Abstract
War as a collective trauma can severely harm the psychosocial well-being of individuals, disrupting their sense of safety, autonomy, and meaning of life. War also weakens individual and communal senses of safety and stability, erodes social cohesion, and forces large-scale displacement, as civilians seek security elsewhere. Research indicates that individuals with prior exposure to traumatic events may be more susceptible to experiencing distress when confronted by additional stressors, especially in times of continuous traumatic stress, such as war. This study examines the impact of the October 7 War on survivors of past sexual violence (SV) in Israel, with a particular focus on the intersection of past SV and the collective trauma of war. We conducted an online qualitative study using reflexive thematic analysis, supplemented by descriptive quantitative summaries based on the responses of 126 survivors to an online qualitative survey, to explore the impact of war on their mental and physical well-being and coping mechanisms. Participants described “re-living the trauma,” and reported marked deterioration in their perceived mental and physical states, including heightened post-traumatic symptoms and disruptions in aspects such as sleep, eating, and interpersonal relationships. Participants identified emotional and structural factors they perceived as exacerbating these conditions (e.g., Relegation to the bottom of social priorities), along with accounts of coping strategies and protective resources described by some participants, and recommendations for the healthcare system during wartime. These exploratory, context-specific findings suggest that individuals with a history of SV may experience particular vulnerabilities during periods of collective trauma, particularly during war, and emphasize the need to adapt frontline SV services to address health crises effectively.
Introduction
Many communities worldwide are affected, directly and indirectly, by large-scale collective stressors, ranging from natural disasters to man-made actions, such as wars (Benjet et al., 2016). From a psychosocial standpoint, the impacts of war have been conceptually associated with the notion of collective trauma (Erikson, 1976), which is defined as a stressful event that broadly affects a geographic region and/or social group, significantly disrupting the structures and relationships within communities. War as a collective trauma may have a severely adverse effect on the psychosocial well-being of all individuals—undermining their worldviews, and challenging their beliefs about safety, autonomy, and the meaning of human existence (Hirschberger, 2018).
Although collective trauma suggests a shared experience, research and theory acknowledge a diversity of individual responses, shaped by factors such as resilience and prior trauma exposure (Bonanno & Diminich, 2013). Vulnerable or marginalized individuals may be particularly affected (Philpot et al., 2021). One such vulnerable population is survivors of sexual violence (SV). SV is a serious and widespread issue, both globally and in Israel. It pertains to a spectrum of severity, from attempts to force a sexual act to completed rape (World Health Organization & Pan American Health Organization, 2012). The reporting rates of SV vary, depending on the definition, and are often underreported due to shame, fear, and difficulties in framing the experience as SV. According to the National Intimate Partner and Sexual Violence Survey (Basile et al., 2022), conducted in 2016 to 2017, over half of U.S. women (54.3%) and nearly a third of men (30.7%) reported experiencing some form of contact SV in their lifetime. Sexual violence is a psychologically traumatic event involving threats to life or bodily integrity, often resulting in helplessness and terror (Herman, 1992). It has profound immediate and long-term impacts, including chronic depression with dissociative symptoms, emotional numbness, anxiety, substance use, and various somatic symptoms (Amado et al., 2015; Campbell et al., 2009).
The present study addresses the intersection of past SV and collective trauma following the October 7 War in Israel. The October 7th events are regarded as the most significant terror attack in Israel’s history (Codish et al., 2024), and ranked by the Center for Strategic and International Studies (CSIS) as the third-deadliest terrorist attack globally since 1970, surpassed only by 9/11 in the number of fatalities, yet there is a lack of empirical knowledge to understand its perceived impact on at-risk populations such as SV survivors. The intersection of early trauma with later collective trauma forms the core of this research, which examines the perceived implication of the October 7 war on the survivors of past SV in Israel.
War as Collective Trauma: October 7, 2023
The attack by Hamas on October 7, 2023, caused profound upheaval in Israeli society as thousands of missiles were launched, and militants entered communities near the Gaza border, killing 1,145 civilians and soldiers and kidnapping 251—including children. The attack escalated into what the Israeli government called the “Iron Swords War,” displacing hundreds of thousands of Israelis to the Central Region. Within Israel, these events were widely experienced as a severe collective traumatic rupture. Attacks occurred in private homes, at a music festival, and during holiday gatherings, contributing to a pervasive sense of vulnerability. Continuous media coverage, including real-time footage and ongoing reporting on hostages and casualties, further intensified the psychological impact. In Israel’s relatively small and interconnected society, exposure was both direct and indirect, as many individuals personally knew someone affected by the events (Reuveni et al., 2025). Another aspect of the October 7 attacks involved reports of sexual violence. According to reports by the Association of Rape Crisis Centers in Israel and the United Nations Mission Report (2024), acts of sexual violence were documented during the attacks. These reports received significant attention within Israeli society and were widely discussed in media and public discourse. At the same time, public debates emerged internationally regarding the interpretation and acknowledgment of these reports. Scholars have examined how recognition of victims in conflict settings may be shaped by political narratives and global power dynamics (Bloom & Erez, 2024). Within Israel, some perceived what they experienced as insufficient acknowledgment or delayed recognition by parts of the international community, which, for certain individuals, contributed to feelings of invalidation and distress. For survivors of prior sexual violence, the public discourse surrounding these events constituted an additional layer of exposure, interacting with their own trauma histories. Importantly, our decision to focus specifically on prior sexual violence (SV), rather than on prior trauma more broadly, is theoretically grounded. The October 7 attacks included documented reports of sexual violence alongside other forms of brutality. Thus, for individuals with a history of SV, media exposure to these events may have involved not only general war-related threat, but also content that directly resembled the form of harm they had previously experienced. Cognitive models of posttraumatic stress disorder (PTSD) suggest that traumatic memories are organized in associative networks that can be involuntarily activated by cues resembling aspects of the original trauma (Brewin et al., 1996; Ehlers & Clark, 2000). Exposure to stimuli that are phenomenologically similar to prior trauma, often referred to as trauma reminders, has been shown to intensify emotional arousal, trigger intrusive memories, and contribute to dysregulated affective responses (Michael et al., 2005). When current events contain salient sensory, thematic, or relational parallels to earlier traumatic experiences, the likelihood of stress reactivation increases.
