Examining Moral Injury Among Gaza’s Healthcare Workers

Bilal Irfan – Harvard Medical School Center for Bioethics; Abdulwhhab Abu Alamrain – Al-Aqsa Martyrs Hospital; Abdallah Abu Shammala – Gaza European Hospital; Hasan Hussein – Harvard University; Mohammed Halimy – Islamic University of Gaza; Majdi Al-Khaldi – Islamic University of Gaza; Alaa Kassab – Al-Aqsa Martyrs Hospital; Fahmy Almedana – Islamic University of Gaza; Hitham Toman – Al-Aqsa Martyrs Hospital; Muna Irfan – University of Minnesota Medical School

Abstract: Healthcare workers in Gaza face extraordinary ethical challenges amidst severe violence, limited resources, and systematic violations of medical neutrality. These repeated ethical compromises lead to moral injury, a profound psychological and spiritual harm arising from betrayal of one's moral beliefs. This study assesses moral injury among healthcare professionals in Gaza using a modified Moral Injury Events and Outcomes Scale. Data from 55 participants, and growing, reveals prevalence of witnessing morally injurious acts, with lower reports of self-committed moral violations. Trust-related outcomes, including loss of faith in humanity and persistent anger, were particularly evident. A notable minority reported spiritual disillusionment, while most maintained or intensified their religious faith as a coping mechanism. Despite extreme conditions and inadequate compensation, Palestinian healthcare workers showed resilience, though chronic moral injury threatens workforce retention and quality of care in a post-ceasefire scenario. These findings add to the literature on the need to mitigate moral injury through improved compensation, supportive leadership, mental health resources, and advocacy for medical neutrality in the reconstruction of Gaza. Addressing the root causes of violence is essential to protecting healthcare workers' moral integrity, safeguarding patient care, and facilitating psychosocial healing in Gaza.

Keywords: Moral injury, Psychosocial impact, Occupational stress