WHO in collaboration with MOH-Syria
Availability of the Health Resources and Services in Public Hospitals in Syria Using HeRAMS
4th Quarter 2013
Table of Contents
Executive summary ...... 3 1. Functionality and Infrastructure Patterns of the Public Hospitals ...... 6 1.1 Functionality of the Public Hospitals ...... 6 1.2 Special cases of functioning hospitals ...... 9 2. Infrastructure Patterns of the Public Hospitals ...... 10 2.1 Analysis of the condition of the hospitals’ buildings ...... 10 2.2 Analysis of the inpatient Capacity ...... 11 2.3 Availability of Ambulances ...... 11 3. Availability of Human Resources for Health ...... 12 4. Availability of Health Services at Public Hospitals ...... 14 5. Availability of Equipment ...... 15 6. Recommendations ...... 17 7. Annex -: Maps ...... 18
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List of Figures:
Figure 1: Comparison of number of reported hospitals during 3rd and 4th Quarter 2013, by governorate 6 Figure 2: Reporting completeness by End of 2013 6 Figure 3: Functionality of hospitals per governorate 6 Figure 4: Number of population per functioning public hospital by governorate 8 Figure 5: Number of reported functioning hospitals by quarter [3rd&4th Q 2013] and governorate 8 Figure 6: Level of Damage to Hospitals 10 Figure 7: Level of damage of public hospitals per governorate 10 Figure 8: The number of emergency beds vs., total number of beds in functional hospitals, by governorate 11 Figure 9: Number of emergency cases per single bed; 4th Quarter 2013 11 Figure 10: Number and proportion of functioning ambulances 11 Figure 11: Proportion of Health Staff 12 Figure 12: Proportion of Population by a medical doctors (Emergency Physicians +Specialists +Resident 12 doctors) by governorate Figure 13: Public Functioning Hospitals without Specialists / Emergency Physicians 12 Figure 14: Availability of Core Services in the Functioning Public Hospitals 14 Figure 15: Average percentage of the Availability of Essential and Specialized Equipment in the functioning 15 hospitals overall governorates
List of Maps:
Map 1: Distribution and Functionality of Public Hospitals 7 Map 2: Functionality of MoH Public Hospitals in relation to population in need for humanitarian assistance 7 Map 3: Average population coverage per functioning hospitals by governorate 8 Map 4: Distribution and level of Damage of the Hospitals’ buildings 10 Map 5: Proportion of population by a medical doctor (Emergency Physicians +Specialists +Resident doctors) 13 by governorate Map-6: Comparison of the hospitals’ functionality; 3rd to 4th Quarter 2013 18 Map-7: Comparison of the hospitals’ level of damage; 3rd to 4th Quarter 2013 19
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Executive summary
HeRAMS (Health Resources & services Availability Mapping System) is a Standardized Approach supported by a software-based platform that aims at strengthening the collection, collation and analysis of information on the availability of health resources and services in Humanitarian Emergencies.
HeRAMS was adapted to Syria in early 2013, after many consultative meetings with the Syrian ministry of Health (MoH) and health sector partners to customize the tool according to the priority identified areas of the health sector. The key information that is assessed through HeRAMS includes the availability of the health services, accessibility, functionality status, health infrastructure and human resources at primary and secondary care level.
According to the MoH - Planning and International Cooperation Director, Dr Talal Bakflouni; “the ongoing crisis in Syria represents a real challenge to all those concerned of providing health services to the people. With the situation changing very rapidly, there was a pressing need for a versatile tool that could identify real time needs. HeRAMS was suggested by WHO based on the experience with other crises. The implementation results were impressive. HeRAMS allowed us in the MoH to make a difference in HIS development and implementation for better emergency response, as well as improved planning and allocation of resources”.
Public hospitals in Syria exist under two authorities; the Ministry of Health (the majority; 91 hospitals) and the Ministry of Higher Education (14 hospitals). This report provides descriptive analysis for the public MoH hospitals that reported to HeRAMS during the 4th quarter of 2013. HeRAMS is planned to expand to include the Ministry of Higher Education hospitals.
Analysis is generally conducted at governorate level with some highlights on special cases of hospitals. Analysis covers the distribution and functionality of the public hospitals, patterns of infrastructure, availability of health Human Resources, health services, and equipment. Analysis is also conducted in relation to the population1 (i.e., average number of people per functioning public hospital, and average number of people per medical doctor at governorate level). Detailed analysis of provision of services at governorate level is also provided.
