There are nights that stay with you.
Years ago, when I was a junior doctor in the NHS (back in the UK) working at the Royal Surrey, I was called down to the emergency department in the middle of the night. A man had been rushed in by ambulance with 95% burns. Self-inflicted.
The smell hit me first—sharp, sickly-sweet, unmistakably human. One of the orderlies joked that he smelled like barbecue sausages. But there was nothing funny about it. That smell still visits me sometimes, especially in summer, when the air carries the scent of smoke and grilled meat.
I remember the futility most of all. Driving morphine through his tibia, the only access point we could find. Trying to thread cannulas through charred flesh. Slicing eschar to relieve pressure. Twenty of us—nurses, doctors, anesthesiologists—working in grim, desperate coordination, while he groaned in agony.
He didn’t die right away. But he was already beyond rescue.
It was one of the most awful nights of my career. And at the time, I didn’t have a name for what I felt.
I do now.
Moral injury.
Not burnout. Not fatigue.
But the shattering that happens when we are forced to act in ways that violate our deepest sense of what is right.
The term originates from military psychology—defined as the psychological distress that results from actions, or the lack of them, which violate one’s moral or ethical code. Unlike burnout, which is about depletion, moral injury is about betrayal—of self, of values, of purpose.
And lately, I’ve been feeling that same slow rupture creeping into the world of global health. Friends and colleagues—people who’ve dedicated their lives to the fight against HIV, TB, malaria, and maternal death—are finding themselves out of work. Whole chapters of effort are being closed mid-sentence.
I don’t have a tidy resolution for this. No “three steps to resilience.” Just a conviction that we have to name what’s happening. This is moral injury on a systemic scale.
And if we pretend not to smell the smoke, we’ll never know what we’ve already lost.