Education and health are closely linked. Healthy behaviors and living are linked to increased knowledge. Education also provides opportunities to earn a better income, which is an important determinant of health (Skolnik, 2020)
Education
Educational System
The education system is under the supervision of the Ministry of Education and the Ministry of Higher Education. These institutions set the curriculum and goals for the schools, colleges, and universities throughout the country. There are a few private schools, with 98% public. Primary and secondary education are compulsory. Students need to take an exam at the end of 12th grade that will determine which university or college they can enter and what specialization they can take (StudyCountry.com, n.d.). The Syrian regime was proud of having practically done away with illiteracy. An authoritarian educational method was used with an emphasis on learning by heart and instilling obedience to the nation and state. Syrian education had an abstract and passive relationship to knowledge (Longuenesse, 2019).
Education Rates
Literacy rate at 86.4% (rated plummeted since data)
Education expenditures at 5.1% of GDP (CIA, n.d.)
Education attainment as of 2017 was 8.3 versus the United States at 13.5 (IHME, n.d.).
Education rate of primary school enrollment in 2011 was 99.6%
Education rate of secondary school enrollment in 2011 was 58% with only slightly more boys (Longuenesse, 2019).
Since the conflict, only 17% of children displaced are now in school with some area as low as 6% (Save the Children International, 2015).
It is estimated that 2.1 million children are out of school, and in one displacement camp there are 400 students, but only 70 can attend due to lack of space (Yamin, 2020).
The lack of education and children out of school has elevated the risk of early marriage, child labor and other forms of exploitation and abuse (UNICEF, n.d.).
Conflict on Education
From January to the end of June 2019, there had been 74 attacks on schools and the military uses 24 schools. From February 2019 to February 2020, 92 educational facilities have been attacked, which killed more than 251 children and injured hundreds of others. It is estimated that 2 out of 5 schools have been damaged or destroyed with 1.3 million children at risk of dropping out. 1 in 8 of these children require specialized psychosocial support (UNICEF, 2019; Yamin, 2020). It is estimated that 150,000 teachers have fled or been killed, so the schools that still function are crammed and have few teachers to run them (Economist, 2019). Functioning public schools have seen class sizes double or triple. Thousands of children have been forced to move from their home multiple times, which causes an interruption or delays in their schooling up to several years. This creates children being abandoned by the public service and are no longer listed in the civil registry. This means they will no longer be allowed to register for school even if they are able to (Longuenesse, 2019)
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Short term effects include death, injury, destruction of educational facilities, and disrupted access to education.
Long-term effects lead to diminished education quality, loss of teachers and academics, weakened educational systems, and creates a culture of impunity. Girls are at increased risk due to the many social and cultural barriers faced by girls. Syrians lack the skills needed to rebuild their country and escape poverty. The uneducated are at increased risk of becoming jihadists and militiamen, or joining Assad's regime for money and a bit of power (Economist, 2019; Yamin, 2020).
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The chances of receiving a good-quality education is being diminished due to disrupted attendance, poor learning environments, unsafe or no school buildings, lack of water, sanitation and hygiene facilities, explosive remnants along school routes, and lack of learning materials (Yamin, 2020).
Economy Status and Poverty
Syria
GDP per capita - $4,708
Total expenditure on health - 376
Total expenditure on health as % of GDP - 3.2%
Health care access and quality index - 67.2%
Coverage of essential health services - 69.9%
Health workers - 2.5 per 1,000 people
Hospital beds - 1.5 per 1,000 people
Doctors - 1.22 per 1,000 people
Average income - $1,892
(IHME, n.d.; WHO, n.d.; World Data.info, n.d.)
United States
GDP per capita - $53,535
Total expenditure on health - 9,403
Total expenditure on health as % of GDP - 17.1%
Health care access and quality index - 88.7%
Coverage of essential health services - 87.8%
Health workers - 13.0 per 1,000 people
Hospital beds - 2.9 per 1,000 people
Doctors - 2.59 per 1,000 people
Average income - $68,340
(IHME, n.d.; WHO, n.d.; World Data.info, n.d.)
Prior to the turmoil, the Syrian government had begun liberalizing economic policies, but the economy remained highly regulated. Long-run economic constraints include foreign trade barriers, declining oil production, high unemployment, rising budget deficits, increasing pressure on water supplies, water pollution, and widespread infrastructure damage. The economy has deteriorated since the beginning of the conflict in 2011 and has declined by more than 70% as of 2017. In 2019, the inflation rate was around 36.7% with 82.5% of people living below the poverty line and 50% unemployed (CIA, n.d.; World Data.info, n.d.). With 4 out of 5 people living below the poverty line, this is pushing people into extreme measures to help make ends meet, such as child labor, early marriage, and recruitment into the fighting for children. There are estimated to be 1.1 million people living in hard to reach areas (UNICEF, 2019).
In 2018, there were around 160,000 stateless persons (Kurds and Palestinians), which prevent these people from voting, owning land, holding certain jobs, receiving food subsidies, public health care, enrolling in public schools or being legally married to Syrian citizens (CIA, n.d.).
