Health, key pillar of stabilisation and resilience of Syrian populations

“The work of health workers on the ground has been essential to help relieve the suffering of the Syrian people for the last ten years. They paid a huge price and they are still at risk every minute” declared Eric Chevallier, Director of the Crisis and Support Centre of the French Ministry for Europe and Foreign Affairs.

Since 2011, Syria has experienced a massive destruction of its healthcare system. The latest data from the WHO in 2019 and recent study conducted by the International Rescue Committee (IRC) underlined that slightly more than half of hospitals and primary health care centers across Syria are functioning. It also highlights that two thirds of the health workforce has fled the country and that half of civilians are afraid of accessing a health facility because they are afraid of an attack.

Healthcare faced with structural wounds

The health sector in North-East Syria (NES) also suffers from deeper and more structural wounds such as poor infrastructure, low quality medicine, weak health information systems, and lack of trained staff. Dr. Abdulkarim Ekzayez, a Syrian epidemiologist and senior research associate at King’s College London, explained that “none of the six SANES [Self Administration for Northern and Easter Syria] regions have more than 2 doctors and nurses per 1 000 people”.

Dr. Kassar Alali, director of the Raqqa National Hospital, shared his testimony on the extent to which medical facilities are stressed and resources scarce: “The number of medical staff decreased by 75% since the beginning of the war and the lack of access and arrival of medication and medical equipment since the closure of the Al-Yarubiya crossing border is a challenge.”

Training at the heart of healthcare strengthening

“There is no sustainability of the health sector without developing the human resources”, Dr. Alali added. This huge need for capacity building was confirmed by Dr. Nynke van den Broek through the example of midwives and birth attendants on maternity care. “Maternity care needs to be available 24h/day, be ready everywhere for everyone and this is a challenge”, explained Dr. van den Broek, an expert in reproductive, maternal, newborn and child health for Expertise France, but “most of the healthcare facilities [in NES] are not able to provide all of the minimum care package”. To reach more women and improve maternity care, she mentioned the opportunity to explore the work to be done with traditional midwives.
 

Working with community health workers – who represent one third of the total workforce in North-East Syria – is also identified as a key issue by Dr. Neha Singh, Health Working Group Coordinator in NES: “That community health workers must lead interventions on the ground: anemia control for pregnant women, children diarrhea, vaccination campaigns, hygiene campaigns… These community-led interventions are important, as they are channel to avoid over-crowding at facilities and making beneficiary travel long distances to get to the facilities."

More generally, civil society has a key role to play in the future of the region. “The civil society strengthening is of particular importance in our stabilisation strategy as it ensures durable impact on the health system, said Eric Chevallier, it contributes to increase the number of local actors who can receive international support and strengthen coordination and partnerships between international and local organizations.”

Coordination as key

More generally, multiple actors are needed to address these multi-layered issues: health providers – whether they are national or international NGOs –, local governance institutions (when legitimate), educational institutions, technical experts and researchers to access reliable information. “Humanitarian and stabilization actors need to work hand-in-hand not only to ensure service delivery but also to contribute to strengthening the sector as a whole”, explained Jérémie Pellet, CEO of Expertise France.

This is the role of the NES Forum, the coordination body for multi-sectoral response in North-East Syria. “The Health Working Group of the NES Forum comprises 16 humanitarian partners and engages with multiple donors, stabilisation actors and the United Nations”, explained Dr. Neha Singh, who also insisted on the need to coordinate with local authorities, for sustainable systems strengthening which is central to stabilization.

Engaged in stabilization efforts in the region, Expertise France is committed to this coordinated approach. Since 2013, the French public international cooperation agency implemented three large health projects with support from international donors like the European Union, the French government or JICA, and works hand-in-hand with a lot of different Syrian partners. “The results are tangible: under Expertise France-managed projects, more than 4 million consultations have been provided and expertise has been deployed to support pharmaceutical control, or waste management for instance”, explained Jérémie Pellet. “Expertise France is willing to continue taking its part in that common effort to support and we would not have been able to do it without the support of donors and partners that have accompanied us in the past”, he added.
 

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Tangible results but remaining challenges

“Massive work has been done in the rehabilitation of the health system in North-East Syria in the last seven years [but] most of the hospitals are partially functional”, stressed Dr. Neha Singh. For his part, Dr. Ekzayez pointed out that, after ten years of conflict, priorities shifted from traumas response to public interventions and strengthening health systems, beyond access to services: “In the active phase of conflict the goals will be more about savings lives, access responsiveness. But as we go further we need to think about additional outcomes like comprehensiveness, social and financial protection and safety”.