Between Care and Catastrophe: The Dual Burden of Female Social Workers in Gaza During Genocide

Abstract

This study examines the lived experiences of female social workers in the Gaza Strip during the genocide, focusing on the intersection of personal vulnerability and professional responsibility. Drawing on in-depth interviews with thirty internally displaced social workers in Rafah, the research employs thematic content analysis to uncover the psychological, emotional, and institutional challenges faced by practitioners. The study is situated within the broader context of humanitarian crises in Palestine, where social workers have historically operated under conditions of political instability and resource scarcity. The findings reveal four central themes: the blurring of boundaries between victimhood and caregiving, the impact of gendered expectations and self-sacrifice, the effects of institutional neglect and the invisibility of female labor, and the role of coping strategies and peer solidarity. These themes collectively define what we term “total immersion trauma”, a condition where the distinction between professional caregiver and victim dissolves because both face the same systematic erasure. Female social workers are situated as both helpers and survivors, carrying dual burdens that are intensified by chronic insecurity, social mandates, and systemic under-resourcing. The study highlights the insufficiency of informal peer support in the absence of organizational care, underscoring the urgent need for formal interventions to support the well-being of Gaza's social work community during the genocide. Furthermore, the findings point to the necessity of addressing the structural conditions that perpetuate this crisis, as psychological support alone cannot resolve the fundamental issues created by the ongoing violence and occupation.

Introduction

The humanitarian crisis in Gaza since October 7, 2023, represents a distinct escalation of violence against Palestinian civilians, resulting in what scholars and international bodies have identified as genocide (Hamamra et al., 2024; Hamamra et al., 2025; Mahajne & Alnabilsy, 2025). This context has created specific challenges for social workers who must provide care while at the same time experiencing the same trauma as their clients. Social work in conflict-affected regions demonstrates the heavy psychological and professional burdens placed upon practitioners (Buheji, 2024). Within this setting, the situation of female social workers in the Gaza Strip presents a compelling case as their professional duties are performed against a condition of political violence, economic siege, and pervasive social distress (Al Riffai, 2024; Hassoun, 2025). These women function as frontline responders to community trauma while being members of the affected population (Algan et al., 2024). Their experience is therefore characterized by a set of distinct challenges, including their dual vulnerability, the impact of gendered social expectations, the institutional conditions of their labor, and their coping strategies (Kooli & Kooli, 2025).

We define this context explicitly as genocide to distinguish the current reality from general warfare or political instability. Unlike conventional conflict, where civilians may be collateral casualties, genocide entails the systematic and intentional destruction of a targeted group's conditions of life (Buheji et al., 2024). This distinction is critical for the analysis of social work, as it alters the basic premises of the profession. In standard war zones, practitioners often operate from relative safety or anticipate a cessation of hostilities. In contrast, the situation in Gaza involves ongoing, systematic violence with no clear endpoint, where the infrastructure of care itself—hospitals, shelters, and aid networks—is a primary target. Consequently, female social workers in Gaza are not merely operating within a crisis but are a direct target of the eradication campaign they attempt to mitigate. This totalizing violence necessitates a conceptual shift away from traditional trauma models, which assume a boundary between the helper and the victim, toward an understanding of the practitioner's experience as one of shared existential threat (Suslovic et al., 2024).

Historical context is essential for understanding the current situation. Social work in Palestine has long been shaped by conditions of occupation, displacement, and limited resources (Al-Kilani, 2019). Previous conflicts, such as the Second Intifada, already revealed the immense pressures on Palestinian social workers who struggled to provide psychosocial support while facing personal insecurity and institutional limitations (Lindsay, 2007). The current genocide represents an intensification of these historical challenges, creating conditions that exceed previously established frameworks for understanding social work in conflict zones.

Research on social work in war zones globally has demonstrated that practitioners face similar challenges across contexts, including secondary trauma, resource limitations, and ethical dilemmas (Duman & Snoubar, 2016). However, the situation in Gaza is distinguished by the prolonged nature of the blockade, the density of the population, and the scale of destruction. These factors create a unique setting where traditional social work approaches are severely tested.

From a feminist perspective, the experiences of female social workers in Gaza reflect broader patterns of gendered labor expectations in conflict zones (Shalhoub-Kevorkian et al., 2022). “Total immersion trauma” is distinctly gendered in this context. While all residents face the threat of violence, women are socially mandated to act as the stabilizers of family and community life. Palestinian women have historically borne disproportionate burdens during times of crisis, often serving as the primary caregivers for families and communities while their own needs remain unaddressed. This gendered dimension of the crisis requires specific attention, as it shapes both the expectations placed on female social workers and their responses to these expectations.

Conventional frameworks of burnout and resilience, while valuable in understanding professional stress, fall short of capturing the scale and nature of trauma endured by Gaza's social workers during genocide. Maslach's burnout framework (1982) emphasizes emotional exhaustion, depersonalization, and reduced personal accomplishment, but these dimensions were developed in stable organizational contexts. They do not account for “total immersion trauma”, where the “depersonalization” of a client is impossible because the worker sees her own potential fate in the client's suffering. Similarly, resilience literature often emphasizes individual capacity to bounce back from adversity (Southwick et al., 2014), yet this concept becomes problematic when applied to those experiencing ongoing, systematic violence with no clear endpoint. Our study seeks to illuminate how these conventional frameworks fail to capture the lived reality of social workers operating under conditions of extreme and sustained violence.

While existing literature has documented the challenges faced by social workers in conflict zones broadly (Buheji, 2024), and Palestinian social workers specifically (Allassad Alhuzail & Mahajne, 2023), there remains a significant gap in understanding how female practitioners experience the collision of personal trauma and professional responsibility under conditions of genocide. Previous research has tended to examine these aspects separately rather than exploring their connection in the lived experience of social workers. This study addresses this gap by introducing the concept of “total immersion trauma” to analyze how the unique circumstances of genocide create a distinctive set of personal and professional challenges for female social workers in Gaza. We define “total immersion trauma” as the psychological and professional state resulting from working within an environment of systematic violence that targets the helper as aggressively as the client. Unlike conventional conflict settings where professionals may have access to safe zones or distinct periods of rest, “total immersion trauma” occurs when there is no physical or temporal boundary between the trauma of the client and the existence of the worker.

