[ HeRAMS ] Health Resources Availability Mapping System

Report: 2ND QUARTER 2017

Turkey Hub Health Cluster for

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HeRAMS (Health Resources Availability Mapping System) is a standardized approach supported by a software-based platform that aims at strengthening the collection, collation and analysis of information on the availability of health resources and services in humanitarian context. It aims to address the needs/gaps expressed by the health cluster on coordination and management by providing timely, relevant, and reliable information.

HeRAMS provides a tool for assessing, monitoring, and processing a comprehensive set of available data collected at health facility level. It covers; geographical location of the HF, demographic data on catchment area, type, functionality, building type, inpatient capacity, managing and supporting partners, health personnel, access and security, and health services provided at different levels of healthcare.

This report provides a summary of the analysis of the available health resources and services in Syria, the report is produced with the data provided mainly by hub health cluster members national and international non-governmental organizations as well as health authorities.

Dr Annette Heinzelmann Dr Jamshed Tanoli Dr Abd Arrahman Mohamed Elamein Alomar Emergency Coordinator Health Cluster Coordinator Information Management Officer World Health Organization World Health Organization HC National Co-Lead World Health Organization Mobile: +90 530 011 4948 Mobile: +90 530 238 8669 Mobile: +90 538 052 9213 Mobile: +905343554947 Email: Email: [email protected] Email: aalomar@sams- Email: [email protected] [email protected] usa.net

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Acronyms

ANC Antenatal care BEmONC Basic Emergency Obstetric and Newborn Care CEmOC Comprehensive emergency obstetric care CHW Community Health Worker HeRAMS Health Resources Availability Mapping System HF Health Facility HIV Human Immunodeficiency Virus HW Health Worker IMCI Integrated Management of Childhood Illness MW Mid Wife MUAC Mid-Upper Arm Circumference PHC Primary Health Care STD Standard STI Sexually transmitted infection

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1. Distribution of Health facilities Primary Health Care facilities are classified into different standard categories based (The Essential Primary health Care Package). The following graph provides the distribution of the functional primary and secondary health facilities (static and mobile).

Figure 1.Distribution of functioning Health facilities

90 85 80 76 70 60 48 49 50 40 36 35 34 30 20 15 10 0 General Hospital Specialized Comprehensive Health Centre Health Unit Mobile clinic Specialized Care Other Hospital Health Centre Facility

Out of 49 main managing health partners, 42 are reported in this quarter, 403 Health facilities reported, out which 378 functional HFs compared to 355 in March 2017. 84 (22%) are Hospitals, 169(45%) are fixed PHCs, 76 (20%) are mobile clinics, 34 (9%) specialized care facility * while 15 (4%) ** other health facilities.

 Out of total functioning health facilities, 51% of facilities are in Idleb , 28% in , 7% in ,6% in Rural ,4% in , while about 1% in Al-Hasakeh, Ar-, Damascus, Dar'a and Lattakia  Increase on the number of specialized hospitals from 42 to 48, decline on the number of fixed PHCs from 172 to 169.  Increase in the mobile clinics number from 66 to 76 compared to the previous quarter.  Specialized care facilities increased from 29 to 34, other facilities increased from 10 to 15.

* Specialized health centers (Physical Rehabilitation centers, Leishmaniosis centers .Etc.) **Ambulance network, Blood Bank, Central Lab

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2. Functionality status

Figure 2. Functionality status of Health facilities

Functionality has been assessed at three levels: fully functioning which mean open and providing full package of essential services, partially functioning means open but not providing the 69, 17% full package of essential services, or not functioning. Out of 403 assessed health facilities, 77% (309) were reported fully 25, 6% functioning compared to 74% in quarter one, 17% (69) partially functioning, 6% (25) out of service, means that 23% 309, 77% of the facilities were non-functioning or partially functioning. See Figure 2.

