Health system and oral health impacts of economic sanctions and blockades: a PRISMA-ScR–guided scoping review with lessons for Yemen

Health system and oral health impacts of economic sanctions and blockades: a PRISMA-ScR–guided scoping review with lessons for Yemen | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Health system and oral health impacts of economic sanctions and blockades: a PRISMA-ScR–guided scoping review with lessons for Yemen Salah M. Bin Hafedh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8789468/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Economic sanctions, embargoes, and blockades are globalization-related policy instruments that reshape cross-border trade, financial flows, and humanitarian access, with downstream effects on health systems. Oral health services are particularly vulnerable because they depend on stable international supply chains for dental materials, local anesthesia, and infection-control consumables. Objectives: To map and synthesize the available evidence on how economic blockades/sanctions affect health systems and oral health, and to derive transferable lessons relevant to Yemen. Methods: A PRISMA-ScR–guided scoping review was conducted. MEDLINE/PubMed, Web of Science, Scopus, WHO IRIS, ReliefWeb and targeted UN/humanitarian sources were searched from inception to 05 December 2025. Eligible sources included peer-reviewed empirical studies and rigorously produced reports linking sanctions/embargoes/blockades to health-system outcomes and/or oral-health outcomes. Screening and data charting were performed by the author using pre-specified criteria; uncertainties were resolved by inclusion at screening and documented at full text. Results: Of 150 records identified, 50 duplicates were removed before screening. One hundred records were screened; 20 reports were sought for retrieval; 15 were assessed for eligibility; and 10 sources of evidence were included (Cuba, Iraq, Haiti, South Africa, Yemen). Across settings, recurring pathways included constrained imports (medicines, fuel, and clinical consumables), macro-financing shocks, infrastructure degradation, workforce attrition, reduced service availability, and widening inequities. Direct oral-health evidence was sparse, but multiple sources described dental supply disruption, infection-control constraints, and increased unmet need. Conclusions: The health impact of sanctions/blockades is mediated by governance, exemption feasibility, and system resilience. Protecting primary care, prevention and essential supply chains can buffer harm, whereas fragile systems incur disproportionate losses. For Yemen, priorities include protected medical/dental supply corridors, workable financial/banking channels for exempt goods, integration of essential oral health into humanitarian health packages, and reinforcement of public primary care and prevention. globalization economic sanctions blockade embargo health systems supply chains humanitarian access oral health Yemen Figures Figure 1 Introduction Economic sanctions, embargoes and blockades are increasingly used within global governance and geopolitical strategies, often operating through trade, finance and mobility restrictions that reverberate through health systems and social determinants of health. While humanitarian exemptions are commonly specified, implementation barriers (e.g., banking de-risking, licensing delays, and disrupted shipping/insurance) can still constrain access to essential medicines and medical supplies. [1] In conflict settings, these restrictions interact with violence, market fragmentation, and institutional breakdown, creating compounded shocks to service delivery. In Yemen, the health emergency is characterized by widespread facility dysfunction, with major drivers including shortages of staff, funds, electricity, medicines, and equipment. [16] Operationally, fuel scarcity is a recurrent constraint because it powers health facilities, cold chains, and the transport of patients and supplies; WHO has repeatedly implemented fuel support to keep facilities functional. [17] Oral health is often excluded from emergency health benefit packages despite its links to pain, infection, nutrition, and dignity. WHO policy work emphasizes integrating essential oral health care into primary care and universal health coverage, including emergency care, prevention, treatment of common conditions, and provision of essential oral health supplies. [18-20] In crisis contexts, a minimum package approach such as the WHO Basic Package of Oral Care offers a pragmatic framework for maintaining urgent and basic dental services when resources and supply chains are disrupted. [19] Oral health is integral to health and well-being, yet oral health services and dental public-health programs are especially sensitive to supply-chain disruption because they rely on imported dental materials, anesthetics, sterilization and infection-control consumables, and functioning referral pathways. In fragile and conflict-affected settings, these vulnerabilities can translate into deferred urgent care, preventable complications, and widening inequities. Yemen provides a high-stakes case where protracted conflict, import dependence, and restrictions affecting ports, fuel and financial channels have contributed to severe service disruption and humanitarian need. This scoping review focuses on sanctions/blockades as conflict-era policy instruments and extracts transferable lessons for health systems and oral health programming in Yemen and similar fragile settings. Review questions (PCC framework): Population: populations living in settings affected by economic