At the Center, Yet at the Margins: Social Work Coordination of Domestic Violence and Sexual Assault in Israeli Hospitals

Social workers hold a central, yet often precarious, position in coordinating hospital-based responses to domestic-violence (DV) and sexual-assault (SA) in Israel. Although designated by the Ministry of Health as responsible for leading institutional responses, their role lacks structural anchoring and relies on local initiative and informal authority. This qualitative study explores how DV and SA coordinators enact and negotiate their roles within hospitals. Based on 28 interviews with social workers, physicians, nurses, and policymakers across five public hospitals and regional health offices, thematic analysis reveals a gap between formal mandates and lived practice. Coordinators are perceived as key figures in ensuring continuity of care, yet lack role clarity and systemic support. Their authority is informally negotiated and contingent upon interpersonal trust and professional reputation. This study conceptualizes the coordinator role as fluid, contested, and ethically charged, emerging within complex institutional terrains. It underscores the need for national-level investment in formal infrastructures, standardized protocols, supervision frameworks, and interprofessional mechanisms to transform coordination from a symbolic designation into a sustainable, system-wide responsibility. Future research should examine how different forms of institutional anchoring, interprofessional accountability, and organizational context shape the authority, legitimacy, and sustainability of hospital-based coordination roles in DV and SA responses.