Exposure to war trauma impacts on both parents' and children's mental health, whose emotional responses are inter-related. Both universal and targeted interventions should preferably involve families. These could be provided by non-governmental organizations in the first instance.

The article reviews developmental research among Palestinians living in Gaza. The aims are, first, to analyze how exposure to traumatic events associates with children's mental health and their cognitive, emotional and social development. Second, we aimed to model familial and symbolic processes that can either harm or protect the mental health of children. Third, we wanted to learn who the resilient children are in conditions of war and military violence. The reviewed research has been conducted in the context of a Palestinian non-governmental organization, the Gaza Community Mental Health Programme, during the political upheavals involving hopes for peace and intensive war and violence: the First Intifada (1987—1993), the Palestinian Authority rule (1994— ) and the Second Al Aqsa Intifada (2001— ). The results show that life threat, violence and losses form a risk for increased psychological distress. There are, however, a myriad of child, family and society related factors and psycho-socio-physiological processes that protect child development and mental health. They include, e.g. loving and wisely guiding parenting, children's flexible and high cognitive capacity, flexible and multiple coping strategies and narrative and symbolic nocturnal dreaming, as well as social support and good peer relations. Different models explain psychological distress and positive resources, including child resilience. Exposure to trauma is crucial in predicting distress, while familial and developmental issues are important in building resilience. Children's conscious and unconscious cognitive-emotional processes are crucial for underlying mental health and knowledge about them is important in tailoring evidence-based preventive interventions among war victims.

The prevalence and determinants of PTSD were assessed among 121 Palestinian children (6-16 years; 45% girls and 55% boys) living in the area of bombardment. The mothers (21-55 years) and the children themselves reported their exposure to military violence (being personally the target of violence or witnessing it towards others) and symptoms of posttraumatic stress disorders (PTSD: intrusion, avoidance and hypervigilance). The results showed that 54% of the children suffered from severe, 33.5 % from moderate and 11 % from mild and doubtful levels of PTSD. Girls were more vulnerable; 58% of them suffered from severe PTSD, and none scored on the mild or doubtful levels of PTSD. The child's gender and age, mother's education and PTSD symptoms were significant, and the exposure to traumatic experiences marginally significant determinants of children's PTSD symptoms. The most vulnerable to intrusion symptoms were younger girls whose mothers showed a high level of PTSD symptoms, whereas those most vulnerable to avoidance symptoms were children who had personally been targets of military violence and whose mothers were better educated and showed a high level of PTSD symptoms. The results are discussed in the context of military violence interfering with the protective function of family and home.

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A B S T R A C TThe aims of this study were, first, to examine how exposure to war trauma, maternal neuroticism and psychological distress are associated with child psychological distress, and, second, whether good maternal mental health and low neuroticism can moderate the negative impact of war trauma on child mental health. Third, we examined whether mother-child dyads' psychological distress was dependent on who was the main war trauma victim in the family: the mother, the child or both. Fourth, we tested whether mother-child dyads express similar or different symptoms. The sample consists of 121 Palestinian children (aged 6-16 years; 45% girls and 55% boys), and their mothers (aged 21-55 years) living under conditions of military violence and war in Gaza. Child psychological distress was measured using the CPTS-RI (child-reported) and Rutter Parent Questionnaire (mother-reported), and mothers' mental health was measured using the SCL-90-R. The results failed to show any moderating effect of good maternal mental health or low neuroticism in protecting child mental health from negative impact of war trauma. The main effects showed that the child's young age, war trauma and poor maternal mental health were associated with children's internalizing symptoms, and male gender, maternal neuroticism and poor mental health with children's externalizing symptoms. There were gender differences in psychological distress depending on whether the mother, the child or both were the main war trauma victim in the family: girls showed particularly high psychological distress when their mothers were exposed to war trauma (family systems model), whereas boys showed high levels of distress when both they themselves and their mothers were exposed to war trauma (accumulative impact model). Similarities were confirmed in dyadic symptom expression: significant associations were found between mothers' depressive and children's internalizing symptoms, and between mothers' hostile and children's externalizing symptoms. K E Y W O R D S mental health, mother-child dyads, Palestinians, war traumaClinical Child Psychology and Psychiatry