Moreover, research on media exposure following mass violence indicates that repeated or graphic exposure to traumatic content is associated with elevated acute stress and posttraumatic stress symptoms, even among individuals not directly affected by the event (Thompson et al., 2019). In this sense, media coverage may function as a trauma cue, particularly when it includes vivid depictions or detailed accounts of violence that overlap with prior traumatic experiences.
SV is associated with distinct psychological sequelae, including shame, bodily violation, disruptions in trust, and threats to autonomy and integrity (Dworkin et al., 2017; Ullman, 2023). Public discourse and media reporting on sexually violent acts in a war context may therefore carry heightened salience for SV survivors, above and beyond the general stress associated with collective trauma. Such indirect or vicarious exposure to trauma-related material has also been conceptualized within the literature on secondary traumatic stress, which demonstrates that exposure to others’ traumatic experiences can evoke symptoms resembling direct trauma responses (May & Wisco, 2016). Taken together, these theoretical and empirical considerations provide a conceptual rationale for examining survivors of prior sexual violence as a distinct at-risk population in the context of the October 7 war.
Exposure to war as a collective trauma profoundly affects individuals and communities, resulting in long-term psychological distress and social disintegration (Nikolic-Ristanovic & Stevkovic, 2016). Research shows that collective trauma increases rates of PTSD, anxiety, and depression (Duane et al., 2020; Hirschberger, 2018), as individuals struggle to process their experiences (Silver & Updegraff, 2013). For example, the COVID-19 pandemic heightened psychological distress and somatic symptoms (Theocharis et al., 2023). Similarly, recent studies on the October 7, 2023, terror attack in Israel report a significant rise in the prevalence of PTSD of between 29.8% and 31.4% (Feingold et al., 2024; Levi-Belz et al., 2024).
Collective trauma can also severely disrupt social relationships and community cohesion. Erikson (1976) described it as “a blow to the basic tissues of social life,” damaging bonds and impairing the sense of commonality. War and similar traumas erode perceptions of safety, stability, and control, drive large-scale displacement, and weaken the social fabric (Kevers et al., 2017; Miller & Rasmussen, 2010). Studies show that trauma survivors often face reduced social support, isolation, and the breakdown of social networks, and despair (Hirschberger, 2018). Collective trauma also disrupts health services, with patients facing limited access as providers struggle to deliver care under heightened stress (Sydorenko et al., 2025). Economic instability, job losses, and financial hardship—common outcomes of war—further increase the risks of depression and anxiety.
Trauma exposure occurs both directly and indirectly. Direct exposure involves experiencing or witnessing trauma firsthand, while indirect exposure, or secondary traumatic stress (May & Wisco, 2016), occurs through professional work, hearing about other people’s trauma, or media coverage (Pearlman & Saakvitne, 1995; Shoji et al., 2015). A longitudinal study on the October 7 attack (Amsalem et al., 2025) assessed 1,052 participants from Israeli conflict zones. People facing traumatic loss, displacement, or economic hardship—and women in general—exhibited significantly higher levels of anxiety, depression, and PTSD across all survey phases (February–May 2024; F = 17.7–215.3, p < .001). However, indirect exposure is also strongly associated with psychological symptoms. A recent study (Regnoli et al., 2024) shows that even in non-conflict regions such as Italy, the Russian-Ukrainian war and Middle Eastern tensions affect mental health. The study, involving 310 young Italian adults, found that fear of war increases their stress, anxiety, and depression, with future anxiety mediating these effects.
Moreover, individuals are more susceptible to the mental-health effects of disasters if they harbor risk factors such as a history of trauma or challenges in daily living (Stoddard et al., 2024; Sutker et al., 2002). In an umbrella review of 33 systematic reviews and meta-analyses, Tortella-Feliu et al. (2019), identified key pre-trauma risk factors, such as female sex, prior physical or mental illness, and childhood trauma. This highlights the importance of studying the implications of war on SV survivors’ well-being, since they often possess multiple pre-trauma risk factors, making them particularly vulnerable to heightened psychological distress in the face of collective trauma.
The Intersection of Early and Later Trauma
The idea that war, as a collective trauma, uniquely affects SV survivors may be connected to the concept of intersectionality, coined by Crenshaw (1989). This framework explains how overlapping oppression conditions amplify their combined impact. Crenshaw (1991) outlined three dimensions of intersectionality: structural, which highlights socio-structural factors like poverty that worsen women’s well-being; political, which examines how laws and policies often erase or silence the experiences of marginalized groups; and representational, which explores cultural narratives that reinforce stereotypes (Cho et al., 2013).
Studies support this, demonstrating that prior trauma heightens vulnerability to PTSD after subsequent trauma. For instance, research on women exposed to war in Croatia found that childhood trauma heightened post-traumatic symptoms after combat exposure (Stevanović et al., 2016). Similarly, Breslau et al. (1999) found that childhood sexual abuse increases susceptibility to PTSD following subsequent trauma. Similarly, a longitudinal study of refugees in Germany revealed that new traumatic events during treatment worsened PTSD, anxiety, and depression symptoms (Schock et al., 2016). During the COVID-19 pandemic, SV survivors reported that limited access to coping resources worsened their well-being (Gueta & Klar-Chalamish, 2022).
However, research on the vulnerability of those with pre-existing trauma—such as SV survivors—during the COVID-19 pandemic revealed a complex pattern of responses (Gueta & Klar-Chalamish, 2022; Tsur & Abu-Raiya, 2020). Two pathways were identified: a negative route, where childhood abuse survivors experienced heightened COVID-19 distress, and a positive route, in which some reported lower distress, possibly due to the trauma acting as a “shield,” or the use of repressive coping mechanisms. The researchers noted the need for further study to understand these dynamics.
These findings highlight the importance of individual and external resources, such as coping strategies, financial support, and social networks, in mediating the effect of trauma and the ability to cope with further trauma (Gueta, 2022; Wright et al., 2007). Coping strategies, although inconsistently defined (Skinner et al., 2003), are often classified as either the approach or avoidant type (Roth & Cohen, 1986), and as problem- or emotion-focused (Lazarus & Folkman, 1984). Avoidant strategies, which aim to protect against perceived threats and emotions, may provide short-term relief but are linked to poorer long-term mental health (Ullman et al., 2014). Conversely, approach strategies actively address stress through problem-solving or emotional regulation (Aldao et al., 2010).
