Egyptian-Syrian Relations after the Declaration of the Establishment of the State of Israel: Alliance, Union, Rivalry?

By Jonathan van de Gronden

“Egypt and Syria are the core actors around which the Arab state system revolves.”[1] Since the Cairo-Damascus axis crosses the very heart of the Middle East and encloses the disputed Israeli-Palestinian territory, Egypt and Syria quickly came to play a key role in the Arab-Israeli conflict, which has set the terms for the region’s geopolitics ever since 1948. Although united by Islam, Pan-Arabism, developmentalism and anti-Zionism, Egyptian-Syrian relations gradually developed in an increasingly ambiguous manner. They have been characterised by both periods of strong unity and severely diverging – even opposing – interests, also at the same time point in time.[2] This paper seeks to understand these relations, focusing on the cases of the United Arab Republic, the Arab Triangle and Egypt’s separate peace with Israel.

In the first two decades of the Arab-Israeli conflict, Egypt and Syria aligned themselves under the banner of Pan-Arabism, fighting Israel from the very day it declared its establishment on the 14th May 1948 and quickly moving to occupy large parts of the Palestinian Territories in conjunction with Transjordan, Iraq and Lebanon. However, Israel struck back in early 1949, regaining all of the territories that Egypt and Syria had taken, except for the Gaza Strip.[3] Tensions between Israel and the Arab states were further stirred by the Suez Crisis. Nasser nationalised the Suez Canal and, in so doing, closed the gateway to Israel’s main port. This led to a joint attack by Britain, France and Israel, initiated by the latter, leaving the Arab states with yet another memory of an Israeli invasion, on top of the one from 1949. However, the joint aggression by Britain, France and Israel, although resulting in a military defeat for Nasser, became a political victory: the three aggressors withdrew under American pressure, which meant, from an Egyptian perspective, not only a triumph over the illegitimate Israeli state, but also loss of face for former colonial powers Britain and France.[4] These events greatly contributed to the rise of Egypt’s president Gamal Abdel Nasser as leader of the Arab world in the 1950s and 1960s.[5]

The Apparent Heyday of Egyptian-Syrian Unity: The United Arab Republic

It was especially in this “Age of Nasser”, from 1952 to 1967, that the Egyptian-Syrian tandem dominated the politics of the region, with its culmination in the establishment of the United Arab Republic (UAR) in February 1958.[6] With the political preeminence of the figure of Gamal Abdel Nasser in Egypt, combined with the ideology of the Ba’th Party that rose in Syria, this union turned out to dominate the pursuit of the Pan-Arab goal, which also seemed to attract other, surrounding Arab countries.[7] This Arab nationalism was combined with a developmentalist approach to domestic economics and politics, which is based on the idea that the state drives both the economic and social development of the country. Massive public expenditures aimed to improve social welfare, which went hand in hand with building a voter base among big parts of the populace.[8] This combination of Arab nationalism with a developmentalist regime became the leading trend in the Middle East and North Africa.

However, as dramatic and sudden as the UAR came into being, so quickly the union collapsed as well. Despite stating to the outside world how logical the validity of the unification was as part of the gradual development of Pan-Arab nationalism, the union was actually in disarray from its very beginning. The countries’ governance structures were completely out of balance. While Nasser made a name for Egypt as leader of the Arab world, the relatively new Ba’th Party found itself unable to govern the political chaos in Syria. Syria’s turmoil derived from the toxic mixture of the French divide and rule politics during the Mandate era, the subsequently established political party system that exacerbated the pre-existing fragmentation, the dissent within the army and the ongoing battle for leadership in the Arab world. The army was divided between those officers who wanted to side with Egypt’s Nasserism and those who wanted to increase cooperation with Iraq’s conservative and pro-Western Hashemite monarchy prior to its demise in the 1958 revolution.[9]

