{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T20:54:45Z","timestamp":1782766485989,"version":"3.54.5"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":59,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012155","name":"Iran\u2019s National Institute for Medical Research Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012155","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004484","name":"Tehran University of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004484","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Prolonged economic sanctions\u2014often framed as non-military tools\u2014have increasingly harmed health systems, especially where institutional and policy capacities are fragmented. Despite the growing debate on sanctions, documented analyses of health system responses remain scarce. This study examines Iran to assess how prolonged sanctions shaped its health policy architecture and resilience capacity, with attention to compounded crises such as COVID-19.<\/jats:p>\n                  <jats:p>Phase one synthesized seven empirical studies conducted by the authors\u2014including document reviews, interviews, Delphi, and policy analyses\u2014to assess how resilience principles were embedded across the four stages of the health policy cycle: agenda-setting, policy formulation, implementation, and evaluation. These findings formed the foundation for Phase two, which applied an expanded Theory of Change (ToC) framework to reconstruct policy logics, surface implicit assumptions, and identify institutional breakpoints. After modelling the ToC, a panel of experts reviewed and validated the findings, ensuring methodological rigour and contextual accuracy in mapping resilience under sanctions.<\/jats:p>\n                  <jats:p>The findings indicate that while Iranian health authorities implemented adaptive measures, responses were shaped by fragmented coordination, untested assumptions, and limited structured learning systems. Resilience limitations emerged during implementation and were embedded in early design phases, not fully anticipated or addressed, given the complex and uncertain policy environment.<\/jats:p>\n                  <jats:p>This study offers an analytical framework for mapping resilience in policy systems under long-term constraints. Building on identified governance and design weaknesses, we recommend strengthening international legal safeguards; establishing protected humanitarian corridors; institutionalizing risk-informed planning; routine scenario-based resilience testing; and feedback-driven learning mechanisms within national policy systems. These capacities are essential to absorb shocks and enable adaptive, inclusive, sustainable responses. By clarifying structural domains where resilience can be embedded in advance, the analysis offers guidance for countries under comparable pressures to target strategies in governance, planning, and resource protection. This provides a transferable blueprint for strengthening justice-oriented health systems under long-term constraints.<\/jats:p>","DOI":"10.1093\/heapol\/czaf091","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:06:05Z","timestamp":1765458365000},"page":"i38-i52","source":"Crossref","is-referenced-by-count":1,"title":["Advancing justice and sustainability through health system resilience under economic sanctions"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8429-5261","authenticated-orcid":false,"given":"Reza","family":"Majdzadeh","sequence":"first","affiliation":[{"name":"School of Health and Social Care, University of Essex , Wivenhoe Park, Colchester, CO4 3SQ ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0897-4080","authenticated-orcid":false,"given":"Haniye Sadat","family":"Sajadi","sequence":"additional","affiliation":[{"name":"Knowledge Utilization Research Center, Tehran University of Medical Sciences , # 1547, North Kargar, 7th floor, Apt 7, 14179, Tehran ,","place":["Iran"]},{"name":"University Research and Development Center, Tehran University of Medical Sciences , # 12, East Nosrat, North Kargar, 14179, Tehran ,","place":["Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"2026062905314825200_czaf091-B1","first-page":"137","article-title":"A historical overview of sanctions on Iran and Iran's nuclear program","volume":"14","author":"Aghazadeh","year":"2013","journal-title":"J Acad Stud"},{"key":"2026062905314825200_czaf091-B2","doi-asserted-by":"publisher","first-page":"e10363","DOI":"10.1002\/lrh2.10363","article-title":"Exploring nationwide policy interventions to control COVID-19 from the perspective of the rapid learning health system approach","volume":"8","author":"Ahmadi","year":"2024","journal-title":"Learn Health Syst"},{"key":"2026062905314825200_czaf091-B3","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s12961-024-01114-w","article-title":"Concept analysis of health system resilience","volume":"22","author":"Al Asfoor","year":"2024","journal-title":"Health Res Policy Syst"},{"key":"2026062905314825200_czaf091-B4","doi-asserted-by":"publisher","first-page":"491","DOI":"10.15171\/ijhpm.2018.06","article-title":"What is resilience and how can it be nurtured? 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