Targeting and disrupting civilian health systems—the governed network of institutions responsible for delivering healthcare services—has become an increasingly routine feature of modern warfare, despite constituting a clear violation of international humanitarian law.

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While the destruction of hospitals and other physical infrastructure often captures media and policy attention, far less focus is placed on the deeper, systemic damage armed conflict inflicts on civilian health systems. Beyond the immediate loss of facilities and personnel, conflicts frequently erode the governance, financing, and administrative architectures required to sustain public health service delivery over time. These harms are compounded by the growing use of hybrid warfare tactics—including cyberattacks, sabotage, and other active measures—that target the operational backbone of health systems and disrupt core functions such as surveillance, supply chains, workforce coordination, and health financing flows.

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A substantial body of research demonstrates that mortality and disability rates remain elevated for years after active hostilities end. These prolonged population health impacts are driven in large part by the inability of health systems to recover to pre-conflict levels of performance, capacity, and resilience.

 

The Threatened Health Systems Project, supported by NATO’s Science for Peace and Security Programme and the Harvard Global Health Scholarly Working Group Program, seeks to develop and operationalize evidence-based strategies to strengthen the resilience of health systems in states facing escalating hostilities, particularly where adversaries are deliberately targeting civilian health infrastructure and system functions.