Female social workers in Gaza oscillate between the roles of professional caregiver and vulnerable citizen (Jebril, 2025; Mohammed et al., 2024; Noble et al., 2024). As residents of Gaza, they share the same exposure to insecurity, economic deprivation, and collective trauma as their clients (Aqtam, 2025; Kooli & Kooli, 2025). This shared reality is the core of “total immersion trauma”; the practitioner cannot distance herself from the event because the event encompasses her entire existence. They worry about the safety of their own families, manage household shortages, and endure the psychological strain of living under a blockade and the threat of military escalation (Diab et al., 2023). This lived experience, while offering a degree of shared understanding with clients, also erodes the personal reserves necessary for effective professional practice (Abu Hamad et al., 2023). In a study conducted by Aqtam (2025), a narrative review of the health and well-being of Palestinian women in Gaza detailed the substantial stressors they face, including food and water insecurity, restricted movement, and high rates of anxiety and depression stemming from the genocide. These findings suggest that female social workers begin their workday already carrying a significant personal burden, which is then augmented by the secondary trauma absorbed through their professional encounters (Aqtam, 2025); their identity as both helpers and victims means there is no clear separation between their personal and professional spheres, leading to a relentless cycle of stress exposure from which there is little break (Buheji, 2024).

The gendered nature of social work labor represents another critical dimension of our analysis. Acker's (1990) theory of gendered organizations highlights how workplace structures and practices reproduce gender inequalities; a phenomenon particularly evident in the expectations placed on female social workers in Gaza. The concept of “emotional labor” (Hochschild, 1983), the management of feeling to create a publicly observable facial and bodily display, is especially relevant here, as female social workers are expected to regulate their own emotions while attending to others’ trauma. This gendered expectation becomes intensified under conditions of genocide, creating unique pressures on female practitioners.

This condition of shared vulnerability is intensified by gendered expectations that shape both social life and professional conduct in the region (Darawshy et al., 2024). Palestinian society often assigns women the primary role of emotional caretakers within the family and the community (Buheji et al., 2024). This cultural script is transposed onto the professional domain of social work, where female practitioners are expected to be repositories of empathy, patience, and resilience. They are socially conditioned to prioritize the needs of others, a mandate that is amplified in their professional capacity (Buheji, 2024). The expectation is not merely to provide services, but to perform a version of idealized femininity centered on nurturing and self-sacrifice (Noble et al., 2024; Shalhoub-Kevorkian et al., 2023). This forces them to suppress their own fear, grief, and exhaustion to project an image of strength and stability for their clients and colleagues (Suslovic et al., 2024). The pressure to appear resilient can prevent them from admitting vulnerability or seeking support, as doing so might be perceived as a personal or professional failure. This performance of resilience becomes a survival mechanism, but one that comes at a considerable personal cost, contributing to emotional depletion and burnout over time (Buheji et al., 2024; Jebril, 2025).

The professional environment in which these women operate further exacerbates their difficulties. Their labor, critical to the functioning of Gaza's social fabric, is undervalued and rendered invisible by the very institutions that employ them (Farajallah, 2024). Many female social workers are employed by local and international non-governmental organizations operating under conditions of chronic underfunding and instability (Hamarsha, 2025). The NGO sector in Gaza comprises both long-standing organizations that have operated in the region for decades and newer entities established specifically in response to the October 2023 genocide. Organizations such as UNRWA, Save the Children, and various local Palestinian NGOs have historically provided essential social services, while newer initiatives have focused primarily on emergency response and trauma counseling. These circumstances translate into precarious working conditions, characterized by short-term contracts, inadequate salaries that fail to reflect the intensity of the work, and persistent job insecurity linked to unpredictable donor funding cycles (Abubaker & Adam-Bagley, 2025).

In a study conducted by Algan et al. (2024) on the challenges facing social workers in the Gaza Strip, the findings highlighted overwhelming challenges, a severe lack of resources, and insufficient professional supervision as major impediments to their work (Algan et al., 2024; Farajallah, 2024). Algan et al. (2024), argues that these institutional failings directly contribute to high levels of stress and burnout among practitioners. The study documents how social workers are often expected to achieve ambitious programmatic goals without the necessary tools, training, or institutional backing, placing the onus of success or failure squarely on the individual practitioner rather than the system. This institutional disregard for their professional needs reflects the societal disregard for their personal well-being, creating a reality where they are expected to give endlessly from a position of insecurity (Al Attar & Brik, 2024).

In the face of these pressures and the absence of adequate formal support structures, female social workers in Gaza have developed their own informal systems of care and solidarity (Allassad Alhuzail & Mahajne, 2023). Peer support networks become a lifeline. Colleagues rely on one another for emotional validation, practical advice, and moments of shared understanding that are difficult to find elsewhere. These relationships, formed under the pressures of shared adversity, provide a crucial space for informal debriefing and mutual encouragement (Fareed, 2024; Jebril, 2025; Noble et al., 2024). This collegial solidarity is a testament to their resourcefulness and their commitment to one another's survival (Hassoun, 2025; Suslovic et al., 2024). It functions as a form of collective resistance against the isolating nature of their work, creating small pockets of safety and trust within a hostile setting (Darawshy et al., 2024). These informal bonds are not a supplementary benefit; for many, they are the primary mechanism for sustaining their mental and emotional health in the profession (Hassoun, 2025).

