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\title{Response to Reviewers}
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\section*{Cover Letter}

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To the Editor,\\
[Journal Name]
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\noindent Dear Editor,

We thank you for the opportunity to revise and resubmit our manuscript, \textbf{“CAUSING SERIOUS MENTAL HARM: PSYCHOSOCIAL EVIDENCE OF GENOCIDAL CONDITIONS IN GAZA (2023–2025)”} (Manuscript ID: [Please Insert]). We are grateful to the reviewers for their thoughtful, constructive, and detailed feedback, which has been invaluable in strengthening our work.

In this revision, we have undertaken substantial changes to address the core methodological and conceptual concerns raised by both reviewers. The primary focus has been to clarify the distinction between our empirical findings and their legal interpretation, to temper and nuance our language regarding legal conclusions, and to enhance the methodological rigor and transparency of the analysis. Key revisions include:
\begin{itemize}
    \item Reframing the abstract, introduction, and conclusion to clearly state that the documented patterns are \textit{consistent with} or \textit{may inform assessments of} serious mental harm, rather than constituting definitive legal proof.
    \item Adding significant new methodological detail, including robustness checks (confidence intervals, sensitivity analysis, VIFs), a detailed data appendix (Appendix A), and explicit acknowledgment of data limitations (e.g., reliance on UNRWA data, correlational nature of findings).
    \item Expanding the discussion of limitations and alternative explanations to directly address reviewer concerns about causality, sampling bias, and the inferential leap to legal intent.
    \item Revising terminology throughout to ensure a more measured, scholarly tone, separating descriptive analysis from normative legal interpretation.
\end{itemize}

We believe these revisions have significantly improved the manuscript's clarity, rigor, and scholarly balance. Below, we provide a point-by-point response to each reviewer's comments, detailing the specific changes made.

\section*{Reviewer-by-Reviewer Detailed Responses}

\noindent \textbf{Reviewer 1}

\textit{Comment 1: Temper Legal Claims: Reframe conclusions to distinguish between empirical findings (e.g., correlations between violence and mental health demand) and legal interpretations (e.g., genocide criteria). The data do not demonstrate intent or systematic calculation, as required by the Genocide Convention.}
\textbf{Response:} We agree that this distinction is crucial. We have significantly revised the manuscript to frame our findings as documenting patterns that are \textit{consistent with} the infliction of serious mental harm, which may \textit{inform} legal assessments, rather than constituting legal proof. Key changes include:
\begin{itemize}
    \item \textbf{Abstract:} The final sentence now reads: “The findings indicate that the documented patterns of systematic obstruction of psychosocial care constitute conditions that are consistent with causing serious mental harm. The MHPSS data serve as a form of forensic documentation that, when interpreted within the broader context of the conflict, may inform assessments of legal criteria under international law, while acknowledging the methodological limitations of inferring intent from service data alone.”
    \item \textbf{Methodology (Section 4.1):} We added: “The design explicitly acknowledges the distinction between establishing statistical associations and making legal determinations of intent. The analysis is structured to document patterns consistent with the infliction of serious mental harm, while remaining transparent about the inferential limits of the data regarding the mens rea element of the Genocide Convention.”
    \item \textbf{Discussion (Section 6):} We added a dedicated paragraph on limitations, stating: “Finally, the inferential leap from documenting patterns of harm to asserting they meet the specific legal threshold for genocide is the most significant limitation. The data presented are consistent with conditions that could cause serious mental harm, but attributing these conditions to a specific genocidal intent requires evidence of a conscious plan or policy, which is beyond the scope of this service delivery analysis.”
    \item \textbf{Conclusion (Section 7):} We revised to state: “The findings present MHPSS data as forensic evidence of conditions that are consistent with the criteria for serious mental harm under Article II(b) of the Genocide Convention, while recognizing that establishing the requisite intent (mens rea) requires integration of this evidence with other political and legal analyses.”
\end{itemize}

