WHO Syria: SITUATION REPORT Weeks 19-20; 10 – 24 May, 2019
WHO Syria: SITUATION REPORT Weeks 19-20; 10 – 24 May, 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.
Between 1-16 May 2019, CCCM Cluster Gaziantep tracked 201,492 individuals moved to different communities in Aleppo and Idleb governorates alone (90,410 in camps and reception centers, and 111,082 outside camps).
On 17 May 2019, the Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Mark Lowcock, in a briefing to the Security Council on the humanitarian situation in northwest Syria; said: … I am most of all concerned about the number of attacks damaging or destroying medical facilities… ….… Since 28 April, WHO and health actors have identified at least 18 facilities that have been damaged or destroyed by air strikes, shelling or other fighting. All of them are inside the so-called de-escalation zone… … The trend has continued, day after day…
There was a reported alleged chlorine attack in Northwest Syria on the morning of May 19, 2019
II. Key Health Issues
1. Between 01 January, through 20th May 2019, 31 confirmed attacks on health care facilities were reported to the SSA. These resulted in 27 deaths and 53 injuries of health care personnel, patients and co-patients.
2. As of 22nd of May 2019, the 16th group of 371 returnees from from Rukban arrived in Homs (105 males, 105 females, 125 children and 36 infants), bringing the total number of people who left Rukban to 13,153 people (31.5% out of 41,700 residents). They were all hosted in Abdul Rahman Shattoor shelter in Bayada. 0n the same day (22 May), 221 people ( 87 males, 69 females, 46 children and 19 infants) left the shelters (27 people left from Mahmoud Othman shelter and 194 people from the Arts Institute shelter). The total number of people who are still in the shelters is 1,023 people (652 from previous groups plus 371 from group 16).
3. Unfortunately, GoS has warned against the delivery of humanitarian assistance to Al Rukban, stressing that sending Humanitarian assistance to Al Rukban Camp will only serve the occupying power. This will further exacerbate the already bad health burden of those Syrian citizens.
4. With about 239,647 IDPs displaced from Northern Hama and Southern Idleb alone between 01 April – 16 May 2019, there is the enormous task of urgently providing humanitarian health assistance for these displaced population. 5. 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.
6. The Syria Health Minister, Nizar Yazigi, discussed with the WHO Director-General, Tedros Adhanom Ghebreyesus, during a meeting held on the sidelines of the international health association session in Geneva on 23 May 2019, Yazigi clarified that the Ministry has rehabilitated dozens of damaged medical centers and vital departments in hospitals in the safe areas. He called upon the WHO to exert more efforts to lift the economic measures imposed on Syria, which are hindering the import of some medicines and medical equipment. Page | 1
III. WHO Response
1) Coordination
Conducted a health sector coordination meeting in Damascus on 21 May 2019 to review: a) Updates on Situation in north-west Syria; b) Health situation in Al Hol camp; c) scale up response in the southern Syria; d) enhancement of 4W health sector 2019 HRP; e) Bi-weekly mandatory health sector updates; f) health sector contact list; g) preparations for May Health Cluster Bulletin; h) MoH’s request to support reconstruction of hospitals and PHC centers and the need for standard specifications; i) overall operational challenges; and j) key priorities on Reproductive Health issues WHO conducted her quarterly WoS WHO meeting in Beirut, 13-14 May. Issues discussed and agreed include the current context and related strategic updates/changes by the hubs from an operational and health cluster/sector perspective, WHO’s internal position on the WoS structure vis-à-vis discussions held at OCHA and RHC level; WHO’s resource mobilization and communication strategy and prospective funding in 2019 and 2020; WHO’s response in Gaziantep vis-à-vis Turkey influence and WHO’s relation/interaction with the Turkish authorities; and WHO’s response to the anticipated returnees of IDPs and refugees. An updated draft of the health sector operational plan was prepared for Dara’a and Quneitra. Enhancement of 4W health sector 2019 HRP is under process. Health sector contact list is being updated.
2) Non-Communicable diseases/Primary health care
In collaboration with UNPFA & UNICEF, adolescent Friendly Health centers were activated at PHC level, with 10 Adolescent friendly health centers established in 10 governorates (Damascus, rural Damascus, Homs, Hama, Aleppo, Qunitera, Daraa, Swayda & Tartous Lattakia). WHO supported the development of health indicators for adolescents for integration into Public Health Care Information system. These indicators will also feed into the standard WHO clinical guideline. A TOT workshop was conducted to develop multi-sectoral action plan aimed at enhancing adolescent health services (including preventive, therapeutic, referral, reactive sessions and consultative services at both PHC & community levels). Continued follow up on 2 MMTs deployed by the MoE to cover oral health project in Eastern Ghoota towns in rural Damascus. 3814 students were examined, and 3890 health promotion sessions for both teachers and students, and 15,896 preventive services were conducted. Dispatched the second shipment of dental supplies in favour of oral health project in EG. 6,848 medical consultations, 139 individual and 64 group PSS sessions, including 1629 medical prescriptions, were provided for returnees including those 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. PHC programme delivered 19,568 treatments during the reporting period.
