Post-Conflict Health System Recovery: A Descriptive Synthesis Across Surgical, Rehabilitation And Governance Domains

Abstract

Background: Post-conflict health systems face complex challenges in restoring essential services, particularly surgical capacity, rehabilitation, and system-wide governance. While global frameworks offer guidance, empirical evidence on recovery trajectories remains fragmented.

Objectives: This review synthesizes evidence across three domains—health-system reform, surgical setup restoration, and rehabilitation integration—to identify patterns, gaps, and actionable strategies for post-conflict recovery.

Methods: A systematic search of peer-reviewed and grey literature was conducted across five databases and institutional repositories. Seventy-eight studies met inclusion criteria, spanning 22 conflict-affected countries. Data were extracted on study design, geographic scope, health system function, and reported outcomes. A descriptive synthesis was applied, supported by comparative tables and thematic mapping.

Results: Recovery is feasible even in fragile settings, with safe surgery and service delivery re-established through standardized protocols and targeted investments. However, evidence is uneven by geography and domain. South Asia contributes only surgical studies; Sub-Saharan Africa lacks rehabilitation data. Outcome reporting clusters around safety and governance, with limited data on workforce, functional recovery, capacity, and financial protection. Rehabilitation is underrepresented despite its long-term impact. Observational designs dominate, with few embedded program evaluations.

Conclusion: Post-conflict systems recover fastest when enabling functions are restored, financial access is protected, and rehabilitation is integrated early. Co-governance with humanitarian partners and standardized indicators are essential. Investment in locally led evaluation—especially in underrepresented regions and rehabilitation—is critical to building resilient, equitable care.