Attacking health care facilities has been a deliberate tactic in the Syrian conflict, which is now 12 years old. Even as international recognition of the systematic nature of these attacks has grown in response to widespread documentation of assaults, impunity for perpetrators continues.

The long-term and cumulative impacts of the conflict have generated a health care crisis for the 4.6 million civilians in northwest Syria. Almost half of this population is female. Understanding how these attacks reduce availability and access to care for women and girls, including sexual and reproductive health (SRH) services, is vital to protect the human right to health, and to promote advocacy efforts in Syria and beyond.

The impact of violence across northwest Syria, combined with reduced donor funding and economic collapse, has meant inadequate and uneven provision of health care for Syrians, particularly women and girls. In response to the violence, providers have been forced to leave or relocate beyond the line of fighting, leaving many unable to reach the care they need. This not only impacts civilian access to services, but also increases demand on the service providers in safer areas, undermining the quality of care.

The devastating earthquakes which struck southeast Türkiye and northwest Syria in early February 2023 further limit the already precarious access to health care detailed in this report.

The findings of this research are intended to raise awareness of the ongoing plight of Syrians and to contribute to policy change. While health actors, including humanitarian organizations, have worked to fill the gaps in health care provision, the current approach to the crisis in Syria is inadequate. Urgent changes are needed to protect the right to health for populations in northwest Syria and ensure access for those who require medical care.

This report reflects the SRH concerns of those living and working in northwest Syria. It establishes a record upon which policymakers, donors, and health actors, including humanitarian organizations, may rely in addressing the crisis of SRH in northwest Syria. It provides core recommendations for the United Nations Security Council, United Nations member states, donors, health actors, and the coordination architecture. Respondents emphasized that accountability, improved access to health care, greater awareness, and sufficient resources should be prioritized by policymakers and practitioners.