HEALTH SECTOR BULLETIN
June 2019 Syrian Arab Republic Emergency type: complex emergency Reporting period: 01.06.2019 to 30.06.2019 13.2 9.5.2 1.16 MILLION 6.1 MILLION 3 MILLION 2.2 MILLION MILLION MILLION in need of internally with children women of in HTR health displaced disabilities (under 5) reproductive locations assistance age
HIGHLIGHTS HEALTH SECTOR 812,648 Number of medical procedures We see you 659,476 Number of treatment courses We stand with you 65,601 Number of trauma cases supported You are not forgotten You are #NotATarget 2,054 Number of deliveries attended by skilled attendant #TheWorldIsWatching 3,042 Number of physical rehab sessions In 2019 (up to 25 June), there have been 35 confirmed 9,247 Number of mental health consultations attacks on health care across Syria, resulting in 31 health 38.1 % of treatment courses provided to workers killed and 55 health workers and patients severity scale > 3 injured. 38.9 of medical procedures supported to Extensive follow up priority issues for health sector severity scale > 3 (see below) 1,940 Number of referred cases Number of reporting organizations into 11 North-east Syria remains one of the most complex 4W operating environments in Syria. Number of implementing sector partners 38 on the ground A total of 2 vaccination teams, 12 medical points, 5 ambulances, 3 field hospitals and 18 mobile medical 95 Districts are reached by health sector teams, 2 specialized leishmaniosis teams, 3 normal partners delivery clinics and a stabilization center for the 82 Reached sub-districts complicated malnutrition cases are engaged in the 32 Reached sub-districts in severity scale response in Al Hol camp. above 3
449 Required (US$ m), WoS
38.3 Funded (US$ m), WoS 8.5 Coverage (%) HEALTH SECTOR BULLETIN June 2019
In the memory of Dr Jeya Kulasingam
Health sector Syria hub extends its deep condolences to the family of Doctor Jeya Kulasingam, who had worked for three years (2013-2016) as a Health Delegate of the International Federation of Red Cross and Red Crescent in Syria. Dr Jeya passed away at home in Malaysia on 22 June 2019. He will be greatly missed by all of us.
SITUATION OVERVIEW
The security situation within the country remains volatile and unstable. The main hot spots remain Al-Hassakeh, Deir-er-Zoir, Hama, Aleppo, Lattakia and Idlib governorates.
North-west Syria: In 2019 (up to 25 June), there have been 35 confirmed attacks on health care across Syria, resulting in 31 health workers killed and 55 health workers and patients injured. A total of 27 health facilities were impacted by these attacks.
On 6 June Al-Mahabah private hospital in north-west Hama was reportedly targeted by indirect rockets three times. A flash update was prepared.
Statement by Panos Moumtzis, Regional Humanitarian Coordinator for the Syria Crisis on Civilians and Humanitarian Workers Being Killed and Ongoing Suffering, Gaziantep, 21 June 2019
Syria: Humanitarian leaders, standing with civilians under fire in Idlib, send a message that ‘The World Is Watching’ (New York/Geneva 27 June 2019) – Eleven chiefs of global humanitarian organizations today spearhead the launch of a worldwide campaign in solidarity with civilians under fire in north-western Syria. We see you We stand with you You are not forgotten You are #NotATarget #TheWorldIsWatching
Hostilities intensify despite the ceasefire announced on 12 June. The humanitarian situation continues to deteriorate within or in the vicinity of the de-militarized buffer zone (DMZ) particularly in southeastern Idleb and north-western Hama Governorates with airstrikes reaching the outskirts of Idleb city. The majority of affected communities are situated along the International Hama-Aleppo and Lattakia-Aleppo Highways (M4 and M5).
Population movements in NSAGs controlled-areas: According to various sources on the ground, between 2 February and 17 June an estimated 493,913 individuals (75,987 HHs), the majority originally from western Aleppo, north and north-western rural Hama and south-eastern rural Idleb, were displaced. Most headed towards multiple locations in Idleb governorate mainly in areas located near the Turkish border in northern Idleb – including Harim collective camps and neighboring towns and villages. And more than half in Dana
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sub-district. Many IDPs are still out in the open due to overcrowded shelters and camps. Temporary population movements are reported in GoS controlled-areas as well.
Afrin IDPs: The latest IDP figures by SARC - as of 28 May 2019, a total of 38,192 families (approximately 186,000 people) are registered for assistance. The total number of individuals is estimated based on five-member family size, except for Sheikh Maqsoud neighborhood in Aleppo City. The number of families in five IDP camps (Ziyara, Shahba, Tal Qrah, Afrin, and Fafin) have increased by five percent, from 1,655 families as per the February 2019 figures to 1,743 families reported in May 2019.
The 2018 Humanitarian Response Plan Year-End Report highlighting the collective achievements of humanitarian partners was released. The report is available online http://bit.ly/2MSkuN2.
