Abstract Background The European Neighborhood Policy (ENP) focuses on security, migration, and economic stability. Strengthening health systems can contribute to these aims by building local resilience and institutions; however, little is known about the EU’s health policy and impacts in the Southern Neighborhood (Syria, Lebanon, Jordan, Palestine, Egypt, Libya, Tunisia, Algeria, Morocco). This paper examines the role of health in the ENP and what is known about the health-related impacts of EU actions in this region. Methods This is a qualitative case study of the EU’s ENP commitments, outcomes, and impacts (2004-2024) in nine middle-income Southern Neighborhood countries. A scoping review of empirical evidence included 5 scholarly databases and grey literature published. Retrieved publications and the ENP documents were thematically analysed with WHO’s health systems building blocks and the alignment between the ENP and practice was assessed. Results ENP health actions have evolved from public health and selected communicable diseases (2004), to health service delivery, vaccine supply, and occupational health (2021). The review included 19 publications (2004-2024). Publications most often addressed the financing (n = 14 papers) and service delivery (n = 9) aspects of health systems (not mutually exclusive), and only once addressed workforce and health information. Publications addressed mostly intentional EU health actions in the region; 4 papers reported unintentional effects. Conclusions The limited scope of health actions in the ENPs suggests health may be instrumentalised to pursue the EU’s security and stability goals. The type of EU health actions reported most often in the literature were consistent with the ENP health priorities. There is no systematic evaluation of the impacts of the EU’s health-related commitments in the ENPs. To build resilience and trust in the region, future EU action should support a range of WHO building blocks and mitigate potential negative effects. Key messages • The EU’s health commitments in the European Neighborhood Policy evolved from public health & communicable diseases (2004), to health service delivery, vaccine supply, & occupational health (2021). • There is no systematic empirical evaluation of the impacts of the EU’s health-related commitments in the European Neighborhood Policy.
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