Abstract

Health systems in war-torn settings face unprecedented challenges, including destruction of infrastructure, 
workforce attrition, disrupted supply chains, and governance breakdowns. Despite these threats, resilience 
strategies can enable systems to maintain essential services and recover functionality during and after conflict. 
This narrative review synthesizes evidence from diverse protracted conflict contexts, including Syria, Yemen, 
South Sudan, and Afghanistan, to identify key resilience mechanisms. These mechanisms encompass adaptive 
governance and leadership, health workforce management, service delivery modifications, health information 
continuity, infrastructure protection, community engagement, financing strategies, and coordination with external 
actors. Comparative analysis highlights recurring patterns and context-specific adaptations, emphasizing the 
importance of decentralized service delivery, contingency planning, and community participation. The review also 
identifies gaps in equity, ethical considerations, and integrated recovery-resilience frameworks. Findings 
underscore the critical need for policymakers and practitioners to adopt multifaceted resilience strategies tailored 
to local conditions to safeguard health service continuity in conflict-affected settings.