Privatization & Human Rights: Risks in Syria’s Healthcare Debate

In early April 2026, statements by Talal Al-Hilali, head of the Syrian Investment Authority, set off a wave of public alarm. Al-Hilali indicated that the state owns 71 public hospitals and is moving toward granting them to the private sector in partnership with the state, as part of an effort to develop the health sector and improve its efficiency. The backlash was swift, and clarification followed. The Syrian Investment Authority stressed that “health is not for sale”, insisting the comments were not about privatising hospitals but about studying modern management models in partnership with the private sector, with the state remaining “the primary guarantor of treatment”. Syria’s Minister of Health similarly affirmed that medical services will remain free of charge and that there are no plans to privatise public hospitals.

The controversy subsided, but the question it raised did not. Even where full privatisation is off the table, public–private partnerships in healthcare are not without risk. In a country still rebuilding both its institutions and its social contract, those risks warrant serious scrutiny.

What Syrians Think

Public opinion is unambiguous. An April 2026 survey conducted across Damascus, Rural Damascus, and Homs found that 88% of respondents oppose transferring state-run hospitals to the private sector. This is not simply a policy preference–it reflects a population that has endured years of infrastructure collapse, displacement, and the erosion of public services, and which is watching closely to see whether the interim authorities will rebuild the state or hollow it out further.

Satisfaction with public services has dropped sharply since February 2026, falling from 49% to 25%, while dissatisfaction has more than doubled. A combined 62% of respondents report difficulties covering living expenses, and only 13% believe the government is doing enough to address price increases. In this context, any move that could indirectly raise the cost of healthcare, degrade its quality, or restrict its access, is not an abstract concern, but rather a matter of survival.

The Right to Health Under International Law

Healthcare is a human right. Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) recognises the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Under General Comment No. 14, the Committee on Economic, Social and Cultural Rights has interpreted this to require that health services be available, accessible, acceptable, and of adequate quality. Crucially, accessibility includes economic accessibility: services must be affordable for all, including the most marginalised.

Under international law, the state bears the primary responsibility to respect, protect, and fulfil this right. This obligation cannot be discharged or delegated to private actors.

The Risks of Private Sector Involvement

Even short of full privatisation, public–private partnerships in healthcare carry well-documented risks.

Profit over people: When healthcare institutions operate under commercial incentives, efficiency tends to be measured in financial terms rather than health outcomes. Services that are costly to provide but essential to vulnerable groups, such as chronic disease management or reproductive health, become liabilities rather than priorities.

Access barriers: Introducing cost-recovery mechanisms, even modest ones, creates access barriers. Analysts have cautioned that without clear ceilings on costs that citizens may have to bear, improving service delivery can become a pretext for imposing additional financial burdens, deepening inequality in access to care.

Digitalisation and exclusion: Syria’s interim authorities have indicated plans to expand digital transformation in the health sector, linking hospital data to improve planning. This is not inherently problematic, but it carries risk. Communities with limited digital literacy, connectivity, or formal documentation risk being excluded or exploited rather than served.

Quality reduction: Privatisation or commercialised management can also result in a degradation of service quality, as providers cut costs to maximise returns. This directly undermines the full realisation of the right to health, in violation of the state’s obligations under international human rights law.

The Broader Danger: Outsourcing Obligation

There is a wider structural risk that deserves attention, particularly as Syria begins engaging with international investment frameworks and reconstruction finance. Scholars have described the emergence of a ‘development as de-risking’ paradigm in which states are gradually reoriented toward protecting the conditions for foreign investment, using public resources to subsidise investor returns, while retreating from the direct provision of public goods. Health, education, water, housing all become potential “asset classes”.

This paradigm is manifest across sub-Saharan Africa, where the privatisation of health systems, through user fees, insurance schemes, and private investment platforms, has deepened inequality and weakened public health infrastructure. Digital health tools have in some instances become surveillance mechanisms, enabling insurers to adjust premiums based on patient data. These outcomes were the structural consequence of a model that places financial returns above public obligation.

The Syrian authorities have given reassurances. But reassurances are not frameworks. Experts have emphasised that the success of any private-sector involvement in public institutions depends on a clear legal framework governing the relationship between the state and investors, transparency in contracts, and effective oversight to prevent monopolies and protect citizens’ rights. In their absence, privatisation can shift from a tool for improving efficiency into a factor that increases burdens on citizens and deepens inequality.

At this critical moment in Syria’s transition, any outsourcing of the state’s human rights obligations, whether through formal privatisation or through the incremental erosion of public provision, would only further undermine trust in state institutions. It would constitute a dereliction of the duty that the current transition exists to fulfil.

What We Are Calling For

The transitional authorities must ensure that any engagement with the private sector in healthcare is:

* Grounded in a binding legal framework that explicitly protects the right to health;
* Subject to independent oversight, with transparent contracts and genuine accountability mechanisms;
* Designed to guarantee that no patient is denied care on financial grounds, nor provided inadequate, inaccessible, or unacceptable services, in line with Syria’s obligations under the ICESCR; and
* Assessed for its differential impact on the most vulnerable, including women, displaced persons, persons with disabilities, and those in low-income areas.

Written by: Alreem Kamal, Legal Officer, Human Rights & Business Unit