The Humanitarian System at a Crossroads: Change or become irrelevant? The Report of the Johns Hopkins Center for Humanitarian Health - Lancet on Health, Conflicts, and Forced Displacement.

Humanitarian action in the health sector has played a crucial role in mitigating the impact of crises - conflicts, famines, and natural disasters - on morbidity and mortality, while also highlighting structural and operational limitations. This contribution reviews the evolution of humanitarian system reforms, from the initiatives following the failures observed in Rwanda, Darfur, Haiti, and Pakistan to the more recent strategies for renewal. Particular attention is given to the report of the Johns Hopkins-Lancet Commission on Health, Conflicts, and Forced Displacement (2026), which proposes a profound transformation of humanitarian architecture and governance, centred on strengthening the role of affected communities, increasing emphasis on accountability and monitoring of humanitarian law violations, achieving more equitable funding, and ensuring effective safeguarding of the right to health.The current convergence of protracted conflicts, attacks against civilians, personnel, and health infrastructures, forced displacements, and drastic reductions in funding has brought the humanitarian system to the brink of collapse. In this context, marked by increasing humanitarian needs, the Commission's recommendations, while not new, provide a platform to promote a structural change in the humanitarian system, oriented towards greater equity and the transfer of resources and decision-making responsibilities to the local level.