This imbalance in governance structures – with Egypt on the one hand being strictly organised under Nasser’s rule, while Syria was divided by different military factions – was further encouraged by the presidency of the former. The UAR turned out to be an Egypt-centric state, as Nasser got rid of Syrian party politics, dismissed most of Syria’s officers and introduced a derivative of Egyptian land reform laws. This made tensions within the Syrian military rise again, which ended in the termination of the experimental union of the two countries by Syria.[10] Subsequently, “the complexities of Syrian-Egyptian relations as they developed in the mid-sixties also led to the 1967 war.”[11] In an attempt to regain legitimacy from the Arab world, Syria started to support the “fedayeen” – meaning ‘self-sacrificers’ – which were groups of activists who had embarked on a guerilla war against Israel.[12] To avoid staying behind, Nasser significantly increased his anti-Israel rhetoric, denying the Holocaust and inviting 300 German engineers and scientists formerly employed by the Nazi-government to develop intermediate-range missiles.[13] Moreover, “Nasser, attempting to maintain his credibility as a leader of militant Arabism and maintain control over events, reestablished his alliance with Syria, and hence set in motion the chain of events which would drag him, along with Syria, into the devastating 1967 defeat.”[14]

So, it was precisely the “shotgun marriage” of the UAR that came to characterise Egyptian-Syrian relations.[15] This led Fouad Ajami to state: “As Nasser discovered, the Syrians can make formidable rivals and difficult friends.”[16]Not only would the failure of this short period of common statehood cast a shadow over the countries’ diplomacy up until this day, but it also prescribed the recurring pattern of momentary unity, followed by longer periods of rancour towards each other.

The Arab Triangle Recreates the Cracks in the Cairo-Damascus Axis

The shameful defeat that the Arab states suffered following less than a week of fighting in June 1967 pushed Egypt and Syria in the direction of Saudi Arabia. To rebuild their countries and militaries, funding was needed. Moreover, Nasserism had lost face, sowing the seeds for a new stance towards Israel. Therefore, the three countries aligned in the pursuit of negotiations to establish peace and the restitution of the territories lost in 1967.[17]

As was the case for the UAR, the detente with Saudi Arabia first appeared to herald a new chapter in Arab and therefore Egyptian-Syrian unity, with the three countries forming the so-called “Arab Triangle”. However, also along the same lines of the UAR’s fate, it was the Arab-Israeli conflict that undermined this trio’s bond. Israel, at that point perceiving itself as outstandingly more powerful than the whole Arab world following the 1967 War, prioritised territorial expansion over  peace. In response to Israel’s unwillingness to negotiate, Egypt started emphasising domestic politics over military revenge against Israel. Syria, however, held on to the goal of the full recovery of territories that had been lost in 1967. It was here that the beginnings of the wedge driven between Egypt and Syria, that would reach its height after the 1973 October War, started to become visible. Saudi funding has, up to this day, played a role in exacerbating this tension in providing both countries with the means to drift away from each other.[18]

However, it was not only for the Saudis that the Cairo-Damascus axis started to show cracks. Increasing doubt was rising in Syria with regard to Egypt’s willingness to pledge loyalty to the Arab cause in the Arab-Israeli conflict. At the same time, Egypt only grew more anxious and distrustful of Syria’s war strategies, afraid that Syria’s rogue behaviour and errors would cause new tensions with Israel and implicate Egypt.[19] So, in bringing new military possibilities, the Saudi funding oddly enough also increased the distrust between Egypt and Syria. While striking back against Israel after the disgrace of 1967 started to become an increasingly viable possibility, underneath their unity, it was not clear to what extent Egyptian and Syrian strategies would align.

The Reverberation of the October War: Egypt’s Separate Peace

The situation became even more unclear after Nasser’s death. His successor, Anwar Sadat, changed both Egypt’s domestic political-economic and foreign policies. His goal was to develop Egypt in a similar way to the Four Asian Tigers – Japan, Vietnam, Singapore and South Korea. In fact, in the 1990s Egypt actually came to be called the “tiger on the Nile.”[20] To this end, Sadat had to overcome the Arab-Israeli conflict, so he believed, because this would be the only way to open up the Egyptian private sector to the markets and capital flows of Europe and the United States. Zooming in on this second case, one could say that Sadat only participated in the October War to gain more negotiating power in an Egyptian-Israeli detente.[21] It could be said, therefore, that the seeming synchronisation of the Egyptian crossing of the Suez Canal into the Sinai and the Syrian attack on the Golan Heights in the October War of 1973 was premised on huge differences in strategy between the two countries. Just like in the case of the UAR and the Arab Triangle, the newly re-established unity of Egypt and Syria on the regional and international level turned out to be the prelude to frosty and tense relations.

