WHO : SITUATION REPORT (7 February – 7 March 2020).

I. General Development, Political and Security Situation

✓ The security situation in the AOO remains unstable and volatile, with the main hot spots remain in Al- Hasakah, Ar-Raqqah, Aleppo, Latakia, Daraa and governorates. ✓ During the reporting period, NSAGs advanced on two different axes in southern and eastern rural Idlib and managed to regain control over several towns in front (eastern rural Idlib) and in Kafr Nobl front (southern rural Idlib). ✓ The UN on March 2nd conducted a one-day inter-agency mission in northwestern Syria to "better understand the humanitarian realities on the ground and to assess the feasibility of a sustained UN presence there." In a statement, Kevin Kennedy, the regional humanitarian coordinator for the Syria crisis, said “the need for humanitarian aid and protection is growing more desperately every day in northwestern Syria”. ✓ Syrian Arab army units entered Saraqeb on 02 March, an strategic city on Aleppo-Damascus international highway in Idleb governorate after expelling the Turkish r backed- armed groups from the area.

II. Highlight of WHO key achievements for January 2020

• 50% % of public hospitals are either partially functioning or non-functioning as assessed by HeRAMS • 53% % of public health centres are either partially functioning or non-functioning as assessed by HeRAMS • 575,900 # of delivered treatment courses provided • 65 Total weight (tons) of regular deliveries across the country including IA convoy • 95% % of sentinel sites submitting weekly surveillance reports • 93,250 # of children under 5 screened • 13 # of national NGOs as implementing partners • 44,493 # of PHC outpatient consultations provided by WHO partners • 8 # of people with disabilities assisted by WHO partners

Highlights of attacks on health care during January 2020 at WoS level • 2 Total Attacks • 0 Killed • 1 Injured • 2 Total Attacks • 0 Killed • 1 Injured

1

III. WHO Response

Non-Communicable diseases & Primary health care:

NCD program: ✓ Thalassemia sectoral meeting was held to discuss and agree on the way forward to alleviate burden of disease and to reduce its prevalence among the new generation, under the MOH slogan (Syria free of Thalassemia). Capacity building: ✓ Strengthened the capacity of medical staff on PHC & NCD topics including Tobacco cessation clinics, NCDs early detection, prevention and management approaches with a focus on WHO PEN protocols, data entry for diabetes registry, Essential Health Service Package including NES governorates, with a total of 200 trainees. 2 ✓ Oral health project is still ongoing in EG schools targeting students to ensure dental examination, prevention and treatment measures along with health promotion sessions for both students and teachers. So far, a total of 4689 students were reached with health promotion sessions, and 16,738 oral health services were provided including promotion, preventive and management interventions in addition to 82 teachers covered with health promotion activities.

Trauma ✓ Conducted a meeting for the Physical Rehabilitation Working Group in Syria. The participants included MOH, SARC, UN agencies (UNFPA, UNHCR and UNDP) and NGOs (Dorcas, ICRC and MEDAIR) with operational update per group members and key priority actions coordinators . ✓ Trained 175 MOE staff and health workers on trauma and disability related topics in five governorates (Lattakia, Homs, Hama ,rural Damascus and Damascus). ✓ Prepared a concept note regarding the launching of a national integrated approach to improving access to assistive technology in Syria in collaboration with the regional office. It includes conducting a system capacity assessment (using the WHO global tool) to inform the development of a national action plan to improve access to assistive technology (guided by the regional action framework).

Immunization ✓ The first national polio campaign in 2020 was conducted during the period 16-20/2/2020 targeting all U 5 children, the total target was 2,804,279 children. During the campaign MOH reached 2,632,605 children ( coverage rate 93,9%). Field workers reached most of the targeted children except for Idleb and Jarables due to the security situation there .The campaign was implemented through health centers and mobile teams. 4198 fixed officers were working in the health centers in addition to 4693 mobile teams working in the field in most of the governates .The independent monitoring was 76% conducted by finger markers and 89% by family recall . WHO covered the operational cost of the campaign including (transportation for vaccines delivery and incentives for field workers). ✓ Development of Comprehensive Multiyear plan where 4 experts from the regional office supported the finalization of the 2021-23 plan in coordination with EPI managers of all the 14 governorates in Syria and senior leading MOH officers. ✓ The country office was represented in the Seventh Inter-Country Meeting of WHO Polio Staff of the Eastern Mediterranean Region Amman, Jordan. 24 -27 February 2020. Discussions dealt with achievements, main concerns and challenges to the program and the way forward in the midst of an ongoing Polio virus circulation in the EMR. Proposed mitigating measures were put in place for children protection through strengthening surveillance and quality vaccination activities.

