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August 2020 Fig.: Al Resala Foundation- Triage Point in Al Resala PHC Afrin

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August 2020 Fig.: Al Resala Foundation- Triage Point in Al Resala PHC Afrin HEALTH CLUSTER BULLETIN August 2020 Fig.: Al Resala Foundation- Triage point in Al Resala PHC Afrin. Turkey Cross Border Emergency type: complex emergency Reporting period: 01.09.2020 to 30.09.2020 12 MILLION* 2.8 MILLION 3.7 MILLION 25**ATTACKS PEOPLE IN NEED OF HEALTH PIN IN SYRIAN REFUGGES AGAINST HEALTH CARE HEALTH ASSISTANCE NWS HNO 2020 IN TURKEY (**JAN - SEPT 2020) (A* figures are for the Whole of Syria HNO 2020 (All figures are for the Whole of Syria) HIGHLIGHTS 137 HEALTH CLUSTER MEMBERS • By the end of the month, over 1,000 SARS-COV-2 41 IMPLEMENTING PARTNERS REPORTING were confirmed from NWS. Of all cases, 16% are MEDICINES DELIVERED1 health care workers (physicians, dentists, nurses, TREATMENT COURSES FOR COMMON 1,024,800 pharmacists and medical/clinical technicians), DISEASES plus an additional 8.7% are ancillary staff working FUNCTIONAL HEALTH FACILITIES HERAMS in healthcare facilities. 150 FUNCTIONING FIXED PRIMARY HEALTH • Two aid workers from the Turkish Red Crescent CARE FACILITIES Society (TRCS) were attacked, one was reported 63 FUNCTIONING HOSPITALS dead the other injured. In addition, several staff 63 MOBILE CLINICS members of Syria Relief and Development (SRD) HEALTH SERVICES2 were injured in separated violent events. 776,716 CONSULTATIONS • New mental health consultations and follow-ups DELIVERIES ASSISTED BY A SKILLED 9,208 by the end of September totalled 69,732, which is ATTENDANT 112% of the all such services provided in the year 14,711 REFERRALS 2019 i.e. 62,099. 865,840 MEDICAL PROCEDURES • The COVID-19 pandemic has unveiled the huge 35,305 TRAUMA CASES SUPPORTED 1,511 NEW CONFLICT RELATED TRAUMA CASES challenges and risks health workers are facing VACCINATION globally such as working in stressful environments which makes health workers more prone to errors 9,785 CHILDREN AGED ˂1 VACCINATED3 which can lead to patient harm. Therefore, the MENTAL HEALTH SERVICES World Patient Safety Day 17 Sept 2020 theme was ‘Health Worker Safety: A Priority for Patient Safety’ 9,835 MENTAL HEALTH CONSULTATIONS with a slogan “Safe health workers, Safe patients”. DISEASE SURVEILLANCE • The Syrian Pound depreciation and the Turkish Lira SENTINEL SITES REPORTING OUT OF A 463 spread in the NWS markets creates serious TOTAL OF 471 operational challenges for the humanitarian actors WOS HEALTH HRP & COVID-19 2020 FUNDING $US4 working in the NWS. HRP RECEIVED $96.7 M (21.8% funded) • 25,387 cases of cutaneous leishmaniasis were COVID19 IN 2020 $66.1 M (41.9% funded) diagnosed so far in 2020. 1 Supplies were cross border delivered by the WHO Gaziantep Hub and distributed to implementing health cluster partners in northwest Syria. 2 Figures reported and updates are from 1 – 30 September 2020. 3 Routine immunization with pentavalent vaccine (5 in 1 vaccine) 4 Source: OCHA Financial Tracking System, Syrian Arab Republic Humanitarian Response Plan (HRP 2020) as of 30 September 2020. https://fts.unocha.org/ 1 Situation Update: Even though two violent attacks involved the humanitarian community during the month of September, in many aspects, since the cease fire of the 6 March, the Syria armed conflict is slowing down. Large-scale military operations are not happening with the exception of the Southern tip of Idleb and northern Hama governorates. As well, with the exception of the northwest, virtually no frontlines remain actively contested, and since mid-2018, the Government of Syria has presided over all of ‘useful Syria’, the Aleppo-Damascus- Homs axis, without serious challenges.5 In 2020, the armed conflict has taken a second role, and so far this year the worsening of the economic crises with the devaluation of the Syrian Pound and the ongoing coronavirus (SARS-COV-2) pandemic outbreak are the leading scenarios at the main stage. In regard to the economy, the devaluation of the Syrian Pound (SYP) has been unprecedented as seen in the SYP/USD conversion rates in 2020 when compared to 2018 (-insert table on right), affecting the salaries of government employees, the public sector which includes healthcare workers. By contrast, is been reported specially in the NWS that armed group salaries have grown, creating a pool for mercenaries as seen by the reported increase number of Syrian military recruitments been used in Libya and other armed conflict countries. Furthermore, the Turkish Lira (TL) found a way to circulate in NWS via circulars issued in both Idleb and Northern Aleppo mandating the use of Turkish Lira and or banning the use of SYP. Both, SYP depreciation and TL spread in the NWS markets creates serious operational challenges for the humanitarian actors working in the NWS. As Syria’s economic deterioration persists, the been established economic, military/political, and geographical boundaries within the Syrian Arab Republic are likely to be further defined in the months to come. As the economic situation worseness in