Process and Methodology A HeRAMS platform has been established to provide systematic approach for data collection and information production, on periodical bases.
As part of the MoH endorsement of the HeRAMS, a team of MoH health staff from all governorates (2 to 4 persons per governorate) was formulated and officially approved by the Health Minister as emergency cell for HeRAMS reporting. In 2013, four HeRAMS workshops were conducted in Damascus, which resulted in strengthened health information capacity and improved completeness and timeliness of reporting.
New data collection mechanisms (i.e., Tele-reporting/Tele-assessment) were introduced to address the shortage of timely and relevant information. The flow of information and reporting channels have been streamlined at various levels of reporting from health facility level to health directorate and central level. Data has been verified rigorously with data collectors and cross-checked randomly with other sources at governorate level. As reported by the data collectors, the main challenges faced during data collection and reporting were accessibility and security, as well as continuous power cuts and disconnect of the network coverage in many governorates.
In the 4th Quarter 2013, reporting completeness improved. A total of 78% (71 out of 91) MoH public hospitals from 12 governorates reported to the HeRAMS, compared to 70% (a total 64 out of 91 public hospitals) from 11 governorates, in the previous quarter.
1 Source of population data is OCHA Syria HeRAMS Public Hospitals Report -Syria 4th Quarter 2013 Page 3 of 18
Functionality of the public hospitals According to MoH, hospitals are considered functioning if open and providing services. Out of 91 public hospitals; 59 (65%) are reported functioning and accessible, 12 (13%) are not functioning, and 20 (22%) hospitals were not able to report due to security reasons and accessibility challenges. The non-reporting hospitals (20) are mostly from 4 governorates, (i.e., all hospitals in Deir-ez-Zor, all hospitals in Ar-Raqqa, 8 hospitals in Homs, and one in Al-Hasakeh).
In Homs governorate, although 4 out of 12 hospitals are reported as functioning, none of the functioning hospitals are in Homs city.
The average number of people per functioning hospital at the governorate level has been explored, and compared to the previous quarter. Aleppo governorate still registers the highest average number of people per functioning public hospital [1: 608,500], followed by Rural Damascus [1:567,200], Idleb [1:500,333], and then Homs [1:450,750] people.
Infrastructure of the public hospitals Level of Damage to hospitals buildings have been measured in terms of whether they are fully damaged (where the building is completely destroyed), partially damaged (where part of the building is damaged), or intact (building with no damage). Analysis of the level of damage provides good indication on the potential costs for reconstruction. Out of 91 public hospitals, 5 (5%) hospitals are reported as fully damaged, 23% (21) are partially damaged, and 49% (45) are intact, while 22% (20) were not able to report.
The fully damaged hospitals are disaggregated as follow; three hospitals in Dar’a (Dar’a national hospital and Dar Eltawleed in Dar’a city, Jasim hospital in Jasim district), and two hospitals in Aleppo (Zahi Azraq hospital in Elhalak district, and E’zaz national hospital in E’zaz city).
The inpatient capacity has been analyzed in terms of the total number of beds within the functioning MoH hospitals (59) and how many are assigned as emergency beds. By analyzing the number of emergency beds available to emergency cases at governorate level, the lowest number of beds available to emergency cases is reported in Damascus; one emergency bed is available for every 844 emergency cases (Damascus hospitals currently serve people from Rural Damascus, Dar’a in addition to Damascus). In Homs, one emergency bed is available for every 462 emergency cases.
Ambulances are available in 83% of the 59 functioning hospitals. In Rural Damascus, only 36% of the ambulances are functioning, while in Dar’a there are no available ambulances in public hospitals.
Human Resources The proportions of different staff categories in public hospitals has been analyzed; among the 59 functioning hospitals, emergency physicians represent the lowest proportion of staff (0.2%) compared to other categories (i.e., specialists (11%), resident doctors (10%), midwives (36%), pharmacists (0.5%), and technicians (21%).
The average number of people per medical doctor within functioning hospitals is analyzed at governorate level. The highest number appears in Homs, followed by Dar’a and Rural Damascus.
