The limits of ethical models: insights from paediatric trauma care in Gaza

The ongoing humanitarian crisis in Gaza has created unprecedented challenges in paediatric trauma care, exposing the limitations of oft-championed traditional bioethical frameworks in conflict settings. This paper examines the ethical dilemmas faced by healthcare workers treating paediatric patients in Gaza amidst extreme resource scarcity, systemic violence, and infrastructural collapse. Using firsthand field observations and case studies, we explore the difficulties of informed consent, surrogate decision-making, and resource prioritization in an active armed conflict. The constraints of distributive justice, individual-focused paediatric autonomy, and non-maleficence are highlighted through examples such as amputation decisions, neonatal care, and managing unaccompanied minors. We propose seeking an ethical framework that considers the role of relational autonomy, Islamic bioethics, and humanitarian ethics, grounded in principles of humanity, impartiality, neutrality, and independence. While recognizing the inherent challenges of delivering ethical care in conflict zones, there is a need to balance immediate clinical needs with broader social and moral considerations. The paper underscores the urgent need for international support, resource allocation, and the development of actionable guidelines for paediatric care in conflict settings. It calls for further exploration of applied bioethics under extreme scarcity, aiming to inform both clinical practice and global humanitarian policies in similar crises.