As Palestinians broke their fast atop bright maroon tablecloths, under purple and gold lights surrounded by heaps of rubble, I received a voice note from Duha Hasan, a writer in Gaza who sent me a greeting for the holy month of Ramadan.

In a Palestine known for its night journeys, in a place where prophets have traversed the skies, people continue to have their nights disrupted by violence. Even during the ceasefire, Israel has blocked humanitarian aid, cut off electricity and water, and resumed attacks. “The war is not back,” Duha said in her message, “but still we don’t know what will happen.”

Days after the Gaza ceasefire deal in January, Duha had shared photographs and videos of her home with me that she and her family revisited after being displaced countless times. Duha’s bed, desk, and bookshelf matched the rubbled condition of the rest of her home.

This prompted a question—one that I’ve been thinking about a great deal over the last year. How did Duha sleep in such circumstances? How has she been sleeping for the past 17 months?

“The last night I spent in my home, I didn’t sleep at all. Nor did any of my family members,” Duha recalled. “We all said the shahada many times and thought that this night was our last night. The tanks were five minutes away from our house and all kinds of artillery was firing. Then, our journey with displacement started.”

She then reflected on a chilling detail that impacted her sleep: “In November 2023, when the four-day truce started, they banned the noise [of the drones]. I swear I couldn’t sleep without the drones’ noise. Toxic but true.”

In conflict zones, sleep is an overlooked indicator of public health. For Palestinians, sleep is a right that has long been violated, often by night raids, violent arrests, and now genocide. Even when worshippers wish to prostrate for night prayers at Al-Aqsa in exchange for sleeplessness, they are met with scathing violence that further distances them from their dreams.

Sleep deprivation is a widely recognized form of torture. It has been used by the IDF and the CIA, and in Palestine, it transcends the prison space and permeates villages, refugee camps, and homes. It even affects Palestinians living across the world in the diaspora. The repeated sleep disruption and deprivation bring both short- and long-term health and public health risks to Palestinian lives.

As Israel stalls the ceasefire, Palestinians are continuing to use every stress response available to them to mitigate their lost sleep. Healthcare providers who develop recommendations around the importance of sleep health should take note. Each of us can learn from the tenacity and tenderness of Palestinians in their attempts to help loved ones sleep.

The sleep crisis knows no boundaries within Palestine. “We aren’t sleeping, no one sleeps in Gaza,” a parent in Gaza told me in November 2023. (Many of the people in this story asked to be kept anonymous.) “One of the 2-year-olds, before he sleeps, says a prayer with his hands up in the air every night, ‘Ya Allah, let us sleep and wake up, and not die.’ From the day we are born until we die, the sound of the drone lives in our ear. We don’t sleep. The bombing keeps us hanging between heaven and earth. When we wake up and have slept, it’s because we haven’t slept in days.”

Current Issue

April 2025 Issue

Dina, a Palestinian from Bethlehem who sleeps no more than two hours every night and has constant nightmares, describes how her sister “can’t sleep without closing the windows tightly and the curtains, even the aluminum cover of the net, so that [we] don’t hear the sounds of clashes and bombs; we had to turn on the air-conditioner even on cold nights just to sleep.” On one occasion, occupation forces brutally entered her family home at 4:20 am, breaking down the doors to interrogate them.

A February 2023 study about sleep health in Gaza estimated that nearly 53 percent of the territory’s residents have a poor quality of sleep. Poor sleep health is determined by two factors: decreased quantity and quality of sleep, which constitutes “fragmentation of sleep by brief arousals.” It is not hard to imagine how the prevalence of poor sleep quantity and quality might have increased since the genocide began.

In 2024, Nour, a medical student in Gaza, told me how lack of sleep—she says she was getting “none to maybe four hours” each day—was impacting her health, “The sleep deprivation has caused my immunity to be horrible. Infections are common and widespread in Rafah because it is densely populated with a lack of hygiene materials, sewage everywhere, and people in close proximity. I caught a bad viral infection from the hospital, and keep catching those because I know my immunity is not great.” Prior to the October 7 attacks, Nour reported sleeping an average of six hours a night. She was eventually able to evacuate from Gaza. When I asked her how she was sleeping after leaving the territory, she said, “It depends. If something is actively happening, I can’t sleep. I stay on the news.”

It is not just in Gaza that sleep has been affected. In the West Bank, Israeli army raids have left Palestinians with no chance to find the rest they deserve.

