Preparing the health sector for conflict and war

The 2026 Global Armed Conflicts Map shows elevated tensions over China’s sweeping territorial claims in the South China Sea, most especially in the West Philippine Sea. It is one of the 29 active armed conflicts being tracked, alongside the Iran-Israel War. With the rising tensions, the risk of a kinetic incident is classified as elevated—meaning there is likelihood of a collision resulting in casualties or a decision to respond militarily.

The risk of a conflict is further fueled by the move to expand Taiwan’s diplomatic presence in the country, with plans for a Taiwan-Philippines economic corridor. China has warned the Philippines about the move, while Defense Secretary Gilberto Teodoro Jr. pushed back against the warning. A year earlier, President Marcos said that the country will be drawn “kicking and screaming” into any war over Taiwan due to proximity and presence of about 200,000 Filipino workers on the island.

Weaponization of health. The deliberate weaponization of health is a tactic in modern hybrid warfare to target civilian infrastructure. Attacks on health-care infrastructure are well-documented in conflicts such as those in Ukraine, Iran, Sudan, Syria, and Gaza. Common tactics include the use of conventional warfare and missile strikes to destroy health facilities and equipment, the killing of health workers, and the militarized targeting of social determinants of health—food, water, and shelter—to amplify health-care needs while cutting off critical access to care.

In the event of a hybrid warfare and targeting of critical health infrastructure, the civilian healthcare system that accounts for over 90 percent of health facilities, will bear the burden of patient care. Its lack of preparedness to manage casualties on a large scale would repeat the COVID-19 pandemic experience, resulting in an easily overwhelmed health system.

Preparing the health sector. The civilian health-care system must be prepared as part of military and strategic planning using the Political, Military, Economic, Social, Information, Infrastructure, Physical Environment, and Time Framework to facilitate decision-making for immediate crisis mitigation and strategic foresight.

The government needs to establish a national response framework on military-civilian integration to mobilize the civilian health-care system efficiently. Military-civilian partnerships will provide additional staffing, training, and preparedness resources. A military-unique curriculum will equip the workforce with the necessary combat casualty care competencies. This will translate to wartime innovations in trauma and critical care, infection control, mental health, and other specialties.

The government will need a national investment plan to help prepare for potential conflict and wartime conditions. This funding proposal will support investment in critical services and infrastructure to strengthen the health sector for crisis conditions.

From lessons during the COVID-19 pandemic, transparent communication is an important pillar to promote trust and combat misinformation. A written emergency response plan should outline leadership roles and strategies, including triage and prioritization decisions and potential relocation areas. Civilian consequences to be managed include widespread war anxiety and panic. The scenario of responding to the health needs of Taiwan refugees also needs to be considered. Health workers as frontliners will require interventions and support for their own health and needs, and the appropriate resources should be made available to them.

Lessons from conflicts in Ukraine and Palestine showed the importance of physical protection of health facilities including explosion protection for windows, bomb shelters, sandbags to cover windows, and use of pressure-resistant doors. Power instability should be anticipated, making electric generators, batteries, and other sources available. A water supply plan will allow identification of alternative on-site water sources for health facilities. Internal and external communication systems need to be established, ensuring uninterrupted access to the Internet to deliver telemedicine services and reliable information. With the common use of chemical, biological, radiological, or nuclear (CBRN) weapons, readiness of hospitals for such CBRN emergencies should be assessed, and any gaps urgently addressed.

The health sector continues to be vulnerable in the face of heightened geopolitical tensions. A proactive unified national approach and investment plan will save lives and avert unnecessary deaths. As the saying goes, “The best time to start was yesterday. The next best time is now.”

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Dr. Kenneth Y. Hartigan-Go is a senior research fellow of the Ateneo Policy Center, Ateneo School of Government, and leads the Health Governance Program that tackles issues in the health-security nexus. Arianna Maever L. Amit is a nonresident research fellow in the same institution.