However, while these informal networks are essential, they are insufficient to address the depth and chronicity of the trauma these women endure. Peer solidarity, however strong, cannot replace specialized, confidential, and professional psychological support (Aqtam, 2025; Bener et al., 2024). The reliance on colleagues for emotional offloading risks creating saturated networks where everyone is overwhelmed and there is no one with the capacity to absorb more distress. This can lead to a situation where the burden of care is simply redistributed among the workers themselves, rather than being addressed at an institutional level (Diab et al., 2023; Qutishat, 2025). Furthermore, sharing personal struggles with colleagues can be fraught with difficulties related to professional boundaries, confidentiality, and workplace politics. The cumulative effect of years of exposure to primary and secondary trauma, combined with personal hardship, requires more than peer-to-peer commiseration. It necessitates structured interventions, such as regular clinical supervision and accessible counseling services, which are largely absent (Farajallah, 2024). The insufficiency of these informal systems highlights a critical gap in the duty of care owed by employers to their staff (Kooli & Kooli, 2025).

This gap is sustained by a culture of self-sacrifice that permeates the humanitarian and social work fields, particularly in high-intensity contexts like Gaza. A strong professional ethos, often internalized by the workers themselves, champions stoicism and prioritizes client needs above all else (Algan et al., 2024). This is interwoven with cultural stigmas surrounding mental health, where seeking psychological help can be viewed as a sign of weakness or an inability to cope. Female social workers in Gaza may fear that admitting to burnout or emotional distress could jeopardize their employment or damage their professional reputation (Bener et al., 2024; Hamarsha, 2025). They are caught in a double bind: the very nature of their work erodes their psychological well-being, while the culture of their profession discourages them from seeking the help they need (Suslovic et al., 2024). This self-silencing is not a personal choice but a response to a system that offers few safe avenues for expressing vulnerability (Darawshy et al., 2024). The absence of systemic support from employers, be it governmental agencies or NGOs, normalizes this state of exhaustion. By failing to implement staff care policies, institutions implicitly endorse the idea that the psychological toll of the work is simply part of the job, a personal burden for the worker to carry alone (Abubaker & Adam-Bagley, 2025; Qutishat, 2025). This ongoing institutional failure ensures that the cycle of stress, depletion, and attrition among Gaza's most dedicated female caregivers continues, signaling an urgent need for a fundamental shift in how their labor and their humanity are valued (Bener et al., 2024; Mohammed et al., 2024).

The Setting

The Gaza Strip has been under Israeli blockade since 2007, creating what scholars have described as an open-air prison where basic necessities, movement, and economic activity are severely restricted. The situation escalated dramatically following October 7, 2023, with sustained military operations resulting in mass displacement, destruction of infrastructure, and a humanitarian catastrophe (Farajallah, 2024; Hassoun, 2025). The genocide designation reflects not only the scale of killing but also the systematic destruction of conditions necessary for life, including healthcare, education, and social services (Jebril, 2025).

The needs of people in Gaza during this period have been immense, with the majority of the population experiencing displacement, food insecurity, lack of clean water, and psychological trauma (Al Riffai, 2024; Kooli & Kooli, 2025). Social workers have been essential in providing psychosocial support, but their capacity has been severely constrained by the same conditions affecting their clients (Al Attar & Brik, 2024). The NGO sector in Gaza includes both international organizations (such as UNRWA, Doctors Without Borders, Save the Children) and local Palestinian NGOs. Some of these organizations have operated in Gaza for decades, while others were established specifically in response to the current crisis. The types of social work emphasized have largely focused on emergency response, trauma counseling, and basic needs coordination rather than longer-term community development interventions (Buheji, 2024).

Given the extreme conditions and sustained violence in Gaza, this study sought to move beyond documenting physical risks to examine the lived, emotional, and professional realities of social workers during genocide. Recognizing that conventional frameworks of burnout and resilience fall short of capturing the scale and complexity of trauma endured by Gaza's social workers, this research was guided by a set of questions designed to illuminate the intricate interplay between personal suffering, professional identity, and the evolving meanings of care and solidarity under siege. Accordingly, the study was structured around the following central research questions: First, how do social workers in Gaza experience and articulate the blurring of boundaries between their professional roles as helpers and their personal realities as victims during genocide? Second, in what ways have traditional professional and therapeutic tools become inadequate or obsolete in the context of persistent deprivation, institutional collapse, and collective trauma? Third, what are the main sources and manifestations of psychological and emotional burden, including compassion fatigue and moral injury—among Gaza's social work workforce? Fourth, how do social workers rely on and redefine peer support, solidarity, and resilience in the absence of functional institutional systems? Fifth, how does witnessing the suffering of vulnerable populations, particularly children and families, affect the professional identity, sense of hope, and emotional well-being of social workers?

Methodology

This research adopts a feminist constructivist qualitative approach (Charmaz, 2006) that acknowledges the co-construction of knowledge between researchers and participants, while paying particular attention to power dynamics and gendered experiences. This epistemological stance recognizes that knowledge is situated within specific social, political, and historical contexts, and that the researcher's positionality inevitably shapes the research process. The feminist perspective specifically guides our attention to how gender structures the experiences of female social workers in Gaza.

Positionality Statement

The research team consists of three Palestinian scholars who are professors in psychology, translation, and literature. Their diverse academic backgrounds provide interdisciplinary perspectives on trauma, representation, and humanitarian experience. They offer a nuanced understanding of both the psychological and cultural dimensions of social work under conditions of siege and genocide. This positionality offers valuable insight into the contextual realities of Gaza, while requiring ongoing reflexivity to reduce potential interpretive bias. The team's dedication to documenting these experiences arises from the belief that social workers, although central to humanitarian response, are often neglected in academic and policy discussions. We recognize that our role as researchers carries an ethical responsibility to represent participants’ voices with honesty and respect, while acknowledging the limits of our ability to fully grasp the depth of their suffering.

