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
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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.
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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. In addition, there has been a positive response and well organized and prepared difficult cases to be operated on. This is a result of the appreciated
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efforts by the new management of the Pediatric Hospital supported by MOHE leadership.
4) Immunization
The vaccination activities in Ein Arab district of Aleppo governorate and Tell Abyad district of Raqqa governorate, were covered through Raqqa vaccination teams till end of 2018, currently the DOH Aleppo had concerns dealing the SDF authority in both locations. A joint TC meeting with Aleppo Health Director and PHC director was conducted to recognize the risks of not vaccinating those areas despite of the available access and the risk of return poliovirus to Syria if we are not able to close the immunity gap in Kurdish areas. The meeting agreed on the below action plan presented by Aleppo Health Director including the following actions: o The SDF health authority will send an official approval letter to the MOH Aleppo and Raqqa to allow EPI vaccination activities through MOH Aleppo and Raqqa o MOH Aleppo and Raqqa to assign vaccination teams according to a set plan for Routine Immunization activities in Ein Al rab and Tal Abiad respectively o Letter will be sent, after Eid Ul Fitr, for endorsement of the central MOH. o Discussed with PHC director the importance of having an interlocutor (from WHO side) to liase with the activities with SDF and MOH Aleppo. No special campaigns conducted during the last couple of weeks. Only Routine Immunization activities are progressing as planned. The final results of the National Immunization week of April 19 in Syria shows that a total 225.090 children under the age of 5 years (91% of the estimated targets) were reached and given a relative routine vaccination dose to their entitlement. All accessible areas in the 14 governorates of Syria were included. WHO in coordination with MOH paid several field visits to stand on the quality of services provided during the campaign. In Urban areas the population were very motivated to present their children while in conflict torn areas there was an environment of fear but in overall the campaign was a success.
5) Mental Health
4 capacity building activities took place across the country, 100 health and community workers were trained on different MH programme. Active family wellbeing centers are in DEZ: Syrian Pulse NGO,in HAMA: Al-Bir Hama NGO. Follow up with MoE, Planning directorate to raise the memorandum of understanding between the two parties for MoFA approval. Working in collaboration with Lebanon office/ MH officer, to adopt new printed materials concerns mhGAP and GBV first line support to be embedded together. Receive fund from HQ/RHR to support GBV programme in Syria, the fund supported capacity building activities for MHPSS with GBV components which are considered to be a reflection for the plan of GBV 2018-2019 Developing an action plan for enhancing MHPSS UHC on Syria level considering full integration with all programmes, further discussion will take place with all technical officers. MH Psychotropic shipment received in Lattakia warehouse, preparing a distribution plan to cover MOH centrally and mainly partners in NWS emergency response. Preparation for MHPSS TWG in June with partners. Continue follow up the potential Azaz asylum 79 mental health medevac with partners: Ibn khaldoun, Aleppo DoH, SARC, Ihssan Charity, and UNFPA, UPDATE from GAZ hub to involve Turkish Red Crescent in the medevac process. Feedback after the Eid. Coordinate with GAZ HUB MH officer to establish "continuity of MH care" plan, for NWS emergency response, emergency response and preparedness plan shared by both HUBs. MHPSS services delivered by MHPSS workers in 9 MMUs and 2 static points in Aleppo.
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The continuous field assessment for chronic neurological patients conducted in Eastern rural Aleppo (specifically people with Epilepsy and mental retardation) initiative shared with health partners in the health sub-working group, more partners to be involved. Psychotropic medications reserved to be shipped to Qamishly HUB. Coordinate with NES MHPSS TWG for implanting mhGAP training for doctors working in the Al-Hol camp. Developing more sophisticated online formula for a comprehensive supervision sessions registry.
6) Nutrition and Child Health
Nutrition screening in rural Aleppo for 1179 children under 5, with 136 MA, 5 SAM. 2 Meetings with Essential Newborn Care Course (ENCC) national committee for over view of the program. Meeting with new born care at home program partners to coordinate the work with other UN partners in the implementation.
Data collection of neonatal resuscitation program from 34 hospitals in 12governorates for April 2019 (except Idlib and Dair Ezzor), with total of 5891 beneficiaries. Data analysis for nutrition surveillance program for 12 governorates, 73,099 services, 1171 global malnutrition. In Job training on IMCI in AL Hol camp for 29 trainees in 3, medical point. Data collection of IMCI program from international medical committee from 3 centers for April 2019, with 3040 beneficiaries.
