We watched him die without oxygen: reflections and responses on moral injury among research staff in LMIC hospitals

Moral injury among healthcare workers is well recognised in extreme conditions such as the COVID-19 pandemic1 2 or critical care settings,3 but its impact on research personnel has received far less attention.4Exposure to moral injury is not part of standard training for research coordinators or investigators.This commentary reflects experiences from an ongoing clinical trial across multiple lowand middle-income countries (LMICs) in sub-Saharan Africa and offers 13 practical approaches by which to build ethical resilience and help mitigate moral injury.