ABSTRACT Background and Aims Prolonged blockade, repeated attacks on health facilities, and extreme resource scarcity place Gaza's clinicians in situations that routinely violate core professional and personal values. We measured the prevalence, character, and functional consequences of moral injury among health‐care workers who have remained in Gaza since hostilities escalated in October 2023. Methods A cross‐sectional online survey incorporated a 6‐item events subscale adapted from the Moral Injury Events Scale (MIES) and an 8‐item outcomes subscale adapted from the Moral Injury Outcome Scale (MIOS) was distributed through professional and social‐media forums from November 23, 2024, to June 1, 2025. Primary outcomes were mean MMIEOS event and outcome scores; secondary outcomes were the proportions endorsing prespecified morally injurious experiences. Descriptive statistics and Spearman correlations assessed associations with age, gender, volunteer status, and surgical role. Results One hundred forty healthcare workers (60.7% male; mean age 24.9 ± 5.6 years; 70% unpaid volunteers) represented 36 hospitals and additional health facilities across all five governorates. Event scores were highest for witnessing immoral acts (mean 3.89 ± 1.79) and betrayal by leadership (3.36 ± 1.77). Self‐transgression items scored lower (2.55–2.84). Seventy‐six percent had witnessed colleagues' moral violations; 47% felt personally betrayed; 28% reported acting against their own values. Outcome scores demonstrated pronounced trust‐violation sequelae (mean subscale 18.08 ± 5.7 of 30) compared with shame‐related sequelae (4.38 ± 2.3 of 10). The most frequently endorsed consequences were loss of faith in humanity (mean 3.27 ± 1.50) and pervasive disgust (3.70 ± 1.33); only 14% agreed they no longer believed in a higher power. Correlations between MMIEOS scores and demographic variables were weak (| ρ | 0.05). Conclusion Gaza's health‐care workers experience high levels of externally driven moral injury marked chiefly by violated trust and disillusionment with institutions rather than self‐directed shame. Persistent moral injury threatens workforce retention and patient‐care quality in a system already on the brink of collapse. Interventions that protect medical neutrality, ensure material support, and offer structured moral‐repair programmes are urgently needed to safeguard clinicians' psychological integrity and the sustainability of Gaza's health sector.
Irfan et al. (Wed,) studied this question.