual products required to fulfill the demands of the population are being supplied; thus, significant gaps in coverage continue to exist [14]. The absence of gender-sensitive planning in humanitarian responses further marginalizes menstruating women, who are frequently excluded from decision-making processes and resource allocation. Overcrowded shelters, inadequate sanitation infrastructure and water shortages render even these limited interventions ineffective,this highlights the systemic failures of humanitarian efforts to address gender-specific health needs [16].

The significance of this study lies in the fact that it is the first to examine the challenges and hardships experienced by women in Gaza in relation to menstrual health during the Israeli war on the Gaza Strip. The study sheds light on the severe struggles these women face in accessing essential menstrual hygiene products and services under conflict conditions. In particular, the study seeks to answer the following research question: First, what are the challenges faced by Palestinian women regarding menstruation and the associated difficulties during the Israeli invasion of the Gaza Strip? Second, has menstruation among women living in the Gaza Strip become associated with social stigma and feelings of shame and psychological pain among Gaza women?

Methods

Design

This study adopts a qualitative research approach to explore the challenges women faced in regard to menstrual health during the Israeli war on the Gaza Strip. By utilizing in-depth semi-structured interviews, the study provides a detailed and personal account of the struggles related to menstrual health faced by these Gazan women. The qualitative method allows for a rich, nuanced understanding of how displacement and dehumanization affect women and their families emotionally, psychologically, and physically.

Participants and recruitment

The study was conducted in February 2025 and involved thirty-two Gazan refugee women selected from internally displaced persons (IDP) camps in the city of Rafah during the ongoing genocide in Gaza, and all interviews were conducted face- to- face with participants. The group comprised 32 females, aged between 20 and 53 years (mean age = 32.13 years, SD = 11.10). All participants were refugee women residing in Palestinian camps in Rafah. They were all sufficiently eligible and spoke Arabic to complete the research tasks.

Data collection

The qualitative data were collected through thirty semi-structured interviews with displaced women in Rafah. All participants (both interviewees and the interviewer) were native Arabic speakers. Research assistants in each camp acted as gatekeepers in recruiting participants. The data collection process began with interviewing the research assistants to explain the aims and purposes of the study. The second step involved informing them about the research activities, the total number of participants to be interviewed, and the ‘snowballing’ technique used for selecting participants from those who accepted the invitation. The survey questions used in the interviews were designed to avoid emotional distress. Participants were informed that they could discontinue their participation at any time if they felt distressed. The investigator, a licensed mental health professional, was available for any participant who experienced an immediate negative response to the survey questions. Furthermore, all participants were given contact information for mental health services in case symptoms appeared after the survey. Participants were women aged 20 to 53 years, recruited from internally displaced camps in Rafah. Individuals under 18 were excluded due to ethical constraints related to obtaining guardian consent in the camp setting. Although the World Health Organization (2020) defines reproductive age as 15 to 49 years, no woman aged 18 to 20 agreed to participate despite repeated outreach during recruitment. In the context of displacement, women in this age group may be less willing to take part in sensitive discussions on reproductive health because of cultural sensitivities, family oversight, or the prioritization of other immediate concerns. The upper age limit was extended to 53 years to include women who may still experience menstrual irregularities or other reproductive health issues associated with perimenopause or early postmenopause. This broader inclusion criterion allowed for a more comprehensive examination of reproductive health experiences across different life stages relevant to the study objectives. A convenience sampling method was used, including all eligible women who were available and consented to participate during the study period. The study received approval from the An-Najah Institutional Review Board (IRB) before data collection began. The shortest interview lasted approximately 35 min, while the longest lasted 60 min; most interviews were around 50 min.

Data analysis

All interviews were audio-recorded and transcribed into Arabic and then translated into English by the researchers who are bilingual. The research team reviewed the translated interviews for accuracy against the original Arabic to ensure that nuances of meaning were preserved. The translated texts were analyzed using thematic analysis (TA) methodology [20, 21] to identify the main themes emerging from the material. A bottom-up, data-driven text analysis approach was applied to extract categories from the raw data [22]. Each interview was carefully examined to identify concepts and statements containing similar words. The analysis process included the following steps: (a conducting open coding analysis to derive the main themes from the participants'narratives,(b coding and organizing the themes into structured texts,and (c discussing and reaching agreement on categories with three professionals. In this study, the researchers continually assessed whether continued data collection would provide further insights into the challenges faced by women, or if the existing data had sufficiently addressed the research objectives. As the study progressed, it became clear that no new significant themes were emerging, and the challenges faced by the women had been thoroughly explored. Once the researchers concluded that additional data would not yield new information, saturation was confirmed, indicating that the data collected was comprehensive and adequately captured the challenges encountered by Gazan menstruating women.