The increasing numbers of affected hospitals and staffing shortages have led to challenges in the provision of, and accessibility to, quality care services. In Dar’a, six out of nine functioning hospitals are operating without emergency physicians, and two hospitals have no specialist staff. A total of 31 functioning hospitals across reported governorates are operating without emergency physicians.
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Health Services The adequacy and equity of service provision in Public Hospitals in Syria has been affected significantly by the current crisis. Availability of core healthcare services is monitored through HeRAMS at hospital level, considering a standard checklist of health services.
Availability of core services is assessed in terms of the percentage of hospitals that provide health services, out of a total of 59 functioning public hospitals.
The availability of general and clinical services (i.e., outpatient, inpatient, emergency, laboratory, blood bank and imaging services) has varied between functioning hospitals; for instance, outpatient services are available in 92% of the functioning hospitals. Although some hospitals are fully damaged, some health staff continue to operate from other functioning hospitals in the affected areas.
Limited availability of services to manage cases of severe acute malnutrition in public hospitals necessitates the establishment of TFCs (Therapeutic Feeding Centres) across Syria.
Availability of Essential and specialized Equipment The availability and functionality of different types of essential and specialized equipment and supplies have been evaluated at the hospital level, based on a standard checklist. Based on a standardized list of essential equipment, the average essential equipment availability within 59 functioning public hospitals is above 80%.
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1. Functionality and Infrastructure Patterns of the Public Hospitals
The analysis of available health resources and services at public hospitals is focused on 12 (out of 14) reporting governorates during the 4th Quarter of 2013. Completeness of reporting during the 4th Quarter of 2013 has improved, with 78% (a total of 71 out of 91) hospitals reporting to the system compared to 70% (a total 64 out of 91 public hospitals) in the previous quarter. Analysis depicts newly reported hospitals in Idleb, Homs and Lattakia governorates [Figure 1]. The types of MoH public reporting hospitals are either General or Specialized hospital.
The following sub-sections provide analysis on the functionality status of the hospitals and average number of people covered by functioning hospitals at governorate level, condition of the hospital buildings and inpatient capacity of the hospitals.
Figure 1: Trend of hospitals reporting through HeRAMS in the 3rd and 4th Quarter 2013, by governorate 12 11 11 11 12 10 10 10 10 9 9 9 8 8 8 8 6 6 6 6 6 6 6 6 6 5 5 4 4 4 4 4 4 2 2 2 2 2 1 1 1 0 0 Aleppo Rural Dar'a Damascus Hama Lattakia Tartous Al-Hasakeh Homs Idleb As-Sweida Quneitra Damascus Total No. of Hospitals 3rd-Q: No. of reported hospital 4th-Q: No. of reported hospital 1.1 Functionality of the Public Hospitals
Functionality of the public hospitals has been defined and assessed Figure 2: Reporting completeness at two levels; by End of 2013 Functioning: the hospital is open and provides healthcare Not services; either with full capacity or partial capacity (i.e., consider Reported staffing, equipment, or infrastructure). , 20, 22% Not functioning: hospital is out of service (either, fully damaged, inaccessible, or no staff)
Out of 91 public hospitals; 59 (65%) are reported as functioning and Not accessible, 12 (13%) are not functioning, while 20 (22%) hospitals Functioni Functioni were not able to report due to security reasons and accessibility ng, 12, ng, 59, 13% 65% challenges [Figure 2]. In Homs governorate, although 4 out of 12 hospitals are reported as functioning, none of the functioning hospitals are in Homs city. The non-reporting hospitals (20) are mostly from 4 governorates, (i.e., all hospitals of Deir-ez-Zor, Ar-Raqqa, and 8 of Homs hospitals, and one in Al-Hasakeh, [Figure 3]. Figure 3: Functionality of hospitals by governorate
Quneitra 1 As-Sweida 2 Tartous 6 Lattakia 6 Damascus 8 Hama 5 1 Functioning Dar'a 7 2 Not Functioning Idleb 3 1 Not Reported Aleppo 8 3 Rural Damascus 5 5 Al-Hasakeh 4 1 Homs 4 8 Ar-Raqqa 4 Deir-ez-Zor 7 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
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The following maps present the distribution of public hospitals, by functionality (Map-1), as well as in relation to the population in need for humanitarian assistance (source of population data is OCHA).
