Arabic translation and psychometric validation of the Moral Distress Instrument and the Moral Injury Events Scale among health care professionals providing care during war in Gaza.

OBJECTIVE: Serving as a health care worker (HCW) during war exposes individuals to increased risks of moral distress (MD) and moral injury (MI), capturing these phenomena encourages further exploration of their causes and consequences and informs the development of tailored interventions. This study aimed to validate two comprehensive tools for measuring MD and MI experienced by Arabic-speaking HCWs in the context of Gaza war, namely, the Moral Distress Instrument (MDI) and the Moral Injury Events Scale (MIES). METHOD: Our research team conducted a cross-sectional study over 3 months (January-April 2025). The recruitment of participants took place at primary health care centers and hospitals in the Gaza Strip. RESULTS: A two-factor structure of the MIES ("perceived transgressions" and "perceived betrayals") yielded acceptable fit indices, with excellent α coefficient values for the total score (.95) and the two factors (0.93-0.94). As for the MDI, we were able to replicate the two-factor structure of the original instrument ("frequency" and "discomfort"). Additionally, reliability findings indicated an excellent Cronbach's α for the two subscales of the MDI (.84-.87). Measurement invariance of the MDI and the MIES was established across sex categories. Greater levels of MD and MI were positively associated with more severe depression, anxiety, posttraumatic stress symptoms and suicidal ideation, supporting good concurrent validity. CONCLUSIONS: The two scales now made available to clinicians and researchers should encourage future endeavors to identify, assess, monitor, and mitigate MD and MI in professionals of diverse disciplines working in different settings. (PsycInfo Database Record (c) 2026 APA, all rights reserved).