WHO : SITUATION REPORT Weeks 32 – 33 (2 – 15 August), 2019

I. General Development, Political and Security Situation (22 June - 4 July), 2019  The security situation in the country remains volatile and unstable. The main hot spots remain , Al- Hassakah, Deir Ezzor, , , and governorates.  The security situation in Idlib and North rural Hama witnessed a notable escalation in the military activities between SAA and NSAGs, with SAA advancement in the area.  Syrian government forces, supported by fighters from allied popular defense groups, have taken control of a number of in the southern countryside of the northwestern province of Idlib, reaching the outskirts of a major stronghold of foreign-sponsored Takfiri militants there  The Southern area, particularly in , experienced multiple attacks targeting SAA soldiers .  The security situation in the Central area remains tense and affected by the ongoing armed conflict in North rural Hama. The exchange of shelling between SAA and NSAGs witnessed a notable increase resulting in a high number of casualties among civilians.  The threat of ERWs, UXOs and Landmines is still of concern in the central area. Two children were killed, and three others were seriously injured as a result of a landmine explosion in Hawsh Haju town of North rural .  The general situation in the coastal area is likely to remain calm. However, SAA military operations are expected to continue in North rural Latakia and asymmetric attacks in the form of IEDs, PBIEDs, and VBIEDs cannot be ruled out.

II. Key Health Issues

Response to Al Hol camp:

 The Security situation is still considered as unstable inside the camp due to the stress caused by the deplorable and unbearable living conditions the inhabitants of the camp have been experiencing . During the reporting period, 126 people left the camp to district in .  WHO distributed batches of medical supplies containing life-saving medicines, antibiotics, therapeutic milk, intravenous fluids, anesthetics and analgesics to both WHO-contracted Al-Hikmah and Al-Hayat private hospitals to strengthen the health response to the referred patients from the camp. Moreover, a shipment which contains 10 836 treatments and 100 trauma kits was delivered to health partners at the camp.  WHO health partners launched the provision of mental health services at the previously distributed two prefabricated caravans in different sectors at the camp. During the reporting period, WHO health partners provided 27 psychiatric consultations about the most common mental health cases like depression and post- traumatic stress disorder.  12 new cases of severe acute malnutrition with complications were referred to join the already referred children who are receiving the proper treatment at the WHO-contracted Al-Hikmah private hospital in Al- Hasakeh governorate. During the reporting period, 9 children were discharged, quite cured, while the rest are still under treatment.

III. WHO Response

Non-Communicable diseases & Primary health care:

 Updated the NCD country profile 2018 in cooperation with MOH.

Page | 1

 Shared the online link survey with health partners and MOH OIC for Elderly Programme, on Decade Of Healthy Aging action plan 2020-2030 developed by WHO .  A Total number of 53,258 of PHC/NCD treatments were provided during the reporting period.  Carried out needs assessment mission to DOH Hama. Visited locations including diabetes center, Thalassemia center & national hospital. Needs assessment was discussed with DOH Hama to support provide dialysis machines, trauma kits and ambulances.

Trauma

 Trained 50 health workers on trauma and disability related topics in .  Finalized the contract with Khotwa NGO to provide artificial limbs to 66 persons in need ( 55 lower limbs and 11 upper lombs) as well as spare of artificial limbs for 102 beneficiaries.  38, 667 treatments and 200 trauma cases of medicines and medical kits ( 5 IEHK supplementary kit, 7 basic IEHK kit, 2 trauma kit A & B)were delivered to Nor Al Hoda NGO in Hama, in addition to 25 trauma cases delivered to SARC in Al Hassakeh.  Participated in a technical meeting by concerned technical officers in UN agencies (UNFPA, WHO, UNERWA,UNICEF and UNHCR) to follow up on IM transition from emergency to early recovery context CRVS (Civil Registration and Vital Statistic) for deaths and births modules in terms of documenting and framing the joint work between UN sister agencies and reflect best practices in support of MoH to reactivate death and birth notification mechanism in line with WHO standards and ICD classification in health facilities .  Conducted a mission to Al Hasakeh with the emergency officer from WHO Regional Office and visited Al Hol Camp to assess the three field hospitals working there (ICRC, KRC and MSJM). In addition, the WHO- contracted hospitals in Al Hasakeh (Al Hekma and Al Hayat hospitals) were also visited to follow up on the ongoing support to the referred cases.

