Jerusalem - There are many things to fear in Gaza: Attacks from Israel's Apache helicopters and F-16 fighter jets, the coastal enclave's growing isolation, the regular blackouts from power shortages, increasingly polluted drinking water and rivers of sewage flooding the streets.
Meanwhile, for most Palestinians in Gaza the anxiety-inducing soundtrack to their lives is the constant buzz of the remotely piloted aircraft - better known as "drones" - that hover in the skies above.
Drones are increasingly being used for surveillance and extra-judicial execution in parts of the Middle East, especially by the US, but in nowhere more than Gaza has the drone become a permanent fixture of life. More than 1.7 million Palestinians, confined by Israel to a small territory in one of the most densely populated areas in the world, are subject to near continual surveillance and intermittent death raining down from the sky.
There is little hope of escaping the zenana - an Arabic word referring to a wife's relentless nagging that Gazans have adopted to describe the drone's oppressive noise and their feelings about it. According to statistics compiled by human rights groups in Gaza, civilians are the chief casualties of what Israel refers to as "surgical" strikes from drones.
"When you hear the drones, you feel naked and vulnerable," said Hamdi Shaqura, deputy director of the Palestinian Centre for Human Rights, based in Gaza City. "The buzz is the sound of death. There is no escape, nowhere is private. It is a reminder that, whatever Israel and the international community assert, the occupation has not ended. We are still living completely under Israeli control. They control the borders and the sea and they decide our fates from their position in the sky," said Shaqura.
The Israeli military did not respond to Al Jazeera's requests for comment.
Suffer the children
The sense of permanent exposure, coupled with the fear of being mistakenly targeted, has inflicted deep psychological scars on civilians, especially children, according to experts.
"There is a great sense of insecurity. Nowhere feels safe for the children, and they feel no one can offer them protection, not even their parents," said Ahmed Tawahina, a psychologist running clinics in Gaza as part of the Community Mental Health Programme. "That traumatises both the children and parents, who feel they are failing in their most basic responsibility."
From a political perspective, there is a deep paradox. Israel says it needs security, but it demands it at the cost of our constant insecurity.
Shaqura observed: "From a political perspective, there is a deep paradox. Israel says it needs security, but it demands it at the cost of our constant insecurity."
There are no statistics that detail the effect of the drones on Palestinians in Gaza. Doctors admit it is impossible to separate the psychological toll inflicted by drones from other sources of damage to mental health, such as air strikes by F-16s, severe restrictions on movement and the economic insecurity caused by Israel's blockade.
But field researchers working for Palestinian rights groups point out that the use of drones is intimately tied to these other sources of fear and anxiety. Drones fire missiles themselves, they guide attacks by F-16s or helicopters, and they patrol and oversee the borders.
A survey in medical journal The Lancet following Operation Cast Lead, Israel's month-long attack on Gaza in winter 2008-09, found large percentages of children suffered from symptoms of psychological trauma: Fifty-eight percent permanently feared the dark; 43 percent reported regular nightmares; 37 percent wet the bed and 42 percent had crying attacks.
Tawahina described the sense of being constantly observed as a "form of psychological torture, which exhausts people's mental and emotional resources. Among children at school, this can be seen in poor concentration and unruly behaviour." The trauma for children is compounded by the fact that the drones also disrupt what should be their safest activity - watching TV at home. When a drone is operating nearby, it invariably interferes with satellite reception.
""It doesn't make headlines, but it is another example of how there is no escape from the drones. Parents want their children indoors, where it feels safer and where they're less likely to hear the drones, but still the drone finds a way into their home. The children cannot even switch off from the traumas around them by watching TV because of the drones."
Israel's 'major advantage'
Israel developed its first drones in the early 1980s, during its long occupation of south Lebanon, to gather aerial intelligence without exposing Israeli pilots to anti-aircraft missiles. Efraim Inbar, director of the Begin-Sadat Centre for Strategic Studies at Bar Ilan University, said drones help in situations where good, on-the-ground intelligence is lacking. "What the UAV gives you is eyes on the other side of the hill or over the border," he said. "That provides Israel with a major advantage over its enemies."
Other Israeli analysts have claimed that the use of drones, with their detailed intelligence-collecting abilities, is justified because they reduce the chances of errors and the likelihood of "collateral damage" - civilian deaths - during attacks.
The advantage from Israel's point of view is that using a drone for these tasks reduces the risk of endangering a pilot's life or losing an expensive plane. That is why we are moving towards much greater use of these kinds of robots on the battlefield.
But, according to Inbar, the drone is no better equipped than other aircraft for gathering intelligence or carrying out an execution.