The Present Study
This study highlights the importance of identifying the impacts of SV survivors in wartime and understanding the mechanisms that shape survivor well-being during collective trauma, rather than solely measuring outcomes such as PTSD symptoms or functional impairment. By examining the pathways, resources, and social and cultural dynamics involved, we can identify factors that promote well-being, address barriers, and develop more effective interventions. Thus, the goal of this exploratory study was to better understand the impact of war as collective trauma on survivors of SV and to provide bottom-up recommendations for policymakers. Accordingly, it sought to address three key questions: How do survivors of SV perceive the war’s impact on their psychosocial well-being? Which factors help or hinder their ability to cope with these impacts? Lastly, what are survivors’ perspectives on improving and adapting SV services and policies to better meet their needs during wartime?
Methods
Research Approach
We employed a qualitative naturalistic approach, which emphasizes a comprehensive understanding of phenomena within their real-life context (Lincoln & Guba, 1985).
Participants and Procedures
This study is a qualitative investigation using reflexive thematic analysis, supplemented by descriptive quantitative summaries of selected survey items. The primary dataset consists of open-ended responses collected via an online survey. Quantitative summaries are reported to contextualize participants’ experiences rather than to test hypotheses or estimate associations. The final analytic sample included 126 voluntary participants (122 women, 3 men, and 1 non-binary) who identified as survivors of SV. The ages in the dataset ranged between 18 and 74. The average (mean) age was 42.46.
In order to minimize participant burden during an ongoing national emergency and reduce the risk of re-distress, we intentionally limited the collection of detailed demographic and trauma-specific information. We did not systematically assess trauma onset age, type of abuse, or socioeconomic indicators. While these factors may meaningfully shape coping and trauma responses, the study prioritized accessibility, anonymity, and psychological safety during data collection.
We used a convenience/volunteer sample, recruiting participants primarily through online platforms such as Facebook pages and websites focused on SV-related issues. Online recruitment enabled rapid, anonymous participation, which can be particularly important in trauma-related research (van Stolk-Cooke et al., 2018). At the same time, we acknowledge the limitations inherent in convenience sampling and self-selection, including reduced control over sample representativeness and the inability to verify self-reported histories. The link to the Qualtrics electronic survey was distributed over 5 weeks, between January 9 and February 6, 2024. This timeframe was chosen to capture survivors’ reflections after the initial phase of the war, allowing for a more settled perspective of their experiences and needs. Inclusion criteria required participants to be over 18 and to self-identify as SV survivors. After providing online consent, participants were asked to complete the self-report survey for the study.
The questionnaire focused on survivors’ experiences during the early stages of the war and explored the resources or support that could have helped them during that period. This approach was designed to gather insights into both immediate and ongoing challenges faced by survivors in a conflict context. In this study, the online qualitative survey comprised eight questions, including demographic questions about gender and age, and questions on various aspects of the war’s impact—such as: “How has the war affected your ability to cope with the trauma you experienced?” Additionally, the survey sought suggestions for policies and practices to support survivors. This open-ended question design adheres to standards for qualitative online surveys, ensuring clarity and openness, and is comparable in quality to interviews (Braun et al., 2021).
Procedure and Recruitment
Participants were recruited via online platforms. The study description presented prior to consent included the study aims, the sensitive nature of the questions, voluntary participation, the academic affiliation of the research team, the ability to skip items or discontinue at any time, confidentiality and anonymity procedures, and information about support resources. A total of 309 individuals accessed the survey link. Responses with less than 50% completion were excluded due to insufficient qualitative material for analysis. Following these exclusions, the final analytic sample comprised 126 participants.
We chose online qualitative surveys for their advantages in wartime, where rapid, risk-free data collection is crucial. This method provides rich, focused data while offering anonymity and flexibility, making it particularly suitable for SV survivors who may feel safer sharing experiences without face-to-face interaction. It also allows participants to easily withdraw and allows for geographically dispersed perspectives (Braun et al., 2021). For researchers, online surveys are time-efficient, cost-effective, and ideal during crisis. They have proven effective in studies conducted during collective trauma, such as the COVID-19 pandemic, which gathered lived experiences to inform strategies, advocacy, and funding by providing timely insights, without compromising data quality (Thomas et al., 2024; Vindrola-Padros et al., 2020).
Data Analysis and Quality Criteria
In Phase I of the study, the research team—comprising the study’s authors, who are both researchers and advocates for SV survivors—conducted a qualitative analysis of the written survey responses, which varied in length from brief phrases to full paragraphs. We used reflexive thematic analysis, guided by critical realist ontology (Braun & Clarke, 2021)—a method well-suited for qualitative online data thanks to its adaptability and capacity to reveal deep, contextual insights. The analysis followed Braun and Clarke’s approach, beginning with immersion in the data, through repeated readings to identify initial patterns. We then generated codes that captured key features relevant to our research questions. These codes were grouped into initial themes, which we refined through iterative review. Final themes were defined and labeled to provide a coherent narrative supported by data extracts and relevant literature. Throughout the process, we maintained reflexivity and transparency, recognizing our active role in interpreting the data.
In Phase II, we quantified the content categories from the survey responses, using simple descriptive statistics to identify patterns and trends (Halevi Hochwald et al., 2023). The responses were coded into categories for qualitative insights and quantitative frequency analysis. This qualitative study, using reflexive thematic analysis, supplemented by a descriptive quantitative summaries approach, provided a comprehensive view of the phenomenon by examining it from multiple angles.
The two authors collaboratively sorted and grouped data units (each comment field counted as a unit), systematically identifying patterns, including disconfirming evidence. Initial coding was developed by analyzing 20 response sets from 10 participants. Recurring themes were categorized (e.g., “flashbacks” for mentions of increased SV flashbacks), and responses were quantified based on these categories. Regular team meetings refined codes and definitions and explored these relationships. The qualitative thematic analysis constituted the primary analytic approach. Descriptive frequency summaries of selected response categories were used to contextualize and illustrate the scope of the identified themes, rather than to conduct statistical analysis or test hypotheses. Cross-case analysis in the final stage identified consistent patterns across responses, capturing depth and scope. Two researchers independently conducted the initial coding of the open-ended responses. Following this phase, the researchers engaged in a series of analytic meetings to compare interpretations, discuss discrepancies, and refine code definitions and theme boundaries. Consistent with reflexive thematic analysis (Braun & Clarke, 2021), we did not calculate inter-rater reliability coefficients. Instead, we emphasized reflexive dialogue, transparency in analytic decisions, and iterative consensus-building to enhance conceptual coherence and rigor.
