The Syrian health system was heavily impacted to the point of almost collapse by the conflict that erupted in March 2011. Following the withdrawal of the Syrian government from large territories across the country, various actors in opposition-held areas were faced with the challenge of providing health services to these populations. In the absence of a unified governance structure, different stakeholders followed different models; top-down, bottom-up or a mixture of the two. This research draws a comprehensive overview of the emerging experience of governance of the health sector. It also studied whether the resilience of bottom-up service delivery in the health sector can provide the impetus for a state-building project that can codify institutional structures and ensure their accountability in the future.