Cross-border strategies for access to healthcare in violent conflict – A scoping review

Abstract

BackgroundThe geographical reconfiguration of healthcare systems in times of violent conflict is increasingly being recognised in academic literature. This includes conflict-induced, cross-border travel for medical treatment. Yet the conceptual approach to this healthcare-seeking behaviour, by a population here referred to as cross-border population, remains poorly understood. This scoping review identifies academic literature on cross-border populations to map the current approach to cross-border populations and to propose a research agenda. MethodsThe study used a scoping review following the Joanna Briggs Institute Scoping Review methodology. We included articles on conflicts between 1980 and 2019. ResultsA total of 53 articles met the inclusion criteria. From these articles, we distinguished four types of studies on cross-border healthcare: Direct analysis, implicit analysis, clinical research, and identification. The 45 articles belonging to the first three categories were then searched for themes specifically relevant to healthcare for cross-border populations and linked with sub-themes such as border crossing time and the types of healthcare available. These themes were structured into three main areas: access to care; quality of care; and governance of care. Our analysis then describes the available knowledge, documented practices, and challenges of cross-border healthcare specifically in conflict settings. ConclusionsA better understanding of cross-border healthcare systems is required to inform local practices and develop related regional and international policies. While the reviewed literature provides some highlights on various practices of cross-border healthcare, there are many gaps in available knowledge of this topic. To address these gaps, our study proposes a research framework outlining key themes and research questions to be investigated by signposting where major research and operational gaps remain. This facilitates well-directed future work on cross-border therapeutic geographies in the context of armed conflict and furthers understanding of a hitherto largely ignored area of the international healthcare system.