WHO Syria: SITUATION REPORT Weeks 21-22; 25 May – 07 June, 2019 I. General Development, Political and Security Situation The security situation in Syria continues to worsen, especially in the Northwest, with the main hot spots being Aleppo, Hama, Idlib, Latakia, and Deir Ezzor Governorates. This has resulted in continued destruction of public infrastructures including health facilities, displacements of people from their traditional livelihoods, and attendant deaths and casualties. On Friday June 7 in Geneva, Jens Laerke, the OCHA Geneva spokesperson of OCHA, at a UN briefing said: o it is "deeply alarmed" by hostilities in northwestern Syria and near daily reports of civilians coming under attack. The actions include airstrikes, artillery shelling, and barrel bombs. o "Hostilities have resulted in at least 160 civilian deaths and hundreds more injured. A total of 3 million people, the vast majority of them civilians, and more than 300,000 of them displaced in April and May are in imminent danger" o Since April 28, there have been 25 confirmed attacks on healthcare in the northwest, including 24 health facilities and one ambulance. o As of May 30, the United Nations has received 36 reports on attacks on schools in the northwest. Twenty-three of these attacks have been verified in Idleb in the month of May alone. o A humanitarian catastrophe is a grave danger if the violence does not cease. Attacks and fighting are also impacting civilians in government-controlled areas On Thursday 6 June, between 6.15 to 7.30pm, Al-Mahabah private hospital in North West Hama was reportedly targeted by indirect rockets three times. On Sunday 26 May between 5 to 8 p.m., As-Suqeilbiye public hospital in North West Hama was reportedly targeted by Indirect rockets five times. Meeting with Hama Governor held on 28/5/2019, and attended by representatives from UN Agencies, LNGO, SARC, ICRC, DRC, SIF and DOSA. The situation in NW Syria was discussed, specially the expectation of arrivals from Idleb to Hama governorate, as around 300,000 individuals are expected to cross through Morek crossing point only, while Abo Thouhor crossing point will not be opened. Preparedness plan was discussed by all UN agencies. II. Key Health Issues 1. The three million people in Idlib (vast majority of them civilians), the injured and the more than 300,000 that were displaced in April and May, requires urgent health protection. 2. The total number of people who left Rukban remains at 13,364 people (32%) out of 41,700 residents. Between 31 May and 3 June, 189 people (32 males, 63 females, 69 children and 25 infants) left Mahmoud Othman shelter. Moreover, 6 people were transported from Baraa Ibn Malek shelter to the Teachers Institute shelter to join their families. The total number for people who are still in the shelters is 637 people. They were all hosted in 5 shelters in Bayada,Der Balba ana Qosour neighborhoods . 3. The As-Suqeilbiye public hospital in North West Hama that was reportedly targeted by Indirect rockets five times on 26 May was fully functioning before the partial damaged. This will about 8,976 beneficiaries of needed consultations and health care every month. 4. The Al-Mahabah private hospital in North West Hama that was reportedly targeted by indirect rockets three times on 6 June was fully functioning before the partial damage. This will deprive beneficiaries of the services on a Page | 1 monthly basis: 120 out-patient consultations (X-ray), 350-400 surgical operations (including CSs), 75-80 normal deliveries, 30 babies in incubator, 50 hospitalized patients. 5. The expected arrivals from Idleb to Hama governorate, of about 300,000 individuals, will result in heightened health needs of the displaced and placed a huge surge in both financial, technical and supply capacity of the health sector. 6. The Health sector is continuously updated on the impact of ongoing military campaign over 157 public health facilities and health personnel located in NSAG controlled areas and direct zones of ongoing violence, help keep the health sector plan up-to-date. III. WHO Response 1) Coordination Produced Health Cluster Bulletin for May 2019. Key highlights included: attacks on health care (33 attacks on healthcare have been confirmed since the beginning of the year); contingency and operational plans for north- west; Al Hol cam response (including opening of SARC/ICRC field hospital); major needs in health service delivery remaining across the southern Syria; health service provision in areas of Hajin and Busayra in Deir-ez- Zoir governorate. Flash Appeal on the attack on As-Suqeilbiye public hospital in Hama, 26 May produced by WHO HIS team was disseminated. 