In this cross-sectional study, we investigated the impact of COVID-19 infection on the quality of life and the quality of sleep among the Iraqi medical staff by using WHOQOL-BREF and ISI instruments. The measurement of internal consistency indicated that the two instruments were reliable among the target population. To the best of our knowledge, there is no previous work in Iraq studying the impact of COVID-19 infection on the QoL and sleep quality.
Regarding the overall perception of QoL, in our study the mean was 3.6 ± 0.91 which was comparable to the mean (3.99 ± 0.95) of a study conducted in Saudi Arabia . Eighteen percent of the participants in the current study felt that their overall QoL was “very good” which was about one-half that reported by the Saudi study . This could be attributed to the differences in the age of the target population, in our study the target was medical staff with a mean age was 37.30 ± 10.07, while in Saudi Arabia the participants were medical students with mean age 21.07 ± 1.70 years, and with increasing age there would be a substantial decrease in the QoL . Additionally, being in the front line in fighting the pandemic may contribute to the lower perception of QoL .
The mean of overall perception of general health (3.68 ± 0.97) was also very close to that found in Saudi Arabia by Malibary et al . In the current study, about 57% of the participants were either satisfied or very satisfied about their health which was in parallel to the finding (59.7 %) of the other study .
The mean scores of the 4 domains in this study showed the following descending order: social relationships, physical health, environmental and finally psychological domains. A study conducted in India by Chawla et al  found the highest mean score was in environmental (72.10 ± 13.0), then physical (67.23 ± 13.74), followed by social (57.13 ± 20.1), and the lowest was in the psychological domain (52.10 ± 17.45). Genta et al  also reported the highest scores in environmental domain (73.0 ± 11.6), followed by physical (68.9 ± 14.2), then social (67.8 ± 20.4) and finally psychological (64.0 ± 15.3). The results in these studies agreed with our results in that COVID-19 infection had the worst effect on the psychological status more than any other domain. In the latter 2 studies, the environmental domain was the highest scoring, disagreeing with our results in being the second lowest. However, a study assessing the QoL in Iraq found that the response was the poorest in the environmental domain .
The lack of significant correlations between the means scores of the four domains with age may give an indication that COVID-19 will affect the QoL of the healthcare staff regardless of their age demonstrating the huge impact of the pandemic.
In the current study, the mean score of the four domains was higher in males than females, Chawla et al  reported similar results regarding physical and psychological domains while in social and environmental domains females showed higher mean scores. This can be due to the differences in human nature as females have less physical power than males, also they are more passionate and sensitive to external pressure . Moreover, Ali et al  attributed the differences in mean scores in terms of gender to the additional responsibilities female workers have in the domestic life. The most significant difference in Table 2 was recorded in the mean of the physical health domain in terms of severity of COVID-19 infection with higher scores in those participants with mild infection. It is known that COVID-19 infection may progress to severe disease with serious health complications affecting number of organs ,  and therefore such a difference is not unexpected. The progression of the infection to severe may also increase the chance of testing for the patient to be eligible to receive hospital care and this may explain the significantly lower scores of physical health domain in those whose infection was confirmed by a laboratory test. With all the stress and anxiety that the pandemic is causing , a positive test result should be expected to psychologically affect the patient in a negative way, and hence the lower scores in the psychological health domain in those whose infection was confirmed by a test.
About 70% of the participants in this study reported some degree of insomnia (ISI scores > 8). This was higher than the 58% reported by Wańkowicz et al  in Poland. The difference may be explained on the basis of the inclusion criteria; in the Polish study, the healthcare professionals were those in contact with COVID-19 patients with no regard to their infection, while in our study, the participants were infected with the virus. This could mean that being infected with COVID-19 has more impact on sleep quality than the stress resulting from dealing with COVID-19 patients.
The negative correlation between ISI score and age was unusual, since it is expected for the sleep pattern to be disturbed with advancing age. One study which found such a positive correlation is that by Dragioti et al . The relatively young age of our sample (37.30 years) compared to much older sample in Dragioti et al study (76.2 years) may be the reason for the negative correlation in the current study.
ISI score was significantly higher in males than females, which means men are suffering from insomnia more than women. This was surprising as it contradicted other studies – where females had higher ISI scores and were more prone to suffer from sleep problems. However, even with this significant difference, both genders reported ISI scores that lay within the same type of insomnia (subthreshold).
The ratio of females to males in this study may be considered as a limitation; females constituted 3 quarters of the sample size with males only accounting for about 25%. The design of the study itself (cross-section) may affect generalizability and causality.