When a society builds its wealth on the suffering of the vulnerable, the resulting divine response is both severe and deeply connected to the harm caused. God reacts to the people's sins with devastating force, delivering severe blows that bring about actual illness and sickness [רש״י, מצודת דוד]. The primary approach among commentators views this punishment through the lens of strict justice, specifically targeting the wealthy elite. Because these powerful individuals committed violence, oppressed the weak, and brought sickness to the hearts of the poor, God strikes them with a sickening blow in return [רד״ק, אבן עזרא, אברבנאל].
This harsh response is not a sudden outburst but the climax of a long, ignored process. God repeatedly disciplined the people to guide them back to the right path. However, because they refused to change their ways and the earlier warnings failed, the punishment escalates [מלבי״ם]. The ultimate result of this stubbornness is total ruin. Following the failure of the initial warnings, God will bring complete destruction and desolation upon the land [רש״י, מלבי״ם, אברבנאל]. The sheer scale of this ruin will be so extreme and unusual that it will cause onlookers to be completely astonished at the magnitude of the punishment [רד״ק].
Yet, alongside this strict justice, a profound sense of divine sorrow emerges. A unique perspective suggests that God Himself, as it were, suffers and becomes sickened by the necessity of repeatedly striking the people. In this view, God stands astonished and pained by the depth of their sins and the tragic ruin they have brought upon themselves [ביאור שטיינזלץ].