Coding reliability

A reliability test of the coding was conducted with two independent researchers, achieving 92% consistency with the author’s original coding (Cohen’s kappa = 0.94). Cohen’s kappa is a statistical measure used to assess inter-coder reliability, with a coefficient of 0.80 or higher considered acceptable.

Results

Thematic content analysis of the interview transcripts led to the identification of six main themes (see supplementary file1): First, Psychological Impact of Menstrual Challenges in Gaza. Second, Economic and Physical Barriers to Menstrual Hygiene. Third, The Social Stigma and Loss of Privacy. Fourth, Health Consequences of Inadequate Menstrual Hygiene. Fifth, Emotional and Physical Strain of Limited Medical Services. Sixth, Socio-Cultural Aspects of Menstrual Hygiene in Gaza.

Theme one: Psychological impact of menstrual challenges in Gaza

The psychological toll of insufficient menstrual hygiene management among women in Gaza is exacerbated by their already precarious living conditions. The voices of women across refugee camps reveal a shared sense of helplessness and shame. One woman, a mother of three daughters, shared her anguish: “I don’t know what to do when all three of my daughters get their periods at the same time. I have to cut old fabric into pieces, however, they complain about rashes and itching. I feel like I’m failing them as a mother.” This burden is exacerbated for mothers managing health and emotional well-being of their daughters while enduring their own struggles. Thus, the stress of menstruation compounds the trauma of genocide against Gaza. A young woman explained that “Every month, I dread my period. It’s not just the pain—it’s the shame of knowing I can’t manage it properly. I don’t even leave the tent because I’m terrified someone will notice.” For many, the lack of privacy and basic hygiene products transforms a natural bodily function into a source of persistent humiliation.

Moreover, the disruption of menstrual cycles which results from stress has exacerbated emotional instability among women. One mother remarked: “Before the war, my cycle was predictable. Now, it comes twice a month or not at all. My body feels out of control and that only adds to my stress.” Such irregularities, coupled with the lack of access to medical care, leave women devoid of resources or reassurance needed to manage their health effectively.

Theme two: Economic and physical barriers to menstrual hygiene

The economic constraints imposed by war-torn Gaza have rendered basic menstrual hygiene unattainable for many women. A mother of six expressed her frustration: “Every month, I have to decide between buying pads for myself or shampoo for my children. It’s not a choice any mother should have to make.” Her narrative resonates with those of many women who must sacrifice their own hygiene (and well-being) for their families’ needs. Another woman recounted, with palpable desperation, “When I can’t afford pads, I use diapers or toilet paper, however, these cause terrible infections. It’s unbearable.”

The deficiency of physical resources (e.g., clean water and private sanitation facilities) further complicates the situation. One participant articulated: “Bathrooms are shared; you can’t guarantee cleanliness. I’m always worried about getting sick because the water we use isn’t safe.” Another lamented, “We’re living in tents surrounded by sand and dirt. Even if I clean myself, it feels like I’m never really clean.” These environmental factors exacerbate health risks associated with inadequate menstrual hygiene. Women also reported severe health complications from using unsanitary alternatives. One mother noted the toll on her daughters: “All three of my girls developed urinary tract infections because we don’t have clean water or proper pads. I feel like I’ve failed them.” These accounts emphasize urgent need for affordable and accessible menstrual hygiene products.

Theme three: The social stigma and loss of privacy

The absence of privacy within refugee camps has rendered menstruation a collective ordeal for numerous women. A widow who raises her two teenage daughters articulated her distress: “Every time one of us gets our period, it feels like the entire camp knows. We have to carry supplies openly to the bathroom and there’s no way to avoid the stares and whispers.” This loss of privacy, however, exacerbates the stigma surrounding menstruation—particularly in Gaza where such topics are regarded as deeply personal. Cultural norms surrounding modesty exacerbates pressure. One participant elucidated, “Before the war, I could manage my period privately in my home. Now, in the camp, everyone knows—even the men. It’s humiliating.” Another echoed this sentiment: “The shame is overwhelming. I feel like I’ve lost all dignity, especially when I have to explain to my husband why I need money for pads.” This public exposure erodes women’s sense of autonomy and dignity, leaving them feeling powerless and exposed.

The erosion of privacy impacts younger girls, many of whom encounter menstruation for the first time under these circumstances. A mother recounted her daughter’s ordeal: “When my youngest got her period, she cried for hours because she didn’t want to go to the shared bathroom. She was so ashamed.” Such experiences elucidate how the deprivation of privacy perpetuates feelings of shame and inadequacy, particularly for young girls traversing the complexities of menstruation for the first time.

