Resilience amid conflict: A qualitative study of perspectives on the provision of and experience with Sexual and Reproductive health services during war

Background: War has far-reaching impacts on health, through direct injury and death as well as indirect causes such as disruptions to health care service delivery. Sexual and reproductive health is among the most affected, due to reduced access to services, limited resources, and its frequent de-prioritization in emergency response. Lebanon, already burdened by multiple crises, was severely affected by the 2024 war, which displaced internally over one million people, mostly women and girls. To date, there has been little in-depth research exploring how Primary Health Care Centers (PHCC) have adapted to sustain services during the war. This paper draws on perspectives from key informants and service users to examine the challenges in delivering and accessing SRH services during the 2024 war on Lebanon and the efforts employed to respond to community needs. Methods: This qualitative study used grounded theory to explore key informants’ and service users’ perspectives on SRH service provision and use in Lebanese PHCCs, focusing on barriers and facilitators to contraception, family planning, and sexuality education. We conducted 20 key informant interviews with health staff and 20 focus groups with community members across 10 PHCCs in Lebanon to explore SRH service provision and user experiences. The interviews were audio-recorded and transcribed verbatim. The authors used thematic analysis to analyze the data. Results: Two main themes emerged: (1) The multifaced impacts of the 2024 war in Lebanon on SRH service delivery in PHCCs (2) The adaptive efforts employed by PHCCs to respond to community needs. The 2024 war on Lebanon exposed major systemic vulnerabilities in PHC, including reduced access, staff shortages, and eroded trust in governance. Despite these challenges, PHCCs demonstrated adaptability through mobile outreach, workforce mobilization, and community needs assessment. Central to this resilience was the civic commitment of healthcare providers who sustained SRH services amid severe strain. However, persistent service disruptions highlight the limits of individual dedication without broader system support. Conclusion: The study underscores the need to institutionalize PHCC’s adaptive responses and support healthcare providers’ resilience and civic engagement during wartime. Expanding workforce capacity, mobile services, and community assessment are key to a more resilient health system.