As children, we are taught right from wrong. We learn this at home, school, and church or other community organizations. We carry these rules into adulthood and, for most, they shape how we conduct ourselves.
Yet many of us may have lived experiences that contradict what the ethical or right way is. The concept of moral injury is often seen in the military and healthcare. Well-documented instances in the military and healthcare include morally unethical acts either witnessed or perpetrated. Some of the most well-known in the military are the My Lai Massacre, the Abu Ghraib torture, and prisoner abuse. In healthcare, the recent COVID-19 pandemic forced hospitals and healthcare providers to work without proper PPE and adequate supplies while caring for patients, and the crisis at Memorial Medical Center in New Orleans during Hurricane Katrina, where patients were abandoned in the hospital and left to die.
These examples clearly illustrate causes of moral injury. Moral injury can cause emotional, psychological, physical, and spiritual distress. Many who have had a moral injury will suffer from PTSD.
Yet, moral injury can happen to anyone, not just those in the military or healthcare. Those working in law enforcement, education, social services, and religious communities can also be affected, and it can happen to anyone at any time.
Moral injury can occur for those who have witnessed or have been victims of violence or abuse. As a child, you believe that your family should care for and protect you. As a child, you believe that your school, church or community organization should be safe. As a woman, and even as a man, you should feel safe in your relationships or your community. Yet, for many, this is not the case. Over a billion children experience sexual violence globally, and over 8 million children are referred to Child Welfare in the US alone. Approximately 25% of women and men experience some type of domestic violence, and approximately 5 women will lose their lives to domestic violence every day. According to the National Center for Education Statistics, 67% of US public schools recorded one violent incident during 2019- 2020. According to the Evangelical Council for Abuse and Prevention, 1 in 3 girls and 1 in 7 boys have been sexually abused, and 12% of churchgoers know someone who has experienced rape or an attempted rape by a member of a church.
These are clearly examples of situations that would cause the victim and the witness to experience a moral injury. Other examples can also result in moral injury, such as the rising number of incidents of insurance companies that deny claims. In 2024, insurance companies denied 496 million claims. The denials often result in delayed or even denied care. For patients and caregivers, this can result in significant health-related challenges in accessing care and medical treatments. Access to women’s healthcare after the Supreme Court struck down Roe-V-Wade has resulted in an increase in deaths due to ectopic pregnancies, as physicians are afraid to perform necessary medical care, which would be considered an abortion in states with abortion bans.
On a community level, the incidents of adults and children who have been taken into custody by ICE and placed in detention centers or deported can be seen as a moral injury to the entire community. Since July of 2026, over 65,000 people have been held in detention centres; 70% have no criminal record, and nearly 60 deaths have been reported in the past two years. There are three high-profile cases of civilians who have been killed by ICE: Renee Good, Alex Pretti, and Ruben Ray Martinez. Such incidents have had a far-reaching impact on families and communities.
Recognizing the impact of moral injury and the resulting moral distress is critical. Over the long term, emotional, psychological, physical, and spiritual distress can affect individuals and communities. This can manifest as a sense of betrayal, a decline in feeling safe and moral trauma.
It is becoming a significant issue that is now reaching into almost every aspect of daily life. While we are just beginning to understand the concept, more research is needed to understand the long-term implications for individuals and communities. We need to develop prevention and treatment plans if we want to help heal those most impacted.
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