Indeed, Syria unequivocally stuck to its initial position of enmity towards Israel. It kept viewing the Palestinian question as the dominant issue in the region, especially in the handling of their international relations, in particular with the US.[22] Whereas Syria’s position was mainly stirred by its material interest in the Golan Heights at first, its motivation changed into an ideational one after Egypt’s turn to peace negotiations with Israel. The Arab-Israeli conflict became the way to commit the country to Arab nationalism, dissenting from Israel’s “imperialism and Zionism.”[23] The ideological nature of Syria’s motives and foreign policy clashed even more with Egypt’s pragmatism that brought it closer to Israel and the US. This was most clearly displayed as Hafez al-Asad severed all diplomatic relations with Egypt following the signing of the Egypt-Israel peace treaty in 1979.

Moreover, tensions were further stirred by the vacuum of Arab leadership after Nasser’s death which remained unfulfilled as Sadat looked west. Cleveland goes even as far as to say that Asad “was seen as a possible successor to Nasser in the drive for Pan-Arab unity.”[24] So, the ever recurring competition for the leadership of the Arab world returned to the stage.  The competition was noteworthy as the Arab leadership came with huge benefits.  The succeeding candidate would not only stand as the Pan-Arab spokesman in foreign relations, but also enjoy the economic advantages of becoming a hub via which all sorts of goods and financial services are distributed. Aforementioned benefits were among the reasons for Syria’s dramatic proclamation of its leadership as the last hope for the Arab world against Israel. However, Syria failed to coordinate the different foreign policies of the Arab states, as they explicitly refused to align under the Syrian flag. As a result, Israel took advantage of this Arab fragmentation, embarking on the Lebanese war in 1982.[25]

This new chapter in the Arab-Israeli conflict gave rise to the Lebanese militia named Hezbollah. Moreover, the outcome of the Lebanese war was a new uprising of Palestinian protests which led to a stricter Israeli regime, which, in turn, facilitated the first intifada.[26] Amidst this violence, another faction rose to the stage: Hamas. Both Hezbollah and Hamas would start to gain the support of Syria, however, given the Egyptian-Israeli peace, they found themselves opposed to Egypt. Therefore, these groups further increased the complexity of Egyptian-Syrian relations. Given the fact that both groups were born as a response to the Egyptian-Israeli separate peace treaty of 1979, Hinnebusch stated: “Thus, from Sadat’s policies flowed a chain of consequences which have fragmented and rendered powerless the Arab world.”[27]

Ongoing troubled relations

It took Syria until 2005 to reestablish diplomatic contacts with Egypt. However, even with Hafez’s son Bashar in power, relations stayed troubled. When the Muslim Brotherhood gained power in Egypt in 2013, they supported the Syrian rebels against Asad’s government. It was only after Abdel Fattah al-Sisi’s coup d’état that state relations were restored. However, although Egypt explicitly supports the Syrian government, under al-Sisi, Egyptian national interests tend to prevail over the Arab bond between the two countries. This is demonstrated by the close relations Egypt tries to maintain with Saudi Arabia, the biggest funder of the armed rebels in Syria.[28] However, Saudi Arabia is also the provider of the so-called “financial aid” that has become of major importance for Egypt’s state budget. Stemming from the Arab Triangle and initiated at the very moment that Egypt and Syria started to diverge under the regime of Sadat, Egyptian-Saudi relations endure to be a divisive issue in Egyptian-Syrian relations up until this day.[29]

In short, the cases of the UAR, the Arab Triangle and Egypt’s separate peace process with Israel, show how the Egyptian-Syrian relations are linked to the Arab-Israeli conflict. There is a continuing paradox that runs through these three cases: appearing as showcases of their unity, they actually hide the tensions between Egypt and Syria that interacted with the Arab-Israeli conflict. Their diverging interests and strategies in fighting Israel, the ongoing struggle for Pan-Arab leadership and the imbalances in the Arab world that this brought about, complicated the situation in the region. Thus, these power asymmetries fed into the involvement of Western countries, whose presence kept prolonging and exacerbating the conflict’s devastating effect on the Middle East.[30] However, it is an ambiguous balance: the antagonism between the two countries was always displayed within the shared ideals of Pan-Arabism. To lead the Arab world, therefore, could be seen as one of the main motives for Egyptian-Syrian rivalry. Therefore, their ambiguous relationship also sparked Arab unity under the banner of Egypt and Syria’s cooperation. In the end, then, it could be said that Egypt and Syria together highly influenced the region’s domestic and international politics, both by unity and division.