This feminist constructivist approach is directly informed by our positionality. Our shared commitment to highlighting gendered experiences and our proximity to the context necessitate a research stance that views knowledge as co-constructed and values the lived, embodied experiences of the participants as central to understanding their reality. We engaged in ongoing reflexive discussions throughout the research process, critically examining how our own backgrounds and assumptions shaped the questions we asked, the interpretations we made, and the themes we identified.

Participants

The sample comprised 30 internally displaced female social workers in Rafah during the most destructive phase of the conflict. Participants ranged in age from 27 to 55 years (mean age = 38.6, SD = 8.7). All participants were currently employed in or had recently left social work positions in Gaza, representing a spectrum of roles such as case managers, counselors, community mobilizers, and support staff. The participants worked for a variety of organizations, including UNRWA (10), international NGOs like Save the Children and Doctors Without Borders (8), and local Palestinian NGOs (12). The types of social work performed included emergency response coordination (40%), individual and group counseling (35%), child protection services (15%), and community-based psychosocial support (10%).

The sample was recruited through purposive sampling combined with snowball techniques. Initial contacts were made through coordinators at three NGOs operating in Rafah, who distributed information about the study to potential participants. These initial participants then referred other social workers who met the inclusion criteria. This recruitment strategy was necessary given the challenging circumstances and limited mobility in Gaza during the data collection period. Diversity in terms of age, years of experience, marital status, and specific role within social work was intentionally sought to capture a range of perspectives. This diversity was important because it allowed us to understand how different personal circumstances and professional positions might shape experiences of the genocide. For example, social workers with children faced different challenges than those without, and those with more years of experience drew on different coping strategies than newer practitioners.

Data Collection

Data collection occurred from 2 January to 10 March 2025, a period marked by ongoing hostilities, widespread displacement, severe shortages of basic necessities, and the near-total collapse of Gaza's social services infrastructure. The primary data collection method was in-person, semi-structured interviews. All interviews were conducted face-to-face by three female graduate students of clinical psychology, who themselves were displaced and residing in Rafah at the time. This shared experience of displacement fostered trust and empathy, encouraging participants to share candid, detailed accounts of their personal and professional struggles.

Semi-structured interviews ranged from 60 to 90 min, with an average length of 75 min. The interview guide was organized around the primary research questions, with prompts designed to elicit detailed narratives about participants’ daily experiences, challenges, and coping strategies. Questions included: “Can you describe a typical day in your work during this period?” “How has the current situation affected your ability to provide support to clients?” “How do you manage the boundary between your professional role and your personal experiences?” “What forms of support have been most helpful to you during this time?” and “How do you see your role as a female social worker during this crisis?”

The semi-structured interview guide was designed to elicit comprehensive narratives on the intersection of professional and personal boundaries, daily adversities, coping mechanisms, experiences of grief and loss, and the shifting realities of peer, institutional, and familial support. The flexible format allowed participants to articulate their stories in their own words, while also enabling interviewers to probe for depth and clarity. In addition to live interviews, the data set was supplemented by written testimonies from social workers who had previously documented their experiences for humanitarian organizations. All interviews were conducted in Arabic, audio-recorded, and transcribed verbatim by the research team. Written testimonies were translated with meticulous attention to preserving linguistic and emotional nuances. Prior to participation, all individuals were briefed on the study's aims and procedures, informed of their right to withdraw at any point, and assured of strict confidentiality. Pseudonyms were used in all transcripts and analyses to protect participant identities.

Data Analysis

Our thematic analysis followed the six-phase approach outlined by Braun and Clarke (2006) and incorporated inductive coding techniques informed by constructivist grounded theory (Charmaz, 2006). The analysis adhered to the principles of thematic analysis (Parker, 2005), employing a bottom-up, data-driven approach (Strauss & Corbin, 1990). We began with line-by-line coding of the first five interviews to identify initial concepts. These codes were then discussed and refined by the research team to develop a preliminary coding framework. This framework was subsequently applied to the remaining interviews, with new codes added as they emerged. Through constant comparison between codes and data, related codes were grouped into potential themes. The process was iterative, with themes being refined, merged, or removed as the analysis evolved. Interview transcripts and written testimonies were analyzed together using the same coding procedure, undergoing open coding to capture recurring concepts, linguistic expressions, and patterns of experience. Codes were iteratively refined and organized into thematic categories through collaborative close reading and extensive discussion among the research team.

The development and refinement of themes were reviewed and validated by a panel of five independent judges, who were scholars with expertise in qualitative methodology, social work in conflict zones, and gender studies. None were involved in the data collection. They were provided with the coded data and emerging themes, along with representative quotes for each theme. Their role was to evaluate whether the themes were adequately supported by the data, assess the coherence of themes, and identify potential alternative interpretations. They provided written feedback that was then discussed by the research team and incorporated into the final analysis, ensuring analytical rigor and consistency.

To further strengthen the reliability of the findings, inter-coder reliability was assessed, resulting in a 92% agreement between independent coders and the original coding (Cohen's kappa = 0.94), exceeding accepted qualitative research standards. Throughout the research process, the team was highly attentive to the risk of meaning loss in translation and transcription, and every effort was made to preserve the integrity and authenticity of participants’ voices.

Results

To address concerns about quote attribution and participant roles, we present the quotes and clarify the professional backgrounds of participants. All participants in this study were female social workers, though some had additional professional training or credentials. When quotes are attributed to “psychologists” or “health providers,” these refer to participants with dual credentials who were working primarily in social work roles during the genocide. To better represent the range of voices in our sample, we have attributed quotes using pseudonyms that indicate participants’ years of experience and primary work setting. For example, “Amal (10 years, NGO)” refers to a social worker with 10 years of experience working for a non-governmental organization.

Thematic analysis of the interview transcripts led to the identification of four main themes: First, Social Workers as Both Victims and Healers, Second, Gendered Expectations and the Moral Economy of Sacrifice. Third, Institutional Neglect and the Invisibility of Female Labor. Fourth, Coping, Solidarity, and the Boundaries of Endurance.

