Sleep impairment and its predictors among frontline physicians and nurses in Gaza during wartime: a cross-sectional study

Background Little is known about sleep quality among healthcare workers (HCWs) in active conflict zones. Since October 2023, Gaza’s hospital workforce has endured continuous bombardment, severe resource shortages, and repeated displacement. This study evaluates sleep quality among frontline clinicians in Gaza and examines factors associated with sleep outcomes, including sociodemographic and work-related factors, psychological distress, and resilience. Methods A cross-sectional survey was conducted in August 2025 among physicians and nurses working in major government hospitals across the Gaza Strip. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), psychological distress with the Patient Health Questionnaire–4 (PHQ-4), and resilience with the Connor–Davidson Resilience Scale–10 (CD-RISC-10). Poor sleep was defined as a PSQI score > 5. Multiple linear regression analyzed factors linked to poor sleep. Additionally, a logistic regression model with poor sleep (PSQI > 5) as a binary outcome was used for sensitivity analysis. Results A total of 437 clinicians participated (52.5% female; 57.6% nurses). Poor sleep was highly prevalent (74.1%), with a mean Global PSQI of 7.98. Psychological distress was elevated (mean PHQ-4 = 6.54), and 58.6% reported scores indicating moderate or high distress. Resilience was in the moderate range (mean CD-RISC-10 = 23.94). Differences in PSQI by sex, profession, and department type were small (Hedges’ g 0.10–0.24). In adjusted models, psychological distress was independently associated with poorer sleep (β = 0.482, p < 0.001), whereas resilience was protective (β = −0.073, p < 0.001). Sensitivity analyses yielded consistent results. Conclusions Frontline clinicians in Gaza face widespread sleep disruptions amid ongoing conflict. Psychological distress is a key factor associated with poor sleep, whereas resilience confers some protective benefits. Ensuring safety and providing organizational and environmental support are essential. Interventions that enhance mental health support and foster resilience may help maintain clinician functioning and stabilize the health system during prolonged crises.