7) Secondary Health Care
Finalized the planned procurement list of medicines and supplies during 2019-2020 Visited Children hospital to follow up the progress of the rehabilitation work. Worked on recruitment process for a focal point in Al- Hol camp under secondary program. Delivered about 966 hemodialysis sessions to Hassakeh Directorate of Health and Aleppo university hospital in Aleppo
8) Communicable Diseases, Surveillance and WASH
Communicable Diseases/Surveillance The following meeting was held during this reporting period: o to prepare the joint WHO – MoH quarterly plan for national TB program for Q3 2019 activities. A health education campaign on waterborne diseases in Al-Hol camp was conducted. The campaign focused on hygiene practices and prevention of waterborne disease for the coming summer season. The estimated number of beneficiaries from the health educational sessions is 11 250, and 12500 WHO brochures on key prevention measures for waterborne disease were distributed. Vector control activities in Aleppo was launched to response to the increased number of leishmaniasis case. The activities including indoor residual spraying (IRS) targets 64 villages and the estimated number of beneficiaries is 141 892 individuals. WHO has coordinated with MoH to secure the second batch of HIV medicines to Idleb governorate though its FP. Those medicines will be handed over to previously diagnosed HIV cases in Idleb governorate. WHO is coordinating with MoH to adapt the last WHO updated guideline about partner notification for HIV cases, once the Arabic version is drafted, one-day workshop will be conducted to finalize the Arabic version. WHO has conducted a progress review mission with IOM project management unit responsible for MER grant in Beirut on 28 and 28 May 2019 to review TB and HIV activities funded by Global Fund MER 2 for Q1 and Q2 2019. 5 WHO staff in addition to 2 IOM staff has participated.
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WASH The following water quality monitoring visits were conducted: o Aleppo: Drinking water (wells, reservoirs, jerry cans, tankers) in the villages of the eastern countryside of Aleppo were tested. Of the 58 tests completed to date, 42 tests showed non-potable results. o Rural Damascus: 61 water points tested for drinking water quality (from IDPs camps, wells, and uncontrolled sources) and among them 29 were found to be not potable.
9) Information and Planning
Joint technical meeting by HIS team and counter partners in MoH (Directorate of Planning and International Cooperation) to discuss the information systems supported by WHO as part of transition from emergency to early recovery context. The following information products were published and distributed: o Report on health facilities in Hajin and its countryside in Deir-ez-Zor governorate until 15 May 2019. o Flash Update report for the recent incident against As-Suqeilbiye public hospital in Hama (26 May 2019). o 4Ws (WHO and Health Sector) snapshots for April 2019. o Summary of WHO key performance indicators snapshot for 1st quarter 2019. o Summary of WHO key performance indicators snapshot for consolidated Jan-Apr 2019. o HeRAMS Summary SARC Health Centres Report Q1 2019. o Two maps for treatment courses and medical procedures delivered to sub-districts higher than 3 of severity scale based on consolidated WHO-4Ws data Jan-Apr 2019. Monitored a weekly update on shift of control, functionality status of public HFs, and control areas for NSAG areas of North West Syria. Provided inputs on reported health facilities in need of further support by Local Health Administration of KSA in Deir-ez-Zor governorate based on HeRAMS. Provided Strategic Framework SF Midyear Reporting review and End Year Arabic English narrative for WHO. Provided List of members (WCO, Ministry of Higher Education, National NGOs) for HeRAMS Evaluation - Phase 2 to HQ. Provided Syrian Case Study - SCORE for health data technical package to strengthening country health to EMRO. Provided 4Ws data for months Jan to Apr 2019 using the ActivityInfo standard template based on HRP indicators 2019 to WoS.
10) National NGO Coordination
Coordination meeting with INGO to finalize planned grant agreement. A field visit conducted by the TPM to partner NGO in Hama # of NGO partners is 22 # of outreach service by medical mobile team/clinic is 62,890
Full list of NGO partners and services they provide on Annex 2.
11) Grant Management
Issued a donor briefing covering January – April 2019 Contributed to the key messages of Dr Rick Brenan for his donor briefing in Amman on May 30 Held a meeting with the Economic and Commercial Counselor at the Chinese Embassy in Damascus to discuss potential partnership in 2019
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12) External Relations and Communications
Participating together with the WR in an official meeting with the Deputy Minister of Health for technical Affairs. The main topics discussed in the meeting were about WHO’s continuous support to the health sector and the joint cooperation between WHO and MoH to provide health care services to all people in need. Preparing and participating together with the WR and the Bambino Gesu hospital team in an official meeting with the Director General of the Pediatric hospital in Damascus. The discussions concentrated on the joint cooperation between the WCO, Bambino Gesu Children Hospital in Rome and the MoHE to strengthen the capacity of medical staff in MoHE hospitals, especially in the children’s department of the Paediatric University Hospital in Damascus and the way forward. Participating together with the WR in the official event conducted on the occasion of the World No Tobacco day 2019 in cooperation with MoH on this occasion the following were conducted: a. A one-day workshop for journalist to commemorate the WNTD 2019 and provide the participants with key advocacy messages under the slogan of Tobacco and Lung Health in cooperation with MOH. b. Production/distribution of some educational materials (posters, brochures and roll up stand) to mark WNTO and create awareness of the deadly effects of smoking on smokers and their companies, especially children. c. Following up with MOI and MOH to get the TV spot on tobacco combating posted on the Syrian TV channels during 31 May till 6 of June, 2019. Preparing Al-Hol SitRep, issue 7: http://applications.emro.who.int/docs/SYR/COPub_SYR_crisis_7_2019_EN.pdf?ua=1 Provided photo documentary on WHO supported capacity building activities covering different intervention areas. Posted several tweets on WHO-Syria Twitter account about WHO interventions and health response: https://twitter.com/WHOSyria
13) Training and capacity building
During the reporting period, 467 participants benefitted from 18 WHO-supported capacity strengthening activities (Annex 2).
