Rebuilding Syria’s Healthcare System: How to Turn Healthcare Needs into Bankable Infrastructure Projects

The first investment in Syria’s healthcare reconstruction may not be a new hospital. It may be the evidence required to decide which hospitals—and which other services—the country actually needs.

Syria has entered a new phase in the reconstruction of its healthcare system.

After more than a decade of conflict, economic deterioration, displacement and chronic underinvestment, the scale of healthcare needs remains enormous. In 2026, the WHO Health Sector estimates that 12.8 million people remain in need of health assistance, while 8.2 million are targeted by the humanitarian health response.

The challenge, however, is no longer only to respond to emergency needs.

The challenge is to move from emergency response to structured healthcare system reconstruction.

This requires more than rehabilitating damaged hospitals or announcing new healthcare facilities. Before deciding what to build, where to build it and how to finance it, Syria needs a comprehensive understanding of what the country already has, what is functioning, what is missing and what will actually be required over the next 10 to 20 years.

Understand the system.
Prioritize the needs.
Structure the projects and their financing.

1. Before building hospitals, understand the healthcare system

The starting point should be a comprehensive national healthcare system assessment.

Recent indicators clearly show the scale of the challenge. Years of conflict have damaged healthcare infrastructure, disrupted referral networks, reduced access to medicines and equipment and contributed to a major loss of healthcare professionals.

The Syria National Health Compact reports approximately 1.5 physicians and 2.8 nurses and midwives per 1,000 inhabitants, with significant geographical disparities and some underserved areas having fewer than 0.5 physicians per 1,000 inhabitants. It also estimates that out-of-pocket expenditure represents approximately 45% of total health spending.

Infrastructure data also illustrate the complexity of establishing the real baseline. The Compact reports that 54% of hospitals and 39% of primary healthcare centres are fully functional, while explicitly recognizing that years of crisis have produced incomplete and sometimes inconsistent datasets. This highlights an important issue: investment decisions require a consolidated, continuously updated national picture of healthcare capacity.

The objective should not simply be to count hospitals. A proper assessment should map, at governorate and district level:

• population and demographic trends;
• expected return of refugees and internally displaced populations;
• existing hospitals, primary healthcare centres and specialized facilities;
• operational, partially operational and non-operational facilities;
• number and type of beds;
• emergency departments, operating theatres, ICUs and maternity services;
• oncology, cardiology, dialysis and other specialized services;
• medical equipment availability and condition;
• healthcare workforce by specialty and geography;
• pharmaceutical and medical supply availability;
• ambulance and referral networks;
• accessibility and travel time to healthcare services;
• public, private, NGO and humanitarian healthcare providers;
• epidemiological profile and burden of disease;
• expected future demand; and
• infrastructure conditions, including electricity, water, medical gases and waste management.

The result should be a national healthcare infrastructure and service map showing not only where facilities are located, but what services they are genuinely capable of delivering.

This approach is consistent with the direction already outlined in Syria’s National Health Compact, which recognizes current data limitations and calls for stronger national capacity to generate and monitor health financing and service coverage data. It also foresees a national costing exercise before investment targets are finalized.

Reconstruction should not start with a list of projects. It should start with evidence.

2. From healthcare gaps to an investment pipeline

Once the national baseline exists, the second step is to identify where investment will generate the greatest healthcare impact.

Not every damaged hospital necessarily needs to be rebuilt. Not every region necessarily needs a new hospital. And a new hospital is not always the answer to a healthcare access problem.

In some areas, rehabilitating and strengthening primary healthcare may generate substantially more impact than constructing a new tertiary hospital. Elsewhere, population concentration, geographical isolation or major gaps in specialized care may justify new secondary or tertiary facilities.

The analysis should therefore identify geographical and clinical gaps and translate them into a prioritized healthcare investment pipeline.

Rehabilitation and modernization

Existing hospitals may require structural rehabilitation, new medical equipment, energy systems, digital infrastructure or complete functional reorganization.

Primary healthcare expansion

New or upgraded PHC centres may improve access while reducing inappropriate demand on hospitals.

