Respectful SRH care during conflict

Abstract

War and armed conflict disrupt health systems, creating resource constraints and burnout that contribute to mistreatment during childbirth and poor-quality sexual and reproductive health (SRH) care. Lebanon has experienced decades of instability, culminating in the 2024 war that displaced over one million people within two months. As part of the GEMSELF study to develop person-informed SRH interventions, we conducted 20 key informant interviews with government officials, NGO and humanitarian actors, primary healthcare center (PHCC) directors, and providers, alongside 20 focus groups with diverse community members across 10 PHCCs. Data collection spanned the active conflict (October 2024) and the immediate post-ceasefire period, capturing both disruptions and adaptive responses. Results showed that war had a dual impact on PHCCs, disrupting SRH service delivery while revealing notable system and workforce resilience. Core domains of person-centered care: dignity, respect, autonomy, communication, and supportive care- remained central. While users reported instances of disrespect, providers described deliberate efforts to ensure communication, consent and trust. Outreach activities addressed inequities and supported informed decision-making, with users attributing positive experiences to providers’ civic responsibility and moral commitment. Workforce adaptations included training general practitioners to address mental health needs, expanded roles for midwives, mobile clinics, and staff redistribution to mitigate access barriers- measures supporting more equitable service delivery despite strain. In conclusion, crisis conditions both challenge and catalyze person-centered SRH care while strengthening empathy, adaptability, and workforce support. Institutionalizing crisis-responsive practices is essential for sustaining equitable care in current and future emergencies.