Nurses' perspectives on compassion fatigue, burnout and moral injury in war zone hospitals

BackgroundThe ongoing genocide (as declared on September 16, 2025 by the UN Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel) and militarized siege in Gaza has led to the systematic collapse of the health system, with hospitals overwhelmed by targeted bombings, mass casualties, infrastructural annihilation, and profound psychological suffering. Nurses have been subjected not only to extreme occupational stress but to deliberate conditions of deprivation and moral violation.Research aimTo explore the lived experiences of nurses in Gaza's hospitals, documenting compassion fatigue, burnout, and moral injury within a genocidal context of healthcare destruction.Research designA qualitative design was employed using thematic analysis of in-depth testimonies.Participants and Research ContextTestimonies were collected from nurses working in Gaza's remaining hospitals between late 2023 and mid2025. Participants served as frontline caregivers while enduring forced displacement, starvation, and personal bereavement.Ethical considerationsEthical approval was obtained from local review boards. Informed consent, confidentiality, and emotional safety were ensured under exceptionally high-risk conditions.FindingsSix themes were identified: (1) collapse of hospital care; (2) nurses' bodies and minds under siege; (3) maternal starvation and neonatal death; (4) burden of infection and decay; (5) solitary mourning and improvised funerary practices; and (6) the struggle to endure and find meaning. Nurses reported compassion fatigue, moral injury, somaticexhaustion, and cognitive impairment, all intensified by the genocide's material and emotional toll.DiscussionCaregiving persisted despite repeated targeting of medical personnel and infrastructure. Findings extend conventional models ofburnout and secondary trauma by situating experiences within the concept of 'medicide,' defined as the systematic destruction of health systems.ConclusionsThis study provides an empirically grounded account of nursing labor under conditions described by international bodies as genocidal. Insights have urgent implications for nursing ethics, international humanitarian law, and interventions to support health workers in colonized and militarized settings.