Theme four: Health consequences of inadequate menstrual hygiene

Health consequences of inadequate menstrual hygiene are profound; however, the ramifications of poor menstrual hygiene in Gaza are severe and extensive, influencing both physical and reproductive health. A mother of four articulated the toll it has exacted on her daughters: “All of my girls have developed rashes and infections because we can’t afford proper pads or clean water. It breaks my heart to see them suffer like this.” Another woman described her own tribulations: “I’ve been using pieces of old cloth and now I have constant itching and discomfort. There’s no relief because there’s no medical care.”

The employment of unsanitary alternatives has precipitated a notable surge in infections,many of which remain untreated. A participant further articulated her distress: “The infections are excruciating, but there exists no available medicine. We’re compelled to endure in silence.” The dearth of access to medical care exacerbates these challenges. A mother of three expressed her exasperation: “My daughter has endured pain for months; yet, each visit to the clinic yields only painkillers. There is no adequate treatment.” Another participant recounted her ordeal of being denied care: “When I required surgery for complications stemming from my period, the hospital informed me they could accommodate only emergency cases. I feel as if my health isn’t regarded as a priority.” These narratives highlight the pressing necessity for healthcare interventions to mitigate the crisis surrounding menstrual hygiene in Gaza.

Theme five: Emotional and physical strain of limited medical services

The dearth of accessible healthcare services has rendered women in Gaza feeling forsaken and susceptible. Many participants articulated concerns regarding the deficiency of qualified medical professionals and vital medications. A widow recounted her ordeal: “I used to have a doctor who comprehended my condition; however, now there’s no one. Every time I visit the clinic, I encounter someone new who doesn’t know how to assist.” Another remarked, “The doctors are overwhelmed, but they lack the supplies necessary to treat us. Even basic antibiotics are unavailable.” This deficiency in medical care intensifies the physical and emotional burdens of menstruation. One participant elucidated, “I experience severe pain during my period; although there’s no means to acquire appropriate painkillers, I am compelled to endure it.” Another conveyed, “Even minor health issues seem like a crisis, because there’s no one to whom I can turn for assistance.” The absence of follow-up care—particularly for complications arising during menstruation—constituted another persistent challenge. A participant disclosed, “I encountered complications after childbirth; yet there was no one to provide treatment.”

The physical ramifications or consequences of insufficient medical care are indeed dire: one mother remarked, “My daughter had a severe infection, but the hospital couldn’t assist because they lacked necessary equipment. We had to return to camp (in desperation) and hope for the best.” These words reveal the urgent necessity for healthcare access to bolster women’s well-being in Gaza.

Theme six: Socio-cultural aspects of menstrual hygiene in Gaza

Exploring the socio-cultural dimensions of menstrual hygiene in Gaza unveils the complexity regarding women’s struggles. Cultural norms surrounding modesty and privacy render menstruation a highly sensitive matter especially in shared living environments. A mother of two teenagers confided, “Carrying sanitary items to the bathroom feels like hauling my shame for everyone to see. It’s unbearable.” Another participant elucidated, “In our culture, menstruation is private; however, now it’s exposed for everyone to witness. It feels as if our dignity has been stripped away.”

In light of these challenges, some women extract resilience from their collective solidarity. One participant articulated: “We’ve learned to depend on one another because no one else will assist. It’s not ideal; however, it’s the sole means by which we can endure.” This sentiment, however, does not engage with the more profound cultural and systemic quandaries that sustain the stigma and shame associated with menstruation. A woman recounted her endeavors to aid her neighbors: “I share whatever I can spare—even if it’s merely a piece of cloth. We’re all in this together, but it ought not to be this way.” The disintegration of cultural boundaries renders women feeling vulnerable and disempowered. Another participant revealed: “The men in the camp now know about our cycles (because) there’s no privacy. It’s humiliating and engenders a sensation of having lost all control over our lives.” Such words illuminate the intersection of socio-cultural expectations with the material realities of warfare, thereby engendering challenging conditions for women in Gaza.

