'Out of My Hands': Palestinian Referral Care in East Jerusalem After October 7, 2023

This paper examines the moral experiences of Palestinian healthcare professionals working at a specialised referral hospital in East Jerusalem during the early months of the Gaza War. Drawing on semi-structured interviews with hospital staff providing oncology care, it analyses how understandings of what constitutes "good" care in a context of occupation, segregation, and genocidal violence are shaped by competing normative frameworks. Three ethical perspectives initially emerged: medical ethics, which prioritises evidence-based protocols; humanitarian ethics, which emphasises neutrality in line with donor requirements; and communitarian ethics, which understands care as an expression of solidarity and national duty. The paper argues that to fully capture the moral labour of healthcare workers, a fourth frame is needed: care ethics, which highlights the relational and reparative dimensions of care work. This perspective is crucial in a context where occupation and segregation deeply affect the "care triangle" of patients, companions, and healthcare providers. Viewing care as a relational practice that resists division and exclusion also offers a strategy to alleviate the moral distress that can arise when professionals are unable to provide care they themselves see as "good enough." The paper calls on employers, communities, and colleagues to value and support the care work professionals provide beyond their clinical tasks, while also recognising the limits of individual responsibility by acknowledging and addressing the structural barriers they face. Ultimately, an end to occupation and segregation remains the primary condition for enabling good care.