On the frontlines of healthcare: Experiences, challenges, and ethical dilemmas during war

BackgroundHealthcare professionals in Israel work within a system shaped by chronic strain, recurring security threats, and continuous organizational pressures. The Iron Swords War of October 2023 (the Israel-Gaza war, referred to in Israel as "Iron Swords") intensified these conditions, heightening workloads, emotional vulnerability, and complex ethical dilemmas. The country's multicultural workforce, including Jewish, Arab, and Druze professionals, added another layer of tension but also revealed moments of solidarity and shared commitment during extreme conditions.Research question and aimThe study examines how healthcare professionals experienced their work during the war, focusing on operational strain, ethical tensions, emotional burdens, and team dynamics in diverse clinical settings.Research designA qualitative abductive design was used to explore emergent themes alongside existing theoretical insights on crisis management, ethics, and healthcare work in conflict zones.Participants and research contextThirty four healthcare professionals from public hospitals across Israel participated. All interviews explored experiences during 2023-2024 in clinical environments directly affected by wartime demands.FindingsThe findings reveal five key themes: (1) Structural and Operational Strain Exposed; (2) Professional Commitment versus Ethical Strain; (3) Emotional Burden and Identity Blurring; (4) Team Dynamics: Solidarity, Fragmentation, and Adaptation; and (5) Reaffirming the Moral Identity of the Healthcare System. The study highlights the psychological toll on professionals, including moral distress and moral injury, as they balanced patient care, personal safety, and professional ethics within this diverse workforce.ConclusionsThe findings underscore the urgent need for structural reforms and institutional support mechanisms that address both operational strain and the emotional and moral burdens faced by healthcare professionals in crisis-prone environments. While rooted in the Israeli context, the study offers broader insights for healthcare systems operating under conditions of chronic strain, political tension, or conflict.