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Definition of guilt-trip

 (Entry 1 of 2)

transitive verb

Definition of guilt trip  (Entry 2 of 2)

Examples of guilt-trip in a Sentence

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'guilt-trip.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

1974, in the meaning defined above

1970, in the meaning defined above

Dictionary Entries Near guilt-trip

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“Guilt-trip.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/guilt-trip. Accessed 9 Nov. 2023.

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What Is Guilt Tripping?

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

damircudic / Getty Images

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Frequently Asked Questions

A guilt trip means causing another person to feel guilt or a sense of responsibility to change their behavior or take a specific action. Because guilt can be such a powerful motivator of human behavior, people can wield it as a tool to change how others think, feel, and behave. 

Sometimes this might involve leaning on something that someone already feels guilty about. In other cases, people might induce feelings of unjustified guilt or responsibility to manipulate the other person's emotions and behaviors.

If someone has ever made you feel bad about something you’ve done (or didn’t do) and then used those bad feelings to get you to do something for them, then you have experience with guilt tripping.

This article discusses the signs, types, and impact of guilt trips. It also covers some of the steps you can take to cope with this type of behavior.

Signs of a Guilt Trip

Guilt trips can be intentional, but they can also be unintentional. There are chances that you have even guilt-tripped people into doing things before.

Sometimes guilt tripping behavior can be easy to spot, but it can also be much more subtle and difficult to detect.  Some key signs that others may be guilt-tripping you include:

• Making comments suggesting that you have not done as much work as they have done
• Bringing up mistakes that you have made in the past
• Reminding you of favors they have performed for you in the past
• Acting as if they are angry but then denying that there is a problem
• Refusing to speak to you or giving you the silent treatment
• Making it clear through their body language , tone of voice, and facial expressions that they disapprove of what you were doing
• Suggesting that you “owe” them
• Engaging in passive-aggressive behavior
• Making sarcastic comments about your efforts or progress

It is important to note that this type of indirect communication can occur in any interpersonal relationship. Still, it is more likely to take place in relationships that are marked by close emotional connections.

It can show up in romantic relationships, but guilt trips may also be utilized in family relationships, parental relationships, and even work relationships.

Types of Guilt Tripping

There are many different types of guilt trips that people may utilize depending on the ultimate goal or purpose of the behavior. Some of the different purposes of a guilt trip include:

• Manipulation : Sometimes, the primary goal of a guilt trip is to manipulate someone into doing something that they normally would not want to do.  
• Conflict avoidance : In other cases, people may use guilt trips to avoid directly talking about an issue. It allows them to get what they want without having to engage in direct conflict.
• Moral education : Guilt trips can also be a way of getting someone to engage in a behavior that the individual feels is more moral or “right.”
• Elicit sympathy : In some cases, guilt-tripping allows the individual to gain the sympathy of others by casting themselves in the role of someone who has been harmed by the actions the other person is supposed to feel guilty about.

Guilt isn't always a bad thing. While often troubling and unpleasant, it can serve an important role in guiding moral behavior. When people experience guilt, they can fix their mistakes and avoid repeating the same errors in the future.

Researcher Courtney Humeny

A guilt trip does not appear to induce the benefits of guilt, such as making amends, honesty, and mutual understanding.

Impact of Guilt Trips

Invoking feelings of guilt to change someone’s behavior can have a wide variety of effects. Whether guilt is wielded intentionally or not, it prevents healthy communication and connections with others. Some of the most immediate effects of this form of covert psychological manipulation include:

Damage to Relationships

Research suggests that guilt trips can take a toll on close relationships. One study found that people hurt by their partner's criticism were more likely to use those hurt feelings to make their partner feel guilty and offer reassurances.

However, the study also found that the partner who had been guilt-tripped into offering assurances was more likely to feel significantly worse about the relationship.

In other words, inducing feelings of guilt may work to get your partner to do what you want—but it comes at a cost. It can impair trust and cause the other person to feel that they are being manipulated. 

One of the reasons why guilt trips can poison relationships is because they can lead to lasting feelings of resentment.

"A guilt trip imposes aversive states associated with guilt, along with feelings of resentment from feeling manipulated," Humeny suggests.

A single occasion of someone using a guilt trip to alter your behavior might not have a serious impact on your relationship. Repeated use of guilt trips can leave you feeling bitter.

