The rapid disintegration of the regime of Bashar Al-Assad stunned observers. Forces from Hayat Tahrir Al-Sham (HTS), the Turkish-backed Syrian National Army and Syrian Free Army converged on Damascus on 8 December 2024, sealing the fall of Ba’athist forces which had ruled Syria since 1971. Eleanor Nott, founder of a development NGO and PhD candidate at King’s College London, travelled to Syria to visit civil society leaders and assess the state of the health system.
Syria, January 2025
We landed early in Beirut and the rising sun illuminated our drive through the mountains to the Jdedeh border crossing into Syria.
The Lebanese border was the familiar experience of uniformed staff checking papers in buildings adorned with the flags of their nation. What I encountered on the other side was different and the first sight of a nation in a state of rebirth. On the first stretch of the road to Damascus, we saw an abandoned checkpoint painted in the faded livery of the fallen regime. Shreds hung where a portrait of former President Bashar al-Assad, the first of many, once looked down. The sheer number of images of Assad and his father, Hafez, was remarkable. On buildings, Bashar’s cold-eyed stare gazed down from posters and in paint, at the entrance to towns, along highways, made of tiles or carved into stone, Assad – both senior and junior – have had their images smashed, torn or scratched out. Bashar in military fatigues; perhaps the final sight of the outside world seen by those entering one of the many notorious mukharbarat sites in Damascus. The footage of liberated Sednaya prison has revealed to the world the torture and degradation meted out by the regime in its cells.
At the Jdedeh crossing there were no uniforms, just a quiet industriousness which set the tone for my forthcoming encounters. A man walked in and proclaimed ‘good morning, welcome to free Syria.’ The men behind the desks asked questions about who I was here to see, wrote things on a piece of paper with biro, conversed among themselves and eventually handed me a form to complete.
In Damascus’ Umayyad Square, the setting for scenes of jubilation in early December as the regime melted away, the tri-star free Syrian flag was draped from buildings and flashed in the windows of passing cars. A group of people were digging up the grass on the roundabout and planting shrubs and flowers. The lobby of the Sheraton hotel was full of activity, the obligatory NGO and UN white Land Cruisers crouched in the car park.
Crossing a bridge to eastern Ghouta, a short drive from the Assads’ palace on the hill and smart international hotels, ranges of shattered apartment blocks loomed in the near distance. This was the scene of the first chemical attack launched by the regime in 2013, when it was on the edge of defeat. American and British red lines evaporated and with a Russian diplomatic sleight of hand, the regime agreed to surrender its chemical weapons – only for them to be used on dozens of further occasions.[1]
The new head of the Syrian Arab Red Crescent (SARC), Dr Hazem Bakleh, served the organisation for decades before resigning in disgust at the corruption he witnessed, an act which marked him out as a transgressor in the cult of Assad. His predecessor had a security buzzer fitted to control entry to his office but Bakleh operates an open door policy with his team, something he considers vital and in the spirit of the new Syria. Since 2016 the President of the SARC had been Khaled Hboubati – an Assad associate . As Hboubati’s business interests in dried apricots suffered due to the conflict, he was rewarded with a government contract to formalise the Khirbet Ghazaleh crossing in Deraa.
The scale of corruption in Syria has been breathtaking and the aid sector was not exempt from the efforts of the regime to co-opt all resources entering the state. Once the conflict started, a key mechanism for monitoring and controlling the activities of humanitarian agencies within the country was the insistence that aid organisations partner with the SARC. SARC’s role was as a gatekeeper and coordinator of all humanitarian actors in Syria, domestic and international. It was the lead implementing partner of the UN. The inadequacy of the SARC-administered cross-line operations from Damascus into opposition-controlled areas was a spur for UN Security Council Resolution 2165 which authorised cross-border operations in 2014; allowing aid to enter opposition enclaves from Jordan, Iraq and Turkey.
The SARC’s brand is a tarnished one and its new chief is keen to restore trust among both the Syrian people and international donors. Dr Bakleh describes how he instructed the contents of a recent planeload of food aid from the King Salman Humanitarian Aid and Relief Center, the humanitarian arm of the Kingdom of Saudi Arabia, to be delivered directly to local distribution points, bypassing SARC’s warehouses, to demonstrate the new era of transparency. This was a response to past SARC activity when some staff used to divide the packages in the quiet of the warehouse and sell the high value items on the black market for profit.
In Homs, the consequences of corruption for the health system are apparent. I am told how the cost of a CT scanner would double, from delivery at the airport to arrival at the hospital, as bribes inflated the price in transit, from the government department through the local intelligence branch to a hospital. Hospital authorities are struggling to settle an unpaid bill left over from old times, some $16,000 and counting. The medical electronics company gave up waiting for payment and no longer maintains the scanner, which sits idle.
I have lunch with a group of doctors who tell me about the patient who was hauled off the operating table by the mukhabarat, the surgeon begging to be able to at least stitch closed the open abdomen.[2] One of them says that when the regime was in power, permission would need to be sought for such a gathering as ours – of ten or more people – from the local police. My host has returned to a family home he left fourteen years ago, happy to find it still standing. Many are not, some 60% of Homs’ residential areas bombed by barrels from helicopters or missile payloads courtesy of the Russian air force.[3] Among the casualties was also the Amal hospital, bombed in 2012 and its flattened buildings still standing in ruins today.[4] The ruins of smashed neighbourhoods were left as a reminder of the fate of those who challenged the regime.