Mental Health ✓ Continuing coordination with WHO GZT MH for medevac of 78 mental health patients to Ibn Khaldoun hospital with partners on the ground “ Ibn Khaldoun-SARC-OCHA”, with full support of WCO senior managers. ✓ Providing comprehensive, integrated and responsive mental health and social care services in community- based settings. ✓ Translating IASC MHPSS guideline “ Briefing Note on Addressing Mental Health and Psychosocial Aspects of COVID-19 Outbreak- Version 1.1” into Arabic, after obtaining the EMRO technical advisor approval , with IASC MHPSS RG permission. Arabic translation could be found in the link below: https://interagencystandingcommittee.org/iasc-reference-group-mental-health-and-psychosocial-support- emergency-settings/briefing-note-about ✓ Initiating a Task force on the level of MHPSS TWG. The outcome of coordination efforts will re-shape the preparedness plan over time to achieve best results at health facilities , community, schools and other social facilities. ✓ Integrating the MHPSS component in the developed UN staff safety plan. ✓ Conducting several workshops for MHPSS program as follows : mhGAP and mhGAP refresher workshops for MoH and NGOs doctors in different governorates, PFA and self-care strategies in emergency response areas

3 in Aleppo with GBV component. Also, supervisory sessions were organized on country level for trained health and community workers on different MHPSS programmes. ✓ MHPSS workers in 9 MMTs teams with 5 NGOs are engaged in NWS emergency area with further need for scaling up the provision of services according to the current escalation of violence and the newly gained areas by GoS, and Affrin response, and HTR areas in the eastern rural areas of Aleppo. ✓ Updating NES emergency response, promoting coordination with partners at Qamishli hub and with other health partners in the field who are providing MHPSS services, taking into consideration the updating of psychotropic medications and capacity building activities needs. ✓ MHPSS services were provided at different locations across NES and NWS, through many modalities: " static health facilities, mobile teams, family wellbeing centers, and caravans" providing mainly psychological first aid, basic counselling for newly IDPs and traumatized population and mhGAP consultations' in health facilities as well as raising awareness sessions.

Nutrition and Child Health ✓ Holding an annual review meeting with directors on nutrition from all governorates to review the 2019 plan and follow up on the 2020 workplan. ✓ Holding an annual review meeting with directors on new borne care at home program with the participation of representatives from 6 governorates to review the 2019 plan and put 2020 plan . ✓ Data collection at 828 health centers of nutrition surveillance ( 9350 services ) , admissions of complicated severe acute malnutrition at 25 stabilization centers ( 95 admissions ) , new borne care at home program in 44 healthy villages ( 992 home visits ) , IMCI program in 202 health centers ( 2523 services ) , neonatal resuscitation program in 36 hospitals ( 3143 services ). ✓ Training UN and NGO’s health workers on how to implement the new borne care at Home program in AL Hol camp .

Secondary Health Care ✓ Supporting Basma NGO with cancer medicines and medical equipment needed for the planned expanded unit for children cancer care, in addition to supporting MOHE as well. ✓ Supporting hospitals in Damascus, Lattakia, Aleppo, Homs, Hama, Tartous , Hassakeh ,Der Zour and Raqqa with basic medical equipment for ICU, operation theaters, dialysis units in addition to supplies needed for IPC interventions, as follows: ✓ Damascus: - Al Assad university hospital: 2 Patient Monitor. - 2 Monitor Battery for Draeger Anesthesia Machine to MOH central warehouse ( final lend user TBC). - Pediatric hospital: 4 neonate/infant ventilators. Aleppo: - Aleppo university hospital :1 infant ventilator for pediatric department, 200 vials of Albumin. Hassakeh: - CADUS hospital at Al Hol IDPs camp :1 patient monitor & 1 ventilator for adults/ children. - Qamishli national hospital : 5 sphygmomanometer devices, 1 otoscope, 20 Tourniquet for the self- injection ,1 ultrasound machine, 2 patient monitors, 300 vials of Metronidazole 500mg/100ml, solution for intravenous infusion. - WHO contracted Al Hayat hospital : 50 bottles of Antiseptic hand soap solution in 1 Liter ,20 Tourniquet ,1 oxygen concentrator, 1 dry sterilizer, 1 infant ventilator, 1 defibrillator, 1 ultrasound machine, 1 operating ceiling light, 6000 Normal saline IV fluids, 800 IV infusion sets, 100 Ampoules of Metronidazole ,2 pulse oximeter, 2 otoscpes,5 sphygmomanometer, 300 Ampoules of propofol for anesthesia . - Al-Hikmeh contracted hospital :5 sphygmomanometer, 1 pulse oximeter, 3990 bags of Sodium chloride IV fluids,1000 Ampoules of Metronidazole, 70 bottles of Antiseptic hand soap,35 Alcohol hand rub in 1 Liter bottle, 20 Tourniquet. 4 Raqqa: - Al Tabaqa national hospital: 5 sphygmomanometer, 1 otoscope, 500 dialysis sessions for adults, ,30 soap ,20 Alcohol, 20 Tourniquet, 1 adult/children ventilator, 800 IV infusion sets. - Al Raqqa national hospital :5 sphygmomanometer, 1 otoscope, 1000 dialysis sessions, 1 dialysis machine, 30 antiseptic hand soap, 20 Alcohol hand rub, 20 Tourniquet, 1 children/infant ventilator, 1 operating light , 800 IV infusion sets, 1 oxygen concentrator. ✓ Conducting two workshops to strengthen the capacity of MOH staff at Public Health Reference Laboratory and other lab technicians at the governorates’ level on infection control and patient safety protocols to prevent hospital acquired infections (Nosocomial infections). Total number of trainees: 60. ✓ Strengthening the capacity of medical staff on secondary and tertiary health care services covering several topics: infection and prevention control guidelines, patient safety, pharmaceutical control. Total number of trainees : 90.

