'Today is better than yesterday, and tomorrow will be better than today.' There is a note of cautious optimism being sounded in the Damascus cafes, where people meet daily to drink tea and smoke, to gossip and do business, and above all to discuss events. When the 30 year rule of President Hafiz Assad came to an end following his death last year, there were doubts about the ability of Bashaar, the quiet, second son, trained as a doctor not a politician, to succeed him. Now, one year later, the view is 'give him time', for although people want change, they also crave stability. Syria is a state in transition, and the new President has to achieve a difficult balancing act. Essential modernisation and a more open society, inevitably carry the seeds of instability, while internal progress has to be managed within the cauldron of wider Middle East politics.

For the man in the café, the most serious concerns are probably about domestic issues - employment, the cost of living, health care and so on - but the most heated debates are about the politics of the region. The Syrians are a hospitable people, but while western visitors are welcomed, their governments are castigated for being 'enemies' of the Arabs. I found on my first day that the names of Blair and Bush were uttered frequently and with contempt, reminding me of the experience of the great travel writer Colin Thubron who noted in l966, that wherever he went in Syria, he was taken to task about the policy of the British government towards Aden.

Recent history and the troubles in the region can be traced back to the end of the first world war when the Middle East was carved up between the victorious powers. Anyone familiar with T E Lawrence will recall the Arab Revolt which led to the Emir Feisal setting up a government in Damascus in l918, but after the French were awarded the Mandate over Syria and Lebanon by the League of Nations in l920 , he was forced into exile. Struggles over territory, and against the French control continued until after the second world war, when Syria finally took control of its own affairs in l946. Since then there have been uneasy relationships with neighbouring Turkey, Iraq, Jordan, Lebanon and especially in more recent years, with Israel. The six day war in l967 resulted in the Golan Heights being taken and for a while, the capital city Damascus being threatened. The attempt in l973 by Egypt and Syria to recover lost territory was unsuccessful in the case of Syria, and the current border disputes between Israel, Syria and Lebanon (in which Syria also has an interest) are well documented and provide a constant threat to peace and stability in the region.

I was not surprised therefore, as I sat in a street cafe drinking thick sweet coffee and smoking a nargileh pipe filled with apple scented tobacco, to hear strong opinions about Syria's neighbours. The new President may have surprised and disappointed the West by his outspoken condemnation of Israel during the visit of the Pope and subsequently, but there is no doubt that his people were delighted by the strong words and uncompromising stance he took.

What did surprise me was the willingness of people to talk openly about their lives, without the sort of fear and secrecy which I had anticipated. The Syrian secret police has always had a formidable reputation throughout the Middle East, and it has even been said that the noisy method of playing tric trac (backgammon) in cafes by slamming the counters loudly, gave people their only chance to talk safely without being overheard. Now, encouraged by the smooth transition of power, people feel that things are becoming more open, and they attribute this to the fact that, unlike other Middle Eastern leaders, the new President has lived and worked abroad in a free society.

In practice, more time is needed to see whether the 'old guard' has really laid down its apparatus of repression. The appearance of a satirical newspaper Al Domari, (the lamplighter) was hailed as proof of new freedoms of expression and was very popular in the capital, but it was not long before the government ordered the publisher Ali Farzat to remove two pages which were critical of the Prime Minister Mohammad Mustafa Miro. Farzat duly removed the pages, but insisted: 'We were evaluating the government's performance and talking about its role..we were not defaming any personality in the government, as has been interpreted.' Human rights organisations will also be biding their time, and the recent claims by the journalist and democracy activist Nazar Nayouf that he was abducted, do not bode well. Nayouf , a founding member of the Committee for the Defence of Democratic Freedom and Human Rights in Syria had already served nine years in prison for 'disseminating false information'. Now, he claimed that he had been abducted and held for two days by intelligence agents on the eve of a press conference to highlight human rights abuses, including killing of political detainees. "They told me word for word, we will cut your tongue and feed it to dogs if you talk about anything, he claimed, but said that he was released after pressure from international agencies and, significantly, from President Bashaar Assad.

