Impact of armed conflict on health systems and population health outcomes in Tigray, Ethiopia: a systematic review (2020–2026)

Armed conflict severely challenges health systems and population well-being, especially in fragile, resource-constrained settings. This systematic review, guided by PRISMA 2020, synthesized empirical evidence on the effects of the 2020–2026 Tigray conflict on health systems and population health. Searches of Scopus, Web of Science, PubMed/MEDLINE, Embase, ScienceDirect, Google Scholar, and Emerald Insight identified 135 records, of which 31 studies were included. The included evidence covered 29,761 live births, 189,087 households, and 31 districts, although some studies may have used overlapping populations or datasets. Findings indicated substantial reductions in healthcare access and service utilization, extensive damage to health facilities, and interruptions in medicines, workforce capacity, chronic-disease care, tuberculosis services, maternal care, and emergency services. Facility assessments reported very low functionality, while mortality studies reported under-five mortality of 59 per 1,000 live births and maternal mortality of 840 per 100,000 live births. Additional evidence documented conflict-period mortality, food insecurity and starvation-related deaths, gender-based violence, mental-health problems, WASH deficiencies, and communicable and non-communicable disease burdens. These findings indicate an association between conflict-related disruption and adverse health-system and population-health outcomes, but causal attribution remains limited by heterogeneous observational designs, retrospective reporting, and potential dataset overlap. Because substantial heterogeneity prevented quantitative pooling, no meta-analysis or meta-regression was conducted, and therefore no meta-regression statistics are reported. Overall, the evidence supports integrated recovery focused on essential services, health-system functionality, workforce, medicines, WASH, nutrition, mental health, and continuity of care. Clinical trail registration Not applicable.