# Occupational and Environmental Determinants of Musculoskeletal Disorders Among Nurses in Conflict-Affected Gaza Hospitals

## TL;DR

Nurses in Gaza hospitals during conflict face high rates of musculoskeletal pain, especially in the neck and lower back, linked to environmental and ergonomic risks.

## Contribution

Identifies specific occupational and environmental factors contributing to MSDs among nurses in conflict zones.

## Key findings

- High MSD prevalence in neck (69.2%), lower back (68.0%), and shoulders (64.5%) among nurses.
- Humid environments and prolonged ergonomic risks like neck flexion and trunk bending were significant contributors.
- Married nurses had fewer MSDs, and adequate rest showed a modest protective effect.

## Abstract

Background: Musculoskeletal disorders (MSDs) are a major occupational health concern among nurses, particularly in high-stress and resource-constrained armed conflict settings. This study assessed the prevalence and occupational and environmental correlates of MSDs among nurses caring for critically ill patients in Gaza City hospitals during the 2023–2025 conflict.

Methods: A cross-sectional descriptive analytic study was conducted among 172 nurses in intensive care units (ICUs), emergency departments, operating rooms, and pediatric ICUs. Data were collected using a structured questionnaire adapted from the Arabic Nordic Musculoskeletal Questionnaire and ergonomic exposure assessment tools. Descriptive statistics summarized MSD prevalence and workplace exposures. MSD burden, defined as the number of affected body regions over the past 12 months, was analyzed using negative binomial regression, with logistic and multiple linear regression used as exploratory sensitivity analyses.

Results: The 12-month prevalence of MSDs was high, most commonly affecting the neck (69.2%), lower back (68.0%), and shoulders (64.5%). Pain intensity was moderate to high, particularly in the lower back (mean 5.31 ± 3.08), and over 70% of nurses reported difficulty performing work tasks due to pain. Ergonomic risks were widespread, including prolonged neck flexion (84.3%) and trunk bending (67.4%). In multivariable negative binomial regression, being married was independently associated with fewer affected body regions (adjusted incidence rate ratio [aIRR] = 0.71, p = 0.002), while working in humid environments was associated with higher MSD counts (aIRR = 1.24, p = 0.026). Adequate rest showed a modest protective association (aIRR = 0.82, p = 0.045). Work pace and perceived stress were not independently associated with MSD burden.

Conclusion: Critical care nurses in conflict-affected Gaza experience a high burden of MSDs, particularly in the neck and lower back. Workplace humidity and insufficient rest were key modifiable correlates. Occupational health interventions are urgently needed to protect nurses and sustain care delivery.