International Journal of Health Policy and Management

International Journal of Health Policy and Management

Changing Wars, Changing Lenses: Understanding Human Resources for Health in Conflict-Affected Settings; Comment on “Human Resources for Health in Conflict Affected Settings: A Scoping Review of Primary Peer Reviewed Publications 2016–2022”

Articles in Press

Document Type : Commentary

Author
Jean-Benoît Falisse
School of Social and Political Science, University of Edinburgh, Edinburgh, UK
Abstract
Onvlee and colleagues’ review of human resources for health (HRH) in conflict-affected settings (CAS), together with the commentaries engaging it, invites closer attention to how the dynamics of conflict shape HRH. This commentary asks how that attention can be operationalised. First, I argue that conflict studies, political science, and political economy offer complementary tools: conflict typologies show who fights whom and across which borders, and therefore who employs, regulates, and protects health workers; theories of wartime violence show where health workers can work and whom they can reach; political settlements analysis shows who decides on pay, deployment, and recognition; and attention to the stage of conflict shows whether windows for reform open at all. Second, drawing on the limited-statehood and “liminal health system” literatures, I argue that cross-border arrangements for training, recognising, and deploying health workers are structural features of HRH: what the health labour market (HLM) framework records as “outflow” is often a reorganisation of the workforce.

Keywords
Health Workforce
Conflict-Affected Settings
Political Economy
Cross-Border Health Systems
Limited Statehood
1.     Onvlee O, Kok M, Buchan J, Dieleman M, Hamza M, Herbst C. Human resources for health in conflict affected settings: a scoping review of primary peer reviewed publications 2016–2022. Int J Health Policy Manag. 2023;12:7306. doi:10.34172/ijhpm.2023.7306
2.     Lim AM, Hung KK, Wong CS, et al. Supporting Healthcare Workers on the Frontline of Conflicts: Comment on "Human resources for health in conflict affected settings: a scoping review of primary peer reviewed publications 2016–2022." Int J Health Policy Manag. 2025;14:9457. doi:10.34172/ijhpm.9457
3.     Aziz R. Rethinking Human Resources for Health Planning in Labour Markets Disrupted by Conflict-Affected and Fragile Settings: Comment on "Human resources for health in conflict affected settings: a scoping review of primary peer reviewed publications  2016–2022." Int J Health Policy Manag. 2026;15:9534. doi:10.34172/ijhpm.9534
4.     Pavignani E. Paying Attention–and respect–to the agency of conflict-affected health workers: Comment on "Human resources for health in conflict affected settings: a scoping review of primary peer reviewed publications  2016–2022." Int J Health Policy Manag. 2026;15:9580. doi:10.34172/ijhpm.9580
5.     Witter S, Falisse JB, Bertone MP, et al. State-building and human resources for health in fragile and conflict-affected states: exploring the linkages. Hum Resour Health. 2015;13:33. doi:10.1186/s12960-015-0023-5
6.     Safeguarding Health in Conflict Coalition (SHCC). Epidemic of Violence -- Violence against Health Care in Conflict 2024. SHCC; 2025.
7.     Kaldor M. New and Old Wars: Organized Violence in a Global Era. 3rd ed. Stanford, CA: Stanford University Press; 2012.
8.     Kalyvas SN. The Logic of Violence in Civil War. Cambridge University Press; 2006.
9.     Behuria P, Buur L, Gray H. Studying political settlements in Africa. Afr Aff (Lond). 2017;116(464):508-525. doi:10.1093/afraf/adx019
10. Fouad FM, Bou-Orm IR. Health systems in limited statehood: a new analytical lens for research and practice. Lancet. 2025;406(10508):1071-1072. doi:10.1016/S0140-6736(25)01403-5
11. DiStefano L, Than KK, Traill T, et al. A liminal health system: exploring the resilience strategies of healthcare providers and communities along the Thailand-Myanmar border. SSM-Health Systems. 2026;6:100209. doi:10.1016/j.ssmhs.2026.100209
12. Fouad F, Than KK, Bertone MP, Witter S, Kyaw NN, Bou-Orm IR. Rethinking cross-border health systems for contexts of mobility and forced displacement. SSM-Health Systems. 2026;6:100172. doi:10.1016/j.ssmhs.2026.100172
13. van de Pas RAM. A Cosmopolitan Outlook on Health Workforce Development. Global Academic Press; 2020. doi:10.26481/dis.20200914rp
14. Bdaiwi Y, Rayes D, Sabouni A, et al. Challenges of providing healthcare worker education and training in protracted conflict: a focus on non-government controlled areas in north west Syria. Confl Health. 2020;14(1):42. doi:10.1186/s13031-020-00287-9
15. Fehmi Z, Nakkash N, Jaroudi R, et al. Preserving Medical Education in Conflict Zones through Transnational Partnerships: Field Lessons from Gaza and Ukraine. Disaster Med Public Health Prep. 2026;20:e101. doi:10.1017/dmp.2026.10359
16. Andriiashenko L, Zabdyr-Jamróz M, Lipowski P, Domagała A. Immigration of medical personnel from Ukraine to Poland – Context, regulations, and trends. Health Policy. 2025;152:105241. doi:10.1016/j.healthpol.2024.105241
17. Moughrabieh A, Weinert C. Rapid deployment of international tele–intensive care unit services in war-torn Syria. Ann Am Thorac Soc. 2016;13(2):165-172. doi:10.1513/AnnalsATS.201509-589OT
18. Alser K, Mallah SI, El-Oun YRA, et al. Trauma care supported through a global telemedicine initiative during the 2023–2024 military assault on the Gaza Strip, occupied Palestinian territory: a case series. Lancet. 2024;404(10455):874-886. doi:10.1016/S0140-6736(24)01170-X 
International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 17 October 2026

  • Received Date 14 May 2026
  • Revised Date 06 October 2026
  • Accepted Date 09 October 2026
  • First Published Date 17 October 2026
  • Published Date 17 October 2026