Intended for healthcare professionals

Feature Humanitarian Disasters

Syria: a healthcare system on the brink of collapse

BMJ 2013; 347 doi: (Published 10 December 2013) Cite this as: BMJ 2013;347:f7375
  1. Keir Stone-Brown, intercalating fourth year medical student1, science journalism student2
  1. 1University of Manchester, UK
  2. 2City University London, London, UK
  1. Keir.Stone-Brown.1{at}

Destroyed hospitals and severe shortages of doctors and drugs are taking their toll in Syria after more than two years of civil war, which has led to more than 100 000 deaths, millions of displaced people, and the re-emergence of polio, writes Keir Stone-Brown

The Syrian civil war has become one of the worst humanitarian disasters of this century. According to Elizabeth Hoff, the World Health Organization’s representative to Syria for the past year, it has claimed 115 000 lives and injured more than 575 000 people. And, worryingly, no end seems in sight.

“The health situation has drastically deteriorated over the past few months, with an estimated 6.5 million displaced within Syria. There are critical gaps in essential healthcare delivery,” she said.

What began in March 2011 as a revolution driven by the hope of the Arab Spring, has since deteriorated into a stalemate between President Assad’s regime and tentatively allied opposition forces.

As of June 2013, two in every five hospitals were out of service. Lack of power has forced many hospitals to operate in almost impossible conditions. In Homs, a city heavily affected by the conflict, only two hospitals remain open, with the major hospital, Al Watani, badly damaged.

In the Aleppo region, near the Turkish border, the situation is unsustainable, according to Omar Abdul Gabbar, a consultant orthopaedic and spinal surgeon and medical lead for the humanitarian organisation Hand in Hand for Syria. “This is a city of five million. Assuming two million have left the town and one million are in the government controlled area, you have a population of two million served by 35 surgeons to treat everything including war injuries,” he said.

WHO is providing humanitarian assistance in conjunction with 36 non-governmental organisations. But their work is not straightforward. “We have difficulties in delivering …

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