Fouad Ajami, “Stress in the Arab Triangle,” Foreign Policy, Winter 1977-78, no. 29 (New York: Slate-Group, LLC, 1977-78): 90-108.

Michael N. Barnett, Dialogues in Arab Politics: Negotiations in Regional Order (New York: Columbia University Press, 1998).

Asef Bayat, “Activism and Social Development in the Middle East,” International Journal of Middle East Studies, 34, no. 1 (Cambridge: Cambridge University Press, 2002): 1-28.

Yehuda U. Blanga, “Saudi Arabia’s Motives in the Syrian Civil War,” Middle East Policy, 24, no. 4 (Hoboken, NJ: Wiley-Blackwell, 2017): 45-62.

William L. Cleveland & Martin Bunton, A History of the Modern Middle East, 6th ed. (New York: Routledge, 2018).

David T. Dumke, “Congress and the Arab Heavyweights” Questioning the Saudi and Egyptian Alliances,” Middle East Policy, XIII, no. 3 (Hoboken, NJ: Wiley-Blackwell, 2006): 88-100.

Raymond A. Hinnebusch, “Egypt, Syria, and the Arab State System,” in The Arab-Israeli Conflict: Two Decades of Change, ed. Yehuda Lukacs & Abdalla M. Battah (Boulder: Westview Press, 1988): 179-193.

Michael Kuntzel, “Nasser’s Antisemitic War Against Israel,” Fathom, Spring 2017 (London: British Israel Communication and Research Centre, 2017)

Mustafa El-Labbad, “Egypt: A ‘Regional Reference’ in the Middle East,” in Regional Powers in the Middle East. New Constellations after the Arab Revolts, ed. Henner Fürtig (New York: Palgrave Macmillan, 2014): 81-99.

Tony Rea & John Wright, The Arab-Israeli Conflict (Oxford: Oxford University Press, 1993).

Panayiotis Vatikiotis, Nasser and His Generation (London: Croom Helm, 1978). Stephen M. Walt, The Origin of Alliances (Ithaca, NY: Cornell University Press, 1990).

[1] Raymond A. Hinnebusch, “Egypt, Syria, and the Arab State System,” in The Arab-Israeli Conflict: Two Decades of Change, ed. Yehuda Lukacs & Abdalla M. Battah (Boulder: Westview Press, 1988): 179.

[2] Ibid., 179-180.

[3] William L. Cleveland & Martin Bunton, A History of the Modern Middle East, 6th ed. (New York: Routledge, 2018): 252-53.

[4] Panayiotis Vatikiotis, Nasser and His Generation (London: Croom Helm, 1978): 277.

[5] Cleveland & Bunton, A History, 320.

[6] Ibid., 286.

[7] Ibid., 310.

[8] Asef Bayat, “Activism and Social Development in the Middle East,” International Journal of Middle East Studies, 34, no. 1 (Cambridge: Cambridge University Press, 2002): 1.

[9] Cleveland & Bunton, A History, 307-09.

[10] Ibid., 298.

[11] Hinnebusch, Egypt, Syria, and the Arab State System, 181.

[12] Tony Rea & John Wright, The Arab-Israeli Conflict (Oxford: Oxford University Press, 1993): 43.

[13] Michael Kuntzel, “Nasser’s Antisemitic War Against Israel,” Fathom, Spring 2017 (London: British Israel Communication and Research Centre, 2017):

[14] Hinnebusch, Egypt, Syria, and the Arab State System, 181.

[15] Michael N. Barnett, Dialogues in Arab Politics: Negotiations in Regional Order (New York: Columbia University Press, 1998): 128.

