Eliana Mahmood, 45, had just begun to doze off on Monday night when she felt her entire room tremble. The <a href="https://www.thenationalnews.com/news/mena/2024/08/06/show-must-go-on-lebanons-summer-season-packed-despite-escalating-conflict-with-israel/" target="_blank">Beirut </a>resident took a few seconds to grasp what was unfolding. Was it another sonic boom over the Lebanese capital? An Israeli strike? Startled, the mother of three attempted to leap out of bed to reach her children but her body failed her and she felt her knees go weak. “I don’t know what happened,” she said. “I got very dizzy and completely lost my breath. I couldn’t move.” Her next-door neighbour, Ghada Salameh, came knocking on her door shortly after. The entire building was wide awake after a 4.8-magnitude <a href="https://www.thenationalnews.com/news/mena/2024/08/12/earthquake-of-magnitude-48-hits-jordan-syria-and-lebanon/" target="_blank">earthquake</a>, which struck Syria and Jordan, was also felt in parts of Lebanon. By the time it ended, the two women were in tears. “We don’t know how much more we can take,” they told <i>The National</i>. “We really are a <a href="https://www.thenationalnews.com/news/mena/2024/08/13/syrian-earthquake-shakes-nerves-in-a-region-already-on-edge/" target="_blank">nervous wreck</a>.” Mental health experts say the tremors were triggering for many Lebanese who are already on edge due to escalating tensions with Israel and fears of an <a href="https://www.thenationalnews.com/news/mena/2024/08/12/us-sends-missile-submarine-to-middle-east-ahead-of-expected-iranian-attack/" target="_blank">all-out war</a>. While an earthquake is a frightening incident, people in Lebanon are “hypersensitised” to any sounds or experiences that might resemble or relate to an Israeli strike, said Dr Joseph El Khoury, a consultant psychiatrist. He said the war in Gaza and the violence at Lebanon’s southern border have become significant stressors and sources of anxiety for many of his patients. “Almost every consultation with a Lebanese this summer has had a mention of the situation,” he said. Israel and Lebanon's Hezbollah have been engaged in <a href="https://www.thenationalnews.com/news/mena/2024/08/09/full-scale-war-could-displace-one-million-in-lebanon-warns-government-contingency-plan/" target="_blank">cross-border hostilities</a> since October but tensions reached a high this month when Israel targeted a senior Hezbollah commander in a densely populated residential area in Beirut, killing him and five civilians, including two children. Israel has been increasingly conducting mock raids and setting off sonic booms over the Lebanese capital, sparking fear in residents and reviving memories of the 2006 Lebanon-Israel war. "I thought they were attacking again," said Ramzi El Habre, 32, recalling the moment he heard a sonic boom last week. The former programme manager at the London-based Westminster Foundation for Democracy expressed his concerns of another <a href="https://www.thenationalnews.com/news/uae/2024/08/08/my-home-was-bombed-uae-expat-fears-for-family-in-lebanon-amid-threats-of-war/" target="_blank">war in the country</a>, fearing this time it "will be much more destructive". His fears are echoed by Reem Nasra, 26, a human resources executive, who has been dealing with anxiety since the onset of the Gaza war, but says she's recently been struggling with constant nightmares and poor sleep due to escalating tensions. "My biggest fear is a closed airport where we can't escape if anything happens, exactly how it happened in 2006," she told <i>The National</i>. The 2006 Lebanon-Israel war, which lasted 34 days, resulted in the deaths of about 1,200 Lebanese and caused significant damage to the country, including to civilian infrastructure such as the country's only <a href="https://www.thenationalnews.com/business/aviation/2024/08/07/wider-lebanon-war-could-halve-tourism-revenue-and-sever-air-links/" target="_blank">international airport</a> in Beirut. Due to that traumatic memory, Israel’s mock raids and sonic booms “have had the most distressing impact on people’s mental health”, said Mia Atoui, a clinical psychologist and co-founder of Embrace, an NGO dedicated to mental health awareness in Lebanon. “During the same week the sonic booms were recorded, the Embrace hotline started receiving more calls,” Ms Atoui told <i>The National</i>. People were reporting feelings of distress, along with complaints of anxiety, poor sleep, stammering in both adults and children, and a growing number of requests for professional help. She explained that, while it typically takes time for people to start reporting their mental health symptoms after traumatising events, in the aftermath of the sonic booms it was almost immediate. This could be due to their timing, which occurred during the first week of August, around the fourth anniversary of the Beirut port blast. Rachelle Maksoud, 35, was working from home when she heard the explosion-like sound of the sonic boom over Beirut on August 6. “It coincided with a nearby fire, which triggered a panic attack,” she recalled. The 2020 deadly <a href="https://www.thenationalnews.com/lifestyle/fashion-beauty/2023/08/03/jewellers-beirut-explosion-anniversary/" target="_blank">Beirut port blast</a> was set off by a fire at a warehouse where hundreds of tonnes of ammonium nitrate were improperly stored. Four years on, both Dr El Khoury and Ms Atoui say the memory is still a trigger for many. They said this past trauma, combined with fears of a potential war, has put people’s nervous systems on "constant alert mode", heightening their anxieties and increasing the need for mental health support. “I can tell you from my discussions with colleagues that clinics in <a href="https://www.thenationalnews.com/news/mena/2024/08/04/lebanon-israel-travel-war-hezbollah/" target="_blank">Lebanon </a>are full at the moment. It’s very hard to find availability with a psychiatrist or psychologist, and this tells you about the big need,” Dr El Khoury said. Even past patients such as Mr El Habre and Ms Maksoud, who had undergone therapy after the Beirut blast and reported improvement, now say they might need to return to therapy. “I was beginning to heal but this new conflict has been a significant setback,” Ms Maksoud said. “The ongoing instability has left me deeply concerned and the thought of a full-scale war is terrifying. The resilience we’ve held on to feels like it's reaching its limit.”