3) Trauma
About 150 health workers were trained on trauma and disability in four governorates (Aleppo, Tartous, Damascus and Rural Damascus) – Annex 2. The following deliveries were made during the reporting period: o Equipment capable of providing 68,000 treatments and 400 trauma cases were delivered to Aleppo SARC and Damascus MOH central. Also included were 4 trauma kit A, 8 Basic kit, and 6 supplementary kit. Page | 2
o 3 Patient monitor devices were delivered to Qamishli National Hospital. o 118 wheel chairs were delivered to 10 NGO partner in Damascus, Daraa, Aleppo, Homs and Rural Damascus. o 13,417 medical treatments were delivered to MOH centrally warehouse in Damascus Updated the Trauma Referral and Medical Evacuation Plan for NWS according to the new development on the ground (the previous potential corridor "from Qalaat al Madiq to Suqaylabiyeh" is not available any more) Mission to Bambino Gesu Hospital in Rome (with the Deputy Minister of Higher Education and the Director of Damascus University Pediatric Hospital), to develop the cooperation between three Syrian University hospitals (Damascus University Pediatric Hospital, Damascus University Cardiac Surgery Hospital and Aleppo University Hospital) and the Bambino Gesu Children’s Hospital within the framework of the cooperation project between the Bambino Gesu Children’s Hospital and the WHO Country Office in Syria.
4) Immunization
The following meetings were held under the immunization programme: o Meeting with head of National Certification Committee (NCC) for Polio in Syria o AFP case review meeting for final case classification. o Meeting with UNICEF to 1) follow up on the final updates on the new GAVI agreement proposed to the MOH and, 2) how to enhance EPI Routine activities in Aleppo in regards to the current challenges faced by the local teams (security, access and availability of PHC services related). The following monitoring visits were also conducted: o Aleppo governorate visit from 12-16 May 2019 to stand on the EPI/Polio program achievements, plan for remaining period in 2019, and agree the need to expand EPI to reach newly accessible populations. The Polio Surveillance activities were reviewed as well. o Dar'aa governorate visit on 19 May 2019, to stand on the EPI service capacities and the need for the coming months. o Sweeda governorate visit on 22 May 2019, to stand on the EPI service capacities. All Routine Immunization activities are progressing as planned. The final results of the National Immunization week of April 2019 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 covered.
5) Mental Health
13 capacity building activities took place across the country on different MH programs, and 325 health workers were trained (Annex 2). MHPSS capacity building agenda (till the end of 2019) was also developed for health and community workers across the country. Active family wellbeing centers beneficiary numbers from MHPSS activities: in DEZ Syrian Pulse NGO "1282 ", in HAMA, Al-Bir Hama NGO "1873". Following the finalization of the GBV plan for 2019, work commenced on the development of IEC and awareness campaign materials on GBV. Brief developed on MH interventions in the area of adolescents and youth for the WCO focal point in the Youth Task Force. Psychotropic procurement plan for 2019 finalized, and Mental health basic and equipment needs plan for 2019 finalized after wide consultation with MoH/MH department and all mental health facilities across the country. Family wellbeing centers mapped with details of focal points contact list, to be shared with Health cluster coordinator and other partners through MHPSS TWG Continue follow up the potential Azaz asylum 79 mental health medevac with partners: Ibn khaldoun, Aleppo DoH, SARC, Ihssan Charity, and UNFPA.
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Developed MHPSS Emergency response and preparedness plan for NWS, in direct and close coordination with Aleppo, Homs, and Latakia HUBS. 1992 services delivered during the reporting period, with the support of MHPSS workers in 9 MMUs and 2 static points in Aleppo. In response to the several reported MH cases in Eastern rural Aleppo, a field assessment for chronic neurological patients (specifically people with Epilepsy and mental retardation) was conducted in Eastern rural Aleppo by MHPSS workers backed by WHO supported specialized doctors. The outcomes will help identify the anti-convulsants medications needed, and will enhance access by this vulnerable group of patients. Conducted integrated participatory MHPSS assessment in Al-Hol camp, wherein 2 MH experts and 30 volunteers 1) were trained for 2 days on how to provide psychological first aid, and communication skills, 2) participated in one-day questionnaire validation in Al-Mabrouka camp, and 3) participated in 5 days’ assessment and supervision. Delivery of psychotropic medications to Al-Hassakeh DoH to be re-allocated to other partners according to needs. Coordination with ICRC centrally and at HUB level to enhance MHPSS referral system and to follow up few cases specifically from the ANNEX by MH experts, health and community trained workers. Development of MPHSS emergency preparedness plan at national level.
6) Nutrition and Child Health
Towards the implementation of IMCI program in Damascus, 25 Nurses from 11 health centers were trained on IMCI. 4552 beneficiaries benefitted from IMCI counselling (based on routine data collected by the International Medical Committee from 3 centers for the month of April 2019). SAM data analysis for neonatal resuscitation from 33 hospitals in 11 governorates for April 2019 revealed that 6,461 children were screened for acute malnutrition; 11.8% had low birth weight, 16.9 % prematurity rate, 1 % death rate, 662 resuscitation actions were presented and 294 refereed to specialized nutrition rehabilitation centers
7) Secondary Health Care
7 hospitals were supported with 7,058 treatments with essential lifesaving medicines and hemodialysis sessions. They are Aleppo University hospital, Hama national hospital, Qamishli National Hospital, Al-Tabqa National Hospital, Tall Abiad National Hospital and two hospitals in Damascus. Delivered (3) patient’s monitor devices to Qamshili National hospital. Finalized the Arabic translation of the final report on “Patients’ and their families’ - views and experiences of cancer care in Syria.” Paid monitoring and supervisory visits to Children Hospital-Damascus (jointly with WHO Architectural Engineer) to follow up the progress of rehabilitation work.
