Health Service Utilization across Public, Private, and Humanitarian Sectors in the Conflict-Affected Region of Northern Syria: A Cross-sectional Study

Abstract

Background: Health service delivery in Northern Syria, amidst ongoing conflict, has shifted toward an NGO-led primary health care (PHC) model. The private sector also plays a significant role in providing health services. This study assesses patterns of private sector health services utilization and perceptions among community members, varying by socio-demographic characteristics, to inform future health system strengthening strategies. Methods: A household survey was conducted among the adult population of Northern Syria (Northeast and Northwest Syria), analysing socio-demographic characteristics, health service utilization, service availability and acceptability, and trust in the private healthcare system. Descriptive and bivariate analyses examined associations between healthcare sources and respondent characteristics. Findings: The survey included 1,919 participants. Overall, 33% used private clinics as their main healthcare source, while 32% sought care from NGO-run PHC centres. Accessibility varied, with Northwest Syria (NWS) respondents reporting closer proximity to PHC centres compared to Northeast Syria (NES). Private general practitioners (GPs) were commonly accessible within a 10–30-minute drive, though perceptions of affordability differed between NWS and NES respondents. Socio-demographic factors and specific health needs influenced service utilization. Internally displaced persons (IDPs) and low-income individuals more frequently used NGO-led services, while higher education and income levels correlated with increased private service use among host communities. Healthcare-seeking behaviour varied by health needs: infectious diseases prompted visits to NGO-run PHC centres, private clinics were preferred for antenatal and gynaecological care, and public hospitals were used for injuries, orthopaedic, and surgical consultations. Provider selection reasons included transportation and care costs for NGO PHC centres and public hospitals, while private clinics were chosen for their perceived appropriateness and specialist proximity. Trust in the private sector positively correlated with higher usage rates. Conclusions: The study reveals distinct healthcare sub-systems for different population groups and provides essential data for understanding healthcare-seeking patterns in Northern Syria. It aims to assist health system stakeholders in comprehending the current service delivery status from community perspectives and guide equitable health system strengthening efforts in the region.