IV. WHO Response in Hotspot Areas
The following sections describe the security and health situation, including WHO response in the hotspot areas in Syria. It is subdivided into:
1. Northeast Syria (Al-Hasakeh; Ar-Raqqa, Deir-ez-Zor), and
2. North West (Aleppo, Homs & Latakia)
Northeast Syria (Al-Hasakeh; Ar-Raqqa, Deir-ez-Zor)
1. Security Situation The security situation within the NES within the last two weeks remains unstable and volatile, with high level of terrorist activities reported both in SDF control areas especially in Deir Ezzor governorate and Ar Raqqa city; and GoS held areas. However, many sleeping cells belonging to ISIL and other terrorist groups are active
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in the areas. The SDF is in a difficult phase of stabilization because it has multiple enemies in new liberated areas such as east Euphrates after ending main military operations against ISIL.
Ar-Raqqa:
Ar-Raqqah governorate witnessed in last two weeks few major Attacks Against SDF members as well as civilians using twin VBIED &IED in Ar Raqqa down town, On Saturday 01 June, at least 10 people were killed when separate explosions rocked the Raqqa, an incident which underlines the continued threat of Islamic State sleeper cells in northeastern Syria. A suicide bomber targeted the city's Paradise Square at 10 p.m. local time, close to a checkpoint of the local internal security forces. Some sporadic attacks also were reported unknown predators using in them Grenades and SAF in few neighborhoods of Ar-Raqqah city and its countryside (Moreover, it also claimed an additional IED attack on an SDF vehicle in Karama, located in the countryside of Raqqa.), while perpetrators behind these attacks are mostly unknown. In the same context several Landmines and UXO/ERWs exploded causing Many causalities among civilians’ despite the efforts of demining by operated Organizations in the region.
Deir Ezzor:
In the last statistic the facts refer that GoS controls only 60% of Deir Ezzor territory, and 15% of its oil, While the ICF and its SDF allies control 30% of its territory and 85% of its oil.
SDF Control Area: Americans airplanes launched several air raid against illegal Transports of oil from east to GoS territory west Euphrates.
while ISIL sleeping cells are carrying out many attacks using IEDs, SAF, VBIEDs against SDF positions, East and south of Deir Ezzor governorate and south of Al Hasakah governorate in several Towns including Al Busayrah, Al Suwar, on other hand SDF and ICFs conducted joint combing operation against ISIL sleeper cells, as per Open Press It was noticed that ISIL has de-facto halted attacks on SDF along the eastern bank of the Euphrates over the past few days.
GoS control area: While few Syrian soldiers and an officer were killed after ISIL attacked near Al Meyadin city 40 Km south of Deir Ezzor city on the west bank of Euphrates where ISIL active in Al Badiah pocket (triangle) located between sukhnah town east Homs and T2 to Close of Meyadin district west bank of Euphrates in Ezzor governorate.
Al Hasakah
A tow attacks using IEDs were reported in Al Hasakah governorate, one of them IED went off in Qamishli city patrols targeting SDF patrol and other one in south Al Hasakah city targeting SDF CP.
2. Coordination
Conducted the regular health working group meeting twice in Al-Hol camp, the meetings discussed:
o The last health situations updates.
o The updates of EWARS system of the camp per the phases and the ways forward develop the reporting method.
o The weekly analyzing of mortalities within the camp.
o Finalizing the internal referral pathways and the links between the health facilities and the three newly established field hospitals.
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o Updated the map of health services of the camp.
Participated in the regular coordination meetings of Al-Hol camp.
3. Capacity building
30 health volunteers on the raising the awareness on the food safety and water borne disease prevention and control
Several on Job training on IMCI for medical staff in Al-Hol conducted by WHO expert.
