Mapping resilience in conflict and recovery: A systems analysis of the health sector in Ethiopia’s Tigray region (2020–2025)

This study explores the resilience of the health system in Tigray (Ethiopia) in the period during and following the most recent conflict (2020-2025). The aim is to gain an understanding of the dynamic ways in which the health system has responded to the crisis and early recovery, highlighting elements of its resilience, including the resilience strategies (adaptation, absorption and transformation), resilience capacities (i.e., underlying broader capacities that the health system must have in place in order to deploy specific approaches) and resilience pathways. The study is grounded in a resilience framework and adopts a systems thinking approach, drawing on data from a documentary review, key informant interviews and focus groups in Tigray. The findings illustrate the impact of the war on elements of the health system, and the resilience strategies adopted within each element to sustain some extent the health system functionality during the conflict as well as the (longer-term) health system recovery. Based on the findings, a Causal Loop Diagram is developed, which helps to identify key emerging resilience capacities (the motivation, dedication and individual coping strategies of health workers; community trust in healthcare providers; and the regional health authority’s leadership), highlighting causal, balancing or reinforcing loops and pathways between elements, and critically exploring how resilience strategies, capacities and pathways connect and interrelate, sustaining some elements of the health system, preventing collapse and potentially supporting a return to a fully functioning healthcare system. Findings provide evidence that could support the reconstruction and recovery efforts in Tigray, and might inform recovery planning in other settings post-conflict. • The study explores health system resilience in Tigray during and after the 2020 conflict. • Key resilience capacities are identified that support resilience, during and following the crisis. • Findings have the potential to inform emergency response and health system recovery planning. • Systems thinking can support health system resilience analysis to identify essential capacities, strategies and pathways.