Moral and spiritual dimensions of trauma-related suffering may be clinically important in acute care but may be less visible than fear-based posttraumatic symptoms. This integrative review examined moral–spiritual injury as a preliminary clinical formulation for trauma-informed care in Iran, including emergency, trauma, critical care, early post-discharge, and family-facing pathways. PubMed, PsycINFO, Scopus, Web of Science, Scientific Information Database, MagIran, and IranDoc were searched for English- and Persian-language sources published from 1997 to 9 July 2026. Reference-list screening and backward and forward citation searching supplemented database searching. Thirty-six substantive sources were included in the final synthesis. Source selection was documented using a PRISMA-informed flow diagram. Sources were critically appraised using the Mixed Methods Appraisal Tool and relevant Joanna Briggs Institute tools, as appropriate to source type. International evidence associated moral injury with posttraumatic stress, depression, burnout, and suicidal ideation or behavior. Iranian evidence supported the contextual relevance of trauma exposure, religious coping, religious and spiritual struggles, mental health stigma, healthcare moral distress, and Persian-language assessment of moral-injury-related constructs. Direct evidence among Iranian trauma survivors, family caregivers, acute-care recipients, and counseling clients remained limited. Moral–spiritual injury is therefore proposed not as a diagnosis or validated treatment model, but as an exploratory formulation for presentations involving guilt, shame, betrayal, perceived unforgivability, spiritual rupture, personally salient family or reputational concerns, and loss of moral self-trust. Clinical implications emphasize anti-pathologizing, client-led, professionally bounded assessment and care, alongside priorities for referral, service development, and research in Iran.