"The advantage from Israel's point of view is that using a drone for these tasks reduces the risk of endangering a pilot's life or losing an expensive plane. That is why we are moving towards much greater use of these kinds of robots on the battlefield," he said.
'Mistakes can happen'
According to Gaza human rights group al-Mezan, Israel started using drones over the territory from the start of the second intifada in 2000, but only for surveillance.
Israel's first extra-judicial executions using drones occurred in 2004, when two Palestinians were killed. But these operations greatly expanded after 2006, in the wake of Israel's withdrawal of settlers and soldiers from Gaza and the rise to power of the Palestinian Islamic movement Hamas.
Drones, the front-line weapon in Israel's surveillance operations and efforts to foil rocket attacks, killed more than 90 Palestinians in each of the years 2006 and 2007, according to al-Mezan. The figures soared during Operation Cast Lead and in its aftermath, with 461 Palestinians killed by drones in 2009. The number peaked again with 199 deaths in 2012, the year when Israel launched the eight-day Operation Pillar of Defence against Gaza.
Despite Israeli claims that the intelligence provided by drones makes it easier to target those Palestinians it has defined as "terrorists", research shows civilians are the main victims. In the 2012 Pillar of Defence operation, 36 of the 162 Palestinians killed were a result of drone strikes, and a further 100 were injured by drones. Of those 36 killed, two-thirds were civilians.
Also revealing was a finding that, although drones were used in only five percent of air strikes, they accounted for 23 percent of the total deaths during Pillar of Defence. According to the Economist magazine, the assassination of Hamas leader Ahmed Jabari, which triggered that operation, was carried out using a Hermes 450 drone.
Palestinian fighters report that they have responded to the constant surveillance by living in hiding, rarely going outdoors and avoiding using phones or cars. It is a way of life not possible for most people in Gaza.
Gaza's armed groups are reported to be trying to find a way to jam the drones' navigation systems. In the meantime, Hamas has claimed it has shot down three drones, the latest this month, though Israel says all three crashed due to malfunctions.
Last week, on the anniversary of the launch of Pillar of Defence, an Israeli commander whose soldiers control the drones over Gaza from a base south of Tel Aviv told the Haaretz newspaper that "many" air strikes during the operation had involved drones. "Lt Col Shay" was quoted saying: "Ultimately, we are at war. As much as the IDF strives to carry out the most precise surgical strikes, mistakes can happen in the air or on the ground."
Random death by drone
It is for this reason that drones have become increasingly associated with random death from the sky, said Samir Zaqout, a senior field researcher for Al-Mezan.
"We know from the footage taken by drones that Israel can see what is happening below in the finest detail. And yet women and children keep being killed in drone attacks. Why the continual mistakes? The answer, I think, is that these aren't mistakes. The message Israel wants to send us is that there is no protection whether you are a civilian or fighter. They want us afraid and to make us turn on the resistance [Palestinian fighters]."
Zaqout also points to a more recent use of drones - what has come to be known as "roof-knocking". This is when a drone fires small missiles at the roof of a building to warn the inhabitants to evacuate - a practice Israel developed during Operation Cast Lead three years earlier, to allay international concerns about its repeated levellings of buildings with civilians inside.
In Pillar of Defence in 2012, 33 buildings were targeted by roof-knocking.
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Israel says it provides 10 minutes' warning from a roof-knock to an air strike, but, in practice, families find they often have much less time. This, said Zaqout, puts large families in great danger as they usually send their members out in small groups to be sure they will not be attacked as they move onto the streets.
One notorious case occurred during Cast Lead, when six members of the Salha family, all women and children, were killed when their home was shelled moments after a roof-knocking. The father, Fayez Salha, who survived, lost a case for damages in Israel's Supreme Court last February and was ordered to pay costs after the judges ruled that the attack was legitimate because it occurred as part of a military operation.
A US citizen who has lived long-term in Gaza, who wished not be named for fear of reprisals from Israel, said she often heard the drones at night when the street noise dies down, or as they hover above her while out walking. "The sound is like the buzz of a mosquito, although there is one type of drone that sometimes comes into view that is silent," she said.
She added that she knew of families that, before moving into a new apartment building, checked to see whether it housed a fighter or a relative of a fighter, for fear that the building may be attacked by Israel.
Shaqura said the drones inevitably affect one's day-to-day behaviour. He said he was jogging early one morning while a drone hovered overhead.
"I got 100 metres from my front door when I started to feel overwhelmed with fear. I realised that my tracksuit was black, the same colour as many of the fighters' uniforms. I read in my work too many reports of civilians being killed by drones not to see the danger. So I hurried back home."