Although my purpose in visiting Syria was to examine the present state of the country and look towards the future, like most visitors to Damascus, I was first drawn irresistibly to the past. Located on two great trade routes - the incense routes of Arabia and the silk traffic from China - with water from the mountains of Lebanon and a fertile hinterland, Damascus has always been a prize worth fighting for. In 333BC when Darius fled in the face of Alexander the Great's approach, he left a prosperous and well-ordered city with an extensive underground irrigation system. The Greeks built a new city complete with agora, gymnasium, houses and arcaded streets, but after the death of Alexander, Syria was tormented by the wars between the Seleucids in Asia and Ptolemies in Egypt, until the legionaries of General Marcus Aemiliau Scaurus arrived in 64BC and the years of Roman civilisation began. The Emperor Julian said with good reason that the city " in very truth belongs to Zeus and is the eye of the East - sacred and most mighty Damascus."

Today, anyone looking for evidence of these civilisations will stumble on them unexpectedly, as Thubron explains so graphically:

The level of the roman city lies 15 feet below the present one…but here and there a plastered up column leans out of a wall, the base of a broken pillar is used for a seat or doorstep.. It is typical of Damascus that she has absorbed them without fondling or jealousy, simply propped herself against them with an Arab indifference to antiquity.

The recent visit of Pope John Paul II to Syria has highlighted the country's importance in early Christianity, most notably the conversion of St. Paul as he was on his way to persecute the Christians in Damascus. The blinded man was taken to the Street called Straight, where the Christian disciple Ananias restored his sight:

And immediately there fell from his eyes as it had been scales; and he received his sight forthwith and arose and was baptised.

Today you can still walk down the Street called Straight, although it is only a quarter of its original width, and remember how it was built nearly 2,000 years ago to link the gate of Jupiter to the Gate of the Sun, flanked by magnificent Roman buildings. It is also interesting to reflect on the coincidence that Damascus - the city where St. Paul lost and regained his sight - has always been recognised in the Arab world as a centre of excellence for ophthalmology.

The other remarkable aspect of the Pope's visit to Syria was that he made the first visit of any Pontiff to a mosque, in order to pray at the site where the Head of John the Baptist is buried. Originally this was the site of the Roman temple of Jupiter, which was converted into a church dedicated to St. John the Baptist in the late fourth century. After the Arabs took Damascus in 636 AD, the site was used to build the Ummayad Mosque, one of early Islam's most magnificent monuments (708-715AD); and the prayer hall houses a lavish marble monument which commemorates the legendary burial site of the head of John the Baptist.

The experience of the old city goes beyond an appreciation of great buildings and historical sites. The Souk Al-Hamidieh, the huge covered market place where you can buy anything from ancient potions to live chickens, was actually built in the 1870s as part of the urban renewal programme by Rashid Nasha Pasha, but most of the old city has escaped the hand of regeneration. It is ancient, teeming, chaotic and mysterious. Again, Thubron sums it up admirably as a place where:

men seem to have lost the battle against their environment and to have wedged themselves against the jumbled architecture of their fathers. Streets, which at first move confidently, strident with voices and the crash of hammers, disintegrate into lanes. Often you can stretch out both arms as you walk, and stroke the sides of an alley until it dies beneath a dwarf arch and is succeeded by anarchy of passageways.

Returning to my hotel involved crossing from the ancient to the modern world. In the business centre to check my email (only recently possible in Syria as part of the liberalisation policy), I was helped by Haala a middle aged woman who told me that she also had a full time position in a government department. "Most people have two jobs. You can't live on a civil servant's wages" she explained matter of factly. Did that apply to doctors too I wondered. "Of course", she said "they all try to get work in private hospitals and clinics if they can."

So for Damascenes, the working day starts at 8am and finishes at about 2pm when people go home for lunch and a siesta. Then for many, the 'second shift' starts at about 5pm after tea and baklawa pastries, when they set off for their next job, usually in private sector offices, restaurants or shops, or clinics. The last meal of the day is taken very late. I found that it was easy to get a table in a restaurant at 10 p.m. but had to queue at midnight. Once in the early hours of the morning there was so much noise outside my hotel that I was convinced that there had been a coup or war declared, and I turned on the television expecting to hear martial music. It turned out to have just been people having a good time on their way home from a nightclub.

