Sustainable universal access to essential medicines amidst conflict: a stakeholder analysis of primary care in Syria

INTRODUCTION: Sustainable Development Goal (SDG) Indicator 3.b.3 is defined as the proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis. Data for these three dimensions is collected and measured as part of the World Health Organization (WHO) Medicines Strategy, which recognizes that sufficient access to medicines is an indispensable element of quality healthcare delivery. Among other long-term consequences, internal conflict in Syria has led to the breakdown of health systems, lack of qualified medical personnel, and shortage of medicines. EVIDENCE ACQUISITION: This report investigates the power and relationship dynamics between key stakeholders involved in the delivery of essential medicines in Syria. A stakeholder analysis was conducted to identify key actors, their influence, and accountability in ensuring access to medicines. Additionally, policy and healthcare system evaluations were performed to assess barriers to universal medicine delivery. EVIDENCE SYNTHESIS: Findings indicate a fragmented healthcare system with multiple actors, including government agencies, international organizations, and local providers, often operating with limited coordination. The role of humanitarian aid has been crucial, but supply chain disruptions, regulatory barriers, and financial constraints continue to hinder consistent access to essential medicines for chronic diseases in primary care. CONCLUSIONS: To improve the universal delivery of essential medicines in Syria, stronger coordination among stake-holders, regulatory reforms, and sustainable funding mechanisms are required. Strengthening local pharmaceutical pro-duction, enhancing supply chain management, and increasing international support for medicine accessibility are critical to addressing the ongoing crisis.