8) Communicable Diseases, Surveillance and WASH
Communicable Diseases/Surveillance Various coordination meetings were conducted to: o discuss the enrollment of Syria in the Global Antimicrobial Resistance Surveillance System o prepare the joint WHO/MoH quarterly plan for national AIDS program for Q3 2019.
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o discuss the development of country plan towards the transition of new deadlines and policies for both MDR TB and LTBI under MER2 grant. An assessment of public health laboratory capacity in Aleppo kicked-off with a field visit. TB active case finding plan was developed to screen IDPs in Sheikh Maqsood in Aleppo to enhance TB notification rate. This plan will be implemented from July 2019 for one month. A joint field mission to TB center in rural Damascus was conducted to assess the newly functioning TB specialized center; with the participation of WHO communicable diseases department. During the reporting period, 10 suspected measles cases were reported. 4 blood samples were sent to the reference laboratory in Damascus (results being awaited). One confirmed measles case was reported in phase 5 (of Al Hol camp). The case was an eigh months old female child, not vaccinated with MMR. Conducted MMR vaccination for 413 children under 5 years in phase 5 on 12th of May. In addition, MMR routine vaccination Figure 1: Figure 1 DoH vaccination team was conducted in the camp and 400 children under 5 years were conducting MMR vaccination campaign in Al Hol camp vaccinated.
WASH The following water quality monitoring visits were conducted: o In Al Hol camp - It was observed that about 72% of the tanks were without covers, a number of children were bathing directly in the tanks, water in the reservoir was exposed to pollution through the tampering of the children of the camp, among others. o In two IDP camps and villages in Rural Damascus; field microbiological analysis was carried out using ATP hygiene monitoring system for various sources of drinking water. Of the 38 water samples collected, 31 (82%) was not potable. o In the villages of eastern Aleppo, water samples of wells, reservoirs, jerry cans and tankers were collected and tested using ATP hygiene monitoring system. Among 108 water samples collected, 51 (47%) were not potable.
9) Information and Planning
2 meetings were conducted during the reporting period, namely; M&E UN TWG meeting held on 15 May 2019, in Damascus; and the joint meeting of WHO, UNFPA, UNHCR, UNICEF, for mapping of health partnerships in South Syria. 1 desktop PC, 1 UPS, and 1 printer were provided to Jub Al Jandali PHC/DOH in Homs. The following information products were published and distributed: o Health profile for health facilities in Al Hol camp based on HeRAMS for Apr 2019. o 4Ws (WHO and Health Sector) snapshots for 1st quarter 2019. o WoS Summary of WHO key performance indicators snapshot for 1st quarter 2019. WoS Attacks on health care infographic snapshot (Marc 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 to WHE Mapping of IT Systems/Tools in Syria linked to GPW13 Outputs to EMRO; and EMRO regional dashboard.
10) National NGO Coordination –
The following coordination meetings were conducted: Page | 5
o Meeting with Society Care and Kindness Act Association (Hama based NGO); to stress on WHO rules and guidelines on program implementation; address key implementation challenges and provide guidance on reporting mechanism. o Meeting with UNICEF on mapping of Health Partnerships in the South. 2 field visits conducted by the TPM to 2 NGOs (1 in Damascus and 1 in Daraa). Full list of NGO partners and services they provide on Annex 1. One-day workshop on “Collective Community Engagement” in Beirut on 13 May.
11) Grant Management
Submitted a proposal to Japan for new funding expected in October 2019 Submitted a briefing on WHO's achievements under Chinese donation to EMRO as a component of the ADG's speech during the WHA72 session (20-28 May 2019). Engaged with the Australian mission in Beirut to finalize a funding decision for WHO Syria. Draft agreement has been forwarded to HQ for final clearances.
