The role of the Syrian non-governmental organizations in rebuilding health system in Syrian opposition-held areas during the conflict

The health system and its public policies in Syria before the Syrian uprising in March 2011 was not an ideal system that would meet the aspirations of the Syrian citizens or satisfy them, and its services were not equitably distributed in accordance with international public health policies, standards, and regulations, rather, it was politicized in favor of the Syrian government, and subject to its centralized policies that serve the parochial interests of the ruling family in Syria. There were also many restrictions on the work of Syrian non-governmental organizations (SNGOs) and societies, although their number was scarce and all their activities were under the control and guidance of government agencies. With the start of the Syrian uprising in March 2011, and its turning into an armed conflict due to the excessive use of violence by the Syrian regime against civilians, The health system was one of the tools of war as the Syrian regime used it as a weapon in its war against its opponents in areas that became out of its control, which led to the collapse of the health system there. This prompted health sector activists to start establishing and rebuilding a health system and new public health policies in those areas to fill the gap that had occurred in the health sector, through alternative health bodies providing health services to the needy, and paving the way for the entry of NGOs in general and Syrian organizations in particular to intervene in the humanitarian crisis in Syria, especially in relation to the health system and the exchange of roles between them. The research aims to show the main reasons that led to the collapse of the health system and its public policies in Syrian opposition-held areas (OHAs) during the conflict from 2011 to 2021, to highlight the main players in rebuilding and forming its new policies, and to show the role that Syrian health bodies and Syrian humanitarian non-governmental organizations have mainly played in this field during the past decade of the conflict in Syria, and the main challenges and difficulties facing the implementation of public health policies, and hinder their development, in addition to exploring the most appropriate form of the health system from participant perspective through which health policies can be implemented and developed in the remaining Syrian OHAs. The research has found that the Syrian regime has played the biggest role in the collapse of the health system by giving up its role in supporting the health sector, and depriving areas that got out of its control of any medical supplies, and the imposition of blockade on them, and using violence against the health sector, using it as a tool of war. The research shows that the health bodies established in the beginning of the Syrian uprising played an important role in rebuilding and establishing the health system and its health policies, and the role of non-governmental humanitarian organizations (NGOs) came to complement this role and support it by providing funding and technical and cognitive support to them, especially through alliances formed between a number of Syrian NGOs for this role and to achieve its goals. The research shows the main challenges and difficulties facing the implementation and development of the health policies, which were manifested in the continued violence used by the Syrian regime, the destruction of the health infrastructure by the Syrian regime, changes in control, donor agendas, and other reasons. This research was based on the qualitative approach of studies through in-depth individual interviews by using open-ended questions with decision makers and key informants (KII) in the health sector through direct contact, in line with the procedures followed with regard to the outbreak of COVID-19, in addition reviewing previous studies, research, academic articles and reports of humanitarian and human rights organizations, and United Nations (UN) organizations. This research will help local and international decision makers identify the main challenges that hinder the building of the health system and the implementation and development of its policies, in addition to being an important reference for rebuilding the health system and its policies in the stabilization and recovery phase in Syria.