The first Syria Humanitarian Response Monitoring product for Q1 2019 was published. The report can be accessed http://bit.ly/2IkYnZQ . The Syria humanitarian response monitoring will now be published quarterly – for a more in-depth analysis and to account for the data from all hubs by the sectors. Hub-level response data will continue to be published on a monthly basis: http://bit.ly/2wCpNow for Syria hub and http://bit.ly/2WgFWiO for Turkey hub.
South-west Syria: Growing instability in the southern governorates as tensions appear to mount. Areas under reconciliation agreements in Dara’a governorate have witnessed increased tensions since the beginning of May due mostly to frustrations over delays in fully implementing local agreements; an arrest campaign against former NSAGs leaders and the establishment of additional GoS checkpoints.
Syria population data (end of April 2019, source: OCHA)
Final Est of Self-Organized Final Est of Res Final Est of total Spontaneous-IDP- Refugee Returns to Final Est of IDPs Governorate pop Pop Returnees Syria during the (April 2019) (April 2019) (April 2019)** (Jan-Apr 2019) calendar year*. Aleppo 2,832,452 26,982 969,681 3,829,115 Al-Hassakeh 735,976 4,267 277,619 1,017,862 Ar-Raqqa 617,907 3,366 139,285 760,558 As-Sweida 301,165 1,081 70,961 373,207 Damascus 1,223,074 20 615,214 1,838,308 Dar'a 848,567 50,935 72,939 972,441 Deir-ez-Zor 515,828 22,755 187,949 726,532 Hama 1,199,731 3,694 235,893 1,439,318 Homs 1,116,807 5,760 312,101 1,434,668 Idleb 1,357,080 4,825 1,216,287 2,578,192 Lattakia 724,478 - 451,327 1,175,805 Quneitra 91,860 7,555 4,829 104,244 Rural Damascus 2,041,544 4,290 1,172,182 3,218,016 Tartous 712,225 - 178,964 891,189 Grand Total 14,318,694 135,530 29,993 5,905,231 20,389,448
North-east Syria
As of 20 June, Al Hol camp population stands at 73,043 individuals. Response efforts to address the situation in Al Hol remain significant with 35 partners implementing a range of activities and services in the camp. No additional returns of Syrian IDPs have taken place to areas of origin since 3 June.
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PUBLIC HEALTH RISKS, PRIORITIES, NEEDS AND GAPS:
Situation in the north-west Syria
Out of 157 public health facilities, located in NSAG controlled areas (including military operations areas) of northern Hama and Idleb. 20% (32) HFs are located in Aleppo, 7% (11) in Hama, an 73% (114) in Idleb. 3% (4) are hospitals (all are non-functioning but three are operating through cross border partner support), and 97% (153) are PHCs. 97% (153) are located in NSAG controlled areas, while 3% (4) are located in GoS controlled area. 25% (40) partially functioning, 74% (116) non-functioning (completely out of service), while the functionality status of 1% (1) of HFs is unknown. 61% (96) were reported accessible, 21% (33) hard-to-access, and 16% (25) were inaccessible, while the accessibility status of 2% (3) HFs was unknown. 17% (26) were reported fully damaged, 39% (61) partially damaged], 29% (45) were reported intact, while the building’s condition of 16% (25) health centres were unknown. Availability of HR: (26) practitioner, (27) specialists doctors, (0) emergency physician, (4) residents doctors, (16) dentist doctors, (327) nurses, (90) midwives.
North-east Syria remains one of the most complex operating environments in Syria due to a combination of ongoing hostilities, weather-related hazards and population movements. Currently, 1.65 million people are in need of humanitarian assistance in NES – 14 percent of the overall total. As of April 2019, NES is hosting 604,853 IDPs, including 133,675 in 57 camps, collective shelters, and last resort sites.
Field fires across NES: Health sector partners report that due to fire accidents and fire breaks across NES, there is an increase of patients in need of burn care. The capacity of Hassakeh national hospital is proposed to be further enhanced. Currently many patients undergo medical treatment in Tal Abiyad hospital. It is estimated that 1-2% of the agricultural planted lands have been destroyed by the fires. The food security sector is currently carrying out its CFSAM assessment which may help capturing the impact of these events.
Northern rural Aleppo: Serdam camp, one of the five camps hosting IDPs from Afrin district since mid-2018. About 3,500 people (735 families) currently live in the camp. People are living under harsh conditions, although the level of services provided is adequate, and the camp is well planned. Nevertheless, there is a need to improve basics services including Health and WASH.