12) External Relations and Communications
Met with the Director General of the Pediatric hospital, Damascus, to finalize plan for the upcoming mission of the Bambino Gesu hospital team to Damascus from 25 -30 May. The aim of the mission is to strengthen the capacity of medical staff in MoHE hospitals, especially in the children’s department of the Paediatric University Hospital in Damascus. Developed different IEC materials including Posters, brochures, and roll up banners for the upcoming World No Tobacco Day on the 31st May 2019. Provided photo documentary on WHO supported capacity building activities covering different intervention areas: https://drive.google.com/open?id=1usiG9ciAOFKfigL4mJFwrKrH5Lo-rqGB Provided the Syrian News Agency as well as local media channels with a briefing on the WHA72 sessions (20- 28 May 2019) along with the main health topics to be discussed. 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, 915 participants benefitted from 36 WHO-supported capacity strengthening activities (Annex 2). This is summarized as follows: 325 participants benefitted from 13 training sessions on Mental Health 125 participants benefitted from 5 training sessions on Trauma care 75 participants, benefitted from each of the 3 training sessions on EWARS, Child Health and HIS 25 participants each, benefitted from each of the 3 training sessions on WASH, Disability, PHC and Nutrition
14) Operational support and logistics:
Dispatched 48.6 tons of medical, WASH, laboratory and nutritional supplies, equipment, health kits, prefab caravans and printing materials, to 11 governorates (except Idleb, As-Sweidaa & Lattakia). The recipients included 17 MoH facilities, MoHE, MoE, MoLA, 14 NGOs, 2 non-governmental hospitals, SARC & others. The consignment will provide 273,259 treatments and 400 trauma cases. The deliveries are summarized in the table below.
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Table 1: Summary of Deliveries
S/N Consignment Recipient 2 324 haemodialysis sessions for adults, 100 for children and Al-Hasakeh DoH different types of PHC & STHC medicines 3 1,992 Fresenius haemodialysis sessions for adults Hama national hospital 4 Accessories for medical equipment devices donated by the 10 MoH hospitals in 10 governorates (rural Japanese government Damascus, Damascus, Aleppo, Homs, Hama, Dar’a, Deir Ez-Zor, Al-Hasakeh, Tartous, & Lattakia) 5 Different types of EWARS & STHC medicines MoH central warehouse in Damascus in favour of Lattakia DoH 6 44,250 ampoules of Glucantime1.5g/ 5ml MoH central warehouse in Damascus in favor of Leishmaniosis programme 7 6 IEHK supplementary kits, 2 IEHK basic kits and different types MoH central warehouse in Damascus of PHC, STHC & trauma medicines 8 100 kits of SuperScript™ III Platinum™ One-Step qRT-PCR MoH – public health labs – flu lab in Damascus 9 5 IEHK supplementary kits, 6 patient monitor devices, 1000 vials Qamishli national hospital at Al-Hasakeh of acyclovir 250mg/10 ml and 200 ampoules of chlorpromazine governorate hydrochloride 25mg/ ml 10 1,000 Fresenius haemodialysis sessions for adults and 1,000 MoHE – Aleppo university hospital bottles of sodium chloride intravenous infusion 11 5 kits of hygiene swab "AquaSnap" MoLA in Damascus 12 10 IEHK supplementary kits and different types of STHC Al-Tabaqa & Tal Abiad national hospitals at medicines Araqqa governorates 13 2 finger oximeters, 1 oxygen concentrator, 116 wheelchairs for 14 NGOs in 6 governorates (Aleppo, adult, 2 for children, 3 prefab caravans and different types of Damascus, rural Damascus, Dar’a, Homs & Al- PHC, STHC and nutritional supplies Hasakeh). 14 2 Trauma kits (A), 6 IEHK basic kits, 2,000 vials of human SARC in Damascus & Aleppo. erythropoietin and 1,000 ampoules of iron sucrose mg/ml 15 441 of Diabetes educational booklets Doctors Syndicate at Al-Hasakeh governorate 16 Research supplies & consumables MoE - regional centre for oral health programme in Damascus
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)
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1. Security Situation
The security situation within the NES remains unstable and volatile, with noticeable increase in the level of terror activities both in SDF and GoS controlled areas, despite the end of major military operations against ISIL following their defeated in Baghoz. However, many sleeping cells belonging to ISIL and other terrorist groups are active in the area.
Below are specific security situations across the region:
Ar-Raqqah: Ar-Raqqah governorate has in the last two weeks witnessed many Attacks Against SDF members as well as civilians using IEDs, Grenade and SAF in different neighborhoods of Ar-Raqqah city and North (Tal Abiad district) and western countryside (Tabqa district). Perpetrators behind these attacks are mostly unknown. In the same context several Landmines and UXO/ERWs exploded causing Many causalities among civilians. Deir Ezzor: ISIL sleeping cells carried out several counter attacks using IEDs, SAF, VBIEDs against SDF positions, CPs and Patrols East and south of Deir Ezzor governorate in several Towns including Al-Judi, Al-Shheel, Hajin, Al-Busayrah, Al Suwar, Ash Sha‘fah, As Sabha and Abu Hamam. On the other hand, SDF and ICFs conducted joint combing operation against ISIL sleeper cells in Twemin village and other areas, Southeast rural Deir Ezzor and found weapons and explosive devices. Al Hasakah: Many security incidents and Sporadic attacks were reported in Al Hasakah city as well as in south countryside targeting SDF positions, CPs and patrols as well as ICF convoys (as it happened on 20 May when SVBIED targeted US convoy on Deir Ezzor-Al Hasakah highway (Al-Khrafi) near Shaddadi town). Al Houl camp and Areesha camp: Several demonstrations took place within Al-Haul camp among Iraqi Refugees as well as IDPs and ISIL families in the Annex. KSA security forces intervened in the camp followed by arrest campaigns. 2. Coordination
Conducted the regular health working group meeting twice in Al-Hol camp. The meetings discussed health situations updates; updates on EWARS in each phase in the camp, developed the reporting method, and agreed way forward; the weekly analysis of mortalities within the camp; and the internal operational desk and the links between the health facilities inside the camp. Participated in the regular coordination meetings of Al-Hol camp. Coordination is in place with various partners for the relocation of Al-Twehenah camp to Al-Mahmoudli new site. Conducted a meeting with a national NGO, where potential interventions in NES was discussed according to the needs and the severity scales. Conducted 2 field visits to two health facilities in Hassakeh and Ras Al-Ain. Conducted a meeting in Al-Mabrouka camp with both the IDPs’ council and WHO supported NGO/ Al-Birr w Al- Ehsan in Ras Al-Ain charity. The meeting aimed to strengthen the role of the local community in the monitoring and evaluation process.
