Samah Jabr used to see about two dozen patients a week in her psychiatric clinic in the West Bank city of Nablus. Those numbers reduced to a trickle as the Israel-Hamas conflict in Gaza — just 80 miles away — also upended normal life in the larger of the two Palestinian territories.

A growing network of physical and virtual barriers put in place by Israel along with an acceleration of its settlement expansion is making it more difficult for the West Bank’s Palestinian population of 3 million people to move around.

Among the patients the 48-year-old consultant psychiatrist still tries to help is a young girl hoarding canned food under her bed because she worries about the hunger now widespread in Gaza reaching her hometown.

“There is grief, depression, anxiety, uncertainty,” said Jabr of the Palestinians she has seen from across the West Bank. “The impact is enormous and it will affect generations to come.”

Jabr, who is also head of mental health services at the Palestinian Authority’s Ministry of Health, says that any form of travel within the territory, or beyond it, has become so complicated, and potentially dangerous, that most people don’t want to go outdoors — even for medical appointments.

It wasn’t meant to be like this. The West Bank has for decades been seen by its advocates as the core of any future Palestinian state. Even after Hamas took control of Gaza in 2007, the Palestinian Authority — run by Fatah, a rival grouping — in the West Bank was viewed by the US and others as the catalyst for any improvement in relations with Israel. But the territory’s changing geographic, social and economic landscape means the path to that state, as outlined in past peace accords, has never looked so far away.

“It’s not the end of the two-state solution,” said Ghassan Khatib, who was part of the Palestinian delegation during negotiations in the early 1990s, “though the passing of time is making this option relatively speaking less viable.”

Israel has controlled entry and exit points to the West Bank since capturing the territory in the 1967 war. Checkpoints and barriers increased after the first Palestinian uprising, or intifada, that ended in 1993, and work began on the separation barrier that divides Israel and the West Bank during the second, far more violent, uprising that ended in 2005.

Israeli authorities justify the ratcheting up in movement obstacles, surveillance and raids inside the West Bank, as well as restrictions on entry to Israel, since the Oct. 7 attack launched from Gaza by Hamas — considered a terrorist organization by the European Union and US — as key to helping protect the country from further assaults.

Hamas threatened more infiltrations from all directions after its militants carried out the deadly incursion into southern Israel, which sparked the retaliatory campaign that has killed more than 42,000 people, according to the Hamas-run health authority, which doesn’t distinguish between civilians and combatants. Israel says its military campaign was intended to crush the Islamist group. Since then, 16 Israelis have been killed in assaults by Palestinians from the West Bank in Israel.

Israelis feel all the more wary because while Palestinian Authority President Mahmoud Abbas has repeatedly said that he is against the killing of civilians, he has never publicly condemned the Hamas attack, in which about 1,200 people were killed and 250 others of all ages were taken hostage into Gaza.

But Israel is divided over its long term role in the West Bank, where settlements are illegal under international law, though Israeli authorities dispute this. Members of Prime Minister Benjamin Netanyahu’s religious-nationalist government and their supporters want Israel’s presence to grow and deepen in the territory, while those on the left are alarmed by the prospect, along with the Palestinians and their allies.

When Israel’s parliament, the Knesset, in July debated a motion rejecting the establishment of a Palestinian state, even through negotiation, Gideon Sa’ar of the New Hope - The United Right party said such a state would become a base for terrorists. Arab-Israeli lawmaker Mansour Abbas argued that lasting peace can only be reached with an independent country, not organizations or factions. The resolution was passed 68-9, with opposition parties abstaining.

Finance Minister Bezalel Smotrich said the goal in the West Bank was to alter “the DNA of the system” to ensure that Palestinian statehood becomes unfeasible during a speech a month earlier at an internal conference of his Religious Zionist Party — a leaked recording of which was obtained by campaign group Peace Now and authenticated by his office.

Israeli Jews live in the West Bank for different reasons. Some see their role as forming a security buffer on Israel’s eastern flank, others cite historic ties to the territory they call Judea and Samaria. As their numbers began increasing from the 1990s to at least 500,000 people, or 5% of Israel’s population, so did a network of roads linking their settlements while bypassing Palestinian communities and connecting to Israel.

For Palestinians, journeys from one of their areas to another takes longer, often involving queues at the entry and exit of cities, searches at checkpoints, and occasionally detours along dirt tracks to avoid obstacles on main roads, even for ambulances. The improvised nature of some checkpoints means they tend to appear, then disappear, leaving drivers unaware if a road will be passable or not. Others are manned by armed settlers.

Travel into Israel, with which the West Bank’s economy is intertwined, for business, or other reasons, meanwhile requires permission that is increasingly hard to get. It often means using a smart card or an Israeli designed App called Almunasseq in Arabic, or the Coordinator, which can access user location details, to confirm a return to the territory. Penalties for breaking the terms of a permit, including a strict curfew, can lead to a person being barred from Israel for up to four months.

With work permits drying up, Israeli Arabs no longer shopping in West Bank markets, and tourists blocked from visiting cities like Bethlehem, job losses are mounting and most businesses folding, forcing families — often wealthier than those in Gaza — to rely on savings and loans to get by.

“All we want is a better life, but how can we manage that under these circumstances?” said Thaer, a Palestinian decorator who works in East Jerusalem when possible and asked only to be identified by his first name for his safety.