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Follow up priority issues for health sector:
Replacement of all tent based health service providers by pre-fabricated containers across the country. Enhancement of referrals for Al Hol camp (private hospitals, Hassakeh national hospital, Children hospital in Hassakeh city, etc.). Expansion of health sector activities across Deir-ez-Zor governorate (currently, plans are underway to establish a UN hub in Deir-ez-Zor governorate to support affected people in Deir-ez-Zor city and Al Mayadin, Abu Kamal, Hajin, and Surat sub-districts). Local procurement and importation of health supplies. Structured approach to further improve NCD related projects across the country. Findings of WHO Syria public health assessment for Al Hol camp. Levels of engagement with DoH Idleb by health sector. Reconstruction of public health facilities: SOPs and guidelines on BoQ. Coordination of capacity building events supported by health sector (e.g. WHO alone supports 67 training courses in May). Further improvement and regularity of Information Management deliverables (besides regular 4W, HeRAMS and EWARS - Primary, Secondary Health Information Systems, Civil records registration, Health indicators database). AAP Collective Approach (based on the outcome of the AAP workshop held in Beirut on 13th of May. Expanding the humanitarian response in Tabqa and Ar-Raqqa (as well as open a guest house in Tabqa, Ar Raqqa to facilitate additional and lengthier missions to affected communities and camps in this governorate). Funding for health sector Syria hub remains a challenge. Access to shelters and areas of return of Rukban residents Advocacy on access to Euphrates shield/Turkish occupied areas Scaled up response and access inside eastern Ghouta Southern Syria (Dara’a and Quneitra – the least served areas) Sustainable and transparent quality humanitarian response to Al Hol camp There are still remaining “neglected” areas for response: Hassakeh, rural Homs and rural Hama, rural Lattakia Need for a wider operational presence of technical actors to address the needs of people with disability
Update on SHF 2019 First Standard Allocation
The SHF 2019 first standard allocation concept note was to be presented to the Advisory Board for endorsement on 20 June. As agreed in the previous meeting the allocation will focus in southern Syria (Dar’a, Quneitra, and Rural Damascus).
Humanitarian Community Key Asks/Messages on Al-Hol (16 June 2019 update)
On medical care in Al-Hol and Hassakeh governorate:
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Parties to grant approvals and/or find alternative security arrangements that would allow for permanent medical teams' presence in all phases of the camp, including the Annex, to enable treatment and/or referral to one of the field hospitals established to take place. Parties to facilitate internal referrals of cases to other areas in the camp – including after 5pm-. Where referrals outside of the camp are required, parties are obliged to facilitate their transportation in a timely and safe manner with special attention to the pregnant women/ girls in need of immediate referral due to any Emergency obstetric care. Children referred to nearby hospitals should not be transferred by themselves and/or separated from their mothers, including in the case of Third Country National minors. GoS to grant approval for road transportation from Damascus to Qamishli for medical supplies to improve the provision of health services in-camps and referral hospitals in surrounding areas. All relevant parties should facilitate the transportation by road of all supplies needed to provide life-saving and life-sustaining assistance, particularly medical supplies.
On access and conditions in the “annexes” hosting third country nationals:
Residents of the annex should have access to full range of services and assistance available in the camp. Humanitarian actors should be allowed to establish permanent presence in the camp, deploy mobile teams and refer residents to services located outside the annex and outside the camps, in particularly medical services, as needed. Specialized protection services provided to especially vulnerable and at-risk groups, such as pregnant women, children, including unaccompanied and separated children, persons with psychological distress, older persons and persons with limited mobility, survivors of gender-based violence and camp residents with sustained wounds and injuries, particularly women and children, should be allowed to scale up with no delay. In particular, the offer of protection services should not be compromised by requests for information which may unintentionally reveal their identity and potentially expose them to further harm. Female translators, if available, should be considered. Protection actors should have regular sustained private and confidential access to all residents.
The Strategic Results for Programme Criticality Assessment
SR 1: Support saving lives, alleviate suffering and increase access to humanitarian response for vulnerable people and those with specific needs. (HRP) SR 2: Enhance protection by promoting respect for international law, IHL and HRL through quality principled assistance, services and advocacy. (HRP) SR 3: Targeted institutions have mechanisms to develop, implement and monitor evidence-based policies, strategies, plans and resilience programmes. (SF) SR 4: Basic and social services and infrastructure restored, improved and sustained to enhance community resilience. (SF/HRP) SR 5: Households and communities benefit from sustainable livelihood opportunities, including economic recovery and social inclusion. (SF)
Protection of humanitarian workers and duty of care: The most urgent matter is to maintain and increase, wherever possible, the continuity of services and humanitarian access in all its current modalities. Integral to this humanitarian access is the ability of humanitarian workers to perform their duties by responding to needs without the fear of being harassed, arrested, or systematically targeted.
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Vaccination in Ein Arab, Aleppo governorate
The final agreement between the DOH Aleppo and Kurdish authority to resume the EPI vaccination activities in Ein Arab district of Aleppo governorate and Tell Abyad district of Raqqa governorate is still in process.
Communicable disease surveillance
EWARS and epidemiological updates (weeks 23 to 25): 1137 out of 1300 sites have reported to EWARS system. Average completeness of reporting is 85%, average timeliness is 93%. Total number of consultations is 641,003. 50% of the cases were among females, and 44% were distributed among children under 5 years. Out of the 641,003 total consultations, 81,071 EWARS notifiable cases were reported:
Influenza-like illness (ILI): 36,142, accounting for 44.4% of total cases, most reported from Tartous, Lattakia, and Aleppo. Acute Diarrhea (AD): 32,102, accounting for 39.5% of total cases, most reported from Deir-ez-Zor, Aleppo, and Idleb. Acute Jaundice Syndrome (AJS): 1,010, most reported from Deir-ez-Zor, Idleb, and Ar-Raqqa. Sever Acute respiratory infections (SARI): 621, most reported from Tartous, Damascus, and Hama. Suspected Measles (SM): 107, most reported from Aleppo, Ar-Raqqa, and Deir-ez-Zor. Bloody diarrhea (BD): 672, most reported from Deir-ez-Zor, Al-Hassakeh, and Ar-Raqqa. Acute Flaccid paralysis (AFP): 13 most reported from Hamah and Aleppo. Two cases of acute watery diarrhea were detected in Daraa.