Communicable Diseases, Surveillance and WASH

EWARS and epidemiological updates at national level (week 6,2020-week 9,2020) Surveillance performance: • A total of 1184 out of 1283 active reporting sites (92.3%) in all 14 reported through early warning alert and response system (EWARS) with 91.1 % of timeliness. • 32 newly recruited as following: (12) Al-Hasakeh, (10) Hama ,(5) Aleppo, (4) Ar-Raqqa, and (1) Deir-ez-Zor • Total number of consultations was 1 259 274. 50.4% of the cases were among females and 43.2% were among children under 5 years. • Out of the 1 259 274 total consultations, a total of 166 301 EWARS notifiable cases were reported.

Morbidity: The leading causes of morbidity among all age groups were influenza-like illnesses, and acute diarrhoea. The breakdown was as follows: o Influenza-like illness (ILI): 110 740, accounting for 66.6% of total cases. Most cases reported from Aleppo, Lattakia and Tartous. o Acute diarrhoea (AD): 31 911 (19.2% of total cases), most reported from Deir-ez-Zor, Idleb, and Lattakia. o Acute jaundice syndrome (AJS): 1 813 most reported from Deir-ez-Zor, Ar-Raqqa, and Idleb. o Sever acute respiratory infections (SARI): 2 738, most reported from Tartous, Hama and Damascus. o Suspected measles (SM): 120, most reported from Ar-Raqqa, Idleb, Dara’, and Aleppo. o Acute flaccid paralysis (AFP): 28, most reported from Hama, Ar-Raqqa, and Damascus. o For the “other diseases” category 18 496 cases were reported, with the most reported cases is leishmaniasis (7 273) , most reported from Aleppo, Deir-ez-Zor, and Al-Hasakeh

Proportion of Morbidity of top 5 diseases among the total consultation between week 10,2019 and week 9,2020 15.0%

10.0%

5.0% Percentage 0.0% 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 Week Number

ILI AD LSH LIC SCA

EWARS and epidemiological situation in Al-Hol camp (week 6,2020-week 9,2020) Surveillance performance: • Total number of reporting sites is 22. 5 • Average completeness of reporting 97.8%, and average timelines is 100%. • Total number of consultations were 31 479. 56.4% of the cases were among females and 50.9% were distributed among children under 5 years. Morbidity: • Out of the 31 479 total consultations, 6 564 EWARS notifiable cases were reported. • The leading causes of morbidity among all age groups were influenza-like illnesses (72.8%/4 781) then acute diarrhoea (16.5%/1086). • 3 suspected measles cases weres reported, the tree cases were above five years old • Zero cases of AFP reported.

Public health responses COVID-19 • As of 29 February, no suspected case of COVID-19 were reported in Syria. • WHO has supported MOH to rapidly detect, diagnose, and prevent the further spread of the virus in line with IHR (2005). There are 8 pillars of the preparedness and response activities for COVID-19:

1. Coordination: a. A Joint MOH/WHO workshop was conducted from 2 and 3 February in Damascus. More than 50 MOH officers participated and discussed the preparedness and response plan, investigation, and laboratory procedures. b. MOH finalized a national plan for COVID-19, which also identifies the roles of other ministries, such as Transportation, Interior, MOA, and MOE. c. WHO and MOE, in collaboration with MOH and UNICEF conducted a 2 days’ workshop for 50 school personnel from 14 governorates between 17 and 18 February. 2. Risk communication: a. MOH conducted a workshop for 25 journalists to officially address the current situation of the country. b. WHO distributed more than 60,000 IEC materials and post awareness messages through SNS and media. c. WHO conducted several awareness sessions to UN agencies and NGO partners. 3. Surveillance, rapid-response teams, and case investigation: a. Severe acute respiratory infection cases and unusual event have been reported through EWARS in 14 governorates. b. WHO supported MOH to develop reporting format and conduct workshop for surveillance officers. 4. Points of entry: a. In total, there are 14 designated points of entry in the country (Damascus, Rural Damascus, Homs, Tartous, Dara’, Deir-ez-Zor, and Lattakia and Qamishli). MOH, in collaboration with the ministries of Transportation and Interior, entry screening measure has been taken, including temperature measurement and travel history to detect suspected cases. b. WHO provided guidance documents on measurement at POE and developed passengers location cards and printed and delivered 10,000 copies. c. Developed banner for IEC 5. National laboratories: a. During the reporting period WHO has provided two test kits for COVID-19 that can cover 200 tests as well as laboratory supplies and PPE (400 gloves, 50 medical masks, 100 surgical masks, 10 googles, 20 aprons and 20 safety boxes). ✓ As of 10 April 2020, , WHO has delivered 62 screening kits (5952 reactions), 7 confirmatory testing kits (384 reactions), 4000 lab swabs, 30 extraction kits (1500 reactions), 5 PCR machines, and PPE. More lab equipment and testing kits are in the pipeline. In addition, to expand the lab diagnosis capacity at MOH, WHO is supporting the rehabilitation of a designated laboratory for COVID-19 on an entire floor in CPHL; which was equipped with two fixed air-conditioners and four laboratory refrigerators to assure proper handling of samples. ✓ WHO conducted a training workshop for 10 MOH laboratory technicians for diagnosis of COVID-19 from 18 to 19 February. 6 6. Infection prevention and control: a. WHO provided MOH with PPE ( 1000 medical masks,10,000 surgical masks, 2000 gloves, 17,000 disposable gowns, 200 googles), 500 alcohol hand rub, and 50 stethoscopes on 3 February. 7. Case management: a. WHO also provided MOH with a portable X-ray on 3 February. 8. Operational support: a. WHO to procure additional PPE and medical equipment to cover the need of 14 governorates.

