Determinants of healthcare infrastructure rebuilding in the MENA region post-conflict: a scoping review

Abstract

Background: Armed conflict damages facilities but also fractures governance, financing, workforces, supply systems and public trust. Evidence on what enables healthcare infrastructure rebuilding in the Middle East and North Africa (MENA) is dispersed across country studies and institutional assessments.

Methods: Following JBI guidance and PRISMA-ScR, PubMed/MEDLINE, Europe PMC and OpenAlex were searched from 1 January 2015 to 22 August 2026, supplemented by targeted searches of WHO, World Bank and UN sources. Population–Concept–Context criteria captured determinants of restoring physical and operational health-system capacity in conflict-affected MENA settings. Findings were charted and synthesised using deductive–inductive framework analysis.

Results: Of 3,477 records identified, 711 duplicates were removed, 2,766 titles/abstracts were screened, 122 reports were assessed and 41 sources were included (35 journal articles; six institutional sources). Twenty-nine sources were published during 2023–2026; evidence concentrated on Syria and Palestine/Gaza. Seven interacting determinant domains emerged: security and political access; legitimate governance and coordination; sustainable financing; workforce retention and return; networked facilities and infrastructure interdependencies; data and learning; and equity with local ownership. Physical capital was necessary but repeatedly rendered ineffective by upstream insecurity, fragmented authority, unpaid staff, blocked procurement or absent utilities.

Conclusions: Rebuilding should be treated as a sequenced political-institutional programme rather than a construction portfolio. The proposed three-gate model prioritises political-security feasibility, implementation capacity and networked service reconstruction, with equity and accountability as cross-cutting safeguards.