International Journal of Public Health

, Volume 60, Supplement 1, pp 55–62 | Cite as

Health system challenges for the management of cardiovascular disease and diabetes: an empirical qualitative study from Syria

  • Balsam AhmadEmail author
  • Fouad M. Fouad
  • Madonna Elias
  • Shahaduz Zaman
  • Peter Phillimore
  • Wasim Maziak
Original Article



To explore through empirical qualitative data health system barriers to effective management of cardiovascular disease and diabetes in Syria before the crisis, and how such analysis can inform the building of a post-crisis system.


Data were collected through document review, semi-structured key informant interviews, and fieldwork in clinics.


Institutional commitment to address the increasing burden of CVD and diabetes in Syria was limited and uncoordinated. Challenges included an increasingly split healthcare system, with private provision for those who could afford it, and a residual state health sector for the majority. Public trust in the system had been declining.


We conclude that lack of effective management of CVD and diabetes indicated weaknesses of the state and its retracting role in providing effective healthcare. Such weaknesses that existed before the crisis are now compounded by new challenges resulting from wide destruction of the health system due to the ongoing war. The rebuilding of post-conflict heath care system may benefit from insights into the structural problems of the pre-crisis system.


Health system Syria Aleppo Cardiovascular disease Diabetes Qualitative study 



The research on which this article is based was conducted as part of MedCHAMPS, a project funded by the European Commission under the Framework 7 Programme (Grant No. 223075).We would like to acknowledge the contribution of Professor Julia Critchley, the Scientific Coordinator of MedCHAMPS.


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Copyright information

© Swiss School of Public Health 2014

Authors and Affiliations

  • Balsam Ahmad
    • 1
    Email author
  • Fouad M. Fouad
    • 2
    • 3
  • Madonna Elias
    • 3
  • Shahaduz Zaman
    • 1
  • Peter Phillimore
    • 1
  • Wasim Maziak
    • 4
    • 3
  1. 1.Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
  2. 2.Department of Epidemiology and Population Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
  3. 3.Syrian Centre for Tobacco StudiesAleppoSyria
  4. 4.Robert Stempel College of Public Health and Social WorkFlorida International UniversityMiamiUSA

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