Theme One: Social Workers as Both Victims and Healers

The position of female social workers in Gaza places them at the intersection of collective trauma and personal vulnerability, forcing them to balance the dual realities of caregiving and survival within an environment of sustained catastrophe. A social worker describes the toll of deprivation: “I come to work exhausted, having walked for miles because there are no means of transportation. I try to support children, but I myself am hungry and haven’t eaten enough” (Layla, 5 years, Community Center). This testimony underscores how basic needs are unmet even for those tasked with offering aid, revealing the embodied cost of caregiving. Another participant reflects this depletion: “Sometimes I feel I am treating trauma while my own body collapses. I smile at the children, but inside I am trembling” (Mona, 7 years, NGO). These layered accounts show that exhaustion is not merely physical but existential, stemming from a collapse of distinction between one's own suffering and that of the clients. The internal conflict experienced by these workers is encapsulated when another social worker confides: “We try to adapt to the crisis for the sake of others, but deep down, I feel unable to continue. The exhaustion is beyond anything I have experienced before” (Sana, 12 years, International NGO). Her words highlight a psychological duality: the simultaneous impulse to care and the recognition of one's own incapacity. This duality reveals the ongoing tension between compassion and collapse that defines daily practice for many social workers under siege. These layered accounts illustrate how the convergence of personal deprivation and professional responsibility fosters a psychological burden that is both acute and enduring.

This porous boundary between the personal and professional is further evident in the reflections of another social worker, who shares: “Every day, I question if I am helping or just pretending. The pain I witness is also my own” (Nadia, 8 years, Local NGO). Her statement reveals the collapse of distance between the suffering of the self and that of the other. The tension between professional obligation and personal grief emerges when she remarks: “We are mothers and daughters before we are workers, and yet, we must ignore our pain to serve others” (Nadia, 8 years, Local NGO). This encapsulates the expectation for women to sublimate their own trauma in order to fulfill their care roles. Finally, the precariousness of their own security is foregrounded by a health provider who laments: “We are expected to provide hope and strength, but our own families are at risk, our homes destroyed” (Dr. Alaa, 15 years, UN Agency). These words expose the impossibility of compartmentalizing suffering, as social workers are simultaneously witnesses, victims, and agents of care. These narratives illuminate the impossibility of compartmentalizing suffering. Social workers are simultaneously witnesses, victims, and agents of care, embodying the paradox of helping while broken. Their emotional fatigue is not a sign of professional inadequacy but a reflection of structural violence that renders care itself a form of survival. The theme thus captures how female social workers’ professional identities are inseparable from their lived experiences of loss, displacement, and fear.

Theme Two: Gendered Expectations and the Moral Economy of Sacrifice

Entrenched gender norms within Gaza impose upon female social workers a moral imperative to endure, compelling them to maintain emotional strength despite exhaustion and despair. The concept of “moral economy” refers to the informal social obligations and expectations that govern economic behavior and resource distribution. In this context, it describes the unspoken rules and expectations that female social workers should sacrifice their own well-being for others, creating a system where emotional labor is undervalued yet morally mandated. One professional candidly reflects on this expectation: “Even when I am hungry and overwhelmed, I push myself to smile for the children, because they need hope. But sometimes I want to cry myself” (Fatima, 6 years, Charity Organization). Her struggle to perform resilience, even in the face of personal depletion, illustrates how gendered labor is both visible and invisible. Another worker reflects, “When I cried in front of my clients once, they said, ‘You are supposed to help us, not to cry with us.’ Since then, I never allowed my tears again” (Mariam, 4 years, Local NGO). This suppression of emotion shows how professionalism is intertwined with gendered scripts of emotional control.

The undervaluing of psychosocial support in favor of material assistance is articulated by a social worker who observes: “The mothers I work with tell me, ‘I don’t need psychological support, I just need bread for my children.’ It makes me feel as though what I offer is never enough” (Khadija, 9 years, International NGO). Her experience points to a prevailing cultural discourse that prioritizes physical survival over emotional recovery, thereby rendering the work of female social workers both essential and perennially insufficient. Another provider voices the broader social expectation placed on women, stating: “Women are always expected to be strong, to care for others even when we are not okay ourselves” (Aisha, 18 years, Local NGO). In her account, the labor of care is naturalized and taken for granted, further intensifying the strain on women during crisis.

The obligation to suppress emotion and maintain composure is another dimension of this moral economy. One social worker reveals, “Sometimes I have to hide my tears until I am alone, because I don’t want to discourage those I am helping” (Fatima, 6 years, Charity Organization). This act of emotional concealment speaks to the internalization of care as sacrifice, where the worker's distress is subordinated to the needs of others. A similar sentiment is voiced by a psychologist, who admits: “We are supposed to inspire hope, but there are moments when I feel hopeless myself” (Dr. Rania, 11 years, UN Agency). Here, the impossibility of sustaining optimism amidst devastation becomes clear. The cumulative impact is described by a health provider: “The families look at me as a source of strength, but inside, I am falling apart” (Dr. Alaa, 15 years, UN Agency). The moral economy of sacrifice thus transforms care into a duty of self-erasure, where empathy coexists with silent suffering. The gendered expectation to “keep giving” makes exhaustion appear as failure rather than as an inevitable response to systemic brutality.

Theme Three: Institutional Neglect and the Invisibility of Female Labor

The broader institutional landscape of Gaza exacerbates the vulnerability of female social workers, who often labor in contexts of acute scarcity and insecurity. A health provider recounts the lack of resources: “There aren’t enough resources—sometimes we have no safe place to hold sessions, so we improvise wherever we can” (Dr. Rania, 11 years, UN Agency). The instability of working conditions not only compromises care but further burdens those delivering it. The ethical dilemmas faced in this environment are articulated by a social worker: “I often have to decide who receives aid, because there is never enough for everyone. These choices haunt me” (Khadija, 9 years, International NGO).