For the “other diseases” category, 11,159 cases were reported: Leishmaniasis 2,716, most reported from Deir-ez-Zor, Idleb, Aleppo. Typhoid 930, most reported from Deir-ez-Zor, Aleppo, and Idleb. Brucellosis 945, most reported from Deir-ez-Zor, Hamah, Aleppo. Mumps 396, most reported from Deir-ez-Zor, Idleb, and Ar-Raqqa. Pertussis 259, most reported from Deir-ez-Zor, Idleb, and Homs.
HEALTH SECTOR ACTION/RESPONSE
During the month of June health sector Syria hub was updated with: 4W WHO Syria for May 2019 EWARS weekly bulletin for Al Hol camp EWARS weekly bulletin for Syria The minutes of health sector coordination meeting in Homs, 12 June 2019 with Homs and Hama coverage by health sector organizations A snapshot on the situation in Al-Hol including a mapping of all activities being undertaken by humanitarian actors in each phase of the camp. A snapshot of the broader NES issue including an overview of all camps and informal settlements and a focus on the latest developments in some key areas. The updated key advocacy messages for Al-Hol camp. WHO Syria biweekly situation report covering 7-21 June 2019. KPI snapshots for WHO Syria performance in April 2019 (north-west, north-east, southern Syria) and WoS WHO for April 2019. The final report from last month’s Raqqa City Area-Based Workshop organized by NES Forum. Al Hol health sector situation A snapshot on Rukban departures as of 17 June 2019. Activity Based Costing, Background Paper, June 2019 Health Sector MSNA Survey Plans and response for Twehina informal settlement (1,680 households) to Mahmoudli camp 4W health sector Syria hub for May 2019
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The minutes of health sector coordination meetings in Al Hol camp The minutes of health sector coordination meetings in Aleppo The first Raqqa Area-Based Response Overview covering the period of January to March 2019 The NES 4Ws Snapshot for April 2019 Communicable disease surveillance
Leishmaniasis
Vector control in Aleppo - WHO began supporting DoH in Aleppo in implementing vector control activities on 26th of May. The activities, including indoor residual spraying (IRS), are being conducted in the priority neighborhoods/areas where the prevalence of leishmaniasis exceeds 1%. A total of 64 villages will be targeted in this ongoing campaign. The locations have so far reported 7289 leishmaniasis cases, a prevalence rate is 5.13%. The estimated number of beneficiaries is 141 892 individuals. The spraying is usually carried out once a year between June and October based of sand-fly breeding season. The campaign will continue until 26 September 2019. To date, the campaign has been completed in eight locations in Aleppo city (Bab Alhaded, Nakaren, Kady Askar, Al-Salhen, Bab Alnerb, Mshateih, Karm Homd, and Karlk) with an estimated 104 619 beneficiaries.
Laboratory training in Damascus - A training workshop on laboratory diagnosis of leishmaniosis was held 10 - 12 June in Damascus. 25 MOH laboratory medical staff was trained on the methodologies and laboratory technics for leishmaniasis diagnosis including biopsy specimens and culture medium.
Acute watery diarrhea in Dara’a - Two cases of acute watery diarrhea were detected in Dara’a governorate. The cases were investigated by rapid response team of Dara’a, and rapid diagnostic tests were conducted. The result showed positive results of Vibrio cholerae, however, the further culture
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diagnosis method performed for two cases found both cases negative for cholera. The two cases were treated properly and recovered.
Acute diarrhea - WHO supports case management of acute diarrhea, providing medicine and medical supplies. Deir- ez-Zor: 5 community cholera kits (for treatment of 500 moderate diarrhea cases) and 23,900 oral rehydration salt (ORS) sachets were delivered to Deir-ez Zor Health authority. East Deir-ez-Zor: 5 community cholera kits and 20,000 ORS sachets were delivered.
HIV/AIDS - WHO is coordinating with MoH to adapt the latest WHO updated guidelines about partner notification for HIV cases. Once the Arabic version is drafted, a one-day workshop will be conducted to finalize the Arabic version.
Tuberculosis - A National Tuberculosis committee meeting was held in Damascus to review and endorse the latest updated national TB control guidelines.
Water quality monitoring in Aleppo - Field microbiological analysis was carried out using the ATP hygiene monitoring system for various sources of drinking water in Aleppo, and samples were taken for chemical and bacterial laboratory analysis from the used wells. The number of points tested for drinking water quality (from IDPs camps, wells, and uncontrolled sources) was 132. The number of points tested and found to be not potable was 111.