3. Capacity building
25 health workers each were trained on vaccination techniques, and shool mental health program, and 3) Mh- GAP interventions (See Annex 1 for list of trainings).
4. Vaccination
2 vaccination teams are working on daily basis in Al-Hol (no data available) 5. EWARS & CDs Page | 8
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 8 medical points provided reports for the epidemiologic weeks 19 and 20. One day on the Job training conducted on case definition for the HW in the camp. During the epidemiological weeks 19 and 20, total consultations were 13,451, the diarrheal cases still high at 1,272 but less than 10% of all consultations, 58 bloody diarrhea and 2 cases AWD. 1347 ALI cases and only 1 case of SARI. 6 measles suspected cases - 5 of them in week 20 3 suspected TB cases reported in week 19. The cases were followed up by DoH FP and referred for treatment with the DoH – TB department. The focal point contacted the patients once a week. 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: 25 cases were reported during these 2 weeks reporting period.
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
20 children with complicated SAM were admitted in WHO supported Al-Hikma Hospital stabilization center during the period, 23 discharged cured and 3 death cases reported. 23 are still under treatment and needed medical care. In Al-tabqah SC ,2 admitted SAM cases, one discharged and one still under treatment
8. Public Health Survey
The Survey was conducted in Al-Hol during the period of 11-16th of May. More than 3200 households were surveyed. All the questionnaires sent to Damascus for analysis. 9. Pharmacy and Secondary Health care:
Followed up with the management of Arraqqa hospital to determine the needs of the recent activated departments. Conducted a site visit to Qamishli hospital to monitor the installation of delivered medical equipment Supported 2 partners in Alhol camp (Almawadda and Alyamama) with 2,256 treatments of antibiotics, NCD medicines, analgesics and antipyretics. Supported Qamishli National Hospital with 6 monitors to enhance intensive care services, in addition to 50,400 treatments of different categories of medicines. Delivered 424 hemodialysis sessions to Al-Hasaka DOH to ensure continuity of hemodialysis service in Al- Hasakah hospital, along with 15,000 bottles of paracetamol to support vaccination activities. Delivered 100,967 treatments of different needed medicines to Tal Abyad and Altabka hospitals. Shared the needs of NES with WCO to prepare the upcoming shipment for Qamishli hub.
10. NGOs coordination in NES Procedures established to ensure the continuity of SHTC and Malnutrition services through Al-Hikmah hospital. Followed up the health situations of the unaccompanied children within the child friendly spaces related to protection sector in Al-Hol camp. Technical and operational discussions held between UNICEF, UNFPA and WHO to ensure provision of comprehensive health services in the new field hospital in Al-Hol cmap. Page | 9
Various discussions and coordination platform are in place to link all the health facilities in Al-Hol camp with the new three field hospitals, the final version will be ready soon. Supported WHO partners with new caravans to enhance the health services quality in NES. Launched new medical mobile team in Hajin area, the mobile team conceded the first health facility in Hajin area. Coordination is in place with various partners for the relocation of Al-Twehenah camp to Al-Mahmoudli new site. Conducted a meeting with a national NGO, where potential interventions in NES were discussed according to the needs and the severity scales. Conducted a meeting in Al-Mabrouka camp with both the IDPs’ council and WHO supported NGO/ Al-Birr Al- Ehsan in Ras Al-Ain charity. The meeting aimed to strengthen the role of the local community in the monitoring and evaluation process.
North West (Aleppo, Homs & Latakia)
1) Aleppo
Security Situation
Aleppo city is still witnessing an increasing of hostilities particularly in the western neighborhoods. Reportedly, 7 war wounded in Masaken Al-Saabil and Tishreen street on 21th May, in addition to 5 war killed + 11 war wounded in Al-Nayrab camp on 14th May 2019. On the other hand, no new cases of UXO, WER and landmine injuries have been reported.
Coordination
Participated in the sub-Education sector meeting in Aleppo HUB, where MH presented School mental health package for the participants and its role in enhancing MH of students, reduction in violence acts in school, and improvement in the overall academic state. The establishment of working group affiliated from the education sector was proposed, with the aim at enhancing MH state at school level and to reduce the violence acts and deal properly with bullying behaviors, as this is increasing dramatically lately. Coordination meeting with UNICEF H&N officer, discussion the needs of screened children under 5 years in rural areas. 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) Plan finalized for TB/HiV screening in Sheikh Maksoud neighborhood and central prison in cooperation with MoH. There were 11000 IDPs family in Sheikh Maksoud neighborhood and prisoners in central prison. Followed up reported case (by SARC) of suspected HiV in Menbij (KSA control). Confirmed that the cases are in Damascus (Al-Mouassat hospital) and MoH is following up. WHO supported the distribution of 41 Mobility aids in northern rural of Aleppo city (Afrin IDPS) through partnership with Yadan Biyad NGO, in addition to 920 trauma and rehabilitation services.
