Health systems in conflict: governance fragmentation and health system resilience in the context of COVID-19 in Yemen

The importance of effective governance for health system resilience is widely recognised but empirical research on this topic remains limited. This chapter presents a case study of governance change in the context of armed conflict in Yemen as a lens for understanding how and why COVID-19 responses in-country unfolded in the ways that they did. We apply a recognised conceptual framework for governance of health system resilience. Significant pre-existing health system vulnerabilities combined with governance fragmentation in the health sector and the catastrophic impact of conflict contributed to disjointed COVID-19 responses in the two major, emerging, governance jurisdictions in Yemen. In particular, response work was undermined by - among other factors - low perceived legitimacy of central institutions, low population trust, and lack of access to stable financing flows especially in the Huthi-controlled north and west of the country. We conclude that analyses of resilience governance should incorporate financing as an additional critical component, but that further work from conflict-affected areas is needed to better understand variations in dynamics between settings.