Introduction
The March 2026 escalation of hostilities in Lebanon, marked by sharply intensified hostilities between Israel and Hezbollah, precipitated a rapid mass displacement emergency that immediately tested shelter capacity, emergency coordination, and continuity of health services. Within days, repeated attacks and evacuation orders affecting southern Lebanon, Nabatieh, the Bekaa, Baalbek, and Beirut’s southern suburbs prompted large-scale civilian displacement across multiple regions. The speed and geographic spread of these movements required simultaneous expansion of collective sheltering and emergency medical response. By 11 March 2026, the Ministry of Public Health reported 816,700 self-registered displaced persons, including 125,800 individuals residing in 590 collective shelters, alongside 2,220 casualties since 2 March, including 634 deaths and 1,586 injuries. 1 , 2
Although displacement from southern Lebanon had occurred during earlier escalations, including the 2023-2024 border hostilities, the March 2026 event unfolded at substantially greater speed and scale. Displacement behavior in southern Lebanon has not been uniform, as some residents may remain despite insecurity because trust in available protection mechanisms may be limited.Reference Diab 3 The Lebanon Flash Appeal, issued 13 March 2026, projected 1.3 million people in need and targeted 1.0 million people for lifesaving assistance over 3 months, while emphasizing that displacement was still ongoing and planning figures were being updated as the crisis evolved. 2
Prior work has examined health system resilience during earlier displacement crises and, more recently, the pressures of war on health service delivery in Lebanon and other settings.Reference Ammar, Kdouh and Hammoud 4 -Reference Lokot, Bou-Orm and Zreik 8 However, there remains a gap in understanding how fragile health systems operationalize care during the first days of large-scale displacement. This paper addresses that gap by examining the March 2026 Lebanon displacement emergency as a case study of early-phase response, with emphasis on how population movement stressed shelter operations, decentralized service delivery, and referral pathways in a constrained health system.
Discussion
Displacement as a Public Health and Disaster Medicine Problem
Rapid mass displacement should be recognized as a disaster medicine event because it reorganizes health risk and service demand faster than stressed systems can adapt. Its significance lies less in displacement counts alone than in the way sudden population movement disrupts access to treatment, weakens referral continuity, and shifts clinical and public health burdens into shelters, host communities, and fragmented service networks.Reference Truppa, Yaacoub and Valente 7 , Reference Bausch, Beran and Hering 9 , Reference Mohammadi, Jafari and Etemadi 10 In that sense, displacement acts as a force multiplier: it converts acute insecurity into a broader systems problem involving treatment interruption, delayed presentation, communicable disease risk, and preventable deterioration.
The Lebanon case is useful because these dynamics became visible early. The response could not be organized around casualty management alone. It also had to preserve medication access, maintain links to primary care, support communicable disease surveillance, and sustain referral function while the geography of need was being rapidly reorganized. At the same time, displacement redistributed demand into receiving areas, where health facilities serving host communities were also at risk of overcrowding as newly displaced populations sought urgent, routine, and follow-up care. By 11 March 2026, WHO reported the closure of 47 primary health care centers and 5 hospitals, linkage of 531 collective shelters to primary health care centers, and hotline requests related to referral and hospitalization, chronic medication access, and cancer treatment support. 1 Because transport, staffing, supplies, and information systems may all be affected simultaneously, the health effects of displacement extend well beyond the precipitating violence.Reference Truppa, Yaacoub and Valente 7 -Reference Mohammadi, Jafari and Etemadi 10 In Lebanon, these risks are intensified by a health sector already operating with limited reserve capacity across service delivery, supplies, financing, and workforce functions.Reference Azzi, El Assaad and Haddad 5 , Reference Bou Sanayeh and El Chamieh 6 , Reference Yamout, Khalil and Raven 11
Operational Consequences
The central operational issue in this emergency was the convergence of sheltering and care continuity in a short period of time. Absorptive capacity relies on collective sites remaining health-protective through adequate sanitation, energy, and information flow.Reference Truppa, Yaacoub and Valente 7 , Reference Mohammadi, Jafari and Etemadi 10 When these conditions deteriorate, shelters compound risk through overcrowding and obscured identification of medically vulnerable individuals.