[16] Fouad Ajami, “Stress in the Arab Triangle,” Foreign Policy, Winter 1977-78, no. 29 (New York: Slate-Group, LLC, 1977-78): 94.

[17] Hinnebusch, Egypt, Syria, and the Arab State System, 182.

[18] Ibid.

[19] Ajami, “Stress in the Arab Triangle,” 99.

[20] David T. Dumke, “Congress and the Arab Heavyweights” Questioning the Saudi and Egyptian Alliances,” Middle East Policy, XIII, no. 3 (Hoboken, NJ: Wiley-Blackwell, 2006): 98.

[21] Cleveland & Bunton, A History, 380.

[22] Cleveland & Bunton, A History, 429.

[23] Stephen M. Walt, The Origin of Alliances (Ithaca, NY: Cornell University Press, 1990): 144.

[24] Cleveland & Bunton, A History, 431.

[25] Hinnebusch, Egypt, Syria, and the Arab State System, 187-88.

[26] Cleveland & Bunton, A History, 451-53.

[27] Hinnebusch, Egypt, Syria, and the Arab State System, 183.

[28] Yehuda U. Blanga, “Saudi Arabia’s Motives in the Syrian Civil War,” Middle East Policy, 24, no. 4 (Hoboken, NJ: Wiley-Blackwell, 2017): 45

[29] Mustafa El-Labbad, “Egypt: A ‘Regional Reference’ in the Middle East,” in Regional Powers in the Middle East. New Constellations after the Arab Revolts, ed. Henner Fürtig (New York: Palgrave Macmillan, 2014): 82-85.

[30] Hinnebusch, Egypt, Syria, and the Arab State System, 179 & 192-93.

Syria’s Experience with Post-Totalitarianism: The Need for Havelian Pre-Political Thinking

Marwan Safar Jalani

Syria’s experience with the Assad regime sets an unfortunate precedent in authoritarian regimes’ ability to survive through violence and repression. However, understanding the regime’s survival requires us to search for explanations grounded in the regime’s techniques to polarise Syrians and limit their ability to dissent civilly and peacefully. One way to explain the regime’s attitude towards dissent is through Havel’s theory on post-totalitarianism. The theory sets forth economic, political and philosophical tools through which post-totalitarian regimes control the functions of society. Havel necessitates the establishment of “pre-political thinking” in order for civil dissent to successfully free the country from post-totalitarianism, a type of thinking which, this paper argues, was doomed to fail in Syria. The regime embodies post-totalitarian elements of consumerism, automatism, ideology, and deference to legal facades to gain legitimacy. However, it differs from post-totalitarianism by defining regime elements around the leader’s personality cult, the crony capitalists, and a powerful security apparatus, elements that polarise and divide Syrians. This polarisation prevents Syrians from grounding their dissent in a shared experience of repression, which is the basis of pre-political thinking that Havel deems so necessary for confronting post-totalitarianism. This lacunae in pre-political thinking forces Syrians into violence, polarises some of them into extreme nihilist thinking, and prevents them from developing a civil and peaceful dissent, grounded in a shared human experience.

Marwan Safar Jalani is a Rhodes-Saïd scholar, pursuing an MPhil in Comparative Government at the University of Oxford. Marwan researches the effects of sequencing of peacebuilding reforms on peace outcomes in multiethnic settings. Marwan completed his BA in political science and human rights with distinction from Yale University, where he researched the effects of territorial divisions or lack thereof in two cities in Bosnia and Herzegovina, Brčko and Mostar, on the operations of inter-ethnic youth initiatives.

Policy Implications of Alternate Medical and Nursing Education in northwest Syria

by Adrienne Fricke, Valerie Dobiesz, Rahaf Safi, Bharathi Radhakrishnan, Timothy Erickson and Phuong Pham*

Abstract: Political identity in armed conflict can significantly impact access to basic state services. In Syria, access to higher education has been restricted, denied, or, in some cases, resulted in physical danger for individuals criticizing the regime and for those suspected of disloyalty. Journalists and NGOs have documented how, since 2011, the state conferred opposition identity on healthcare workers providing patient services to injured civilian protestors. Effectively, the provision of medical services has become “militarized.” In 2019, researchers from the Harvard Humanitarian Initiative (HHI) conducted qualitative interviews with health educators, administrators, and students in northwest Syria and observed a trend of reports documenting restricted access to official medical and nursing programs due to political identity. Facing a shortage of healthcare providers in opposition areas, educators developed alternate teaching institutions for medical and nursing students. These efforts, unrecognized by the state, directly align with the United Nations Sustainable Development Goal 4 to “ensure inclusive and equitable quality education,” even in war-affected settings, with policy implications for the international community.