Preliminary code saturation was observed after the analysis of 89 participant responses, as few new thematic issues emerged at that stage. However, data collection continued to ensure meaning saturation and conceptual depth, consistent with qualitative standards (Hennink et al., 2017). Lincoln and Guba’s (1985) constructs were applied, to ensure trustworthiness. Credibility was achieved through data triangulation, member checking, and grounding the analysis in extracts, to allow readers to assess the findings and their context. Transferability was supported by detailed methodological descriptions and rich accounts of participants’ perspectives.
Ethical Considerations
The study was approved by the Research Ethics Committee of Bar-Ilan University. Special ethical measures were implemented to address the participants’ vulnerability (Vindrola-Padros et al., 2020). All participants provided online informed consent and were assured that they could skip any question or exit the survey at any time. They were encouraged to reply in their own words and at their preferred level of detail. To ensure their well-being, participants were guaranteed access to free professional support by telephone or online chat after completing the questionnaire. They could contact the authors directly with any concerns or for support, and were also offered the option to complete the survey with the second author’s assistance. The study was conducted in collaboration with Israeli sexual assault crisis centers that provide 24/7 confidential emotional support and counseling services. As part of the informed consent process, participants were provided with contact information for these centers and were reminded of these resources at the conclusion of the survey. These organizations were available to offer immediate assistance should participation evoke distress. This procedure was implemented to ensure trauma-informed and ethically responsible research conduct during an ongoing national crisis.
Findings
Data analysis revealed four key themes: the survivors’ perspectives on war’s impact on their well-being; the mechanisms driving these effects; protective factors; and recommendations for improving SV services and policies during wartime.
“Re-Living the Trauma”: The War’s Perceived Impacts on the Mental and Physical Well-Being of Survivors
The research participants described a form of “reliving the trauma” in the war’s aftermath—a recurrence or intensification of patterns and symptoms they had previously experienced after SV. The statistical analysis revealed that some 74% of the study participants reported their mental state declined after the war and its consequences.
The Psychological Toll of War: Escalating Anxiety, Regression, and Overwhelm
The participants described a long list of post-traumatic symptoms that had recurred or intensified since October 7—including an overflow of traumatic content, feelings of anxiety and panic attacks, depression, shock, anxiety, nightmares, flashbacks, intrusive thoughts, suicidal thoughts, difficulty concentrating, and extreme mood swings. Answering the question “How has the war impacted your coping with past trauma?,” one wrote: “It [the war made me] relive it again. Every day, it [the trauma] is deeply present with what the victims experienced on October 7. Those who haven’t endured something like that struggle to understand why one returns to that abyss.” The participants described the symptoms as significantly damaging their mental state—at times to the point of actual mental breakdown. For example, One participant described experiencing a severe deterioration in functioning during this: “Anxiety, remembering things I had gone through as a child, and remembering everything I’ve been through in life. Mental collapse.” Another participant described how her past trauma related to what was happening now, which revived it: “A link between the horror of the past and the images of the present.”
Even survivors who were in a “stable” mental state before the war and felt balanced in their coping with the SV they had endured described a deterioration of their mental state: “Hell. A mental crisis like no other I’ve ever had. Everything collapsed—after years of ‘recovery’, work, studies, and marriage. The trauma erupted at full blast. It’s indescribable. Symptoms that I didn’t even have before.”
Participants reported needing to focus all their resources on basic survival and daily functioning—in stark contrast to the surge of volunteering in society at large at the outbreak of the war. Societal expectations contribute to heightening their sense of isolation. One participant confessed: “I had a strong desire to help, but an overwhelming lack of mental and physical capacity to do so.”
The statistical findings align with the participants’ narratives, confirming the impact of their experiences. A significant portion—57%—reported a worsening of their SV-related symptoms. Additionally, 53% noted that the war had intensified their trauma-related flashbacks, while 40% experienced greater general anxiety. Notably, 83% reported an increase in intrusive thoughts concerning their past SV experiences.
The Body Under Siege: Sleep and Eating Struggles in Times of War
Participants reported somatic symptoms such as difficulty breathing, frequent crying, fatigue, freezing, and physical pain. Sleep disturbances and eating issues were the most common, reflecting the physical toll of their emotional distress.
A significant proportion (61%) of participants reported worsening sleep disruptions—including difficulty falling asleep, fragmented sleep, nightmares, altered schedules, and greater use of sleeping pills. One noted “Poor sleep, even with sleeping pills,” while another reported “Nightmares have returned.” Another wrote they “couldn’t sleep more than four hours a night for nearly two months.” Additionally, 33% reported worsening eating patterns—including loss of appetite, overeating, emotional eating, and night-time binge eating. One participant wrote: “Sometimes I only eat one meal a day,” while another said: “I eat much more—even food I don’t like—mostly at night.”
Relationships Under Fire: The War’s Toll on Interpersonal Connections
The research participants reported significant challenges in their interpersonal relationships due to the war—with 25% experiencing impaired social connections, and 17% reporting adverse impacts on their romantic relationships. Many described heightened conflicts and emotional strain, often attributed to the difficulty of managing relationships while coping with their own distress. Additionally, participants noted that their loved ones struggled to provide the support and understanding they needed during this challenging time. As one participant put it: “I take every argument with family members now much harder. I would like greater sensitivity.”
Specifically, participants reported significant challenges in their intimacy and sexual activity, attributing their difficulties to the overall war situation and the emotional overwhelm triggered by exposure to the SV that occurred during the October 7 massacre and hostage-taking. Many described a heightened sense of distress that interfered with their ability to engage in intimate relationships. One participant noted: “There was a long period during the war when I found it difficult to have intimate relations with my partner.” Another participant echoed similar struggles: “I felt I couldn’t, and any intimate situation would throw me back to images of horror.”
