Moral Injury in Gaza: The Impact on Healthcare Professionals

Area of Science:

• Medical Ethics
• Psychology
• Public Health

Background:

• Gaza's healthcare workers face extreme conditions, including blockades and attacks on facilities.
• These conditions routinely violate professional and personal values, leading to moral injury.
• The study assesses moral injury among healthcare workers remaining in Gaza since October 2023.

Purpose of the Study:

• To measure the prevalence, character, and functional consequences of moral injury.
• To understand the impact of moral injury on healthcare workers in Gaza.
• To identify the primary sources and outcomes of moral injury in this population.

Main Methods:

• A cross-sectional online survey was conducted from November 2024 to June 2025.
• The survey used adapted Moral Injury Events Scale (MIES) and Moral Injury Outcome Scale (MIOS) subscales.
• Data were analyzed using descriptive statistics and Spearman correlations.

Main Results:

• 140 healthcare workers participated; 70% were unpaid volunteers.
• Highest event scores were for witnessing immoral acts (3.89) and leadership betrayal (3.36).
• Outcome scores showed pronounced trust-violation sequelae (18.08/30) over shame (4.38/10); loss of faith in humanity (3.27) and disgust (3.70) were common.

Conclusions:

• Gaza's healthcare workers experience high levels of externally driven moral injury, characterized by violated trust and institutional disillusionment.
• Persistent moral injury threatens workforce retention and patient care quality in a collapsing health system.
• Interventions are urgently needed to protect medical neutrality, provide support, and offer moral repair programs.