Fully Functioning Non-functioning Partially Functioning

3. Condition of health facilities Figure 3 Level of Damage infrastructure

The condition of the health facilities infrastructure has been assessed at three levels: fully damaged: major damage requiring 3, 1% 63, 16% complete reconstruction, partially damaged: requiring substantial to large scale repair, and not damaged, 25% (101) health facilities were reported damaged [1% fully damaged and 24% partially damaged], 59% (239) were reported intact, while 16% (63) of 98, 24% health facilities were not relevant to evaluate. See figure 3. 239, 59%

Not damaged Partially damaged Fully damaged Not relevant (e.g mobile clinic)

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4. Health facilities based on date of establishment

The health facilities has been assessed according to Figure 4 New establlished HFs whether the health facility exist prior to the crisis or new established health facilities, 67% (255) health facilities were newly established, while 33% (123) of health facilities were prior to the crisis. See figure 4.

Out of the new established health facilities 35% were 33% established in new building, 20% works in residential building, 16% in governmental Building, 5% in schools and 23% in others public building. 67%

New established HFs Prior to the crisis health facility

5. Health facilities delivery points Figure 5 Delivery point types

85% health facilities are located in settlements while 15% are located in IDP camps. HF located in IDP Camp Its worth to mention that 61% of HFs located in 4% and serving exclusively settlement are also serving IDPs and 11% of IDP 11% IDPs facilities are also serving residents HF located in IDP Camp but also serving Residents

24% HF located in Settlement 61% and serving exclusively Residents HF located in Settlement but also serving IDPs

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6. Health facilities resources

Figure 6: Accessibility to patients Figure 7: Electricity Figure 8: Water Sources

0% 4% 1% Fully accessible Fully Functioning 31.0% Available Not accessible Non-functioning 62.4% Not available 96% Partially accessible 6.3% Not available 99% 0.3% Partially Functioning

4% of functioning facilities reported difficulties in 37.6% of the functioning facilities works 1% of the facilities are without water accessibility mainly due to security reasons. without/with an interrupted electricity services

Figure 9: Source of Electricity Figure 10: Modiliaty of health facilites

100% 90% 90% 80% 70% 25% 60% 50% 40% 30% 20% 12% 10% 7% 65% 10% 5% 0% National Neighborhood Private Other Electricity generator generator

Percentage of health facilities per source of electricity. *Some facilities have more than one source Permanent structure Others Temporary structure

25% of facilities are in temporary structure building. P a g e | 8

7. Provision of Provision of General Clinical Services

Figure 11:Outpatient services:

100% 3% The main reasons for the non- 17% 13% 15% 90% 26% availability of outpatient services are 80% 33% 34% lack of health staff, lack of operational 70% cost and lack of drugs and medical 60% supplies. 50% 97% 83% 87% 85% 40% 74% 67% 66% 30% 20%

10% 0% Comprehensive General Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Hospital Facility Hospital

Available Not available

Figure 12: Inpatient capacity 100% 6% 6% 90% The availability of inpatient services in 80% the general and specialized hospitals is 70% 71% more than 94%, while 11% of these 60% hospitals provide inpatient services 50% 94% 94% with low capacity. 40% It’s worth to mention that only 29% of 30% the comprehensive health centers are 20% 29% providing inpatient service while it’s 10% necessary as per essential primary 0% Comprehensive Health Centre General Hospital Specialized Hospital health care package. Available Not available

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Figure 13:*Basic Laboratory Services 100% 3% 2% 90% 26% In hospitals basic laboratory services 80% availability is about 98%, while 74% of 70% 64% 63% comprehensive health Centers 60% 79% 85% providing basic laboratory Services. 50% 97% 98% 40% 74% 30% *CBC, urine analysis, stool microscopy, sputum 20% 36% 37% microscopy 10% 21% 15% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 14: *Basic Imaging Service 100% 6% 90% 15% 89% of the hospitals provide Basic 80% imaging services while 16% of primary 70% 63% health facilities providing this Service. 60% 73% 98% 50% 94% 85% 40% 30% 20% 37% 10% 27% *X-Ray and Ultrasound 0% 2% Comprehensive Health General Hospital Health Centre Health Unit Specialized Hospital Centre

