Abstract
BACKGROUND: The prevalence of undernourishment is significantly higher in conflict-affected low- and middle-income countries (LMIC), compared to LMICs not experiencing conflict. Evidence suggests that in these settings households may adopt coping strategies such as consuming less nutritious food and thereby reducing food diversity to mitigate the impact of food insecurity. The long-term trend of food diversity in a protracted conflict setting has not been explored in detail due to challenges in collecting systematic and representative data in conflict-affected and fragile settings. METHODS: This study examined food diversity - measured using food consumption scores (FCS) - among Palestinians in the Gaza Strip and the West Bank, utilizing a serial cross-sectional design to analyze a systematically random sampled dataset that was collected by the Palestinian Central Bureau of Statistics - from 2014, 2016, 2018, and 2020. We analyzed the distribution of household location by survey year and used multivariate linear regression to evaluate factors associated with changes in food consumption score. RESULTS: Mean household FCS climbed from 71·9 in 2014 to 93·6 in 2016 but slipped to 73·4 in 2018 and 71·2 in 2020, signifying an overall decline in dietary diversity. For the West Bank, household location to the barrier, head of household gender (female), living in a refugee camp, and households with middle- or lower-income levels were associated with a reduction in FCS. For the Gaza Strip, households that reported minor mobility restrictions and middle- or lower-income levels were associated with a reduction in FCS. CONCLUSIONS: The findings elucidate the long-term impact of conflict on household food diversity, highlight a significant and worsening issue of food insecurity amongst Palestinians residing in the occupied Palestinian territory, and underline urgent need to address this critical issue and further protect vulnerable populations in conflict-affected regions.