Influenza • An increase of proportional morbidity of influenza-like illness (ILI) and severe acute respiratory infection (SARI) has been observed. This trend is in line with the seasonality of the diseases considering that the same trend was observed in the previous two years.

Figure 6: Proportion of ILI cases among EWARS total consultations

( week 1-52,2018,2019,2020)

15.0%

10.0%

5.0% Percentage

0.0% 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031323334353637383940414243444546474849505152

Week Number

2018 2019 2020

Figure 7: Number of SARI cases between week 10,2019 and week 9, 2020 761 800 700 680 600

500

400 300

Number of cases of Number 200 100 0

Week Number

Tuberculosis ✓ WHO delivered three GeneXpert systems and testing cartridges to the National TB Programme. The delivered system will contribute to scaling up the TB laboratory up to more than 60% of their capacity. The related kits will cover testing of 2400 sputum samples plus 1200 body fluid samples. Also 45,000 Vit B6 was secured to support multi drug resistant patient from side-effects of TB medicine. • 2 mobile clinics for TB diagnosis and case management started working in Aleppo and Deir-ez-Zor. o Four villages (Ayach, Chemeteih, Howaij Diab, andn Kharetieh) were visited in Deir-ez-Zor. o In Aleppo, 2232 prisoners in Aleppo were screened. A total of 517 suspected cases were detected during the screening and among them five cases were confirmed.

7 Information and Planning ✓ The following information products were produced and shared: • WoS Summary of WHO key performance indicators for 2019. • WHO Syria KPI for January 2020, at the following levels: (Across Syria; North-east Syria; North-west Syria; Southern Syria). • HeRAMS annual report 2019 of the UNRWA health centres • HeRAMS annual report 2019 of the SARC health centres • MVH Flash Update #42 for the recent incident against Tarbine private pharmacy in Damascus City (06 February 2020). ✓ Joint technical meeting with UN IMOs on 4Ws; with MoH on joint health information systems; CTFMR with UN agencies, SF pillar1 with UN agencies, HRP targets with WoS IMOs. ✓ Provided ICTs to health partners staff in Al-Hasakeh governorate. ✓ Installed CanReg5 in National cancer registry in MoH. ✓ Provided (4Ws, Health Sector Syria) information for Jan 2020 to WoS. ✓ Provided the Country Office’s KPIs Measurement Framework Focal Points to EMRO. ✓ Provided HeRAMS indicators of Damascus hub based on 3rd & 4th quarters 2019 data for public health facilities to WoS. ✓ Provided key information and map on public hospitals and private hospitals in Ar-Raqqa & Deir-ez-Zor, HeRAMS Dec 2019 with ICU and Isolation rooms as part of Corona Virus preparedness. ✓ Shared [WHO/EMRO - Weekly Summary of Events and Signals] and weekly [Attacks on Health Care] developed by HQ.

National NGO Coordination ✓ Under the Global Program of Work (GPW 13) health emergency objective “Health emergencies rapidly detected and responded to” WHO is strengthening timely access and provision of the essential package of health care services at the community level in NES and NWS. ✓ Health emergency response in NES ( Al hasakeh, Ar-Raqqa and Deir Ez Zor: through 8 rolled out medical mobile teams and 12 fixed health facilities. The essential package of health care services was delivered to 79,438 beneficiaries at Al Hole camp, Areesheh camp, Al Hasakeh collective shelters, Tal Tamer collective shelters, Karama, Mahmudli camp, Ein Issa , Abu Khashab were covered. ✓ Health Emergency Response in NES

# of delivery # of cases referred for specialized treatment # of trauma consultations supported # of mental health consultations supported # of treatment courses delivered to health… # of outpatient consultations

0 5,000 10,00015,00020,00025,00030,00035,00040,000

Host Community IDPs Refugees / Asylum Seekers Returnees

✓ Health Emergency response in NWS ( Aleppo, Hama and Idleb): through 13 rolled out medical mobile teams and 5 fixed health facilities, the essential package of health care services was delivered to 33,566 beneficiaries.

8 Health Emergency Response in NWS

# of physical rehabilitation sessions supported # of mental health consultations supported # of treatment courses delivered to health… # of outpatient consultations

0 5,000 10,000 15,000 20,000 25,000

Host Community IDPs

✓ In addition, under the GPW 13 objectives of “Universal health coverage and healthier population’’39,347 people benefited from the essential package of health care services through 13 fixed health facilities and 2 medical mobile teams providing health assistance to affected areas with a focus on high health severity scaled ones.