4. Vaccination
2 vaccination teams are working on daily basis in Al-Hol about 13,149 children been vaccinated since 9th of December 2018 tell May 30th 2019. 5. EWARS & CDs
In coordination with AlHasaka – DoH, Leishmania treatment mobile team supported by WHO provided treatment to the camp residences in phase 5. The Early warning system is ongoing effectively within the camp. During the reporting period 11 medical points provided reports for the epidemiologic weeks 21 and 9 health point in 22. During the epidemiological weeks 21 and 22, total consultations were 11,969, the diarrheal cases still high at 1,502 and exceed 10% of all consultations, 101 bloody diarrheas and 2 cases AWD. 1274 ALI cases and 0 case of SARI. 7 measles suspected cases - 6 of them in week 21 No suspected TB cases reported. EWARs focal point collected stool samples from the diarrheal cases and blood samples from measles suspected cases and the results were negative. WASH response: 35 different water sources were tested for microbial contamination in Al-Hasakah water national lab. The results were negative. Leishmaniosis: 38 cases were reported during these 2 weeks reporting period. Health education comping conducted on the food safety and water borne diseases and caring children with diarrhea.
6. Mental health
12 health workers provided PFA and counseling.
Mh-GAP services provided through the functioning medical points in the camp 7. Nutrition and child care
30 children with complicated SAM were admitted in WHO supported Al-Hikma Hospital stabilization center during the period, 22 discharged cured and 1 death cases reported, 26 are still under treatment and needed medical care.
IMCI medicines received and will be distributed immediately after Eid
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Implementation of IMCI in the camp is continuing and supported by WHO expert 8. Pharmacy and Secondary Health care:
Prepared a list of the most urgent needs of medicines, supplies and equipment in Alhol camp and shared with WCO for local procurement. Provided on job training in Alhol camp about Antimicrobial Resistance, targeted doctors and pharmacists who work within the camp to rationalize the use of antimicrobial agents. Continuing preparations to conduct a workshop on Pharmaceutical Supply Chain Management in Alhasaka from 15-17 June. The workshop targets 20 pharmacists and logisticians of National Partners working in NES, 10 of them are involved in Alhol Response. Supported Ar-Raqqa National Hospital with a 5 tons’ medical shipment which covers 40,800 treatments and 650 trauma cases. It included different standard health kits in addition to vital function & cardiac equipment, surgery, lab, and medical gases equipment. Supported a health actor in Alhol camp with NCD kit to cover the need of chronic medications. Delivered a shipment to SARC branch in Alhasaka governorate, contained mainly kits to support their work, especially in Alhol camp, through providing 50,967 treatments and covering 50 trauma cases. Supported Dierzzor Health Authority with 5 IEH kits to be distributed to health facilities eastern the river. Delivered a shipment to the newly established hospital in Suluk town in Tal Abyad district. Consisted of different medical devices and 20,800 treatment of different requested medicines. Procured and dispatched lab reagents in favor of Tal Abyad hospital will cover the need for 6 months. Received 6 items of pediatric medications (Analgesics and Antipyretics, Antibiotics and bronchodilators) which were procured locally, the total amount is 19,300 bottles. Distributed 168 personal protective equipment kits to 10 Hospitals in NES.
9. NGOs coordination in NES
The deployed surgeon team will start operating in the field hospital (phase 4) to provide the technical triage and the post-surgery follow up. Started the returning process into the areas of Raqqa and Aleppo from Al-Hol camp, WHO with the other health actors ensured to provide the health services for the departures within the reception area. Procedures are still in place to ensure the continuity of SHTC and Malnutrition services through Al-Hikmah hospital. The MoU of Al-Hayat hospital is ongoing to support the referral cases from Al-Hol camp and other camps across NES. Conducted field visits to the newly established field hospitals to ensure the available services and the gaps, WHO is coordinating for special meeting for the field hospitals’ operators to discuss the technical issues and to emphasize on the last agreed points in the last HWG-meeting. Kicked of two new static medical points in Al-Hol camp, to support the health services provision in the new established phases (phase 6 & 8). Launched new medical mobile team in Hajin area, the mobile team conceded the first health facility in Hajin area. Continue the discussions regarding the relocation from Al-Twehenah camp to Al-Mahmoudli camp, a health coordination meeting will be in place next week. Conducted 2 field visits to Al-Hikmah hospital in Hassakeh to follow up on the ongoing activities. Planned meeting with the admin assistants and the M&E assistants of the supported health facilities to enhance the quality of the reporting. Page | 10
Conducted 2 on-job trainings in Al-Hol camp, the trainings included: Standards of case definitions / EWARS and the diarrhea management. Antimicrobial resistance. WHO supported mobile team operates in Hajin is facing a high pressure due to the absence of other health facilities, additional potential pressures due to the planned returning process to Hajin after Eid. Coordinated with protection sector to evacuate a MH patient from Al-Hol camp to Ibn Khaldoun hospital in Aleppo, the needed approvals have been obtained.
