Syria is looking to rebuild its healthcare system after a 14-year long civil war that left at least 300,000 dead and 70% of its population dependent on humanitarian aid.

But the new government faces a major challenge in ensuring the safety of minority groups, along with access to healthcare and humanitarian aid.

The primarily Druze region of Sweida in southern Syria saw a fresh wave of violence in July, displacing 175,000 people. More than 1,400 people were killed, including in reported extra-judicial executions by Bedouin and government troops sent to secure the area, according to multiple media and eyewitness reports as well as the UK-based Syrian Observatory for Human Rights.

UN Syria Envoy Geir Pedersen has expressed serious concerns over “credible reports” of summary executions, arbitrary killings, and abductions of Druze women in Sweida city, following the entry of government security forces in July.

Sweida, which is 91% Druze, has remained under siege with water, food and fuel being in short supply and only one ICRC convoy reaching the area on 29 July – just before fresh clashes erupted again over the weekend between Druze militias and Syrian security forces.

Huge gap in governance, Syrian Health Minister admits  

The new government of Syrian President Ahmed Al-Shaara, which took charge earlier this year, says stabilizing its health system is a priority, but lack of finance and the fact that most of the country’s health workers have left the country to flee the brutal conflict, are its two biggest challenges.

“We still have a huge gap in governance. We have more than one system. There are discrepancies and differences between different regions and geopolitical areas in Syria,” said Syrian Health Minister Dr Musaab Nazzal al-Ali. “Also, in financing we have very limited resources,” he said, speaking through a translator.

Al-Ali, who refused to address the situation in Sweida, was speaking at an online discussion organized by the Center for Strategic and International Studies (CSIS), a think-tank based in Washington, DC.

There’s no part of the health system that hasn’t been spared in terms of the effects of the conflict, said Dr Diana Rayes, former chair of the Syria Public Health Network, which advocates for the health issues of Syrians.

“Thinking about people and how they have endured such suffering over time, there has been a significant mental health impact. And I think the prevalence is about half of Syrians, whether diagnosed or not, have symptoms related to a mental health condition,” Rayes said.

Nearly 40% of the country’s healthcare infrastructure was destroyed in the conflict, according to government estimates. What makes the task harder for the Syrian government is that it is trying to raise funding to rebuild in a landscape of multiple humanitarian crisis and donor fatigue.

Finance, health workers needed 

DuringSyria’s civil war, the ruling regime led by President Bashar al-Assad targeted health facilities and  healthcare workers, according to various stakeholders. Anywhere between 50% – 70% of the country’s healthcare workers have left the country.

“Most of them were politically persecuted, especially in the early years of the Syrian situation, and also their ability to integrate in other contexts is much more likely. So, there’s a significant displacement of the health workforce,” Rayes said.

To add to the woes, medical equipment in Syria is outdated. “The most recent equipment in Syria in the public sector was purchased in 2011,” al-Ali said.

The Assad regime had faced international sanctions which was lifted only a few months back. The country is short of dialysis and MRI machines, as well as basics like ambulances but the government has been unable to do much as it lacks the money to do so.

The UN estimates that this year alone, the funding required for Syria is $3.2 billion but the country has received only 12% of that aid.

Liberia is an example, Iraq a cautionary tale

Syria’s health system is currently in a transitional phase, seeking to move from one that responded to emergencies to a more sustainable healthcare system coordinated by the health ministry.

“In addition to meeting immediate health needs in the current moment, they also have to lay the groundwork for a more permanent, more sustainable health system, and that’s no easy feat,” Rayes said.

She said Syria can learn from Liberia which, post-conflict, rebuilt its health system by focussing on primary healthcare, training the health force, and working with donors.

Syria’s neighbour, Iraq is a cautionary tale which had a similar healthcare system to Syria before the conflict, she warned.

“Despite a lot of international support that came in to support the Iraqi health system in rebuilding, it’s never really fully recovered, and access in rural areas remains very limited, and there’s an over-reliance on the private sector,” Rayes said.