Available Not available

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Figure 15: Pharmacy having Essential 100% 3% 3% 2% 2% 10% 5% Drugs 90% 80% Most of the reported health facilities 70% 62% have pharmacy having essential drugs. 60% 50% 97% 97% 98% 98% 90% 95% 40% provide it partially as there is no 40% 30% sustainable drugs and consumables 20% 38% supply and management system. 10% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

100% 3% 3% 4% 90% Figure 16:Referral capacity 32% 29% 80% 73% of the facilities have referral 70% 57% mechanism in place, such as 60% communication and safe 50% 97% 97% 96% transportation. The main reason for 40% 68% 71% inadequate referral mechanism in 30% some facilities is the shortage of 20% 43% vehicles and finance required for fuel. 10% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Health Centre Hospital

Available Not available

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8. Provision of Surgery services

Figure 17: *Primary Injury care 100% 90% 20% 33% 63% of the facilities are providing 80% 36% 41% primary injury care. 70% 62% 60%

50% 100% *Treatment of open wounds, fracture 40% 80% immobilization, patient stabilization and proper 64% 67% referral (including antibiotics and tetanus toxoid 30% 59% when needed) 20% 38% 10% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Hospital Health Centre

Available Not available

Figure 18:*Trauma, surgical care, 100% 3% and elective surgery 90% 25% 80% 85% of the hospitals are providing 70% trauma, surgical care, and elective 60% 83% surgery. 50% 97%

40% 75% *At least 1 operation room with/without gas 30% anaesthetic 20% 10% 17% 0% Comprehensive Health Centre General Hospital Specialized Hospital

Available Not available

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Figure 19:Intensive Care Unit 100%

31% 60% of the hospitals are with 80% 48% intensive care unit. 60%

40% 69% 52% 20%

0% General Hospital Specialized Hospital Available Not available

Figure 20:Blood bank services 100% 90% 48% of the hospitals provide blood 80% bank services. 42% 70% 60%

60% 91% There are three blood banks, one in 50% Idleb and 2 Aleppo governorates 40% outside the health facilities. 30% 58% 20% 40% 10% 9% 0% Comprehensive Health Centre General Hospital Specialized Hospital

Available Not available

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100% Figure 21: *Physical rehabilitation 90% services 80% 70% 69% Only 11% of the facilities provide 60% 83% 89% 88% 85% physical rehabilitation services. 50% 96% 97% 40% *Disabilities rehabilitation & support 30% 20% 31% 10% 17% 11% 12% 15% 0% 4% 3% Comprehensive General Health Centre Health Unit Mobile clinic Specialized Specialized Health Centre Hospital Care Facility Hospital

Available Not available

9. Provision of maternal, newborn and child health services

Figure 22:*IMCI 100% 90% 54% 26% of the facilities provide IMCI, of 33% 80% 40% which 33% partially mainly due to 46% lack of finances and trained health 70% 61% staff. 60% 76% 50% *Integrated Management of Childhood Illness 40% IMCI is an integrated approach to child health that 74% 67% focuses on the well-being of the whole child. IMCI 30% 60% 54% aims to reduce death, illness and disability, and to 20% promote improved growth and development 39% among children under five years of age. 10% 24% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Health Centre Hospital

Available Not available

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Figure 23:*Screening of acute 100% 9% malnutrition 32% 80% 47% 37% 39% 44% 65% of the facilities provide 60% 40% 91% screening of acute malnutrition, 68% 53% 63% 61% 56% compared to 60% in the previous 20% quarter. 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Hospital *MUAC or Weight for Height, and/or bilateral Health Centre pitting oedema Available Not available

