Can trust in healthcare be restored after armed violence? Evidence from a randomized field experiment in north-eastern Nigeria

Abstract

Armed violence undermines public health not only by destroying infrastructure but also by eroding trust in government institutions, including the health system. Prior research shows that victimized individuals often withdraw from public services, with particularly adverse consequences for child health. Yet it remains unclear whether such distrust can be restored. We address this question in northeastern Nigeria, a region heavily affected by armed violence, through a randomized field experiment embedded in a representative household survey of caregivers of young children ( n = 2 , 594). Half of respondents received an official letter from their state health authority that acknowledged hardship and invited families to return to public clinics. The intervention significantly increased trust in health institutions among respondents who had previously experienced violence—a pattern consistent with theoretical expectations—while effects for non-victimized respondents were negligible. Although we find no corresponding changes in stated intentions to use government health facilities, exploratory analyses suggest greater willingness to vaccinate children. These findings highlight the potential of acknowledgment-based interventions as a scalable approach to rebuilding trust between citizens and public health systems in conflict-affected settings. • Armed conflict erodes trust in public institutions, including the health system. • We test a low-cost intervention to rebuild trust in conflict-affected northeast Nigeria. • Acknowledgment letters from state health authorities raised trust among the victimized. • No corresponding effects were found for non-victimized caregivers. • Symbolic recognition can help restore citizen trust in health systems after violence.