New hospitals

Where demographic demand and accessibility analysis demonstrate a genuine infrastructure gap, new secondary or tertiary hospitals may be required.

Specialized centres

Oncology, cardiology, dialysis, rehabilitation, trauma or maternal and paediatric services may require dedicated regional investments.

Diagnostic and laboratory networks

Centralized or regional diagnostic systems can sometimes provide greater impact than building additional inpatient capacity.

Emergency and referral systems

Ambulance networks, referral protocols and regional coordination are essential components of healthcare infrastructure planning.

Digital health infrastructure

Electronic records, asset management, telemedicine and national health information systems can connect facilities and improve the efficiency of the entire network.

CAPEX is only the beginning

A hospital that can be built but cannot subsequently be staffed, maintained or supplied is not a sustainable healthcare investment.

Every proposed project should therefore be assessed against both capital expenditure—CAPEX and long-term operating expenditure—OPEX. This includes staffing, utilities, maintenance, medical equipment lifecycle, consumables, pharmaceuticals and future replacement investments.

The question should never be simply, “Can we finance the construction?” It should also be, “Can the healthcare system sustainably operate this facility for the next 20 or 30 years?”

3. Turning priority projects into bankable projects

Only after priority projects have been identified should the financing structure be selected. There is no single financing model suitable for every healthcare project. Different projects require different combinations of public resources, private capital and development financing.

Government resources

Some projects may be financed directly through the national budget. This provides strong public control and can be appropriate for strategic facilities.

However, Syria’s fiscal space remains extremely constrained. The World Bank reported in 2026 that government revenue had declined from close to 20% of GDP before the conflict to less than 5% of GDP. Public resources will therefore need to be allocated very selectively.

Sovereign borrowing and development finance

Borrowing can mobilize substantially larger amounts of capital and spread infrastructure investment over longer periods. International financial institutions are already re-engaging with Syria.

In April 2026, the World Bank approved US$225 million in IDA grant financing for water and health services, including a US$75 million Health System Recovery and Strengthening Project intended, among other objectives, to strengthen 150 high-impact primary healthcare centres selected using a data-driven prioritization methodology.

Such financing can be extremely important for national infrastructure, but future borrowing must remain consistent with fiscal capacity and debt sustainability.

Grants and development assistance

Grants will continue to play an essential role, particularly for primary healthcare, vulnerable populations, public health, workforce development, institutional capacity and regions where projects cannot generate financial returns.

The European Union, for example, announced €8 million in February 2026 to strengthen primary healthcare and support health-system recovery in Syria through initiatives implemented by WHO and Un Ponte Per in coordination with the Ministry of Health.

The limitation is obvious: grants are scarce and donor priorities cannot be assumed to finance the entire reconstruction programme. They should therefore be directed toward interventions where the social impact is high but commercial financing is unrealistic.

Public-Private Partnerships

PPPs may become relevant for selected projects where risks can be properly allocated between the public and private sectors. A PPP can potentially combine private-sector financing, construction, lifecycle management and operational expertise.

But PPP should not be considered free infrastructure. Ultimately, someone must pay for the service—through government availability payments, insurance mechanisms, users or another sustainable revenue source.

A PPP therefore becomes viable only when there is:

• a clearly defined service requirement;
• predictable long-term revenues;
• adequate risk allocation;
• credible public-sector commitments;
• a stable contractual and regulatory framework; and
• demonstrable value for money.

PPPs may be useful tools. They are not substitutes for healthcare planning.

Export Credit Agency-backed financing

ECA-supported structures may potentially become another route for selected equipment-intensive or turnkey healthcare infrastructure projects. They can facilitate medium- and long-term financing connected with exports of equipment, technology and services from supplier countries.

Such structures could be particularly relevant for major hospital projects containing significant imported medical equipment and technology. However, their feasibility depends on factors including country risk, sovereign creditworthiness, banking capacity, export content, compliance requirements and the specific risk appetite of each ECA.

They should therefore be considered project by project, rather than treated as a universal financing solution.