Map 1: Distribution and Functionality of Public Hospitals
Map 2: Functionality of MoH Public Hospitals in relation to population in need for humanitarian assistance
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By looking into the coverage of functioning hospitals by population2, presently there is almost one public hospital for every 325,000 people. Compared to the previous quarter, Aleppo governorate still registers the highest average number of people per functioning public hospital [1: 608,500], followed by Rural Damascus [1:567,200], Idleb [1:500,333], and then Homs [1:450,750] people; [Figure 4] and [Map-3].
Figure 4: Number of population per functioning public hospital by governorate Number of Population per Functioning Public Hospital 800,000 608,500 567,200 600,000 500,333 450,750 378,000 400,000 325,600 219,250 185,000 168,000 146,714 132,833 200,000 90,000
0 Aleppo Rural Idleb Homs Al-Hasakeh Hama Damascus As-Sweida Lattakia Dar'a Tartous Quneitra Damascus
In comparison to the 3rd Quarter 2013, the number of hospitals reported as functioning has improved due to an overall improvement in reporting (i.e., Idleb, Homs, and Lattakia) as well as improvements in accessibility (i.e., in Aleppo) [Figure 5]. Figure 5: Number of reported functioning hospitals by quarter [3rd&4th Q 2013] and governorate 3rd-Q Functioning 4th-Q Functioning 9 8 8 8 8 7 7 6 6 6 6 5 5 5 5 5 5 4 4 4 4 4 3 3 3 2 2 2 2 1 1 1 0 0 Aleppo Dar'a Damascus Tartous Lattakia Rural Hama Al-Hasakeh Homs Idleb As-Sweida Quneitra Damascus Map 3: Average population coverage per functioning hospitals by governorate
2 Source of population data is OCHA Syria HeRAMS Public Hospitals Report -Syria 4th Quarter 2013 Page 8 of 18
1.2 Special cases of functioning hospitals
Although the total functioning hospitals is 59; not all are easily accessible to the public, and in certain cases, buildings are fully damaged but the staff is operating from different hospital. The table below provides more details on those cases:
Province District Hospital Name Status
Dar’a Elsanameen Elsanameen Elsanameen hospital in Elsanameen district in Dar’a, functioning only for military people; not accessible for civilians Dar’a Dar’a Dar’a National The hospital is fully damaged but the staff is operating from Elshifa private Hospital hospital in Dar’a city. Hard to reach for security reasons Dar’a Dar’a Dar Eltawleed The hospital is fully damaged but the staff is operating from Elshifa private hospital in Dar’a city, Hard to reach for security reasons Homs El-qariatain Elshaheed Basil The hospital is partially damaged and serves only the population living Al assad within the village; not accessible for surrounding villages that used to be served before (more than 60% of catchment population) Aleppo Elduairya Ibn Khaldoun The hospital is partially damaged but the staff is operating from the Leishmaniasis centre in Aleppo. Hard to reach for security reasons Aleppo Elhalak Zahi Azraq The hospital is fully damaged but the staff is operating from Elrazi public hospital in Aleppo. Elhalak district is not accessible for security reasons
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2. Infrastructure Patterns of the Public Hospitals The following sub-sections portray the infrastructure patterns of the public hospitals, in terms of level of damage to the hospitals’ buildings, inpatient capacity, and available number of ambulances at governorate level. 2.1 Analysis of the condition of the hospitals’ buildings
The level of damage to hospital buildings has been measured in terms of either fully damaged (where the building is completely destroyed), partially damaged (where part of the building is damaged), or Intact (building has no damage). Analysis of the level of damage provides good indication on the potential costs for reconstruction.
Out of 91 public hospitals, 5 hospitals are reported as fully Figure 6: Level of Damage to Hospitals damaged, 23% (21) are partially damaged, and 49% (45) are Fully damaged, intact, while 22% (20) were not able to report [Figure 6]. No eport, 5, 6% 20, 22% Partially The fully damaged hospitals are disaggregated as follow: damaged, Three in Dar’a: Dar’a national hospital and Dar Eltawleed in 21, 23% Dar’a city, Jasim hospital in Jasim district. Two in Aleppo; Zahi Azraq hospital in Elhalak district, and E’zaz national hospital in E’zaz city Intact, 45, 49% Level of damage to the hospitals’ buildings by governorate has been assessed in [Figure7] and [Map 4].