Although inflation is high, to the visitor, Syria seems absurdly cheap. You can get a taxi anywhere in the city for the equivalent of one US dollar and buy four pieces of freshly baked flat bread for five cents. However the most common complaint I heard was that wages are too low and even with two jobs, people are struggling to maintain their standard of living. I only saw one woman begging during my stay, but noted many, people who were eking out the most meagre income from services like shoe cleaning and portering. As in all cities, there is a constant ebb and flow of population. People are drawn in from the rural areas, believing there will be work for them, and trying to escape from rural poverty.

Syria is larger than neighbouring Lebanon, Jordan and Israel but is still only about half the size of Italy. Most of the population is concentrated in the west of the country, in the strip running from Damascus in the South to Aleppo in the North, and in other areas of economic activity including oil production around Deir el-Zor and heavy industries around Homs. One of the main problems facing the government over recent years has been to improve the infrastructure and provision of services in the rural areas, including health care. Until this happens, people will continue the drift to the urban areas, and in some cases will leave Syria in their search for a better standard of living. In my hotel, a Saudi Arabian company was recruiting labour. "We like the Syrians because they always want to return home at the end of the contract. They want to spend three years earning enough money to buy a house and get married, but they always want to go home at the end" explained the recruiting manager.

Those who can afford it also want to buy a car, but these are very expensive and a new car is a rarity. In consequence, the streets are full of old and battered vehicles and the air is choked with exhaust fumes, raucous engine noise and the incessant sound of hooting and shouting. There are of course some signs of change. In recognition of the growing demand from tourism and business, a number of old Volvos are appearing to provide 'superior' car hire for this market; and driving around the city you can now see the occasional mobile phone showroom and Italian designer clothes shop.

These kinds of changes raise interesting questions about the overall management of the economy. The motto of the ruling Baath party is Unity, Freedom and Socialism, but even during the presidency of the late president Assad, there was some loosening of state control of the market, with a gradual increase in imports, particularly of machinery and food. In l991, the government introduced Law No 10 to encourage private sector investment, and the need for new oil exploration has encouraged reforms in the oil sector. Private factories are now permitted in order to increase the range of products which can be made at home rather than imported, and this is an increasing trend which is giving rise to the flexing of new, entrepreneurial muscles. Faris Chaheen works as chief engineer in a chemical factory. He originally came from Hama in the north of Syria where his family own some land and he derives a modest income from a small orchard and from letting a couple of houses in the town. Now, pooling his money with three associates in Damascus, he bought a restaurant, then a small factory manufacturing T-shirts. Excited by the possibilities, he told me that the next project would be a T-shirt printing facility, to produce instant pictures and slogans - presumably not too radical.

At the same time as his small businesses are expanding in the city, he is also feeling the effects of changes in the traditional rural economy. On the one hand, he told me that he would no longer have to employ people to sell his fruit in local markets, because he has contracted a fruit distribution company to purchase his entire stock. On the other hand, the local labour, which he has always used to prune the fruit trees in spring, was not available this year, perhaps employed more profitably elsewhere. Luckily he is resourceful, and takes great pride in the fact that he bought a book on pruning and cut back all 300 trees himself. However, the development of modern methods of agriculture is gradually sounding the death knell for traditional farming and for absentee landlords of smallholdings.

Chaheen's strategy of pooling resources with friends or family, is a common practice in Syria, not just in business but as a means of helping individuals solve financial problems, including paying for private medicine. When I told Haala in the hotel business centre that I was interested in health care, she told me that her father had needed an eye operation which cost SP 35,000, equivalent to $700, so each of his five children had contributed a share, to make it possible. Was it necessary to have it done privately I asked. "Of course," she said. "There was no choice."

But of course there is a choice, since Syria - like its Arab neighbours - has a public health service. However it was clear that many people in the towns share Haala's view that public medicine is to be avoided if possible (and those in the rural areas can only reflect on the inadequacies of local services.) The growth of the large private health sector is widely attributed to deficiencies in the state health system.

Once area of medicine for which Syria is well known is ophthalmic surgery, so I started my investigation into health care at the ophthalmic teaching hospital in Damascus, where I arranged to meet Professor Rida Saeed. There was barely standing room in the outpatient department when I arrived, and with no appointment system, the arrangements seemed chaotic. Professor Saeed explained that 65% of his patients travel a long distance from the north east of the country where there is currently a lack of clinical facilities. "After making the nine hour journey from Kamishli to Damascus with their families, we simply can't send them back just because they don't have an appointment, so we have to see them all and decide how to deal with them,' he explained.