Private investment

The private sector can also play an important role. Private hospitals, diagnostic centres, dialysis networks, laboratories, outpatient facilities and specialist services may attract domestic or international investors where sufficient demand and an appropriate payment mechanism exist.

Private investment can reduce pressure on public capital budgets and introduce operational expertise. But it cannot replace the government’s responsibility to ensure equitable access to essential healthcare.

The key is to determine where private investment complements the national health system rather than fragments it further.

Financing should follow the project—not the other way around

One of the biggest mistakes in infrastructure development is starting from an available source of financing and then trying to create a project around it. The process should work in the opposite direction:

Only at that point can a healthcare need become a bankable infrastructure project.

Importantly, not every necessary healthcare project needs to be commercially bankable. Some projects will appropriately remain publicly financed or grant funded because their value is primarily social rather than financial.

Bankability means identifying a credible and sustainable mechanism to pay for an investment over its lifecycle—not forcing every healthcare service into a commercial model.

Syria now has an opportunity to plan differently

There are encouraging signals.

The Syria National Health Compact and the Ministry of Health Strategic Plan 2026–2028 establish a direction toward a unified, PHC-centred, more equitable and financially sustainable healthcare system. The Compact specifically calls for evidence-based resource allocation, national costing, stronger health information systems and coordination between public, private and development partners.

International financial engagement is also returning. Syria’s arrears to the World Bank were cleared in May 2025, reinstating eligibility for new operations. In 2026, the EU restored the full application of its cooperation agreement with Syria. The EU lifted broad economic sanctions in 2025 while retaining security-based and targeted measures; the United States also revoked its Syria sanctions programme in 2025 while preserving targeted sanctions against designated actors. These changes materially improve the environment for international economic engagement, but every project still requires careful sanctions, compliance and counterparty due diligence.

This creates an important opportunity. But the objective should not be to reconstruct the healthcare system exactly as it existed before the war. It should be to design the healthcare system Syria will need for the coming decades.

And that starts with one fundamental question:

What does Syria’s healthcare system actually need?

Before deciding how many hospitals to build, the country needs a reliable national picture of existing capacity, population needs, geographical inequalities, clinical gaps and future demand.

From that evidence, priorities can be established. From priorities, projects can be developed. And from properly developed projects, the most appropriate combination of public funding, borrowing, development finance, grants, PPPs, ECA-backed financing and private investment can be identified.

The first investment in Syria’s healthcare reconstruction should therefore not necessarily be a new hospital. It should be the knowledge required to decide which hospitals—and which other healthcare services—Syria actually needs.

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About the author. This article reflects Daher Nourieh’s professional perspective on healthcare infrastructure planning, project development and financing. He is an international healthcare infrastructure executive with experience across project management, procurement, business development and general management.

Sources

1. WHO Health Cluster (2026). Syria Whole of Syria—Health Sector data and 2026 Humanitarian Response Plan. Access the source.
2. Syrian Arab Republic, with technical review and support from the World Bank and WHO (2025). Syria National Health Compact. Access the Compact.
3. World Bank (2026). New $20 Million Grant to Enhance Public Financial Management for Syria’s Recovery and Development. Access the announcement.
4. World Bank (2026). Syria: World Bank Approves US$225 Million Financing to Restore Water and Health Services. Access the announcement.
5. WHO Regional Office for the Eastern Mediterranean (2026). EU commits EUR 8 million to strengthen primary health care and support health system recovery in Syria. Access the announcement.
6. World Bank (2025). Syria’s Arrears to the World Bank Group Cleared. Access the announcement.
7. Council of the European Union (2026). Syria—renewed relations, assistance and sanctions policy. Access the policy overview.
8. Council of the European Union (2026). Council restores full application of EU-Syria Cooperation Agreement. Access the announcement.
9. U.S. Department of the Treasury, Office of Foreign Assets Control (2025). Revocation of Syria Sanctions; Publication of Syria Frequently Asked Questions; Syria and Syria-related Designation Updates and Removals. Access the official notice.