Managing health systems under armed conflict: a scoping review of international evidence and a document review of Iranian experiences

Wars and armed conflicts are among the most critical crises that can severely impact a country's vital infrastructures, particularly the health system. During wartime, health systems face major challenges, including attacks on healthcare facilities and personnel, which disrupt access to services and undermine public health. This study aims to conduct a scoping review to assess reported international strategies for wartime health system management, focusing on resource allocation, workforce distribution, financing, and access to essential supplies, followed by a document review of Iranian experiences to inform policy recommendations. We used the JBI framework for the scoping review phase. Relevant English and Persian studies were systematically searched across multiple databases without time limitation, and data were analyzed using qualitative content analysis. We included 26 international studies and 27 Iranian documents in our study. Findings showed that health systems in armed conflict settings face multiple challenges, including damaged infrastructure, shortages of health workforce, disruptions in essential services, limited financial resources, psychological stress on staff, and reduced patient access to care. Interventions such as digital health tools, e-learning, intersectoral collaboration, national and international networks, and community-based approaches were commonly reported as strategies that may support service continuity and resilience in conflict settings. Key recommendations for building resilient health systems in conflict settings include systematic emergency preparedness and coordination plans, decentralization of essential health services to ensure continuity of care, strategic investment in workforce capacity and mental health support, and the establishment of mechanisms that foster flexibility, learning, and international collaboration.