Health System
Before the War
A country's optimal health care is to have modern facilities staffed by professional medical workers with access to current health information. Syria was near this goal before the start of the war. Syria had 5 medical schools, a National Health and Medication Plan, and 37 medical libraries (Phillips, 2016). Health indicators had significantly improved with 77% of mortalities linked to non-communicable diseases. There was an uncontrolled and unregulated expansion of private providers, which was causing an uneven distribution of health and medical services. Standardized care, quality assurance and accreditation were areas that needed to be addressed (Kherallah, Alahfez, Sahlou, Eddin, & Jamil, 2013)..
Now
From January to July 2019, 51 medical facilities have been attacked in northwest Syria, and half of all health care facilities are partially or not functioning at all (UNICEF, 2019). It is estimated that 11.5 million people do not have access to health care with 55% of public hospitals and 49% of health centers closed or partially functioning. Around 45% of medical professionals are left working in Syria, with 1:6 surgeons working 80-hour weeks and 38% of health workers having received no formal training. People fear hospitals and health centers due to their bombing risk, and many have removed the symbolic Red Cross or Red Crescent markings from the hospital or moved underground. It has been noted that 1:10 health care worker receives threats due to their occupation (AVSI Foundation, 2017; Rae, 2018).
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The Syrian government along with the rebel forces, Russia, and ISIS have purposely and aggressively targeted health care personnel, facilities, ambulances, manufactures and suppliers of medical equipment, pharmaceuticals, and NGOs. Over 700 health care workers have been killed or injured, and over half of Syria's physicians have been forced to flee the country. Medical facilities are understaffed, poorly equipped, under-supplied, and overwhelmed. Restrictions on travel and sanctions have resulted in major shortages of needed resources (Phillips, 2016). Elective surgeries and non-urgent routine medical visits have been delayed or interrupted. It is estimated that over half of those with chronic conditions could not continue their treatment. The quality of health care has majorly deteriorated, due to the lack of functional medical equipment and shortage of supplies and medications (Kherallah, et al., 2013).
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The collapsing of the Syrian health system is making it almost impossible for hospitals to respond adequately to the needs of the people. The poor are affected the greatest, since they are not able to pay for their medical treatment. With even basic health care in shambles along with lack of clean water, energy, and sanitation services, Syria is at risk for an outbreak of water related diseases (AVSI Foundation, 2017).
References
AVSI Foundation. (2017). The health crisis in Syria. What is happening, in ten simple points. Retrieved from https://www.avsi.org/en/news/2017/03/03/the-health-crisis-in-syria-what-is-happening-in-ten-simple-points/1342/
Central Intelligence Agency [CIA]. (n.d.). Middle east: Syria. The World Factbook. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/sy.html
Economist. (2019). Syrian’s broken schools will make it difficult to fix the country. Retrieved from https://www.economist.com/middle-east-and-africa/2019/03/14/syrians-broken-schools-will-make-it-difficult-to-fix-the-country
Institute for Health, Metrics and Evaluation [IHME]. (n.d.). Syrian arab republic. Retrieved from http://www.healthdata.org/syria
Institute for Health, Metrics and Evaluation [IHME]. (n.d.). United states of america. Retrieved from http://www.healthdata.org/united-states
Kherallah, M., Alahfez, T., Sahloul, Z, Eddin, K. D., & Jamil, G. (2013). Health care in Syria before and during the crisis. Global Research. Retrieved from https://www.globalresearch.ca/health-care-in-syria-before-and-during-the-crisis/5302448
Longuenesse, E. (2019). Syria: A wrecked school system, a country in ruins. TheNewArab. Retrieved from https://english/alaraby.co.uk/english/comment/2019/2/5/syria-a-wrecked-school-system-a-country-in-ruins
Phillips, S. J. (2016). Syria’s compounding health care crisis. Fikra Forum. Retrieved from https://www.washingtoninstitute.org/fikraforum/view/syrias-compounding-heathcare-crisis
Rae, M. (2018). Impacts of attacks on healthcare in Syria. Syrian American Medical Society. Retrieved from https://www.sams-usa.net/2018/10/19/the-impacts-of-attacks-on-healthcare-in-syria/
Save the Children International. (2015). More than half of all attacks on schools in Syria. Retrieved from https://syria.savethechildren.net/article/more-than-half-all-attacks-schools-syria
Skolnik, R. L. (2020). Global health 101. Burlington, MA: Jones & Bartlett Learning.
StudyCountry.com. (n.d.). Syrian education. Retrieved from https://www.study.country.com/guide/SY-education.htm
UNICEF Middle East and North Africa. (2019). Syrian crisis fast facts. Retrieved from https://www.unicef.org/mena/reports/syria-crisis-fast-facts
UNICEF USA. (n.d.). Education crisis in Syria. Retrieved from https://www.unicefusa.org/infographic-education-crisis-syria
World Data.info. (n.d.). Country comparison. Retrieved from https://www.worlddata.info/country-comparison.php?country1=SYR&country2=USA
World Health Organization [WHO]. (n.d.). Syrian arab republic. Retrieved from https://www.who.int/countries/syr/en/
Yamin, A. (2020). The impact of attacks on education in north west Syria on children [PDF]. Save the Children. Retrieved from https://www.savethechildren.net/research-reports/search?region=Europe%20and%20the%20Middle%20East&search=Education