Academic Journal
Impact of the prolonged economic crisis on healthcare delivery and workforce resilience in the Kurdistan Region of Iraq: a qualitative study.
| Τίτλος: | Impact of the prolonged economic crisis on healthcare delivery and workforce resilience in the Kurdistan Region of Iraq: a qualitative study. |
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| Συγγραφείς: | Mahmood KA; Faculty of General Medicine, Koya University, Koya, Kurdistan region, Iraq., Abdalla AQ; College of Nursing, University of Raparin, Rania, Sulaymaniyah, Kurdistan Region, 46012, Iraq., Sadraldeen GS; Faculty of General Medicine, Koya University, Koya, Kurdistan region, Iraq., Hawezy DJ; Faculty of General Medicine, Koya University, Koya, Kurdistan region, Iraq., M-Amin GI; Department of Business management, College of Humanity Sciences, University of Raparin, Rania, Sulaymaniyah, Kurdistan Region, 46012, Iraq., Ahmed SK; College of Nursing, University of Raparin, Rania, Sulaymaniyah, Kurdistan Region, 46012, Iraq. sirwan.k.ahmed@gmail.com., Esssa RA; School of Medicine, University of Kurdistan Hawler, Erbil, Kurdistan region, Iraq.; Rizgary Teaching Hospital, Erbil, Kurdistan Region, Iraq., Abdullah AJ; Department of Nursing, Koya Technical Institute, Erbil Polytechnic University, Erbil, Iraq.; Department of Medical Laboratory Science, Faculty of Science, Knowledge University, Erbil, Kurdistan Region, Iraq. |
| Πηγή: | BMC health services research [BMC Health Serv Res] 2026 Feb 05; Vol. 26 (1). Date of Electronic Publication: 2026 Feb 05. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : BioMed Central, [2001- |
| Ιατρικοί όροι (MeSH): | Delivery of Health Care*/economics , Physicians*/psychology , Economic Recession* , Resilience, Psychological*, Workload/psychology ; Burnout, Professional/psychology ; Humans ; Qualitative Research ; Iraq ; Salaries and Fringe Benefits ; Interviews as Topic ; Female ; Male ; Adaptation, Psychological ; Adult |
| Περίληψη: | Background: The economic crisis in the Kurdistan Region of Iraq has severely affected public sector salaries and healthcare infrastructure. These disruptions have increased pressures on the healthcare workforce and exposed gaps in the region's institutional and workforce resilience. This study explored physicians' experiences and adaptive responses to the prolonged financial instability and its consequences for healthcare delivery. Methods: A qualitative design was adopted using semi-structured interviews with 25 physicians from various specialties working in both public and private sectors across the Kurdistan Region. The study was conducted from March to August 2024 during a period of heightened financial instability. Data were analyzed thematically using a structured six-step qualitative analysis, using an inductive qualitative thematic analysis approach. Results: Ten interrelated but analytically distinct themes emerged: workload-related operational stress, salary instability, psychological stress, burnout and hopelessness, coping mechanisms, institutional inaction, clinical decisions under constraints, proposed reforms, need for support, emerging innovations, and impact on patient care. Physicians described increased workloads, delayed or reduced salaries, emotional exhaustion, and a deep sense of hopelessness. Institutional inaction compounded these challenges, forcing doctors to ration care and delay procedures. Despite adversity, participants demonstrated moral resilience through volunteering, free care, and semi-private models. Limited innovations-such as telemedicine and community outreach-were also noted. Collectively, these findings reveal a fragile health system sustained primarily by physicians' ethical commitment rather than institutional stability. Conclusion: The Kurdistan healthcare system endures economic hardship through the moral endurance and adaptability of its physicians. Sustaining healthcare quality requires transforming this individual resilience into institutional resilience through salary stabilization, leadership accountability, and structured psychosocial and professional support. Framing these findings through a resilience lens highlights the urgent need to strengthen both workforce resilience and system-level resilience to sustain healthcare delivery during prolonged crises. (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Ethical approval and consent to participate: The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Ethics Committee of the Faculty of General Medicine at Koya University (Reference number: 12/37). All participants provided written informed consent after receiving both oral and written explanations of the study’s objectives, voluntary nature, confidentiality safeguards, and right to withdraw. Consent for publication: Not applicable. Use of generative AI and AI-assisted technologies in the writing process: The authors declare that they used ChatGPT (OpenAI) to support the writing process of this article, specifically for language refinement, and improving clarity. The tool was employed to enhance the quality of expression, but did not contribute to the scientific content, data interpretation, or final conclusions of the manuscript. All AI-generated outputs were carefully reviewed, revised, and approved by the authors, who take full responsibility for the integrity and originality of the work. The use of AI adhered to ethical standards for scholarly publishing. Competing interests: The authors declare no competing interests. |
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| Contributed Indexing: | Keywords: Economic crisis; Health system reform; Healthcare delivery; Kurdistan Region of Iraq; Resource shortages; Salary instability; Telemedicine; Workforce resilience |
| Entry Date(s): | Date Created: 20260205 Date Completed: 20260706 Latest Revision: 20260813 |
| Update Code: | 20260813 |
| PubMed Central ID: | PMC12973756 |
| DOI: | 10.1186/s12913-026-14147-4 |
| PMID: | 41645193 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1472-6963 |
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| DOI: | 10.1186/s12913-026-14147-4 |