sanctions/embargoes/blockades. Concept: impacts on health systems (service availability, financing, workforce, supplies, governance) and oral health services/programmes. Context: low-, middle- and high-income settings where sanctions/embargoes/blockades were implemented. Primary questions: (1) What health-system and oral-health impacts have been reported in embargo/sanctions/blockade settings? (2) Through what mechanisms do these measures affect health systems and oral health? (3) What transferable policy and program lessons are relevant to Yemen? Methods Design and reporting: This scoping review followed PRISMA-ScR reporting guidance and JBI scoping review methodology. PRISMA-ScR is used for transparent reporting of scoping reviews, including eligibility criteria, information sources, selection processes and evidence mapping. [2-3] Protocol: No protocol was registered before commencing the review. This was due to the applied, time-sensitive policy focus and resource constraints. To mitigate bias, eligibility criteria, information sources, and charting fields were defined a priori and are provided in Supplementary materials (Additional file 1; PRISMA-ScR checklist). Eligibility criteria: Included sources were (i) peer-reviewed empirical studies (quantitative, qualitative, or mixed methods) and (ii) rigorously produced institutional reports (e.g., WHO/UN/major humanitarian organizations) that explicitly linked sanctions/embargoes/blockades to health-system outcomes and/or oral-health outcomes. Opinion-only pieces without empirical or documentary evidence, purely economic analyses without health outcomes, and sources unrelated to sanctions/blockades were excluded. Information sources and search strategy: Searches were conducted in MEDLINE/PubMed, Web of Science Core Collection and Scopus, and in WHO IRIS and ReliefWeb. Targeted searches of UN/humanitarian portals were also conducted for Yemen-relevant documentation. The final search date was 05 December 2025. A reproducible PubMed strategy is provided in the Supplementary search appendix. Selection process: Screening was performed by the author (SMBH). Titles/abstracts were screened first, followed by full-text assessment. Where eligibility was uncertain at title/abstract, records were retained for full-text review. Full-text exclusion reasons were logged and are reported in Supplementary Table S1 (Additional file 3). Data charting and synthesis: A standardized charting form captured publication type, setting, sanctions mechanism, outcomes and key findings. Evidence was synthesized narratively and mapped by country and by pathway (trade/supply chains, financing/banking, infrastructure, workforce, service delivery, equity). Critical appraisal: Although not mandatory for scoping reviews, a pragmatic appraisal was conducted to inform interpretation. Peer-reviewed observational studies were appraised using the AXIS tool for cross-sectional designs where applicable, and grey-literature reports were appraised using the AACODS checklist. Appraisal results are summarized in Additional file 2 and are not used as exclusion criteria. [4] [5] Results Study selection Searches identified 150 records; 50 duplicates were removed before screening, leaving 100 records for title/abstract screening. After screening (n = 100), 20 reports were sought for retrieval; five were not retrieved. Fifteen full texts were assessed; five were excluded with reasons; and 10 sources of evidence were included in the review (Fig. 1 ). Full-text exclusions with reasons are listed in Supplementary Table S1 (Additional file 3). Characteristics of included sources Table 1 Characteristics of included sources of evidence (n = 10). Source Country / period Design / type Sanctions/blockade exposure Key health-system outcomes Oral-health relevance Spiegel & Yassi (2004) Cuba Policy/case analysis US embargo Primary-care orientation; resilience mechanisms Notes prevention orientation; indirect relevance to oral health Drain & Barry (2010) Cuba Review/commentary with data US embargo Medicine/supply constraints; outcomes paradox Highlights supply constraints affecting care broadly Ali et al. (2000) Iraq Cross-sectional survey analysis UN sanctions (1990s) Childhood mortality signals; regional differences No direct oral-health outcomes Daponte & Garfield (2000) Iraq Demographic analysis UN sanctions (1990s) Child mortality estimates; health system deterioration context No direct oral-health outcomes Gibbons & Garfield (1999) Haiti Empirical analysis Embargo (1991–1994) Nutrition/mortality/service use declines No direct oral-health outcomes Coovadia et al. (2009) South Africa Historical/policy analysis Sanctions within political transition Health inequities; system reforms post-transition No direct oral-health outcomes Qirbi & Ismail (2017) Yemen Health policy & planning case study Conflict + restrictions affecting imports/access Facility functionality, workforce, financing constraints Mentions service constraints relevant to dental care Safi et al. (2020) Yemen Geospatial analysis Conflict setting with access constraints Access to healthcare; facility functionality distribution Applies to dental service access World Bank (2021) Yemen Policy note/report Macroeconomic/import constraints in conflict Health financing, system gaps, policy priorities Notes supply and service constraints OMCT (2022) Yemen Human rights/advocacy report Economic blockade Humanitarian access, imports and essential goods constraints Mentions medical/dental supply impacts (qualitative) Critical appraisal summary Critical appraisal was conducted to support interpretation (not to exclude evidence). Across included sources, reporting quality varied, with common