Mental Health
WHO supported: a) Ibn Khaldoun psychiatric hospital - 4172 consultations; b) Mental Health directorate – 154 consultations; c) University neurological clinic – 109. Page | 10
Response plan developed with Ibn khadloun mental health hospital and DoH/ MH department to support MHPSS mobile teams’ involvement in NWS response /Aleppo leg; to receive patients from Azaz asylum; from NES, specifically from Al-Hol camp that hold the Syrian nationality, and through a governmental referral/ Al-hassakeh DoH, Al-Qamishly national hospital. The number of consultations provided through 9 MMTs and 2 statics points of active NGOs in Northern, Eastern and Southern rural of Aleppo through was 1992.
Operational support & Logistics
Based on the urgent request from Aleppo University Hospital, 1000 I.V fluids + 1000 hemodialysis sessions have been delivered to Aleppo AUH. In coordination with NGOs unit, 4 mobility aids (4 wheel chairs + 4 toilet chairs + 1 air mattress) have been delivered to 4 patients in the remote area in eastern part of rural Aleppo. WHO support the distribution of in kind donation support of medicines for 4 national NGOs (Al-Ihsan, AL-Taalouf, AL-Beer & AL-Ihsan. These donations will cover the health needs of 7 MMTs and more than 3000 treatment courses.
2) Homs
1. Health situation
Vaccination: Most of the children were vaccinated and have vaccination cards. Total vaccinated children u5 were 410. There were 58 children totally dropout. 3 vaccination mobile teams from Homs DOH – with WHO support are vaccinating in 5 shelters
Mental Health: 2 MHPSS-DOH teams visited 3 shelters and returnee families in Industrial Hasya. Basic counselling and psychological first aid were provided in 31 individual sessions and 3 group sessions. 2 cases were referred to psychiatrist.
Primary health services: DOH MMT with WHO support, provided health services in the shelters Figure 2: WHO FP Mouna Akhras in in the Arts institute in Bayada with free medicines. Total number of the medical with vaccination team consultation for the period8-21/5 /2019 was 481.
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: 2,174 (Annex 4).
3 mobile health teams from DOH Hama supported by WHO provided health services in rural Hama and Sinjar sub-district in Idleb Governorate. The total number of health services was 1,161 (Annex 5).
2. NGO activity
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 1,917 (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 Page | 11
n of beneficiaries was 1370 (Annex 6).
3. Capacity building: Facilitated 7 training in Homs and Hama with 175 participants (Annex 7).
3) Latakia
Coordination: Weekly meetings conducted with DOH director to monitor health updates on ground and highlight gaps and challenges. Immunization: Obtained the result of the national POLIO campaign conducted from 22-30 April 2019, to track dropouts. Results show that 49,962 children were vaccinated in Lattakia, and 6,768 vaccinated in Tartous. SCH: Followed up the installation process of X-Rays Machines procured under the Japanese award, through a field visit to Al-Basel hospital in Tartous, Obstetrics hospital in Tartous, Banyas hospital, Jbleh hospital, on 15th May 2019. Mental Health: Meeting with MH director in DOH, to follow up on the psychiatric ward needs and shortages. Field assessment mission to the psychiatric ward at National hospital in Lattakia, on 19 May 2019. NGO Coordination: o Meeting with Mossaic & SACSN NGOs (deployed MMTs as preparedness step to NWS response). Assessment Field visit to Disabled Association & Friends (DAF NGO), on 14th of May 2019. o 4 large families (about 51 people) arrived indirectly from Idleb (from Hama to Lattakia). All of them were reunited with their relatives in Lattakia. A team from DOH conducted the required examinations and screening (no dropouts or severe health cases) o Continuous communication and coordination with Lattakia DOh and Lattakia governance to monitor the accelerating humanitarian changes surrounding the governance, track IDPs movements and prepare ahead in case of emergencies. Operational support and logistics: Delivered 8 glucose testing devices to SACSN NGO. Delivered 3 Trauma A Kits to Lattakia DOH. Received 1 mobile clinic and 6 dry heat sterilizers from the seaport. Supported the newly established MSUs with fire alarm systems
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.
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V. Key Health Actions for the Next 2 Weeks
Non-Communicable Diseases 1. Deliver 18 NCD kits with insulin vials in favour of Qamishly Hub for NES response. 2. Install X-Ray machine for SARC health center in Damascus (Al Akram PHC). 3. Procure medical equipment under JPRM new allocation (3 CR machine s & 22 syringe pumps) in favour of MOH health facilities. 4. Carry out missions to Daraa & Swayda to follow up diabetes and Thalassemia programs (scheduled missions on 2 & 10 June respectively).
