Health system recovery in Northwest Syria–challenges and operationalization

The demonstrations in Syria in 2011 became an uncompromising conflict that divided the country into three main areas of control: governmental areas, northeast Syria, and Northwest Syria. A series of United Nations resolutions adopted in 2014 authorizing official cross-border humanitarian aid in opposition-held areas to allow humanitarian agencies and organizations to use routes across the border from neighborhood countries like Turkey to deliver humanitarian assistance to people in need in Syria. The resolution was extended annually until 2021 when it was adapted to involve a cross-line humanitarian response from governmental areas besides cross-border operations. The last adaptation of the cross-border resolution, whose original form was interpreted as a politicized action by Russia and China, implicates an unframed and unplanned transition from an emergency to an Early Recovery status. Without an appropriate framework for the current geopolitical complexity in Syria, Early Recovery programs are doomed to fail, resulting in further complications in the political and humanitarian scenes. Moreover, the effectiveness of the cross-line mechanism is questionable, considering the lack of accessibility and acceptability for Damascus-based humanitarian operations in areas out of government control. The article reviews studies about Early Recovery guidelines and operational frameworks of health systems recovery in post-conflict settings to derive a practical and hybrid framework for operationalizing health system recovery in Northwest Syria, considering current geopolitical and humanitarian circumstances. This article draws upon the six building blocks of the health system, the essential package of public health services, Early Recovery integration criteria, health system resilience dimensions in the literature, and public health determinants to identify context-specific health system recovery challenges and priorities. As a result, we introduce a new health system recovery framework, which is operationalized for the context of Northwest Syria.