limitations including incomplete description of data sources and potential confounding from co-occurring conflict and macroeconomic shocks. Appraisal judgments for each source are provided in Additional file 2. Synthesis of findings Across contexts, sanctions/blockades influenced health systems through interlinked pathways: (1) constrained imports and disrupted supply chains; (2) macro-financing and banking constraints; (3) infrastructure degradation (fuel/electricity/water); (4) workforce attrition and unpaid salaries; (5) reduced service availability and quality; and (6) widening inequities, particularly affecting vulnerable groups. Cuba: multiple analyses describe how strong primary care, prevention, and public-sector orientation buffered embargo-related resource constraints, with system design playing a mediating role. [6–7] Iraq: empirical analyses during the 1990s sanctions period reported increased childhood mortality indicators and severe constraints on medicines, water/sanitation and health system functioning, complicating attribution because of overlapping conflict impacts. [8–9] Haiti: embargo-era analyses reported deteriorations in nutrition and child mortality and declines in service use, illustrating how trade and aid restrictions can cascade into avoidable health losses. [10] South Africa: sanctions interacted with broader political economy changes; the post-transition period included major policy reforms, but deep inequities persisted, emphasizing the importance of governance and redistribution mechanisms. [11] Y Discussion This scoping review maps evidence across five country contexts and identifies consistent globalization-related mechanisms through which sanctions/blockades affect health systems: constraining cross-border trade and logistics, restricting finance and payment channels, and limiting humanitarian access. These mechanisms can reduce availability of essential medicines and clinical consumables, undermine service delivery, and widen inequities. [1] A key cross-context lesson is the mediating role of health system resilience and governance. Settings with strong primary care, prevention and publicly coordinated service delivery appear better able to absorb external shocks, whereas fragile systems experience cascading failures across infrastructure, workforce and supply chains. For Yemen, where import dependence is high and conflict has damaged infrastructure, sanctions-like constraints can magnify shortages and disrupt continuity of care. [6–7,11–14] Oral health evidence was limited relative to broader health system evidence, reflecting chronic under-representation of oral health in humanitarian and health-systems research. Nevertheless, multiple pathways directly implicate oral health services: (i) supply disruptions for anesthetics, restorative materials and infection-control items; (ii) fuel/power interruptions affecting sterilization and clinic operations; and (iii) prioritization patterns within humanitarian health packages that often exclude basic oral health services. [12–15] Policy implications for Yemen include: protected supply corridors for medical and dental goods; practical financial/banking mechanisms to operationalize exemptions; inclusion of essential oral health interventions (pain relief, infection control, emergency care, atraumatic restorative treatment and prevention) in humanitarian health packages; and reinforcement of primary care and community prevention as shock absorbers. These align with the journal’s emphasis on how globalization mechanisms shape health system performance and equity. Limitations: The evidence base is heterogeneous and causal attribution is challenging because sanctions/blockades often co-occur with armed conflict and economic crises. The review included English-language sources, which may introduce language bias. Screening was conducted by a single reviewer; this was mitigated by conservative inclusion at screening and transparent documentation of exclusion reasons. Finally, oral health–specific outcomes were rarely measured, limiting specificity of inferences. Conclusions Economic blockades and sanctions affect health systems through globalization-linked channels that disrupt trade, finance and humanitarian access. Health system resilience and governance mediate the magnitude of harm. In Yemen, feasible mitigation includes protected supply chains, workable exemptions, and integration of essential oral health into humanitarian and primary-care strategies. Declarations Ethics approval and consent to participate: Not applicable (review of published and archival sources). Consent for publication: Not applicable. Availability of data and materials: All data extracted are contained within the article and its supplementary files (Additional files 1–3). Competing interests: The author declares no competing interests. Funding: No external funding was received. Authors’ contributions: SMBH conceived the study, designed the search and eligibility criteria, performed screening and data charting, interpreted findings, and drafted/revised the manuscript. AI assistance statement: The author used a large language model (ChatGPT, OpenAI) for language polishing and formatting support. All scientific content, interpretations, and references were verified by the author. References Pintor MP, et al. The impact of economic sanctions on health and health systems in low- and middle-income countries: a systematic review. BMJ Global Health. 2023;8:e010968. doi:10.1136/bmjgh-2022-010968. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467–473. doi:10.7326/M18-0850. Peters MDJ, Godfrey C, McInerney P, et al. JBI Manual for Evidence Synthesis: Chapter 10 Scoping reviews (updated guidance). Joanna Briggs Institute. 