Figure 7: Level of damage of public hospitals per governorate Quneitra 1 As-Sweida 2 Tartous 6 Lattakia Damascus 1 7 Idleb 1 3 Fully damaged Hama 2 4 Partially damaged Rural Damascus 5 5 Intact Aleppo 2 6 3 No eport Dar'a 3 3 3 Al-Hasakeh 1 3 1 Homs 2 2 8 Ar-Raqqa 4 Deir-ez-Zor 7 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Map 4: Level of Damage of the Hospitals’ buildings, by governorate
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2.2 Analysis of the inpatient Capacity
The inpatient capacity has been analyzed in terms of the total number of beds within the functioning MOH hospitals (59) and the proportion assigned as emergency beds3. The proportion of the number of beds assigned for emergency cases by governorate is illustrated below [Figure 8]. Figure 8: The number of emergency beds vs., total number of beds in functional hospitals, by governorate
Actual No. of Beds Emergency No. of Beds
1187 1002 1056 896 768 850 555 430 446 284 189 101 186 112 133 32 35 77 50 15 41 35 36 7
Damascus Rural Aleppo Idleb Lattakia Tartous Homs Hama Al-Hasakeh Dar'a As-Sweida Quneitra Damascus Analysis of emergency cases per single emergency bed by governorate shows that the highest number is reported in Damascus; one emergency bed is available for every 844 emergency cases, followed by 476 in Homs and 462 in Hama governorate. At present, Damascus hospitals are serving patients from other governorates, including Rural Damascus and Dar’a [Figure 9]. Figure 9: Number of emergency cases per single bed; 4th Quarter 2013 Proportion of emergency beds to emergency cases
Damascus 844 Homs 476 Hama 462 As-Sweida 340 Quneitra 337 Al-Hasakeh 241 Idleb 208 Lattakia 204 Rural Damascus 167 Aleppo 124 Dar'a 112 Tartous 73 0 100 200 300 400 500 600 700 800 900 1,000
It should be noted that other inpatient departments in the hospitals could be occupied by emergency cases in mass casualty or trauma events; however the analysis above has been carried out for the number of beds assigned exclusively for emergency cases.
2.3 Availability of Ambulances The availability of ambulances has been assessed at hospital level in terms of the total available number of ambulances and how many of them are functioning. Ambulances are available in 83% of the 59 functioning hospitals. The disaggregation of number and proportion of functioning ambulances is presented in [Figure 10]. In Rural Damascus, only 36% of the ambulances are functioning, while in Dar’a there are no available ambulances in public hospitals. Figure 10: Number and proportion of functioning ambulances Functioning Not-functioning 100% 1 2 1 9 50% 8 7 3 1 11 11 1 5 0% Damascus Rural Damascus Aleppo Idleb Lattakia Homs Hama As-Sweida
3 The beds assigned for emergency is part of the total number of beds in the hospital HeRAMS Public Hospitals Report -Syria 4th Quarter 2013 Page 11 of 18
3. Availability of Human Resources for Health
Overall Health Staff patterns show the distribution of staff per category based on the national health system set-up of Syria. The proportion between different staff categories in public hospitals has been analyzed; among the 59 functional hospitals, emergency Figure 11: Proportion of Health Staff physicians represent the lowest proportion of staff (0.2%) Emergency Physician compared to other categories (i.e., specialists represent 11%, Specialist 0.2% 11% resident doctors (10%), midwives (36%), pharmacists (0.5%), Others and technicians (21%); [Figure 11]. 22% Resident Doctor A detailed analysis of human resources trends in public hospitals 10% could lead to a better understanding of the current situation Pharmacists 0.5% and an identification of key gaps Technicians 21% The average number of people per medical doctor (incl. Nurses & midwives Emergency physicians + Specialists + Resident doctors) within 36% functioning hospitals is analyzed at governorate level.
The highest population to every medical doctor appears in Homs, followed by Dar’a and Rural Damascus [Figure 12] and [Map-4].