In displacement emergencies, some of the most serious health impacts arise from interruption of care for chronic disease, pregnancy-related care, disability-related needs, and other conditions that depend on repeated contact with the health system.Reference Bausch, Beran and Hering 9 , Reference Mohammadi, Jafari and Etemadi 10 Rather than waiting for evacuees to independently navigate back into ordinary care, agencies like WHO and UNICEF treated shelters directly as service-delivery sites, integrating satellite primary health care units within the first 48 hours. 1 , 12 The Lebanese national primary health care network offered an established platform for this decentralized strategy, though routine access for older adults has been historically hindered by transport and financial barriers, which are exacerbated during crises.Reference Hemadeh, Kdouh and Hammoud 13 , Reference Dableh, Frazer and Azar 14
These same dynamics also strained coordination and referral. The primary challenge was not isolated hospital crowding, but whether patients, supplies, and data could successfully navigate a disrupted geography. The Flash Appeal explicitly linked displacement management to strengthened crisis coordination, service mapping, municipal continuity, and emergency operational support, while also noting that overcrowded shelters were placing heavy pressure on water and sanitation systems. 2 This reinforces a broader disaster medicine point: surge should be understood as a network function, not simply as a hospital function.Reference Truppa, Yaacoub and Valente 7 -Reference Bausch, Beran and Hering 9 When shelters, primary care, transport, water, sanitation, hygiene, and coordination structures are weakly connected, displacement becomes a pathway through which conflict is translated into wider health-system instability.
Preparedness Implications for Fragile Settings
To mitigate the specific failures observed during the early days of a mass exodus, preparedness frameworks must adapt in 3 concrete ways:
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1. Integrated Shelter-Health Operations: Shelter and health planning must be unified from the outset. Collective shelters must be provisioned and operated as frontline medical response sites, not merely as temporary accommodation.
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2. Prioritization of NCD Continuity: Prior Lebanon-based research demonstrates that repeated shocks disrupt essential service delivery through interacting demand- and supply-side pathways.Reference Ismail, Tomoaia-Cotisel and Noubani 15 Preparedness necessitates simplified medication access and shelter-linked mobile care. Humanitarian frameworks must classify noncommunicable disease continuity as a core component of early health security, rather than a deferred recovery issue.Reference Collins, Karapici and Berlina 16
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3. Adaptive Referral Networks: Disaster responses require decentralized, contingency-based pathways connecting shelters to higher-level care, rather than relying on the assumption that pre-crisis service geographies will remain navigable.
Conclusion
The March 2026 Lebanon displacement emergency shows how quickly conflict-driven population movement can become a health systems emergency. Beyond shelter creation, the immediate challenge was preservation of safe shelter conditions, access to essential services, and referral function during rapid redistribution of need across a constrained system. Displacement preparedness in fragile settings should be organized from the outset around integrated shelter-health operations, continuity-preserving service delivery, and adaptive referral coordination. Models focused mainly on casualty surge or accommodation capacity risk missing a major source of preventable harm: treatment interruption and failed service referral during mass displacement.
Data availability statement
This article is based on analysis and synthesis of published literature and publicly available institutional reports. No original dataset was generated for this study.
Author contribution
C.S. conceived the study design. C.S. drafted the manuscript. C.M. and M.H. contributed to literature review, critical revision of the manuscript, and interpretation of the disaster medicine implications. All authors reviewed and approved the final version of the manuscript.
Competing interests
None.
Funding statement
The authors received no specific grant from any funding agency, commercial entity, or not-for-profit organization for the preparation of this manuscript.
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