This scoping review examines health systems resilience (HSR) in fragile and conflict-affected settings (FCAS). It identifies key conceptual frameworks, the roles of different actors in health governance and service provision, and the operations of health systems in relation to absorption, adaptation, and transformation in FCAS. The review found that governance-centred, capacity-oriented frameworks are most frequently used to analyze health responses to conflict and chronic violence. Most studies focused on public health systems, while the private sector is examined in complementarity. Communities are minimally represented, despite their role in supporting HSR. The documentation of HSR operations in FCAS is focused on absorption and adaptation, while transformation is seldom described. Absorptive, adaptive, and transformative interventions are described across seven domains: safety and security, society, health system governance, stocks and supplies, built environment, health care workforce, and health care services. The review highlights the importance of governance, coordination, and social capital in HSR in FCAS. It also emphasizes the need for a social justice lens in HSR research and operations. The review found that the governance-centred framework can be useful to better understand HSR in FCAS. Future HSR research should document adaptive and transformative strategies that advance HSR, particularly in relation to actions intended to promote the safety and security of health systems, the built environment for health, and the adoption of a social justice lens. The review also identifies the need for stronger coordination mechanisms among diverse institutions, the importance of information flow, and the role of community engagement in HSR. The review concludes that HSR in FCAS requires a multi-faceted approach that includes governance, coordination, and social capital.This scoping review examines health systems resilience (HSR) in fragile and conflict-affected settings (FCAS). It identifies key conceptual frameworks, the roles of different actors in health governance and service provision, and the operations of health systems in relation to absorption, adaptation, and transformation in FCAS. The review found that governance-centred, capacity-oriented frameworks are most frequently used to analyze health responses to conflict and chronic violence. Most studies focused on public health systems, while the private sector is examined in complementarity. Communities are minimally represented, despite their role in supporting HSR. The documentation of HSR operations in FCAS is focused on absorption and adaptation, while transformation is seldom described. Absorptive, adaptive, and transformative interventions are described across seven domains: safety and security, society, health system governance, stocks and supplies, built environment, health care workforce, and health care services. The review highlights the importance of governance, coordination, and social capital in HSR in FCAS. It also emphasizes the need for a social justice lens in HSR research and operations. The review found that the governance-centred framework can be useful to better understand HSR in FCAS. Future HSR research should document adaptive and transformative strategies that advance HSR, particularly in relation to actions intended to promote the safety and security of health systems, the built environment for health, and the adoption of a social justice lens. The review also identifies the need for stronger coordination mechanisms among diverse institutions, the importance of information flow, and the role of community engagement in HSR. The review concludes that HSR in FCAS requires a multi-faceted approach that includes governance, coordination, and social capital.