Engines of Distress: Emotional and Structural Mechanisms Undermining Survivors’ Well-Being in Wartime
Participants described specific characteristics of the war that served as fertile ground for re-living their trauma, resulting in the consequences outlined above. This theme had two key dimensions: emotional and structural mechanisms.
Emotional Mechanisms Contributing to the “Re-Living of Trauma.”
War Trauma Mirroring Sexual Violence Experiences
One of the mechanisms contributing to the war’s impact on survivors’ well-being concerns the shared characteristics of war trauma and sexual victimization: both involve threats to life and bodily integrity. The fear of death triggered by war often triggers the terror associated with the original trauma. As one participant described it: “I don’t care about dying anyway, so why should I care about the war, or violent death—besides moments of terror, which I believe are a connection between the fear of the past and the images of the present?”
Second, the loss of control over one’s body and autonomy—a hallmark of SV—was also present during the war, characterized by unpredictability and powerlessness, thereby heightening survivors’ emotional distress. One participant noted: “The feeling of being back in a place of vulnerability and lack of control is very threatening and frightening—especially when it concerns my children who might get hurt.”
Additionally, 30% of participants highlighted a profound identification with the hostages as a contributing factor to their turmoil. As one explained: “I feel a profound empathy for the hostages—as though I’m sharing their suffering.”
Echoes of Trauma: Continuous Exposure to War-Related Reports of SV as a Trigger for Survivors
Participants described the intense media and public attention surrounding the SV that occurred during the October 7 massacre and hostage-capturing as a powerful trigger of emotional overwhelm and distressing flashbacks to their own experiences of SV. One participant said: “I’m glued to the news—experiencing anxiety, pressure, and flashbacks every time words like ‘rape’ or ‘sexual assault’ are mentioned.” Another noted: “It raises many triggers and a profound identification with the pain.”
“Hierarchy of Vulnerability”: Relegation to the Bottom of Social Priorities
Participants described experiencing what they perceived as a hierarchy of victimhood following the outbreak of war. As public attention shifted toward conflict-related sexual violence, particularly assaults perpetrated by an external enemy, survivors of prior, non-war-related sexual violence felt comparatively deprioritized. Importantly, this shift was not experienced merely as a change in public discourse. Participants described it as reshaping their internal sense of legitimacy and worth as survivors. In this sense, social recognition functioned as a constitutive element of psychological reality rather than as an external backdrop. The perceived elevation of certain forms of sexual violence over others implicitly organized a hierarchy of suffering, which participants internalized as a hierarchy of value. For many, this dynamic reactivated earlier experiences of silencing, disbelief, or minimization associated with their original abuse. The perception that some forms of trauma were now considered more “worthy” of empathy and collective mobilization threatened survivors’ identity coherence and intensified feelings of invisibility and alienation. As one participant stated, “The war proved that sexual trauma doesn’t matter, unless an Arab raped you. We are invisible . . . There’s valuable trauma, and less-valuable trauma.” Thus, the sociopolitical reprioritization of victimhood did not remain at the level of political critique; it reorganized participants’ internal meaning-making processes, shaping how they understood their own trauma, social standing, and psychological significance.
Participants described how their marginalization and lack of public attention—as evident in the limited services available to them—revived feelings from their SV experiences, when no one intervened or acknowledged their suffering. They contrasted this with the significant support and sympathy given to the “new” victims of war-related SV, deepening their sense of exclusion. One participant put it: “The war brought up helplessness, terror, and a sense of abandonment. My difficulties were forgotten or considered less important.” Another added: “When I was abused, no one paid attention—let alone provided care, resources, or tailored treatments.”
Relegation to the bottom of social priorities was internalized by some participants as though seeking help for their own SV trauma was illegitimate. As one survivor put it:
I don’t want to burden her [my therapist] with more suffering, so I try to manage on my own. This has led me to start self-harming again, after a long period of not doing so. I find it hard to ask for help . . . Sometimes, I suffer deeply from triggers related to the war—and then feel guilty for focusing on myself instead of the ongoing suffering.
Silenced and Betrayed: Survivors’ Feelings of Neglect by the International Community
Participants described profound feelings of abandonment and silencing in response to what they perceived as the international community’s lack of acknowledgment of SV committed during the war, particularly the silence of international women’s organizations. Notably, participants were not asked to evaluate political actors or international events; they were invited to describe their emotional and psychological state following the outbreak of war. References to international responses emerged spontaneously as part of their attempts to make sense of their distress. For many, the perceived absence of recognition resonated with earlier experiences of not being believed, minimized, or required to justify their suffering. The silence was described as deeply painful not only because of its public meaning, but because it reawakened familiar internal states of doubt, invisibility, and vulnerability. As one participant wrote, “I feel half defeated by this familiar situation—where perpetrators receive public and legal support, while victims suffer further harm through denial.” Another stated, “It’s incredibly painful that women’s organizations didn’t condemn the events. We have to prove and explain, but it still feels insufficient, because of the ongoing denial.” These accounts suggest that public acknowledgment, or its absence, became intertwined with participants’ inner sense of legitimacy and safety. The perceived lack of collective validation did not remain external; it shaped how survivors understood their own suffering, their place within the social world, and the degree to which they felt protected or supported.
Structural Mechanisms Contributing to the “Reliving of Trauma”
Displacement and Uncertainty: A Catalyst for Psychological Distress
Participants in peripheral areas near conflict zones experienced direct trauma, with many experiencing heightened psychological distress by their forced evacuation. This structural displacement heightened their feelings of instability, intersecting with ongoing challenges of past SV. Some survivors described this dual burden of war-related hardships compounding their trauma. As one of them put it: “I’m being evacuated from the north, so it’s a kind of difficulty—an additional difficulty, with no end in sight.”
Reduced Access and Financial Barriers in Treatment Availability
Participants reported disruptions to their emotional-support services, as therapists canceled or rescheduled sessions to help evacuees, survivors, or because of military call-ups. Many were left without essential therapeutic support, compounding their distress. One participant noted that “The social worker who treated me was sent to help the massacre survivors,” while another reported: “My psychologist was called up for reserve duty, so I felt abandoned.”
