Health System Fragility in Conflict: Implications for Women’s Maternal, Sexual, and Reproductive Health in Syria, and The Democratic Republic of Congo

Within conflict-affected settings, women’s sexual and reproductive health (SRH) is disproportionately affected by health systems collapse, gendered violence, and displacement. Using a comparative qualitative case study approach of the Syrian conflict and the Democratic Republic of Congo (DRC), this thesis explores how conflict-driven health system disruption shapes women’s SRH outcomes and examines how global health and policy frameworks translate into practice in conflict settings. Employing a deductive content analysis of over 60 humanitarian and policy documents published by international organisations, including the World Health Organization (WHO), United Nations agencies, Médecins Sans Frontières (MSF), and Human Rights Watch, the analysis centres on women’s gendered health experiences as reported in these documents and assesses whether policy commitments are meaningfully implemented in practice. The findings demonstrate how widespread destruction of healthcare infrastructure, sexual violence, and socio-economic and cultural barriers restrict women’s SRH care in conflict. Global policy frameworks recognise gender-sensitive interventions as priorities, but implementation is undermined by short-term emergency responses, funding constraints, and health system collapse. Fragmented and temporary interventions to women’s health are evident across both conflicts, with limited sustainable systemic healthcare. The thesis argues that policy intentions and documented outcomes remain disconnected, illustrating deep inequalities within conflict-affected health systems. Meaningful interventions to women’s SRH require long-term implementation, sustained investment, and context-specific gender-focused action during conflict periods.