‘Afraid to Sleep’: Nights Bring Fresh Horrors in War-Torn Gaza

Displaced Palestinians sleep in a tent on the first day of the Eid al-Fitr festival, marking the end of the holy month of Ramadan, at a camp beside a street in Rafah, southern Gaza Strip, on April 10, 2024, amid the ongoing conflict between Israel and the Hamas group. (AFP)
Displaced Palestinians sleep in a tent on the first day of the Eid al-Fitr festival, marking the end of the holy month of Ramadan, at a camp beside a street in Rafah, southern Gaza Strip, on April 10, 2024, amid the ongoing conflict between Israel and the Hamas group. (AFP)
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‘Afraid to Sleep’: Nights Bring Fresh Horrors in War-Torn Gaza

Displaced Palestinians sleep in a tent on the first day of the Eid al-Fitr festival, marking the end of the holy month of Ramadan, at a camp beside a street in Rafah, southern Gaza Strip, on April 10, 2024, amid the ongoing conflict between Israel and the Hamas group. (AFP)
Displaced Palestinians sleep in a tent on the first day of the Eid al-Fitr festival, marking the end of the holy month of Ramadan, at a camp beside a street in Rafah, southern Gaza Strip, on April 10, 2024, amid the ongoing conflict between Israel and the Hamas group. (AFP)

As the sun sets over Gaza, displaced Palestinians in plastic tents are plunged into darkness, tormented by the buzzing of Israeli drones, constant artillery fire and fear they may not survive the night.

"Mother, let me sleep in your arms, I don't want to die," said six-year-old Yasmine, clinging to her mother in their small, make-shift shelter.

"My children are afraid to sleep," said Safa Abu Yasin. "I'm afraid for their lives too."

Abu Yasin and her four daughters are in Al-Mawasi, an area Israeli forces have said is a humanitarian zone.

Despite repeatedly shrinking this designated safe area, more and more displaced Palestinians continue to cram into it, seeking refuge that has become increasingly elusive.

The majority of Gaza's 2.4 million people have fled their homes at least once during the war, now in its 11th month.

Abu Yasin is often wide awake throughout the night, trying to soothe her baby girl Loujain, born in April, who repeatedly wakes up crying.

"It is very difficult to calm her," said Abu Yasin.

"We want her to feel safe, but I don't even have a cradle... for her to feel comfortable."

"Come to sleep, come to sleep," she softly sings an old Levantine lullaby that tells children that a bird will come to watch over them as they sleep.

Her other daughters complain about the thin mattress they all share on the floor, often waking up when they bump into each other.

- Sleeping in the rubble -

"I miss my pillow," said Farah Sharshara, 32, from her tent in the central area of Deir al-Balah, once a thriving district but now reduced to rubble by Israeli bombardment.

She rarely takes a shower due to the lack of water, while privacy in the tents is simply nonexistent.

"You always have to adapt to other people's ways," she said.

"There are those who snore, those who wake up screaming, crying in fear, and then there are the insomniacs who just chat and disturb everyone," Sharshara said.

One displaced man, Rami, describes his six-by-four-meter tent in which 27 members of his extended family sleep.

"Before the war each of us had our own room" in their respective homes, he said, giving only his first name.

"Now we all sleep on a plastic mat, a blanket and a foam mattress," said Rami, who has been displaced several times during the war.

In a territory where the United Nations estimated in May that over 55 percent of buildings had been completely or partially destroyed, tents -- some provided by international organizations, others purchased at high prices -- have become the most common form of shelter for the displaced.

Just days after the war broke out on October 7, several aid groups distributed sleeping kits containing essential materials for resting at night.

But now they say much-needed materials for repairs and shelter construction are not being allowed in by Israeli authorities, who control all points of access to the besieged territory.

Without other options, more and more Gazans now sleep in the rubble of destroyed buildings, or on the streets, where flies and insects swarm amid stinking sewage.

Palestinians can often be seen rummaging through the debris, while there are reports of many breaking into empty homes to get their hands on whatever furniture they can to use as firewood for cooking.