There are two main out patient clinics. In the general clinic, initial tests are carried out and basic treatment provided where appropriate. Those diagnosed as needing urgent care, for example for glaucoma, diabetic complications or retinal detachments are sent to a specialist department staffed by residents and postgraduate students, all within the course of the day and with no appointments. The hospital has a staff of 40 residents and 27 specialists, and is well equipped with modern technology including the capacity for laser treatment. Not surprisingly its 100-bed capacity is always full, and there is a waiting list. Professor Saeed explained that a procedure like cataract extraction has a wait of about six months, but patients might be admitted as an emergency if their vision is compromised. Treatment and care are free, but cataract patients have to pay for their intraocular lenses (although there is a charity within hospital, which can help with the cost of this).

My discussion with Professor Saeed was constantly interrupted by a stream of queries, most of which seemed to be administrative rather than clinical. "Yes", he said, "it's a problem for doctors. I told the Minister that we are now having to deal with more and more administration at the expense of seeing patients". So does this affect morale, I wondered? He explained that he has no problem recruiting residents but this is mainly because the specialist accreditation opens the door to private practice. " Without the hope of private practice, there would be a mass emigration of doctors. Here a newly qualified doctor only earns $70 a month, so private work is essential to maintain a decent standard of living." Like most Arabs, Syrians are not embarrassed to talk about their own earnings and Professor Saeed told me: "after 24 years of service with increments and awards I only get $150 a month," However money is not everything. His father and grandfather were leading ophthalmic surgeons and he has high hopes that his son will follow in the family footsteps.

I was still curious about the origin of this special interest in ophthalmology in Syria and talked to Dr. Riad Matouk chairman and co founder of the Syrian ophthalmic society. He reminded me that many of the ancient doctors who practiced the art of ophthalmology lived in Syria such as Ibn Isaac and Thabit bin Quora, and that Syria had made a special contribution to the eradication of trachoma in Middle East. The ophthalmic society which was established in l965 has over 500 members, and Dr. Matouk confirmed that there is a flourishing private sector (he estimated that the the public private split was probably about 50:50).

One of the main problems currently facing his members working in the private sector, is the availability and cost of corneas for transplantation. During the past three years, about 500 operations were performed, using corneas from the United States. At the moment, these are provided free for public sector use, although the Syrian government pays approximately $50 towards transportation and storage. However for private sector use, the American Eye Bank charges up to $1000 for each eye delivered, thus limiting the number of private operations performed. Dr. Matouk suggested that there is spare capacity for private eye surgery, if these services could be more effectively marketed throughout the Arab world and perhaps beyond, as the Lebanese have done. In Syria, he told me, a cataract operation would cost between $300 and $800 all-inclusive, depending on the type of lens used.

This problem of over capacity is not limited to doctors. A recent study which looked at the school of dentistry at the University of Tishreen in the north west city of Latakia has warned of the urgent need to limit the number of training places. The author, Dr. Faisal Deyoub who is chairman of the Syrian Dental Association, points out that in l970, there were 321 dentists for a population of 5.5 million. This figure has risen to 11,000 for a population of 17 million, so the ratio has risen from 1:17,500 to 1:1,500 in thirty years. In spite of this, the six schools of dentistry continue to produce up to 950 students each year, at a cost of about $10,000 dollars per student per year. Government jobs are limited and in any case can only offer a wage of approximately $80 a month, so he is recommending an initial 10% reduction in the intake of students. It is not surprising that the Saudi employment agency recruiting in my hotel is particularly targeting doctors and dentists to work in the Saudi Arabia, and appears to have no shortage of applicants.

The problem as always comes down to resources and the difficult choices that have to be made in planning the country's health care. To get an overview of the situation and some insight into current policies, I arranged a meeting with the Minister of Health, Dr. Mohammad Eyad Chatty. His office is in a modest building in down town Damascus and when I entered the building I was surprised to see a notice prominently displayed in the foyer stating that the Minister will be personally available every Monday from 11.30 - 1.30 to receive citizens with complaints. No appointment necessary.

