Care under attack: a qualitative study of healthcare system disruption and health worker resilience during airstrikes on Lebanon
Samar Al-Hajj, Rakan Nassereldine, Noor Srour, Michelle E Bauer, Danielle Poole, Ibrahim Issa, Rami Zurayk, Hani MowafiIntroduction
War severely disrupts healthcare systems by damaging infrastructure, limiting access to care and placing healthcare workers (HCWs) at physical and psychological risk. During the 2024 Israeli war on Lebanon, repeated airstrikes created major challenges for healthcare delivery. This study explored HCWs’ experiences and examined the impact of conflict on healthcare system functioning and service continuity.
Methods
A qualitative study was conducted using semi-structured interviews with 19 HCWs involved in emergency response and patient care, including nurses, paramedics and ambulance staff affected during the conflict. Data were analysed using reflexive thematic analysis informed by a critical health systems framework.
Results
Two overarching themes emerged: (1) operational disruption and failures in preparedness and accountability and (2) workforce resilience and professional commitment during crisis. Participants described attacks on healthcare facilities, ambulances and infrastructure that disrupted services, caused shortages of staff and medical supplies and reduced access to care. HCWs described a substantial psychological toll, including fear, anxiety, burnout and emotional exhaustion, alongside moral distress arising from having to weigh patient care against their own safety and from being unable to provide the standard of care they were committed to. Despite these conditions, participants demonstrated resilience through teamwork, rapid adaptation and strong professional dedication, helping sustain essential healthcare services during the conflict.
Conclusions
The findings highlight the vulnerability and resilience of healthcare systems in conflict settings, as well as the considerable psychological and moral burden borne by HCWs. Strengthening emergency preparedness, protecting HCWs and facilities and improving accountability for attacks on healthcare are essential to maintaining healthcare delivery and safeguarding workforce well-being during armed conflict.