WHO Emergency Appeal, Syrian Arab Republic (March 2021)



Syria is experiencing a protracted political and socio-economic crisis that has resulted in a severe deterioration of living conditions. The already fragile health system is overstretched with additional strain from the COVID 19 pandemic.

As the crisis completes tenth year, 6.7 million people are internally displaced since the onset of the crisis; 5.6 million people have fled the country as refugees, the vast majority to neighboring countries. Up to ninety per cent of the population is estimated to live under the poverty line, largely due to the recent severe economic decline. This is a 10% increase compared to previous years. Displacement continues to be heavily concentrated in urban centres – where more than 87 per cent of IDPs now reside, compounding the stress on overstretched resources, infrastructure and services.

At least 12.4 million people are in need of health assistance. The essential health service infrastructure such as hospitals and health centers are in a state of disrepair, requiring extensive maintenance and rehabilitation to provide a minimum level of service delivery.

By the end of December 2020, out of the 113 assessed public hospitals, 50% (56) were reported fully functioning, 26% (30) hospitals were reported partially functioning (i.e. shortage of staff, equipment, medicines or damage of the building in some cases), while 24% (27) were reported non-functioning. Out of 1790 assessed public health centres, 47% (842) were reported fully functioning, 21% (373) partially functioning, 32% (575) non-functioning (completely out of service).

There is chronic shortage of health care staff driven by displacement, death, injury, and flight of health workers particular in northeast Syria.

Up to 50 per cent of the health workforce is estimated to have left the country. These gaps can only be addressed with long-term investment.

Half a million children are chronically malnourished and an additional 137 000 children under five years of age are suffering from acute malnutrition, heightening their exposure to preventable morbidity and mortality.

Non-communicable diseases – cardiovascular diseases, injuries, cancer and diabetes, amongst others – and epidemic-prone diseases are the most common causes of morbidity in Syria. 45 per cent of all deaths in Syria are estimated to be related to non-communicable diseases (NCDs) – a 40 per cent increase when compared with 2011 rates. This rise in morbidity rates can be linked to the cumulative damage of health and WASH infrastructure in parts of the country, the lack of qualified personnel and import restrictions for key supplies and equipment, which combined have reduced the availability and accessibility of health services. Displaced persons require continuity of care for the prevention and treatment of cardiovascular and renal diseases, diabetes, cancer, psychosocial and mental health, and as well maternal and child health services.

Available surveillance data for non-COVID epidemic-prone diseases indicates that influenza-like illnesses, acute diarrhoea, leishmaniasis, and suspected hepatitis are the leading causes of morbidity across all age groups. This is particularly the case for IDP camps and sites where indicators related to access to safe water, sanitation and hygiene services are consistently worse than in resident and host communities. Displaced people are at increased risk of infectious diseases due to limited access to safe water and sanitation, overcrowding and other risk factors. Persons with disabilities (27% all types) require rehabilitation and assistive services.

Syria declared its first COVID-19 case on 22 March 2020, while the first case in NWS was confirmed on 9 July 2020. As of 7 March 2021, the number of reported cases in whole Syria has reached 45,879, including 2023 deaths.

Community transmission of the disease has been reported in several governorates, and the virus presents a significant risk especially in light of colder months and flu season upon us. Due to the prolonged crisis, the health system in the Syrian Arab Republic has become weaker and even more fragile. According to the annual report of the International Health Regulations (IHR), the national capacity for health preparedness and response is considered as level 2 out of 5, which indicates a limited capacity that requires technical and operational support from WHO and partners.

To address the increased health needs of Syrian population, WHO will continue to support health service provision using a Whole-of-Syria coordination and response approach, which targets people in need using the most direct route.

Additional resources are required to expand operations in northeast Syria, including crossline, since the closure of the cross-border option from Iraq.