Bridging the evidence gap: research equity in conflict-affected health systems

Despite bearing a disproportionate share of the global disease burden, low- and middle-income countries (LMICs) contribute minimally to clinical trial data. Using the Palestinian Territories as a case study, this commentary explores how structural barriers in conflict-affected health systems create gaps in clinical evidence. Fragmented health services and inequitable publishing opportunities disrupt continuity of care and limit participation in global research. These barriers are rarely acknowledged in the medical literature, yet they profoundly shape clinical outcomes and research capacity. Addressing this evidence gap requires structural reform, equitable authorship, and locally led research agendas. Without including structurally excluded regions in evidence production, global clinical guidelines remain incomplete and inequitable.