Upholding Care Under Constraint: Moral Distress, Psychological Trauma, and Resilience Among Nurses in West Bank Hospitals.

Introduction: Nurses in conflict zones face unique ethical challenges distinct from stable environments. The West Bank, under prolonged military occupation and structural violence, presents a critical context to examine how nurses sustain ethical practice. Despite growing awareness of moral distress, the lived experiences of nurses in such settings remain underexplored through qualitative, phenomenologically-informed approaches. Objectives: This study aimed to explore the lived experiences of moral distress and resilience among nurses in West Bank governmental hospitals and to identify key ethical challenges, coping mechanisms, and institutional support needs. Methods: A qualitative design using Interpretive Phenomenological Analysis was implemented with 21 purposively sampled nurses from three hospitals. Data collection involved semi-structured, in-depth Arabic interviews (60-120 minutes), transcribed, translated (forward-backward method), and analyzed iteratively. Data saturation was achieved after the 18th interview. Exclusion criteria included nurses who were not currently employed in a direct patient care role, those with less than one year of experience in the setting, and non-Arabic-speaking staff. Reporting followed COREQ guidelines. Results: Analysis yielded three superordinate themes: (1) "The Double Burden", moral distress from political barriers and chronic resource scarcity; (2) "Our Shared Strength", reliance on peer, family, cultural ( Conclusions: Palestinian nurses demonstrate extraordinary resilience through informal networks, but this reveals a systemic failure, as their distress is structural. There is an urgent need for contextually-adapted institutional support programs to preserve workforce well-being and uphold care integrity.