The Syrian conflict, starting in 2011, has been described as the worst man-made disaster since World War II. Beyond the immense loss of life and displacement (at least 400,000 deaths and 5.6 million refugees), the conflict has had devastating consequences for the health and well-being of the Syrian population. The destruction of healthcare infrastructure has reversed progress in infant mortality, increased infectious diseases, and limited access to treatment for chronic conditions. Damage to housing and food systems has impacted basic needs, while war-related trauma has led to widespread psychological distress with long-term effects. Prior research on major disasters highlights age, gender, exposure to conflict, and lack of social support as risk factors for decreased well-being; however, the "weaponization of healthcare" in Syria significantly complicates objective assessment. This study utilizes self-reported well-being data to understand the conflict's impact, contrasting Syria's experience with other global events. While previous research on events like the 2008 financial crisis or the Fukushima disaster showed limited long-term effects on well-being, this study aims to clarify these findings by comparing Syria's experience with a global dataset, considering the unique intensity and sustained nature of the Syrian conflict.

Existing literature extensively documents the individual and societal impacts of major population events, including wars, natural disasters, and economic crises. However, direct comparisons across different events are infrequent. Studies on mental well-being following events such as the 2007-2008 global financial crisis, the 2011 Fukushima disaster, or the 2015 Paris terrorist attacks often reported minimal or no long-term decreases in well-being. This supports the hypothesis that life circumstances have a limited impact on long-term well-being. Conversely, disaster and health research consistently demonstrates significant negative consequences. This study bridges this apparent gap, providing a global comparison of Syria’s well-being trajectory against other countries experiencing conflict, unrest, or disasters, providing a much-needed contextualization of Syria's experience.

This study leverages data from the Gallup World Poll, a globally representative survey (1,722,558 participants across 163 countries from 2006-2016), specifically focusing on Syria's data from 2008-2015 (11,452 participants). The Gallup World Poll employed face-to-face interviews in low-income countries like Syria, using stratified random sampling to ensure representativeness. Thirteen indicators across physical, mental, and social well-being were analyzed. Physical well-being was measured by assessing health problems, physical pain, well-restedness, satisfaction with healthcare, access to food, and access to shelter. Mental well-being was assessed through indicators of positive and negative emotions, life satisfaction, and hope. Social well-being was evaluated through measures of social support, feeling respected, and freedom to choose life choices. Exposure to conflict (assessed in 2013 and 2015) was determined by displacement, injury, loss of life, or income loss among household members. Multilevel linear and logistic regression models were employed to analyze the longitudinal trends in Syria, accounting for governorate-level clustering. Cross-national comparisons were conducted using multilevel analyses, contrasting Syria's well-being with other WHO regions and countries experiencing various events (war, protests, and natural disasters). Multiple imputation techniques addressed missing data. The study employed a serial cross-sectional design, acknowledging limitations in assessing within-person changes.

The study reveals a significant and widespread deterioration of well-being in Syria during the conflict. Eleven out of thirteen well-being measures showed substantial declines from 2008 to 2015, with notable increases in dissatisfaction with healthcare (3.57 times more likely), difficulties accessing food (OR = 6.74), and shelter (OR = 3.45). Life satisfaction was halved (from 5.15 to 2.55), and access to social support decreased dramatically (OR = 0.20). Geographic variations were observed; for example, Rural Damascus showed significantly worse healthcare satisfaction compared to the national average. Interestingly, direct exposure to the conflict did not show a statistically significant difference in well-being compared to those not directly exposed (except for food and shelter access). Prior to the conflict, social support was positively associated with well-being, but this effect dissipated during the war. Cross-national analyses showed Syria's decline in well-being to be unparalleled among the 163 countries studied. Syria experienced the most substantial declines in almost every well-being indicator, even when compared with other countries affected by armed conflict, major protests, or natural disasters. The magnitude of the decline in life satisfaction (a drop of 1.1 SD) is striking, exceeding that observed in other significant life events like bereavement and disability.

The findings highlight the devastating impact of the Syrian conflict on population well-being, exceeding that of other major events. The study's global perspective provides critical context, demonstrating that Syria's decline is unique and not attributable to broader regional or global trends. The lack of association between direct exposure and well-being suggests societal-level effects, while the erosion of social support's protective role speaks to the conflict's immense scale. Counter-intuitive findings regarding reported health problems and physical pain may be attributed to sampling biases and "prevalence-induced concept change." While acknowledging limitations, the study’s robust findings underscore the profound psychological and social impact of the conflict, far exceeding that of other major population events. The findings strongly support the implementation of evidence-based psychosocial interventions.

The study provides compelling evidence of the pervasive and profound impact of the Syrian conflict on population well-being, far surpassing the effects of other major global events. The unprecedented decline in physical, mental, and social well-being highlights the urgent need for sustained humanitarian aid and targeted psychosocial interventions. However, lasting improvements necessitate an accelerated peace process to rebuild social structures, address fundamental health needs, and restore hope for the Syrian people. Future research should use more detailed and validated measures of well-being, and longitudinal studies to examine within-person changes and recovery trajectories.

The study employed a serial cross-sectional design, limiting the assessment of within-person changes in well-being. The use of predominantly single-item and dichotomous self-reported measures, while facilitating cross-national comparisons, may reduce precision compared to more comprehensive assessments. Sampling biases, stemming from safety concerns during data collection, could lead to underrepresentation of individuals with high levels of conflict exposure. The possibility of "prevalence-induced concept change" could have influenced self-reported health problems and physical pain. Finally, although the Gallup World Poll is designed to be globally representative, cultural differences could have affected responses.