Addressing liver disease in conflict zones requires a coordinated, multi-level framework that integrates local ingenuity with international support. In these high-intensity environments, external intervention (for example, via humanitarian organizations) is a clinical and ethical imperative to mitigate the effects of health system collapse. Beyond financial aid, this scenario necessitates specialized logistical support, such as maintaining ‘cold-chain’ integrity for hepatology-specific pharmacotherapy, deploying mobile diagnostic units to circumvent damaged infrastructure, and establishing international referral pathways for individuals with acute disease, such as acute liver failure or for post-transplant monitoring, that exceed local capacity2.

Drawing from lessons in low- and middle-income countries, community-led initiatives — including health education, social support networks and culturally tailored lifestyle advice — can mitigate care gaps. Even in resource-scarce environments, success in continuation of care is driven by local leadership, cross-sector cooperation and empathetic engagement12.

National and international stakeholders must formalize the inclusion of non-communicable diseases, specifically hepatology, into disaster planning. The COVID-19 pandemic highlighted the efficacy of context-adapted patient education, remote care and the proactive dispelling of misinformation. To ensure medication continuity and diagnostic access, humanitarian organizations must elevate liver disease within their primary non-communicable disease initiatives13,14.

Structured models such as CSCATTT (Command and Control, Safety, Communication, Assessment, Triage, Treatment, Transport) should be adapted to manage chronic care. Such frameworks allow healthcare systems to optimize resource allocation, maintain critical services for patients at high risk of progression of disease and enhance interagency collaboration (such as collaboration between healthcare providers and aid agencies) under extreme pressure. Future research should prioritize simulation exercises and the real-world validation of these models in fragile states15.

In settings with fractured infrastructure, pragmatic clinical models are essential. Utilizing telemedicine, non-invasive fibrosis scoring (for example, Fibrosis-4 or the aspartate aminotransferase-to-platelet ratio index) and prioritizing immediate treatment over exhaustive staging can preserve continuity. Although current guidelines from global hepatology associations — including the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, the Asian Pacific Association for the Study of the Liver and the African Middle East Association of Gastroenterology — offer robust frameworks for stable environments, dedicated recommendations for the specific challenges of active armed conflict and systemic infrastructure failure remain lacking. There is an imperative need for conflict-adapted guidelines that prioritize decentralized care, high-risk triage and simplified monitoring. Such a framework would establish a necessary protocol for managing hepatological management when the traditional ‘standard of care’ is physically or logistically unattainable. Implementing these guidelines would provide a vital roadmap for clinicians and legislators to ensure equitable care in uncertain times.