Title : A roadmap for post-crisis health system recovery in Gaza based on the who health system building blocks framework

Background: This study addresses the critical gap between theoretical frameworks and actionable strategies for health system recovery in fragile, conflict-affected settings, with a specific focus on the Gaza Strip following the catastrophic 2023 crisis. The research aims to create a comprehensive, contextualized, and stakeholder-informed roadmap for reconstructing Gaza's devastated health system using the World Health Organization's (WHO) Health System Building Blocks as an analytical framework.

Methods: A qualitative methodological approach was adopted, involving semi-structured interviews conducted online with nine key Palestinian stakeholders, including representatives from the Palestinian Ministry of Health (MoH), hospital directors, as well as officials from various international and national non-governmental organizations. Data analysed using thematic analysis and guided by WHO health system building blocks framework.

Results: The findings emphasize the necessity to address socio-political issues in addition to technical recovery. Rehabilitating a formal primary healthcare network with a digital referral system and incorporating the wartime adaptations into a phased, geographically intelligent design are key components. To ensure retention and capacity building, the health workforce needs comprehensive support that addresses safety, dignity, financial precarity, and psychological trauma. Restoring the Health Information System (HIS) must prioritize interoperability and actionable analytics, positioning it as a central nervous system for care coordination, financial accountability, and supply chain management. The supply chain of medicines and supplies require a paradigm change from a fragmented donation-driven model to a strategic commodities system under state management. A transparent, multi-year national health recovery fund under national leadership is necessary to change health finance's reliance on donors. Crucially, the study found that policymakers and implementers had significant governance perception gap, highlighting the necessity of an inclusive, authoritative steering platform.

Conclusion: By converting theoretical concepts into practical, tailored strategies, this work bridges a significant implementation gap and advances academic knowledge of health system resilience in protracted conflict. The study concludes that a successful recovery is essentially a political and justice-oriented undertaking. Radical transparency, a clear dedication to Palestinian leadership, and the persistent pursuit of the right to health as its ultimate goal are all crucial.

Dr Othman Alagha is a dedicated healthcare professional with a strong medical background and extensive experience in medical education and teaching. Dr Alagha recently completed an MSc in Public Health (with Distinction) from Sheffield Hallam university.