When bullets are flying, it can sound naive to talk about vaccines. Yet in several of the world’s most violent conflicts, fighting has paused—sometimes for only a few hours—so children can line up for immunizations. Doctors have crossed front lines to treat patients from opposing factions. In waiting rooms thick with suspicion, families who would never share a meal sit shoulder to shoulder over a sick child.
According to a recent study by Jason Beste and colleagues, those moments are more than humanitarian footnotes. They offer clues to how health systems, if deliberately designed, can help rebuild trust in societies fractured by war.
This study examines decades of “health and peace” efforts across the World Health Organization’s Eastern Mediterranean Region, which stretches from North Africa to parts of South and West Asia. Of the region’s 21 countries, roughly two-thirds have experienced armed conflict in recent decades. Hospitals have been bombed, supply chains shattered and medical staff driven into exile. Maternal and infant mortality have climbed, and untreated trauma lingers long after front lines shift.
Rather than viewing health systems solely as casualties of war, the researchers suggest that they can also function as connectors, which are critical to peacebuilding across divides. The intellectual roots of health-based peacebuilding reach back more than a century. The International Committee of the Red Cross (ICRC) advanced the principle of medical neutrality: even in war, the wounded and those who treat them should be protected. After World War II, the creation of the World Health Organization (WHO) reinforced the idea that health is a universal concern transcending politics.
In the late 1990s, WHO formalized that logic through its “Health as a Bridge for Peace” framework. The premise was pragmatic: even bitter enemies often agree that children should be vaccinated and epidemics contained. Shared vulnerability to disease can create rare space for dialogue.
Researchers documented examples that illustrate the point. So-called “Days of Tranquility” have been negotiated to allow vaccination campaigns during active fighting. Rival armed groups have coordinated logistics and shared information so health workers could reach contested areas. In some settings, medical staff received training not only in clinical skills but also in negotiation and conflict sensitivity. Policymakers, the study found, have at times attempted to design health services perceived as equitable across ethnic, sectarian or political divides.
A related framework, known as “Peace through Health,” treats violence itself as a public health issue. It emphasizes preventing conflict by addressing structural drivers such as inequality and exclusion, reducing harm during war and rebuilding inclusive institutions afterward. In practice, that can mean integrating mental health services for trauma survivors, strengthening primary care in marginalized communities, and ensuring transparent allocation of resources.
Recent conflicts in Yemen and Syria underscore both the promise and the limits of such approaches. Emergency relief has saved countless lives, but short-term interventions do not automatically rebuild social cohesion. Recognizing that gap, WHO launched its Global Health and Peace Initiative, which aims to embed conflict sensitivity and peacebuilding considerations into routine health programming rather than treating them as add-ons.
Still, the study is careful not to overstate the case. Health programs can be politicized, obstructed or co-opted by armed actors seeking strategic advantage. Funding often arrives in short cycles, disappearing as relationships begin to take root. Many health professionals receive limited preparation for navigating political tensions, despite operating at their center.
Perhaps most striking is the lack of rigorous evidence linking health initiatives to sustained peace outcomes. While temporary ceasefires for immunization clearly save lives, few programs have systematically measured whether they generate durable trust or social cohesion. According to the authors, that evidentiary gap makes it harder to secure long-term investment from governments and donors.
At the same time, attacks on healthcare facilities and personnel have increased in several conflicts, eroding the norm of medical neutrality that underpins these efforts. When hospitals become targets, the notion of health as neutral ground weakens, and with it the possibility of health systems playing any stabilizing role.
No clinic can substitute for political negotiation or resolve entrenched grievances. But the study argues that the manner in which healthcare is delivered sends a powerful signal. Services distributed fairly across communities communicate inclusion and shared citizenship. Unequal access, by contrast, can deepen resentment and entrench division.
In fragile states, health systems often represent one of the few remaining interfaces between citizens and public institutions. Each vaccination campaign, reopened clinic or restored supply chain can embody a basic social contract: that every life holds equal worth.
For policymakers and donors searching for practical levers in protracted conflicts, the message is measured but clear. Health interventions alone will not end wars. Yet when designed with equity, neutrality, and long-term trust in mind, they may help create the conditions in which peace becomes more plausible.
Keywords: Eastern Mediterranean, healthcare, health, systems, peace, conflict, conflict resolution
Dan Campbell
Dan served in the Peace Corps in El Salvador from 1974 to 1977 and was a member of the team that planned and launched El Salvador’s first national park. After the Peace Corps Dan worked on a series of USAID projects and for the U.S. State Department as a knowledge management specialist and assisted in the planning of information centers in Kenya, Ghana, Thailand, Nicaragua and other countries.