If you feel that your partner is always going to guilt you into something that you don't want to do, it can decrease intimacy, reduce emotional closeness, and ultimately make you start to resent your partner.

Research suggests that appeals to guilt are a common type of persuasion technique . However, while guilt can compel people to take certain actions, it can also sometimes backfire.

Low-level guilt tends to motivate people to act on the persuasive message. High levels of guilt, however, often fail due to what researchers call "reactance." 

"An individual in a state of reactance will behave in such a way as to restore his freedom (or, at least, his sense of freedom), for example, by performing behaviors that are contrary to those required," explain researchers Aurélien Graton and Melody Mailliez in a 2019 article published in the journal Behavioral Sciences .

In other words, guilt trips can backfire and lead people to behave opposite how someone else wants them to act. For example, someone guilt-tripping you into calling them more often might actually result in calling them less.

Poor Well-being

Feelings of excessive guilt are associated with several mental health conditions, including anxiety, depression , and obsessive-compulsive disorder . Being subjected to guilt trips may contribute to the development or worsening of such conditions.

Experiencing guilt can also lead to many immediate and unpleasant emotions and symptoms such as anxiety, sadness, regret, worry, muscle tension, and insomnia.

This type of covert manipulation may also sometimes contribute to the development of a guilt complex , which is a persistent belief that you have done (or will do) something wrong.

Over time, guilt can lead to feelings of shame. Shame can affect your self-image, which can then contribute to social withdrawal and isolation.

How to Cope With Guilt Tripping

There are a number of tactics that can be helpful when dealing with a guilt trip. Some steps you can take include:

• Acknowledge the request. Let them know that you understand that it is important to them. Responding with empathy and showing that you see their needs may help them feel that they are not simply being ignored. Validating their emotions may help lessen the intensity of those feelings.
• Share your feelings . Explain that you also see how they are trying to make you feel guilty so that you'll do what they want. Then tell them how that type of manipulation makes you feel. Suggest that interacting in that way will lead to resentment and that more direct communication forms would be more effective. 
• Set boundaries . Boundaries help set limits on what you will and will not accept. Even if you do end up helping them with their request, make sure you clearly articulate your limits and explain the consequences of crossing those boundaries. Then be sure that you enforce those limits if they are crossed.

Other things that you can use include protecting your self-esteem and distancing yourself if needed. You're more likely to fall for a guilt trip if you already feel poorly about yourself, so find strategies to build up your sense of self-worth. 

If the other person keeps trying to manipulate you with feelings of guilt, reduce your communication with them or even consider ending the relationship.

Protecting your own well-being should be a top priority. A person who tries to manipulate you with toxic feelings of shame and guilt does not have your best interests at heart.

Getting Help for Guilt

If you are experiencing feelings of guilt or related symptoms of anxiety, stress, or depression, talk to your health care provider or a mental health professional. They can recommend treatment options such as psychotherapy or medications that can help manage symptoms and improve the quality of your life.

Your doctor or therapist may suggest a type of therapy called cognitive-behavioral therapy (CBT) , which may help reduce inappropriate guilt feelings. This type of therapy can help you identify and change the negative thoughts and cognitive distortions that can contribute to feelings of guilt.

Your therapist can also help you learn to recognize the signs of a guilt trip—and help you practice strategies to cope with this type of emotional manipulation.

An example of guilt tripping might be your friend calling you and saying, "I know you are too busy with work to hang out. I'll just spend the evening by myself. I just thought that since I helped you get that job you would make sure to make a little more time for me." This type of comment is designed to induce feelings of guilt and bring up the idea that you "owe" them in some way.

Guilt tripping is often designed to manipulate other people by preying on their emotions and feelings of guilt or responsibility. This can be a form of toxic behavior that can have detrimental effects on a person's well-being as well as their relationships.

While both behaviors are destructive and toxic, they differ in key ways. Gaslighting is a type of emotional abuse that involves denying another person's reality and making them question their own experiences. Guilt tripping, on the other hand, is about causing another person to feel guilty in order to get them to change their behavior.

Humeny C. A qualitative investigation of a guilt trip . Conference: Institute of Cognitive Science Spring Proceedings.