2024. Downes MJ, Brennan ML, Williams HC, Dean RS. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open. 2016;6:e011458. doi:10.1136/bmjopen-2016-011458. Tyndall J. AACODS checklist. Flinders University; 2010. Spiegel JM, Yassi A. Lessons from the margins of globalization: appreciating the Cuban paradox. J Public Health Policy. 2004;25(1):96–121. doi:10.1057/palgrave.jphp.3190007. Drain PK, Barry M. Fifty years of U.S. embargo: Cuba’s health outcomes and lessons. Science & Diplomacy. 2010; (as archived on PubMed Central). Ali MM, Shah IH. Sanctions and childhood mortality in Iraq. Lancet. 2000;355:1851–1857. doi:10.1016/S0140-6736(00)02289-3. Daponte BO, Garfield R. The effect of economic sanctions on the mortality of Iraqi children prior to the 1991 Persian Gulf War. Am J Public Health. 2000;90(4):546–552. Gibbons E, Garfield R. The impact of economic sanctions on health and human rights in Haiti, 1991–1994. Am J Public Health. 1999;89(10):1499–1504. doi:10.2105/AJPH.89.10.1499. Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. The health and health system of South Africa: historical roots of current public health challenges. Lancet. 2009;374(9692):817–834. doi:10.1016/S0140-6736(09)60951-X. Qirbi N, Ismail SA. Health system functionality in a low-income country in the midst of conflict: the case of Yemen. Health Policy Plan. 2017;32(6):911–922. doi:10.1093/heapol/czx031. Safi S, et al. Estimating access to health care in Yemen: a descriptive geospatial analysis. Lancet Glob Health. 2020;8(11):e1435–e1443. doi:10.1016/S2214-109X(20)30359-4. World Bank. Health Sector in Yemen – Policy Note. 2021. World Organisation Against Torture (OMCT). Torture in slow motion: The economic blockade of Yemen and its grave humanitarian consequences. 2022. World Health Organization. Yemen Health Emergency (Yemen crisis). Page last updated 11 April 2024. Accessed 4 Feb 2026. World Health Organization, Regional Office for the Eastern Mediterranean (WHO EMRO). Support to health facilities – Yemen (includes diesel/fuel delivery to keep facilities functional). Accessed 4 Feb 2026. World Health Organization. Global strategy and action plan on oral health 2023–2030. Published 26 May 2024. Accessed 4 Feb 2026. Frencken JE, Holmgren CJ, van Palenstein Helderman WH. Basic Package of Oral Care (BPOC). World Health Organization / Nijmegen; 2002. Accessed 4 Feb 2026. Benzian H, Beltrán-Aguilar E, Mathur MR, Niederman R. Pandemic considerations on essential oral health care. J Dent Res. 2020 Dec 9;100(3):221-225. doi:10.1177/0022034520979830. Additional Declarations No competing interests reported. Supplementary Files Additionalfile3TableS1Fulltextexclusions.docx Additionalfile2QualityAssessmentTableFINAL.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8789468","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":585891898,"identity":"b654db70-f05d-445e-9b3e-57b075fb6d5f","order_by":0,"name":"Salah M. 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While humanitarian exemptions are commonly specified, implementation barriers (e.g., banking de-risking, licensing delays, and disrupted shipping/insurance) can still constrain access to essential medicines and medical supplies. [1]\u003c/p\u003e\n\u003cp\u003eIn conflict settings, these restrictions interact with violence, market fragmentation, and institutional breakdown, creating compounded shocks to service delivery. In Yemen, the health emergency is characterized by widespread facility dysfunction, with major drivers including shortages of staff, funds, electricity, medicines, and equipment. [16] Operationally, fuel scarcity is a recurrent constraint because it powers health facilities, cold chains, and the transport of patients and supplies; WHO has repeatedly implemented fuel support to keep facilities functional. [17]\u003c/p\u003e\n\u003cp\u003eOral health is often excluded from emergency health benefit packages despite its links to pain, infection, nutrition, and dignity. WHO policy work emphasizes integrating essential oral health care into primary care and universal health coverage, including emergency care, prevention, treatment of common conditions, and provision of essential oral health supplies. [18-20] In crisis contexts, a minimum package approach such as the WHO Basic Package of Oral Care offers a pragmatic framework for maintaining urgent and basic dental services when resources and supply chains are disrupted. [19]\u003c/p\u003e\n\u003cp\u003eOral health is integral to health and well-being, yet oral health services and dental public-health programs are especially sensitive to supply-chain disruption because they rely on imported dental materials, anesthetics, sterilization and infection-control consumables, and functioning referral pathways. In fragile and conflict-affected settings, these vulnerabilities can translate into deferred urgent care, preventable complications, and widening inequities.\u003c/p\u003e\n\u003cp\u003eYemen provides a high-stakes case where protracted conflict, import dependence, and restrictions affecting ports, fuel and financial channels have contributed to severe service disruption and humanitarian need. This scoping review focuses on sanctions/blockades as conflict-era policy instruments and extracts transferable lessons for health systems and oral health programming in Yemen and similar fragile settings.\u003c/p\u003e\n\u003cp\u003eReview questions (PCC framework):\u003cbr\u003e\u0026nbsp;Population: populations living in settings affected by economic sanctions/embargoes/blockades.\u003cbr\u003e\u0026nbsp;Concept: impacts on health systems (service availability, financing, workforce, supplies, governance) and oral health services/programmes.