Secondary Health care 5. Draft the hospital information management development work plan, in collaboration with HIS team. 6. Disseminate the translated copy of the cancer study with MOHE and MOH and follow up the implementation of the study’s recommendations.
Aleppo 7. Continue the closed coordination/collaboration with partners regarding the current situation in rural Hama, Idleb and rural Aleppo. 8. Follow up with WCO on the proposed project to support the dissemination of the optimal Health Care of the severe injuries caused by ERW, UXO and Landmines 9. Conduct field visits to TB and HiV Center and meetings to finalize the planned survey in Sheikh Maksoud and the central Prison. 10. Meet with selected group MHPSS workers from active NGOs in NWS, to discuss the situation of service provision, obstacles, needs and solutions. 11. Field visit to South rural of Aleppo to follow up program implementation by health facilities supported by WHO. 12. Finalize two MOUs under process with two WHO partners (CCS, AL-Beer & AL-Ihsan), and renew the activities of 7 medical mobile teams, to ensure access and timely delivery of essential package of health care services.
Operational support & Logistics 13. Deliver through airfreight, 200 mt of health supplies to Quamishli within the next 10 days. 14. Deliver essential life-saving medicines and supplies to different hospitals in different governorates.
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 36 activities for 915 participants)
Date No of Detailed title Program participants 10-13/05/2019 25 Infectious disease and diagnosis case management for EWARS NGOs Staff in Damascus 11-13/05/2019 25 First Aid and Basic Life Support in Damascus Trauma 12/05/2019 25 School Mental Health Program follow up for MoE from As- MH Swaidaa 12-16/05/2019 25 School Mental Health Program for MoE from Al Hasakeh MH 12-16/05/2019 25 Mental Health GAP-Intervention Guide Ph1 for MoH MH doctors from Homs 12-13/05/2019 25 Psychological First Aid "PFA" and Self-care strategies for MH MoH health workers Lattakia 12-21/05/2019 25 Integrated Management of Childhood Illness (IMCI) in Child Health Care Damascus 12-21/05/2019 25 Integrated Management of Childhood Illness (IMCI) in Child Health Care Hama 12-14/05/2019 30 International classification of Diesease ICD10 in Damascus HIS 12-14/05/2019 25 Shoulder Rehabilitation after Surgery in Damascus Disability 12-13/05/2019 25 Mental Health GAP-Intervention Guide Refresher for NGOs MH from Al Hassakeh 13/05/2019 25 Completing the 2018 Global Analysis and Assessment of Wash Sanitation and Drinking-Water GLAAS National Survey for SYRIA in Damascus 13/05/2019 25 School Mental Health Program follow up for MoE from MH Daraa 13-15/05/2019 30 Improve utilizing and investing the collecting HeRAMS data HIS using office program in Damascus 13-17/05/2019 25 Ventilator Management in Hama Trauma 14/05/2019 25 School Mental Health Program follow up for MoE from MH Homs 14-17/05/2019 25 Hazmat management and evacuation of buildings in Trauma Damascus 15-16/05/2019 25 Psychological First Aid "PFA" and Self-care strategies for MH MoH health workers Damascus in Damascus 18-21/05/2019 25 Burn Management in Damascus Trauma 18-22/05/2019 25 Ventilator Management in Damascus Trauma 19-23/05/2019 25 School Mental Health Program NGOs from Hama MH 19-20/05/2019 150 6 trainings on Vaccination technics in Aleppo, Lattakia, PHC Tartous, Al Hassakeh, Deir Ezzour, Ar-Raqqa 19-23/05/2019 25 Mental Health GAP-Intervention Guide PH1 for MoH MH doctors from Tartous 19-23/05/2019 25 School Mental Health Program for MoE from Deir Ezzour MH 19/05/2019 25 School Mental Health Program follow up for MoE from MH Tartous 19-21/05/2019 25 Neonatal resuscitation in Damascus Child Health Care 19-23/05/2019 25 Expansion on nutrition surveillance clincs + Infant and Nutrition Young Child Feeding (IYCF) counselling in Qunaitera 19-21/05/2019 30 International classification of Diesease ICD10 in Damascus HIS 20/05/2019 25 School Mental Health Program follow up for MoE from MH Lattakia 21-23/05/2019 25 Early warning for reporting officials in Tartous EWARS 21-23/05/2019 25 Training for national disease surveillance officers on timely EWARS outbreak investigation and response in Hama
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Annex 3: List of current WHO agreement with national NGOs (by NGO)
Governorate Location of current of ongoing MOUs # of ongoing # of MOUs in MOUs preparation Damascus Al Zahera 1 2 Rural Damascus Qutaifeh - Douma - Harasta and Al Tal 2 6 Lattakia Lattakia city- Al Baset - Saqubeen- Qnanas and Al 1 1 Ramel Al Janoubi Dara'a Dara'a , Al Laja'at, Al Yarmouk 1 1 Qunaitera Qunaitera 1 Homs Old Homs, Al Ghassani and Ayoun Al Wadi 1 5
Hama Hama city, Souran, Moardes ,Taybet alemam, 1 Alsawa'aek ,Alhashimyaa , ean albad, Jarjesah ,tal kartal,tellef ,herbenafsah,maardeften and alzarah.
