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Draft, the Minutes of Health Working Group Meeting, Syria 24 April (Tuesday), 10:00 – 12:00

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Draft, the Minutes of Health Working Group Meeting, Syria 24 April (Tuesday), 10:00 – 12:00 Draft, the Minutes of Health Working Group Meeting, Syria 24 April (Tuesday), 10:00 – 12:00 Present: UNHCR, UNICEF, EU Delegation, WHO, Danish Red Cross, MSJM, Dorcas, Al Sham Association, SSSD, OCHA, UNRWA, SARC, UNFPA, Medair, Canadian Red Cross, ICRC, ICMC/PoM, Tamayouz, IMC. COORDINATION Attendance of health sector meetings 2018 The latest attendance of national health sector meetings (January – April 2018) was demonstrated. Organizations were requested to improve participation and contributions in these meetings. Violence against health care The sector remained deeply concerned for the safety and protection of tens of thousands of civilians following the recent intensification of hostilities around besieged Yarmouk and surrounding areas. Recent air and ground strikes have reportedly resulted in civilian deaths and injuries, as well as displacement from Yarmouk camp to the neighboring area of Yalda. Prior to the recent hostilities, the United Nations estimated that there were 6,000 Palestine refugees living in Yarmouk refugee camp, not including tens of thousands of civilians in surrounding areas. In total, there are some 12,000 Palestine refugees living in the area around Southern Damascus. Statement (17 April) by Ramesh Rajasingham, Deputy Regional Humanitarian Coordinator for the Syria Crisis, on ongoing violence against health facilities was shared. When addressing the advocacy on issues around violence against health care, it is proposed to have a look and consider different aspects of it, including: GoS attacks on health facilities and health care workers in non GoS controlled areas. Attacks by non-state armed groups on health facilities and workers, civilians in GoS controlled areas. The impact on health infrastructure and its destruction in north-east Syria as a result of actions of the International Coalition. Most public PHC centres and hospitals in the north-eastern governorates of Ar-Raqqa, Al-Hasakeh and Deir-ez-Zor have been forced to close as a direct result of the Coalition’s military offensive. The lack of access to health facilities – often by creating impossible conditions for health care workers – is another important issue. The Kurdish Self-Administration (KSA) in north-east Syria has systematically prevented MOH staff from working in the area; as a result, thousands of Syrians have been deprived of access to health care. The KSA is creating a parallel health structure, which raises questions of legal governance and capacity. Parts of northern Syria are now under Turkish occupancy with no information on the status of health care facilities in these areas (e.g., Afrin). The militarization of health facilities - for example, KSA military and intelligence currently occupy functioning PHC centres in north-east Syria. Most of the public health facilities in the areas under the control of non-state-armed groups have been used by military personnel and have been destroyed. All of this has put a tremendous impact on health care. Our role remains the same – to consistently and strenuously advocate with all parties of the conflict for safety and protection of health care. Response to eastern Ghouta and Afrin displacement Afrin MoH/MoHE, Syrian Arab Red Crescent (SARC), International Committee of Red Cross (ICRC), WHO, UNICEF, UNFPA, National NGOs (Al- Ihsan Charity, Al-Berr w Al-Ihsan Charity, Syrian Family Planning Association (SFPA), Monastery Saint James the Mutilated (MSJM), Al-Taalouf Charity) IDPs key locations are covered. 16 medical mobile teams and 1 public health clinic are supported by the sector. 5 mobile clinics and 6 health facilities (DoH/SARC) have been mobilized through the support by the health sector. 37,500 outpatients medical consultations are provided on a weekly basis. Shipments of health supplies are delivered to SARC. A survey of drinking water sources is conducted in Fafin, Kafar Naya (IDPs locations) in coordination with SARC. SARC facilitates the referral system to Zahraa local hospital with 4 ambulances. The sector supports also the referral to the secondary and tertiary health care (30 patients, including 16 pregnant women). 