This document summarizes findings from the Gender and Adolescence: Global Evidence (GAGE) longitudinal research programme regarding adolescent mental health and psychosocial wellbeing in Gaza, Jordan, and Lebanon. GAGE is following 20,000 adolescents across multiple countries and has found high levels of psychological distress driven by conflict, violence, poverty and restrictive gender norms. Stressors have intensified during COVID-19, increasing anxiety, depression, and violence in homes and communities. While some services exist, access and acceptability are limited. Expanding gender-sensitive programming and strengthening mental health systems are priorities to better support adolescent wellbeing.

1. S. Youssef, N. Jones, B. Abu Hamad and A. Malachowska
‘My heart hurts a lot … the doctors told me it is from stress’
Adolescent mental health and psychosocial wellbeing
in Gaza, Jordan and Lebanon
Syrian girls in Jordan © Nathalie Bertrams/ GAGE 2020

2. Gender and Adolescence: Global Evidence (GAGE):
A longitudinal research programme (2015-2024)
By finding out ‘what works,’ for whom, where
and why, we can better support adolescent girls
and boys to maximise their capabilities now and
in the future.
We are following 20,000 adolescent girls and boys - the largest cohort
of adolescents in the Global South

3. GAGE 3Cs Conceptual Framework

4. GAGE longitudinal research sample
Jordan: 4,100 230 50
Palestine: 1,000 100 50
Lebanon -- -- 100
Global: 20,000 800 200

5. Background contexts
LEBANON
• In the midst of deep economic and political crisis
• Has prohibited UNHCR from building formal
camps and (since 2015) registering refugees
• Authorities demolish homes and use forced
deportation to encourage Syrians to leave
• Some Palestinian refugee camps are heavily
weaponised
JORDAN
• One-third of those living in Jordan are refugees.
• Jordan faces significant economic and social
challenges—unemployment and poverty rates
are high, and services are stretched.
• Home to UNICEF Jordan’s Makani programme—
aimed at reducing myriad risks facing children
and improving their psychosocial wellbeing
STATE OF PALESTINE
• 40% of the population are refugees—66% in Palestine
• Repeated outbreaks of conflict with Israel, economy has faltered due to
fragmented governance and Israel’s deliberate de-development polices
• Esp. in Gaza, services are increasingly unavailable—due to occupation
and UNRWA budget cuts

6. GAGE findings
Photo story from Lebanon © Adolescent Syrian girl / GAGE participatory research 2019

7. Key stressors and underlying factors
Key stressors affecting adolescents in all three contexts, originate from political
turbulence, conflict and chronic exposure to repetitive traumas, economic hardship
(acute and chronic) and increasingly conservative social norms.
‘I feel angry and depressed, like it is my
fault that I am an adolescent. Everything
is forbidden, everything is restricted and
always what you do is being supervised
because you are an adolescent’.
(17-year-old girl, Gaza)
‘It is scary here. My father doesn’t let me
go out in the camp, he gets very scared
when problems and fighting happen.’
(19-year-old Syrian girl, Lebanon)
‘Since the last conflict in Gaza, I scream when I
hear bombing. I even feel frightened to go to the
toilet by myself’.
(15 year-old adolescent with disability, Gaza)
In Jordan at baseline, about 1/3 of adolescents
exhibited psychological distress.
• Distress is caused by household violence,
displacement-driven uncertainty, and poverty.
‘Depression … comes from very severe poverty … It
has a high effect on adolescents as all their needs
aren’t complete.’ (social worker, Jordan)

8. Micro-level threats to adolescents’ psychosocial wellbeing
Girls are distressed by
gender norms that lead to
sexual harassment, social
isolation, and child marriage.
• At baseline in Jordan, older
girls were 38% less likely to
leave home daily and 54%
less likely to leave the
community weekly (than
older boys).
• In Gaza, 26% of girls were
exposed to harassment,
20% of adolescents reported
quarrelling and feuding with
others.
Pandemic restrictions have deepened girls’ isolation
and distress.
• Older girls report not leaving home for a mean of 5
days—compared to 2.9 for boys.
• 70% of girls reported more gender-based constraints on
their behaviour post-COVID
‘I’m not happy with my life. The life in general is miserable.’
(14-year-old Syrian girl, Jordan)
‘Here in the camp life is very suffocating. Everyone says ‘it is
forbidden’ all the time for everything. We cannot go out …
they say ‘it is shameful’. There are many restrictions on us
girls, especially now.’
(19-year-old Palestinian girl, Ein el-Hilweh camp, Lebanon)
‘I don't think there will be future for us. I am desperate about
the whole life. I want to commit suicide-it’s better than this
life…’ (16-year-old early married girl, Gaza)

