# Impact of the prolonged economic crisis on healthcare delivery and workforce resilience in the Kurdistan Region of Iraq: a qualitative study

## TL;DR

This study examines how a prolonged economic crisis in the Kurdistan Region of Iraq has impacted healthcare delivery and the resilience of healthcare workers.

## Contribution

The study provides new insights into physician experiences and adaptive responses to economic instability in a healthcare system under stress.

## Key findings

- Physicians faced increased workloads, delayed salaries, and emotional exhaustion due to economic instability.
- Healthcare workers demonstrated moral resilience through volunteering and free care amid institutional inaction.
- The study identifies the need for institutional reforms to strengthen healthcare system resilience during crises.

## Abstract

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.

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.

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.

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.