Health system resilience in countries facing terrorist threats: a scoping review

The increasing frequency of terrorist events has led to a growing need for healthcare services. Indeed, the unexpected nature of terrorist attacks affects the healthcare system. The number of deaths among victims admitted to healthcare facilities calls into question the ability of health systems to cope with shocks. This article aims to strengthen the understanding of the resilience processes of healthcare systems and identify support strategies for other systems facing significant shocks.

A scoping review included empirical research on health system resilience and terrorism threats from peer-reviewed literature was conducted. A comprehensive search strategy was conducted in four electronic databases (Medline/PubMed, CINAHL, Global Health, and PsycInfo) in January 2023. The data was thematically analysed using the Braun and Clarke approach. This enabled us to map, organise and synthesise the results using the WHO building blocks as a framework for analysis.

We screened 37 papers and then completed a full-text review of 35 identified as relevant. A total of 33 papers were retained for analysis. The results indicate that when health service utilization and stress are associated with service delivery, human resource capacity erodes, compromising system functioning. In most cases, health services were surprised by events because they lacked a minimum emergency preparedness plan. These systemic shocks reinforced the need to strengthen the health systems? resilience. However, the practical application of interventions to make systems resilient has yet to be clearly defined. Moreover, the absorptive capacities of the healthcare system enable an immediate response to a crisis, drawing on available human and organizational resources. It is also clear that by remaining flexible in organizing services, healthcare systems can strengthen their adaptive capacities to ensure better service delivery.

Bringing order to the chaos following a terrorist attack requires discipline and a well-prepared, professional healthcare team.