Figure 24: Outpatient treatment of 100% acute malnutrition 37% 80% 45% 51% 51% 50% 60% 67% 50% of the facilities provide 40% 63% outpatient treatment of acute 55% 49% 49% 50% 20% 33% malnutrition, of which 42% with 0% limitations due to lack of medical Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Hospital supplies. Health Centre Available Not available

Figure 25: *Antenatal Care 100% 6% 90% 15% 68% of the facilities provide 27% 29% antenatal care, compared to 73% in 80% 46% 38% 70% March. 60% 85% 50% 94% 40% 85% *Antenatal Care: Assess pregnancy, birth and 73% 71% emergency plan, respond to problems (observed 30% 54% 62% and/or reported), advise/counsel on nutrition & 20% breastfeeding, self-care and family planning, 10% 15% preventive treatment(s) as appropriate 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

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Figure 26: *BEmONC 100% 90% 20% 31% 68% of the hospitals and 80% Comprehensive PHCs are providing 46% 70% 63% 71% 65% BEmONC, compared to in 60% quarter one. 89% 88% 50%

40% 80% 69% 30% *Basic Emergency Obstetric and Newborn 54% Care (BEmONC) package includes Parenteral 20% 35% 37% antibiotics + oxytocic/anticonvulsant drugs + 10% 11% 12% manual removal of placenta + removal of 0% retained products with manual vacuum Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized aspiration (MVA) + assisted vaginal delivery Health Centre Facility Hospital 24/24 & 7/7 new-born care includes: Basic new-born resuscitation + warmth Available Not available (recommended method: Kangaroo Mother Care - KMC) + eye prophylaxis + clean cord care + early and exclusive breast feeding

Figure 27:Comprehensive 100% emergency obstetric care (CEmOC)* 90% 29% 80% 49% 57% of the hospitals and the 70% 57% comprehensive health centers are 60% providing CEmOC. 50% 40% 71% 30% *CEmOC includes BEmONC +surgery+ 51% anesthesia+ blood transfusion. 20% 43% 10% 0% Comprehensive Health Centre General Hospital Specialized Hospital

Available Not available

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10. Provision of treatment for non-communicable diseases and mental health

Figure 28: Treatment of High Blood 100% 6% 14% 4% 29% 30% Pressure and Cardiovascular 80% 44% Diseases 60% 76% 74% 94% 96% of the facilities provide 40% 86% 71% 70% treatment of HBP and cardiovascular 56% 20% diseases. 24% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 29:Treatment of diabetes 100% 4% 14% 29% 26% 80% 38% 76% of the facilities provide treatment of diabetes. 60% 79% 100% 96% 40% 86% 71% 74% 63% 20% 21% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 30:Mental Health Care* 100% 90% Only 18% of the total health facilities 80% 70% provide mental health services. 21% 60% 78% 73% 78% 89% 85% 90% of PHCs provide mental health 50% 91% services. 40% 30% 20% Mental health includes: Support 10% 22% 27% 22% 11% 15% 10% of acute stress and anxiety, front line 0% 9% management of common and severe mental Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized disorders Health Centre Facility Hospital

Available Not available

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11. STI & HIV/AIDS and sexual violence

Figure 31: Syndromic management 100% of sexually transmitted infections 80% 56% 60% 67% 67% 57% 60% 80% 31% of the facilities provide this 91% service. 40% 44% 20% 40% 33% 33% 43% 20% 0% 9% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 32: HIV counselling and 100% testing 80%

60% 75% 77% Only 13% of the facilities provide 86% 89% 88% 93% 94% HIV counselling and testing. 40% 20% 25% 23% 14% 12% 0% 11% 7% 6% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 33: Clinical management of 100% rape survivors* 80% 54% 56% 65% 31% of the facilities provide clinical 60% 77% 71% 79% 76% management of rape survivors. 40% 30% of the PHC facilities and 35% of 46% 44% hospitals providing the services. 20% 35% 23% 29% 21% 24% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized *Including psychological support Health Centre Facility Hospital Available Not available

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12. Community health services