- Psychological threat -

"People frequently lack the basic necessities for quality sleep: privacy, temperature control, darkness, and quiet," Eman Alakhras, a psychologist for the Doctors of the World aid group, told AFP.

Many, especially the sick, request sleeping pills, she said.

"There are those who cannot sleep in order not to die, as many have died in front of their eyes and they feel that they must stay awake so that they can escape in case of danger."

Prolonged sleep deprivation increases the risk of post-traumatic stress syndrome, cognitive disorders, and developmental delays in children, she added.

The war in Gaza broke out after Hamas attacked Israel on October 7, which resulted in the deaths of 1,198 people, mostly civilians, according to an AFP tally based on official Israeli figures.

Vowing to destroy Hamas, Israel's retaliatory military offensive has so far killed at least 40,139 people in Gaza, according to the health ministry of the Hamas-run territory, which does not provide details of civilian and militant deaths.

"Nothing is the same as before," said Mohammed Abdel Majid, who was displaced along with his family of 30.

Before the war, the family had a roof over their heads.

"Today, all we have is a tent, be it the freezing winter or under the scorching sun in the summer."



Aid Groups in Gaza Aim to Avert a Polio Outbreak with a Surge of Vaccinations 

A Palestinian child looks on while being examined by a doctor at Al-Aqsa Martyrs Hospital, amid fears over the spread of polio after the first case was reported by the Ministry of health, as the conflict between Israel and Hamas continues, in Deir al-Balah in the central Gaza Strip, August 18, 2024. (Reuters)
A Palestinian child looks on while being examined by a doctor at Al-Aqsa Martyrs Hospital, amid fears over the spread of polio after the first case was reported by the Ministry of health, as the conflict between Israel and Hamas continues, in Deir al-Balah in the central Gaza Strip, August 18, 2024. (Reuters)
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Aid Groups in Gaza Aim to Avert a Polio Outbreak with a Surge of Vaccinations 

A Palestinian child looks on while being examined by a doctor at Al-Aqsa Martyrs Hospital, amid fears over the spread of polio after the first case was reported by the Ministry of health, as the conflict between Israel and Hamas continues, in Deir al-Balah in the central Gaza Strip, August 18, 2024. (Reuters)
A Palestinian child looks on while being examined by a doctor at Al-Aqsa Martyrs Hospital, amid fears over the spread of polio after the first case was reported by the Ministry of health, as the conflict between Israel and Hamas continues, in Deir al-Balah in the central Gaza Strip, August 18, 2024. (Reuters)

The threat of polio is rising fast in the Gaza Strip, prompting aid groups to call for an urgent pause in the war so they can ramp up vaccinations and head off a full-blown outbreak. One case has been confirmed, others are suspected and the virus was detected in wastewater in six different locations in July.

Polio was eradicated in Gaza 25 years ago, but vaccinations plunged after the war began 10 months ago and the territory has become a breeding ground for the virus, aid groups say. Hundreds of thousands of displaced Palestinians are crowded into tent camps lacking clean water or proper disposal of sewage and garbage.

To avert a widespread outbreak, aid groups are preparing to vaccinate more than 600,000 children in the coming weeks. They say the ambitious vaccination plans are impossible, though, without a pause in the fighting between Israel and Hamas.

A possible ceasefire deal couldn't come soon enough.

“We are anticipating and preparing for the worst-case scenario of a polio outbreak in the coming weeks or month,” Francis Hughes, the Gaza response director at CARE International, told The Associated Press.

The World Health Organization and UNICEF, the United Nations children's agency, said in a joint statement Friday that, at a minimum, a seven-day pause is needed to carry out a mass vaccination plan.

The UN aims to bring 1.6 million doses of polio vaccine into Gaza, where sanitation and water systems have been destroyed, leaving open pits of human waste in crowded tent camps. Families living in the camps have little clean water or even soap to maintain hygiene and sometimes use wastewater to drink or clean clothes and dishes.

At least 225 informal waste disposal sites and landfills have cropped up around Gaza — many close to where families are sheltering, according to a report released in July by PAX, a Netherlands-based nonprofit that used satellite imagery to track the sites.