Financial strain due to the war further limited access to mental healthcare. Some participants reduced or halted their treatment entirely to prioritize essential expenses hindering their recovery during an already distressing time. As one put it: “The financial situation became unbearable, and I had to cut back on treatment.”
Participants also described how the war exacerbated their mental-health struggles while limiting access to the urgent therapeutic support they needed. Increased demand for mental health services, particularly in southern Israel, left many without care. One participant noted: “No treatment facilities were available, due to a shortage of space and staff,” while another reported: “I was rejected for treatment, as all resources were reserved for southern residents.”
Erosion of Ontological Security: Loss of Trust in the State
Participants described a profound disruption in their sense of basic security following the events of October 7. The scale and suddenness of the attack, alongside the perception that the state had failed to protect its citizens, were experienced not only as a national crisis but as a deeply personal rupture. For many, the belief that the state would provide protection in moments of danger had functioned as an implicit source of stability. Its perceived collapse intensified existing feelings of vulnerability and abandonment. Participants described a growing sense of aloneness and uncertainty, as if a foundational layer of protection had been removed. One participant wrote, “[The war] amplifies the loneliness and abandonment by the state.” Another stated, “The state betrayed me/us so severely, and unfortunately, I no longer believe in it.”
These accounts suggest that the loss of trust in national institutions was not limited to political disappointment. Rather, it destabilized participants’ internal sense of safety and predictability. The perceived withdrawal of protection blurred the boundary between collective crisis and personal insecurity, deepening emotional distress and reinforcing feelings of exposure and fragility.
Protective Factors Amidst War-Related Stress
Participants identified various protective factors and resources that helped them manage the psychological challenges of war-related stress. These included resilience and coping skills developed through past trauma, support from treatment services, and a shift in perspective that helped them reframe past trauma in terms of the current crisis.
Relationships as a Source of Support
Some of the participants (25%) identified their romantic relationships as a significant source of emotional support and stability during this challenging time. They attested that their partners provided comfort and an essential escape from the overwhelming stress of war. As one participant put it: “My romantic relationship provides amazing and meaningful support, and also serves as an escape.” Others highlighted community support as a crucial resource during the crisis. One participant said: “Fortunately, my surroundings are relatively supportive—the community helped when my husband was on reserve duty, and my mother helped a lot.”
Resilience and Coping Skills Developed Through Coping With Past Trauma
A small number of participants reflected on how their past experiences with SV helped them develop resilience and coping strategies that proved valuable in coping with the stress induced by the war. They described certain tools they had developed over the years—such as engaging in meaningful activities to channel their pain, or maintaining a consistent exercise routine—as key factors in their ability to endure the current crisis. One participant cited her volunteer work: “From Day 1, I set up a support center, and through it, I channeled the pain. Post-trauma has protective layers, and in national stress situations, it brings out the best in me.” Another noted: “I continue physical activity—running and cycling. That, without doubt, is what keeps me going.” Similarly, another participant noted: “I cope relatively well, considering I was previously traumatized. I assume it’s because I’ve gone through therapy over the years.”
“Leveraging Resources”: The Role of Treatment Services in Coping With War-Related Stress
While some participants described difficulties in accessing therapeutic support, others (22%) reported being able to use available resources (mostly through private clinics) by seeking treatment, or even increasing the frequency of their sessions. This proactive approach helped them cope more effectively with the challenges of the war. As one put it: “I rely on private psychological therapy. At one point, I increased it to twice a week, just to hold on.”
“A Shift in Perspective”: Minimizing Past Trauma in the Face of Current Crisis
Some participants described how exposure to the “new” traumas of war gave them a different perspective on their past experiences of sexual violence. This shift—perceived by some as a positive reframing—allowed them to diminish their past trauma, as their own experiences seemed “mild” in comparison to the current horrors. One participant reflected: “It put my trauma in a new perspective.” Others highlighted emotional numbing as a positive coping mechanism. As one participant put it: “The war pushed the trauma of sexual violence to the corner—in a way, that makes it easier.” For these individuals, the overwhelming scale of the current crisis appeared to reduce the emotional weight of their past trauma, offering a temporary relief or detachment.
“Bridging the Gaps”: Addressing Survivors’ Needs During Wartime
Participants stressed the need for expanded public therapeutic services tailored to their needs, and special recognition of those with prior trauma, to acknowledge their compounded challenges.
Accessible Survivors’ Needs During a Wartime Crisis
A key need expressed by 52% of participants was the availability of subsidized, high-quality mental health treatment that is easily accessible without complex bureaucratic hurdles. They also underscored the importance of specialized training for therapists in trauma-informed care. One participant expressed the hope “that one day it will be possible to receive government funding and there will be enough therapists. Right now, one has to wait a year for treatment, which is unreasonable.” Another participant wished for “Greater availability of psychiatric services, flexibility in the preconditions of rehabilitation benefits, and a reduction in bureaucracy.”
“Shared Healing”: The Need for Peer Support as a Resource for Survivors
Participants expressed a strong need for peer-led support circles and therapy groups specifically designed for survivors of SV—particularly considering the intersecting traumas of sexual violence and war. They stressed the importance of having somewhere where they can connect with others with similar experiences, given the unique therapeutic value of peer-led support in fostering understanding, empathy, and solidarity. One participant sought “A treatment/group dedicated to survivors of sexual assault in the current situation, which is very overwhelming.” Another asked for “[. . .] circles of women my age who can speak in a shared language about what we’re going through right now. To see each other, to know that we’re not alone.”
“Breaking the Silence”: Raising Awareness of the War’s Impact on Survivors of Sexual Violence
Participants emphasized the urgent need to raise public and professional awareness about the unique impact of the war on survivors of SV. They expressed a desire for greater recognition and understanding of how war-related events can act as powerful triggers that exacerbate their trauma and emotional struggles. As one participant put it: “In public discourse, space should be given to how the events in this war trigger sexual-assault survivors.” Another wrote:
I felt I could have received help, but most people didn’t understand how it connected to my past trauma. Only when a newspaper article on sexual assault was published did my friends finally understand my crisis. There needs to be greater media awareness.
