Rethinking cross-border health systems for contexts of mobility and forced displacement

Health systems today are deeply affected by conflicts, forced displacement, and other stressors such as climate change. Traditional health system frameworks, while influential, often assume stable, territorially bounded national systems and do not fully capture the realities of mobility, contested authority, and health care seeking and delivery across borders. This paper explores how health systems operate in contexts where both internationally recognized borders and internal power lines shape the dynamics of health provision for displaced and mobile populations. Drawing on illustrative cases from Northwest Syria and Myanmar, we examine how health systems adapt across and beyond borders in the absence of formal national response. In Syria, humanitarian cross-border mechanisms, local governance bodies, and mobile referral networks have sustained care despite fragmented authority. In Myanmar, ethnic health organizations, diaspora networks, and transnational supply chains have long supported communities in border areas, with populations frequently moving across borders into Thailand, China, and Bangladesh to access essential care. We propose a new approach to cross-border health systems that includes recognizing the roles of non-state and humanitarian actors, enabling flexible financing and workforce recognition across jurisdictions, and developing interoperable data systems sensitive to mobility. By incorporating these dimensions, health systems can be better understood and supported in ways that reflect the realities of forced displacement and mobility in complex conflict-affected settings.