Figure 12: Proportion of Population by a medical doctor (Emergency Physicians +Specialists +Resident doctors) by governorate Population/Medical Doctors
25,000 21,464 20,000
15,000 10,480 9,298 10,000 7,984 6,040 5,040 5,000 2,103 1,336 1,111 1,077 718 441 0 Homs Dar'a Rural Idleb Aleppo Al-Hasakeh Hama As-Sweida Lattakia Damascus Tartous Quneitra Damascus
Estimated population figures4 by governorate are presented below: Governorate Rural Al- As- Homs Dar'a Idleb Aleppo Hama Lattakia Damascus Tartous Quneitra Damascus Hasakeh Sweida Total 1,803,000 1,027,000 2,836,000 1,501,000 4,868,000 1,512,000 1,628,000 370,000 1,008,000 1,754,000 797,000 90,000 population
The increasing number of affected hospitals and the staffing shortages suffered by them has led to challenges in the provision of, and accessibility to, quality care services, especially for populations in areas with access and security challenges. In Dar’a, six out of nine functioning hospitals are operating without emergency physicians. Two of these six have also reported no specialists. A total of 31 functioning hospitals across reported governorates are operating without emergency physicians; distribution of functioning hospitals without Specialist or Emergency Physician is presented in [Figure 13].
Figure 13: Public Functioning Hospitals without Specialists / Emergency Physicians No. of hospitals without Specialists No. of hospitals without Emergency Physicians
7 6 5 6 6 4 5 3 2 3 3 3 3 1 2 2 1 1 0 Dar'a Aleppo Damascus Rural Idleb Lattakia Al-Hasakeh Tartous Homs Hama Damascus
4 Source is OCHA – Syria, 2013 HeRAMS Public Hospitals Report -Syria 4th Quarter 2013 Page 12 of 18
Map 5: Proportion of population by a medical doctor (Emergency Physicians +Specialists +Resident doctors) by governorate
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4. Availability of Health Services at Public Hospitals
The adequacy and equity of provision of services in the Public Hospitals in Syria has been affected significantly by the current crisis. Provision of core healthcare services is monitored through HeRAMS at hospital level, considering a standard list of health services: i. General Clinical Services ii. Surgical and Trauma care iii. Child Health iv. Nutrition v. Maternal & Newborn Health vi. Non-communicable Diseases vii. Mental Health viii. Health care waste management
Availability of core services is assessed in terms of percentage of the hospitals provide the service, out of a total of 59 functional public hospitals [Figure 14], while utilization of the services is assessed in terms of number of cases seen in the functioning 59 hospitals5 during December 2013.
Figure 14: Availability of Core Services in the Functioning Public Hospitals
Outpatient services 92% Emergency services 89% Laboratory services 88% Inpatients services 88% Imaging service 88% ICU services 85% Elective surgery 84% Mass casualty management 83% Emergency surgery 79% Cardiovascular services 79% End Stage Kidney Disease (ESKD) treatment 78% (CEmOC) Comprehensive Emergency Obstetric Care 74% Solid waste management 71% Blood bank service 67% Management of children diseases 65% Cancer treatment services 53% Management of severe acute malnutrition with complications 30% Outpatient psychiatric care 29% Acute psychiatric inpatient unit 24%
0% 20% 40% 60% 80% 100%
The availability of the general and clinical services (i.e., outpatient, inpatient, emergency, laboratory, blood bank and imaging services) varies between the functioning hospitals, considering the special cases of hospitals’ functionality mentioned before (please refer to Section 1.2); for instance the outpatient services are available in 92% of the functioning hospitals. It should be noted that although some hospitals are fully damaged, some health staff continue to operate from other functioning hospitals in the affected areas.
Availability of specialized healthcare services is limited in public hospitals; for example, management of severe acute malnutrition is only available in 30% of in public hospitals
5 The disaggregated number of functioning Hospitals by governorate is provided in Section 1.1 HeRAMS Public Hospitals Report -Syria 4th Quarter 2013 Page 14 of 18
5. Availability of Equipment
The availability of different types of essential and specialized equipment and supplies has been evaluated at hospital level, based on a standard checklist. 6 The average percentage of availability of essential equipment in 59 functional public hospitals throughout the governorates is above 80%, as shown in Figure 15.
