Through a Humanitarian Lens: Witnessing War and Hope in Syria

In 2021, nine years into Syria’s ongoing civil war, I traveled to Northeast Syria (NES) on a humanitarian medical mission with Doctors of the World. My work took me to different regions, where I met with local community leaders, health professionals, refugees, and internally displaced people to identify the most pressing health and humanitarian needs. The situation on the ground was more complex than the official reports and other international news headlines I had read before coming to Syria. I met families who had been living for years in overcrowded desert camps, children studying in tents under relentless sun, mothers waiting for hours to get food and clean drinking water, and patients dying from diseases that were eminently treatable. A country once famous for its ancient cities, well developed public services and vast reserves of oil, had been hollowed out by years of conflict.

An informal displacement camp on the outskirts of Raqqa

In my interactions with authorities and residents, I was informed that Syria’s healthcare system, prior to the conflict, had been comparable to those in other middle-income countries. Public hospitals and clinics in large cities such as Damascus, Aleppo, and Latakia were well equipped and provided modern care. In contrast, rural areas, especially in the northeast and northwest- had significantly fewer resources, a disparity I also observed during my on-site visits to these regions.  When fighting broke out, the health system was among the first national structures to fracture along the geopolitical fault lines. The conflict had divided the country into three distinct regions which made it hard for people to travel between them. The Assad regime controlled the center and western parts of Syria, the Autonomous Administration held the northeast, and the Syrian Salvation Government governed the northwest. Fear of arrest by regime forces prevented critically ill Syrians - particularly men from the northwest and northeast regions- from seeking specialized medical care in Damascus and Latakia. The memory of hundreds of patients I encountered in Northeast Syria—who died of cancer and other critical medical conditions after being unable to travel to Damascus for advanced treatment—is one of many incidents that left a profound mark on me.

Displaced families from Aleppo in a camp near Raqqa

After fourteen years of devastating war, Syria experienced a decisive moment on December 8, 2024, when opposition forces seized the capital city of Damascus, ousted the previous government and announced the formation of a new one. I will never forget the historic night in Hasakah. The city erupted in celebrations: people poured into the streets, the sound of fireworks and gunshots resounded from every corner, sweetshops were emptied and dancing went on until the first light of dawn. But as I watched the jubilant scene from my window, a tumult of questions arose in my mind. Has fourteen years of conflict truly ended? Will the people's suffering ease? And most importantly, can the country's damaged health system be restored? As a global health expert, I knew that the answers would not soon be forthcoming. Syria is no longer the same country it was before the war.

An amazing view of Hasakah city

Today, poverty affects Syria more than ever. According to a recent UNDP report, almost 66% of people in Syria live in extreme poverty while in 2010, the figure was around 11 %. Before the conflict, the northeast Syria was known as the food basket of the Middle East but today, 9.1 million people are classified as acutely food insecure and 1.4 million are severely food insecure. Between 2021-2022 alone, cases of acute malnutrition among Syrian children increased by 48% which is indeed a serious humanitarian concern. Reductions in public sector funding have further crippled the healthcare sector in Syria, leaving most health facilities dependent on donor funding. Based on the latest available information, the government health expenditure as a percentage of GDP was 5.13% in 2003 and declined to 3.05% in 2013. Throughout the conflict, this figure remained at or below 1% of GDP.

According to the WHO's Humanitarian Response Plan for Syria for 2025, 57 percent of hospitals and 37 percent of primary healthcare centers in the country are fully functional. These figures may actually understate the crisis, as many humanitarian organizations in Syria have scaled back or halted their support following the withdrawal of USAID and funding cuts by other donors.

Many functional public health facilities across Syria face significant operational and financial challenges. The absence of good infrastructure, a shortage of essential staff, a critical lack of essential medical equipment and medicines, limited or no access to safe drinking water and sanitation are among the most significant health problems I documented through firsthand observation and conversations with people during my visits to various hospitals in Syria. Because of unavailability of quality health services, many Syrians have lost much of their trust in government-run health facilities. This loss of trust, in turn, has created an opportunity for private hospitals, clinics and pharmacies to expand their services without adhering to any regulatory mechanisms. Most of the people in Syria cannot afford private healthcare due to post conflict economic hardship. According to a research study report, out-of-pocket spending in 2008 was approximately 61% of the total health expenditure. Although, this percentage has likely increased in recent years, however, there is no reliable latest data to support it.

An evening walk, drawn to the beauty of Hasakah, Syria

Hundreds of thousands of health workers fled Syria following the onset of the conflict, leading to a severe shortage of medical staff in the country. Furthermore, due to poor salaries and benefits, many of the remaining professionals chose to work at private hospitals or non-governmental organizations, which made the quality of care in public hospitals even worse. According to a recent UNDP report, in 2010, each doctor served an average of 700 patients, today, one doctor on average serves over 2000 patients. Another demotivating factor for public sector health professionals is the lack of training opportunities. In fact, many have not participated in any skills development programs since the conflict began. The new government and other relevant institutions should prioritize addressing this issue. Academic institutions such as Aga Khan University, known for excellence in medical education across Asia and Africa, should also bring their expertise to Syria and play their role in improving quality health education in the country.

Fourteen years of conflict in Syria have severely weakened the entire health system resulting in a crisis of significant magnitude. Chronic diseases are now more prevalent than they were before, access to quality and affordable medicines is limited, preventable illnesses such as cholera, measles, meningitis, scabies, and Leishmaniosis have made a troubling comeback, mental health issues are growing, life expectancy has sharply declined, and mortality rates that were once lower before the conflict are now climbing again.

Most of the humanitarian assistance in Syria over the last 14 years was funded by the United States. In 2024 alone, US allocated over 1.1 billion USD to support millions of displaced people and refugees across Northeast and Northwest Syria. However, the dismantling of the USAID in 2025 is placing millions of lives at risk in Syria. As mentioned, Syria’s health system is already weakened from years of conflict and will further be strained by the return of 7.4 million internally displaced people and 6 million refugees. Without a united global effort, the situation can also lead to another humanitarian crisis. Now more than ever, the U.S. government and other donor agencies must stand by the people of Syria and continue their vital support.