Overall NC, Girme YU, Lemay EP Jr, Hammond MD. Attachment anxiety and reactions to relationship threat: the benefits and costs of inducing guilt in romantic partners . J Pers Soc Psychol . 2014;106(2):235-56. doi:10.1037/a0034371

Aurélien G, Melody M. A theory of guilt appeals: a review showing the importance of investigating cognitive processes as mediators between emotion and behavior .  Behav Sci (Basel) . 2019;9(12):117. doi:10.3390/bs9120117

Tilghman-Osborne C, Cole DA, Felton JW.  Definition and measurement of guilt: Implications for clinical research and practice .  Clin Psychol Rev . 2010;30(5):536-546. doi:10.1016/j.cpr.2010.03.007

Miceli M, Castelfranchi C.  Reconsidering the differences between shame and guilt .  Eur J Psychol . 2018;14(3):710-733. doi:10.5964/ejop.v14i3.1564

Herr NR, Jones AC, Cohn DM, Weber DM.  The impact of validation and invalidation on aggression in individuals with emotion regulation difficulties .  Personal Disord . 2015;6(4):310-4. doi:10.1037/per0000129

Cleantis T. Boundaries and self-care . Hazelden Betty Ford Foundation.

Hedman E, Ström P, Stünkel A, Mörtberg E. Shame and guilt in social anxiety disorder: effects of cognitive behavior therapy and association with social anxiety and depressive symptoms . PLoS One . 2013;8(4):e61713. doi:10.1371/journal.pone.0061713

Johnson VE, Nadal KL, Sissoko DRG, King R. "It's not in your head": Gaslighting, 'splaining, victim blaming, and other harmful reactions to microaggressions .  Perspect Psychol Sci . 2021;16(5):1024-1036. doi:10.1177/17456916211011963

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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Meaning of guilt trip in English

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• be/weigh on your conscience idiom
• breastbeating
• feel bad idiom
• prick someone's conscience idiom
• regretfully
• wretchedness

guilt trip | Intermediate English

Examples of guilt trip, translations of guilt trip.

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The Psychology of the Guilt-Tripper

Projection, "pathological certainty," and lack of self-awareness..

Posted December 23, 2021 | Reviewed by Vanessa Lancaster

• Coping With Guilt
• Find a therapist near me
• Guilt-tripping is a form of unconscious emotional blackmail whereby the guilt-tripper feels entitled and innocent of any misdeed.
• Lack of awareness of self or others fuels the narcissistic tendency to adhere rigidly to their perceptions with "pathological certainty."
• Our reactions in relationships are determined by what we think someone's behavior means and how this affects our sense of security.

Alongside love, gifts, and food, guilt is often served up for the holidays and other emotionally loaded family gatherings. We’ve all tasted it. “Why can’t you stay longer? You're too busy now for me?” mom said to Michael as he kissed her goodbye. Later that week, when he called his mom, she seemed aloof, giving him the cold shoulder.

And so it goes when guilt is used unconsciously to get loved ones to do what we want and “feel our pain” – though it does not always produce the intended result. Further, when it does “work,” guilt is costly to the relationship – breeding resentment and limiting authentic engagement, co-opting the genuine desire to connect, and replacing it with robotic compliance, rebellion, and/or avoidance. Regardless, it’s not uncommon for certain people to resort to using and manipulating others without awareness to manage longing, loss, disappointment, anxiety , and other states of mind.

Guilt-tripping is, in effect, a form of emotional blackmail. But it is typically an unconscious process whereby the guilt-tripper feels entitled and innocent of any misdeed. On the receiving end, it feels like an oppressive intangible force that invisibly intrudes into our personal space confusingly and frustratingly, bolstered by plausible deniability and reversal of blame.

What leads some people to be so easily offended and resort to emotional manipulation to get others to do what they want or pay the price?

How we feel in relationships and whether disappointments are tolerable is mostly determined not by what another person does but, rather, our interpretation of what it really means, how it affects our sense of security, and, importantly, whether these assumptions are taken as facts.

In a healthier version of events, the mom might have interpreted her son’s decision to leave in a way that was more benign and less self-focused, which would have made it easier for her to tolerate her feelings of disappointment about him leaving.

If she had thought: “I know he has a lot going on in his own life now, but it’s hard to say goodbye,” she might have felt a bittersweet feeling, appreciated him more, or maybe felt gratitude . In this mindset, she might have said, “I’ve missed you - it’s always so wonderful to see you. I’m glad you came over.” Expressing love and validation in this way nurtures the relationship and organically paves the way for more good experiences together.

