Healthcare professional retention and return in Syria across conflict and political transition: a targeted literature review and qualitative analysis

Background Healthcare professional (HCP) retention and return are key to maintaining a functioning health system, especially in conflict and post-conflict settings. In Syria, protracted conflict and severe health system destruction have decimated its health workforce, with factors both pre- and post-December 2024 (when the Syrian regime collapsed) negatively impacting HCP retention and return. This study aimed to explore factors influencing HCP retention and return in Syria, with the goal of informing context-specific policy recommendations. Methods We undertook a qualitative study which included a facilitated workshop (conducted in July 2023) with 53 HCPs, and 26 Key Informant Interviews with HCPs in Syria (September 2024 to March 2025,) spanning the fall of the regime in December 2024. We supplemented this with a targeted literature review of relevant peer-reviewed and grey literature. From these, key themes and subthemes were identified, and policy recommendations were drawn by integrating information from these methodologies. Results Key push factors included insecurity, financial instability, and poor working conditions, while pull factors related to better remuneration, training opportunities, and the recognition of degrees or training abroad. Post-December 2024, participants noted insecurity to be less of a push factor but that similar pull factors persisted, though external migration was harder. Persisting socioeconomic and governance challenges continued to influence decisions about retention and return. Across the different regions, different education and training systems evolved with concerns raised about accreditation (in areas outside of former regime control) and unequal opportunities across regions with the former northeast of Syria particularly neglected. Across all areas, concerns were raised about the quality of education and graduates. Syria’s fragmented health system (pre-December 2024,) contributed to limited and fragmented workforce data describing the total numbers of HCPs and their production, distribution and specialisation. Discussion Despite the post-December 2024 political changes, socioeconomic, governance, and workforce challenges continued to influence HCP retention and return across Syria. Our recommendations highlight the importance of integrated health governance, strengthening workforce information systems, better workforce planning, improving working conditions, ensuring fair remuneration, strengthening training and accreditation systems, and expanding career development opportunities to support health workforce recovery in the post-conflict period.