Continuous trauma, sleep, dreams, and the collapse of care in Gaza: a narrative review

Abstract

The aim of this article is to examine the specific characteristics of trauma in contemporary war settings, with particular reference to the Gaza Strip, and the effects of prolonged exposure to threat on the psychological life of affected populations. In such contexts, trauma is not a discrete and concluded event but an ongoing condition characterized by repeated violence, the absence of safe spaces, and the persistent anticipation of further traumatic events. This condition particularly affects vulnerable populations, including children and adolescents. A literature search was conducted in PubMed, Scopus, and PsycINFO using combinations of terms related to war and armed conflict, Continuous Traumatic Stress (CTS), Post-Traumatic Stress Disorder (PTSD), complex
trauma, childhood and adolescence, sleep, insomnia, sleep fragmentation, nightmares, dreams and dream reports, mental health, psychiatric services, continuity of care, and healthcare system collapse. Particular attention was given to studies examining sleep, nightmares, and dream reports
in war-exposed populations. The literature review brought together three dimensions that are often examined separately: exposure to continuous traumatic threat, disturbances in sleep and dreaming, and the breakdown of systems of care. From this perspective, dreams represent a privileged expression
of unconscious mental life, in which the persistence of threat, difficulties in transforming traumatic experience, and the progressive loss of the capacity to imagine a future may emerge. In Gaza, these dimensions are not simply co-occurring phenomena but mutually reinforcing components of the same clinical and humanitarian condition. Understanding trauma in war settings therefore requires an integrated model encompassing persistent threat, disruption of sleep and the transformative capacity of dreaming, and the progressive loss of access to continuity of care.