The health system in Syria (2000-2024): assembling the pieces of a fragmented system-A scoping review

Abstract

This study provides a detailed overview of Syria's health system from 2000 to 2024 by synthesizing existing literature and data. Its goal is to inform the health sector recovery plan following recent political changes in Syria, detailing the health system's characteristics and evolution on the basis of the WHO's conceptual framework. A scoping review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Data sources included PubMed, MEDLINE, Scopus, Google Scholar, grey literature and government reports. The analysis identified service delivery, financing, and governance as the most frequently discussed aspects of the health system. It revealed a distorted health system that retained aspects of the Semashko model whilst also incorporating elements of liberalization from the 2003 modernization program. The study underscores major challenges, including the politicization of healthcare, workforce shortages, fragmented financing, and disparities in access to healthcare services. The findings indicate that the Syrian health system has been characterized by centralized governance, inconsistent financing strategies, a fragmented health information system, and a growing dependence on the private sector. The post-conflict recovery phase offers a chance to rebuild a more equitable and resilient health system. Policymakers are urged to consider necessary reforms to the health system recovery plan in Syria.

Fig. 1

Healthcare spending per capita US$ in Syria between 2000 and 2012 (blue-dotted line) compared with public health indicators. The data indicate a gradual increase in spending from 2000 to 2006, followed by a sharp rise between 2006 and 2010. However, this rise was not consistent with the GDP% share (Fig. 2), or most public health indicators which remained stable or increased, except for the DPT coverage and life expectancy at birth (Source: World Bank Data)

Fig. 2

Percentage of GDP allocated to healthcare spending from 2000 to 2012. The data show a gradual increase in the early 2000s, peaking around 2003, followed by a steady decline from 2004 onward, reaching its lowest point around 2011. This trend suggests a reduction in the governmental investment in the health sector overtime, especially in 2011 due to the crisis. Compared with Fig. 1, the governmental expenditure per capita on the health system was not proportional to the overall GDP (Source: World Bank Data)

Fig. 3

PRISMA flowchart showing the studies identified and the process of inclusion and elimination

Fig. 4

Health system profile—Syria (Source: WHO regional office for the Eastern Mediterranean 2005)