Disrupted Care, Enduring Lessons: Health Systems Under Crisis in the Philippines, Zimbabwe, South Korea, and Israel A Mixed-Methods Comparative Review of Service Disruptions and Policy Resilience
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Disrupted Care, Enduring Lessons: Health Systems Under Crisis in the Philippines, Zimbabwe, South Korea, and Israel A Mixed-Methods Comparative Review of Service Disruptions and Policy Resilience Abstract Background: Health systems worldwide are vulnerable to sudden shocks from natural disasters, epidemics, and armed conflict. Yet comparative evidence across low- and high-income settings remains fragmented. This study synthesizes quantitative and qualitative data from the Philippines (Typhoon Haiyan), Zimbabwe (cholera epidemics), South Korea (MERS outbreak), and Israel (armed conflicts, 2014–2023) to examine health service disruptions and resilience strategies. Methods: We conducted a mixed-methods systematic review and evidence synthesis of 40 peer-reviewed studies. Quantitative outcomes included service utilization (hospital admissions, outpatient visits, maternal and child health, infectious disease trends) and mortality. Qualitative and policy-oriented studies were integrated through thematic analysis. Sources included hospital records, national surveillance, insurance claims, syndromic surveillance (SPEED), and facility-level surveys. Results: Across contexts, crises precipitated sharp and immediate declines in health service utilization. In the Philippines, hospital admissions decreased significantly post-Haiyan, with obstetric care reduced (OR 0.4, 95% CI 0.3–0.6) and infectious/respiratory admissions increased (1,2). Syndromic surveillance confirmed spikes in communicable diseases and a fall in non-communicable visits (2). Zimbabwe’s 2008–09 cholera epidemic caused 98,585 cases and 4,287 deaths (CFR 4.3%) (3), while subsequent outbreaks sustained high CFRs (4). South Korea’s 2015 MERS epidemic reduced outpatient visits by ~17.2% (5) and increased healthcare avoidance (34.5%) (6). In Israel, ED visits declined by 13% during the 2014 Gaza conflict, yet admissions rose 10%, with 30-day mortality significantly higher (OR 1.42, 95% CI 1.18–1.70) (7). Comparator evidence from Syria (8), Yemen (9), Ukraine (10), and Ebola-affected West Africa (11) confirmed similar patterns of disrupted maternal, infectious, and chronic disease services. Qualitative analyses identified recurrent challenges: damaged infrastructure, staff attrition, interrupted supply chains, and inequities in vulnerable populations (12,13). Conclusions: Despite diverse crises, common patterns emerge: abrupt service disruption, delayed recovery, and disproportionate impacts on maternal, child, and chronic disease care. Policy lessons include the value of syndromic surveillance (Philippines), adaptive telehealth (Israel), and resilient PHC networks (Zimbabwe, Yemen). Cross-crisis learning can inform global frameworks for health system resilience. Keywords: Health system resilience; service disruption; disasters; epidemics; armed conflict; Philippines; Zimbabwe; South Korea; Israel.