In contrast, Michael’s mom personalized the meaning of her son’s decision to leave and, feeling rebuffed, confused her feelings with his intention and motivation – a common cognitive attribution error. Because she feared being forgotten and abandoned, she assumed, “He’s leaving because he doesn’t care about me anymore.” This interpretation set the stage for a self-fulfilling prophecy, creating the very avoidance and rejection she feared, with her accusation, implicit demand, and cold shoulder.

The Psychology of a Guilt Tripper

We have all felt slighted or rejected at times, even when the other person’s behavior or attitude had nothing to do with us. It is easy to project our reactions and fears onto situations when we feel insecure, especially ambiguity. But reading negative intent into something a person says or does because it made us feel bad is a false equivalency that typically leads to the wrong conclusion, usually a more painful one.

A characteristic pattern of misinterpretations like these coupled with emotionally manipulative behavior is different from normal insecurity. This dynamic results from an essential inability to step outside of oneself and notice, as well as tolerate, that a loved one is separate from us with their mind and motivations. People who habitually relate in this way are not onto themselves. They lack “mindsight” – the capacity to reflect, recognize and interpret their state of mind and other people’s. (Siegel & Hartzell, 2018) This lack of awareness fuels a narcissistic tendency to rigidly adhere to one’s beliefs and impressions with “pathological certainty,” creating a perfect storm to perceive others as disloyal and abandoning and punishing non-compliance.

What About When Someone Actually “Deserves” It?

When someone does us wrong, it’s human to want justice and seek vindication. We want whoever hurt us to suffer too, and even the score. In this case, unlike the previous example, the need to punish someone and make them feel bad is not disowned but deliberate, conscious, and even satisfying (mostly in fantasy ).

Does Punishing Other People Help Us Feel Better?

(For more on this topic: Should You Punish Bad Behavior? The Answer May Surprise You )

In practice, evening the score means you are caught being controlled by what the other person did and perpetuates a destructive cycle, rather than solving the problem. Winning the battle of vengeance is a defeat for the relationship, reinforcing the practice of dirty fighting and one-upmanship to manage hurt and anger . Further, encouraging this mindset in oneself rehearses a repetitive inner script and neural pathway fueling anger.

Alternatively, when we choose to uphold our standard of behavior rather than be reactive and indulge anger, we feel more peaceful, in control, and freed up to create new pathways.

A Positive Motivation: Trying To Make a Connection

There is also a positive, unconscious motivation for making someone feel bad when they’ve hurt us that is often misunderstood and missed. When someone we are attached to seems impervious or indifferent to how we feel, trying to make them feel bad and evoke a reaction can be an instinctive, primitive effort to communicate pain, elicit empathy, and create a “felt” connection. This can happen when the need to connect is intense, but there is no way to get through and wake the other person out of their detachment or indifference or get them to feel something closer to the intensity of what we feel.

Jenny was close with her dad until high school when her parents divorced . Hurt and angry when he left, Jenny became cold towards her dad and acted like she didn’t care, avoiding his calls and texts and making excuses not to see him.

Her dad already felt guilty about leaving and handled his guilt and his daughter’s rejection by being detached and distant. When he told his therapist the story, she helped him understand Jenny’s behavior as communication – an attempt to get him to feel how she felt to bridge the gap between them. Then, rather than seeing Jenny as manipulative and taking her behavior literally and withdrawing out of guilt, anger, and defeat, the dad used his feelings to help him be empathic to what Jenny was going through. Empowered, he reached out to her in a heartfelt way, healing a painful impasse in their relationship. (My previous post may help further an understanding of the causes and effects of shame and guilt.)

How Can We Tell if the Guilt in Our Lives Is Pathological?

For more on this topic check out my next post: How to Tell What Your Guilt Means )

The answer lies in how it affects our relationships. The hallmark of a healthy relationship is mutuality – the back and forth dance between two people as they move between connection and autonomy. Guilt-tripping is an unwitting attempt to manage perceived rejection, loneliness , or other difficult feelings by controlling other people, seeing them as responsible for our state of mind, and trying to force them to make up for our suffering or else pay the price.

The predominant attitude of entitlement and lack of respect for other people’s separateness and autonomy that is endemic to guilt violates the mutuality of relationships. And the feeling of gratitude that nourishes love and peace.

