Recent wars in Iraq and Afghanistan have re-ignited debates on how to prevent and manage psychological injury among returning troops. We use a unique ethnography of a military medical team's tour of duty in Camp Bastion, Afghanistan, to explore the role of the institutional context as a contributing factor to psychological injury from war. We find that exposure to war and its consequences can invoke sustained experiences of senselessness, futility, and surreality that form a stark contrast with cultural expectations, professional role identity, and organizational protocol, and can thus threaten people's existential grounding in this institutional context. We show how people are forced to rely on a range of personal coping strategies to deal with this dislocating experience. We argue that these coping strategies fail to fully resolve the existential trauma that lies at the heart of psychological distress at war, and may even contribute to it, thus increasing the likelihood of psychological injury. We discuss implications for practice as well as directions for future research.