Whose crisis is it? Local experiences and health governance in the era of polycrisis.

The concept of polycrisis has gained traction to describe the interconnected shocks-pandemics, climate-related disasters, conflict and economic instability-shaping global risk. Yet for many communities in low-income settings, such entanglements are not new but reflect long-standing conditions of permacrisis. We advance a situated perspective that examines how global shocks intersect with pre-existing local vulnerabilities, drawing on examples from Somalia, northern Kenya, Zimbabwe and Lebanon. These cases show that crises are experienced unevenly and simultaneously across systems of food, water, livelihoods, health and security, raising the question: whose crisis is it?We argue that responding to polycrisis requires moving beyond siloed notions of 'health systems' towards integrated systems for health, supported by multisectoral governance at national and especially local levels. Practical components include shared early-warning triggers, clear cross-sector roles, flexible local financing and co-produced planning with communities. For research, this perspective redirects attention to how interconnected systems shape risk, resilience and equity, and how coordinated arrangements can be designed, tested and strengthened. A systems-for-health approach offers a more realistic and context-grounded pathway for navigating overlapping crises in settings where disruptions have become the norm.