Awareness of our loved one’s limitations and propensities, in this case being on to the guilt-tripper, can allow us to preempt difficult situations and binds. We don’t have to feel guilty for setting the boundaries we need. We can love and care about someone and legitimately, without malice, have different boundaries and needs that compete with theirs.

On the one hand, setting limits makes us feel better and seem selfish. But the truth is that respecting our boundaries allows us to protect our relationships from being contaminated by resentment and emotional distance, making it safe for us to truly engage. It is an act of love, respect, and wisdom all around.

Facebook image: fizkes/Shutterstock

Siegel, D.J., & Hartzell, M. (2018). Parenting from the inside out: how a deeper self-understanding can help you raise children who thrive. Scribe Publications.

Lynn Margolies, Ph.D., is a clinical psychologist and former Harvard Medical School faculty and fellow. She has helped many different types of people and families overcome obstacles and improve their lives.

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Definition of 'guilt trip'

Guilt trip in american english, guilt-trip in american english, examples of 'guilt trip' in a sentence guilt trip, browse alphabetically guilt trip.

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A moment that changed me: I heard people sneer at me – and my mummy guilt turned to anger

When I took my daughter to work I was criticised, just as I was when I left her at home. In time, I realised my children’s opinions are the only ones that matter

I was invited to speak at a travel conference in Dublin in 2013 and I brought my 18-month-old toddler with me to the event. As a professional travel writer and photographer, my presentations had been well-received, and my daughter ran around the conference on wobbly feet, charming fellow speakers and attenders.

Afterwards, I took my daughter and my friend Germaine, who had come along to support me, to the pub reserved for attenders. That was when I heard their sneers. Four people – three men and a woman – were sitting right across from me, sharing the same table, throwing loaded looks and loud-whispering for my benefit. “Who brings a kid here? ” I heard one of the men saying. Their hushed conversation said it all. I was a “bad mother”.

Ten years later, I still replay that moment over in my mind. Up until that point, I had always shrunk with guilt whenever I travelled for work. After all, I lived in Stockholm and Sweden’s parental leave was one of the most generous in the world with more than a year of paid time off. Why wasn’t I choosing to simply stop working and stay home? What was I trying to prove?

I have always carried this damned-if-you-do, damned-if-you-don’t mummy guilt, whether I took my children (I now have two) on a work trip or not. Many tears were shed on plane rides and in hotel rooms over the years because it was often too exhausting to explain to complete strangers that I was the breadwinner and needed to work to support my family.

That conference was when my mummy guilt first morphed into anger. How dare they judge me when they don’t know my story, I thought. The irony today is that Instagram is awash with profiles of family travel influencers. Dragging your children along on trips has become palatable and normalised, as long as you’re doing it as a family unit and not as a working mother.

Unfortunately, travelling for work as a family unit wasn’t an option for me, even though I craved it. My then-husband wanted us to stay home. As an immigrant, I couldn’t afford to be a stay-at-home mum simply living off Swedish work-life balance benefits without scorn. So I started travelling for work without my daughter. When my son arrived, those judgmental questions from others morphed into “Who takes care of your kids? How can you leave them behind? You must be so lucky to have a husband who watches your kids …”

Was I truly a bad mother for not choosing a more socially acceptable line of work? For not shrinking my dreams and making them manageable so that others might deem them worthy enough for motherhood?

That moment of anger at the conference made me realise nothing I did in life would ever be enough for those intent on making assumptions about me.

I continued to travel precisely for my kids. I was working against stereotypes, opening up new worlds of career possibilities for them, letting them see themselves reflected back in their mother, an African immigrant to the land of their birth, Sweden. Letting them know that they never have to settle for what society says is the upper limit for Swedish kids, who also happen to be brown or Black, in the Nordics.

I’ve struggled with all the conflicting messages about whether women can have it all. Especially since I was part of the most harshly judged group when it comes to parenting – a working mother of young children who travels often.

It is a choice to show my children that there are many ways to be a loving mother beyond just domesticity. I am tearing those boxes apart so their worlds are never framed by “ don’ts” tied solely to gender roles.