Mass peaceful demonstrations demanding political change in Syria began in March 2011. Syria’s President, Bashar Al-Assad, rapidly employed the political identity of protestors to justify violence against them. The regime created a strict binary identity: those who are “with the regime” and were unharmed by state violence, and those who “oppose the regime” and were targeted. As discussed below, in time this binary became conflated with religious identity. Eight years later, multiple competing foreign entities have entered the conflict, reinforcing this polarization in a complex narrative that lies outside the scope of this brief but merits further scholarly attention.

Sustained fighting has led to the displacement of over half of the pre-war population of twenty-two million. Approximately six million Syrians have fled to neighbouring countries, while a similar number are displaced internally throughout Syria.[1] In this context, the regime’s well-documented attack on healthcare facilities and personnel has deeply impacted civilian populations, particularly in opposition-held areas.[2]

The Harvard Humanitarian Initiative (HHI) study, in which researchers conducted qualitative interviews with health educators, administrators, and students in northwest Syria, was designed to collect information about the needs, priorities, challenges, and successes of educational initiatives created in response to conflict conditions. Respondent groups included students, educators, and administrators at alternative medical and nursing institutions. Programmesrepresented include the Free Aleppo University (FAU); FAU’s nursing affiliate, the Omar Ibn Abdelaziz Nursing Program; and the Syrian Board of Medical Specialties (SBOMS) residency programme.  A bilingual member of the interdisciplinary team at the Harvard Humanitarian Initiative (HHI) conducted remote interviews in Syrian Arabic with respondents in northwest Syria using a survey to assess the impact of war on healthcare education in April and May 2019.[3] The purposive sample included respondents in opposition-held territory in Idlib and Aleppo because these areas sustained heavy aerial bombardment.

The central research question of this study is how conflict affects the teaching and learning of medicine and nursing. The findings indicate that two primary factors influenced access to official health education programmes, in addition to triggering state violence in the form of beatings, detention, and torture. The first was whether the respondents’ chose to identify as protesters; the second was the nearly automatic imposition of an anti-regime identity by the regime on healthcare workers based on their status as providers, and their real or perceived involvement in treating opposition members. Consequently, Syrian medical and nursing personnel residing outside of regime-held areas created an alternative medical and nursing education system to provide opportunities for young people to become healthcare providers. These findings demonstrate the potential policy impact of political identity on access to higher education, and the attendant effect on access to medical services in contravention of United Nations (UN) mandates.

Political Identities and the Syrian Context

As identity scholar Christopher Phillips has detailed, academic debate rages over the nature of political identity in the Middle East.[4] He notes that while the conflict in Syria is commonly described as sectarian, references to sect by all parties to the conflict have developed in a complex political, social, economic, and ethnic context.[5] He outlines how religious “sub-state” identities developed over time in parallel with the Syrian national discourse, noting that “[s]ectarianism has been deliberately and subconsciously encouraged by elites as a ruling strategy… alongside a successful attempt to promote a sense of Syrian national identity.”[6]  Phillips argues that structural shifts, such as the collapse of the regime in certain areas, allowed a variety of political responses by local elites, with some embracing an inclusive Syrian national identity and others employing an ethnic or sectarian discourse. He therefore asserts that the conflict is only “semi-sectarian” because of “multiple other fault lines of contention, notably class, ideology and… sub-state ties.”[7] The findings from this study suggest that an additional ‘fault line of contention’ applies: the status of being a healthcare provider or medical/nursing student, as discussed below.