9. COVID is stressful—to adolescents and adults
 Pre-Covid stressors have been
intensified by the pandemic:
adolescents are scared for themselves,
their families and their communities.
 Increased anxiety: in our sample 19% of
the adolescents in Gaza and 13% in
Jordan are experiencing moderate-to-
severe anxiety (using GAD-7 scale). Our
qualitative interviews in Lebanon show
severe stress and signs of depression
among many adolescents.
 Signs of depression: 5% of adolescents
in Palestine (9% in Gaza) and 12% in
Jordan had scores indicating possible
moderate-to-severe depression (using
Patient Health Questionnaire 8 (PHQ-8))
‘There are more suicides…For example,
someone is upset because of his living
conditions and corona, so he took a rope and
hanged himself and committed suicide.’
(18-year-old Syrian adolescent girl, Jordan)
‘The young people with a disability are more
affected by corona because they used to go to the
centres…, but now they can’t! They feel alone and
afraid!‘. (15-year-old girl with a disability)
‘My father is very nervous and annoyed because he
can’t fulfil our needs. Recently, he spent the money
allocated for university fees of my sister to meet
the household needs’.
(15-year-old girl, Jabalia Camp, Gaza)

10. Increases in household stress and violence
‘My parents are fighting a lot. About debts. They
fight about being back in debt….In the past my
father was put in prison for one month because of
the debts, and now with corona it is more difficult
and to repay debts.’ (12-year-old Jordanian boy)
‘My husband beats me every time he feels upset
because he has no job.’ (married girl, Gaza)
16% in Jordan 36% in Gaza
Emotional violence from parents to
adolescents has increased:
8% in Jordan 24% in Gaza
Physical violence from parents to
adolescents has increased:
11% in Jordan 37% in Gaza
Violence from fathers to mothers has
increased:
25% in Jordan 58% in Palestine
Married girls report more yelling:
6% in Jordan 8% in Palestine
Married girls report more forced sex:
At home:
 In Jordan 37% of female caregivers admitted to using
violent discipline in the last month and 8% admitted to
severely beating their adolescent child in the last
month
 In Gaza, 92% of Palestinian adolescents experienced
physical or psychological aggression in the past month.

11. Meso-level threats to adolescent psychosocial wellbeing
‘I have no solution except beating
them. I like beating… it is like emptying
and a release.’ (Syrian adolescent
mother, host community)
At school:
 In Jordan, 58% of boys and 26% of girls have
experienced corporal punishment in the last month
 In Gaza, 51% of boys and 17% of girls were
exposed to violence at schools
In the community:
 Boys are bullied by their peers
 Nearly all older girls face sexual harassment
 In Gaza, 45% of girls reported feeling unsafe
walking alone in their neighbourhood after dark
‘He [stranger] took my hand. I was shocked for two days
and I did not eat at that time and I kept crying. After that, I
never went out on my own.’ (17-year-old girl, Zaatari camp)
‘Many people here [in Baalbek] keep fighting
each other. There is shooting, and there are cars
going and coming with weapons every day and
everywhere … I do not interact with people here.
I avoid problems as much as possible.’ (17-year-
old Syrian boy, collective shelter, Lebanon)
Adolescents face violence in multiple
environments
‘I decided to stop schooling. I am
frequently beaten whenever I make
wrong answers.’
(16-year-old dropout boy, Gaza)

12. Receipt of support and trusting relationships
Receipt of support from family and friends
varies by age, location, marriage and
disability status
 Younger adolescents more likely to report
higher rates of support
 Most married girls have little access to friends
 Adolescents with disabilities are less likely to
have a trusted friend than those without
• In Jordan, 94% of GAGE adolescents
have someone in their lives (usually
parents) who supports them.
• In Gaza, 64% of girls, 33% of boys are
not invited to go out with friends, only
14% of boys and 0.8% reported being
a member of a sport club
‘My friends and I lost contact after we got
married because we did not have phones to
talk and now each of us live in a different place
whereas before we lived in the same camp ...
Even now after I got a phone, I do not talk to
my friends because the phone is their
husband’s.’ (18 y.o. Syrian girl, Lebanon)
57% in Jordan 56% in Gaza
Adolescents who had a friend they could trust:
65% in Jordan 69% in Gaza
Adolescents who had an adult they could trust:

13. How do adolescents cope?
Generally, strong reliance on emotion-focused coping strategies, rather than on problem
solving strategies, especially in Gaza, including joining religious activities
• There was also a tendency among girls more than boys to use positive coping
approaches like investing in education and using social media outlets, watching TV.
• Sleep patterns have changed, slept less than before the
pandemic
19% in Jordan 18% in Gaza
• Boys are smoking more:
36% in Jordan 33% in Palestine
• Adolescents report community drug use has increased:
5% in Jordan 15% in Gaza
Camps in Palestine and Lebanon are esp. impacted
But negative coping strategies are common, especially post-Covid.
‘Boys are smoking more after
corona [virus] because they
want to forget these conditions
and to take care of
themselves.’
(13-year-old refugee girl, WB)

14. Macro-level challenges – limited access to and acceptability of
PSS support services
Although there is some access to PSS services from medical professionals and NGOs, many
GAGE participants reported that they were unaware of how to access such services.
Family honour and stigma limits service uptake.
‘I would rather handle the problem on my own [than report]… … after that everyone is
going to be gossiping about that…’ (Focus group, Zaatari Camp)
Service providers attitudes and adolescent non-friendly approaches lower acceptability
of services
Adolescents isolate themselves – they prefer not to reach out for help, rather
internalizing stress
Some families also seek the support of religious leaders and traditional healers for their
children
The parents of divorced girls were especially interested in services for their daughters