While my mummy guilt started losing steam long ago at that conference, it finally evaporated this summer. I was in Estonia for a week-long photography workshop. My now 11-year-old daughter saw my WhatsApp status update and sent me this message: “It makes me happy to see you smile. ”

I cried in my hotel room that day because I realised my children’s opinions are the only thing that matter to me. They watch what lights up their parents’ eyes. They feel our mood shifts and observe what brings us unbridled joy, alongside kissing them goodnight and giving them the tightest hugs. They are witnessing what it means to fully show up in your life.

• A moment that changed me

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As Gaza Hospitals Collapse, Medical Workers Face the Hardest Choices

Doctors say they are performing surgeries without anesthesia after weeks of Israeli bombings and siege left severe shortages of medicine, water, food and fuel. “We choose who gets ventilation by deciding who has the best chance of survival,” one doctor said.

Medics treating a wounded Palestinian man on the floor of the Al Aqsa Martyrs hospital in Deir Al Balah, central Gaza Strip, on Sunday. Credit... Samar Abu Elouf for The New York Times

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By Ameera Harouda ,  Maria Abi-Habib and Abu Bakr Bashir

• Nov. 6, 2023

Every day is a choice between who lives and who dies.

Doctors and nurses in Gaza’s teetering hospitals, which are nearing collapse without electricity and basic supplies, say they must now decide which patients get ventilators, who gets resuscitated, or who gets any medical treatment at all. They make snap decisions amid the screams of small children undergoing amputations or brain surgeries without anesthesia or clean water to wash their wounds.

Some veterans of wartime medicine in the Gaza Strip say conditions inside the overcrowded and impoverished territory are the worst they have ever seen, as entire apartment blocks, schools and hospitals crumble under an Israeli bombardment that has meted out a devastating civilian toll.

“Our teams are physically and psychologically exhausted,” said Basem al Najjar, the deputy of the head of Al Aqsa Hospital in the city of Deir al Balah in central Gaza.

“Some doctors remain a whole week in the hospital. Some of their families are brought to the hospital killed or injured. And some doctors go home and are killed there,” and then the bodies are brought back to the hospital, he said. He added that three of the hospital’s staff members had died at home, under Israeli military bombardment.

Israel has been bombing Gaza for weeks now in response to an attack on Oct. 7 by Hamas, the armed Palestinian group that rules the territory. The assault killed roughly 1,400 people inside Israel.

More than 9,700 Palestinians have been killed in Gaza and nearly 25,000 have been wounded, the Gaza Ministry of Health said on Sunday. The toll rises every day, with some of the casualties believed to still be buried under rubble.

An Israeli siege of the territory imposed after the Oct. 7 attack has also created crippling shortages of fuel, food, water medicine and other basic goods. Much of Gaza is now without electricity after Israel cut off the supply and the main power plant ran out of fuel nearly four weeks ago. Israel is holding up fuel deliveries and sharply limits humanitarian aid entering the territory.

Doctors say they are struggling to keep their patients alive with what few medical supplies they have. Damage from airstrikes and severe fuel shortages have shut down nearly half of Gaza’s hospitals entirely, while the ones with their doors still open are providing minimal care, at best, doctors say.

A lack of fresh water supplies and iodine has left wounds filthy, with maggots nibbling at patients’ charred and torn flesh, according to interviews with doctors at four hospitals across Gaza. Without adequate water, doctors and nurses are unable to provide sufficient sanitation for their patients, to wash wounds or hospital bedsheets.

In some hospitals, patients arriving in cardiac arrest are not resuscitated, because medical staff choose to work on patients with a greater chance of survival instead. Few of the critically wounded get a hospital bed. Fewer still, a ventilator or anesthesia when operated on, including for brain surgeries, the doctors said. Anesthesia has been in short supply for about two weeks, doctors say.

On top of all those challenges, the hospitals have become temporary orphanages, too, according to the medical workers.

In some cases, children have arrived at the hospitals after their entire families were killed in the war or watched as their parents died on hospital gurneys or tile floors. The medical staff have cared for some of the children until a relative can come to take them.

Dr. Najjar said that each day in his hospital starts with a fight to preserve dwindling fuel supplies. That struggle is shared by the 19 other hospitals that are still functioning, to varying degrees, in Gaza.

And the pressure on those hospitals is mounting as they compensate for 16 hospitals that are now out of service, according to a health ministry statement on Thursday.

