Journal Article

Rebuilding trust and equity in Syria's health system: a governance-driven transition

Abbara, Aula, Alzoubi, Zeidoun, Dashash, Mayssoon, Ekzayez, Abdulkarim, Obaydo, Reem Hasan, Alghatrif, Majd, Aboumayaleh, Maher, Kharrat, Zuhair, Sullivan, Richard, Fouad, Fouad M, Alkhalil, Munzer

2025

Overview

[...]former opposition areas in northwest Syria had benefited from investment and capacity-building efforts by international and local humanitarian organisations and diaspora to serve the 5·6 million people in the area. 8 Locally established initiatives included the formation of health quasi-governmental bodies to meet some health-care needs. 8 However, this cross-border humanitarian response was marred by underfunding, weak governance, poor distribution of services, and overburdened health services. 9 In northeast Syria, the situation for an estimated 3–4 million people in the area remains precarious with health needs met by a combination of local health authorities from the Autonomous Administration of North East Syria and regional and international organisations. Primary and community health care must be the backbone of the health system to support equitable population coverage, 10 particularly in rural areas and for the most vulnerable populations, including children, people living with disabilities, internally displaced people, returnees, and released detainees. 11,12 Investment is needed in health-care workforce production, distribution, and training, including recognition of graduates from unaccredited universities and their equitable disbursement. Immunisation strategies should take into account the continued mobility of the population for both internally displaced people and returnees. 19 Additionally, addressing relevant infrastructure, such as water and sanitation, electricity, and shelter, is key to disease prevention. 20 To address these public health priorities, the reformed health system must prioritise equity and governance, ensuring care is based on needs, not on top-down political decisions—a shift away from the “punishment by neglect” approach implemented by the former Assad regime. 21 There must also be a transitional justice process that includes all sectors and professionals (including employees previously dismissed by the Assad regime for political reasons), and the development of a human resources plan (in coordination with the Ministry of Social Affairs and Labour) to ensure equitable distribution of resources and personnel.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Assad, Bashar Al / At risk populations / Capacity development / Community health care / Diaspora / Disease prevention / Displaced persons / Epidemics / Health care / Health services / Humanitarianism / Immunization / Infectious diseases / Infrastructure / Planning / Politics / Public health / Rural areas / Sanctions / Sanitation