\textit{Comment 2: Address Causality: Include time-series analyses, Granger causality tests, or instrumental variables to better support causal inferences about "obstruction."}
\textbf{Response:} We acknowledge that our observational design cannot establish definitive causality. We have clarified this limitation throughout and have strengthened our correlational analysis with robustness checks, but have not applied advanced causal inference techniques as they are not appropriate for our primarily descriptive and associational research aims with this dataset. We have:
\begin{itemize}
    \item \textbf{Methodology (Section 4.4):} Explicitly stated: “No advanced causal inference techniques (e.g., Granger causality) were applied as the data structure and research design are primarily associational and descriptive, aligning with the study's aim to document patterns rather than prove causation.”
    \item \textbf{Results (Section 5.2):} Added caution: “It is crucial to interpret these correlations as evidence of strong statistical associations, not definitive proof of causal mechanisms or intent.”
    \item \textbf{Limitations (Section 6):} Added: “Second, while strong correlations are documented, the observational design cannot definitively establish causation or disentangle the effects of confounding variables not included in the analysis.”
\end{itemize}

\textit{Comment 3: Contextualize Findings: Compare mental health indicators in Gaza with other conflict zones (e.g., Syria, Yemen) to establish the relative severity of "serious mental harm."}
\textbf{Response:} We agree this is an important point for context. While a full comparative analysis is beyond the scope of this paper (and challenging due to data availability and differing contexts), we have explicitly noted this as a limitation and a direction for future work.
\begin{itemize}
    \item \textbf{Limitations (Section 6):} Added: “Fifth, the lack of a comparative baseline from before October 2023 or from other contemporary conflict zones (e.g., Ukraine, Yemen, Syria) makes it difficult to contextualize the absolute severity of the mental health burden documented here, though the internal patterns and rates of increase remain stark.”
    \item \textbf{Future Work (Section 7):} Added: “Future research directions include... comparative analysis with other contexts of systematic violation (e.g., utilizing similar MHPSS metrics from conflicts in Syria, Myanmar, or Ukraine to establish relative benchmarks).”
\end{itemize}

\textit{Comment 4: Expand Data Sources: Incorporate non-UNRWA service providers and pre-2023 baseline data to mitigate sampling bias.}
\textbf{Response:} We acknowledge this as a key limitation of our data. We have addressed it directly:
\begin{itemize}
    \item \textbf{Methodology - Participants (Section 4.2):} Added: “A key limitation of this sampling frame, as noted in the reviews, is its exclusive reliance on UNRWA data, which excludes populations served by other NGOs and those receiving no services. This limitation constrains generalizability and is addressed in the discussion of findings.”
    \item \textbf{Limitations (Section 6):} Listed as the first limitation: “First, the exclusive reliance on UNRWA data introduces potential selection bias, as populations served by other NGOs or receiving no services are excluded.”
    \item \textbf{Future Work (Section 7):} Added a methodological recommendation: “Methodologically, future work should aim to... actively seek to include data from all service providers in a conflict zone to mitigate selection bias.”
\end{itemize}

\textit{Comment 5: Include all referenced tables/figures in the manuscript.}
\textbf{Response:} All tables referenced in the text (Tables 1-6) are included in the full manuscript. The revised text provided for this response shows their placeholders (e.g., “as detailed in Table 5”). We confirm they are present in the complete LaTeX document.

\textit{Comment 6: Define and operationalize terms like "famine fear" using established clinical frameworks.}
\textbf{Response:} We have clarified that this is a descriptive term used by practitioners, not a clinical diagnosis.
\begin{itemize}
    \item \textbf{Results (Section 5.3):} We now introduce it as: “...child beneficiaries experiencing what practitioners termed "famine fear."”
    \item \textbf{Limitations (Section 6):} Added: “Fourth, the term "famine fear," while evocative and grounded in practitioner observation, is not a clinically validated construct; its use here is descriptive rather than diagnostic.”
\end{itemize}

\textit{Comment 7: Clarify researcher positionality and its impact on interpretive frameworks (e.g., decolonial theory).}
\textbf{Response:} We have expanded the discussion of positionality.
\begin{itemize}
    \item \textbf{Discussion (Section 6):} Added a new paragraph: “Researcher positionality shapes the interpretation... We explicitly acknowledge that the choice to examine the data through the lens of the Genocide Convention is an interpretive framework that guides the research questions and discussion, not a foregone conclusion dictated by the data.”
\end{itemize}