Detailed operations of NGOs in NES is shown on Annex 8.
North West (Aleppo, Homs & Latakia)
1) Aleppo
Security Situation
Aleppo is still witnessing an increasing of hostilities particularly in the western rural Aleppo moreover, sporadic shelling is reported in several neighborhoods if the city
Coordination
Heath working group meeting (Aleppo sub-national health sector) is conducted in participation of 12 partners (UN agencies, INGOs, and NGOs) in addition to SARC and ICRC. Health sector follows the developed “Preparedness operational plan, north-west Syria”, and Trauma referral and medical evacuation plan is updated. Furthermore: According to the Relief Office (shared by OCHA) , should IDPs/returnees arrive in GoS areas, they will be hosted in the following locations throughout three stages based on the number of people arriving: a) First stage: Tal Eddaman (C1058) Kolet Albuweider (C1116) Brida (C1063); b)Second stage: Amriyeh Blas (C1076); c)Third stage: Banan (C2185). Coordination sub-Education sector meeting in Aleppo HUB to address health care needs for students coming from HTR areas. WHO-supported mobile medical teams will cover the essential health needs for the students in their accommodation sites, in addition to support referral system for any emergency cases. 4 WHO implementing partners (Al-Taalouf , Beer & AL-Ihsan , Ihsan , ASSLS ) were distributed among the 23 accommodation sites and prepared to provide the essential health services Three ongoing MOUs signed with WHO implementing partners (Yadan Biyad Health promotion, AL-Taalouf).
Communicable Diseases
Followed up on 58 identified TB cases in Fafin area (28 – completed treatment, 2 drop outs, 30 - under treatment) Aleppo DoH has started insecticide spreading campaign as a part of vector control of Leishmaniasis supported by WHO. This is targeting Aleppo city and rural of Aleppo and for 88 days
Mental Health WHO supported: a) Ibn Khaldoun psychiatric hospital - 3821 consultations; b) Mental Health directorate – 143 consultations; c) University neurological clinic – 92. mhGAP phase 2 workshop for 5 days, has been conducted for 25 doctors from 7 NGOs that are working in the fields of NWS emergency response areas. 3 group supportive supervision sessions were conducted in 3 days in a row for trained doctors on mhGAP, the sessions covered 25 doctors. Page | 11
3 group supportive supervision sessions were conducted in 3 days in a row for trained psychologists on SMHP, the sessions covered 48 psychologists. MHPSS consultations provided through 9 MMTs and 2 statics points of active NGOs in Northern, Eastern and Southern rural of Aleppo. Meetings with 25 volunteers " educational and PSS workers " Caritas Aleppo " in eastern side of the city in Abu bakr neighborhood, also, the first session of psychological first aid has been conducted, with basic PSS skills.
Operational support & Logistics
700 Fresenius Hemodialysis Complete Sessions are delivered to Aleppo University Hospital, as an immediate response to their urgent request. 2 ANAESTHESIA VENTILATOR are delivered to Aleppo University Hospital of OBGYN 2 shipments that consist of a diversity of medicines are delivered to MoHE hospitals (Cardio surgical, OBGYN Hospitals) 16 tons of Several standard kits (Trauma A, Trauma B, Surgical kit, IEHK kit), are delivered to (SARC, AUH, DoH). In addition to 5 kits of NCD cold chain type have been delivered to SARC.
2) Homs
1. Health situation
Vaccination: Vaccination status for the period 22/5-5/6/2019: Most of the children were vaccinated and have vaccination cards, Total vaccinated children u5 were 76: Including 11 children totally dropout. 3 vaccinations mobile teams from Homs DOH – with WHO support- vaccinating in 5 shelters.
Mental Health:2 MH PSS DOH teams had visited 3 shelters and the returnee families in Industrial Hasya: Basic counselling and psychological first aid provided in individual sessions, identifying needed cases to be referred for Psychiatrist. 2 PSS group sessions, 17 Figure 2: WHO FP Mouna Akhras in Fruglus with Rukban returnee families Individual sessions, 1 case were referred to psychiatrist.
Primary health services: DOH MMT with WHO support, providing health services in the shelters with free medicines
Total N of the medical consultation for the period 22/5 - 5/6 /2019 was 696:( Annex 3)
4 mobile health teams from DOH Homs supported by WHO provided health services (medical consultations and medicines) in northern Homs area. Total N of health services: 1,261 (Annex 4).
3 mobile health teams from DOH Hama supported by WHO provided health services in rural Hama and Figure 3: Internal doctor in North Hama area- Alsawari village Sinjar sub-district in Idleb Governorate. The total Page | 12
number of health services was 1,265 (Annex 5).