“There were 3,000 night raids a year before October 7 [in the West Bank]. Since then, thousands more have been arrested,” Salwa Duaibis of Military Court Watch, which monitors the treatment of children under Israeli military detention, tells me. “Night raids have increased, with a devastating effect. They often happen in Palestinian villages that are next door to settlements and in refugee camps. It is not a surprise when families tell me that they have been raided not once but multiple times, and it is not a question of if, it is when.” So frequent is the rate of night raids that some Palestinians sleep with their shoes on.

In Aida refugee camp, Israeli occupation forces arrested community health worker Mahmoud Mashayikh at 3 am, a time when he and his family should have been sleeping. Athal, Mashayikh’s colleague, shared an account of a typical night raid:

Since my home is next to the path that the IDF walks through to go back to the military base, I sit by the window for hours listening to the voices of the Palestinian youths getting arrested, screaming. [In one instance, while] they were being handcuffed and beaten by the IDF, I was listening to the voices of the IDF stopping the ambulance and the car that [one of the youths] was in, and fighting with his father to get him out of the car. They got him out to the ground leaving him for 20 minutes bleeding until death. Everyone in the camp was awake at that time, and at 6:30 am, everyone was in front of his house with his family when they heard the news of their child’s death.

Each night spent like this has health consequences. There are links between poor sleep health and increased pain. When we don’t get enough sleep, the amyloid-beta in our brain is not processed; a long-term build up of amyloid-beta has been found in the brains of people with Alzheimer’s disease. As a result, over an extended period, sleep deprivation could have an impact on the collective memory that has historically extended Palestinians the fortitude and steadfastness to confront the horrors of the on-going Nakba.

“In the short term, sleep deprivation can affect alertness, response times, and decision-making, and can increase the risk—particularly as many Palestinians are working in dangerous, physically demanding labor conditions—of accidents and injuries. It also takes a toll on social life,” says Dr. Bram Wispelwey, co-founder of Health for Palestine, a community health initiative in Palestinian refugee camps.

“In the long run, sleep loss works synergistically with other toxic conditions generated by settler colonialism, apartheid, and military occupation to drive the high rates of chronic diseases experienced by Palestinians. Long-term sleep loss can drive a number of health conditions, including some of the most common chronic diseases faced by Palestinian refugees: diabetes, hypertension, obesity, and cardiovascular diseases like heart attack and stroke. There is also a strong link between sleep loss and mental health, including depression. For Palestinians living under occupation, many of whom face regular sleep disruption from night raids and home invasions, acute and prolonged periods of sleeplessness are unavoidable.”

In the worst cases, according to Harvard Medical School neuroscientists, prolonged lack of sleep can lead to death due to the build-up of reactive oxygen species in the gut. While the amount of sleep one needs depends on the individual, severe and prolonged cases of sleep deprivation can be fatal as a result of weakened functioning of the body.

Even when there is no night raid or drone attack, sleep can still be hard. Repeatedly, Palestinians who shared their testimonies with me cited guilt as a barrier to getting rest. In the West Bank, it is due to witnessing what is happening in Gaza; in Gaza, it is due to being alive in the aftermath of resounding and repeated losses of loved ones; and in the diaspora, it is due to not being able to be in Palestine itself.

Mohammad Alazza, the executive director of the Lajee Center in Bethlehem, says that he sleeps on average four disrupted hours each night. “I feel I am cheating my people in Gaza when I go to bed and sleep because I think of more than one million people who don’t have a house, they don’t have a bed, they cannot sleep, they don’t have enough clothes and it’s cold,” he says. Other Palestinians report similar problems.

“I am writing this past 5 am, which should be a solid indicator of how bad and inconsistent my sleeping schedule has been.… I find it hard to sleep with thoughts running through my head non-stop. I wish I could make them stop. I think about my city, my family, and my friends a lot,” shares an undergraduate student at the Massachusetts Institute of Technology. She is a fifth-generation refugee from Gaza. Her entire family is still there.

“When I sleep, my dreams are foggy and ominous,” she tells me. “Physically, I am at MIT, but in my head, I am always back home even in my sleep. I have been dealing with constant headaches because of the lack of adequate sleep. However, my problems are nothing compared to what my people are experiencing, so I don’t complain knowing that I am not the one under the bombings. I am ashamed of myself and I feel guilty every time I get a decent meal or enough amount of sleep to function.”

Despite enormous barriers to their sleep health, Palestinians are still attempting to rebuild their homes, play, garden, and stay connected with nature, animals, and one another. Each of these aspects helps to soothe and regulate the nervous system which can lead to better sleep.

