Mental health professionals (MHPs) working with war-affected refugees are highly susceptible to Secondary Traumatic Stress (STS) an occupational hazard that mirrors post-traumatic reactions due to prolonged empathic engagement with trauma survivors. In Pakistan’s humanitarian context, this vulnerability is heightened by inadequate supervision, limited trauma-informed training, and persistent sociocultural stigma surrounding mental illness. This study explored the lived experiences of Pakistani MHPs exhibiting high levels of STS while providing psychological care to war-affected refugees.

A qualitative design grounded in reflexive thematic analysis was employed. Six clinicians actively engaged in refugee mental-health services participated in semi-structured interviews. The interviews were audio-recorded, transcribed verbatim, and analyzed inductively and reflexively to capture the emotional, moral, and systemic dimensions of STS within the Pakistani clinical and cultural context.

Six overarching themes were identified: (1) immersion in humanitarian duty; (2) emotional saturation and empathic strain; (3) blurred boundaries between self and client; (4) professional isolation within unsupportive systems; (5) coping strategies and sources of resilience; and (6) transformation through suffering. Participants described moral over-responsibility, emotional exhaustion, and organizational neglect, yet also reported meaning-making, spiritual coping, and professional growth as pathways to resilience.

STS among MHPs in Pakistan reflects a multifaceted interplay between emotional, cultural, and institutional factors. The findings underscore the need for culturally attuned supervision , trauma-informed training , and systemic organizational support to protect clinician well-being and sustain ethical, effective humanitarian mental-health practice. This study contributes to a broader cross-cultural understanding of STS by situating clinicians’ experiences within their moral, cultural, and institutional contexts.