Rapid mass displacement can transform active conflict into a broader public health emergency by compressing shelter demand and continuity-of-care needs into a narrow time frame. The March 2026 escalation in Lebanon provides a timely case to examine these dynamics within a health system already operating under severe constraints. This paper analyzes the early response phase, focusing on how displacement reshaped shelter operations, access to primary care, continuity of medications, and referral pathways. Much of the resulting health risk emerges from treatment interruption and weakened linkage to essential services. Beyond being a humanitarian outcome, displacement should be understood as a health systems event that can amplify secondary morbidity. In fragile settings, preparedness must prioritize health-protective sheltering, continuity of care, and coordinated referral mechanisms under conditions of disruption.

No standardized cognitive aid (CA) exists to support the first medical responder during the initial organizational phase of a mass casualty incident (MCI). We aimed to develop such a tool through expert consensus using the Delphi method.A 2-round Delphi process was conducted with 20 expert prehospital physicians. Following a structured literature review, 46 items were submitted for evaluation using a 9-point Likert scale. Consensus criteria were defined a priori in accordance with HAS methodological guidelines. Retained items were ergonomically optimized using the Cognitive Aids in Medicine Assessment Tool (CMAT).All 20 experts participated in round 1 (100%); 18 completed round 2 (90%). After 2 rounds, 31 items were retained (acceptance rate 67%): 20 with strong agreement and 11 with relative agreement. The final CA is organized along the operational timeline of the first medical responder.This Delphi-based CA provides a structured, consensus-derived support tool for first medical responders during MCIs. Prospective studies in real or high-fidelity simulation settings are needed to evaluate its operational impact.

Patient transfers provide a critical mechanism for enhancing care capacity and distributing patient load across hospitals and communities. Yet, during disasters and surge events, decisions about where to send patients are often made by Medical Operations Coordination Centers and similar centralized regional coordination bodies, with limited visibility into how transfers are unfolding across the broader hospital system. This study proposes a spatial-network framework, informed by a typology of patient transfers, that represents interhospital transfers as patient flows across a geographic network of hospitals. The framework provides tools to identify and interpret transfer patterns that coordination bodies need to enhance situational awareness and make timely, informed decisions at the local, regional, and state levels. Using inpatient discharge data from a Florida health agency, this study further demonstrates the framework's applicability during a disaster and shows how administrative health data can be transformed into spatial networks that support interhospital transfer coordination decision-making.

The Supply Chain and Pharmacy breakout session focused on participants' real-world experience with supply chain and pharmaceutical needs for their alternate care facility (ACF). This included details around acquisition and utilization of durable medical equipment, personal protective equipment (PPE), consumables, and pharmacy stock. Participants were encouraged to discuss supply chain management considerations, resource allocation and acquisition, and influencing factors that impacted these topics. Participants explored various approaches to obtain medical supplies and pharmaceuticals, including leveraging existing vendor relationships and establishing climate-controlled storage spaces, while emphasizing the importance of electronic tracking systems and documentation. The overarching goal was to focus on what participants did and how deficiencies were managed. The discussion covered challenges in healthcare coordination during disasters, including supply chain issues, the management of unsolicited donations and volunteers, and the need for innovative solutions like drones and alternative medical applications, concluding with reflections on regulatory oversight and opportunities for process and systems improvements. The group identified several key gaps in emergency response systems, particularly the disconnect between emergency management agencies and healthcare systems, while emphasizing the need for qualified liaisons, just-in-time training, and systematic approaches to ensure effective medical resource management during crises.

Following the 2011 Great East Japan Earthquake and Fukushima Daiichi nuclear accident, the Hamadori region of Fukushima Prefecture experienced severe physician shortages. To address this challenge, three hospitals established postgraduate clinical training programmes aimed at attracting early-career physicians. We reviewed publicly available information on 61 trainees who entered these programmes between 2013 and 2025. Approximately two-thirds graduated from medical schools outside Fukushima Prefecture, indicating successful recruitment from outside the region during the early recovery phase. Over time, the proportion of Fukushima Medical University graduates increased, suggesting a transition from emergency workforce recruitment to locally established training pathways. Among graduates with confirmed practice locations, nearly half remained working in Fukushima Prefecture. These findings suggest that postgraduate clinical training programmes may contribute to physician workforce recovery and long-term healthcare system resilience in disaster-affected, ageing, and depopulating regions.