Since the start of the war in October, Palestinians in Gaza have had little sleep due to heavy Israeli bombardment, the constant hum of drones and repeated forced displacement, which experts warn could cause a long term health issues.
Palestinians in the besieged enclave have not been able to get proper sleep, leaving them constantly exhausted and weak.
Sleep deprivation coupled with a lack of food and nutrition due to the little emergency aid coming in has further worsened conditions and impacted the health of civilians.
Rizq Abdul Jawad, 40, from Gaza City is currently displaced in Khan Younis in the southern Gaza Strip and says he has not had sufficient sleep in the last ten months due to air and ground bombardment.
"Many times, I feel sleepy and need to sleep, but whenever I go to bed and start sleeping, I wake up terrified by the sounds of explosions near where I live in one of the tents set up in the Mawasi area of Khan Younis,” he told .
For Rizq, trauma from the bombing has also hindered his ability to sleep, leaving him constantly imagining bombs will kill him and the eight other members of his family.
"I have come to hate the night because it means that the Israeli army will kill more civilians, even us who live in the tents,” he added, explaining
As well as affecting Palestinians’ ability to do everyday tasks, the long-term disturbed sleep has also raised the alarm of more serious conditions such as greater risk of strokes, heart and kidney disease and mental illnesses.
Rizq says he was staying in a tent last month when when Israeli warplanes bombed the area, in a strike that Tel Aviv claimed had killed Mohammed al-Deif. The attack caused mass casualties, including children.
"I cannot forget the horror of what I saw - the people running everywhere, the images of the mutilated bodies of the victims and the women screaming everywhere," he said.
After that day, he said he suffers from extreme anxiousness, is fatigued and has very dark circles around his eyes.
"I feel like I have become an old man and my face has become wrinkled," he said.
Sleep deprivation and health issues
Even prior to Israel’s latest war on Gaza, Palestinians had been dealing with sleep deprivation and associated health issues due to psychological trauma from previous Israeli bombardment.
A 2022 study by researchers at Sfax University in Tunisia measured the sleep of Palestinians using the Pittsburgh Sleep Quality Index, and found more than half of Palestinian adults surveyed had poor sleep quality.
The survey was based on hours of total sleep, disturbances and daytime drowsiness.
The ongoing bombardment of Gaza means researchers have not been able to assess the sleep of Palestinians since October, however experts and sleep research organisations, including the Indian Society for Sleep Research has warned that Palestinians are vulnerable to insomnia and post-traumatic stress disorder.
"We receive cases daily from displaced people staying in schools. Most of them complain about lack of sleep, disturbing dreams and nightmares they experience almost every night," Halima Abu Sukhaila, a psychological and educational specialist working with UN teams in north Gaza told The National.
She added that the disturbed sleep has a clear impact on people's expressions, the way they talk and how they conduct themselves.
"People have psychological trauma…sometimes they don’t sleep for a week, and those cases need intensive psychological therapy for over weeks to gradually regain less than normality," Abu Sukhaila added.
Continued lack of sleep could also lead to further issues, including mood disorders, paving the way for depression as well as affecting the brains ability to organise memories, causing memory loss.
Too afraid to sleep
Many Palestinians have expressed fearing going to sleep due to the possibility that they may be killed by Israeli air strikes. Since the start of the war, Palestinian women have shared going to sleep in their prayer clothes, in case bombing forces them to leave their homes in the middle of the night or kills them.
Reports show children in the Strip also frequently wet their beds, have night mares and shake as a result of Israeli bombardment.
Elham Al-Shaer, 35, from Rafah in southern Gaza is a mother of seven children, three of which have been killed in Israeli bombing that targeted their home in the Al-Shaboura camp five months ago.
Al-Shaer told that her children were killed in their sleep.
"I woke up terrified to a pile of black smoke that was choking me. I was trying to see what was happening around me, but I could hear my little daughter calling for help, but the black cloud was preventing me from seeing what was happening," she said.
As soon as the black smoke cleared, she saw her daughter, heavily wounded.
"I couldn't close my eyes. I was afraid that my daughter would die, but she died while I was looking at her eyes without even being able to save her," she explained.
"Since then, I can't sleep at all. Every time I close my eyes, I see my children in front of me, so I'm afraid to sleep" she continued.
Since then, she has been experiencing headaches “all the time” as well as extreme fatigue, shortness of breath and says her “eyes are bulging”.
There are also very few resources available to help Palestinians work through sleep deprivation and mental health issues, as Israeli assaults have destroyed healthcare and key infrastructure in the Strip.
"There are about 1.2 million children who are in need of mental health and psychosocial support. This is basically means nearly all Gaza’s children," Ulrike Julia Wendt, the emergency child protection coordinator with the International Rescue Committee said.