Another worker laments: “I feel I am filling forms while people are starving. We are counting pain, not reducing it” (Huda, 7 years, NGO). This statement captures the bureaucratization of care that strips meaning from humanitarian work and deepens moral exhaustion among practitioners. Her words highlight the secondary trauma induced by resource triage, with the moral weight of such decisions adding a unique layer of distress. The professional's inability to meet the material needs of those she serves becomes a source of psychological distress, as Amal (10 years, NGO) explains: “When I sit with families, they tell me their children need milk or diapers, and I can’t provide that. I feel helpless because they need more than psychological support.” This highlights the ethical and emotional burden placed on social workers when structural limitations prevent them from addressing basic needs, creating a moral distress that compounds their secondary trauma. Another social worker notes: “I have changed organizations three times in one year; every time, they say the funding ended. Our work is treated as temporary, but our trauma is not” (Nour, 8 years, Local NGO). Her experience reflects how humanitarian institutions reproduce instability, forcing women to live in constant anxiety about employment and survival.

In addition, professional insecurity is an ongoing concern, as a social worker describes: “We work on temporary contracts, and when the project ends, we are left without jobs, not knowing how we will feed our own children” (Sama, 3 years, International NGO). The precarity and disposability experienced by these women reflect broader patterns of institutional neglect that devalue their labor. Not only is their work rendered precarious, but the psychological needs of social workers themselves are systematically overlooked. A health provider makes this explicit: “There is no one to talk to about what we go through; we’re just expected to keep going” (Dr. Alaa, 15 years, UN Agency). The absence of professional psychological support perpetuates cycles of unresolved trauma, as another social worker confesses: “After long days of listening to others’ pain, I return home with no support for my own struggles” (Layla, 5 years, Community Center). One participant adds: “Our supervisors ask for reports, not feelings. They want numbers, not our stories” (Huda, 7 years, NGO). This bureaucratic silencing demonstrates how institutional priorities privilege documentation over well-being, erasing the emotional reality of those sustaining the system. The invisibility of their suffering is made plain by a further account: “Our mental health needs are not considered important; as women, we are just supposed to cope” (Aisha, 18 years, Local NGO). These testimonies reveal how humanitarian systems reproduce structural inequalities, transforming compassion into an unacknowledged form of labor. The result is a cycle of attrition and despair, where those providing care remain unprotected and unseen.

Theme Four: Coping, Solidarity, and the Boundaries of Endurance

Despite overwhelming adversity and systemic neglect, female social workers develop creative forms of resilience, often relying on peer solidarity and mutual care to survive. One social worker captures the significance of such informal networks: “My colleagues and I lean on each other; sometimes just having someone to talk to who understands makes all the difference” (Sana, 12 years, International NGO). The affective bonds among workers serve as a crucial buffer against psychological collapse, as another notes: “We exchange advice on how to manage stress, but there are days when even talking is not enough” (Sama, 3 years, International NGO). Another participant elaborates: “We meet secretly after work to cry and pray together. It's our therapy, though it never really heals us” (Mariam, 4 years, Local NGO). These informal gatherings become sanctuaries of shared grief where exhaustion and strength coexist. Yet, the enormity of the trauma frequently outstrips the capacity of informal support, as articulated in the words of a psychologist: “I have learned to hide my pain from my family, but some nights I cannot sleep because the stories haunt me” (Dr. Rania, 11 years, UN Agency). One worker adds: “We sometimes joke to survive; humor is the only shield we have left” (Nour, 8 years, Local NGO). Humor becomes both a coping mechanism and a fragile act of defiance against despair. The cyclical nature of secondary trauma is exposed, where stories from the field infiltrate the most private spaces of the worker's life.

Stigma around seeking formal psychological assistance persists, despite the clear need. A social worker acknowledges, “I have not sought therapy because it would be seen as weakness, even though I know many of us are struggling” (Nadia, 8 years, Local NGO). The normalization of self-sacrifice limits the pursuit of much-needed care, a fact reflected by a health provider: “Peer support helps, but it cannot replace real mental health care, which we are afraid to ask for” (Dr. Alaa, 15 years, UN Agency). Another worker confides: “Sometimes I think we have normalized pain so much that we don’t even recognize it anymore” (Layla, 5 years, Community Center). This normalization of suffering transforms endurance into a cultural expectation, leaving little room for recovery. The line between endurance and collapse grows ever thinner, as a final account from a psychologist reveals: “We have become used to surviving without care, but the exhaustion never leaves” (Dr. Rania, 11 years, UN Agency). Another participant adds: “We pray, we share, we laugh, but every day feels heavier than the one before” (Fatima, 6 years, Charity Organization). These accounts reveal that resilience, far from signifying strength, often conceals unaddressed despair. These reflections demand recognition of the urgent need for systemic support and for a reimagining of care that includes those who provide it.

Discussion

While our findings confirm many aspects of previous research on social workers in conflict zones, they make several contributions to the literature. First, our study provides new insights into how the experience of genocide creates a unique convergence of personal and professional trauma that differs from other conflict contexts. Unlike studies of social workers in more stable conflict zones, our participants were subject to active violence, displacement, and resource scarcity while providing services. This creates what we term “total immersion trauma.” As introduced earlier, this concept distinguishes the experience in Gaza from standard definitions of secondary trauma or burnout. In typical crisis settings, the practitioner maintains a physical or psychological distinction from the victim. However, under the conditions of genocide—characterized by systematic targeting and no clear endpoint—this separation is obliterated. “Total immersion trauma” represents a complete collapse of the “safe other.” It explains the findings in Theme 1 (Victims and Healers), where participants could not separate their own fear from their clients’ terror. Furthermore, this concept clarifies the intensity of the “moral economy of sacrifice” (Theme 2). Because the female social worker is immersed in the same existential threat, her refusal to sacrifice herself feels like a betrayal of her own community's survival. Thus, “total immersion trauma” is not just about exposure to violence; it is about the inability to ever step out of the role of the victim-survivor, even while trying to perform the role of the professional helper.