External Relations and Communications

✓ Held a meeting with Australia – based on Australia’s request in Beirut with the aim of assessing WHO Syria’s potential as a strategic partner to Australia for the coming 3 years . ✓ Submitted a new concept note for funding by Japan for the support of hospitals in Hama. ✓ Contributed to the WoS proposal to CERF for support to NES. ✓ Conducted Several capacity building workshops for journalists and IEC professionals representing audio- visual and social platforms from different Syrian governorates to raise awareness in the community on the prevention measures needed to be taken and provide them with the best practices of disseminating the correct information on the COVID19, with a special focus on how to combat rumors and fake news. ✓ Developing Information, Education and Communication (IEC) materials (posters and flyers ) on COVID-19 ✓ Supporting the MOH & MOI in developing radio & TV spots as well as billboards to raise awareness among the community on the prevention measures needed to be taken concerning COVID-19. ✓ Providing response to all local and international media requests on the latest updates on COVID 19 and WCO response in this regard. ✓ Posting several tweets on WHO-Syria Twitter account about WHO interventions and health response: WHO Syria (@WHOSyria) | Twitter.

Training and capacity building

✓ During the reporting period, 4360 participants benefitted from 142 WHO-supported capacity strengthening activities.

Operational Support and Logistics

✓ Dispatched 51.3 tons of medical, nutritional, WASH, ICT & lab supplies and printing materials to 13 governorates (except Idleb). The recipients included 33 MoH facilities, 4 MoHE facilities, MoE, MoLA, 14 NGOs, INGO, 2 NGPHCs, 4 NGHs KRC, SARC, 2 camps & UNRWA. Total number of treatments is 246,849 and 640 trauma cases.

IV. WHO Response in Hotspot Areas The following sections describe the security and health situation including WHO response in the hotspot areas in Syria. It is subdivided into:

1. Northeast Syria (Al-Hasakeh; Ar-Raqqa, Deir-ez-Zor), and 2. North West Syria (Aleppo, Homs & Latakia) 9 Northeast Syria (Al-Hasakeh; Ar-Raqqa, Deir-ez-Zor)

The polio vaccination campaign was conducted in Raqqa governorate except forTal Abiad district between 16 – 20/ Feb 2020 targeting all children under 5 years.

District Target < 1 Year First Time 1 – 5 Years First Time TOTAL Coverage

Raqqa City 83382 29918 2504 56008 1269 89699 108%

Tal Abiad 26914 0 0 0 0 0 0% Al Tabqa 33449 12606 1076 26214 287 40183 120% Karama 16160 3082 89 18141 32 21344 132% Madan 22168 3993 308 18806 123 23230 105% TOTAL 182073 49599 3977 119169 1711 174456 96%

EWARS:

✓ 2 blood samples from measles suspected cases were collected and sent to the central lab in Damascus. ✓ 2 stool samples of suspected AFP cases and their contacts were collected and sent to central lab in Damascus. ✓ Meeting with the Director of the National Hospital to assess the situation of the hospital and to provide the national hospital with supplies and materials for COVID-19. ✓ Updating the data of public hospitals in Al-Raqqa governorate for the month of February and March,2020 ✓ Updating the health centers data in Al-Raqqa governorate ✓ Updating the data of private hospitals in Al-Raqqa governorate until March,2020 ✓ Determining the needs of the National Hospital in Raqqa and explaining the measures taken to confront the (COVID-19). ✓ Conducting a study for health centers in Al-Raqqa governorate:

Organizing a report showing the age groups and the health situation in Abu Khashab camp:

10 Updating the data of private hospitals in the areas controlled by the SDF in the countryside of Deir-ez-Zor, bearing in mind that the number of private hospitals is 25.

Bacterial laboratory analysis:

✓ Visiting 6 drinking water sources on 17 Feb 2020, (Al-Azizyah water Station ,Rad shaqrah station ,Al.Aqqaidy well, Al. Daly well, Al-Hammah well and Tal Azan water station) which supply drinking water to Al.Hol, Areesha camps and collective shelters in Al.Hassakeh city or bacterial laboratory analysis ( E. Coli ) at the laboratory of drinking water unit in Qamishli .Results showed all of them were potable and not contaminated.

Water chlorination:

✓ 425113 chlorine tablets ( NaDCC 1.67g, for 1000L) were distributed to the camps of Al Mahmoudly camp,,Deir Ezour Civil Council and 64 shelters in Al-Hasakeh. The beneficiaries are 34,197 for 6 months.

Indicators:

# of samples tested

✓ Al-Hol: 78 samples, Areesha: 61 samples, Abu Khashab: 22 samples, Mahmoudli:25 samples, Rouge: 20 samples, Nowruz: 9 samples, 22 Old Menbge: 20 samples,New Menbge: 22 samples, collective shelters in Al-Hasakeh city: 42 samples.

Deir ez Zor

✓ A total of 316,816 children under five were vaccinated against polio during the national polio campaign in Deir ez Zor governorate16-20 February 2020. WHO supported DoH by renting more than 80 vehicles, and providing incentives for more than 900 health workers for implementing the campaign. ✓ Deir ez Zor governorate was identified as among the highest risk areas with cutaneous leishmanial. There was a remarkable increase in recorded cases during the 4th quarter of 2019. During 2019 , Leishmaniosis control program in DeZ DOH provided treatment to 13257 individuals, 4136 of them were reportedly coming from the eastern bank of the Euphrates. ✓ On 16th of February , 2020 ,DoH with support from WHO launched a campaign by establishing five medical points on river ferries for treating CL cases coming from the eastern Euphrates. Till the date of March 5th, the mobile teams have provided diagnosis and treatment to 1403 CL cases, and the work is still ongoing.

