Economic sanctions linked to worse health outcomes in scoping review of 32 studies

Economic sanctions, widely deployed as instruments of foreign policy, are associated with adverse effects on population health and on the performance of health systems, according to a scoping review of primary empirical evidence published in the journal Conflict and Health. The review, led by Mohannad Al Nsour and colleagues, set out to systematically map and synthesize observed data on the associations between economic sanctions and health outcomes and health system performance, in a field the authors describe as fragmented and often dominated by non-empirical commentary.

To build the evidence base, the researchers followed the Arksey and O’Malley, Levac, and Joanna Briggs Institute scoping review frameworks and reported their methods according to the PRISMA-ScR guidelines. They searched four databases—MEDLINE, Scopus, Web of Science, and ProQuest—for studies published between January 1990 and March 2026. Eligible studies had to be primary empirical research examining the impact of economic sanctions on health outcomes, health systems, or related determinants, a criterion designed to exclude opinion pieces and secondary commentary in favor of studies based on observed data.

The search yielded 32 included studies encompassing diverse methodological approaches. Across this body of work, the overall direction of the evidence was predominantly adverse, although the review is careful to note that several studies reported null or mixed findings for specific outcomes, and that the magnitudes and time horizons of the effects varied across different sanction episodes. This heterogeneity means the picture is not uniform: the weight of the evidence points toward harm, but individual studies and individual outcomes did not always align with that pattern.

Among the reported harms were increased mortality, worsening disease outcomes, and compromised maternal and child health. These are the headline findings of the review in terms of direct health outcomes, and they emerged from the pool of primary empirical studies rather than from narrative or advocacy literature. The authors emphasize that the evidence concerns associations observed in the included studies, with effects that differed in scale and duration depending on the episode examined.

Beyond direct health outcomes, the review found that sanctions were associated with disruptions in health system performance. The mechanisms described were particularly operational: constraints in procurement, financing, and service delivery. These constraints resulted in reduced access to medicines and essential services, and the authors argue that they compromise the dual goals that health systems are meant to achieve—health security and Universal Health Coverage. In other words, the damage documented in the evidence is not only measured in disease and death but also in the capacity of health systems to function under sanction conditions.

The review also documented deterioration in key social determinants of health. Sanctions were associated with food insecurity, poverty, and reduced household income in the included studies. These findings situate the health effects of sanctions within a broader socioeconomic context, since the conditions that shape health outcomes extend well beyond clinics and hospitals into households and food systems.

A central analytical contribution of the review is its description of how these effects are connected. The authors report that the observed impacts were mediated through interconnected pathways involving macroeconomic disruption, supply chain constraints, and weakened health system capacity. Rather than a single channel running from sanctions to poor health, the evidence points to a web of mechanisms: sanctions disrupt the wider economy, which constrains supply chains and household resources, which in turn weakens the health system’s ability to procure medicines, finance services, and deliver care.

The authors conclude that the available empirical evidence suggests economic sanctions are associated with widespread and interconnected impacts on health. They propose that recognizing sanctions as structural determinants of health may provide a useful framework for understanding their effects and informing policy decisions. On this framing, sanctions would be considered alongside other large-scale social and economic forces that shape population health, rather than being treated solely as matters of diplomacy and economics with incidental health side effects.

Looking forward, the review identifies two critical priorities: strengthening mechanisms to mitigate adverse health consequences, and integrating health considerations into the design of sanctions regimes. As a scoping review, the study maps and synthesizes the existing primary empirical evidence rather than producing new estimates of effect, and its conclusions rest on 32 studies whose designs, magnitudes, and time horizons varied. The authors note that the field has historically mixed empirical and non-empirical evidence, limiting conclusions based on observed data—a limitation this review was explicitly designed to address by restricting inclusion to primary empirical research.

The article was published open access on 25 September 2026 in Conflict and Health, with the author team including Mohannad Al Nsour, Aws Rababah, Awad Mataria, Yousef Khader, and Haitham Bashier.

Subject of Research: A scoping review of primary empirical evidence on the associations between economic sanctions and health outcomes and health systems.

Article Title: The impact of economic sanctions on health outcomes and health systems: a scoping review of primary empirical evidence

Article References: Al Nsour, M., Rababah, A., Mataria, A., Khader, Y., & Bashier, H. (2026). The impact of economic sanctions on health outcomes and health systems: a scoping review of primary empirical evidence. Conflict and Health. https://doi.org/10.1186/s13031-026-00843-9

Image Credits: AI Generated

DOI: 10.1186/s13031-026-00843-9

Keywords: economic sanctions, scoping review, health outcomes, health systems, mortality, maternal and child health, Universal Health Coverage, food insecurity, social determinants of health, medicine access, PRISMA-ScR, Conflict and Health