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The Regional Equalization of Health Care and Education in Syria Since the Ba'thi Revolution

Published online by Cambridge University Press:  29 January 2009

Alasdair Drysdale
Alasdair Drysdale
Affiliation:
University of New Hampshire Durham, New Hampshire
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Abstract

Virtually all underdeveloped countries suffer acute and sometimes debilitating geographical inequalities in the distribution of wealth and opportunity. These spatial inequities exist at all levels: between regions, between urban and rural areas, and between center and periphery. Some regional planners view such imbalances as essentially transitory and argue that with increasing economic development, wealth and opportunity will eventually spill over from growth centers and trickle down through the urban hierarchy to backward, less-developed areas.

Type
Research Article
Information
International Journal of Middle East Studies , Volume 13 , Issue 1 , February 1981 , pp. 93 - 111
Copyright
Copyright © Cambridge University Press 1981

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References

NOTES

Author's note: An earlier version of this paper was presented at the annual meeting of the Middle East Studies Association, Salt Lake City, Utah, November 8, 1979.

1 There is now a vast and diverse literature on the whole problem. For contributions to and summaries of the debate, see especially Alan, Gilbert and David, E. Goodman, “Regional Income Disparities and Economic Development: A Critique,” in Development Planning and Spatial Structure, ed. Alan, Gilbert (New York: John Wiley and Sons, 1976), pp. 113–141;Google ScholarCoates, B.E., Johnston, R.J., and Knox, P.L., Geography and Inequality (London: Oxford University Press, 1977), pp. 31–42, 111–134;Google ScholarKeeble, D.R., “Models of Economic Development,” in Socio-Economic Models in Geography, ed. Richard, J. Chorley and Peter, Haggett (London: Methuen, 1967), pp. 257–266;Google ScholarWilliam, Alonso, “Urban and Regional Imbalances in Economic Development,” Economic Development and Cultural Change, 17 (1968), 1–14;Google ScholarJohn, R.P. Friedmann, Regional Development Policy: A Case Study of Venezuela (Cambridge, Mass.: M.I.T. Press, 1966),Google Scholar and his “The Spatial Organization of Power in the Development of Urban Systems,” Development and Change, 4 (1972–1973), 12–50;Google ScholarAndre, Gunder Frank, Capitalism and Underdevelopment in Latin America (New York: Monthly Review Press, 1969);Google ScholarAlbert, O. Hirschman, The Strategy of Economic Development (New Haven: Yale University Press, 1958);Google ScholarGunnar, Myrdal, Economic Theory and Underdeveloped Regions (London: Duckworth, 1957);Google ScholarWilliamson, J.C., “Regional Inequality and the Process of National Development: A Description of the Patterns,” Economic Development and Cultural Change, 13 (1965), 3–43;CrossRefGoogle ScholarRoland, J. Fuchs and George, J. Demko, “Geographic Inequality under Socialism,” Annals of the Association of American Geographers, 69 (1979), 304–318;Google Scholar and Slater, D., “Underdevelopment and Spatial Inequality: Approaches to the Problems of Regional Planning in the Third World,” Progress in Planning, 4 (1975), 97–167.CrossRefGoogle Scholar

2 Anthony, R. de Souza and Philip, W. Porter, The Underdevelopment and Modernization of the Third World (Association of American Geographers, Resource Paper no. 28, Washington, D.C.,1974). p. 60.Google Scholar

3 This change is documented in Alasdair, Drysdale, “The Syrian Political Elite, 1966–1976: A Spatial and Social Analysis,” Middle Eastern Studies, 17 (1981), 3–30,Google Scholar and in Nikolaos, van Dam, “Sectarian and Regional Factionalism in the Syrian Political Elite,” Middle East Journal, 32 (1978), 201–210.Google Scholar

4 Cited in Itamar, Rabinovich, Syria under the Ba'th, 1963–1966: The Army-Party Symbiosis (Jerusalem:Israel Universities Press, 1972), p. 95.Google Scholar

5 Cited in Eliezer, Be'eri, Army Officers in Arab Politics and Society (New York: Praeger, 1970), p. 337.Google Scholar

6 Syrian Arab Republic, Ministry of Planning, Second Five-Year Plan for Economic and Social Development, 1966–1970 (Damascus, 1967), pp. 3–4.Google Scholar

7 Idem, , Third Five-Year Plan for Economic and Social Development in the Syrian Arab Republic (1971–1975) (Damascus, 1971), p. 10.Google Scholar

8 For example, in Jamaica there are one-sixth as many people for each doctor in the capital city as in the rest of the country. The ratio between people and doctors in Thailand is seventeen times higher outside Bangkok (John, Bryant, Health and the Developing World [Ithaca, N.Y.: Cornell University Press, 1969], p. 50).Google Scholar A similar pattern is evident in Tunisia, where 53 percent of all physicians practice in Tunis governate, which has only 22.4 percent of the country's population. In this region there is one physician for every 2,529 people, compared to one for every 23,090 in Kasserine govemate (U.S. Department of Health, Education, and Welfare, Office of International Health, Division of Program Analysis. Tunisia, Vol. XV of Syncrisis: The Dynamics of Health [Washington, D.C., 1975], p. 52).Google Scholar For other Middle Eastern examples, see idem, Kingdom of Morocco, Vol. XXII of Syncrisis: The Dynamics of Health (Washington, D.C., 1977), pp. 81–93,Google Scholar and The Hashemite Kingdom of Jordan, Vol. XXI of Syncrisis: The Dynamics of Health (Washington, D.C., 1977), pp. 44, 48.Google Scholar Other examples are provided in Paul, F. Basch. International Health (New York: Oxford University Press, 1978), p. 287.Google Scholar