North West (Aleppo, Homs, Lattakia)

1- Aleppo:

NGOS: Health Service Providing : ✓ During the reporting period , WHO supported 6 medical mobile teams in addition to 3 Static medical points throughout four WHO Implementing partners ( AL-Ihsan , CCS , SYC and Health promotion ) to ensure access and timely delivery of essential package of health care services including Medical consultations on internal and chronic diseases, child health and MHPSS services ✓ WHO provided medicines to 11 Mobile\Static medical teams; the medications were distributed to 4 WHO partners through whom more than 11,500 treatment courses will be provided.

11 TB/HIV Programme ✓ Two fully equipped mobile clinics for treating TB started working in Aleppo and Deir Ezzor. The TB staff provided awareness sessions and examinations for TB. The mobile clinic visited during February four villages in Deir Ezzor (Ayach, Chemeteih, Howaij Diab and Kharetieh) and the prison in Aleppo ✓ The number of people who were examined through the mobile clinic in Deir Ezzor is 3815 with 16 awareness sessions. The number of suspected cases is 389 (115 Female and 207 Male, 67 > 14).The number of confirmed cases (by sputum and X-Ray) is 3 TB cases. The clinic in Deir Ezzor provided treatment to 6 TB previously registered cases in the mentioned areas . ✓ Global Fund meeting to review implementation for MER 2 was organized in Amman 13 Feb 2020.The participants were TB/HIV technical officer and M7E officer. The main objectives for this meeting were presenting the current status of all activities in the approved work plan, discussing the challenges faced during implementation and discussing country priorities and needs and requests of the reprogramming of some activities and Completing the reprogramming exercise. ✓ WHO supported during the mentioned period 2 supervisory visits for TB Programme, 2 supervisory visits for HIV Programme and 4 HIV educational sessions for 40 participants in each session.

Trauma ✓ One (HAZMAT Management and evacuation of the buildings) training has been conducted in closed coordination and cooperation with Aleppo DoH. ✓ Al Razi hospital and Aleppo University Hospital are still providing a full range of trauma management services for civilian trauma injuries and war injuries through a close and full support from WHO in Aleppo. ✓ SARC is still providing the first aid and pre-hospital care for civilian trauma and ERWs injuries. ✓ Assessing the needs of the partners regarding the trauma and disability management, a full detailed work plan is discussed concerning the NWS response.

Mental Health : WHO supported: ✓ a) Ibn Khaldoun psychiatric hospital –outpatient clinic providing consultations in hospital location with a full range of services for 235 in-patients in the hospitalin addition to several assessments and preparations for medevac of Azaz asylum patients. ✓ b) Mental Health directorate – Zahi Azrak Hospital out-patient provided psychiatric consultations, mhGAP consultations on PHC level, psychological services, raising awareness session and consultations on community level by trained psychologists. ✓ In response to the current NWS emergency, and in line with MHPSS preparedness plan updated recently, Integrated MHPSS services were delivered to the community through the supported NGOs in the city, the emergency areas, and HTRs, wherein, 9 MHPSS teams embedded with MMTs are functioning in NWS . ✓ Technical meeting conducted with Health partners, focused on MHPSS, aiming to align 2020 Priorities and ✓ share new updates and tools .A shared tool for cross-sectorial under development with partners and capacity ✓ building assessment tool was shared, to be filled from partners, and a COVID19 MHPSS response to be unified, ✓ Several MHPSS raising awareness sessions for UN agencies took place in order to highlight the better coping skills and knowledge to deal with stress related to COVID19. ✓ MHPSS HR need mapping finalized, the trainings will be aligned accordingly. ✓ Several MHPSS took place in Aleppo, covering many programmes , mhGAP, PFA, First line support for GBV, targeting DoH doctors and health workers, NGOs MHPSS workers, and Caritas AA project. ✓ Field visit to Dar Al-Safaa was conducted to finalize the support plan through a partnership with ASSLs. ✓ ASSLs finalized family wellbeing center in Aleppo city in the eastern rural Aleppo.

2- Homs

✓ HWG coordination meeting: was conducted on 24th of February 2020 in the presence of UN agencies at Homs Hub, DOH and local NGOs in Hama. Operational updates & suggestions were discussed by health partners. ✓ The update of WHO programs was presented:

12 ✓ Presentation on Emerging respiratory viruses, including nCoV, methods for detection, prevention, response and control was given. ✓ Updating WHO programs during the fourth quarter of 2019 ✓ Capacity building trainings for DOH Homs and Hama were conducted . ✓ Update on NWS situation, and the possible scenarios for people displacement, and the health activities in the targeted area. ✓ Meeting with Hama DOH Director and discussing the urgent needs of the Hama National hospital due to the escalation of the security situation in NWS. ✓ The response plan for the northwest Hama was updated at the end of January 2020. ✓ NWS contingency plan covering GoS shifted-control areas in Idleb Governorate was updated and shared. ✓ Rukban returnees: The total number of people who left Rukban transiting through Homs shelters remains at 19,102 people, of whom 329 people left Rukban supported by UN/SARC. ✓ On 11 and 12 February, 44 people (11 males, 10 females, 16 children, and 7 infants) left Abdul Rahman Shattor shelter. ✓ As of 12 February, only 4 males are still in the shelter. ✓ Humanitarian response plan matrix for Rukban Second Destination was developed and shared. ✓ IMCI: 13 teams (pediatrician +2 nurses) in rural PHCs were trained on IMCI program during 2019 and another 13-teams were planned for 2020. ✓ 43 teams were trained in Hama and planned for 20 during 2020. ✓ National Polio vaccination campaign: Targeting in Homs 180,000 children u 5 and in Hama 298,000 children with a coverage of 101% and 91,6% respectively ✓ Independent monitoring was done in 52 clusters in Homs and 77 clusters in Hama . ✓ Nutrition: New born resuscitation program: 25 participants were trained on the resuscitation steps from 5 general hospitals in Homs (3 in the city, Talkalakh and Mukharam hospitals) ✓ Following up Baby friendly hospitals in Homs city and the implementation of the standard criteria in it. ✓ HeRAMS: NGOs HeRAMS reports were collected and reported from all Syria. ✓ Staff from 10 general hospitals in Homs and Hama governorates and 11 PHCs were trained on HeRAMS program ✓ MH program: A monitoring visit was conducted to MH department in Homs DOH: 48 trained doctors on 1, 2 MHGap program provided mental health services to 7472 patients during 2019, and 932 cases during Jan., 2020. ✓ HIS: Health assessment was done to Palmyra City and its suburbs: total population is around 250 families, 70% of them are returnees from Al-Rukban ✓ Communicable Disease (COVID-19 outbreak) : There are 3 designated functioning points of entry from Lebanon to Homs governorate , DOH Homs took screening mechanisms measures to detect the entry of suspected COVID-19 cases from the Lebanese border. • 14 cases were investigated and the follow up continued till 14 days of supposed contamination. ✓ Primary health care: WHO-supported 2 medical mobile teams in Hama to cover health needs in north- eastern Hama (which is still receiving returnees from Idleb), south-west Hama (940 medical consultations and 422 PSS services were provided during the reported period ). ✓ WHO supported 2 medical mobile teams in Homs to cover health needs in the second Rukban destination ( east Homs district ) and Quseer district ( 1008 medical consultations were provided and 65 children were screened for malnutrition ). ✓ National NGOs’ Coordination: WHO-supported 4 mobile medical teams (including PSS services) in Hama governorate to provide primary health services in south Idleb District ( Sinjar area), east northern area (Alhamra district) , south Hama area ).7658 medical consultations and 1889 PSS services were provided)

3- Latakia Health Update:

✓ Updating the preparedness plan for NWS with health partners. ✓ Conducting an assessment visit to the national hospital in Latakia to check the preparedness measures taken for the isolation room (separate report will be produced in this regard). 13 ✓ Supporting 4 NGOs in Latakia (SACSN, Child care, Mosaic and heart giving NGOs) with essential health supplies to support their health centers in both Latakia city and the rural areas. ✓ Supporting Jbleh hospital with a defibrillator device and the Pediatrics hospital with one defibrillator and 2 patient monitors. ✓ Conducting a POLIO campaign from 16 to 20 Feb 2020 with a coverage rate reaching 97% in Latakia governorate (117944 / 121000) and 98% in Tartous governorate (110941 / 113227)

NGO update: ✓ 6 Families from Mourat Al-numan were supported by WHO NGOs partners . All health needs were covered including trauma operations. ✓ Receiving a project proposal from AL-Ekha family NGO to establish a wellbeing center in Latakia city. ✓ No. of beneficiaries who received Health services during the report timeline:

Ramel Jnoubi Center Squbeen Center Qnenas Center The city Center Ras albaset static point 1255 1374 1290 1063 129

Communicable disease: Reported cases during four epidemic weeks ( 7,8,9,10) are as follows:

Reported cases in Latakia 16738 Reported cases in Tartous 17344 AJS 9 15 ILI 13553 15437 AD 1856 925 SARI 148 867 SMN 8 2 SM 3 Leishmania 47 TB 1

KEY CONTACTS: Representative a.i. Dr. Nima Saeed Abid [email protected] WHE Team Lead Dr Gabriel Novelo [email protected] Communication Officer Mr. Yahya Bouzo [email protected]

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V. Annexes

Annex 1: List of current WHO agreements with national NGOs

# of ongoing # of MOUs in Governorate Location of current of ongoing MOUs MOUs preparation

Damascus Damascus city 1 3

Yalda- Darayya - Douma - Saqba, Kafr Batna, Rural Damascus 4 2 Hammura

Lattakia city- Al Baset - Saqubeen- Qnanas and Al 2 1 Lattakia Ramel Al Janoubi Baath - Um Batna - Ofania - Jbata Elkhashab - Khan Arnaba - Qahtaniyyeh (Quneitra) - Majdolieah and Nabe 1 Qunaitera Elsakher Hama city, Souran, Moardes ,Taybet alemam, Alsawa'aek ,Alhashimyaa , ean albad, Jarjesah ,tal 1 2 Hama kartal,tellef ,herbenafsah,maardeften and alzarah.