\u003cbr\u003e\u0026nbsp;Context: low-, middle- and high-income settings where sanctions/embargoes/blockades were implemented.\u003cbr\u003e\u0026nbsp;Primary questions: (1) What health-system and oral-health impacts have been reported in embargo/sanctions/blockade settings? (2) Through what mechanisms do these measures affect health systems and oral health? (3) What transferable policy and program lessons are relevant to Yemen?\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eDesign and reporting: This scoping review followed PRISMA-ScR reporting guidance and JBI scoping review methodology. PRISMA-ScR is used for transparent reporting of scoping reviews, including eligibility criteria, information sources, selection processes and evidence mapping. [2-3]\u003c/p\u003e\n\u003cp\u003eProtocol: No protocol was registered before commencing the review. This was due to the applied, time-sensitive policy focus and resource constraints. To mitigate bias, eligibility criteria, information sources, and charting fields were defined a priori and are provided in Supplementary materials (Additional file 1; PRISMA-ScR checklist).\u003c/p\u003e\n\u003cp\u003eEligibility criteria: Included sources were (i) peer-reviewed empirical studies (quantitative, qualitative, or mixed methods) and (ii) rigorously produced institutional reports (e.g., WHO/UN/major humanitarian organizations) that explicitly linked sanctions/embargoes/blockades to health-system outcomes and/or oral-health outcomes. Opinion-only pieces without empirical or documentary evidence, purely economic analyses without health outcomes, and sources unrelated to sanctions/blockades were excluded.\u003c/p\u003e\n\u003cp\u003eInformation sources and search strategy: Searches were conducted in MEDLINE/PubMed, Web of Science Core Collection and Scopus, and in WHO IRIS and ReliefWeb. Targeted searches of UN/humanitarian portals were also conducted for Yemen-relevant documentation. The final search date was 05 December 2025. A reproducible PubMed strategy is provided in the Supplementary search appendix.\u003c/p\u003e\n\u003cp\u003eSelection process: Screening was performed by the author (SMBH). Titles/abstracts were screened first, followed by full-text assessment. Where eligibility was uncertain at title/abstract, records were retained for full-text review. Full-text exclusion reasons were logged and are reported in Supplementary Table S1 (Additional file 3).\u003c/p\u003e\n\u003cp\u003eData charting and synthesis: A standardized charting form captured publication type, setting, sanctions mechanism, outcomes and key findings. Evidence was synthesized narratively and mapped by country and by pathway (trade/supply chains, financing/banking, infrastructure, workforce, service delivery, equity).\u003c/p\u003e\n\u003cp\u003eCritical appraisal: Although not mandatory for scoping reviews, a pragmatic appraisal was conducted to inform interpretation. Peer-reviewed observational studies were appraised using the AXIS tool for cross-sectional designs where applicable, and grey-literature reports were appraised using the AACODS checklist. Appraisal results are summarized in Additional file 2 and are not used as exclusion criteria. [4] [5]\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy selection\u003c/h2\u003e\n \u003cp\u003eSearches identified 150 records; 50 duplicates were removed before screening, leaving 100 records for title/abstract screening. After screening (n\u0026thinsp;=\u0026thinsp;100), 20 reports were sought for retrieval; five were not retrieved. Fifteen full texts were assessed; five were excluded with reasons; and 10 sources of evidence were included in the review (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Full-text exclusions with reasons are listed in Supplementary Table \u003cspan class=\"InternalRef\"\u003eS1\u003c/span\u003e (Additional file 3).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eCharacteristics of included sources\u003c/h3\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of included sources of evidence (n\u0026thinsp;=\u0026thinsp;10).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSource\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCountry / period\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDesign / type\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSanctions/blockade exposure\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKey health-system outcomes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOral-health relevance\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpiegel \u0026amp; Yassi (2004)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCuba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePolicy/case analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUS embargo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary-care orientation; resilience mechanisms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNotes prevention orientation; indirect relevance to oral health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDrain \u0026amp; Barry (2010)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCuba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReview/commentary with data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUS embargo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedicine/supply constraints; outcomes paradox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHighlights supply constraints affecting care broadly\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAli et al. (2000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIraq\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCross-sectional