33 registered kidney failure patients are treated in SARC Nubul dialysis center. Vaccination teams reached 1,450 children between 1 and 15 years-old (in Fafin, Ehres, and Tal Refaat). The routine vaccination programme is also active in Nabul, Zahraa, and Meskan DoH point. DoH mobile team has 12 monthly visits target 12 deferent locations in Azzaz health district on vaccination and active disease case finding (the sector supports operational costs) Coordination with DoH and SARC is ongoing to facilitate medical evacuations, as approval was received from MoFA to facilitate medical evacuations for IDPs who fled from Afrin and are currently in Nabul, Zahra and surrounding villages to the city of Aleppo. Response to Afrin is not sufficient and health sector partners should enhance their operational presence. Eastern Ghouta: MoH/DoH, SARC, ICRC, WHO, UNICEF, UNFPA, UNHCR, IMC, Syrian Family Planning Association. Monastery Saint James the Mutilated, Qara – Syria, Dummer Youth Charity, Al Qutaifah Health Charity, Circassian Charity, Tamayouz For Orphan Sponsorship/ Social Care Association, Al Sham association, Al Qutaifah Health Charity, Islamic Association, Association for Poor charity, Nour Foundation For Relief And Development, Union Of Charitable Associations, Zahret Al Madaien Association, Lamset Shifa Association, Syria Pulse. Support to 85 medical mobile teams, clinics, mobile health units and medical points have been mobilized. Up to 22,000 outpatient medical consultations, including for children under 5 years, integrated reproductive health services and psychosocial support, are continuously provided on a daily basis across the shelters. Medical teams reach areas outside the shelters, such as Kafr Batna, Ein Tarma, Arbin, Saqba, Zamalka, Hazzeh, Harasta, Douma. 3 PHC centers were opened in Saqba, Hazzeh and Ein Tarma. Support with operational costs for 350 DoH personnel. Support in place for family planning, antenatal care including ultrasound scans and supplements, natural deliveries, postnatal care, treatment of reproductive tract infections and referral of high risk pregnancies to public health facilities. Vaccination activities covered an estimated of 2,000 children. 10 teams of trained community psychosocial support workers providing basic psychological interventions, educational and recreational activities. People with mental health conditions received psychological and /or pharmacological interventions. People in need for medical assistance were identified and referred by the MHPSS teams to receive the needed health care and medicines in the shelters. An estimated 5,000 people benefit weekly from this program. 19 EWARS (An early warning and response system) sentinel sites are supported. Increased EWARS coverage in IDP shelters through assigned DoH EWARS focal points to provide systematic weekly reporting inside 6 shelters as well as assigned central rapid response teams to conduct daily visits for investigation of any emerging outbreaks or diseases. The approval of MoFA has been received to conduct a joint MoH/SARC/WHO public health assessment in eastern Ghouta. The composition of the team is defined: 2 epidemiologists, 2 health sector coordinators, 1 public health officers and 1 Information Management Officer. The plan includes visiting all 25 public health facilities across EG and in addition to carry out community based assessments. Technical consultations are being held with MoH and SARC. The approval of MoFA was received to deploy the surge health sector coordinator who will provide lead for a coordinated and effective health sector response. 1078 injured and critically ill patients referred to Damascus hospitals (from the beginning of the displacement) and under health monitoring. Health supplies provided to SARC and DoH Rural Damascus. Inputs to OCHA situation reports are being provided. Earlier disseminated UNHCR shelter sheets should be disregarded as not reflective of health sector coverage. Among other points follow up actions were discussed: Remaining challenges and lack of clarity among the health workers on the ground on hospitalization of patients outside the shelters and within eastern Ghouta. Organizations are requested to work closely with DoH medical teams and centers established inside eastern Ghouta for hospitalization. Note: DoH medical teams reach areas outside the shelters, such as Kafr Batna, Ein Tarma, Arbin, Saqba, Zamalka, Hazzeh, Harasta, Douma. 3 PHC centers were opened in Saqba, Hazzeh and Ein Tarma. Requests for hospitalization should come from these 3 PHC centers. SARC and partners objectives are to roll out and enhance service provision inside eastern Ghouta which will minimize eventually the number of people in need of transportation and hospitalization in Damascus public hospitals. The issue of the use of private hospitals is not being considered. SARC deploys ambulances inside and outside of shelters. Considering the decreased number of people remaining in shelters, SARC objective is to have 1 assigned ambulance per 3 shelters (depending on the size of population). There is a need to deploy more teams inside eastern Ghouta, including Douma and Saqba (as example). There are many people who have stayed in different locations across eastern Ghouta and in need of continuous health care (at PHC and secondary levels). SARC plan to have established Emergency Health Points (EHP)
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