Cumulative war-related trauma in the MENA region: a systematic review

The Middle East and North Africa (MENA) region has endured decades of conflicts, civil wars, political instability, and socio-economic challenges. This study systematically reviews qualitative and quantitative evidence on cumulative and war-related trauma among MENA populations. We systematically searched for relevant literature through multiple databases and regional resources for studies and reports on civilians and refugees from MENA countries with multiple or chronic traumatic experiences. We included quantitative, qualitative, and mixed-methods studies reporting psychological outcomes (e.g. post-traumatic stress, depression, anxiety) related to cumulative trauma exposure. Evidence was synthesized narratively, and integration mapped with a joint-display logic. Sixty-seven studies met inclusion criteria across multiple MENA contexts including Lebanon, Palestine, Syria, and Iraq. Quantitative findings consistently associated multiple or chronic exposure to traumatic events with higher rates of post-traumatic stress disorder, depression, and anxiety, with clear exposure-response gradients. Qualitative findings yielded seven analytical themes: perpetual threat, family fragmentation and bereavement, intergenerational trauma, moral injury and humiliation, coping through faith and collective meaning, community erosion and reconstruction and barriers to care. This review revealed that psychological distress in the MENA region is widespread and enduring, with its severity and persistence closely linked to the cumulative and repeated nature of traumatic exposures. This review consolidates evidence on the complexity and chronicity of cumulative trauma outcomes across diverse MENA populations, contexts, and research methodologies. It provides a foundation for advancing research, assessment approaches, and culturally and contextually grounded psychosocial and mental health interventions, while also identifying key gaps for future research.