Cervical Cancer Prevention and Screening in fragile and conflict-affected countries in the Middle East
 
Background
Cervical cancer is one of the most preventable malignancies affecting women; however, it continues to cause substantial morbidity and mortality globally. The burden is disproportionately high in fragile and conflict-affected countries of the Middle East, where armed conflict, protracted displacement, and environmental stressors have weakened health systems and disrupted essential prevention and care services. In these settings, HPV vaccination, organized screening, and timely diagnosis and treatment are often fragmented or inaccessible, limiting progress toward the World Health Organization (WHO) cervical cancer elimination targets of 90% HPV vaccination, 70% screening coverage, and 90% access to treatment. These challenges are further compounded by adverse living conditions, including water scarcity, air pollution, overcrowding, unsafe housing, and climate-related displacement, which increase women’s vulnerability to HPV infection, delay early detection, and worsen outcomes.
Objectives
This scoping review aims to synthesize peer-reviewed and grey literature on cervical cancer prevention and screening strategies implemented in fragile and conflict-affected countries of the Middle East. The review seeks to identify delivery models, health-system adaptations, barriers, and enabling factors influencing access to HPV vaccination, screening, and referral to care in humanitarian and crisis settings.
Methods
A comprehensive scoping review will be conducted using searches of PubMed, Scopus, and the Cochrane Library, complemented by relevant grey literature sources, covering a five-year period up to December 2025. Eligible sources will include studies, program evaluations, and reports describing HPV vaccination delivery; screening approaches such as HPV self-sampling and point-of-care testing; community-based outreach; mobile or decentralized service delivery models; and digital tools supporting follow-up and referral in low-resource and displacement contexts. Data on conflict-related disruptions—including damaged health infrastructure, population displacement, workforce shortages, and service interruptions—will be systematically extracted and analyzed.
Results
Findings will be mapped across three analytical domains: (1) adaptive models for cervical cancer prevention and screening in conflict-affected settings, (2) conflict-related disruptions and access barriers affecting service delivery and uptake, and (3) policy, governance, and system-level enablers relevant to advancing the WHO 90–70–90 elimination framework in fragile contexts.
Conclusions/Implications
This review will generate actionable, context-specific evidence to inform equitable and resilient cervical cancer prevention and screening strategies in crisis-affected Middle Eastern countries. The findings aim to support policymakers, implementers, and partners in adapting elimination efforts to fragile settings and accelerating progress toward cervical cancer elimination, even in the face of conflict and humanitarian instability.
 
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