When Constraint Becomes Constitutive: Moral Distress and Ethical Coping Among Emergency Healthcare Workers in the West Bank, Palestine

Emergency healthcare workers in the West Bank deliver care under sustained structural constraint that limits access, resources, and clinical decision-making. This study examines how such conditions generate moral distress and shape ethical practice. A qualitative design was used. Nineteen semi-structured interviews were conducted with physicians and nurses in emergency departments across three cities. Data were analyzed using thematic analysis. Findings show a progression from acute, episode-based distress to chronic forms linked to persistent structural barriers, culminating in moral numbing. This trajectory reflects repeated exposure to situations where clinicians cannot act in line with professional obligations. Some participants reported that peer support and professional advocacy can partially interrupt this process, though these responses shift burden onto individuals. Moral distress in this context is structurally produced and sustained. Addressing it requires institutional and systemic responses rather than reliance on individual coping.