Figure 34: Health Education

Out of functioning HFs 67% of the 100% facilities provide health education 90% 23% 31% 26% services. 80% 40% 41% 35% 42% 70% 70% of the PHC facilities and 59% of 60% hospitals provide health education 50% services. 40% 77% 74% 69% 65% 30% 60% 59% 58% 20% 10% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 35:Screening for malnutrition 100% (MUAC) 90% 17% 80% 41% 51% 50% 50% 48% of the facilities provide 70% screening for malnutrition through 60% 78% 82% outreach services. 50% 40% 83% 83% of the comprehensive health 30% 59% 49% 50% 50% centers provide the screening 20% through community health workers. 10% 22% 18% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

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Figure 36: Follow up of 100% malnourished children 90% 23% 80% 36% 49% 51% 49% 50% 53% of the facilities follow-up 70% malnourished children, out of which 60% 85% 59% of the PHC facilities and 51% of 50% hospitals provide the service. 40% 77% 30% 64% 51% 49% 51% 50% 20% 10% 15% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 37:Screening for pregnancy 100% 3% for referral to ANC: 90% 16% 33% 80% 40% 35% 65% of the facilities provide 47% 70% screening for pregnancy and referral 60% for ANC. 85% 50% The highest provision of this service is 97% 40% 84% through Comprehensive centers 67% 30% 60% 65% (97%). 53% 20%

10% 15% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

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13. Gap in Health Staff

Figure 38: percentage of HFs without general medical doctors Figure 39:percentage of HFs without nurses

Specialized Hospital 33% Specialized Hospital 0%

Specialized Care Facility 41% Specialized Care Facility 21%

Mobile clinic 29% Mobile clinic 4%

Health Unit 53% Health Unit 2%

Health Centre 25% Health Centre 0%

General Hospital 14% General Hospital 3%

Comprehensive Health Centre 23% Comprehensive Health Centre 0%

0% 10% 20% 30% 40% 50% 60% 0% 5% 10% 15% 20% 25%

Figure 40: Percentage of HFs without internists Figure 41: Percentage of HFs without Paediatrician

Specialized Hospital 73% Specialized Hospital 27%

Specialized Care Facility 88% Specialized Care Facility 79%

Mobile clinic 91% Mobile clinic 86%

Health Unit 55% Health Unit 61%

Health Centre 51% Health Centre 29%

General Hospital 39% General Hospital 36%

Comprehensive Health Centre 31% Comprehensive Health Centre 6%

0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%

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Figure 42:Percentage of HFs without Gynaecologist Figure 43:percentage of HFs without Midwife

Specialized Hospital 31% Specialized Hospital 19%

Specialized Care Facility 82% Mobile clinic 39%

Mobile clinic 95% Health Unit 43% Health Unit 92% Health Centre 19% Health Centre 65%

General Hospital General Hospital 53% 53%

Comprehensive Health Centre 37% Comprehensive Health Centre 8%

0% 20% 40% 60% 80% 100% 0% 10% 20% 30% 40% 50% 60%

Figure 44: :Percentage of hospitals without surgeon

67% Specialized Hospital 44%

14% General Hospital 6%

0% 10% 20% 30% 40% 50% 60% 70%

Orthopaedic surgeon General surgeon

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Table 1: Distribution of health staff by districts/populations (Aleppo/Idleb)

Orthopedic Governorates District Population* #Hospitals #PHCs** General medical doctor General surgeon Pediatrician Gynecologist Internist Midwife Nurse CHWs Pharmacist/ dispenser surgeon

