War and wellness: health-system barriers and access-constrained medication adherence for diabetes, hypertension, and dyslipidemia in the West bank, Palestine (2025).

Abstract

BACKGROUND: Diabetes (15% prevalence), hypertension (24%), and dyslipidemia (66.4%) are major health challenges in Palestine, with poor control rates (≤ 16.7%) due to low medication adherence. Chronic disease management is further hindered by socioeconomic barriers, treatment complexity, and geopolitical instability, including restricted healthcare access. This study assesses adherence levels and identifies key barriers; such as cost, psychological stress, and war-related disruptions, to inform targeted interventions in conflict-affected region. METHODS: This cross-sectional study recruited 423 adult patients with diabetes, hypertension, and/or dyslipidemia from West Bank primary health care centers (March–June 2025) via convenient sampling. Using the MARS-10 questionnaire, adherence (primary outcome) and barriers (cost, conflict-related access, side effects) were assessed. A two-stage sampling approach selected 3 governorates (north/center/south) and 6 clinics (central/peripheral). Data collection involved structured interviews for illiterate participants. RESULTS: Apparent medication adherence was low, largely reflecting access-constrained treatment interruption due to medication shortages and health-system disruption rather than behavioral non-adherenc: only 10.3% for diabetes, 10.0% for hypertension, and 7.8% for dyslipidemia. Key barriers included high medication costs (44.4%), multiple daily doses (38.5%), war-related unemployment (37.6%), and psychological distress (depression: 14.7%). Age, education, and income significantly influenced adherence (p < 0.05), while war-specific disruptions (checkpoints, clinic closures) they were not independently associated with Forced treatment interruptionin adjusted analyses; however, war-related unemployment emerged as a significant predictor of poor adherence. Findings highlight the urgent need for targeted interventions addressing financial, regimen complexity, and psychosocial challenges in conflict zones. CONCLUSION: Chronic illness medication adherence in conflict zones is low due to systemic, financial, and emotional barriers. Effective solutions require psychosocial support, simplified regimens, and culturally sensitive approaches. Further research should explore long-term impacts of trauma, health beliefs, and adaptive behaviors to develop context-specific interventions.