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



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.

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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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Correspondence to Balsam Ahmad.

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This article is part of the supplement “The rising burden of noncommunicable diseases in four Mediterranean countries and potential solutions”.

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Ahmad, B., Fouad, F.M., Elias, M. et al. Health system challenges for the management of cardiovascular disease and diabetes: an empirical qualitative study from Syria. Int J Public Health 60 (Suppl 1), 55–62 (2015).

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  • Health system
  • Syria
  • Aleppo
  • Cardiovascular disease
  • Diabetes
  • Qualitative study