9 Family Health Care, Inc.Health Manpower and Health Services in the Syrian Arab Republic: Issues. Analyses and Recommendations (Report to U.S.A.I.D., Washington, D.C., 1976). p. 66.Google Scholar

10 Bryant, , Health in the Developing World, p. 52.Google Scholar

11 Raymond, M. Susan Weber, Health and Policymaking in the Arab Middle East (Washington, D.C.: Center for Contemporary Arab Studies, Studies in Arab Development, 1978). p. 2.Google Scholar

12 Ibid., p. 40.

13 Because data on the distribution of doctors in 1964 were unavailable, 1963 data have been used here. A number of new provinces were created between 1964 and 1977. To facilitate time-series statistical comparisons 1964 administrative divisions have been used. Therefore Damascus province includes Damascus city, al-Lādhiqīyah includes Sarhūs, and Dar'ā includes the largely abandoned and partly Israeli-occupied al-Qunaytirah.

14 U.S. Department of Health, Education, and Welfare. Office of International Health, Division of Program Analysis, The Syrian Arab Republic. Vol. XXIII of Syncrisis: The Dynamics of Health (Washington, D.C., 1977), p. 73.Google Scholar

15 This measure, used by Williamson in “Regional Inequality and the Process of National Development,” is derived in the following way:

16 These figures are all computed from data in Syrian Arab Republic, Ministry of Health, Division of Health Statistics, Annual Statistical Report, 1978 (Damascus, 1978), p. 82.Google Scholar

17 U.S. Department of Health, Education, and Welfare, Syrian Arab Republic, Syncrisis, pp. 57–65.Google Scholar

18 Family Health Care, Health Manpower and Health Services in the Syrian Arab Republic, p. 26.Google Scholar

19 Ibid., p. 16.

20 U.S. Department of Health, Education, and Welfare, Syrian Arab Republic, Syncrisis, p. 75.Google Scholar See also Hossein, G. Askari and John, Thomas Cummings, “The Middle East and the United States: A Problem of ‘Brain Drain,’ ” International Journal of Middle East Studies, 8 (1977), 76,Google Scholar and Nadim, A. Nassar, “Higher Education and External Migration from Developing Countries: The Syrian Case,” Ph.D. dissertation, University of Pittsburgh, 1979.Google Scholar According to a Syrian estimate, 14,000 Syrians with higher technical qualifications left the country in the 1970s. Among them were 5,668 doctors, engineers, and sociologists (?) who went to the United States between 1970 and 1975. This exodus cost Syria an estimated $877 million (Middle East Economic Digest, 21 03 1980, p. 41).Google Scholar

21 This is true within the region generally. See Raymond, , Health and Policymaking in the Arab Middle East, pp. 8–20.Google Scholar See also Vinayak, Patwardhan and William, J. Darby, The State of Nutrition in the Arab Middle East (Nashville, Tenn.: Vanderbilt University Press, 1972).Google Scholar

22 Data on provincial enrollment ratios have been computed on the basis of each province's age structure, as detailed in the 1970 census. It is assumed that the percentage of each province's population of primary school age (6–11) and intermediate and secondary school age (12–17) in 1970 was the same in 1964 and 1977. This approach is necessarily approximate. It does not weight provinces which are gaining population rapidly through migration. Most important, it does not take account of the fact that many primary school students are much older than 11. According to one estimate, students between the ages of 12 and 18 account for up to 11 percent of all primary students. See “Development Planning and Social Objectives in Syria,” in United Nations Economic and Social Office in Beirut, , Studies on Selected Development Problems in Various Countries in the Middle East, 1971 (New York: United Nations, 1971), pp. 10–11.Google Scholar

23 The Vuwmeasure of overall inequality decreased from 0.24 to 0.14.

24 This is reflected in a rise of the Vuwinequality measure from 0.39 to 0.57 during the period.

25 Syrian Arab Republic, Office of the Prime Minister, Central Bureau of Statistics, Population Census in the SyrianArab Republic, 1970, Vol. I (Damascus, n.d.), pp. 18–21.Google Scholar

26 Syrian Arab Republic, Ministry of Education and Central Bureau of Statistics with the UNESCO Regional Office for Education in the Arab States, Population Dynamics and Education Development in Syria: Analysis and Perspectives, exhibit 2, Educational Development (Beirut, 1974), p. 20.Google Scholar

27 Ibid., pp. 22–23, 34–36.

28 Middle East Economic Digest, 25 05 1979. p. 47.Google Scholar

29 Syrian Arab Republic, Population Dynamics and Educational Development in Syria, p. 84.Google Scholar

30 It should be emphasized that overcrowding has been a serious problem in cities too. Because of migration, between 1960 and 1970 the school age population increased by 6.7 percent annually in urban areas but by less that 4 percent annually in rural areas. See Youssef, Courbage and Georges, Zouain, “Rural- Urban Migration and Its Implications on Education: The Case of Syria,” in Population. Education, and Development in the Arab Countries (Beirut: UNESCO Regional Office for Education in the Arab Countries, 1977), pp. 227–228.Google Scholar

31 Syrian Arab Republic, Population Dynamics and Educational Development in Syria. exhibit I, Population Dynamics, p. 39.Google Scholar