Relying on humanitarian aid alone in the long run will be unsustainable, experts agreed.

Dr Bachir Tajaldin, Türkiye Country Director of the Syrian American Medical Society Foundation (SAMS), said that while the support of the international community is important in health system strengthening “that will not continue forever”.

Building bridges – Syrian government’s attempt

The conflict in Syria has also broken trust between the government and the population, as well as between the Syrian government and other countries.

After being polio-free for decades, Syria experienced an outbreak in October 2013 after the disruption in the routine immunization programme.  Many believed this disruption to be deliberate retaliation by the Assad regime against citizens who rejected his rule, Tajaldin explained.

Al-Ali said that his government is working on rebuilding relationships with other countries, and has already signed agreements with some governments to rebuild health facilities.

But the dismantling of USAID has disrupted aid flowing into Syria as US was the leading donor globally for humanitarian response.

“We’ve also seen other countries scale back some of some of their support as well, due to donor fatigue, but also this changing landscape,” Rayes said, adding that Syrians in the diaspora are a potential source of support, and especially technical support, apart from regional players like Qatar.

Security situation remains ‘volatile’

But stabilizing Syria’s healthcare system also requires inter-religious and ethnic violence to abate. Minority groups like the Druze and Alawites are at heightened risk of persecution because of their perceived past support for the Assad regime, and their religious and ethnic differences from the current Sunni Arab government, led by Ahmed al-Sharaa.

In March, more than 970 civilians, mostly from the minority Alawite community, were killed following attacks by government security forces on community strongholds in Latakia and Targus, along the Mediterranean coast. Former President Assad, whose government was overthrown in December 2024, was an Alawite.

In July, Bedouin militia invaded Sweida, a governorate in southern Syria covering some 5,000km with a population of about 375,000 people, 91% of which are Druze. Extra-judicial killings, rapes and random executions have been reported.

Government troops sent to quell the violence reportedly entered the fray themselves. The government forces finally withdrew after an internationally-brokered deal but Sweida has remained under siege with little fuel or food reaching major population centers, including Sweida city, home to some 75,000 people.

Renewed clashes over the weekend

Last weekend, renewed clashes broke out again, killing at least four people including both Druze militia members and Syrian security forces.

Currently, the situation in Sweida is volatile with humanitarian access constrained, and ambulances and aid workers obstructed or becoming targets in the violence, said Edem Wosornu, of the UN Office for the Coordination of Humanitarian Affairs (OCHA).  Drinking water and food is scarce, according to reports on the ground.

In a recent statement,  UN Envoy Pedersen expressed concern about “reports of abductions of Druze women after the entry of security forces into particular areas, and reports of women, children and men who are missing.”

While Druze were the initial victims of killings, summary executions and kidnappings carried out by “members of security forces and individuals affiliated with the authorities,” other “armed elements from the area, including Druze and Bedouins” have also perpetrated violent attacks, Pedersen noted.

“Sweida is besieged and it is forbidden to bring in aid,” said one former Sweida Druze resident, speaking to Health Policy Watch from the United Arab Emirates. “They are bringing in some materials but it is forbidden to [bring in] fuel such as fuel oil and gasoline.”

He blamed government forces, more than Bedouin militia, for pursuing a campaign against the Druze, noting that some three dozen villages and towns in the region are either surrounded or occupied by government troops, triggering the mass displacement of residents along with the reports of killings, kidnappings, and property destruction.

“This issue is not a war between the Druze and Bedouins. This is a systematic war by the interim authority… this is not a national army but an extremist army from ISIS and Al-Nusra, not only against the Druze but against Christian and even moderate Sunni Muslims.”

When questioned about the humanitarian situation in the area, al-Ali refused to elaborate. Speaking through a translator, he would only acknowledge that there are divisions within Syria that remains challenging. 

Image Credits: UNOCHA/Ali Haj Suleiman, UN Syria, Flickr, France 24, UNOCHA/Ali Haj Suleiman, European Union Agency for Asylum..