Water quality monitoring in Rural Damascus - Field microbiological analysis was carried out using the ATP hygiene monitoring system for various sources of drinking water in Rural Damascus, and samples were taken for chemical and bacterial laboratory analysis from the used wells. The number of points tested for drinking water quality (from IDPs camps, wells, and uncontrolled sources) was 141. The number of points tested and found to be not potable was 84.
Rukban camp and related displacement:
As of 23 June, the total number of people who left Rukban remains at 14,828 people (35.5%), out of 41,700 residents. A total of 19 batches were completed. 361 people remain in 5 shelters while others left to their areas of origin. Together with other sectors, a follow up is in place on 215 families who used to leave in Shamsin camp till it was closed and emptied on 22 June.
North-east Syria:
Al Hol camp response:
Coordination: Weekly health working group meetings takes place. Focus on: updates on the general health situation; EWARS; referrals pathways (challenges and ways forward); weekly mortality analysis. XL and XB coordination: A continuous daily operational dialogue is established. Nutrition: Technical discussions are in place to establish another stabilization center on the premises of one of the field hospitals in Al Hol camp. Reproductive health and GBV: UNFPA launched a separate flash appeal for the response in Idleb and Al Hol camp. IA surge response mission in Al Hol camp: IA surge response mission comprised also of health experts from WHO, UNICEF, UNFPA is currently in Qamishli actively working together to enhance quality of health services in the camp. Separate updates from the respective technical officers on trauma, secondary health
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care, and reproductive health were made available. Mortality update: The regular mortality update is being shared. Foreign nationals: Health sector continues to follow up on all individual requests for foreign nationals in need of emergency health assistance.
Field hospitals in Al Hol camp: Out of three hospitals SARC/ICRC provides surgical interventions. Special coordination arrangements are in place.
Table: Available health services with 3 field hospitals in Al Hol camp
Availability of Name of the Location Number 24/7 general Types of main services provided Support services field hospital in phase of beds surgery and anesthesia KRC/Cadus – 1 17 No Simple surgery (facture, cleaning Laboratory is available XB partner infected wounds, etc.); External (CBC, cross matching, urine, fixator removal; Debridement SGPT); No pharmacy UNFPA/MSJM 4 25 No PHC services Pharmacy is available
SARC/ ICRC 7 30 Yes Normal delivery; Caesarian; Laboratory is available Simple and major emergency (CBX, cross matching, blood surgeries; Pediatric care. group, urine test, Emergency surgeries can be done Electrolytes, CRP, Glucose, during daytime. HIV, HBs AG, HCV, Syphilis, HCt).
Health services which not available at the field hospital level and in need for referrals outside of Al Hol camp: Intensive care; Severe malnutrition cases; Major surgery; Burns; Caesarian (in need for hospitalization); Neurology and Pulmonary diseases; Ophthalmology; Clinical investigation required advanced diagnostic test such as CT, Mammogram, etc.; Health services needed for NCD patients including kidney dialysis treatment, cancer care and Thalassemia.
Among other operational priorities, there is a need to activate the operational desk for: (i) Organizing a smooth internal and external referral mechanisms among the field hospitals (ii) Developing an updated information of number of referred cases (for both internal and external referrals) (iii) Sharing a list of NCD patients in need for regular external referrals (dialysis, cancer, thalassemia, etc.) (iv) Updating weekly or biweekly information on available health services in field hospitals
Communicable disease surveillance: Health and WASH sector work closely to follow up on the reported increase of diarrheal diseases. Technical operational exchange is in place at the national and sub-national levels.
EWARS and epidemiological situation in Al Hol camp (weeks 23-25)
10 medical points operating in the camp are reporting into the EWARS system. Average completeness of reporting is 87%, average timeline is 100%. Total number of consultations is 20,584. 52.3% of cases were among females and 51% were distributed among children under 5 years.
Out of 20,584 total consultations, 5,845 EWARS notifiable cases were reported: Influenza like illness (ILI): 2,233, (38.2%); Acute diarrhea (AD) 2,918 (49.9%); Suspected Tuberculosis cases: 8; Scabies: 188; zero cases of acute watery diarrhea during this reporting period.
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Response to the increase in acute diarrhea cases - A total of 7700 acute diarrhea (AD) cases was reported in weeks 14- 25, 2019. During weeks 23-25, an average of 972.7 cases was reported. There has been an upward trend of AD cases since the reporting started in week 14. Children under 5 years represent 54.2 % of total reported cases; female to male ration is 1:1.
Table: Total number of acute diarrhea cases by week
Week number Reporting period # of consultations # of AD cases 23 2-8 June 4813 829 24 9-15 June 8706 1042 25 16-22 June 7065 1047
Case management
Establishment of oral rehydration corners (ORCs) - WHO plans to establish two ORCs in each phase, starting with health points with pediatricians and qualified staff, including WHO Al-Mawada in phase 1, UNICEF in phase 3, KRC in phase 1 and 4, MSF in phase 5, and IRC in phase 3.