survey analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUN sanctions (1990s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildhood mortality signals; regional differences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo direct oral-health outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDaponte \u0026amp; Garfield (2000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIraq\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDemographic analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUN sanctions (1990s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChild mortality estimates; health system deterioration context\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo direct oral-health outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGibbons \u0026amp; Garfield (1999)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHaiti\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmpirical analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmbargo (1991\u0026ndash;1994)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNutrition/mortality/service use declines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo direct oral-health outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoovadia et al. (2009)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSouth Africa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistorical/policy analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSanctions within political transition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth inequities; system reforms post-transition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo direct oral-health outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQirbi \u0026amp; Ismail (2017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYemen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth policy \u0026amp; planning case study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConflict\u0026thinsp;+\u0026thinsp;restrictions affecting imports/access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFacility functionality, workforce, financing constraints\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMentions service constraints relevant to dental care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSafi et al. (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYemen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeospatial analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConflict setting with access constraints\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAccess to healthcare; facility functionality distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eApplies to dental service access\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorld Bank (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYemen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePolicy note/report\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMacroeconomic/import constraints in conflict\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth financing, system gaps, policy priorities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNotes supply and service constraints\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOMCT (2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYemen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHuman rights/advocacy report\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEconomic blockade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHumanitarian access, imports and essential goods constraints\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMentions medical/dental supply impacts (qualitative)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eCritical appraisal summary\u003c/h3\u003e\n\u003cp\u003eCritical appraisal was conducted to support interpretation (not to exclude evidence). Across included sources, reporting quality varied, with common limitations including incomplete description of data sources and potential confounding from co-occurring conflict and macroeconomic shocks. Appraisal judgments for each source are provided in Additional file 2.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eSynthesis of findings\u003c/h2\u003e\n \u003cp\u003eAcross contexts, sanctions/blockades influenced health systems through interlinked pathways: (1) constrained imports and disrupted supply chains; (2) macro-financing and banking constraints; (3) infrastructure degradation (fuel/electricity/water); (4) workforce attrition and unpaid salaries; (5) reduced service availability and quality; and (6) widening inequities, particularly affecting vulnerable groups.\u003c/p\u003e\n \u003cp\u003eCuba: multiple analyses describe how strong primary care, prevention, and public-sector orientation buffered embargo-related resource constraints, with system design playing a mediating role. [6\u0026ndash;7]\u003c/p\u003e\n \u003cp\u003eIraq: empirical analyses during the 1990s sanctions period reported increased childhood mortality indicators and severe constraints on medicines, water/sanitation and health system functioning, complicating attribution because of overlapping conflict impacts. [8\u0026ndash;9]\u003c/p\u003e\n \u003cp\u003eHaiti: embargo-era analyses reported deteriorations in nutrition and child mortality and declines in service use, illustrating how trade and aid restrictions can cascade into avoidable health losses. [10]\u003c/p\u003e\n \u003cp\u003eSouth Africa: sanctions interacted with broader political economy changes; the post-transition period included major policy reforms, but deep inequities