\textit{Comment 8: Add confidence intervals and effect sizes to correlation analyses.}
\textbf{Response:} We have added these as requested.
\begin{itemize}
    \item \textbf{Methodology (Section 4.4):} Added detail: “To address reviewer concerns regarding robustness and transparency, several additional steps were integrated: (1) 95\% confidence intervals were calculated for all correlation coefficients using bootstrapping with 1000 resamples...”
    \item \textbf{Results (Section 5.2):} Now reports: “The strongest correlation emerged between malnutrition rates and child distress reports (r=0.81, 95\% CI [0.72, 0.88])...” and includes CIs for all correlations.
    \item \textbf{Appendix A:} Provides full variable definitions and notes that analysis code is available.
\end{itemize}

\noindent \textbf{Reviewer 2}

\textit{Comment 1: Reframe legal conclusions as interpretive frameworks rather than research findings.}
\textbf{Response:} This aligns with Reviewer 1's first comment. We have undertaken a comprehensive reframing as detailed in our response to Reviewer 1, Comment 1. The most significant changes are in the Abstract, Methodology (Section 4.1), Discussion, and Conclusion, where we now consistently present the legal connection as an interpretive application of the empirical findings, not a finding itself.

\textit{Comment 2: Add rigorous discussion of methodological limitations, particularly regarding causal inference.}
\textbf{Response:} We have substantially expanded the limitations section.
\begin{itemize}
    \item \textbf{Discussion (Section 6):} We added a dedicated subsection titled “Limitations and Alternative Explanations” which now includes six specific, detailed limitations addressing causality, sampling bias, data reliability, terminology, lack of comparative baseline, and the inferential leap to legal intent.
\end{itemize}

\textit{Comment 3: Include sensitivity analysis for correlation coefficients.}
\textbf{Response:} Added as part of enhanced robustness checks.
\begin{itemize}
    \item \textbf{Methodology (Section 4.4):} Added: “(2) sensitivity analyses were conducted by recomputing correlations with different time lags (0-1 month) to assess the stability of associations;”
    \item \textbf{Results (Section 5.2):} Added: “Sensitivity analyses using one-month lags for independent variables produced similar coefficients (within ±0.08), confirming the robustness of the associations.”
\end{itemize}

\textit{Comment 4: Incorporate critical examination of UN data collection methodologies and potential biases.}
\textbf{Response:} We have integrated this concern into our limitations.
\begin{itemize}
    \item \textbf{Limitations (Section 6):} Added: “Third, the use of institutional data carries inherent risks of reporting biases, both in terms of under-reporting due to access constraints and potential inflation of service numbers for advocacy or funding purposes. We attempted to mitigate this through data triangulation.”
    \item \textbf{Methodology - Trustworthiness (Section 4.5):} We already noted data triangulation across multiple UN agencies (WHO, OCHA, UNICEF) as a strength.
\end{itemize}

\textit{Comment 5: Discuss alternative explanations for observed patterns beyond the genocide framework.}
\textbf{Response:} We have addressed this within the limitations.
\begin{itemize}
    \item \textbf{Limitations (Section 6):} The entire “Limitations and Alternative Explanations” subsection implicitly and explicitly acknowledges alternative explanations (e.g., confounding variables, reporting biases, the complexity of conflict environments). We state: “the observational design cannot definitively establish causation or disentangle the effects of confounding variables not included in the analysis (e.g., pre-existing trauma levels, cultural factors in help-seeking).”
\end{itemize}

\textit{Comment 6: Tone down definitive legal language to reflect the limitations of empirical data.}
\textbf{Response:} This was a primary focus of our revision. We have systematically replaced definitive language (e.g., “constitute evidence of,” “demonstrate”) with more measured phrasing (e.g., “are consistent with,” “may inform,” “serve as forensic documentation of conditions associated with”) throughout the manuscript, particularly in the Abstract, Introduction, Results interpretation, and Conclusion.

\section*{Closing Note}

We again extend our sincere gratitude to both reviewers for their insightful and challenging critiques, which have pushed us to produce a more nuanced, rigorous, and transparent manuscript. We believe the revisions have directly addressed the core concerns regarding methodological overreach and have strengthened the paper's scholarly contribution by more clearly delineating the empirical analysis from its potential legal implications. We hope the revised manuscript now meets the journal's standards for publication.

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