Rebuilding cancer care in post-conflict Syria: restoring continuity across the cancer care continuum

Protracted armed conflict causes profound disruption to health systems both directly and indirectly; this has high impacts on complex, resource-intensive conditions such as oncology. In Syria, fourteen years of conflict after the violent suppression of uprisings in 2011 resulted in the fragmentation of its health system into at least four subnational systems; these emerged as parallel structures with uneven governance, service availability, and access to care. Despite the fall of the regime in December 2024, the impact of this fragmentation on access to oncology services remains. In this perspective, we explore its impact on the cancer care continuum from prevention through to detection, diagnosis, and management; we argue that early recovery efforts must prioritize institutional coherence over rapid service expansion. In the early recovery period, constraints include the absence of a national cancer registry, limited diagnostic capacity and centralized distribution, shortages in radiotherapy and systemic therapies, and the lack of integrated multimodal care within oncology centers. Patient journeys, particularly outside of major urban centers, require patients to traverse large geographies, adding to costs and burdens. Drawing on lessons from post-conflict health system reforms in other countries, we propose a sequenced approach to oncology recovery centered on three priorities: strengthening governance and national stewardship, formalizing referral pathways aligned with system capacity, and defining a phased essential cancer service package linked to financial protection. Restoring continuity across the cancer care continuum requires aligning governance, service delivery, and financing before expanding specialized services. Without this consolidation phase, expansion risks reinforcing existing inequities rather than addressing them.