In mid-May, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) announced that around 160 health facilities in northwestern Syria, including 46 hospitals, would have to suspend operations by the end of June this year if funding was not increased.

Fearing the consequences of closing these facilities, UN and local warnings of the health sector falling into a disaster affecting millions of people in need of services and healthcare are pouring in, becoming almost an annual announcement.

In a special report prepared by Enab Baladi a few days ago titled “Health Sector in Northwestern Syria: Emergency Call Before Disaster,” the report shed light on the reality of the sector in the region, the role of local authorities and organizations amid continuous deterioration of the sector, and included experts’ opinions on seeking sustainable long-term solutions to revitalize the sector and reduce its dependency on decreasing external support over the years.

Enab Baladi directed questions to the World Health Organization (WHO) regarding its description of the medical situation in northwestern Syria and the proposed solutions in this context.

“Dire situation” 

Rosa Crestani, head of the WHO office in Gaziantep, Turkey, said in an email correspondence with Enab Baladi that after 13 years of conflict, the health system in northwest Syria has been severely disrupted. The escalating conflict and natural disasters, such as the 2023 earthquake, have compounded the crisis. Health actors have been fully engaged in emergency response and have lacked sufficient opportunity to focus on building the resilience of the health system.

According to the organization’s official estimates, the health situation in northwest Syria is “dire,” according to Crestani, relying on a set of figures as follows:

• An estimated 2 million people in northwest Syria live in over 1,500 displacement camps and informal sites with limited or no access to healthcare, clean water or other basic services. 87,000 camp residents live with at least one form of disability.
• WHO estimates that 8 out of 10 people require health assistance, that is 80% of the entire 5.1 million population of northwest Syria, while 1 in 5 people also suffer from a mental health disorder in the region.
• Communicable and non-communicable diseases continue to threaten the population accounting for up to 75% of mortality.
• Outbreaks of disease such as cholera and measles, once episodic, are now common in Syria while endemic diseases like scabies and leishmaniasis are surging in the northwest and the rest of the country.
• Demand on trauma care and disability services has spiked in the face of increased hostilities.

However, nearly a third of health facilities in northwest Syria are non-functional. Human resources in healthcare have dramatically decreased since the escalation of the conflict in Syria, with large numbers of staff displaced and a high turnover rate, especially among newly trained personnel. There is also a lack of clear, accurate, and trustworthy data concerning the availability of healthcare providers in health facilities.

The majority of healthcare services in northwest Syria are “public”/NGO-run health facilities, offering free of charge services and are entirely financed through humanitarian assistance mechanisms, except for some private health facilities that require direct payment for services. Local health directorates themselves rely entirely on donor funds to pay staff salaries, purchase medicines and medical materials, conduct rehabilitation or maintenance, cover regular operational costs, and provide training.

Crestani pointed out that WHO, along with other health partners, continues to intervene to improve the situation. Yet, without donor support, all health activities currently serving 4.2 million people in northwest Syria will be left without access to primary, secondary, and specialized healthcare services, severely disrupting existing life-saving medical supplies and systems.

A holistic approach towards a sustainable solution

In addition to immediate relief efforts, WHO and its partners are also implementing early recovery interventions to enhance the overall resilience of the health system by ensuring emergency preparedness and strengthening the provision of essential health services and the health system. However, long-term solutions, according to Crestani, require a holistic approach with investment and interventions in the following areas by all health partners:

1. Strengthening healthcare infrastructure: Rebuilding and upgrading hospitals and primary healthcare facilities, and implementing robust health information systems.
2. Human resource development: Providing continuous training and incentives for healthcare professionals and training community health workers to provide basic health services.
3. Supply chain management: Establishing reliable supply chains for medicines and equipment, and encouraging local production of medical supplies.
4. Healthcare financing: Developing sustainable funding models.
5. Public health initiatives: Implementing disease prevention and control programs, addressing malnutrition with targeted nutrition programs, and expanding mental health services.
6. Community engagement and education: Conducting health education campaigns and involving local communities in health program planning and implementation.

On the responsibility of entities for implementing this approach, Crestani said that health partners responsible for delivering these long-term solutions are local health authorities to ensure coordination, partnership, and access; international and regional donors for funding; the UN and specialized agencies for providing technical assistance, supervision, and monitoring; international and national NGOs for implementing health projects and filling service gaps; the private sector for investing in healthcare infrastructure and supply chains; and local communities for participating in health programs and initiatives to ensure positive health outcomes for themselves.

Bleak future

If the current funding situation is to go by, the future of the health sector in northwest Syria remains bleak and risks of going into deeper peril, Rosa Crestani highlighted.

Crestani pointed out that further shortages of funding could disrupt the treatment of patients in need of life-saving care, leading to complications that may result in disability or even death.

Within the coming six months, WHO estimates that 1.5 million people may lose access to life-saving and emergency care services, while over a million children will be at greater risk of disease outbreaks, especially cholera and acute waterborne diseases, and other communicable diseases due to poor living conditions, lack of access to clean drinking water, overcrowding in camps, and health services in remote areas.

The cost of inaction is high

• Up to 86 health facilities have already suspended their operations fully or partially due to a lack of funding, and up to 160 health facilities are expected to suspend operations by June 2024.
• Access to mental health and psychosocial support services is severely limited in northwest Syria, and funds have run out in major mental and psychiatric hospitals, training centers, and public health centers that currently deliver mental health and psychosocial support services in northwest Syria.
• By June 2024, 32% of emergency obstetric care facilities will suspend their services.
• An estimated 450,000 women of reproductive age in northwest Syria will face increased difficulties in accessing life-saving obstetric care and reproductive health services.

Rosa Crestani, Head of the WHO Office in Gaziantep, Turkey

Northwest Syria has a population of 5.1 million, with 4.2 million in need of assistance, 3.4 million suffering from food insecurity, 3.4 million internally displaced, and two million living in camps, according to the UN. Local statistics report a population of 5.5 to 6 million people.

Earlier this year, WHO issued an emergency appeal for the health situation in Syria for 2024, stating that 15.3 million people needed health services, targeting 13 million people.

According to the organization, funding requirements for operations across Syria amounted to $79,829,000, while specific funding requirements for WHO emergency operations in Syria reached $53,428,000.