Organizational resilience of non-governmental organizations in conflict environments: a case study of Health Poverty Action in northern Myanmar

Background Non-governmental organizations (NGOs) are critical actors in global health governance, particularly in conflict zones where they deliver humanitarian aid and support health system development. However, the mechanisms that enable some NGOs to not only survive but also thrive in highly volatile environments remain underexplored. This study investigates the concept of ‘organizational resilience’ to explain this phenomenon. Methods This qualitative case study analyses the Health Poverty Action (HPA)’s operation between 1993 and 2025 in northern Myanmar, a region characterized by protracted conflict, political instability, and systemic fragility. Data were drawn from longitudinal observation (2021-2025), field visits to HPA offices in China (July 2023, November 2025), 12 semi-structured interviews, internal reports, and public lectures by HPA leadership. Thematic analysis was conducted to identify patterns of adaptation. Results The case demonstrates that HPA’s sustained presence and growth through three distinct political eras, military rule (1993-2009), the period often characterized as a democratic transition (2010-2020), and the post-coup state of emergency (2021-2025), resulted from iterative cycles of adaptation. HPA consistently recalibrated its cognitive understanding of the environment and its role, adapted its operational behaviors and programmatic strategies, and strategically built and maintained relationships with diverse stakeholders, for example, ethnic armed organizations, Myanmar’s Union government, Chinese authorities, and international donors. The dynamic ‘Cognition-Behavior-Relationship (CBR)’ process model for organizational resilience explained well how HPA absorbed shocks, transformed challenges into opportunities, and contributed to a form of resilient health governance in northern Myanmar. Conclusions The HPA case underscores that organizational resilience in conflict settings is dynamic and iterative rather than a static process. For NGOs operating in fragile contexts, conscious and continuous adaptation in cognition, behavior, and relationship-building is critical for survival and impact. The findings offer practical insights for NGOs, donors, and policymakers seeking to support effective and durable health interventions in conflict-affected regions.