Aleppo / Efrin Nabul - Zanairta - Mayasah - AL-Mogambo - Burj Al- 2 3 Response Kaaf -Al-Zouk - Tall Refaat - Kafar Naya - Al-Zyara - Deer Jmal - Ihras - Kashtaar - Al-Ukaibeh - Kherbat AL-Hayat - Tal Jbeen - Ibeen - Sheikh said - Salah AL- Deen - Al-Mshatia - Bostan AL-Zahra - Al-Villat - Menbej - Agior , Deir Hafer and surrounding villages ((Babiri -Upper Babiri , Babiri -Lower Babiri , Rasm Elbokhar , Kayariyieh , Big Habbuba , little Habobieh , Southern Rasm Elharmal ) NES Deir- Ez-zor - Ar Raqqa city - Al Hasakeh. 5 7 Total 14 26
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Annex 4: Provision of Medical Consultations
# of beneficiaries, from 24/4/- 7/5 2019 Area Provision of medical Medicines consultations Shelters 1 Dier balba shelter 75 75 2 Al kosour shelter 45 45 3 Al bayada shelter 16 16 Total 136 136 Area of Returns 4 Shamseen 120 120
5 Mheen 105 105
6 Hasyaa industrial 75 75 7 Al soukhna 45 45 Total 345 345 Northern Homs district 8 3 locations in Alholeh 387 387 9 289 289 5 locations in Rastan
10 5 locations in Talbiseh 749 749 Total 2174 2174
Annex 5: 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 – 431 13 13
Idleb Governorate
10 locations in Hamrat district –east 275 15 1 Hama Governorate 10 locations in Hur Benafseh district- 455 13 19 west south Hama Governorate Total 1161 41 33 Hama city and villages across eastern and northern Hama Eastern-northern rural Hama villages 1057 119 539 Al- Hamraa district (20 locations)
Northern Hama (20 locations) 739 115 321 Health center Abi Alfidaa 520 131 250 Total 1917 365 1110
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Annex 6: Health Service provision in Alghasaniya old Homs city, Fairouza village in East Homs, & Ayoun Alwadi in Mesyaf Hama district.
# of # of outpatient Hearin # of Commune/Vill SHC Medical District consultation g trauma age/Town service glasses s PHC aids patients s services Alghassani Homs city 987 65 6 2 3 Fairouza. Eastern Homs 264 10 1 0 2 Ayoun Alwadi. Western Homs 119 9 1 2 2 Total: 1370 84 8 4 7
Annex 7: Capacity Building sessions in Homs and Hama
Course Title Participants Location Subject Area
Training for national disease surveillance officers MOH response teams in Homs EWARS on timely outbreak investigation and response Tartous and Lattakia Mental Health GAP-Intervention Guide Ph1 for MoH Homs MH MoH doctors from Homs School Mental Health Program follow up for MoE MoE Homs MH from Homs Integrated Management of Childhood Illness Nurses, MoH Hama Child Health (IMCI) Care Ventilator Management MOH Health workers Hama Trauma School Mental Health Program NGOs from Hama NGOs Hama MH Training for national disease surveillance officers MOH response teams in Hama EWARS on timely outbreak investigation and response Al Raqa
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Annex 8: Operations Achievements in North East Syria
Governorate Area PHC services SHC services Trauma services # of # of # of # Referral of # of # of First # of Mental outpatient beneficiaries referrals for treatment trauma aids and Health consultations reached with secondary for children referrals emergency Psychosocial the medicines health with Severe services in Services services Acute the camps Malnutrition Al-Hassakeh Hassakeh city center 1219 1012 1 0 0 0 4
Al-Mabrouka camp 673 673 25 0 25 146 233
Ras Al-Ain city 290 290 26 0 129 0 0
Al-Areesha camp 463 399 1 0 4 39 63 Al-Hol camp / Phase 1 910 910 37 12 52 372 276 Al-Hol camp / Annex 835 835 0 0 8 330 450 Al-Hol camp / 634 634 0 0 4 326 473 Reception area Al-Hol camp / Phase 5 276 268 0 0 0 27 40 Al-Hol camp/ phase 7 320 306 0 0 11 32 63 Al-Raqqa Al-Raqqa city 497 411 0 0 0 0 1066 Al-Jurneay + Al- 259 179 0 0 0 17 45 Mansoura Al-Tabqa 114 163 0 0 0 16 36 Ain Issa camp 1307 1154 0 0 0 151 227 Al-Twehenah camp 939 939 0 0 0 21 84 Al-Karama 575 539 0 0 0 48 107 Al-Kasrat 477 477 0 0 0 24 68 Aleppo Manbij 820 820 0 0 0 25 99 Dier Ezzour Hajin 447 229 0 0 0 35 77 Al-Busayra 337 282 0 0 0 35 75 Al-Jerzi 624 398 1 0 0 88 96 Abu Khashab camp 739 739 0 0 0 48 233 Dier Ezzour city 804 608 1 0 0 0 0 Sub-total: 13,559 12,265 92 12 104 1,780 3,944
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