On Friday, an explosion near the entrance of Al Shifa Hospital in Gaza City struck a convoy of ambulances carrying wounded people preparing to evacuate to Egypt, according to a Hamas spokesman and the head of the hospital, Dr. Mohammad Abu Salmiya. Thirteen people were killed and many others injured, Dr. Abu Salmiya said, adding that paramedics and patients being evacuated were among the injured while the hospital sustained damage from the explosion.

Two other hospitals came under attack on Friday, according to the World Health Organization.

The Israeli military said it had carried out an airstrike on an ambulance “being used by a Hamas terrorist cell.” An Israeli military spokesman, Maj. Nir Dinar, confirmed it was the same strike that had caused the explosion outside the hospital.

Doctors in two hospitals in Gaza said that, with nothing to power air-conditioners, the heat has gotten bad enough that it is making patients’ wounds fester. Medical staff need their diminishing fuel stocks to light up operating rooms instead.

In the Kamal Adwan Hospital in northern Gaza, surgeries are being done by cellphone flashlight, according to one doctor there. Vinegar is sometimes used to disinfect wounds, with no iodine left.

The Gaza Strip has been plunged into darkness and cut off from the world after the territory’s only electricity plant ran out of fuel and as Israel’s military has cut telecommunications. Ambulance drivers say they often have to chase the sounds of airstrikes in order to know where they are needed.

With food in Gaza now so scarce, medical staff members say they eat only one meal a day, if the hospital can provide it to them, and sleep in the hallways with thousands of displaced people who have sought refuge in medical wards across the Gaza Strip.

“We are making hard decisions,” said Mohammed Qandil, an emergency medicine and critical care consultant at Nasser Hospital in Khan Younis, a city in southern Gaza.

“We choose who gets ventilation by deciding who has the best chance of survival,” he said. “For us as a team, these aren’t easy decisions. It’s a morally sensitive issue with a lot of guilt.”

He paused, reflecting on growing international calls for Israel to agree to a cease-fire to allow humanitarian aid to flow into Gaza.

“We have to make these decisions, but we don’t think it’s our fault,” Dr. Qandil said. “We think it is the fault of the whole humankind who are unable to deliver safe, continuous medical aid to us.”

“All the people who come here, we cannot save them,” he said, taking stock of the lives he watched slip away, many of which he said would have been able to save before the current conflict.

“The hospital doors are open, but the care we are able to give — it is negligible.”

Hiba Yazbek contributed reporting.

Maria Abi-Habib is an investigative correspondent based in Mexico City, covering Latin America. She previously reported from Afghanistan, across the Middle East and in India, where she covered South Asia. More about Maria Abi-Habib

Our Coverage of the Israel-Hamas War

What Comes Next?: By saying that Israel will maintain security control over Gaza “for an indefinite period,”  Prime Minister Benjamin Netanyahu set off alarm bells in Washington. The Biden administration quickly pushed back .

A Possible Endgame: Secretary of State Antony Blinken said that Gaza should be unified with the West Bank under the Palestinian Authority  once the war is over, offering a strong signal about what the United States sees as its preferred arrangement.

The Civilian Toll: Facing global criticism over a bloody campaign in Gaza that has killed thousands of civilians , Israeli officials say it is impossible to defeat Hamas without killing innocents, a lesson they argue Americans and their allies should understand .

Gaza’s Teetering Hospitals: Doctors and nurses in Gaza’s hospitals, which are nearing collapse without electricity and basic supplies after weeks of an Israeli siege, say they are facing hard choices about who lives and who dies .

The Conflict’s   Global  Reach

Arab States: Facing growing anger from their own people, Arab countries are intensifying their appeals to the United States to pressure Israel to implement a cease-fire in Gaza  or risk sabotaging the security of the entire Middle East.

U.S. Congress: Democrats in Congress, torn between their support for Israel and concern about civilian suffering in Gaza, are struggling with how far to go in calling for measures to mitigate civilian casualties as the left wing of the party escalates pressure for a cease-fire .

President Biden: After weeks of terror and retaliation in Israel and Gaza, and 20 months of war in Ukraine, Biden is confronting the limits of his leverage  in the two international conflicts defining his presidency.

A Worldwide War of Words: Iran, Russia and, to a lesser degree, China are using state and social media  to support Hamas and undercut Israel, while denigrating Israel’s principal ally, the United States.

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• November 10, 2023 Setlist

Guilt Trip Setlist at SWX, Bristol, England

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