Homs Talbiseh 1 3

Akramiye ,Al-Hader,Tal Qerah , Babinis , Um - Haoush , Taiena , Al-Alousheh Farm , Hassin , Oqayba , Aleppo 1 3 Wahshiyeh Farm, Abtin, Wdeihi, Haddadin, Blaas, Tall Ed-daman, baradah and Menbje

Al Hasakeh: Al Hasakeh city, Al Hole camp, Areesheh camp, Tal Tamer.

NES Ar Raqqa: Karama, Mahmudli camp , Kisret Elsheikh 8 3 Jomaa and Ein Issa.

Deir Ez Zor: Deir-ez-Zor city

Total 19 17

Annex 2 : The dispatched supplies during the reported period included: - 65,000 tablets of Aquatab were delivered to 2 camps at Al-Hasakeh & Raqqa governorates. - 1 patient monitor device, 1 oxygen concentrator and 1 ventilator for adult/children were delivered to CADUS INGO at Al-Hasakeh governorate. - 5 Sphygmomanometer, 1 otoscope, 10 IEHK basic kits, 1 oximeter, 2 fingertip pulse oximeters, 1 mobile anaesthesia machine, 1 portable ventilator, 2 trauma kits A and different types of PHC, STHC & trauma medicines were delivered to KRC at Al-Hasakeh governorate. 15 - 25,704 bottles of PERMETHRIN 1%, shampoo was delivered to the ministry of education. - Different types of PHC equipment were delivered to Al-Khaldyeh PHC centre in Aleppo governorate. - NCD guidelines, 400 vials of human anti-rabies vaccine and different types of trauma & STHC medical supplies were delivered to Al-Hasakeh DoH. - 12,514 cans of therapeutic milk & 11,300 sachets of ResoMal were delivered to DoHs, MoHE central warehouse & 1 nongovernmental hospital at 12 governorates (except Idleb & Raqqa). - 1 electronic mother/child function digital scale was delivered to MoH – children hospital in the Aleppo governorate. - 900 vials of vancomycin were delivered to MoH - Damascus hospital. - 350 Uni-Gold HIV kits were delivered to MoH central warehouse in favour of HIV program. - 4500 bottles of sodium chloride 500ml and 2500 vials of ceftriaxone 1g were delivered to Lattakia DoH. - 8 kits of both EIA measles & EIA rubella were delivered to MoH – public health labs – measles lab in Damascus. - 1490 prefilled syringes of PNEUMOCOCCAL POLYSACCHARIDE vaccines were delivered to MoH central warehouse in favour of NCD & CD directorates. - Different types of TB medicines were delivered to MoH central warehouse in favour of TB program. - 1 ventilator was delivered to MoH central warehouse in favour of both obstetric & paediatric hospitals in Tartous governorate. - 2 ventilators were delivered to MoH central warehouse in favour of Pediatric and Obstetric hospital in Lattakia governorate. - 14,000 indelible finger marker pens were delivered to MoH central warehouse to support the polio campaign. - 173,500 tablets of Doxycycline 100mg were delivered to MoH central warehouse in favour of the zoonotic diseases program. - Different types of lab supplies, kits & consumables were delivered to MoH – public health labs to support flu, measles & polio labs. - 400 prefilled syringes of human anti-rabies, 5 Sphygmomanometer, 1 otoscope, 1 burn dressing kit, 1 digital ultrasonic device, 2 patient monitor devices, 1 vortex tube mixer and different types of trauma & PHC medicines were delivered to Qamishli national hospital. - 200 vials of human albumin and 1 neonat/infant ventilator were delivered to MoHE - Aleppo university hospital. - 2 HP LaserJet printers were delivered to MoHE – hospitals directorate in Damascus. - Different types of cancer medicines were delivered to MoHE central warehouse to support the oncology departments at MoHE hospitals. - 4 neonat/infant ventilators were delivered to MoHE – children hospital in Damascus. - Different types of lab supplies & equipment under WASH project were delivered to ministry of local administration & environment. - 6 IEHK supplementary kits, 2 trauma kits B, 35 Sphygmomanometer, 6 otoscopes, 30 IEHK basic kits, 6 fingertip pulse oximeters, 2 dry heat sterilizer, 1 trauma kit B, 2 neonatal/infant ventilator, 1 adult/child ventilator, 2 defibrillator,1 steam sterilizer, 2 ultrasonic scanner devices, 1 biological microscope, 2 LED surgical light, 1, haemodialysis machine, 500 haemodialysis sessions, 3 electrocardiograph devices, 2 vortex mixer, 1 burn dressing kit, 2 surgical cattery device for operating room, 1 surgical supply kit, 1 portable oxygen concentrator, 4 examination tables and different types of PHC, STHC & trauma medicines were delivered to 4 non-governmental hospitals & PHC centres at Al-Hasakah & Raqqa governorates.

16 - 4 first aid kits, 9 blood glucose meters, 1 neonat/infant ventilator, 10 electrocardiograph devices, 2 steam sterilizers, 10 patient monitor devices, 2 defibrillators and different types of EWARS, PHC, STHC & Trauma medical supplies & printing materials were delivered to 14 NGOs at Aleppo, Al-Hasakah, Damascus, rural Damascus, Lattakia, Homs & Hama governorates. - 15 wheelchairs were delivered to Aleppo SARC.

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