NGO activities Albir Hama NGO health project: Provided services from one fixed health point and 2 mobile health teams in Hama city and villages across eastern and northern Hama. Total N of beneficiaries for the period was 2,146 (Annex 5).
Orthodox Association for Helping the Poor health project: Provided health services through 3 fixed health points in Alghasaniya old Homs city, Fairouza village in east Homs, Ayoun Alwadi in Mesyaf Hama district. Total n of beneficiaries was 1222 (Annex 6).
2. Capacity building: Facilitated one training in Homs with 25 participants (Annex 7) under EWARS program. Figure 4: PSS in Northern Hama –Ein Albad village
3) Latakia
Security Update:
UNDSS LSA shared information about notable increase in the back and forth fights northern Latakia, Back and forth fight continued between SAA and NSAGs in Kabani town and its vicinity, SAA attempted to advance towards NSAGs positions, high number of casualties reported among SAA. This operation was supported by intensive SAA artillery shelling and RF airstrikes targeting NSAGs positions. But however, no change was reported in control. 23 May, SAA targeted with artillery shelling NSAGs positions in Jabal AL Turkman axis. NSAG claimed in a new statement that its forces launched a surprise attack on SAA positions in Rasho Hill of Jabal Al-Akrad, North-east rural Latakia. The claimed that 10 SAA members were either killed or injured in during the attack. SAA started an operation to advance into Kbani axis in Jabal Al Akrad area, northeast countryside of Latakia governorate, according media sources several casualties were reported among SAA members, this attempt was accompanied by heavy artillery shelling and intensive air strikes, Casualties: 8xKIA(8xSAA). Russian air defences shoot down multiple projectiles and drones targeted Basil al-Assad International Airport, one of the projectiles landed in Al Hwaiz town and multiple projectiles landed in Acharashir town resulted in one fatality and resulted 1xKIA(1xSAA).
Coordination:
Conducted a conjoined meeting with Lattakia DOH and Heart giving NGOs, to discuss about the NGO new medical project and health activities in Lattakia, and the possibility to deploy a mobile team to cover some parts of rural Lattakia under WHO support. Attended a coordination meeting at Lattakia DOH to discuss about DOH new: “Health education “project that will be implemented in all PHC centres in presense of several NGOs and agencies that will be involved in this project (more details will be provided once finalized with DOH)
EWARS:
1 AJS case received at Jbleh national hospital in Lattakia (water and food sources were tested) 1 suspected SM case reported at 8th project center in Lattakia (samples sent to lab) 1979 ILI cases in all reporting centers
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349 AD cases in Lattakia 14 SARI cases 7 LSH and BRU cases. Received an urgent request from Lattakia DOH to provide them with Aqua tabs 1000
MH:
Received the below psychiatric medicines:
Amitriptyline, 25 mg tablets in blisters by Medopharma/India 500,000 tabs
Fluoxetine, 20 mg tablets in blisters by Medopharma/India 600,000 tabs
Haloperidol, 5 mg tablets in blisters by Medopharma/India 150,000 tabs
Risperidone, 2 mg tablets in blisters by Medopharma/India 300,000 tabs
Valproic acid, 200mg/ 5ml syrup in 300 ml bottle by Medopharma/India 15,000 bottles
Valproic acid, 500 mg e.c tablets in blisters by Medopharma/India 600,000 tabs
IV. Key Operational Challenges
Coordination 1. Access to shelters and areas of return of Rukban residents 2. Vaccination in Ein Al Arab/Kobane in Aleppo governorate 3. Scaled up health response inside eastern Ghouta 4. Southern Syria (Dara’a and Quneitra – the least served areas) 5. Need for scale up in various parts of Deir-ez-Zor 6. Key Ar Raqqa locations (Tabqa and Ar Raqqa towns) remain to be out of prioritized response and advocacy. 7. There are still remaining “neglected” areas for response: Tal Hamis in Hassakeh, in Homs and Hama, rural Lattakia 8. Need for a wider operational presence of technical actors to address the needs of people with disability
Operational support and Logistics 9. Delay in receiving facilitation letters for offshore procurements from MOH. 10. Government insistence that all emergency supplies be first delivered to Central warehouse in Damascus before redistribution to the districts/governorates. 11. High cost required to air freight more than 200 tons of WHO health supplies currently reserved in MOH warehouse in Damascus, to Qamishly; and the urgency of the needed supplies.
V. Key Health Actions for the Next 2 Weeks
Non-Communicable Diseases & PHC Prepare for Thalassemia World Day celebration is in process under patronage of Minister of Health & WHO sponsorship, Thursday 27 June 2019. Carry out mission to Swayda to follow up diabetes and Thalassemia programs and Salkhad hospital (scheduled mission on 10 June respectively).