Figure 15: Average percentage of the Availability of Essential and Specialized Equipment in the functioning hospitals overall governorates
Surgical sets 95%
Oxygen cylinders 95%
Delivery table 94%
Advanced surgery equipment 94%
Generators 94%
Fetoscope 93%
Anaesthesia machines 93%
Operating tables 92%
Pulse Oximeter 89%
Suction machine 88%
Imaging machines 87%
Sterilizer/ Autoclave 87%
Ambu bag (Paediatric and Adult) 86%
Ventilators 86%
DC Shock machine/ Defibrillator 86%
ECG and other ICU/CCU Monitors 86%
Safe delivery kit 85%
Nebulizer 83%
Incubator for new born 83%
Cardiotocography (Monitoring of fetalheart frequency) 81%
Haemodialysis machine 75%
0% 20% 40% 60% 80% 100%
6 A more detailed list of essential equipment is available upon request. HeRAMS Public Hospitals Report -Syria 4th Quarter 2013 Page 15 of 18
A detailed analysis of essential equipment availability in functioning public hospitals at the governorate level is shown in summary Table below.
Availability of the essential and specialized equipment by governorate Essential Damascus Rural Aleppo Idleb Lattakia Tartous Homs Hama Al- Dar'a As- Quneitra Equipment Damascus Hasakeh Sweida Generators 95% 100% 100% 100% 100% 100% 88% 94% 83% 100% 100% 67% Pulse Oximeter 93% 100% 100% 50% 93% 94% 100% 100% 46% 100% 93% 100% Oxygen cylinders 100% 79% 83% 100% 98% 100% 100% 92% 95% 100% 99% 100% Safe delivery kit 100% 75% 33% 100% 94% 100% 100% 100% 88% 90% 43% 100% Fetoscope 55% 100% 100% 100% 100% 92% 100% 100% 100% 100% 75% 100% Delivery table 75% 83% 100% 100% 100% 92% 100% 100% 100% 100% 83% 100% Sterilizer/ 89% 81% 86% 80% 92% 92% 88% 88% 70% 83% 93% 100% Autoclave Ambu bag 90% 55% 100% 100% 100% 86% 100% 90% 24% 100% 90% 100% (Paediatric and Adult) Suction machine 86% 94% 100% 78% 95% 94% 73% 75% 76% 97% 88% 100% Nebulizer 90% 67% 100% 60% 89% 96% 81% 70% 65% 78% 100% 100% Operating tables 90% 79% 100% 100% 91% 97% 83% 96% 79% 100% 93% 100% Surgical sets 84% 98% 100% 100% 100% 98% 100% 100% 96% 77% 93% 100% Anaesthesia 94% 100% 100% 93% 85% 84% 70% 94% 100% 100% 90% 100% machines DC Shock machine/ 85% 100% 96% 56% 82% 95% 83% 76% 78% 75% 100% 100% Defibrillator
Specialized Damascus Rural Aleppo Idleb Lattakia Tartous Homs Hama Al- Dar'a As- Quneitra Equipment Damascus Hasakeh Sweida Incubator for new 76% 89% 100% 86% 59% 94% 65% 75% 82% 82% 84% 100% born Haemodialysis 88% 74% 100% 23% 92% 93% 53% 43% 54% 92% 90% 100% machine ECG and other 95% 79% 100% 57% 71% 92% 85% 85% 100% 70% 91% 100% ICU/CCU Monitors Imaging machines 82% 97% 100% 100% 74% 84% 76% 90% 67% 92% 82% 100% Cardiotocography 8% 50% - 100% 75% 85% 100% 100% 90% 100% 79% 100% (Monitoring of fetalheart frequency) Ventilators 79% 73% 97% 72% 90% 100% 85% 66% 84% 100% 87% 100% Advanced surgery 99% 100% 100% 100% 100% 89% 100% 86% 67% 91% 100% 100% equipment
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6. Recommendations
An immediate intervention is critical to rehabilitate the damaged hospitals especially in Dar’a, Aleppo, Homs and Rural Damascus governorates. For example, in the city of Homs all hospitals are damaged. While, in Dar’a there is a lack of emergency units, physicians and ambulances, so funding support would be required to provide adequate health care provision.
Establishment of TFCs (Therapeutic Feeding Centres) across Syria is a necessity to manage cases of severe acute malnutrition in children <5 years old.
More detailed assessments are recommended for Damascus hospitals to measure the healthcare provision, considering the increased number of displaced people from Rural Damascus, Dar’a and other affected areas. In Rural Damascus, only half of the hospitals are functioning with one of them partially damaged.
Conducting regular workshops at the central and governorate levels to strengthen HeRAMS reporting is vital.
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7. Annex -:
Map-6: Comparison of the hospitals’ level of damage; 3rd to 4th Quarter 2013
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