Rebuilding a nation from the ruins of war is no easy task, especially when the nature of the conflict is fratricidal. But if a devastated post-World War II Europe proves anything, it is that where there is unity of purpose all is possible.
Even as the Second World War was still being fought, Allied leaders began thinking about Europe’s reconstruction. Now, Syria too is in need of a master plan to rebuild, painstakingly, what has been lost during the last six years of turmoil. And besides the restoration of economic and agrarian infrastructure – the collapse of the latter (due to one of the worst droughts this relatively prosperous Arab country endured between 2006 and 2009) was a major trigger for the rebellion against Bashar al-Assad’s regime in 2011 – Syria’s now virtually non-existent healthcare system requires urgent reconstruction too. After all, the lingering health effects of this bitter conflict may be as far-reaching as the civil war itself in the years to come.
The question is whether a country where hospitals have been targeted, and medical professionals viewed with distrust, by combatants, can really bounce back to its former state of medical provision. Before the onset of the war, Syria boasted of one of the best healthcare systems in the entire Middle-East. As Dr.Talal Bakfalouni, a senior health administrator and the former Director of Planning and International Cooperation for his country’s health ministry, puts it: “Syria’s health system was close to achieving universal coverage. Healthcare indicators were among the best in the region and were comparable to advanced countries, while efficiency of provision was the hallmark.”
Indeed, Syria had optimal healthcare infrastructure comprising state-of-the-art facilities staffed by well-trained providers with access to authoritative and up-to-date medical science information. The country’s healthcare delivery was robust: national life expectancy rose to 75.7 years in 2012 from 56 in 1970, with substantial reductions in death rate from all causes. And immediately before the country descended into a brutal fratricidal conflict, infant and maternal mortality rates dropped significantly. Interestingly, access to health services rose dramatically from the 1980s, with rural populations achieving better outcomes than ever before despite low public investment in healthcare – total government expenditure on health was just 2.9 percent of GDP in 2009.
Unfortunately, Syria’s medical system has now been decimated completely, with hundreds of thousands battling chronic illnesses and disabilities left untreated. Aleppo’s once-booming pharmaceutical industry has crumbled and patients are forced to buy medicines at inflated rates. With casualties from treatable diseases and combat-related injuries skyrocketing, the time for weighing only short-term, emergency solutions is up.
Syria’s health system was close to achieving universal coverage. Healthcare indicators were among the best in the region and were comparable to advanced countries, while efficiency of provision was the hallmark
According to Elise Baker, who is chief Syria researcher at the NGO Physicians for Human Right, follow-up care for wounds, amputations and infections is now seriously inadequate. A long-term plan capable of addressing future health needs and issues must be formulated urgently, she says. One senior medical professional conversant with the situation on the ground, says there is no reason why the country cannot redevelop a self-sustaining medical infrastructure – if the leap is made now from crisis-response to strategic planning and recovery.
To that end, outside help will be crucial. India, for one, has amassed considerable expertise in strengthening healthcare infrastructure in various parts of Africa and in war-torn Afghanistan, where it is involved in hospital construction and medical management. As Syria looks to repair its battered healthcare system, best practice from other regions must be adopted. For that to happen, however, “Syria will first have to get its borders and unity re-established,” believes Rajendra Abhyankar, a former Indian envoy to Syria.