Notably, 11% of participants expressed gratitude for this study, and appreciation for its focus on survivors’ unique needs, with comments such as: “Well done on conducting the study and trying to help,” and “Thank you for seeing our special struggle.” They felt validated and relieved, noting that the study offered a rare opportunity to voice their challenges that are often overlooked in public discourse and support systems.
Discussion
War, as a form of collective trauma, is a severe crisis that rapidly inflicts widespread and profound negative impacts on individuals, communities, and society (Sabag et al., 2024). However, prior research (Tortella-Feliu et al., 2019) suggests that individuals with a history of trauma may be particularly vulnerable, potentially placing their well-being at greater risk. Accordingly, this exploratory qualitative study examined how survivors of SV in our sample perceived and made sense of the impact of the war that broke out in October 2023 in Israel as a form of collective trauma.
The study’s findings—supported by both participant narratives and statistical analysis—highlight a distinct aspect of the war’s impact on survivors: the “reliving of trauma.” This was evident in the deterioration of their mental health and the negative effects of various aspects of their lives. The state of emergency imposed on all Israeli citizens on October 7 appeared to have an especially overwhelming effect on many SV survivors in our sample—as found in past research on at-risk populations during war and collective trauma. Furthermore, our findings contribute to the literature by identifying processes that may help explain how war complicates survivors’ well-being and the protective factors that help mitigate those effects. Finally, the study emphasizes the need for targeted interventions at various levels to better support survivors during such crises.
This comprehensive understanding was achieved by adopting an intersectional perspective. This approach facilitates a more nuanced and multifaceted analysis of survivors’ well-being in wartime by examining how multiple identities—such as prior trauma history, geographic location, Israeli nationality, socioeconomic status, and overlapping systems of oppression— interact to shape survivors’ well-being. By recognizing these interconnected factors, the analysis moves beyond one-dimensional explanations by offering deeper insights into the challenges and vulnerabilities described by survivors in this study.
Taken together, the findings reflect what we term trauma convergence, a process in which prior interpersonal sexual trauma and subsequent collective war trauma intersect within the same individual. Rather than representing a discrete new stressor, exposure to the October 7 attacks and their aftermath appeared to reactivate existing trauma memory networks, leading to renewed intrusions, heightened arousal, and emotional distress.
Importantly, this reactivation did not occur in a psychological vacuum. It unfolded within a broader social, institutional, and political environment that participants experienced as shaping how they interpreted their distress and trauma-related meaning-making. Public discourse, media representations, institutional responses, and patterns of recognition or silence were not experienced merely as contextual background, but as meaningful forces influencing survivors’ internal sense of legitimacy, safety, and belonging. In this respect, the convergence of traumas operated not only at the level of symptom activation, but also at the level of sociopolitical meaning-making. This framing extends existing literature on the psychological consequences of sexual violence, which has primarily focused on immediate interpersonal, clinical, and relational outcomes. Our findings indicate that in contexts of national crisis, broader political dynamics—such as hierarchies of victimhood, collective recognition, and institutional trust—may become intertwined with survivors’ internal trauma processes. The political sphere thus functions not simply as an external stressor, but as a domain shaping the subjective organization of trauma, identity positioning, and perceived validation or invalidation. At the same time, participants varied in their trajectories, with some describing increased vulnerability and others drawing upon previously developed coping resources. This variability aligns with resilience research suggesting heterogeneous adaptation trajectories following trauma exposure, including patterns of chronic distress, recovery, and resilience (Bonanno & Diminich, 2013). We suggest that conceptualizing these findings as trauma convergence provides a structured framework for understanding how interpersonal and national forms of violence may dynamically interact to shape well-being, coping, and service needs, particularly when sociopolitical recognition becomes intertwined with psychological stability.
This process may also be understood through the lens of shattered assumptions (Janoff-Bulman, 1992), whereby traumatic events disrupt fundamental beliefs about safety, trust, and predictability. For survivors whose core assumptions were previously destabilized by sexual violence, the collective violence of war may further erode perceptions of security at both personal and societal levels.
Specifically, our findings add to the literature by highlighting underlying mechanisms of the harmful consequences of war on SV survivors—such as their marginalization by the focus on “new” victims; the neglect and denial by the international community contributing to their “reliving of trauma”; and their sense that the state and treatment services failed to recognize their unique needs during the war (echoing the sidelining, or even abandonment, they had experienced from those institutions at the time of their original SV). These responses reveal the unintended consequences of shifting therapeutic resources during times of national crisis, leaving some survivors feeling unsupported and vulnerable. This pattern warrants attention, especially given findings from the COVID-19 pandemic suggesting that shared societal restrictions temporarily reduced feelings of otherness and mitigated distress for some individuals (Campbell et al., 2009; Herman, 1992).
Furthermore, many participants described experiencing what they perceived as insufficient acknowledgment by state institutions and by parts of the international community, which they associated with heightened feelings of invisibility—particularly in light of the strong public focus on victims of the October 7 attacks. In line with previous findings regarding Israel (Gueta et al., 2020), periods of intensified national conflict may shift media and public attention toward security concerns, potentially sidelining ongoing issues related to sexual violence.
Public debates surrounding the reports of sexual violence during the October 7 attacks were experienced by some participants as invalidating or distressing. As Bloom and Erez (2024) suggest, recognition of victims in conflict settings may be shaped by political narratives and processes of moral positioning. Within this broader context, certain survivors interpreted international responses as delayed or insufficient, an interpretation that, from a psychological perspective, may function as a retraumatizing experience.
These accounts can be analytically understood through the framework of institutional betrayal (Lahav & Ben-Ezra, 2024; Smith & Freyd, 2013), which refers to individuals’ perceptions that institutions on which they depend have not adequately responded to their needs. In a collective trauma context, such perceptions may intensify distress, reactivate prior trauma-related schemas, and diminish trust in formal systems of care and justice.
For some participants, the perceived failure of state and international institutions to adequately recognize or respond to suffering may also resonate with the concept of moral injury (Litz et al., 2009), particularly when deeply held expectations regarding protection and justice are violated.
This pattern is also consistent with representational intersectionality (Crenshaw, 1991), which highlights how cultural narratives and power relations influence whose victimization is publicly recognized, legitimized, or marginalized.
