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Thank you for visiting nature. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser or turn off compatibility mode in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. The growing prevalence and influence of non-state armed groups NSAGs in armed conflict requires a deeper understanding of how their territorial control and contestation affect sub-national healthcare availability and outcomes, particularly with regards to gender dynamics.
However, there are gaps in existing research in understanding how NSAG governance influences health care outcomes. Furthermore, a disconnect exists between the literature on international humanitarian interventions, NSAG governance and national health systems.
Each perspective tends to prioritise a specific health service provider—whether NSAGs, State actors, or international humanitarian organisations—and often treats populations as homogenous. To address these gaps, we propose a complex adaptive system framework centred on the influence of territorial control for health services in intra-state conflict settings, with a gender lens.
This systems framework accounts for the influence of all parties significant for health service delivery. It recognises that those governing the localised health system may differ from those physically delivering health services. Our framework enables empirical examination of health service delivery and outcomes. We apply the framework to three conflict-affected settings Colombia, Iraq, Mali using publicly available data and offer recommendations for policymakers and practitioners targeting health service provision in intra-state conflict contexts.