Capacity building - WHO conducted on the job training for case management of child dehydration in late June. Planning for the training workshop on case management of child dehydration was conducted.
Provision of medicine and medical supplies - 56 community cholera kits have been prepositioned in the WHO Qamishli warehouse for the treatment of 5,600 moderate dehydration cases. 21 kits were delivered to Al-Hol camp. 57,800 ORs were prepositioned to the WHO Qamishli warehouse, which is sufficient for 11 560 cases (approx. 12 week-supply based on case estimates).
Water quality monitoring
A total of 47 water samples (22 water tanks and 25 jerry cans) were tested between 9 and 26 June, and 17 water sources were determined not potable.150,000 chlorine tablets were dispatched to Al-Hol camp and received by KRC on 19 June 2019. The tablets were used for the water provided by NRC to the camp. 125,000 tablets are the current stock in the WHO Qamishili warehouse.
Other public health response activities:
Leishmaniasis: WHO continued to support leishmaniasis medical points in Al Hol camp; during the reporting period 360 suspected leishmaniasis cases had medical consultation by DoH team, of which 19 confirmed diagnosis of leishmaniasis and received medication. The total number of leishmaniasis cases receiving treatment since March 2019 is 1155.
Suspected tuberculosis: 8 suspected TB cases were reported. The cases were investigated by the TB program in Al- Hassakeh and will be referred next week to the TB specialist center for laboratory diagnosis. Total number of TB confirmed cases in the camp is 29 by the end of June. Among them, one case has recovered and 28 cases are still under treatment.
Overall mobilized health resources: A total of 2 vaccination teams, 12 medical points, 5 ambulances, 3 field hospitals and 18 mobile medical teams, 2 specialized leishmaniosis teams, 3 normal delivery clinics and a stabilization center for the complicated malnutrition cases are engaged in the response.
Phase 1: 1 Field hospital; 2 delivery clinics, 4 static medical points; 1 leishmaniosis team; 23 beds in SC& 4 ambulances &2 teams for physical rehabilitation + 2 community health workers and 1 vaccination team
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Phase 2: 2 community health workers and 2 teams for physical rehabilitation+ 1 vaccination team Phase 3: 2 static medical points + communication for development (C4D) team + 2 community health workers + 2 teams for physical rehabilitation and 1 vaccination team Phase 4: 1 Field hospital; 1 static medical point, 1 ambulance; I leishmaniosis team & 2 community health workers and 2 teams for physical rehabilitation and 1 vaccination team Phase 5: 2 static medical point + C4D team; I leishmaniosis team; 3 medical teams; 1 emergency team + 2 community health workers and 1 vaccination team Phase 6: 1 MMU and 1 static medical point and 1 vaccination team & 1 H&N clinic (planned) Phase 7: 1 Field hospital; 1 static medical team + 1 C4D team; I leishmaniosis team; 1 ambulance; 3 medical mobile teams; 1 emergency team & 16 outreach volunteers and 1 vaccination team Phase 8: 1 medical mobile team, 1 static medical point and 1 vaccination team & 1 H&N clinic (planned) Annex: 8 medical mobile teams, 1 emergency team; 1 leishmaniosis team; 1 vaccination team & 1 ambulance; 1 24/7 health services (planned)
Mental Health Psychosocial Working Group
Regularly gets updates. Among priorities are the annual work-plan; updates on the situation in the NES/NWS, Al Hol Camp and Aleppo; Data information 4Ws analysis and usage for planning; Capacity Building needs & gaps mapping.
Students cross lines in various areas to conduct their exams
Almost 6,000 students from Menbij and Ain Al-Arab districts and some from western rural Aleppo arrived to GoS- held Aleppo city for the national 9th-grade examinations. Health teams were dispatched on temporary accommodation sites.
Abstract of 4W health sector May 2019
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Health sector partners update
Medair - Al Jalaa PHCC (Aleppo) was handed over to DOH after completion. PHCC rehabilitation finalised in Thiabiyeh (Rural Damascus), Nahta (Daraa) and Husseniyah (Deir ez Zour). PHCC rehabilitation started in Al Thawra PHCC (Deir ez Zour). Clinic furniture, clinic and laboratory equipment sets delivered to Al Jalaa (Aleppo), Nahta (Daraa), Thiabiyeh (RD) and Husseniyah (Deir ez Zor) PHCCs. Completed distribution of assistive devices in Mneen, Rural Damascus to 74 beneficiaries in total. Completed distribution of assistive devices in Daraa to 291 beneficiaries in total. Conducted training on IYCF and early child development for CHWs in Aleppo, 6 separate Reproductive health refresher days for midwives (Aleppo staff), and initial 8 day CHW training in 2 locations (Homs and Aleppo). We completed our 12 month support package for 3 clinics in Rural Damascus (At Tal, Mneen, Sasa) and one in Aleppo (Yusuf Al Azmah) this month; DOH will continue service provision in these locations . PHCC support continues in Aleppo (Bustan Al Qasser, Al Jallaa), Homs (Al Ghanto and Rustan clinics). Data entry of household survey data from Aleppo and Homs by MOH staff.
