Access to essential medicines for noncommunicable diseases during conflicts: The case cardiovascular diseases, diabetes and epilepsy in Northern Syria

Access to essential medicines is a critical component of healthcare. Conflicts severely disrupt pharmaceutical supply chains. This study examines the availability and prices of essential noncommunicable diseases (NCDs) medicines in Northern Syria, and explores the underlying factors contributing to medicine shortages and price variability. We applied a mixed-methods approach, combining a cross-sectional quantitative survey based on the World Health Organization/Health Action International (WHO/HAI) methodology with qualitative interviews. Medicine availability and price data were collected from public healthcare facilities and private pharmacies across Northeast and Northwest Syria. Availability was calculated as the percentage of facilities with the medicine in stock and categorized into four levels. Prices were reported using median price ratios. Qualitative data were collected from retailer pharmacists, representatives from non-governmental organizations (NGOs), and personnel working in medicine warehouses and wholesale distribution. Thematic content analysis was employed to analyze the qualitative data. The findings indicate low medicine availability, falling well below WHO targets. The mean availability was 45.5%. Of 28 medicines surveyed, 11 had somewhat high availability (50%-80%), 12 had low availability (30%-49%), and 5 had very low availability (<30%). Epilepsy medicines had the lowest availability, highlighting a particularly neglected area of care. Qualitative report suggested that the observed price variations were largely driven by the geopolitical tension, supply chain disruptions, and the absence of effective regulatory mechanisms. The conflict has caused or exacerbated shortages through the destruction of infrastructure, trade restrictions, and economic instability. Additionally, concerns over the quality of medicines were frequently reported. This study highlights challenges in accessing essential medicines in Northern Syria but also reveals that medicine supply systems, although disrupted, continue to operate through alternative and informal channels. Moving forward, efforts must prioritize coherent, context-sensitive policies that build on existing structures and human resources to rebuild a well-regulated and equitable system.