Health systems in the Amazon face deep structural challenges that limit access to timely and quality care. This study provides a cross-country comparative analysis of health care infrastructure and hospital utilization in the Amazon, with a particular focus on urban settlements. Using a descriptive analysis across geographical areas and publicly available data from Bolivia (Plurinational State of), Brazil, Colombia, Ecuador, Guyana and Peru from 2021 to 2022, facility availability and hospital discharges are analyzed across different geographical groups: national, non-Amazon area and the Amazon. Within the Amazon, data are disaggregated by urban and non-urban areas. Facility density in the Amazon is slightly lower than national averages, although urban areas within the Amazon have the highest concentration of health care infrastructure and specialized services. Despite this concentration, hospitalization rates are consistently higher in the Amazon than nationwide. Maternal and neonatal admissions carry relatively higher intrahospital mortality, reflecting potential delays in care. Hospitalizations for ambulatory care-sensitive conditions account for a similar share of admissions in the Amazon and national contexts, but their per capita rates are higher in Amazon areas, including urban settlements. These results highlight that an urban location mitigates but does not eliminate structural barriers to accessing effective health care in the Amazon. Strengthening primary care and referral systems, and providing culturally adapted service delivery are essential to improve health systems and health outcomes across this diverse and vulnerable area.