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We are experiencing an era of great and rapid changes that directly affect biocultural systems. Ethnomedical systems are complex social-ecological structures and processes affected by drivers that may lead to changes in the trajectories of these systems, or even to collapse, according to their resilience and adaptation capacity. We examine ethnomedical systems in the context of social-ecological resilience, discussing how these systems are adapting and responding to current challenges, threats and risks. Seven case studies from Indigenous Peoples and Local Communities living close to forest ecosystems in South America (Argentina, Brazil, and Paraguay) provide an overview and offer strategies for research and public policies related to biocultural diversity and health. We discuss some nuances of ethnomedical systems resilience, such as the importance of utilitarian redundancy, the effects of biomedicine and technologies on traditional practices, including the hybridization process; the effects of contaminated environments in the use of plants; the influence of COVID-19 on traditional practices and peoples' creative responses to the pandemic; and the influence of Brazilian health care policies for Indigenous Peoples. Based on these case studies at different spatial scales (individual, local community, metacommunity, and macrosystem levels), we discuss the adaptation, transformation, and resilience of ethnomedical systems, as well as the role of local ecological knowledge in this process. We highlight new perspectives for research, actions and public policies that can favor the quality of life and health of Indigenous Peoples and Local Communities. • Local ecological knowledge contributes to understanding resilience. • Ethnomedical systems are complex systems that face drivers at different scales. • These systems have been resilient, incorporating innovations and adaptations over time. • Decolonial research and public policies in Ethnomedical systems resilience must be expanded and strengthened. [ABSTRACT FROM AUTHOR]