Occupational strain among hospital social workers coordinating responses to domestic violence (DV) and sexual assault (SA) remains underexplored, despite extensive research on burnout, moral distress, and interprofessional tensions in healthcare. This qualitative study examines how coordinators in Israeli hospitals interpret and navigate the organizational, relational, and ethical conditions shaping their roles. Fourteen social workers involved in DV and SA coordination took part in in-depth semi-structured interviews. The findings generated a typology of four interrelated configurations of strain shaped by the interplay between structural–operational pressures and relational–moral responsibilities. The typology is presented as an empirically grounded analytic framework. Acceleration Strain reflects the mismatch between the rapid tempo of acute medical care and the slower, relational engagement required for practice. Fragmentation Strain arises from overlapping clinical and coordination responsibilities without protected time. Moral-Isolation Strain captures the experience of carrying ethical and emotional responsibility with limited opportunities for consultation or shared decision-making. Boundary Strain describes the paradox of being formally central to DV and SA response while remaining structurally marginal within hospital hierarchies. Together, these configurations suggest that strain is a systemic, multi-layered phenomenon. The typology offers a framework for understanding and addressing strain through institutional support, clearer role boundaries, and system-level interventions.