Gaza crisis: Are you wrestling with moral injury? How to manage the internal struggle

June 13, 2024, marks 250 days of what the United Nations has termed a genocide in Gaza, and we’ve seen it all.

Families buried alive. Others wiped from the civil registry. Hospitals relentlessly attacked. Doctors, aid workers, and journalists indiscriminately targeted and killed.

Children maimed, orphaned, murdered.

This is a mild description of the daily atrocities in Palestine since October 7, 2023 — and decades before. The world is witnessing the horrific attacks on Palestinians all over the Occupied Territories in real time.

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Dr Sarah Almarzooqi, a consultant clinical psychologist and Post Traumatic Stress Disorder (PTSD) therapist, discusses how this collective global trauma can result in moral injury.

What is moral injury?

Moral injury is a very personal, individual experience where someone develops psychological and emotional distress because of conflict between their morals and values, and their behaviours, actions, or inaction.

The internal struggle can occur when someone witnesses or participates in events that go against their sense of right and wrong, or against what they’ve always perceived as just or fair. It can also be felt because of their lack of action — failure to stop or speak out fully against injustices they see around them.

The long-term psychological impacts of moral injury on individuals involved in, or witnesses to, conflict can be significant with feelings of relentless guilt, shame, and grief. In the long term, individuals may feel disconnected from others and struggle to reintegrate into society.

Moral injury and Gaza

Witnessing extreme acts of violence on social media is triggering. There is a general sense of hopelessness and grief, anger, betrayal, guilt, and shame — or a combination of all these things.

Most common is a sense of helplessness for not being able to prevent or stop the violence. People also feel despair as they witness suffering and the senseless loss of innocent lives. They are in a constant state of grief. Anger at injustice can develop into a deep rage, sometimes causing people to act rashly and boldly to highlight their feelings or to prevent more injustice. People can feel betrayed as social constructs of morality are disregarded and broken, leaving them to question humanity overall.

Crushing guilt and shame is a huge impact of moral injury — for not taking action, for not doing enough, for not being directly affected, for being able to live “normally”.

Guilt becomes a cycle of mental suffering because people feel guilty for their own mental turmoil — falling into depression and suffering from extreme anxiety — when they know it is not a fraction of what Palestinians are experiencing themselves.

PTSD vs moral injury

Though both are related forms of trauma, they are different. Post-traumatic Stress Disorder (PTSD) is classified as a form of mental illness with an agreed definition and criteria. However, moral injury is not a mental disorder yet; it has been described as a syndrome.

PTSD primarily focuses on the psychological and physiological reactions to experiencing or witnessing a traumatic event. Moral injury relates to ethical behaviour, the meaning attached to events and perceptions of the self, moral philosophy and spirituality. It specifically refers to the moral and ethical dimensions of trauma, and is more focused on the internal conflict and distress caused by a perceived violation of one’s moral code.

While PTSD and trauma-related conditions can occur independently or in conjunction with moral injury, moral injury specifically addresses the existential consequences of trauma, highlighting the importance of addressing the ethical dimensions of healing and recovery.

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