A research consortium is building the first evidence-based model of how to keep a health system running inside a war zone, using northern Syria as its test case. Since 2011, Syria’s conflict has killed roughly half a million people and displaced more than 13 million. The health systems in the north-west and north-east are chronically underfunded, losing staff to violence and emigration, and have been largely ignored by researchers who instead study refugees abroad. This project fills that gap by examining four concrete pillars of health system strengthening: how services are delivered, how medical training works, how governance and financing function, and how digital tools can manage health data. If successful, the research will produce a replicable model for strengthening health systems in other protracted conflicts. That model could help aid organisations and local authorities allocate scarce resources more effectively, sustain medical training despite violence, and build digital health records that survive infrastructure collapse. The immediate impact is not on a UK patient or clinic, but on the quiet, life-or-death infrastructure that keeps healthcare running in places where war has shattered everything else.
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Background: The Syrian armed conflict which began in 2011 is the deadliest of recent wars and the worst humanitarian catastrophe this century. With approximately half a million deaths and more than 13 million people displaced, the conflict continues to have a devastating impact on the health system and health outcomes within Syria. Health systems in north west (NW) and north east (NE) Syria are facing enormous challenges relating a chronic shortage of financial resources, decreasing external influence, health workforce drain, and violence against healthcare. Most large scale health research relating to the Syrian conflict has been focusing mostly on Syrian refugees in neighbouring countries and in Europe. There has been with very little focus on health issues inside the country. Research for Health Systems Strengthening in northern Syria (R4HSSS) addresses these significant gaps through studying the experience of health systems in NW and NE Syria in relation to four interrelated elements of health system strengthening: provision of health services – by comparing different models of health service provision; health education and medical training; health governance and financing; and the use of digital solutions in health information systems. Conducting locally-driven, co-produced research on hybrid health systems and proposing evidence-based solutions on their scaling up, sustainability and integration for these two regions in Syria is crucial. Research Consortium: King’s College London (KCL) and the Union of Medical Care and Relief Organisations (UOSSM) are the key lead organisations for the research consortium. UOSSM has accumulated considerable experience in health systems strengthening and collecting health data in northern Syria and KCL has considerable experience in strengthening research capacity in conflict-affected regions. The KCL-UOSSM partnership creates a strong basis for collaborative research and capacity strengthening. Study aims and Objectives: The main aim of R4HSSS is to produce a model on health system strengthening in conflict settings which could be applied in other contexts affected by protracted and complex conflicts. Study Methods: The research will use a mixed methods approach with qualitative and quantitative research methods to include systematic reviews, a case studies on NE and NW Syria (with key informant interviews, direct observations, focus-group discussions, questionnaires and surveys where several units of analysis representing different pillars of health system will be studied) and policy validation workshops. A separate methodology will be used to develop digital solutions for health data. The surveys will target communities, patients and service-users to capture information related to the effectiveness, responsiveness and quality of health interventions provided by the health system focusing on the modalities that are designed to strengthen the health system under conflict circumstances. Capacity Strengthening Approach: We will use a context-specific, adapted DFID research capacity framework focusing on three levels of interventions; individual, organisational and institutional level.
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