From Attack to Recovery: An Integrated Cyber Resilience Framework for Healthcare Institutions

Hospitals have become frequent targets of ransomware, phishing and data theft, and an outage can endanger patients as well as records. This review traces how attacks on healthcare organisations since 2016 turn into clinical harm and examines how strong the evidence is for the measures proposed against them. English-language literature was searched mainly in PubMed, and 29 records were synthesised thematically. Phishing-enabled ransomware and unpatched legacy systems account for most reported incidents, from WannaCry in 2017 to the Irish HSE attack in 2021, and their consequences include cancelled procedures, diverted emergencies and medication-safety risk during downtime. Mandatory annual awareness modules have not been shown to reduce successful phishing, whereas repeated simulation with feedback and rehearsed downtime drills look more promising, although most evidence comes from single sites. Only a small minority of organisations were reported to go beyond basic monitoring. The paper proposes a Prevent–Prepare–Respond–Recover framework that treats clinical downtime competence as a security control, and calls for outcome-based evaluation of drills, training and legacy-device management.