The recent twelve-day armed conflict in Iran has once again exposed critical weaknesses in the country's health system when facing large-scale emergencies. Despite earlier warnings about rising geopolitical tensions, healthcare infrastructure -similar to failures seen during earthquakes, floods, the COVID-19 pandemic, and climate-related disasters- proved ill-prepared for the disruption’s scale and complexity.1 Iran’s digital infrastructure experienced limitations during the conflict. Reports of severe disturbances are available in the literature, namely Northern Ethiopia (Tigray) Conflict, where digital health systems -including patient records- were destroyed, highlighting the need to transition from fragile, outdated systems to resilient digital health architecture.2 Research emphasizes that digital resilience demands not just technical backups but adaptive and transformative capacity to resist cyber threats and infrastructure breakdowns.3 Communication among healthcare personnel also failed. Social media platforms, often used for coordination, were inaccessible, which hindered real-time team response. The EU’s Critical Communication System (EUCCS) offers a model for secure communication during crises.4 Healthcare workers -from students to professionals-demonstrated commitment, but faced immense psychological and financial burdens. In the absence of structured support, this underscores the urgent need to invest in health workforce resilience. According to WHO and OECD guidelines, this involves workforce planning, crisis training, and well-being programs.5, 6 To enhance health system resilience, we urge immediate action in the following areas: · Integrate academic and clinical institutions into emergency preparedness. · Establish health policy think tanks linked to crisis response bodies. · Develop secure, redundant systems for health data and server access. · Equip health systems to function during infrastructure failures and displacement. · Stockpile critical resources for high-risk critical regions. · Train formal rapid response teams with institutional support. · Include disaster preparedness and trauma training (e.g., ATLS) in medical education.7 Iran’s experience is not unique. Global crises are increasingly outpacing health system responsiveness. OECD’s post-pandemic findings affirm that resilience must be a pillar of national security -alongside defense-requiring long-term commitment.5 This crisis presents an opportunity to reform, rebuild, and embed health security into national resilience frameworks. Post-crisis evaluations should be standard and used to guide future preparedness.
Mojtaba Sehat (Sat,) studied this question.