This is particularly important as a contributing factor to “the reliving of trauma,” as it underscores the profound psychological impact of continuous exposure to war-related SV media reports, which has not only retraumatized survivors, but also revived memories of their past experiences, and harmed their well-being.
Besides emotional mechanisms triggering the reliving of trauma, structural factors also played a role—such as reduced access to treatment when most needed, and economic hardships that force survivors to prioritize financial needs over therapy. In an ongoing war, the challenge is how to address evolving trauma, as opposed to a single event. This crisis was especially severe, as Israel’s public mental health system was already overstretched, with psychiatric wait times exceeding a year in many parts of the country (Reuveni et al., 2025). Such experiences may be understood through the lens of institutional betrayal (Lahav & Ben-Ezra, 2024; Smith & Freyd, 2013), as it means that institutions invalidate survivors’ trauma instead of supporting them, thereby deepening distress and eroding trust in justice systems. This ties in with the notion of structural intersectionality (Crenshaw, 1991), whereby socio-structural barriers such as poverty and institutional failures compound survivors’ disadvantages.
Our findings also highlight the role of external support systems and internal coping strategies described by participants when navigating the psychological challenges posed by the war, by noting the survivors’ resilience and resourcefulness in the face of adversity. These findings align with past research that found survivors’ need for a broad range of psychological, social, economic, and cultural resources in normal times, particularly in wartime (Gueta, 2022).
Interestingly, a small number of participants noted that the coping mechanisms they had developed over the years to manage the impacts of SV—such as attending therapy—had better prepared them to handle the challenges of war. This finding aligns with previous research that found experiences of abuse were associated with enhanced coping abilities (Sudbrack et al., 2015). These accounts are consistent with what has been described in the literature as a possible “shielding” effect, whereby exposure to previous trauma can, in some cases, foster resilience against subsequent acute stressors. In the current context, the shielding effect relates to the accumulation of resources—such as the use of approach-oriented coping strategies—that help individuals navigate the stressors of war more effectively.
Participants viewed their “shift in perspective” as something positive, as the war crisis helped diminish their past trauma, thereby reshaping coping mechanisms. While this reframing provided a certain relief and resilience, it also bore both protective and harmful effects. In the short term, it eased distress by downplaying past trauma, but in a war-focused society, it also risked invalidating past SV, deterring help-seeking, and reinforcing trauma downplaying. These accounts suggest the importance of carefully considering both the benefits and risks of trauma reframing for survivors.
These accounts partially resonate with post-traumatic growth frameworks (Tedeschi & Calhoun, 1996), which describe positive psychological changes following adversity. However, in the present context, such shifts appeared complex and ambivalent, reflecting adaptive reframing rather than broad transformative growth. Only a limited number of participants described substantial change, suggesting that these responses are better understood as context-dependent coping processes within an ongoing crisis, rather than evidence of widespread post-traumatic growth.
Lastly, participants stressed the urgent need for expanded public therapeutic services that are tailored to their needs, free of bureaucratic demands, as well as readily available and dedicated support groups. These responses point to a perceived need for more comprehensive and accessible mental health services during wartime. Like the findings of a study on survivors’ coping during the COVID-19 crisis (Gueta & Klar-Chalamish, 2022), the present study points to the importance of adapting services and making them accessible in times of emergency. Developing group therapy options, and providing accessible information on available treatment services, are crucial to addressing survivors’ needs. This demand may be due to the nature of collective trauma. In Israel, these needs may also reflect cultural norms, where shared grieving and healing rituals play a significant role in recovery from collective trauma (Theisen-Womersley, 2021).
Limitations and Future Directions
This qualitative study explored how participants made sense of their experiences during an ongoing national crisis without employing standardized diagnostic or symptom-based measures. Accordingly, descriptions of distress or coping should not be interpreted as clinical assessments of PTSD or overall psychological functioning. Future research could incorporate validated PTSD and coping instruments to allow for quantitative triangulation and systematic evaluation of symptom severity and adaptation patterns. The use of a self-selected, online convenience sample facilitated accessibility and anonymity but may have excluded individuals with limited literacy, internet access, or technological resources, who are often among the most vulnerable (Braun et al., 2021). Additionally, due to the anonymous and open recruitment strategy, it was not possible to calculate a response or refusal rate, limiting assessment of sampling coverage and potential nonresponse bias. The absence of detailed demographic and trauma-specific variables, including trauma onset age, type of abuse, and socioeconomic background, further constrains the ability to examine variability across coping trajectories. Several interpretive boundaries should also be noted. As data were collected during an ongoing and volatile period of war, the findings reflect participants’ subjective perceptions at a particular point in time and may capture distress processes that evolve. The analysis does not provide an objective evaluation of institutional policies, but rather an interpretation of how participants experienced sociopolitical dynamics. Consistent with reflexive thematic analysis, findings are shaped by the researchers’ interpretive engagement with the data, and alternative readings are possible despite efforts to ensure rigor. Lastly, the findings should be interpreted within the specific Israeli cultural context, although they may have heuristic value for similar contexts (Lincoln & Guba, 1985).
Recommendations for Policy and Practice
Within the limits of this exploratory and context-specific qualitative study, the findings underscore the importance of adopting a survivor-centered and trauma-informed perspective in collective trauma preparedness and response. It highlights the need to tailor interventions and policies to address the compounded and context-specific needs of survivors during periods of national crisis. Given the heightened risks and limited coping resources it has identified, services must be expanded and made more accessible by advocates, therapists, and helpline practitioners. A variety of services—such as independent advocacy, peer support, and mentoring—should be offered to promote survivors’ mental health through a sense of community belonging (Philpot et al., 2021).
To meet increased demand services must remain consistently available. This includes adjusting service hours and developing scalable online interventions for crises, such as those tested for interpersonal violence survivors (Nguyen-Feng et al., 2016). Despite the benefits of online support, the findings also underline the importance of providing face-to-face services and creating safe spaces for survivors, including peer support groups.
Footnotes
Ethical Considerations
The authors of this manuscript have complied with APA ethical principles in their treatment of individuals participating in the research, program, or policy described in the manuscript. The research has been approved by the ethical board committee of Department of Criminology Bar- Ilan university.
Funding
The authors received no financial support for the research and/or authorship of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interests with respect to the authorship and/or publication of this article.