15. Positive interactions – the value add of Makani ‘plus’
programming for PSS wellbeing
BOYS
Makani contributes to improved mental wellbeing
among older adolescent boys through life skills,
child protection activities and opportunities to
interact with peers and trusted mentors.
 Our survey found that older boys who attend
Makani are 16% less likely to suffer from
emotional distress than their peers who do
not participate.
 They are also 35% more likely to play a sport
(51% versus 38%), score 21% higher on the
index of issues they can discuss with their
fathers, and 10% higher on the index of
issues they can discuss with their mothers.
GIRLS
Makani contributes to adolescent girls’ mobility
through providing a safe space and some
transportation.
 Makani contributes to improved social
networks among adolescent girls and life
skills messages.
 Girls who participate are 16% more likely to
have a trusted friend.
 Centres connect adolescents with caring
adults:
‘You can talk to her [Makani facilitator] if you
have any problem and she helps you to solve it.’
(12-year-old girl, Zaatari camp)

16. Programming and policy
implications
Refugee girl in Lebanon © Natalie Bertrams / GAGE 2019

17. Priority actions
1
• Strategies and policies should address the key determinants of psychosocial and mental
wellbeing. Intersectoral interventions to address the multiple vulnerabilities adolescents
face are essential.
2
• Expand opportunities for adolescents-especially girls-to interact with peers and
participate in empowerment and reactional activities such as Makani
3
• Strengthening the links between PSS services and social protection programmes especially
the large scale cash assistance programmes
4
• Support service providers to provide more age- and gender-sensitive services, filling gaps
is the quality of services provided, enhance coordination, provision of training to service
providers
5
• Develop and expand a cadre of social workers trained to support young people’s mental
health needs, and simultaneously provide training to healthcare workers and teachers on
how to identify and refer young people in need of support and counselling

18. Priority actions
1
• Invest in hotlines for young people with psychosocial illbeing/ mental ill-health, given
increasing access to mobile phones for adolescents and drawing on international good
practice
2
• Expand support for the survivors of violence—stepping up access to reporting avenues,
legal and psychosocial support.
3
• Address gaps in adolescents' access and utilization of specialized services through
community outreach services, referrals and awareness-raising and proactive training/early
detection esp. in schools/NGOs, invest in recruiting specialized service providers
4
• Support positive parenting practices, adolescents’ friendly spaces, gender equity,
combating violence

19. GAGE
publications
on
global
covid-19
impacts
‘Some got married, others don’t want to attend school as they are
involved in income-generation’: adolescent experiences following
covid-19 lockdowns in low- and middle-income countries
Adolescent well-being in the time of covid-19
Intersecting barriers to adolescents’ educational access
during COVID-19: Exploring the role of gender, disability
and poverty
Adolescent well-being in a time of crisis: assessing
SDG progress during covid-19 and priorities for a
resilient recovery for adolescents and youth
Life skills for adolescent girls in the COVID-19
pandemic
‘I have nothing to feed my family…’: covid-
19 risk pathways for adolescent girls in low-
and middle-income countries |
Intersecting vulnerabilities: the
impacts of COVID-19 on the
psycho-emotional lives of young
people in low- and middle-income
countries |
Social isolation and disrupted
privacy: impacts of covid-19 on
adolescent girls in humanitarian
contexts | GAGE (odi.org)

20. GAGE
MENA
publications
on
covid-19
impacts

21. GAGE
publications
on
child
marriage
and
adolescent
well-being
‘No One Should Be Terrified Like I Was!’ Exploring
Drivers and Impacts of Child Marriage in Protracted
Crises Among Palestinian and Syrian Refugees
Child Marriage in Humanitarian Crises: Girls and
Parents Speak Out on Risk and Protective
Factors, Decision-Making, and Solutions |
Through their eyes: exploring the
complex drivers of child marriage in
humanitarian contexts
Adolescents in protracted displacement:
exploring risks of age- and gender-based
violence among Palestine refugees in
Jordan, Lebanon and the State of Palestine
Adolescent well-being in the time of covid-19
Empowering adolescents through an
integrated programming approach: exploring
the effects of UNICEF’s Makani programme on
Dom adolescents’ well-being in Jordan
Adolescent well-being in a time of crisis: assessing
SDG progress during covid-19 and priorities for a
resilient recovery for adolescents and youth

22. Contact Us
WEBSITE
www.gage.odi.org
TWITTER
@GAGE_programme
FACEBOOK
GenderandAdolescence
About GAGE:
 Gender and Adolescence: Global Evidence
(GAGE) is a nine-year (2015-2024) mixed-
methods longitudinal research programme
focused on what works to support
adolescent girls’ and boys’ capabilities in
the second decade of life and beyond.
 We are following the lives of 18,000
adolescents in six focal countries in Africa,
Asia and the Middle East.