Polio, which is highly contagious and transmits mainly through contact with contaminated feces, water or food, can cause difficulty breathing and irreversible paralysis, usually in the legs. It strikes young children in particular and is sometimes fatal.

The aid group Mercy Corps estimates some 50,000 babies born since the war began have not been immunized against polio.

WHO and UNICEF said Friday that three children are suspected of being infected and that their stool samples were being tested by a laboratory in Jordan. The Ministry of Health in Ramallah in the West Bank said late Friday that tests conducted in Jordan confirmed one case in a 10-month-old child in Gaza.

“This is very concerning,” UNICEF spokesperson Ammar Ammar said Saturday. “It is impossible to carry out the vaccination in an active war zone and the alternative would be unconscionable for the children in Gaza and the whole region.”

Aid workers anticipate the number of suspected cases will rise, and worry that the disease could be hard to contain without urgent intervention.

“We are not optimistic because we know that doctors could also be missing the warning signs,” said Hughes of CARE International.

Health workers in Gaza are gearing up for a mass vaccination campaign to begin at the end of August and continue into September. The goal is to immunize 640,000 children under the age of 10 over two rounds of vaccinations, according to WHO.

The Israeli military body responsible for Palestinian civilian affairs, which goes by the acronym COGAT, said it is “preparing to support a comprehensive vaccination campaign.” The military said a vaccination campaign has begun for all ground troops and that it was working with various organizations to bring more vaccines into Gaza.

Hamas said in a statement Friday that it would support a seven-day truce to facilitate the vaccinations. Ceasefire talks resume in Cairo next week.

The alarm over polio was first raised when the WHO announced in July that sewage samples collected from six locations in Khan Younis and Deir al-Balah, in the south and center of Gaza, tested positive for a variant of the virus used in vaccines.

The weakened form of the virus used in vaccines can mutate into a stronger version and cause an outbreak in areas that lack proper immunization, according to WHO.

The only countries where polio is endemic are Afghanistan and Pakistan. But outbreaks of the vaccine-derived virus have occurred in war-torn Ukraine and Yemen, where conditions aren't nearly as bad as they are in Gaza.

Part of the challenge in Gaza, where polio hasn't been seen in a quarter-century, is to raise awareness so that health workers recognize symptoms, the UN says. The territory's health care system has been devastated by the war, and workers are overwhelmed treating the wounded and patients sick with diarrhea and other ailments.

Before the war, 99% of Gaza's population was vaccinated against polio. That figure is now 86%, according to WHO. The goal is to get polio immunization levels in Gaza back above 95%.

While more than 440,000 doses of polio vaccine were brought into Gaza in December, that supply has diminished to just over 86,000, according to Hamid Jafari, director of polio eradication for the WHO Eastern Mediterranean Region.

The 1.6 million oral doses being brought into Gaza will be a more advanced version of the vaccine that is less prone to mutating into an outbreak, the WHO said.

Getting the vaccine into Gaza is just the first step.

UN workers face difficulties retrieving medical supplies and other aid because of Israel’s military assaults, fighting between troops and Hamas, and increasing lawlessness that has led to the looting of convoys.

Also, vaccines must be kept refrigerated, which has become difficult in Gaza, where electricity is scarce. About 15-20 refrigerated trucks serve all of Gaza, and they also must be used to transport food and other medical supplies, said a senior Israeli army official with COGAT who was not authorized to talk with media and spoke on condition of anonymity.

Palestinians also face difficulties getting around. Their inability to reach health facilities will be an additional obstacle to the vaccination campaign, said Sameer Sah of Medical Aid for Palestinians.

“There’s no transport system. The roads have been destroyed and you have quadcopters shooting at people,” said Sah, referring to Israeli drones that often carry out strikes. Israel says its strikes target Hamas fighters.

WHO said a pause in the fighting is vital to enabling “children and families to safely reach health facilities and community outreach workers to get to children who cannot access health facilities.”

Only about a third of Gaza’s 36 hospitals and 40% of its primary health care facilities are functioning, according to the UN. But the WHO and UNICEF say their vaccination campaign will be carried out in every municipality in Gaza, with help from 2,700 workers.