Rebuilding the Syrian public health system

The Syrian public health system has suffered extensive damage due to over a decade of conflict, with hospitals destroyed, healthcare professionals displaced, and essential services disrupted. The conflict has led to the re-emergence of communicable diseases, a weakened primary healthcare system, and an exodus of medical personnel. As of 2024, Syria's health indicators remain alarming: life expectancy has declined from 75 years in 2010 to approximately 64 years, and maternal mortality rates have surged to 68 per 100,000 live births, compared to 52 before the war. To rebuild Syria’s public health infrastructure, a multi-pronged approach focusing on immediate and long-term strategies is required. Below are seven key priorities:

1. Restoring Healthcare Infrastructure

The conflict has resulted in the destruction of nearly 50% of Syria’s healthcare facilities. In Aleppo, Idlib, and Deir ez-Zor, more than 70% of hospitals and primary healthcare centers have been rendered non-functional. Immediate efforts should focus on rebuilding essential infrastructure, prioritizing regions with the highest population density and lowest access to services. A model similar to the WHO’s Build Back Better approach, which integrates disaster resilience into reconstruction, should be adopted to ensure long-term sustainability.

2. Reintegrating and Expanding the Healthcare Workforce

The war has led to the displacement of more than 70% of Syria’s medical workforce. Addressing this crisis requires offering incentives for returnee health professionals, establishing medical training programs within Syria, and fostering international partnerships for capacity-building. The establishment of remote learning platforms for medical students and residency programs can help bridge educational gaps caused by the conflict.

3. Strengthening Primary Healthcare and Preventive Medicine

Before the war, Syria had an extensive primary healthcare network that played a crucial role in disease prevention. The current collapse of these services has led to the resurgence of diseases such as polio, measles, and leishmaniasis. Expanding community health worker (CHW) programs and integrating vaccination campaigns must be a priority. Special focus should be placed on maternal and child healthcare, with an emphasis on reducing neonatal mortality, which has risen to 18.2 per 1,000 live births. Vaccination coverage has dropped significantly, with estimates indicating that only 60% of children are fully immunized against preventable diseases, compared to 95% pre-war. Urgent mass immunization efforts, supported by local and international health agencies, are necessary to curb disease outbreaks and improve public health resilience.

4. Enhancing Access to Essential Medicines and Medical Supplies

Syria’s pharmaceutical sector, once capable of covering 90% of domestic needs, now operates at only 30% of its pre-war capacity. Drug shortages, black-market inflation, and lack of quality control pose significant risks. Efforts should focus on rehabilitating local pharmaceutical production, establishing transparent drug procurement systems, and improving supply chain logistics. The role of international agencies in stabilizing medication access remains critical.

5. Mental Health and Psychosocial Support (MHPSS) Services

The conflict has resulted in a mental health crisis, with an estimated 54% of Syrians experiencing post-traumatic stress disorder (PTSD) and depression. Despite high demand, only two psychiatric hospitals remain operational in Syria. Expanding MHPSS services through community-based interventions, integrating psychological support into primary healthcare, and training general practitioners in mental health management are essential to addressing this crisis.

6. Developing a Resilient Health Financing System

Out-of-pocket healthcare expenditures in Syria have skyrocketed, with an estimated 65% of the population unable to afford basic medical services. To ensure equitable access, Syria must transition towards a mixed-financing health system that incorporates pre-payment mechanisms, donor-supported safety nets, and community-based insurance models. Establishing a national health insurance fund could provide a sustainable financing mechanism for vulnerable populations.

7. Implementing Data-Driven Public Health Surveillance

Epidemiological monitoring is crucial for early disease detection and outbreak response. However, Syria’s health information system has been severely disrupted, leading to underreporting and delayed responses to public health threats. Strengthening disease surveillance through digital health solutions, integrating electronic health records (EHRs), and collaborating with international

Conclusion: 

Rebuilding Syria's public health system is a complex endeavor that demands a multifaceted approach. By focusing on restoring healthcare infrastructure, reintegrating and expanding the healthcare workforce, strengthening primary healthcare and preventive medicine, enhancing access to essential medicines, and bolstering mental health services, Syria can lay a solid foundation for recovery. Developing a resilient health financing system and implementing data-driven public health surveillance are also crucial steps toward a sustainable and effective healthcare framework. These combined efforts aim to address the immediate health crises while establishing a robust system capable of withstanding future challenges.