4W 2019 HRP health sector snapshot produced by WHO HIS team was disseminated. Weekly EWARS Bulletins for Syria and Al Hol camp produced by WHO communicable disease team were disseminated. Technical consultations were carried out with Regional Office and HQ concluding on agreement for SSG level issues: WoS leadership, costing approach. Operational briefing to USAID/OFDA team was provided on: southern Syria, north-west, north-east and key health sector advocacy points. WHO Syria donor update for 1 quarter 2019 was shared with health sector. A separate, day-to-day, operational support is provided for the response in Al Hol camp on a range of issues. Preparations are in place for upcoming annual DfID/WHO review meeting in Gaziantep, Turkey, 12 June, 2019. An operational update will be provided for WHO Syria. 2) Non-Communicable diseases & Primary health care Continued follow up for the 2 MMTs deployed by MOE to EG towns and currently providing oral health services to school students. Total of 4122 school students reached with total oral health services 20,639, health promotion sessions for 97 teachers and 4122 students in addition to 12,298 preventive services. The project ends 30 June 2019. Preparing for PHC Measurement & Improvement initiative is in place in consultation with MOH counterparts. Regional Consultative meeting to be Held in Cairo/EMRO, 30 July -1 August, to discuss objectives, data to measure key aspects of PHC, identification of progress towards and key challenges for performance improvement in PHC. Dispatched 30 NCD kits (insulin & syringes) in favour of Afrin Aleppo, SARC Aleppo, 4 NGOs working in Eastern Ghouta in rural Damascus, MOH in favour of DOH Qunitera, rural Damascus & Dara. Total provided treatments 1600. Finalized and submitted PHC list of medicines and equipment to be procured under new OFDA. Consolidated list for PHC/NCD strategic procurement plan is finalized and shared with Procurement team. Page | 2 Held a joint meeting on Monday 27 May with OIC for elderly & nutrition programs at PHC Directorate to discuss elderly assessment survey, methodology, sample size, questionnaire. A budget breakdown is under review at WCO technical officers. Submitted mapping for WHO interventions under Youth Task Force initiative on Thursday 30 May. Dispatched 13 patients’ beds in favour of two PHCs in DOH Aleppo: Khaled Ebn Al-Waleed & Maasranya which were rehabilitated by WHO in 2018. Continued follow up for the installation of X-Ray machine for SARC health center in Damascus (Al Akram PHC). Continued follow up for procurement of medical equipment under JPRM new allocation (3 Computed -Reader with mammography feature machines & 22 syringe pumps) in favour of MOH health facilities. Allocations for PHC, secondary & trauma programs (USD 3,407,000) under Japan award 68108 to support procurement of sophisticated medical equipment in favour of SARC: Magnetic Resonance Imaging System /MRI, Cardiac & Angio System and Digital Mammography. /MEMO is signed. On Sunday 2 June, carried out one-day mission to comprehensive ploy clinics & national hospital in Dara governorate to follow up electronic registry of diabetes program, Thalassemia center & the national hospital functionality and urgent needs. Report to be shared. The total number of treatment under PHC/NCD program is 10,567 during the reporting period. 682 medical consultations,39 individual and11 group PSS sessions, including 682 medical prescriptions, were provided for returnees from Rukban camp recently returned to Homs governorate. Provided the following medical equipment to Jub Al Janadlai PHC in Homs DOH: 1 spectrophotometer, 1 Basic X-ray system, 2 portable Oxygen Concentrators, 6 examination beds, 2 blood pressure devices, 1 Water Bath. Figure 1: Internal doctor with Rukban returnees in Almalahha village 3) Trauma About 100 health workers were trained on trauma and disability in four governorates (Aleppo, Daraa and Damascus) – Annex 2. The following deliveries were made during the reporting period: o Medical supplies capable of providing 238,100 treatments and 9700 trauma cases were delivered to Aleppo, Al-Hassakeh, Ar-Raqqa, Damascus, Rural Damascus, Deir-ez-Zor, Homs and Hama. Also included were 97 trauma kits, Basic and supplementary IEHK kits. o 3 medical devices were delivered health partners in Al-Hassakeh, Ar-Raqqa. o 168 personal protective equipment, PPEs, for chemical exposure were delivered to health partners in Aleppo, Al-Hassakeh, Ar-Raqqa and Deir-ez-Zo. o Facilitated aa mission of a specialist team from Bambino Gesu’ Hospital in Rome to Damascus University Hospitals as a part of the joint training programme, in collaboration with MOHE, in order to enhance the capacity of Syrian medical specialists in the Pediatric and Cardiac surgery hospitals of Damascus University on the latest techniques and practical skills in laparoscopy, interventional radiography, paediatric catheterization and paediatric intensive care. This mission has been remarkably recognized by the Syria health professionals. Few unique surgical operations have been conducted jointly by the Italiane and Syrian specialists including a successful 7-hour cardiac surgery to a 3- month baby girl. A well-known pediatric cardio surgeon in Bambino Gesu Hospital gratefully joined the team and has been a great added value.