Physicians for Human Rights (PHR) estimate more than 949 healthcare workers have been killed directly during the conflict, with more than 92 percent killed by the Syrian government and its allies.[5] The assault on health is one of the most striking features of the Syrian conflict. One of the most authoritative investigations was the Lancet-American University of Beirut Commission on Syria which used the term ‘weaponisation’ to describe the strategy of violently depriving people of healthcare they need at the cost of hundreds of healthcare workers killed, incarcerated or tortured and scores of healthcare facilities attacked.[6] In addition to denying wounded civilians’ impartial medical treatment, PHR reported about the invasion, attack and misuse of hospitals, impediment and attack of medical transport and detention and torture of doctors.
The new head of the Homs Health Directorate is from Idlib, the quasi-state from which Hayat Tahrir al-Sham (HTS) launched its lightning offensive in November. The doctor did not know what to expect when he returned home to Homs. To his surprise the standard of healthcare provision he found in government areas was inferior to that in the northwest.
The health system, among other services, in the northwest has been sustained by a range of Syrian charitable and governance organisations. Many were established in the wake of the revolution with strong support from the Syrian diaspora in the Gulf, North America, Europe and the UK. These organisations were able to sustain the functions of the state in the absence of the Damascus government. Financial resources were often modest but well-managed and high standards of probity applied to governance.
The new government faces huge economic, political, and security challenges. HTS has demonstrated itself to be a disciplined force, stopping looting and thus far maintaining its commitment to protecting rights of minorities. In Homs and Damascus, I visited churches where worshippers were attending Mass and the Divine Liturgy as usual. In Homs, a queue snaked around the block of former security personnel handing in their weapons and military identity cards, an early Disarmament Demobilisation and Reintegration (DDR) move. There will be a temptation to centralise management and coordination of services. In many of my conversations there was a sense that the civil society activity that sustained the northwest was only for the emergency period and that the right leadership body is central and local government. This would represent a blow to those who strove tirelessly to maintain vital services and whose talents Syria will need to restore the national fabric. Civil society is also a route to political participation and engagement, the call of the revolution, and essential for building peace and stability.
Calls for restoration and resilience over retribution and revenge
The Assad regime sought to project an image of stability which many people were convinced by. Assad had been readmitted to the Arab League, the EU was calibrating an early recovery approach that would fall short of reconstruction, and Italy had re-opened its embassy in Damascus.
It was an illusion. The state was a facade constructed to serve one small section of the population. All economic and political mechanisms were geared toward capturing resources that would sustain the regime and its allies, including international aid.
Civil society organisations sustained the northwest, kept services running and provided a space for the development of associations and grassroots institutions. The new government will need the resources – intellectual, financial and social – of all those who continued to serve their country and nurture the wellspring of institutional life.
Witnessing the condition of Syria, destroyed cityscapes and a state hollowed out by corruption and cynicism; the resilience of the Syrian people is all the more remarkable. I heard calls for justice, not revenge. For restoration, not retribution. This is a resourceful and proud nation. It deserves the best chance of success.
Most of all, there is relief that the regime’s arbitrary and sadistic rule is over. Describing the evaporation of the secret police, my friend said: ‘the shadows that followed us have gone now.’ As have a million Assad portraits, rendered in stone, tile, fabric and paint.
Eleanor Nott is a Senior Adviser and Co-Founder of the David Nott Foundation. Since 2015 the DNF has trained over 2,000 doctors in life and limb-saving surgical skills. Eleanor oversaw the development of the Hostile Environment Surgical Training (HEST) course, a trademarked programme accredited by the Royal College of Surgeons of England and supported by bespoke simulation equipment. Eleanor was recognised with her husband and Co-Founder, Professor David Nott, on Foreign Policy’s Global Thinkers list of 2016 for their work training doctors in conflict areas. She has contributed to The Telegraph, British Medical Journal, IISS Voices, CNN and has appeared on Sky News. Eleanor is also a PhD student in the department of War Studies at King’s College London.
Photographs courtesy of author.
Disclaimer: Eleanor is writing in a personal capacity. The views expressed in this piece are those of the author and do not reflect the views of The Foreign Policy Centre nor the David Nott Foundation.
[1] Tobias Schneider and Theresa Lütkefend, ‘Introduction: The Syrian Regime’s Approach to Chemical Warfare’, GPPi, April 2020, https://chemicalweapons.gppi.net/analysis/introduction/
[2] Mukhabarat is an arabic phrase used to describe intelligence agencies and secret police used to spy on civilians
[3] Marwa al-Sabouni, ‘The Lost Heritage of Homs: From the Destruction of Monuments to the Destruction of Meaning’, Cultural Heritage and Mass Atrocities, https://www.getty.edu/publications/cultural-heritage-mass-atrocities/part-2/11-al-sabouni/
[4] American Association for the Advancement of Science, ‘Geospatial Technologies and Human Rights Project: Assessing the status of medical facilities in Syria’, AAAS Centre for Scientific Responsibility and Justice, 14 May 2014, https://www.aaas.org/resources/assessing-status-medical-facilities-syria
[5] Physicians for Human Rights, ‘Medical Personnel Are Targeted in Syria’, March 2024, https://phr.org/our-work/resources/medical-personnel-are-targeted-in-syria/
[6] Fouad M Fouad et al., ‘Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet-American University of Beirut Commission on Syria’, The Lancet, Volum 390, Issue 10111, 02 December 2017, https://www.thelancet.com/article/S0140-6736(17)30741-9/fulltext