Second, our analysis reveals how conventional burnout and resilience theories fail to capture the specific experiences of social workers under conditions of genocide. Burnout implies a gradual depletion of resources in a functioning system; “total immersion trauma” implies an immediate and continuous assault on the worker's basic existence. Rather than following a predictable pathway of stress leading to burnout, our participants described a more complicated pattern of emotional numbing, compartmentalization, and moral injury that is not adequately addressed in existing models.

Third, our feminist analysis shows how gender expectations merge with professional obligations in ways that create burdens for female social workers. The moral economy of sacrifice we identified demonstrates how cultural expectations of female self-sacrifice become intensified under conditions of genocide, creating specific burdens grounded in the social assignment of care work to women.

Finally, our study documents the limitations of peer support as a sustainable coping mechanism under extreme conditions. While previous research has highlighted the importance of informal support networks, our findings suggest that these networks become saturated when all members are concurrently experiencing primary and secondary trauma, revealing the critical need for external support structures.

The results of the study offer substantial evidence that broadens our understanding of the lived experience of social workers in Gaza. The theme of social workers as both victims and healers demonstrates the inseparability of personal and professional suffering. Previous work by Jebril (2025), Mohammed et al. (2024), and Noble et al. (2024) describes the dual vulnerability of social workers in conflict zones, and the present findings substantiate this by showing how daily life and professional obligation are merged under conditions of deprivation and violence. Our findings extend this by introducing the concept of “total immersion trauma” to describe the complete collapse of boundaries between personal and professional life under genocide, a phenomenon less pronounced in more stable conflict zones. Aqtam (2025) identified that Gazan women begin their day already burdened by anxiety and resource scarcity; the current study shows that for social workers, these burdens are intensified by the emotional demands of their roles. Participants’ narratives illustrate how their own hunger, fear, and exhaustion become inseparable from the needs of those they support, confirming the absence of clear boundaries between self-care and professional duty.

These results further expand on the problem of secondary trauma and burnout, not as isolated outcomes but as ongoing conditions shaped by continuous exposure to trauma. Our study challenges the applicability of conventional burnout models, which were developed in stable organizational contexts and do not adequately account for the simultaneous experience of being both service provider and victim during genocide. Rather than occupying a position of distance from their clients’ experiences, social workers in Gaza are immersed in the same environment of instability and threat. This supports and extends the findings of Diab et al. (2023) and Abu Hamad et al. (2023), who demonstrate that health professionals in Gaza experience a steady depletion of their psychological resources due to the constant state of emergency and insecurity.

The discussion of gendered expectations and the moral economy of sacrifice directly engages with the arguments of Darawshy et al. (2024), Buheji et al. (2024), and Noble et al. (2024), who note that social work in Gaza is structured by social mandates of self-sacrifice, resilience, and emotional endurance for women. The current study provides empirical evidence for this “moral economy of sacrifice,” revealing how it operates as an informal system of obligation that intensifies the gendered burden on female practitioners. The testimonies here illustrate that the expectation to maintain composure and provide comfort is internalized by female practitioners as a moral responsibility. Shalhoub-Kevorkian et al. (2023) highlight how women are required to prioritize the needs of others and downplay their own distress; the present study demonstrates that such self-suppression is a persistent requirement, resulting in ongoing emotional depletion and increasing the risk of burnout.

The identification of institutional neglect and the invisibility of female labor is strongly supported by Farajallah (2024), Al Attar and Brik (2024), and Algan et al. (2024), who examine the structural challenges facing social workers in Gaza. The findings from this research confirm that precarious contracts, inadequate pay, limited resources, and lack of professional support directly undermine the well-being and job security of practitioners. Our analysis adds to this by revealing the moral distress experienced by social workers when institutional limitations prevent them from meeting their clients’ basic material needs, a burden that compounds their secondary trauma. These institutional failures force social workers into impossible choices about who receives assistance, increasing their emotional burden and compounding their sense of powerlessness—concerns also described by Hamarsha (2025) and Abubaker and Adam-Bagley (2025). Moreover, the absence of organizational support for the psychological needs of staff is made visible by participants’ statements that they have no one to confide in and are simply expected to persevere.

The study's exploration of coping, solidarity, and the boundaries of endurance highlights the critical role of peer support networks. Allassad Alhuzail and Mahajne (2023), Fareed (2024), and Jebril (2025) have documented the importance of mutual care among social workers. This research supports their conclusions, showing that peer networks offer emotional validation and practical advice, yet are limited in their ability to absorb the overwhelming trauma faced by all members. Our findings introduce the concept of “network saturation” to describe how these informal support systems become overwhelmed when every member is a trauma survivor, rendering them insufficient as a long-term solution. Bener et al. (2024), Qutishat (2025), and Aqtam (2025) describe how peer support, while essential, cannot substitute for formal psychological care—a point made clear by participants who feel unable to seek therapy due to stigma and fear of judgment. The study also identifies that institutional culture discourages expressions of vulnerability, thereby normalizing exhaustion and emotional withdrawal.

These findings move the discussion beyond conventional models of burnout and resilience, revealing that the trauma experienced by Gaza's social workers is compounded, chronic, and shaped by structural neglect, gender norms, and organizational failures (Farajallah, 2024; Kooli & Kooli, 2025). The evidence underscores the urgent necessity for humanitarian organizations and employers to establish formal, confidential, and ongoing psychological support and clinical supervision for staff (Bener et al., 2024; Qutishat, 2025).

However, the findings also point to a critical limitation in focusing only on individual-level interventions such as psychological support and supervision. While these measures are necessary, they are insufficient to address the root causes of the crisis facing social workers in Gaza. The very professionals who would provide such support would themselves be subject to the same conditions of violence, displacement, and resource scarcity that affect all residents of Gaza. This creates a paradox where the proposed solutions are undermined by the structural conditions that generate the problem in the first place.