Discussion

This study explored the challenges faced by Gazan women regarding menstrual health during the recent war on the Gaza Strip. The main findings revealed significant difficulties in accessing basic menstrual hygiene supplies, compounded by displacement and the harsh conditions in internally displaced camps in the Rafah region. Themes that emerged included limited availability of menstrual products, lack of privacy and sanitation facilities, and the psychological impact of these hardships on the women’s well-being. These findings underscore the profound effect of war on women’s reproductive health and highlight critical areas in need of intervention. The findings of the current study are supported by previous research that has explored the challenges and difficulties related to menstrual health in conflict settings. For instance, Mykolayivna et al.investigated the impact of prolonged exposure to war on the menstrual cycles of teenage girls in Ukraine. Their study revealed that 65.8% of participants experienced menstrual cycle disorders, highlighting the significant physiological toll of war-related stress and instability. Similarly, Schmitt et al. conducted research in two distinct conflict-affected settings—Myanmar and Lebanon—examining the barriers to menstrual hygiene management (MHM) among girls and women. Their findings indicated a widespread lack of access to safe and private MHM facilities, with displacement contributing to changes in menstrual practices and increased challenges in maintaining hygiene [23, 24].

The cultural stigma surrounding menstruation in Gaza is exacerbated by the ongoing Israeli attacks and the genocide, which have created a humanitarian crisis that amplifies preexisting social norms framing menstruation as impure and unfit for public discourse [3]. These norms perpetuate silence and marginalization, isolating women and girls in their struggle to manage menstruation under conditions of displacement and siege. The cultural and social stigmas reflect structural neglect, where menstruation is dismissed as a private issue rather than an essential public health concern, leaving women without access to the necessary resources or education to manage their hygiene [1, 5].

The psychological toll of inadequate menstrual hygiene management (MHM) in Gaza must be understood within the broader context of the genocide. The destruction of homes, displacement, and the loss of family members compound the trauma experienced by women and girls. This context intensifies the emotional burden of menstruation, which is already stigmatized and poorly addressed. Goffman’s [7] concept of hidden stigma explains how women internalize shame around menstruation, leading to heightened levels of anxiety, distress, and feelings of invisibility.

For adolescent girls, menarche becomes a traumatic event, as they face the dual challenges of managing their periods in overcrowded shelters and coping with the psychological effects of war. These experiences are exacerbated by the lack of preparation, guidance, and resources, leaving girls vulnerable to emotional and mental health challenges [1]. The ongoing violence amplifies these struggles, turning a natural bodily function into a source of humiliation and distress.

The Israeli blockade and systematic destruction of Gaza’s infrastructure have created insurmountable economic and physical barriers to menstrual hygiene. Women are forced to prioritize essentials such as food and water over menstrual hygiene products, leading to unsafe practices such as using torn fabric or scraps of tents. These practices result in severe health risks, including infections and long-term reproductive health complications [12, 13].

The destruction of water infrastructure has left residents with less than two liters of water per day, far below global standards for hygiene, making it impossible for women to maintain basic cleanliness during menstruation [15]. Overcrowded shelters, where hundreds of people share a single bathroom, further exacerbate the physical challenges, exposing women to unhygienic conditions and increasing their risk of infections. These barriers reflect not only the consequences of the ongoing genocide but also the failure of humanitarian responses to address the specific needs of women and girls.

The loss of privacy in overcrowded shelters due to displacement caused by Israeli attacks has turned menstruation into a public issue, compounding the social stigma associated with it. Shared living spaces and the lack of separate facilities for women force them to manage their menstruation in full view of others, violating their dignity and autonomy. In conservative societies like Gaza, where menstruation is traditionally considered a private matter, this public exposure exacerbates feelings of humiliation and shame.

The destruction of homes and displacement have disrupted the cultural and familial structures that previously allowed women to manage menstruation discreetly. Young girls experiencing menarche in these conditions face heightened emotional distress, as they navigate the challenges of menstruation in environments where privacy is nonexistent. This loss of privacy highlights the intersection of cultural stigma and material deprivation, both of which are intensified by the ongoing genocide.

The health consequences of inadequate menstrual hygiene in Gaza are severe, particularly given the collapse of the healthcare system under the weight of Israeli attacks. Women are at increased risk of infections due to the use of unsanitary materials, and the lack of access to medical care means that many of these infections go untreated. The reliance on menstruation-delaying pills, often taken without medical supervision, reflects the desperation of women forced to manage menstruation in the context of siege and war. These pills, while providing temporary relief, carry significant risks such as hormonal imbalances and long-term reproductive complications [14, 19].

The deliberate targeting of healthcare facilities further exacerbates these challenges. Hospitals and clinics, already overwhelmed and under-resourced, are unable to provide adequate care for menstrual-related health issues. This systemic neglect reflects the broader dehumanization of Gazans, where women’s health needs are systematically deprioritized. The inability to address even basic health concerns highlights the intersection of military aggression, humanitarian failure, and structural violence.

