Executive Summary:
Recent UN reports warn of a gradual collapse of the health sector in Syria due to severe funding gaps, declining institutional preparedness, and the marginalization of rural areas. In the absence of central authority after the fall of the Assad regime, the need to redefine health legitimacy on participatory, equitable, and sustainable principles is highlighted.
This paper reviews the structural challenges facing the Syrian health system and proposes a reform framework based on international experiences in rebuilding health systems after conflicts, with recommendations applicable to the Syrian context.
Background of the health crisis in Syria:
Since 2011, the Syrian health sector has been subjected to systematic destruction, including infrastructure, personnel, and supply chains. With the collapse of the regime in December 2014, the crisis worsened due to the lack of central coordination, declining international funding, and the multiplicity of actors controlling the ground. A July 2015 report by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) described health preparedness as “weak,” warning of a potential gradual collapse. Meanwhile, health financing in Syria suffers from three major gaps:
- Sustainability gap: Overreliance on international aid without a national financing mechanism.
- Geographical equity gap: Marginalization of rural and southern regions in resource distribution.
- Coordination gap: The absence of a central body regulating the relationship between local and international actors.
These gaps not only reflect a financial crisis, but also point to the absence of a legitimate model for public health governance, threatening the social contract between state and citizen.
Health as a gateway to rebuilding legitimacy in the post-conflict phase:
In political literature, health is considered a “political commodity” that enhances state legitimacy when administered efficiently and fairly. In the Syrian context, health can be:
- A tool for community reconciliation: by providing equal services to all regions.
- A platform for building trust: through transparent funding and resource distribution.
- A model of good governance: if administered through independent and participatory institutions.
An applicable international model that can be leveraged in the Syrian context is Rwanda after the genocide (1994), which established an independent Ministry of Health with broad powers. It relied on blended funding (international + local).
It focused on community care and mental health as an entry point for reconciliation.
The same applies to post-war Kosovo (1999), which established a sovereign health fund under international supervision. It relied on decentralization in the management of health facilities and integrated health into transitional justice programs.
Analysis of Current Policies in Syria:
Despite the multiplicity of actors (local councils, international organizations, transitional government factions), health policies suffer from:
- Lack of unified standards for recruitment and distribution.
- Weak institutional oversight of funding and procurement.
- Politicization of health services in some areas.
This creates a repulsive environment for staff and weakens community trust in health institutions.
Accordingly, we, at the Scientific Office of the Syrian Future Movement, propose a three-dimensional framework for redefining health legitimacy:
- Procedural legitimacy, by adopting clear standards for recruitment, distribution, and accountability.
- Societal legitimacy, by involving local communities in setting health priorities.
- Institutional legitimacy, through the establishment of an independent health financing body, overseen by local and international bodies.
Conclusion:
Based on the previous proposal, we recommend, at the local level:
- Establishing elected local health councils.
- Adopting a transparent system for distributing resources based on need indicators.
- Launching training programs for health professionals in liberated areas.
At the national level:
- Establishing an independent national health financing body.
- Issuing a transitional health declaration regulating the relationship between actors.
- Integrating mental health into reconstruction programs.
At the international level:
- Restructuring international support to make it conditional on transparency and fairness.
- Supporting local health governance initiatives.
- Investing in community care as a gateway to reconciliation.
The collapse of the health sector in Syria reflects a crisis of institutional legitimacy.
In the post-Assad era, health emerges as one of the most important sectors capable of rebuilding trust between the state and society, if managed efficiently, transparently, and fairly. This paper proposes a reform model based on international experiences, applicable to the Syrian context, provided political will and institutional coordination are present.