The experiences of female social workers in Gaza must be understood within the broader context of occupation, apartheid, and genocide. These structural conditions create an environment where normal professional practice becomes impossible, and where the psychological toll is not merely an individual issue but a collective one rooted in political violence. As Mahajne and Alnabilsy (2025) argue, social work in such contexts cannot be separated from the political realities that shape daily life. The genocide in Gaza represents not just a humanitarian crisis but a systematic destruction of the conditions necessary for human flourishing, including the ability to provide and receive care.

From a feminist perspective, the gendered dimensions of this crisis reflect broader patterns of how women's labor is undervalued and exploited during times of conflict (Shalhoub-Kevorkian et al., 2022). The expectation that female social workers will continue to provide care without adequate support or recognition is a manifestation of patriarchal structures that view women's emotional labor as inexhaustible. Addressing this requires not only institutional changes within NGOs but also a transformation of how society values and compensates care work, particularly in crisis contexts.

Implications and Recommendations

Based on our findings, a fundamental shift in how humanitarian organizations and the social work profession approach staff well-being is urgently required. At the organizational level, a multi-pronged approach is essential to address the immediate and overwhelming needs of practitioners. This begins with implementing formal psychological support systems that are external to the immediate work environment, a crucial step to avoid the ‘network saturation’ identified in our study and to provide confidential, specialized care. Furthermore, organizations should develop protocols for regular staff rotation between high-intensity and lower-intensity assignments, where feasible, to mitigate the effects of chronic trauma exposure. Equally important is the deliberate creation of clear boundaries between work and personal time, even in crisis settings, to protect the limited personal reserves of practitioners. Finally, these efforts must be coupled with material support for social workers themselves, recognizing that they are not just service providers but also community members struggling with the same deprivation as their clients.

Beyond the responsibilities of individual employers, the social work profession as a whole must adapt to the realities of practice under extreme conditions. This involves developing specialized guidelines for practice in contexts of genocide and mass trauma, which explicitly acknowledge the limitations of traditional psychosocial support models. In parallel, the profession must create and adopt new ethical frameworks that directly address moral injury and the psychological distress caused by impossible choices and resource triage. Professional development curricula also require updating, incorporating training that specifically addresses the unique pressures of the ‘moral economy of sacrifice’ and the gendered expectations that intensify burdens on female practitioners in crisis contexts. Such a transformation would ensure that the profession's response is not merely reactive but is grounded in a deep understanding of the specific challenges faced by its members in the world's most difficult environments.

Finally, this study illuminates critical avenues for future research necessary to build a more robust evidence base for supporting social workers in extreme contexts. A key priority is conducting comparative studies of social workers across different conflict zones to identify contextual variations in the experience of “total immersion trauma.” In addition, longitudinal research is essential to understand the long-term impacts of working under genocide conditions on practitioners’ careers and personal lives. Ultimately, the field must move towards designing and rigorously evaluating the effectiveness of support interventions specifically created for these environments, such as the external supervision models recommended here, to ensure that care for caregivers is both evidence-based and truly effective.

Limitations

This study has several limitations that should be considered when interpreting its findings. The findings are based on the experiences of 30 internally displaced social workers in Rafah, and therefore offer deep insights into this specific context rather than aiming for broad generalizability to all social workers in Gaza or those in other regions. The data were collected during an intense period of violence and displacement, which may have constrained participation and influenced the candor of responses, as those experiencing the most acute distress might have been unable or unwilling to participate. Reliance on self-reported, narrative accounts raises the possibility of recall bias and the influence of social desirability, especially given the stigmatization of mental health struggles in the local context. The interpretation of data may also reflect the positionality of the research team, who shared certain experiences with participants and may have brought their own perspectives to the analysis. Finally, the study focuses solely on the perspectives of social workers during an ongoing crisis, without incorporating the views of clients, institutional leaders, or follow-up over time, which may further contextualize or extend the results.

Conclusion

This study provides a comprehensive analysis of the unique personal and professional challenges faced by female social workers in the Gaza Strip during the ongoing genocide. The testimonies of participants reveal that the boundaries between their roles as caregivers and their experiences as victims have largely collapsed, placing them in a state of constant vulnerability. Their burdens are not limited to the typical pressures of social work, but are compounded by exposure to primary and secondary trauma, the need to support both clients and their own families, and the requirement to perform emotional resilience under conditions of extreme insecurity and deprivation.

Working conditions for these social workers are characterized by chronic neglect and the invisibility of women's labor, with inadequate funding, unstable employment, and little to no access to formal psychological support. Gendered expectations intensify these challenges, positioning emotional strength and self-sacrifice as moral duties, while discouraging open discussion of personal distress. Informal support networks among colleagues offer brief moments of relief, but cannot provide a lasting solution to the overwhelming trauma encountered daily.

The findings point to the necessity for a major shift in how humanitarian organizations and employers approach the well-being of Gaza's social workers. Recognition of their difficulties must be matched by concrete action, including the introduction of structured psychological care, regular clinical supervision, and tangible institutional safeguards. Policies should reflect an understanding of social workers as both essential providers of care and as individuals who are themselves affected by ongoing violence and hardship. Ensuring their well-being is crucial not only for their own sake but also for the continued strength and resilience of Gaza's broader social fabric.

However, the study also demonstrates that individual and organizational responses alone are insufficient to address the scale of the crisis. The structural conditions of occupation, apartheid, and genocide create a setting where normal professional practice becomes impossible. Any meaningful solution must therefore address these root causes, advocating for an end to the violence and policies that create such extreme suffering. The international community has a responsibility not only to provide humanitarian aid but also to work toward a just resolution to the conflict that allows Palestinians to live with dignity and security. Without addressing these structural issues, the cycle of trauma and burnout among social workers will continue, regardless of how well-designed individual support interventions may be.