Jebel Saman 351,963 8 33 40 14 9 18 13 15 40 221 37 28

A'zaz 382,909 9 25 79 26 12 37 15 15 49 198 101 38

Afrin 305,663 1 5 14 2 2 5 7 8 8 36 7 9

Jarablus 78,444 1 9 15 0 0 11 0 2 10 33 29 7

Aleppo Al Bab 124,323 0 3 1 0 0 2 0 3 3 5 1 2

As-Safira 45,827 0 1 0 0 0 0 1 1 0 3 4 1

Ain Al Arab 128,463 0 1 1 0 0 0 0 0 0 3 0 1

Aleppo Total 1,417,592 19 77 150 42 23 73 36 44 110 499 179 86

Al Ma'ra 448,814 12 27 139 27 18 34 34 22 75 337 98 44

Ariha 183,688 3 14 12 7 4 17 9 14 33 102 34 11

Idleb 488,618 9 26 92 16 18 29 26 22 57 347 58 34

Idleb Harim 685,051 14 37 138 17 22 43 38 31 67 364 99 69

Jisr-Ash-Shugur 206,045 5 13 16 14 9 15 7 12 27 154 61 19

Idleb Total 2,012,216 43 117 397 81 71 138 114 101 259 1304 350 177

Grand Total 3,429,808 62 194 547 123 94 211 150 145 369 1,803 529 263

*population for Jebel Saman district is for the area of operation by Turkey hub.

*Total of the 4 levels of PHCs

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14. Global health indicators and benchmarks for Aleppo and Idleb a. Number of health workers (medical doctors + nurse + midwife) per 10,000 population, by administrative unit (benchmark >22 HWs for 10,000 population)

Number of Available for every Gap in Health Governorates District Population* STD No of HWs %Gap health workers 10,000 pop Workers

Jebel Saman 351,963 370 11 810 440 54%

A'zaz 382,909 431 11 881 450 51%

Afrin 305,663 82 3 703 621 88%

Jarablus 78,444 71 9 180 109 61%

Aleppo Al Bab 124,323 14 1 286 272 95%

As-Safira 45,827 5 1 105 100 95%

Ain Al Arab 128,463 4 0 295 291 99%

Aleppo Total 1,417,592 977 7 3,260 2,283 70%

Al Ma'ra 448,814 686 15 1,032 346 34%

Ariha 183,688 198 11 422 224 53%

Idleb 488,618 607 12 1,124 517 46%

Idleb

Harim 685,051 720 11 1,576 856 54%

Jisr-Ash-Shugur 206,045 254 12 474 220 46%

Idleb Total 2,012,216 2,465 12 4,628 2,163 47%

Grand Total 3,429,808 3,442 10 7,889 4,447 56%

P a g e | 24 b. Number of Community health workers per 10 000 population, by administrative unit(benchmark >=10 CHWs for 10,000 population)

Available for Number of STD No of Governorates District Population every 10,000 Gap in CHWs %Gap CHWs CHWs pop

Jebel Saman 351,963 37 1 352 315 89%

A'zaz 382,909 101 3 383 282 74%

Afrin 305,663 7 0 306 299 98%

Jarablus 78,444 29 4 78 49 63%

Aleppo

Al Bab 124,323 1 0 124 123 99%

As-Safira 45,827 4 1 46 42 91%

Ain Al Arab 128,463 0 0 128 128 100%

Aleppo Total 1,417,592 179 1 1,418 1,239 87%

Al Ma'ra 448,814 98 2 449 351 78%

Ariha 183,688 34 2 184 150 81%

Idleb 488,618 58 1 489 431 88%

Idleb

Harim 685,051 99 1 685 586 86%

Jisr-Ash-Shugur 206,045 61 3 206 145 70%

Idleb Total 2,012,216 350 2 2,012 1,662 83%

Grand Total 3,429,808 529 2 3,430 2,901 85%

P a g e | 25 c. Number of hospital beds per 10 000 population (inpatients & maternity), by administrative unit (benchmark >=10 beds for 10,000 population)

Total #Comprehensiv STD no. of Governorates District Population #Hospitals available Gap %Gap e PHCs beds beds Jebel Saman 351,963 8 3 352 174 178 51% A'zaz 382,909 9 2 383 551 -168 No gap

