The impact of peer and media pressure on muscle dysmorphia for men and women in the general German population is mediated by the internalization of muscularity ideals.

The armed conflict that erupted in Sudan in April 2023 has caused a severe humanitarian crisis, devastating the healthcare system and leaving only a fraction of hospitals operational in conflict zones. While the physical destruction of infrastructure is visible, the psychological toll on the healthcare workers (HCWs) who remain to treat the wounded is often overlooked. This study provides a rare and critical assessment of the mental resilience and perceived sense of danger among doctors, nurses and pharmacists working directly on the frontlines in Omdurman. Our findings reveal that while work attendance remained relatively high due to a sense of duty, the workforce is operating under extreme duress, with over 70% reporting a high sense of danger and nearly half exhibiting low psychological resilience. Crucially, we identified that previous crisis management training significantly improved attendance and resilience, yet few workers had received it. The wider impact of this research lies in its ability to guide immediate humanitarian interventions. By identifying specific vulnerabilities, such as the lack of crisis training and the correlation between security escalations and mental distress, this study offers a roadmap for policymakers, NGOs and hospital administrators. It highlights that sustaining a functioning health system during war requires more than just medical supplies; it requires urgent, targeted psychosocial support and safety training for the workforce. Protecting these essential workers is vital not only for their well-being but for ensuring the continuity of life-saving care for the entire population during instability. Mental health is defined by the World Health Organization (WHO) as a state of well-being that allows individuals to handle stress, use their abilities, work and learn effectively and contribute to society (World Health Organization [WHO], ). Stressful and traumatic situations pose risks to this state. The WHO estimated that 10% of people exposed to trauma will be severely affected (Murthy and Lakshminarayana, ). Armed conflicts in particular disrupt all citizen’s lives, their mental health and health care systems. Moreover, the emerging threat of weapons of mass destruction (nuclear, biological and chemical) creates serious psychological burdens due to their catastrophic impacts on humanity, ecosystems and global stability. Such events can lead to long-term mental health problems, including trauma, anxiety and depression, complicated by limited access to mental health services. Studies have also stated a correlation between exposure to the atomic bombings of Hiroshima and Nagasaki and severe intellectual or developmental impairments (Ahmed and Al Diab Al Azzawi, ). Healthcare Workers (HCWs), being an essential workforce in critical times, are prone to mental health disturbances even during their standard working conditions. Studies conducted between 2020 and 2022 reported that approximately one quarter of HCWs worldwide experience symptoms of anxiety, depression and burnout (WHO, ). In conflict zones, these stressors are exacerbated. A study in Syria showed that HCWs had worked for 6.5 h longer than average while treating double the number of patients(Abdelrahman and Haar, ). In Gaza, they had to operate under constant threat of violence while navigating the limited supplies, including anesthesia (Abed Alah, ). Another study demonstrated high levels of PTSD among Palestinian HCWs, reaching up to 89% (Abu-El-Noor et al., ). Other mental health effects of conflicts include anxiety, depression and burnout. Close results were obtained in other conflict settings too, such as Yemen, Afghanistan, Congo and Pakistan (Merlin, ; Baker and Heisler, ; Rubenstein, ; Monaghan, ; Afzal and Jafar, ).