Strengthening healthcare system resilience: a comprehensive framework for tropical cyclone preparedness and response

This review examines healthcare system resilience to tropical cyclones through complementary frameworks of temporal phases (Before-During-After) and geographic contexts (Inside-Outside Impact Zone). The paper highlights how climate change is intensifying cyclone threats while demographic transitions create increasingly vulnerable patient populations dependent on continuous healthcare. Despite decreasing immediate mortality from cyclones, research reveals concerning increases in delayed morbidity and mortality due to disrupted healthcare access. Seven critical dimensions of healthcare resilience are identified: maintaining continuity of care for vulnerable populations, transitioning from reactive response to proactive resilience, strategic resource prioritization, adapting to climate change, integrating efforts across phases and zones, ensuring health equity, and addressing research gaps. A tiered approach to strengthening resilience is proposed, from immediate low-resource actions to long-term structural investments. The review emphasizes that healthcare systems must transform from reactive disaster response to proactive resilience strategies to protect vulnerable populations in an increasingly turbulent future climate.