Afrin 305,663 1 1 306 32 274 90% Jarablus 78,444 1 1 78 23 55 71%

Aleppo Al Bab 124,323 0 0 124 3 121 98% As-Safira 45,827 0 0 46 3 43 93% Ain Al Arab 128,463 0 0 128 1 127 99% Aleppo Total 1,417,592 19 7 1,418 787 631 44% Al Ma'ra 448,814 12 4 449 355 94 21%

Ariha 183,688 3 1 184 94 90 49% Idleb 488,618 9 5 489 313 176 36%

Idleb Harim 685,051 14 3 685 472 213 31% Jisr-Ash-Shugur 206,045 5 3 206 116 90 44% Idleb Total 2,012,216 43 16 2,012 1,350 662 33% Grand Total 3,429,808 62 23 3,430 2,137 1,293 38% d. Number of HF with Basic Emergency Obstetric Care/ 500 000 population, by administrative unit benchmark >= 4 BEmOC/500 000)

Governorates District Population Available BEmOC STD no. of BEmOC HFs Gap Jebel Saman 351,963 12 3 -9 A'zaz 382,909 11 3 -8

Afrin 305,663 4 2 -2 Jarablus 78,444 2 1 -1

Aleppo Al Bab 124,323 1 1 0 As-Safira 45,827 0 0 0 Ain Al Arab 128,463 0 1 1 Aleppo Total 1,417,592 30 11 -19 Al Ma'ra 448,814 21 4 -17

Ariha 183,688 6 1 -5 Idleb 488,618 15 4 -11

Idleb Harim 685,051 22 5 -17 Jisr-Ash-Shugur 206,045 9 2 -7 Idleb Total 2,012,216 73 16 -57 Grand Total 3,429,808 103 27 -76 P a g e | 26

e. Number of HF with Comprehensive Emergency Obstetric Care/500 000 population, by administrative unit (benchmark >= 1 CEmOC/500 000)

Governorates District Population Available CEmOC STD no. of CEmOC HFs

Jebel Saman 351,963 8 1

A'zaz 382,909 8 1

Afrin 305,663 1 1

Jarablus 78,444 3 0

Aleppo Al Bab 124,323 0 0

As-Safira 45,827 0 0

Ain Al Arab 128,463 0 0

Aleppo Total 1,417,592 20 3

Al Ma'ra 448,814 13 1

Ariha 183,688 4 0

Idleb 488,618 10 1

Idleb

Harim 685,051 15 1

Jisr-Ash-Shugur 206,045 4 0

Idleb Total 2,012,216 46 4

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T - b r q e i a a l l d Health severity scale Jawadiyah Severity scale:Health Access + Health services availability (HeRAMS) + People in Need of Health Services Darbasiyah Ain al Arab Turkey Jarablus Ghandorah Raju Tell Sharan Suran Ar-Ra'ee Abiad Ma'btali A'zaz Aghtrin Aleppo Afrin Suluk Jandairis Ein Issa Al-Hasakeh Mare' Al Bab Daret Harim Dana Azza Jebel Qourqeena Saman Atareb Maaret Zarbah Teftnaz Darkosh Tamsrin µ Bennsh Banan Ar-Raqqa Janudiyeh Idleb Badama Rabee'a Jisr-Ash-Shugur Abul Tall Idleb Thohur Ed-daman Ziyara Ehsem Ma'arrat Mhambal An Nu'man Kafr Sanjar Cyprus Nobol Heish Lattakia Madiq Khan Tamanaah Castle Shaykun Hamra As-Saan Kafr Suran Zeita Tartous Hama Mediterranean Deir-ez-Zor Sea Ar-Rastan Tartous Taldu Homs Homs

Lebanon

Raheiba Rural

Harasta Duma Damascus Damascus Damascus Iraq Babella Severity scale

Bait Jan Kisweh Dhameer Sa'sa' 1 Dar'a 2 As-Sanamayn 3 Hrak As-Sweida 4 Dar'a Jordan West 5 6 Bank