Disrupted Care, Enduring Lessons: Health Systems Under Crisis in the Philippines, Zimbabwe, South Korea, and Israel A Mixed-Methods Comparative Review of Service Disruptions and Policy Resilience

Abstract Background: Health systems remain acutely vulnerable to sudden shocks from natural disasters, epidemics, and armed conflict. Comparative cross-country evidence bridging low- and high-income contexts is limited. This study synthesizes quantitative and qualitative data from the Philippines (Typhoon Haiyan), Zimbabwe (cholera epidemics), South Korea (MERS outbreak), and Israel (armed conflicts, 2014–2023) to examine health service disruptions and resilience strategies. Methods: We conducted a mixed-methods systematic review of 40 peer-reviewed studies. Quantitative outcomes included service utilization (hospital admissions, outpatient visits, maternal and child health, infectious disease trends) and mortality. Qualitative and policy-focused studies were integrated via thematic analysis. Data sources included hospital records, national surveillance, insurance claims, syndromic surveillance (SPEED), and facility-level surveys. Results: Across settings, crises precipitated sharp, immediate declines in service utilization. In the Philippines, hospital admissions decreased significantly post-Haiyan, with obstetric care reduced (OR 0.4, 95% CI 0.3–0.6) and infectious/respiratory consultations increased【1–2】. Syndromic surveillance confirmed spikes in communicable disease visits and reduced non-communicable consultations【2】. Zimbabwe’s 2008–09 cholera epidemic caused 98,585 cases and 4,287 deaths (CFR 4.3%)【3】, with subsequent outbreaks sustaining high CFRs【4】. South Korea’s 2015 MERS epidemic reduced outpatient visits by ~ 17.2%【5】 and triggered healthcare avoidance in 34.5% of the population【6】. In Israel, ED visits declined by 13% during the 2014 Gaza conflict, while admissions rose 10% and 30-day mortality increased (OR 1.42, 95% CI 1.18–1.70)【7】. Evidence from Syria【8】, Yemen【9】, Ukraine【10】, and Ebola-affected West Africa【11】 revealed parallel disruptions in maternal, infectious, and chronic disease services. Qualitative studies consistently highlighted infrastructure damage, staff attrition, supply chain breakdowns, and disproportionate effects on vulnerable populations【12–13】. Conclusions: Despite contextual differences, common patterns emerge: abrupt disruption, delayed recovery, and disproportionate burdens on maternal, child, and chronic disease services. Policy lessons include syndromic surveillance (Philippines)【2】, adaptive telehealth (Israel)【7】, and resilient PHC networks (Zimbabwe, Yemen)【3,9】. Cross-crisis learning can inform global frameworks to strengthen health system resilience.