The impact of economic sanctions on health outcomes and health systems: a scoping review of primary empirical evidence

Economic sanctions are widely used foreign policy tools, yet growing evidence suggests they may have adverse effects on population health. Existing literature remains fragmented and often combines empirical and non-empirical evidence, limiting conclusions based on observed data. This study aimed to systematically map and synthesize primary empirical evidence on the associations between economic sanctions and health outcomes and health system performance. A scoping review was conducted following Arksey and O’Malley, Levac, and Joanna Briggs Institute frameworks, and reported according to PRISMA-ScR guidelines. Four databases (MEDLINE, Scopus, Web of Science, and ProQuest) were searched for studies published between January 1990 and March 2026. Eligible studies included primary empirical research examining the impact of economic sanctions on health outcomes, health systems, or related determinants. A total of 32 studies were included, encompassing diverse methodological approaches. Across studies, the overall direction of the evidence was predominantly adverse, although several studies reported null or mixed findings for specific outcomes and the magnitudes and time horizons varied across episodes. Reported harms included increased mortality, worsening disease outcomes, and compromised maternal and child health. Sanctions were also associated with disruptions in health system performance, particularly through constraints in procurement, financing, and service delivery, resulting in reduced access to medicines and essential services and compromising the dual health system goals of health security and Universal Health Coverage. In addition, sanctions contributed to deterioration in key social determinants of health, including food insecurity, poverty, and reduced household income. These effects were mediated through interconnected pathways involving macroeconomic disruption, supply chain constraints, and weakened health system capacity. The available empirical evidence suggests that economic sanctions are associated with widespread and interconnected impacts on health. Recognizing sanctions as structural determinants of health may provide a useful framework for understanding their effects and informing policy decisions. Strengthening mechanisms to mitigate adverse health consequences and integrating health considerations into sanctions design are critical priorities.