Assessing health system readiness for reconstruction in post-conflict Damascus Governorate, Syria: a cross-sectional study

BACKGROUND: The Syrian conflict has severely damaged health infrastructure and displaced large portions of the skilled medical workforce. This study aims to assess the readiness of the health system in Damascus Governorate for the reconstruction phase and to identify priority areas for recovery in similar post-conflict contexts. METHODS: In February 2025, we conducted an anonymous Delphi-based online survey (Cronbach’s α = 0.89) among physicians, dentists, pharmacists, and nurses working in hospitals across Damascus Governorate. Five domains were assessed: health infrastructure, medical workforce, medications and supply chains, reconstruction priorities, and context-specific lessons relevant to health emergency preparedness. Data were analyzed descriptively. RESULTS: A total of 1,013 participants responded (41.57%). Nearly 43.30% reported that hospitals were heavily damaged, and 70% indicated shortages in medical personnel. Essential medicines were inconsistently available, with 38.90% reporting limited access and 59.60% identifying supply-chain constraints. Additionally, 41.20% reported lack of coordination with international organizations, and 51.60% noted insufficient involvement of local healthcare workers in reconstruction planning. CONCLUSION: Rehabilitation of damaged infrastructure, restoration of supply chains, and strengthening of the medical workforce represent key reconstruction priorities in Damascus Governorate. Locally developed approaches—such as deployable field units, emphasis on primary care, and multidisciplinary coordination—may offer adaptable models for other post-conflict health systems. Continued international support remains essential to mitigate workforce losses and enhance resilience.