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KEY CONTACTS:
Representative Elizabeth HOFF [email protected] Health Cluster Coordinator Azret Stanislavovich KALMYKOV [email protected] Emergency Team Lead Isiaka Stevens ALO [email protected] Communications Officer Yahya BOUZO [email protected]
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V. Annexes
Annex 1 No of health services provided by NGOs,
NGO Health Facility Location # of # of # of SHC # of MHPSS # of outpatient patients services services Trauma an consultation received provided d s PHC assistance Rehabilitati services with on Services medicines East rural of Aleppo 1 Al-Ber & Mobile team 1 Hazaza , Zubayda , Tal 652 410 0 369 0 AL-Ihsan Ayub , Akola , Southern Rasm Elharmal , Little Hmeimeh 2 Al-Ber & Mobile team 2 Um Arkileh , Halabiyeh , 789 355 0 415 0 AL-Ihsan Dikwaneh , Tal Sabeen , Kaskis , Rasm Elkhabbaz 3 ASLSS Mobile team 3 Babiri - Lower - Upper 609 465 0 128 0 Babiri , Maskanieh , Kayariyieh , Mufliseh , Rasm Elabed 4 ASLSS Mobile team 4 Mahdum , Abu 1395 880 12 185 0 Maqbara , Rasm Elkhamis , Um Adae Ajami , Abu Hanaya , Atireh , Mufliseh 3445 2110 12 1097 0 AFRIN 1 Al-Ihsan Mobile Team 5 Kafr Naya - Abin , Kafen 436 200 0 171 0 , Burj AL-Kaas , Hardening 2 Al-Ihsan Mobile Team 6 Tenib - Znarita , 200 90 0 118 0 Mayasa , Zyara , AL- Zahraa 3 SCC Static Point 1 Al-Asser Camp 795 680 195 25 4 YBY Static Point 2 Fafin 415 396 6 65 0 5 YBY Mobile team 7 Deer Jmal , Babnis , 362 521 5 169 0 Qaramel ,Wahshieh , Al-Alousheh 2208 1887 11 718 25 South Rural 1 Al- Mobile Team 8 Hadher , Abtin , Wdeihi 832 744 0 82 0 Taalouf , Haddadin 2 Al- Mobile Team 9 Blaas , Big Oweinat , 785 717 0 95 0 Taalouf Tall Ed-dama 1617 1461 0 177 0
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Annex 2: WHO supported capacity strengthening (supported 18 activities for 467 participants)
Date No of Detailed title Venue Program participants Central Expansion on nutrition surveillance clinks + Infant 26-30/05/2019 25 administration/ R. Nutrition and Young Child Feeding (IYCF) counselling Damascus 26-30/05/2019 33 Economic feasible in health domain workshop MoH/ Damascus HIS Improve utilizing and investing the collecting Strategic study 26-28/05/2019 30 HIS HeRAMS data using office program center/ Damascus WHO old office/ 26-28/05/2019 30 International classification of Disease ICD10 HIS Damascus Ibn Nafice 26-28/05/2019 25 Rehabilitation of dry necks Hospital/ Disability Damascus 28-29/05/2019 28 Communication and Psychosocial support UN hub/ Aleppo NGOs Early warning program for reporting officials in the Al Sirian hall/ Al 28-30/05/2019 25 EWARS province of Hassakeh at the district level Hassakeh Early warning for reporting officials in Aleppo 28-30/05/2019 25 PHC/ Aleppo EWARS governorate National disease surveillance officers on timely 28-30/05/2019 25 DoH/Aleppo EWARS outbreak investigation and response WHO old office/ 29-31/05/2019 30 International classification of Disease ICD10 HIS Damascus Rasheed Mohi School Mental Health Program follow up for MoE 30/05/2019 25 Edden School/ MH from Qunaitera Damascus Early warning for reporting officials in Darra 01-03/06/2019 25 PHC/ Darra EWARS governorate Expansion on training regarding nutrition Central 01-05/06/2019 25 surveillance clinics + Infant and Young Child Feeding administration/ Nutrition (IYCF) counselling Damascus Ibn Nafice 02-04/06/2019 25 International Standards of Prosthetics Hospital/ Disability Damascus Child 02/06/2019 15 Basic neonatal care national guide discussion PHC/ Damascus Health Care 05-06/05/2019 26 Communication and Psychosocial support DoH/ Hama NGOs Child AL ASSAD medical 08-17/06/2019 25 Integrated Management of Childhood Illness (IMCI) Health center/ Hama Care Child National hospital/ 08-17/06/2019 25 Integrated Management of Childhood Illness (IMCI) Health Lattakia Care
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Annex 3: List of current WHO agreement with national NGOs (by NGO)
# of ongoing # of MOUs in Governorate Location of current of ongoing MOUs MOUs preparation
1 2 Damascus Al Zahera
Rural Qutaifeh - Douma - Harasta - Al Tal - Yalda 3 5 Damascus
Lattakia city- Al Baset - Saqubeen- Qnanas and 1 1 Lattakia Al Ramel Al Janoubi Dara'a Dara'a , Al Laja'at, Al Yarmouk 1 1 Qunaitera Qunaitera 1
Old Homs, Al Ghassani and Ayoun Al Wadi 1 5 Homs Hama city, Souran, Moardes ,Taybet alemam, Alsawa'aek ,Alhashimyaa , ean albad, 1 Jarjesah ,tal kartal,tellef Hama ,herbenafsah,maardeften and alzarah.