Last year, Salwa, a resident of Jenin, told me that Israeli incursions were so frequent that she started to time them and adjust her own sleep patterns accordingly in an attempt to get a few hours of sleep before going to work in the morning.

When I spoke to her again this past February, Salwa said that her neighborhood, including the entrance to her home, was completely destroyed, and that her family no longer has electricity. Israel’s Operation Iron Wall has further escalated the situation in Jenin with a constant presence of IDF soldiers and tanks, which had not been seen since 2002.

Salwa said that the “sirens, bombs, and explosions” start happening every two or three days during the time when she is trying to sleep at night. She is forced to sleep outside of her normal circadian rhythm times and to resort to shorter sleep cycles and naps.

Additionally, Salwa told me that during Israel’s nine-day incursion into Jenin in September 2024, she could not feel hunger or thirst. She said this continued for two weeks even after Israel had left. Communities who are facing such severe and frequent violence might experience a suspension in sensation of hunger and thirst due to their activated stress responses. When our bodies are perpetually caught in an activated stress response phase, it is as if they are running endless marathons. The type and level of restoration our bodies require, therefore, is similar. Immediately upon awakening, having any available water and electrolytes that might include dates or fruits can be life-sustaining.

According to neuroscientist and sleep researcher Dr. Matthew Walker, how you wake up can make a big difference to your cardiovascular health. This is also a problem Palestinians have to cope with.

Salwa Duaibis, from Military Court Watch, describes testimonies of Palestinian mothers in the West Bank who “sleep by the window to keep an eye out for the Israeli Occupation Forces,” getting shallow rest in an attempt to more gently wake up their family before a soldier barges in.

Similarly, a parent in Gaza shares, “We don’t sleep as we guard [the children’s] bodies with our own. Always ready to run. It is false, the sense of security in running, [because] if the house is bombed, the only place we go is to God.”

But when do these parents who are keeping watch over their families get sleep? “We take shifts sleeping. Just in case the bombing gets close we can wake the others to try and escape,” a sleep testimony from Gaza reveals.

Sleeping in shifts so that one person is on watch is not new. According to the sentinel hypothesis proposed in 1966 by Frederick Snyder, “[hu]man[s] and other animals have learned that under conditions of danger it is safe to sleep only if sentinels are employed to remain vigilant.” For Palestinians undergoing an active genocide, this form of sleep adaptation becomes vital.

Another testimony from Gaza helps us understand how sleeping in shifts during genocide can look: “Our house is full now, so some of us sleep against the wall sitting up. There aren’t enough mattresses or blankets. Four people sleep on one mattress, half their bodies on the mattress and half on the floor.”

Sleeping close to someone you trust makes a big difference in sleep health, especially for children. Research shows that skin-to-skin contact (SSC) is found to regulate “child stress by biological indicators such as the autonomic nervous system (ANS), heart rate variability (HRV), cortisol, and oxytocin.”

“The children sleep in between us from the anxiety,” another sleep account from Gaza reports. This close proximity resulting in skin-to-skin contact with their parents might be a possible factor that would grant a child any semblance of sleep in a place such as Palestine undergoing an active genocide.

The skin-to-skin contact coping strategy comes with a sobering reality: “The people of the Gaza Strip agreed on one idea: e sleep together so we can die together,” journalist Hanan Abu Daghim told Al-Quds in 2023. Palestinians have repeatedly had to make the horrifying decision of whether to sleep in one place as a family or separate each family member so that there might be survivors.

Duaibis says that ultimately, “to reclaim rest or sleep, we have to treat the underlying symptoms. Due to the occupation, there is settlement construction, heavy military presence, arrests, and night raids. You can’t achieve both objectives, you can’t sleep or rest under an occupation.”

In sleep, Palestinians become equals across space. Beyond apartheid walls and across continents, they discover that the distances created by checkpoints and exile have been momentarily suspended. Sleep during a genocide becomes a place that might resurface fresh horrors or reminders to bear witness—the night becoming a steady reminder of losses fresh from that day, thereby invading the life of every impacted Palestinian.

Palestinians may have lost their sleep, but they have not lost their humanity. It is a deep love for others as well as for Palestine that leaves those with whom I spoke perpetually restless; sleeplessness is a testament to the hearts of Palestinians that are very much alive.

This piece was made possible by the contribution of each Palestinian who shared their lived experiences, and it is dedicated to them. Please read their full sleep testimonies here. If you are from a community impacted by violence, you can submit your sleep testimony here.