Before taking over the health portfolio fourteen years ago, Dr. Chatty held the chair of Pathology at the school of medicine, Damascus University for many years. He then became the Dean of the medical school until his current appointment in 1987. He has Masters degrees in both cytology and neuropathology and is a member of the American Board of Pathology. I asked him first about the 'meet the people' initiative, advertised downstairs and he explained that this was established earlier this year as a way for him to listen to people's problems and try to deal with their concerns, assisted of course by a team of civil servants to follow things up.

He went on to say that in terms of charting improvements in health care, the significant figures are those for the period l970 (when the late President came to power in what is described in Syria as the corrective revolution) to the present day, and he noted that during that time, there has been a steady improvement in the medical services offered by the state. He explained that he had no problem in being open about health issues because "under the leadership of Dr. Bashaar", it is our aim to be as transparent and candid as possible. 'The only thing I can't tell you', he joked, 'is how much we spend per capita on health, because it is so little you won't believe how we can support the whole health system.'

Since l970, the number of hospitals and health centres has increased from 248 to 1,188, and the Annual Report for 2000 shows that over 31 million health encounters took place during the year in all branches of medicine. Nevertheless, one of the main problems in such a large country is to reduce the level of dependence on the health centres and hospitals in the major cities, and the Ministry has been working with the WHO and UNICEF to establish the concept of health villages, with the aim of eradicating certain diseases and improving a range of health indicators. Under this scheme, 113 health villages have been established with an additional 100 to be completed this year, and the effects so far have been positive. The rate of immunisation against infectious diseases is now over 90%, with 92% of women given advice on family planning and 95% of expectant mothers receive ante natal care. 'Currently, the main emphasis is to concentrate on primary care services and prevention,' explained the Minister, 'because in our opinion this will reduce the overall cost of secondary services.' However the Ministry is also working on the introduction of nominal fees for patients seeking advice within the public sector, perhaps even including a contribution towards the cost of hospitalisation. 'The country cannot cope with the increase of demand and this may be the only way to deal with the problem', he explained.

The government has also been concentrating on developing those specialities, which are used extensively by the public, for example Accident and Emergency medicine. In l997 the first batch of A&E doctors qualified, and there are now 215 doctors training or qualified in this speciality. The Minister also emphasised the need for training in health economics and management and noted the successful co-operation with Liverpool University in training health service managers, which has been organised with support from UNICEF and the WHO.

Health service improvements have led to a significant improvement in infant mortality, with the death rate of children under one year old reduced from 132 per thousand in l970 to 24 per thousand in 2000. Similarly, for children under five, the mortality rate has decreased from 164 to 29 per thousand for the same period, and maternal mortality rate from 82 to 71 per 100,000. Linked with this, life expectancy has increased from 56 to 70 years. Currently the most significant cause of death is coronary vascular disease, although this is partly attributable to congenital diseases such as rheumatic fever, which are now more effectively under control. The next most important cause of death is cancer, notably the fairly local Mediterranean lymphoma Immune Proliferative Small Intestine disease, together with lung and breast cancer.

The government can claim considerable success in curbing many diseases, which used to be common. There have been no cases of polio or cholera in the last two years, and other diseases such as bilharizasis and malaria have declined. However there has been a steady increase in cases of TB and an alarming increase in skin leishmaniasis with the number of cases shooting up from 9,000 in l998 to 12.000 in l999.

The government also seems to be winning the battle against AIDS, with only 217 reported cases of HIV positive, of which 75 have full blown AIDS. This must be due in part to the health education campaign but mainly to the rigorous screening programme. Last year, nearly a quarter of a million people were tested for HIV, and there is a compulsory programme for some groups including prostitutes and bar hostesses, and all blood donors. In 2,000 only 16 new cases of HIV positive were detected.

