Strengthening health systems during conflict

When airstrikes destroyed the health facilities where Sister Su worked in Myanmar, she and her colleagues had to find somewhere else to treat their patients.

They moved into ordinary houses, dug makeshift bomb shelters and hid medical supplies to prevent them from being seized. Reaching patients in remote mountain villages sometimes meant travelling on foot, carrying medicines packed into carefully labelled containers.

For Sister Su, this has been everyday healthcare since the military coup in 2021.

Sister Su described her experiences at a recent Global Health Partnerships (GHP, formerly THET) webinar on strengthening health systems in fragile and conflict-affected states, a subject GHP is exploring in a forthcoming report. Stories like hers show how much healthcare workers can achieve in conflict. They also raise a harder question for funders and partners: how to support healthcare during an emergency and in the years that follow.

Keeping healthcare going against the odds

Since 2017, the World Health Organization has recorded more than 9,400 attacks on healthcare workers and infrastructure across 25 countries, killing an estimated 4,700 people and injuring thousands more.

The damage outlasts the attacks themselves. Experienced staff leave and medical training grinds to a halt. Health services already under strain lose the people and resources they need to serve their communities. And every day needs do not stop. Women still need somewhere safe to give birth and people with long-term conditions still need care.

Also discussed at the webinar was northwest Syria, where doctors have worked out how to train the next generation of specialists despite being unable to access the national medical education system. The solution they came up with was the Syrian Board of Medical Specialties (SBOMS). Set up in 2016, it began with surgery and anaesthesia, the specialties most urgently needed to treat people injured in the fighting. Working with Syrian doctors overseas, universities and international partners, including GHP since 2022, SBOMS had steadily expanded its programme. By December 2025, it had trained 436 specialist doctors, with another 346 in training, and had grown from 2 specialties to 35.

This means people in northwest Syria could still see a specialist if they needed one, despite years of conflict.

Together with the wider discussion at the webinar, these stories point to four lessons for anyone supporting healthcare in conflict-affected countries.

1. Long-term system strengthening is possible, even in war
   
   With aid budgets under growing pressure, there is a risk that funders will see health system strengthening in conflict-affected areas as too difficult or too risky.
   
   Yet Sister Su and her colleagues are still reaching patients, and hundreds of Syrian doctors have qualified as specialists through a programme built in wartime. With the right support, health workers can do more than hold services together.
   
   Emergency aid will always be needed. But without sustained investment in training and local services, countries lose skills and expertise they will need long after the fighting ends.
   

2. Diaspora health workers are vital
   
   Health workers who have left their home countries often continue to support them, yet are rarely formally recognised. Their work ranges from supporting training to helping to keep services running during conflict.
   
   In the Syrian programme, doctors in the diaspora have supported training, supervised trainees, helped run examinations and shared specialist expertise, often remotely.
   
   The same is happening elsewhere. Sudanese healthcare professionals living overseas have helped organise medical services for communities affected by conflict. In Yemen, diaspora networks have connected local practitioners with public health training they might otherwise have been unable to access.
   
   Better support for diaspora networks could help countries keep and rebuild medical expertise, especially where insecurity keeps international specialists away.

3. Local health workers are best placed to lead
   
   Healthcare programmes should follow local priorities wherever they operate. In conflict, this matters even more because international partners may have to leave at short notice.
   
   Local health workers are the ones that know what their communities need and should have the final say in how support is designed and delivered.

4. Good partnerships need time
   
   Even the most effective health partnerships struggle when funding is short-term and unpredictable.
   
   Health workers at the webinar described projects ending abruptly when grants ran out. Uncertain funding also makes it hard to keep staff or plan improvements which can then take years to deliver.
   
   In some cases, repeated cycles of international organisations arriving and leaving has damaged trust.
   
   Rebuilding a medical training programme or strengthening a hospital takes years. Local teams need to know that support will continue long enough for their work to make a difference.

Sister Su and her colleagues are still reaching patients. Syrian doctors are still training the specialists their country will need for decades. Neither group waited for the fighting to stop before building something that lasts, and funders and partners should not wait either. That means multi-year funding for health system strengthening, support for diaspora health workers, decisions led by the local health workers and support that continues after the emergency ends.

With thanks to everyone who contributed to the Global Health Partnerships webinar, particularly the health workers who shared their experiences. We also remember Dr Safwan Alchalati, one of the founding members of the Syrian Board of Medical Specialties, who presented at the webinar and who sadly passed away in August 2026.

Sister Su’s name in this blog is an alias to protect safety.