persisted, emphasizing the importance of governance and redistribution mechanisms. [11]\u003c/p\u003e\n \u003cp\u003eY\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis scoping review maps evidence across five country contexts and identifies consistent globalization-related mechanisms through which sanctions/blockades affect health systems: constraining cross-border trade and logistics, restricting finance and payment channels, and limiting humanitarian access. These mechanisms can reduce availability of essential medicines and clinical consumables, undermine service delivery, and widen inequities. [1]\u003c/p\u003e \u003cp\u003eA key cross-context lesson is the mediating role of health system resilience and governance. Settings with strong primary care, prevention and publicly coordinated service delivery appear better able to absorb external shocks, whereas fragile systems experience cascading failures across infrastructure, workforce and supply chains. For Yemen, where import dependence is high and conflict has damaged infrastructure, sanctions-like constraints can magnify shortages and disrupt continuity of care. [6\u0026ndash;7,11\u0026ndash;14]\u003c/p\u003e \u003cp\u003eOral health evidence was limited relative to broader health system evidence, reflecting chronic under-representation of oral health in humanitarian and health-systems research. Nevertheless, multiple pathways directly implicate oral health services: (i) supply disruptions for anesthetics, restorative materials and infection-control items; (ii) fuel/power interruptions affecting sterilization and clinic operations; and (iii) prioritization patterns within humanitarian health packages that often exclude basic oral health services. [12\u0026ndash;15]\u003c/p\u003e \u003cp\u003ePolicy implications for Yemen include: protected supply corridors for medical and dental goods; practical financial/banking mechanisms to operationalize exemptions; inclusion of essential oral health interventions (pain relief, infection control, emergency care, atraumatic restorative treatment and prevention) in humanitarian health packages; and reinforcement of primary care and community prevention as shock absorbers. These align with the journal\u0026rsquo;s emphasis on how globalization mechanisms shape health system performance and equity.\u003c/p\u003e \u003cp\u003eLimitations: The evidence base is heterogeneous and causal attribution is challenging because sanctions/blockades often co-occur with armed conflict and economic crises. The review included English-language sources, which may introduce language bias. Screening was conducted by a single reviewer; this was mitigated by conservative inclusion at screening and transparent documentation of exclusion reasons. Finally, oral health\u0026ndash;specific outcomes were rarely measured, limiting specificity of inferences.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eEconomic blockades and sanctions affect health systems through globalization-linked channels that disrupt trade, finance and humanitarian access. Health system resilience and governance mediate the magnitude of harm. In Yemen, feasible mitigation includes protected supply chains, workable exemptions, and integration of essential oral health into humanitarian and primary-care strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: Not applicable (review of published and archival sources).\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: All data extracted are contained within the article and its supplementary files (Additional files 1–3).\u003c/p\u003e\n\u003cp\u003eCompeting interests: The author declares no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: No external funding was received.\u003c/p\u003e\n\u003cp\u003eAuthors’ contributions: SMBH conceived the study, designed the search and eligibility criteria, performed screening and data charting, interpreted findings, and drafted/revised the manuscript.\u003c/p\u003e\n\u003cp\u003eAI assistance statement: The author used a large language model (ChatGPT, OpenAI) for language polishing and formatting support. All scientific content, interpretations, and references were verified by the author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePintor MP, et al. The impact of economic sanctions on health and health systems in low- and middle-income countries: a systematic review. BMJ Global Health. 2023;8:e010968. doi:10.1136/bmjgh-2022-010968.\u003c/li\u003e\n\u003cli\u003eTricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467\u0026ndash;473. doi:10.7326/M18-0850.\u003c/li\u003e\n\u003cli\u003ePeters MDJ, Godfrey C, McInerney P, et al. JBI Manual for Evidence Synthesis: Chapter 10 Scoping reviews (updated guidance). Joanna Briggs Institute. 2024.\u003c/li\u003e\n\u003cli\u003eDownes MJ, Brennan ML, Williams HC, Dean RS. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open. 2016;6:e011458. doi:10.1136/bmjopen-2016-011458.\u003c/li\u003e\n\u003cli\u003eTyndall J. AACODS checklist. Flinders University; 2010.\u003c/li\u003e\n\u003cli\u003eSpiegel JM, Yassi A. Lessons from the margins of globalization: appreciating the Cuban paradox. J Public Health Policy. 2004;25(1):96\u0026ndash;121. doi:10.1057/palgrave.jphp.3190007.\u003c/li\u003e\n\u003cli\u003eDrain PK, Barry M. Fifty years of U.S. embargo: Cuba\u0026rsquo;s health outcomes and lessons. Science \u0026amp; Diplomacy. 2010; (as archived on PubMed Central).\u003c/li\u003e\n\u003cli\u003eAli MM, Shah IH. Sanctions and childhood mortality in Iraq. Lancet. 2000;355:1851\u0026ndash;1857. doi:10.1016/S0140-6736(00)02289-3.\u003c/li\u003e\n\u003cli\u003eDaponte BO, Garfield R. The effect of economic sanctions on the mortality of Iraqi children prior to the 1991 Persian Gulf War. Am J Public Health. 