'What if I don't wake up?': Lack of sleep causing long-term health concerns among Gazans

Displaced Palestinians try to get what rest they can in tents, shelters or in the open air, but insomnia is adding to the misery caused by Israeli strikes

Displaced Palestinians sleep in a tent in Rafah, southern Gaza Strip. AFP

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Crammed into a storage room with 14 family members in Jabalia Camp in northern Gaza, Munther Hussein longs for just one peaceful night of sleep.

The lack of privacy in the 20-square-meter space and constant fear of bombardment from Israeli aircraft have robbed the 44-year-old of this most essential need. Instead of dreaming at night, he lies awake, going over the living nightmare his existence has become, again and again.

“Sleeping has become a huge problem and far from normal. We were used to comfort and stability, but now we can’t sleep properly.” Mr Hussein told The National from the room.

Mr Hussein’s original home in Jabalia was spacious, containing several apartments housing his siblings and other family members. It was destroyed in an Israeli air strike in January, forcing the family to flee after his siblings, who left in the early stages of the war.

“After our house was gone, we stayed with relatives, but their house was also bombed, forcing us to move into this storage room we rented because there were absolutely no apartments available for rent,” he said.

Israeli strikes, together with frequent orders to leave areas previously declared “safe zones”, have led to 90 per cent of Gaza’s population of about two million being displaced, often multiple times, the UN estimates.

More than 40,200 Palestinians have been killed in Gaza since the war began last October.

The options for where to lay your head at night are limited. Some Gazans sleep in the ruins of destroyed houses, others in tents. Even the lucky ones who can get a roof over their head still find sleep elusive amid sweltering summer temperatures, while Israeli aircraft pass overhead, further jangling already frayed nerves.

Mr Hussein said he barely cobbles together three hours of sleep a night these days; the WHO recommended amount for adults is eight to 10 hours.

“I never feel fully rested, so I’m tired and sluggish throughout the day, always feeling sleepy and weak. Sometimes, I get very irritable because of it, he said.

Sleep deprivation and its myriad health impacts have long been a problem in Gaza. Even a year before war broke out last October, a study found injuries from previous conflicts, psychological conditions and poor well-being were leading to sleeplessness among the population.

The 2022, researchers at Sfax University in Tunisia found more than half of Palestinian adults surveyed had poor sleep quality as measured by the Pittsburgh Sleep Quality Index. This is based on data on hours of total sleep, disturbances and daytime drowsiness.

Researchers have not carried out updated studies since the war began, though the Indian Society for Sleep Research said this leaves Gazans vulnerable to insomnia and post-traumatic stress disorder, with significant health ramifications.

In an editorial published in the journal Sleep and Vigilance, 25 scientists from around the world said that as most of Gaza's health system has been badly affected by the war, it is difficult for Palestinians to get treatment for sleep disorders.

Halima Abu Sukhaila, a psychological and educational specialist working with UN teams in northern Gaza, has been monitoring and seeking to address the psychological effects of the war on the population. The past 10 months have left deep scars, she says.

“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. This has a clear impact on their expressions, the way they speak, and their overall demeanour,” Ms Abu Shkhaila told The National.

Sleep deprivation not only impacts the day to day, but can cause long-lasting health issues. It is associated with greater risk of stokes, heart and kidney disease, and mental illness, according to the US Johns Hopkins Hospital. A US Department of Defence study on military staff found those living with chronically less sleep were at elevated risk of suicide.

“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.” Ms Abu Sukhaila said.

“Lack of sleep can also lead to mood disorders, increasing the likelihood of depression and other mental health issues. It affects the brain's ability to organise memories, leading to memory loss. Additionally, sleep deprivation impairs concentration and cognitive function, which negatively impacts a person’s ability to perform daily activities effectively.”

In Gaza city, resident Faten Haza says she is terrified of going to sleep, fearing she might not wake up again – or worse, that she'll wake to the sound of her house being bombed.

“I can't help but wonder, what if I wake up and see my family in a way I never wanted to? What if I sleep and don’t wake up? If that happens, what was the last thing I did, or who was the last person I saw?” she told The National.

Ms Haza, 25, experiences vivid nightmares, so on occasion opts not to even try to sleep. But this brings little respite, as her mind whirls with thoughts of the horrors of the war and fears for the future.

“I spend the whole night thinking about my future, my life, and everything I've lost. I think about my friends who were martyred, those who were injured, the ones who went to the south, and those who travelled away, and how seeing them or meeting them again now feels like a distant dream,” she said.

Before the war, Ms Haza said she used to enjoy spending her evenings studying and chatting with friends, before turning in for the night for good quality rest. She sometimes slept for up to 10 hours.

“But now, everything has changed … Like everyone in Gaza, I've lost the sense of security,” she said. “And to sleep, you need to feel safe.”