Agior , Deir Hafer , Rural villages of Aleppo city ((Babiri -Upper Babiri , Babiri -Lower Babiri , Rasm Elbokhar , Kayariyieh , Big Aleppo 2 3 Habbuba , Little Habobieh , Southern Rasm Elharmal ). Hananou , AL-Martini , Tal Refaat and surrounding villages
NES Deir- Ez-zor - Ar Raqqa city - Al Hasakeh. 6
Total 16 24
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Annex 4: Provision of Medical Consultations
# of beneficiaries from 22/5-5/6 2019 Area Provision of medical consultations Medicines
32 32 1 Dier balba shelter 2 Al kosour shelter 22 22 3 Al bayada shelter 13 13
Total 76 76
Annex 5: Number of beneficiaries for the period 22/5- 4/6 /2019 in Northern Homs district
Provision of medical Area medicines consultations 369 369 3 locations in Alholeh
255 255
5 locations in Rastan
637 637 5 locations in Talbiseh
Total 1261 1261
Annex 6: Health Services Provision
Provision of medical PSS PSS Area consultations with Individual group sessions free medicines sessions Rural Hama and Sinjar sub district (Idleb Governorate)
10 locations in Sinjar sub district – 358 12 8
Idleb Governorate
10 locations in Hamrat district –east 364 19 4 Hama Governorate 10 locations in Hur Benafseh district- 543 11 14 west south Hama Governorate Total 1,265 42 26 Hama city and villages across eastern and northern Hama Eastern-northern rural Hama villages 933 35 182 Al- Hamraa district (20 locations)
Northern Hama (20 locations) 702 36 216 Health center Abi Alfidaa 511 23 122 Total 2146 94 520
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Annex 7: Health Service provision in Alghasaniya old Homs city, Fairouza village in East Homs, & Ayoun Alwadi in Mesyaf Hama district.
# of # of outpatient Commune/Villa SHC Hearing Medical District consultatio ge/Town service aids glasses ns PHC s services Alghassani Homs city 833 45 4 4 Fairouza. Eastern Homs 250 20 0 2 Ayoun Alwadi. Western Homs 139 13 1 3 Total: 1222 78 5 9
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Annex 8: NGO Coordination in North East Syria
PHC services SHC services Trauma services # of # Referral # of First # of referrals of aids and # of Mental # of # of Governorate Area beneficiaries for treatment emergency Health outpatient trauma reached with secondary for children services in Psychosocial consultations referrals the medicines health with SAM the camps Services services Hassakeh city 0 0 815 665 25 33 0 center Al-Mabrouka 0 199 672 672 28 17 214 camp 0 0 Ras Al-Ain city 409 409 24 0 0
Al-Areesha 2 34 853 635 0 3 118 camp Al-Hol camp / 38 310 Al-Hassakeh 785 785 2 30 203 Phase 1 Al-Hol camp / 0 0 247 830 830 0 467 Annex Al-Hol camp / 0 0 242 572 572 0 215 Phase 6 Al-Hol camp/ 0 0 29 351 310 0 66 phase 7 Al-Hol camp/ 0 0 0 39 556 525 134 phase 8 Al-Raqqa city 347 264 0 0 0 0 480 Al-Jurneay + 0 0 0 33 583 436 137 Al-Mansoura Al-Tabqa 608 494 0 0 0 25 97 Al-Raqqa Ain Issa camp 1298 1270 0 0 0 172 194 Al-Twehenah 0 0 0 26 889 889 81 camp Al-Karama 673 654 0 0 0 60 88 Al-Kasrat 658 658 0 0 0 26 80 Aleppo Manbij 885 869 0 0 0 32 107 Hajin 681 449 0 0 0 0 123 Al-Busayra 565 464 0 0 0 12 129 Al-Jerzi 819 522 0 0 0 0 128 Dier Ezzour Abu Khashab 0 0 0 52 662 662 279 camp Dier Ezzour 0 0 0 0 655 464 0 city Sub-total: 15166 13498 79 40 83 1538 3340
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