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Lets go down the realism rabbit hole.
A scav shoots you in the chest with a shotgun, your armor blocks it but some of the buckshot hit your gun and it's now damaged and unusable. You have to take it out of raid again to repair it.
You drank too much fruit juice for hydration so you now have Negative Effect: Diarrhea. Your PMC at random times in raid will need to go squat in a bush.
You or someone else fired a gun in a confined space and you weren't wearing comtacs so your ear drums ruptured. You now can't hear anything.
You walked through the swamp on Shoreline a few raids ago and never changed your socks. Now you have trench foot and have a limp.
The grenade you just threw was a dud and never explodes.
You reach 100 PMC kills and get PTSD. Now at random times in raid your PMC will want to kill himself and you have to call up the therapist so she can talk him down. You must pay the therapist 500k roubles for MDMA therapy to permanently remove PTSD effect.