In terms of resources the Minister was proud of the fact that Syria is one of the few Arab countries which is largely self sufficient in drug production, with only 13% of the country's needs imported, mainly insulin, vaccines, cytotoxic drugs and blood products. He explained that there are 47 drug manufacturers in the country, producing nearly 3,000 types of pharmaceuticals working under stringent quality control procedures. Even so, I observed quite a few Syrians in local pharmacies showing little faith in locally produced drugs, preferring to buy imported drugs instead. The other product which is not in short supply is blood, due to the country's policy of requiring people to donate a pint of blood when they leave school, join the armed forces and apply for a driving license. Last year there were over 182,000 blood donors and the Minister was not apologetic about this compulsory policy: " These people are healthy, and lose nothing by giving a pint of blood to help other fellow citizens," he said.

Finally, I asked him if he was worried about the numbers of doctors and dentists being trained. He pointed out that the country now has just over 22,000 doctors, 11,000 dentists and 8,200 pharmacists, and agreed that the number of dentists may be cause for concern. He was however proud of the standard of medical education, and did not agree that the use of Arabic as the medium of instruction was a problem, even though this is uncommon throughout the Arab world.

On the way down from the Minister's office I noticed a large crèche on the ground floor of the ministry providing supervision for children aged 9 months and above. The supervisor told me that the childcare and food for the children are provided free to encourage women with young children to return to work for the ministry. This helped to answer one of my unspoken questions about the place of women in Syrian society. I knew that Syria's l946 constitution states that Arab women should enjoy all the rights of citizenship, and that the late President had made frequent references in his speeches to the emancipation of women. I had seen women at work in key areas of the economy, and learned that nearly 50% of medical graduates are now women. My problem was this. In the traditional extended family, older women looked after their grandchildren, but with older women now routinely working, who will look after the babies? Will this force women back into the home, or will public childcare be provided? The Ministry of Health crèche suggests what the answer will be.

Of course, it is difficult to generalise about these things. Like its Arab neighbours, Syrian society is diverse with many minority groups, and there have been too many examples of internal conflicts throughout the Arab world, to ignore the possibility of this in Syria. For this reason I went in search of the Syrian Christians, nearly 12% of the total population, to enquire about the experience of living as a minority community.

I started in the courtyard of an Armenian Catholic Church in Babtoma, a Christian district of Damascus, where a memorial commemorates the Armenian victims of the Turkish massacre in l915. It was a sunny morning and the church was overflowing with people. Unexpectedly, I found myself the guest of Sami Haddad and his family, whose son Pierre had just received his first communion. He told me that his grandfather had escaped the massacre of l915 when an estimated 1.5 million Armenians were killed, and fled to Syria. "We are proud to be Syrian, he told me, with his brother Elias nodding agreement over snack of spinach rolls and croissants, "but we are at risk of losing our identity." Now, his father is the only member of the family who can speak Armenian, and the rest are all Arabic speakers.

This sentiment of upholding their Christian heritage but being proud of national identity seems common to the many Christian groups in Syria, and no one spoke of religious discrimination or persecution. The main concern which I heard expressed was that the Christians were becoming more of a minority because of their lower birth rate " Look at my next door neighbour," one man told me. "He got married three years after I did but he has seven children and I have two. Why? Well it's our tradition to go to university, look for a job, buy a house and not marry until we are past thirty. My neighbour married when he was still studying, and he lives with parents with two other brothers…. We have to change our ways if we want to preserve our identity."

So I sat at the first communion party and thought about the future. People were eating and smoking, and of course the rich Syrian diet and the universal addiction to smoking will be storing up plenty of health problems for years to come. The young Pierre, if he works hard, may be able to get a place at University to study medicine, but will there be work for him, or will he have to emigrate to make a living? Will the public health service be able to afford to give his parents and grandparents the care they will need as they grow old, or will they have to depend on all these family members gathering together again but in an altogether more somber mood , to have a whip round for their private health care?

At least Syria's minorities feel that they are reasonably safe; and I could now understand better the common view in the cafes of Damascus…"Give the new President time. Things are better today than yesterday, and tomorrow will be better than today." But this is a fragile optimism which can easily shattered by events inside the country or beyond its borders. Internally, repression has been an instrument of government for so long, that first signs of serious dissent may see a return to the bad old days of fear and intimidation. Externally, the ever present fear of regional conflict remains strong and the new President, like his father, could well prove to be a hawk rather than a dove. Although Syria is taking significant steps to develop the economy and improve public services, the region is a cauldron - more used to conflict and conflagration than peaceful progress. A new President gives cause for hope, but no guarantee of significant change.