AL-TA'ALOUF Charity Association
الجهة الممولة المشروع الخدمة المقدمة المجموع عدد العمليات الجراحية 45 المرضى الذين تم تخديمهم في قسم اإلسعاف 283 جمعية التآلف مشفى التآلف عدد المرضى الذين تم تخديمهم في العيادات 372 عدد المرضى المقبولين في العناية المشددة 15 عدد المرضى المقبولين في المشفى 115
عدد المرضى الذين تم تخديمهم في العيادات 2134 جمعية التآلف عيادات األكرمية عدد األطفال الذين تم اجراء مسح تغذوي لهم 118 عدد السيدات اللواتي تم اجراء مسح تغذوي لهن 144
االستشارات الطبية 950 االستجابة الستضافة طالب منظمة الصحة تقديم األدوية 670 الشهادتين اإلعدادية WHOالعالمية الدعم النفسي 1177 والثانوية في المدارس حاالت الصدمات 37
IMC continued to provide primary health care for beneficiaries through three static clinics in Masaken Barzah clinic (Damascus), Jaramana clinic (Rural Damascus) and As-Sanamayn clinic (Dara’a), and Five Medical Mobile Clinics (MMCs) in Rural Damascus and Damascus. During Jun-2019, a total of 12,587 consultations were provided to 10,390 beneficiaries. In addition, IMC provided patients with advanced health care through referral system to International Medical Corps’ contracted hospitals/ specialists. The advanced health care includes consultations in various specialities, surgeries, and providing hearing aid services to children with hearing impairments, this service covers audiometry tests, installing H.A devices, and speech therapies. Mental health services are provided along with primary health care, during June, a total of 24 cases were provided with MH services. Besides, disability aids are provided
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continuously to people in needs as per IMC criteria. During June, 85 patients received different types of disability aids including: wheel chair, diapers, walkers, toilet seats, crutches, catheters and colostomy.
UNFPA regional director visited Syria during the period 15-20 June 2019 to provide oversight and support to UNFPA Syria CO, discuss cross-border support from Iraq to North East Syria (NES), Increase nuanced understanding of the political, programmatic, and operational context of Syria, support partnership with local and international entities and UN organizations, support staff by providing guidance and feedback and recognition for their work, increase visibility of UNFPA Syria CO, advocate among donors scaling up resource mobilization for more integrated humanitarian and development programming and provide recommendation to improve the CO program, operation, resource mobilization and staff dynamics. During his visit to Daraa governorate Dr Shabaneh said: "There is a dire need for support on the ground, UNFPA teams are responding to the high needs of people in Syria, yet there is still a lot to be done, Clinics, equipment, healthcare facilities and lifesaving resources, all are destroyed. This hospital used to serve 1 million inhabitants. Now, there is a high need for its rehabilitation to meet the needs of women, children and families in Daraa. The quality and volume of work implemented by our Syria team is outstanding- they made me proud.”
SUCCESS STORY
Safe Birth, Even here A displaced mother gives birth to the first baby born in the field hospital in Al-Hol camp, Syria UNFPA
“I never expected that I will be in this situation and suffer so much. I have no home, I have lost everything, and now I have to give birth to my baby in a camp,” explains Khadija, an 18-year-old Syrian to a UNFPA health worker in AL-Hol camp.
The camp, situated in North-East Syria, currently hosts around 75,000 people who have fled mounting tensions in their hometowns in search of some semblance of safety. More than 90 percent of the camp’s residents are women and girls — many of whom pregnant — are in need of urgent medical and psychological care.
Khadija and her husband Mahnmoud had fled from their hometown of Hajin in North-East Syria when hostilities in the area intensified. Khadija was pregnant at the time, and she and her husband walked aimlessly for many days and nights seeking shelter and security, going without food and water for extended periods of time. As Khadija’s pregnancy progressed, her body became increasingly frail due to lack of proper nutrition and adequate healthcare and rest.
We fled our homes and left behind all our memories and possessions, and we were barely able to carry any clothes on our backs,” explains Khadija.
Eventually, they arrived in Al-Hol, where Khadija was able to receive immediate life-saving care at the new UNFPA-supported field hospital (or hospitainer), a 20-bed facility established in response to the growing needs for a wide array of reproductive health services at the camp. On the night of June 13, Khadija gave birth to a healthy baby girl named Fadia. Due to the distress, trauma, malnutrition and acute fatigue that Khadija had experienced, the health workers did everything they could to ensure that Khadija had a safe birth.
“They saved my life and that of my beautiful baby girl,” said Khadeeja, her face beaming with joy. “I feared the worst, that I would lose my baby and also die in the process. But now, Fadia and I are happy and grateful to be alive. We are safe and healthy.”
Despite the spikes in demand for services and increasingly difficult working conditions, the health workers at the field hospital persevered in tending to the health and needs of the mother and her newborn child. “We are happy to have delivered the first baby to be born in the new field hospital in Al-Hol camp,” commented Mother Agnes-Mariam from the Monastery of Saint James the Mutilated, UNFPA’s implementing partner in the establishment and operation of the hospitainer. “She is a lovely little girl and the parents are very happy and grateful.”
