Medication access barriers and perceived health consequences in post-war Syria: a cross-sectional study in Homs

Abstract

BACKGROUND: Armed conflict can disrupt medication access through damaged infrastructure, supply shortages, service disruption, transport barriers, and financial hardship. Community-level evidence remains limited in post-war Syria. OBJECTIVE: To assess medication accessibility, perceived barriers and consequences, and factors independently associated with greater barriers among residents of Homs. METHODS: A cross-sectional study using convenience sampling included 1,042 participants in Homs between 29 March and 22 April 2026. Data were collected using an adapted, Arabic-translated, pilot-tested questionnaire. A seven-item medication access barrier score was calculated (range, 7-35). Descriptive analyses, nonparametric bivariate tests, and multivariable linear regression with robust standard errors were performed. RESULTS: Median age was 26 years (IQR, 22-42), and 62.0% were female. Self-reported poor economic status increased from 10.8% before the war to 30.3% during the war, and only 10.9% reported easy medication access during the war. The median barrier score was 22 (IQR, 20-26). High medication prices were the most frequently endorsed barrier (69.7%). Perceived consequences included health deterioration due to inability to access medications (68.5%) and deaths attributed to medication shortages (53.2%). In adjusted analysis, self-reported poor wartime economic status, student status, and greater distance to the nearest medication provider were associated with higher barrier scores, whereas less than high-school education was associated with lower scores. CONCLUSIONS: Medication access problems were commonly reported and were associated with socioeconomic and geographic factors. These findings may inform post-conflict strategies addressing medicine affordability, supply continuity, and access to care.