Limitations

This study has several limitations that should be acknowledged to properly interpret the findings. First, the use of convenience sampling of internally displaced women living in camps in Rafah limits the transferability of the findings beyond similar contexts, which is typical in qualitative research prioritizing depth over generalizability. Second, data were collected through semi-structured interviews relying on participants’ self-reports, which may be subject to recall or social desirability biases. Third, data collection took place during the Israeli war on Gaza, likely intensifying menstrual health challenges and influencing participants’ responses. Future studies could strengthen the rigor and trustworthiness of findings by using strategies that enhance credibility, transferability, and triangulation. Additionally, longitudinal qualitative research is recommended to explore how menstrual health challenges evolve over time, complementing the present study. Finally, one limitation of the study is the predefined age range of participants (20–53 years), which may have influenced the findings. This range was selected to focus on women of reproductive age, given the study's emphasis on menstrual changes. While this decision was made to ensure relevance and minimize ethical concerns associated with interviewing minors, it may have excluded potentially important perspectives from younger or older women. Future research could consider including a broader age range to capture a more comprehensive understanding of the topic.

Conclusion

The struggle of Gazan women for menstrual health and dignity during the ongoing genocide highlights a severe humanitarian crisis that goes beyond basic survival needs. This study has revealed the complex challenges these women encounter, arising from economic hardship, infrastructural destruction and deeply rooted cultural stigmas surrounding menstruation. The lack of access to sanitary products, clean water and private sanitation facilities threatens their physical health because it increases the risk of infections and long-term reproductive issues, however, it also severely impacts their mental well-being and social status.

Cultural stigmas amplify the challenges faced by menstruating women and girls, transforming a natural biological process into a source of shame and isolation. In the context of overcrowded and unsanitary refugee camps, the lack of privacy heightens feelings of vulnerability and humiliation; this is especially true for adolescent girls experiencing menarche without adequate support or resources. The necessity to rely on improvised menstrual management methods—such as using torn clothing or tent materials—further elevates health risks, demonstrating the urgent need for immediate assistance.

The breakdown of Gaza’s healthcare infrastructure due to the Israeli military aggression has left women without essential medical support, forcing them to manage their menstrual health in an environment where even basic healthcare services are inaccessible. This systemic failure not only leads to physical ailments, but also increases the emotional and psychological burdens on women, who must cope with their health needs amidst relentless violence and instability.

The public nature of menstruation in overcrowded shelters strips women of their autonomy and dignity; this illustrates how cultural expectations intersect with material deprivations caused by the genocide. Although this loss of privacy and respect further marginalizes women, it limits their ability to advocate for their needs and engage fully in societal discussions. To effectively address the menstrual health challenges faced by Gazan women, urgent coordinated efforts from humanitarian organizations, local authorities, and the international community are required. Immediate priorities should include ensuring reliable access to affordable and culturally sensitive menstrual hygiene products, safe and private sanitation facilities, and clean water within displaced persons’ camps. In parallel, educational initiatives aimed at dismantling menstrual stigma and empowering women and girls are essential.

Long-term solutions must focus on rebuilding and strengthening Gaza’s healthcare infrastructure to provide accessible reproductive and mental health services. Policymakers and aid agencies should integrate menstrual health into emergency response and recovery frameworks, recognizing its critical role in preserving women’s dignity, health, and social participation. Future research should monitor menstrual health in conflict and displacement contexts to guide evidence-based policy and interventions that uphold women’s reproductive rights during crises.

As researchers from Palestine, we recognize that Palestinian identity influence our approach to this study. Having grown up in Occupied Palestine, we have been shaped by the challenging realities of political conflict and ongoing trauma. In conducting this research, we are mindful that our positionality may affect how we interpret data and interact with participants. We are committed to maintaining a reflective stance to ensure transparency and awareness of these influences throughout the research process. To ensure transparency and reduce potential bias, the researchers maintained a reflective stance and coded the data independently. Discrepancies were reviewed collectively and resolved through discussion until consensus was achieved.

Authors’ contributions

All authors contributed equally to this work. Bilal Hamamra prepared the theoretical background and conclusion sections. Mai Atiya prepared the methodology section. Finally, Fayez Mahamid and Dana Bdier prepared the discussion and analysis sections. All authors read and approved the final manuscript.

Funding

No funding was received for this study.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

All procedures performed in this study involving human participants were in accordance with the ethical standards of the American Psychological Association (APA, 2010) and with the 2013 Helsinki Declaration. Informed consent was obtained from all participants. Our study was approved by An-Najah National University Institutional Review Board (IRB) before data collection was initiated.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.