Access to Higher Education in Syria: The Role of Identity

In wartime Syria, the political binary of being either anti- or pro-regime can impact survival, with populations in opposition-held areas subject to airstrikes and sieges. However, residing in such areas does not always correlate to political affiliation. Regime-area critics faced with the decision of security or liberty may feel forced to live in regime-held areas to protect their families. Native residents of besieged Aleppo and Idlib may not have professed loyalty to either side, but were caught in geographic polarization. The imposition of political identity on the basis of geography falsely assumes equal opportunity of choice.

“I could not leave the hospital because it would be looted, but if I stayed in it the regime would consider me an enemy. I decided to stay in the hospital to take care of it and its machines and the operations. The staff who stayed with me, we stayed together. All of us were seen as enemies. We could no longer visit our families” (SYNU01, Male, Nursing Educator).

Moreover, when students were displaced by violence to opposition-held areas, they lost access to regime-controlled institutions. Students also described how previous political protest restricted their access to education:

“[W]e were a part of the revolution, so it is not possible for us to go back to the regime even though we were the lowest resisters” (SYME12, Female, Medical Student).

In response to the provider gap, Aleppo University faculty and administrators critical of the regime founded the Free Aleppo University (FAU). FAU “started [as a result of] the number of students displaced to a certain area because of their opposition to the regime,” including “students in their first and second year of medical school, [and] some who just graduated high school” (SYME06, Male, Educator). A student explained, “[W]hen I was studying the baccalaureate [the final high school examination], there were no universities, so when [the FAU] opened [in the opposition-held area], it was a window of hope for a lot of students – not just me” (SYME12, Female, Student).

Political identity also foreclosed opportunities for medical residents – graduates of medical schools hoping to specialize – in much-needed areas, notably in trauma surgery and obstetrics and gynaecology. Consequently, “a large number of doctors [were prevented] from specializing in residency programs. It is because of [fear of] arrest…. [M]ost residents moved from accredited hospitals in regime-controlled areas to continue their training in field hospitals that are not accredited” (SYME04, Male, Faculty).  A resident indicated that “Before the conflict… we were all enrolled in [official] programs… the regime chasing us required us to go to areas that did not have programs. These programs were established because we were no longer able to access education [in] regime-controlled areas” (SYME17, Male, Resident).

Some prospective students reportedly moved to regime-controlled areas because they were unsure of the quality of the FAU program. One student explained, “[T]his was still a new program, and they believed it would not be able to provide the necessary medical education” (SYME 02, Male, Medical Student). This indicates that some individuals, whose identities were presumably not clearly known to regime agents, retained physical and academic mobility. Accreditation, or government recognition of an institution’s legal authority to grant degrees, is extended to regime-area programmes. Enrolment in accredited programs in regime territory was functionally impossible, however, where intelligence actors knew or believed medical students and residents had anti-regime affiliations. This group risked arbitrary arrest and forced disappearances, tactics commonly employed by the regime against critics and healthcare workers, alike.

Healthcare facilities and healthcare providers have been directly targeted; observers have documented at least 583 attacks on health facilities since 2011.[8]  An administrator explained that “the hospital might at any point be targeted through airstrikes or destruction.” (SYME04, Male). Critically, the Syrian government considers healthcare workers providing patient services to injured civilian protestors, including medical and nursing faculty and students, “terrorists.”[9]  When medical residents treat patients who are anti-regime, their individual political identity is reduced to that of their patient. “When I was working on my residency [in] regime areas, I was filled with fear from the possibility of being arrested because I was treating protesters, so I was a target” (SYME17, Male, Resident). In this way, providing care in a neutral and unbiased manner results in the assignment of an anti-regime identity, and the consequences this may entail.


Collective and individual political identity can impact access to key services in armed conflict settings, as in Syria. While much analysis of Syria focuses on sectarian dimensions of political identity, a focus on the geographic and ideological dimensions of identity is necessary to inform robust policy decisions. HHI’s study finds that medical and nursing students who had taken part in the peaceful opposition to the regime, as well as those residing in opposition-held areas, or treating patients deemed to be anti-regime, faced physical insecurity and other barriers to accessing higher education, particularly in opposition-held areas.[10]

Efforts in northwest Syria to promote equal access to medical and nursing education demonstrate that local actors can develop programmes aligned with the aims embodied in the UN Sustainable Development Goals (SDGs). The fourth goal (SDG 4) is particularly relevant to the findings of this study: “[e]nsure inclusive and equitable quality education and promote lifelong learning opportunities for all.” A critical target to achieve this broader goal is to “ensure equal access for all women and men to affordable and quality technical, vocational and tertiary education, including university” (SDG Target 4.3).[11] Policymakers should explore practical aspects of political identity to understand how to promote access to higher education in medicine and nursing during conflict.