Roughly one million West Bank Palestinians, representing just over half the workforce, will be jobless in early 2025, Palestinian Authority Finance Minister Mohammad Alamour told reporters in Ramallah last month. He said donor fatigue and a dispute over tax revenues — which Israel collects on behalf of the Palestinian Authority then transfers to Ramallah and which account for most of the budget — is adding to the pressure.

The biggest casualty of the past year in the West Bank is the Palestinian Authority, said Khatib, the former negotiator who is also a lecturer at Birzeit University in Ramallah. He added, it is “not far from bankruptcy and at risk of collapse.”

Widely perceived as entrenched, aging and illegitimate, the Palestinian Authority was already in crisis before the war. Many Palestinians have little faith it can offer protection from expanding Israeli violence, or provide key services. Octogenarian Abbas, who has been president for 16 years, is trying to show that it can change, and also run Gaza after a cease fire. In March, he named economist Mohammad Mustafa prime minister, then asked his cabinet of technocrats to draw up reforms, including a crackdown on graft, an overhaul of the justice system and plans for elections in 2026 — the first in the Palestinian Territories in years.

There is some skepticism in the international community that they’re up to the task. Nonetheless such is the desire to keep a two-state solution alive that Spain, Ireland and Norway formally recognized Palestine in May. Five other countries, including the US, UK, and France, imposed sanctions on Israeli settlers who have attacked Palestinians.

Among western powers, France is pushing the hardest, at least publicly, for a diplomatic solution to the war in Gaza that safeguards a reinvigorated Palestinian Authority. Gaza’s future must be based on unity with the West Bank, a senior French official said on the sidelines of an EU summit last month, while acknowledging that the deterioration in both territories is concerning.

“The war has to end,” May Pundak, a Jewish Israeli human rights lawyer who co-founded Land for All, a joint Israeli-Palestinian campaign group, told the Geneva-based Inter-Parliamentary Union last month. “It is very clear that at this point, this war does not ensure the safety of Israelis or Israel, on contrary, Israel has never been in more danger in its history.”

Pundak, whose late father, Ron Pundak, helped negotiate the Oslo Accords in the 1990s, added that a revitalized two-state solution is the only way forward. “History tells us that segregation and separation doesn’t ensure a sustainable future,” she said.

Israeli military raids in the West Bank over the past year are its largest and most extensive in the territory since the second intifada. It has used ground soldiers, tanks and bulldozers supported by drones and airstrikes to target armed groups in areas where it says the Palestinian Authority holds no sway. Houses, shops and key infrastructure, including roads, in Tubas, Jenin and Tulkarm have suffered extensive damage. Mounds of dirt and rubble add to the movement obstacles. Hundreds of people have been displaced.

At least 767 Palestinians have been killed in the West Bank since last October — the highest toll in the territory in a calendar year, according to local health officials who say that 24% of them were women and children under the age of 18. Many more have suffered life-changing injuries. Israel says most of the dead were rioters, gunmen killed in shootouts, and terrorists who were planning or already carried out attacks in Israel and the West Bank. Twelve were killed by settlers.

Jabr said that while most West Bank Palestinians are “paralyzed” by events, some will feel galvanized to help the push for a future state. They “are resilient and won’t lose their political agency, they will aspire for change,” she said.

There is also a risk that a new generation will be radicalized in a territory that has so far avoided the kind of chaos that many observers feared would erupt because of the war in Gaza. A poll by the Palestinian Center for Policy and Survey Research from June shows Hamas, which rejects the legitimacy of a Jewish state, has been outstripping Fatah in popularity since the Oct. 7 attack.

Netanyahu’s government has introduced a number of measures since last October that support settlement expansion. Activists say that, along with the approval of a record number of residential building permits, extra funds to build more roads and for security, and the declaration of state ownership over more West Bank land, has emboldened groups of violent settlers.

The Knesset also passed a law on Oct. 28 that essentially bans the United Nations’ Palestinian refugee agency, UNRWA, from operating in Israel, cutting off a lifeline to people in the Palestinian Territories who rely on the aid it provides, including education and healthcare. Without coordination with Israel, it won’t be able to secure entrance permits to Gaza, the West Bank or East Jerusalem. Last year, Israel accused some UNRWA employees of participating in the Oct. 7 attack. The agency investigated the claims, then fired nine employees after finding they may have been involved.

Just outside Ramallah, the Palestinian Authority’s base, is an area under full Israeli jurisdiction. Hills are studded with stone terraces, pine trees and olive groves, and settlements on hilltops overlook a dwindling number of Palestinian communities in the valleys below.

Nasser Agnimat, a 55-year-old Bedouin shepherd, says his family became the last to leave one of those communities, Ein Samia, in May.

“We suffered a whole year because of settlers. We put up with a lot and remained steadfast. Then one day, they arrived at 6 p.m., destroyed our homes, took my car and some of the sheep,” he said. Holding up photos of that day as well as legal papers stating his right to live on the land, he added, “They took everything we have.”

Life was difficult in other ways, too. Requests by residents to hook up to water, electrical and sewer systems, controlled by Israel, were all denied. And the local elementary school was bulldozed by the Israeli military which said it lacked a building license.

For now, Agnimat is renting a nearby farm with his brother. He doesn’t dare return to the land where his parents and grandparents were born, although he is working with local non-profit organizations to try to get it back and has filed complaints with the Israeli police and military.

“We dreamed of staying,” he said, “but we couldn’t.”

Updates casualty figures. A previous version corrected a reference to Israel designating UNRWA a terrorist organization; that was not included in the final version of the bill.