Keeping Medical Education Alive in Conflict: A Resilience Framework for Continuity and Learner Well-Being

Abstract

Armed conflict severely disrupts medical education at critical moments of need. Integrating recent literature and experiences from the 12-day Israel–Iran war, we identify key challenges, including infrastructure failures, interrupted rotations, and psychological distress. We propose a “resilience package” with 3 principles: established planning, learner welfare, and institutional partnerships, while underscoring the importance of multilevel teamwork, adapted teaching, and role modeling. This framework supports education continuity, safeguards trainee well-being, and helps preserve the educational mission under challenging conditions.

Background

Armed conflict causes serious disruption to health professional education at a point of time when healthcare systems face peak demands. The learners are at risk of being the silent casualties of the war, facing displacement, interrupted training, and psychological stress. ¹ In Afghanistan, medical students expressed insecurity and declining educational quality. ² In Iraq, unsafe conditions and faculty emigration left major teaching gaps. ³ In Sudan, displacement and limited online capacity disrupted access to learning. ⁴ Consistent with the results from Ukraine ⁵ and the findings of a global review on health professional education during wars, ⁶ these studies indicate that wars damage infrastructures, the professional development, and the psychological health of learners.

Challenges in the 12-Day Conflict

Medical education in our country was affected by the multidimensional disruptions following the Israel–Iran 12-day war. Due to airstrikes, the internet was unstable, and the usual clinical rotations were suspended. Some faculty members were reassigned to provide clinical care, while relocated students were having difficulties accessing digital platforms. Despite these problems, the combined efforts of all hospital staff, from interns to fellows and attendings, together with bedside discussions, rapid debriefings, and faculty role-modeling, maintained both the training and patient care successfully. This action was like “pre-mapped preparedness,” a concept barely being referred to in previous wartime literature but acknowledged as a potential source of resilience.

Recommendations and Policy Implications

The COVID-19 pandemic has proven worldwide that e-learning and tele-simulation are effective tools, even in emergencies.^7–9 Based on international evidence ¹⁰ and our own experiences, we present a “Resilience Package” framework supported by 3 principles:

Preparedness and continuity planning: Essential rotations should be mapped in advance, and teaching activities with offline accessibility should become the norm. These should be incorporated into hospital emergency plans. This approach aligns with the Ukraine needs analysis ⁵ and the wartime scoping review findings. ⁶

Learner welfare and psychosocial support: Financial support and relocation aid are critical to assist students in times of conflict. Similar situations happened in Sudan, where training was disrupted by the anxiety and displacement, ⁴ and in Afghanistan, where professional emigration was attributed to the uncertain condition of the country. ²

Global and institutional partnerships: Cross-border mentorship, international teaching projects, and establishing temporary placements to overcome the faculty loss are the first 3 strategies that are in line with the recommendations of WHO. ⁷ Key challenges are weak infrastructure and the lack of resources. Practical solutions include decentralization of the education, basic technology refinement, and international academic support.

Conclusion

In conclusion, we recommend the “resilience package” as a framework in times of military conflicts. This package is intended to accomplish the educational mission in difficult situations and protect the welfare of the learners by integrating the literature with the recent war experience.^6,10 Therefore, organizations such as WHO, WFME, and other academic societies in the field should be the first to include resilience planning in their institutional governance policies since protecting education during armed conflict is a moral and professional obligation from which the future health workforce will emerge.