The findings from this study have greater implications for the Middle East and the international community as regards access to education in conflict-affected settings. Discussions about implementation of the SDGs have been widespread since the 2016 World Humanitarian Summit, and the international community is increasingly aware of higher education’s value in promoting long-term positive outcomes for vulnerable populations. Local educators’ endeavours to provide equal access to medical and nursing education, and the role identity plays in determining access, merit further study by humanitarian actors, including UN partners, donors, and governments.


*Adrienne Fricke is a visiting Scientist at the Harvard School of Public Health and Fellow at the Harvard Humanitarian Initiative.

Valerie Dobiesz is a Core Faculty Member of the Harvard Humanitarian Initiative and Assistant Professor of Emergency Medicine at Bringham and Women’s Hospital.

Rahaf Safi is reading for a Masters in Public Policy at the Harvard Kennedy School of Government.

Bharathi Radhakrishnan is a Post-Doctoral Student at the Harvard Humanitarian Initiative.

Timothy Erickson is a Core Faculty Member of the Harvard Humanitarian Initiative and Associate Professor of Emergency Medicine at Bringham and Women’s Hospital.

Phuong Pham is an Assistant at the Department of Global Health and Population and Harvard School of Public Health and Director of Evaluation and Implementation Science at the Harvard Humanitarian Initiative.


[1] UNHCR and the Government of Turkey, “Syria Regional Refugee Response,” Operational Portal Refugee Situations, 2019,, retrieved November 21, 2019; Internal Displacement Monitoring Centre, “Syria,” Country Information, 2019,, retrieved November 21, 2019.

[2] Physicians for Human Rights, “The Syrian Conflict: Eight Years of Devastation and Destruction of the Health System,” March 12, 2019, work/resources/the-syrian-conflict-eight-years-of-devastation-and destruction-of-the- health-system/, retrieved November 21, 2019.

[3] Since December 1, 2019, the Syrian government has pursued an offensive in northwest Syria, resulting in the displacement of more than 900,000 people according to UN Special Envoy Geir Pedersen. See “Briefing to the Security Council by UN Special Envoy Geir O. Pedersen,” February 19, 2020, UN Under-Secretary for Humanitarian Affairs and Emergency Relief Coordinator, Mark Lowcock, has noted that violence in northwest Syria has severely damaged civilian targets including health facilities, many of which have been closed. See “Statement on Northwest Syria,” February 17, 2020,

[4] Christopher Phillips, “Sectarianism and conflict in Syria,” Third World Quarterly 36 (2015):357-76.

[5] Ibid, 371.

[6] Ibid, 362.

[7] Phillips, “Sectarianism and conflict in Syria,” 357.

[8] Physicians for Human Rights, “Illegal Attacks on Health Care in Syria,”

[9] Security forces tortured and killed medical students who had tried to smuggle painkillers through a checkpoint. The security forces then asked their fellow students to collect their corpses, which had holes in their foreheads, tongues and eyes “from a power drill.” Jack Ewing and Karam Shoumali, “Where Doctors are Criminals,” New York Times, December 21, 2019. Available at, retrieved February 20, 2020. See also Physicians for Human Rights, “’My Only Crime Was That I Was a Doctor’, How the Syrian Government Targets Health Workers for Arrest, Detention, and Torture,” December 4, 2019. Available at, retrieved 20 February 2020.

[10] The Assad regime is not alone in employing this tactic; respondents reported that local militias allied with the extremist political groups who seized power in Idlib in January 2019 have restricted university access where students do not profess loyalty.

[11] United Nations, “Sustainable Development Goal 4,” Sustainable Development Goals Knowledge Platform, 2019,, retrieved 13 November 2019.