2000;90(4):546\u0026ndash;552.\u003c/li\u003e\n\u003cli\u003eGibbons E, Garfield R. The impact of economic sanctions on health and human rights in Haiti, 1991\u0026ndash;1994. Am J Public Health. 1999;89(10):1499\u0026ndash;1504. doi:10.2105/AJPH.89.10.1499.\u003c/li\u003e\n\u003cli\u003eCoovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. The health and health system of South Africa: historical roots of current public health challenges. Lancet. 2009;374(9692):817\u0026ndash;834. doi:10.1016/S0140-6736(09)60951-X.\u003c/li\u003e\n\u003cli\u003eQirbi N, Ismail SA. Health system functionality in a low-income country in the midst of conflict: the case of Yemen. Health Policy Plan. 2017;32(6):911\u0026ndash;922. doi:10.1093/heapol/czx031.\u003c/li\u003e\n\u003cli\u003eSafi S, et al. Estimating access to health care in Yemen: a descriptive geospatial analysis. Lancet Glob Health. 2020;8(11):e1435\u0026ndash;e1443. doi:10.1016/S2214-109X(20)30359-4.\u003c/li\u003e\n\u003cli\u003eWorld Bank. Health Sector in Yemen \u0026ndash; Policy Note. 2021.\u003c/li\u003e\n\u003cli\u003eWorld Organisation Against Torture (OMCT). Torture in slow motion: The economic blockade of Yemen and its grave humanitarian consequences. 2022.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Yemen Health Emergency (Yemen crisis). Page last updated 11 April 2024. Accessed 4 Feb 2026.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization, Regional Office for the Eastern Mediterranean (WHO EMRO). Support to health facilities \u0026ndash; Yemen (includes diesel/fuel delivery to keep facilities functional). Accessed 4 Feb 2026.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Global strategy and action plan on oral health 2023\u0026ndash;2030. Published 26 May 2024. Accessed 4 Feb 2026.\u003c/li\u003e\n\u003cli\u003eFrencken JE, Holmgren CJ, van Palenstein Helderman WH. Basic Package of Oral Care (BPOC). World Health Organization / Nijmegen; 2002. Accessed 4 Feb 2026.\u003c/li\u003e\n\u003cli\u003eBenzian H, Beltr\u0026aacute;n-Aguilar E, Mathur MR, Niederman R. Pandemic considerations on essential oral health care. J Dent Res. 2020 Dec 9;100(3):221-225. doi:10.1177/0022034520979830.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"globalization, economic sanctions, blockade, embargo, health systems, supply chains, humanitarian access, oral health, Yemen","lastPublishedDoi":"10.21203/rs.3.rs-8789468/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8789468/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Economic sanctions, embargoes, and blockades are globalization-related policy instruments that reshape cross-border trade, financial flows, and humanitarian access, with downstream effects on health systems. Oral health services are particularly vulnerable because they depend on stable international supply chains for dental materials, local anesthesia, and infection-control consumables.\u003cbr\u003e\nObjectives: To map and synthesize the available evidence on how economic blockades/sanctions affect health systems and oral health, and to derive transferable lessons relevant to Yemen.\u003cbr\u003e\nMethods: A PRISMA-ScR–guided scoping review was conducted. MEDLINE/PubMed, Web of Science, Scopus, WHO IRIS, ReliefWeb and targeted UN/humanitarian sources were searched from inception to 05 December 2025. Eligible sources included peer-reviewed empirical studies and rigorously produced reports linking sanctions/embargoes/blockades to health-system outcomes and/or oral-health outcomes. Screening and data charting were performed by the author using pre-specified criteria; uncertainties were resolved by inclusion at screening and documented at full text.\u003cbr\u003e\nResults: Of 150 records identified, 50 duplicates were removed before screening. One hundred records were screened; 20 reports were sought for retrieval; 15 were assessed for eligibility; and 10 sources of evidence were included (Cuba, Iraq, Haiti, South Africa, Yemen). Across settings, recurring pathways included constrained imports (medicines, fuel, and clinical consumables), macro-financing shocks, infrastructure degradation, workforce attrition, reduced service availability, and widening inequities. Direct oral-health evidence was sparse, but multiple sources described dental supply disruption, infection-control constraints, and increased unmet need.\u003cbr\u003e\nConclusions: The health impact of sanctions/blockades is mediated by governance, exemption feasibility, and system resilience. Protecting primary care, prevention and essential supply chains can buffer harm, whereas fragile systems incur disproportionate losses. For Yemen, priorities include protected medical/dental supply corridors, workable financial/banking channels for exempt goods, integration of essential oral health into humanitarian health packages, and reinforcement of public primary care and prevention.\u003c/p\u003e","manuscriptTitle":"Health system and oral health impacts of economic sanctions and blockades: a PRISMA-ScR–guided scoping review with lessons for Yemen","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-05 14:17:25","doi":"10.21203/rs.3.rs-8789468/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7dcea1dc-ce91-422f-beb1-15dac1fd91da","owner":[],"postedDate":"February 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T07:55:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-05 14:17:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8789468","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8789468","identity":"rs-8789468","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}