This scoping review examines the state of health systems resilience (HSR) research in fragile and conflict-affected settings (FCAS). The study aims to identify conceptual frameworks, describe the representation of different actors involved in healthcare governance and service provision, and identify health systems operations related to absorption, adaptation, and transformation in FCAS. Thirty-seven studies met the inclusion criteria, with most focusing on public health systems' resilience. The governance-centred, capacity-oriented framework for HSR was the most frequently used lens. Communities were minimally represented despite their acknowledged role in supporting HSR. Operations enacting HSR in FCAS were primarily focused on absorption and adaptation, with transformation rarely described. Absorptive, adaptive, and transformative interventions were documented across seven domains: safety and security, society, health system governance, stocks and supplies, built environment, healthcare workforce, and healthcare services. The review suggests that a governance-centred framework can be useful for understanding HSR in FCAS, and future research should focus on adaptive and transformative strategies, particularly in promoting safety and security, the built environment, and social justice.This scoping review examines the state of health systems resilience (HSR) research in fragile and conflict-affected settings (FCAS). The study aims to identify conceptual frameworks, describe the representation of different actors involved in healthcare governance and service provision, and identify health systems operations related to absorption, adaptation, and transformation in FCAS. Thirty-seven studies met the inclusion criteria, with most focusing on public health systems' resilience. The governance-centred, capacity-oriented framework for HSR was the most frequently used lens. Communities were minimally represented despite their acknowledged role in supporting HSR. Operations enacting HSR in FCAS were primarily focused on absorption and adaptation, with transformation rarely described. Absorptive, adaptive, and transformative interventions were documented across seven domains: safety and security, society, health system governance, stocks and supplies, built environment, healthcare workforce, and healthcare services. The review suggests that a governance-centred framework can be useful for understanding HSR in FCAS, and future research should focus on adaptive and transformative strategies, particularly in promoting safety and security, the built environment, and social justice.