Around the world, a woman dies every two minutes while giving birth, with most of these deaths being largely preventable with skilled healthcare before, during and after delivery. Over half of global maternal deaths occur in countries affected by humanitarian crises or fragility. In Syria, UNFPA is working to scale up its humanitarian response and to provide life-saving reproductive healthcare and equipping facilities with the skills needed to ensure safe birth.
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Even in Al-Hol, UNFPA supported the establishment of the first hospitainer in the camp to provide medical care and treatment including trauma care. The field hospital, which launched its operations as of June 2nd, 2019, has the potential to increase in- patients care and types of service provision.
“The field hospital is considered one of the most advanced health facilities used in humanitarian response,” explained Karen Daduryan, UNFPA Syria Country Representative. “We wouldn't have gotten this far without the support of our local humanitarian partner, the Monastery of Saint James the Mutilated (MSJM). We are proud to work with MSJM to provide life-saving reproductive health services to the people in Al-Hol."
UNFPA and humanitarian partners continue to respond to the needs of the camp’s population as they continue to face a wide array of protection risks. As Daduryan notes, "we are trying to meet increasing humanitarian needs, which are overwhelming. UNFPA teams have been working to urgently scale up sexual and reproductive health services with support from donors, including the European Commission Humanitarian Aid and Civil Protection (ECHO), the Government of Australia, the United Kingdom’s Department for International Development, and assistance from the Syria Humanitarian Fund which is a donor’s pool fund, but the needs remain high.”
UNFPA will continue to work with existing partners in Al-Hassakah governorate and other available partners. Other existing services in Al-Hol will be maintained through static clinics, normal delivery clinics, medical emergency teams, Women and Girls’ Safe Spaces, and integrated SRH and GBV mobile teams.
WHO, Evacuation of mental health patient from Al Hol camp and Aleppo city
WHO, SARC, DoH Hassakeh and Aleppo, camp administration and authorities on the ground enabled transportation of one mental health patient from Al Hol camp via Menbij to Aleppo for further specialized treatment in Ibn Khaldoun mental hospital. This action pathed the road to the agreement and readiness by SARC to transfer any patients in need of urgent specialized health care from NES to Aleppo city based hospitals.
Al Tamayoz Bashar seven years old child has a beautiful spirit and innocent face with fixed smile. Bashar registered at AlTamayoz three years ago. During crisis the child’s father died with heart attack and Bashar lost his father and displaced from home at Al Nashabiah with his mother and two brothers and lived in a shelter. Therefore he was followed up at CP section. Despite bad circumstances one thing still recognized Bashar among other children was his smile and vitality, he was full of energy and smile all the time.
The child’s mother wished to work and secure resources to cover all needs of her children but due to residence at the shelter, she stopped working because she felt afraid to leave her kids alone for long time, after circumstance became better, Bashar’s family returned to Al Nashabiah and the mother started to work at biscuits factory to support her family and secure a decent life and do not need anyone.
While the mother at work, she received a telephone call and went immediately home to find her two children died because of mine explosion and Bashar covered with blood.
Unexpectedly, Bashar caused a shock to all CP team when he came to the CC without legs and was carried between his mother’s arms. Bashar and his mother attended many awareness sessions and focus discussion at CP section to adapt with the new situation and to educate the mother on correct ways to deal with Bashar and help him to accept the changes occurred on his body. Bashar was followed up by case manager and referred to share targeted activities at the CFS.
Moreover, CP section coordinated with health section to provide the suitable support to the child and the mother and brought a wheelchair to the child. When Bashar saw the wheelchair, he jumped from his mother arms and settled on the chair and looked with a smile to his mother and said “now I can help you and depend on myself and relieves you tiredness”. The child’s mother thanked case manager and said “thank you for your generosity and support, I will never forget your help”.
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HeRAMS: http://www.emro.who.int/syr/information-resources/herams-reports.html EWARS: http://www.emro.who.int/syr/information-resources/ewars-weekly-bulletin-2019.html Health sector, Syria hub: http://www.emro.who.int/syr/information-resources/infographics-4ws-and-key-indicators.html https://www.humanitarianresponse.info/en/operations/syria/health
CONTACT INFORMATION (NATIONAL AND SUB-NATIONAL LEVELS):
Damascus: Aleppo: Homs: Lattakia/Tartous: Qamishli national sub-national level sub-national level sub-national (north-east Syria): level level sub-national level Coordinators Mr Azret Kalmykov Dr Kady Fares Dr Nadia Aljamali, Mr Hamza Hasan Dr Khaled Al Khaled Health sector coordinator Head of WHO Head of WHO Head of WHO Head of WHO sub-office [email protected] sub-office sub-office sub-office [email protected] [email protected] [email protected] [email protected] Information Management Unit Mr Mutasem Mohammad, Information Management Officer, WHO Syria, [email protected] Mr Ayman Al Mobayed, Information Management Officer, WHO Syria, [email protected]
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