Health systems in fragile and conflict-affected settings

Healthcare in fragile and conflict-affected settings (FCAS) remains a real challenge, with poor performance on many health-related goals. And with a projected 60% of the world’s extreme poor living in conflict-affected settings by 2030, it is clear that the SDG targets, including on universal health coverage, will not be achieved without a focus on health systems strengthening in FCAS. Yet there is limited evidence available to inform appropriate approaches for governments, development partners, implementing agencies and others seeking to address the particular challenges for health system strengthening in these settings.

The Thematic Working Group on Health Systems in Fragile and Conflict Affected States (TWG-FCAS), part of Health Systems Global, is working for better awareness and dissemination of current and new knowledge on health systems in FCAS, and its translation into policy and practice. This Collection of Resources (below), and linked Key Issue Guides (above), have been collated as part of the Eldis platform, to help those working in these challenging settings to better access relevant published literature and other resources, including relevant organisations, in support of their work.

This Collection will be kept as up to date as possible, and we welcome suggestions for additional relevant resources and other material, including organisations/projects. If you have suggestions for such additional material, please email with details for consideration by the TWG-FCAS.

For more information and to join the TWG-FCAS, visit our web-page.

This resource has been developed for the TWG-FCAS by the ReBUILD Research Programme, funded by UK Aid from the Department for International Development.

Image credit: Women and children queue at a health clinic in Kapua, Turkana County, northwest Kenya, 29 January 2017 | Russell Watkins/DFID | Flickr | CC BY 2.0

The TWG-FCAS is a working group of researchers, policy-makers, implementers and funders working to support the creation, sharing and use of new knowledge on health systems in fragile and conflict affected settings.

ReBUILD is an international health systems research partnership working to improve access to equitable & effective health care for the poor and vulnerable in conflict and crisis affected settings. ReBUILD is funded by the UK Department for International Development

In this collection


Showing 1-10 of 80 results

  • Health financing in fragile and conflict-affected settings: what do we know, seven years on

    Elsevier, 2019
    In 2012, an exploratory literature review was con-ducted to analyse the main themes and findings of recent literature focusing on health financing in FCAS. Seven years later, this paper presents an update of that review, reflecting on what has changed in terms of the knowledge base, and what are the on-going gaps and new challenges in our understanding of health financing in fragile and conflict-affected states....
  • Resilience capacities of health systems: accommodating the needs of Palestinian refugees from Syria

    Elsevier, 2019
    This study of the United Nations Relief and Works Agency for Palestinian Refugees in the Near East  (UNWRA) in Lebanon and Jordan explored their degree of health system resilience to the impact of shocks and stressors arising from the Syrian crisis. The study used a capacity-oriented resilience framework (including absorption, adaptation and transformation) with professionals at primary care, area and country management levels; 62 semi-structured interviews were done (30 in Lebanon in November–December 2016, and 32 in Jordan in January 2017)....
  • Health in postconflict and fragile states

    United States Institute of Peace, 2012
    The role of health in development and aid policy in conflict-affected and fragile states remains a conundrum. Evidence is increasing that conflict and fragility have a devastating impact on health. At the same time, knowledge on how to construct effective and sustainable health systems in these states through local leadership and donor commitment is expanding. Yet, except in countries of strategic or political interest to donors, such as Afghanistan, Iraq, or the Balkans, the level of donor investment in these states remains low even as global health spending has dramatically increased....
  • The role of risk perception in willingness to respond to the 2014–2016 West African Ebola outbreak: a qualitative study of international health care workers

    BioMed Central, 2017
    The 2014–2016 West Africa Ebola Virus Disease (EVD) outbreak was an unprecedented public health event, and in addition to claiming over 11,000 lives, it resulted in the deaths of more healthcare workers than any outbreak in recent history. While a cadre of willing and able health workers is essential for an effective epidemic response, health workforce capacity in times of crisis may be significantly impacted by how risks are perceived by health staff....
  • The role of public health information in assistance to populations living in opposition and contested areas of Syria, 2012–2014

    BioMed Central, 2017
    The Syrian armed conflict is the worst humanitarian tragedy this century. With approximately 470,000 deaths and more than 13 million people displaced, the conflict continues to have a devastating impact on the health system and health outcomes within the country. Hundreds of international and national non-governmental organisations, as well as United Nations agencies have responded to the humanitarian crisis in Syria....
  • Factors influencing non-institutional deliveries in Afghanistan: secondary analysis of the Afghanistan Mortality Survey 2010

    Nagoya University School of Medicine/Graduate School of Medicine, Nagoya Japan, 2015
    Home delivery in unhygienic environments is common among Afghan women; only one third of births are delivered at health facilities. Institutional delivery is central to reducing maternal mortality. The factors associated with place of delivery among women in Afghanistan were examined using the Afghanistan Mortality Survey 2010 (AMS 2010), which was open to researchers. The AMS 2010 data were collected through an interviewer-led questionnaire from 18,250 women. Odds ratio (OR) and 95% confidence interval (CI) of non-institutional delivery were estimated by logistic regression analysis....
  • Analysing disrupted health sectors - a modular manual

    Department of Recovery and Transition Programmes, World Health Organization, 2009
    This practical, experience-based, action-oriented manual on Analysing Disrupted Health Sectors in crisis includes: countries on the verge of an economic, political and/or military catastrophe, protracted crises and situations of transition from disaster to recovery. The intended users are apprentice analysts, already with field experience, familiar with quantitative techniques, attempting to analyse a disrupted health sector.The manual offers materials for use, rather than for reading....
  • Leaving them behind: healthcare services in situations of armed conflict

    Norwegian Red Cross, 2017
    In the 2030 Agenda for Sustainable Development in 2016, the international community agreed to ‘leave no one behind’. However, the community is doing precisely that by failing to act as millions living in conflict-affected areas are deprived of access to healthcare services. The few healthcare services operating in these situations are attacked with impunity. We need to seek new ways to protect healthcare workers operating in armed conflicts....
  • Making sense of apparent chaos: health-care provision in six country case studies

    Cambridge University Press, 2014
    This research examines the impact on health-care provision of advanced state failure and of the violence frequently associated with it, drawing from six country case studies. In all contexts, the coverage and scope of health services change when the state fails. Human resources expand due to unplanned increased production. Injury, threat, death, displacement, migration, insufficient salaries, and degraded skills all impact on performance. Dwindling public domestic funding for health causes increasing household out-of-pocket expenditure....
  • Rebuilding research capacity in fragile states: the case of a Somali–Swedish global health initiative

    Taylor and Francis Group, 2017
    This paper presents an initiative to revive the previous Somali–Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries....


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