the NWS and the state defragmentation , as well is the COVID-19 outbreak. By the end of the month of September, 1,072 cases have been confirmed positive for SARS-COV-2 causative agent of COVID-19, with 526 cases recovered and 6 associated deaths. Besides the obvious risk of virus transmission in the communities and into the IDP camps, a worrisome seen behavior are the refusal of suspected contacts and/or asymptomatic/mild cases to be quarantined and isolated for the required 14 day. Furthermore, the number of cases within the healthcare workforce and among the humanitarian workers is staggering. Of all cases, 172 (16%) are 100 90 health care workers; 80 70 such as physicians, 60 50 dentists, nurses, 40 30 pharmacists and 20 10 various medical / 0 clinical technicians. In 9 20 301 10 20 301 10 20 30 addition to, another 8.7% are ancillary July August September staff working in healthcare facilities. Fig. Epi-curve – Laboratory-confirmed COVID-19 Cases in Northwest Syria (9 Jul - Sept 30, 2020) @WHO Some of the local de-facto authorities, such as the ‘Syrian Salvation Government’ (SSG) in Idleb issued a circular closing all wedding halls, public swimming pools, gyms, amusement parks, private educational institutions and restaurants for a week as precautionary measures from COVID-19. As well, the Local Council in Jarablus town in northern Aleppo governorate issued a circular to close cafes, restaurants and barber shops and all residents are asked to wear masks and implement physical distancing rules while vising public markets. Both these actions/recommendations were welcome but did not lasted. The Health Cluster NWS COVID-19 Taskforce continues to advocate for preventive measures at both community and health facility level in attempt to mitigate the further spread of the outbreak and aim to decrease avoidable morbidity and mortality. 5 https://coar-global.org/2020/09/30/the-economy-of-war-in-syria-armed-group-mobilization-as-livelihood-and-protection-strategy/ 2 Public health risks, priorities, needs and gaps • The significant and increasing number of SARS-COV-2 infected healthcare workers is a public health risk for both the community and the patients’ safety. In addition, there is a potential of a foreseen collapse of the health service delivery if the contagion is not control. • Due to the community transmission of the virus, there is risk of disruption to routine immunization activities due to both COVID-19 related burden on the health system and decreased demand for vaccination because of physical distancing requirements or community reluctance. The high potential for vaccine preventable diseases (VPD) outbreaks makes it imperative for the NWS to maintain continuity of immunization services wherever services can be conducted under safe conditions. • Seen the spread of the virus within the health staff, scaling-up of testing for health care workers (HCWs) is needed with a special focus on those who are working in COVID-19’s designated health facilities (e.g. hospitals, CCTCs) and those caring for the vulnerable groups such as in TB clinics, dialysis centres, etc.. • There are increasing demands on testing in the next period as cases increases there is the need of strengthening the contact tracing and expanding the screening to the affected population. • Sigma and possible discrimination against the positive cases inside the communities are playing an important role in creating high resistance from the “contact cases” to be place on isolation and/or quarantine facilities. • Infection and Prevention Control measures need to be rigorously implemented not only at health facilities but at communities and camp settings, therefore, camp managers need to be aware on preventive activities and to emphasize on the public use of fabric face masks, physical distancing, avoiding mass gatherings and other measures as recommended by WHO guidelines. • Due to shortage of masks in the market, there is a need to enhance the local procurement and production of fabric masks in the field. This should be done in line with the COVID-19’s taskforce recommendations and WHO’s global guidelines for fabric mask production and usage. • Multi-Drug Resistance (MDR) Tuberculosis and as well visceral leishmaniasis cases are raising in NWS. Health Cluster Coordination and Service Delivery As for the Cluster coordination regular activities, two virtual bi-weekly and one ad-hoc Health Cluster meetings were held in the month of September and attended by more than 80 health cluster partners and stakeholders. In addition, the NWS Health Cluster COVID-19’ Taskforce continue to meet biweekly and ad-hoc as required by the ongoing outbreak needs. A Health Cluster benchmark for the month of September, was to resume the process for the Health Cluster Co-Coordination position, a post vacant for almost 2 years after a couple of unsuccessful attempts for a transparent election process and insufficient participation/quota of active Health Cluster partners. The nomination was opened with an expectation to have a Co-Coordinator from an active cluster partners in early October.
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