Immunization

 Unicef and WHO delegation met with HE the deputy Minister of Health to follow up on the finalization of the GAVI (PEF); HE is holding meetings with the MOFA and MOE to develop the government policy towards the GAVI proposition.  Internal WHO meeting, led by theWHO country Representative a.i., to strengthen interdepartmental coordination within the country programs was held . During the discussion the EPI program has received the 2 recommended Prefabs to be installed in the camp for the fixed Routine Immunization activities implemented by Emergency/EWARS program. The MOH will provide the cold chain and assign the vaccinators while WHO provides the prefab with electric power and AC and the transport of the service providers from and to the camp site. WR a.i. recommends regular interdepartmental meeting prior to any field mission to be aware of the local needs and priorities of different sections well in advance.  The two week long EPI accelerated implementation of Routine Immunization in Der Ez Zor (eastern districts) succeeded to reach 53,344 children. MOH mobilized 35 vaccination teams with supplies (Vaccine and Non-Vaccine), WHO supported technical and operational cost and UNICEF supported the social mobilization component. The local population demand for continuous vaccination services was a plus in the campaign  New cold chain equipment (freezers) and reagents were procured for the National Polio Laboratory as part of the requested items by the MOH Syria for the year 2019.  The discussion is still ongoing with the Director of Primary Health Care department and the National EPI manager for the access of Ain al Arab and Tel Abiad districts since the vaccination activities are still on hold since the beginning of 2019 despite the many opportunities that can have been seized.

Mental Health

 MHPSS services were delivered by NGOs partners through five active family wellbeing centers .  Integrated MHPSS services were delivered on community level in Qunaitra, Rural Damascus, Aleppo, Homs and Al-Hassakeh through agreement with 10 local NGOs.  In the pipeline: an integration project with Trauma programme through a pilot and focused community center with KHOTWA NGO to provide psychological rehabilitation beside the physical one.  Number of MH consultations provided through NGOs partners reached 18260 in July, which reflects the up trending of MHPSS services delivery through NGOs partners, as well the healthy process of integration.

Page | 2

 Extract from MH KPIs from the 1st half of 2019: o Number of mental health and psychosocial support interventions provided at NGOs & community health facilities, and by mobile teams : 48,527 o Number of mental health and psychosocial support interventions provided at MoH health facilities: 74,339  Mental health focal point in Al-Hol camp provided specialized psychological and psychiatric services for 45 cases.  MHPSS preparedness and emergency plan has been updated on the level of HUBs and verified by NGOs unit, with special consideration for NS possible response.  Finalize with MOH/ MH directorate the Global survey on Syria progress on SDG health target 3.5 (2019), the data will be analysed and the results will be extracted at regional meeting in September.  Conducted MHPSS TWG on the central level with the participation of up to 20 national and international active partners in the field the meeting led to finalizing referral pathway and capacity building activities mapping tools before digitalizing both, Also finalizing the MHPSS work plan for TWG in 2019 in depth discussion about the MH preparedness plan in NS emerging response.  A workshop titled M&E for MHPSS Global framework in emergencies has been conducted for the first time on Syria level, on 7-8th August for project managers and key personals in 10 NGOs that are supported by WHO, and active in Damascus, R. Damascus and DEZ.  The second batch of 25 community workers in CARITAS Aleppo has been trained on psychological first aid and self-care strategies to provide MH basic services in eastern Aleppo.

Nutrition and Child Health

 The response of the first semester of the stabilization center in Al Hol camp is : 597 admissions of severe acute malnutrition with complications , low mortality rate ( 3.6 % ) and high gain weight during hospitalization ( 10.5 g/kg / day ) .  Monitoring of integrated Management of Childhood Illness training for 15 trainees from Deir ez Zor governorate.  Data collection of IMCI in AL Hol Camp of 940 children: 83 cases of acute diarrhea , 101 cases of respiratory infections , and 101 acute otitis media. 10 cases of Severe acute malnutrition were detected and referred for treatment .  Meeting with mortality program group in WHO to correct the final draft of the national survey mortality form.

Secondary Health Care

 Organized a training workshop on pharmaceutical supply chain for health workers from different NGOs and SARC in Aleppo.  Followed up with Al team the health needs on medical supplies needed in filed hospitals at Al-Hol camp.

Communicable Diseases, Surveillance and WASH Communicable Diseases/Surveillance

Mission Field visit to Al-Hasakeh governorate  The mission to Al-Hol camp and the referral hospitals was conducted from 29 July to 3th of August. The objectives of the mission were to review the water situation and morbidity of communicable diseases among the camp population, to visit the WHO-supported medical points and field hospitals in the camp, the referral hospitals, and discuss the situation, the needs and gaps, as well as to coordinate with the Al Qamishili hub and the partners on the current activity implementation, the strategy and the plan. The recommendations include improvement of coordination with WASH partners on the response activities to the increase of acute diarrhea cases, as well as the setting up of the DOH medical points in phase 1 and 5.

Public health interventions: HIV screening in Al-Hol camp  From 22 to 4 August, the HIV campaign was conducted targeting high risk groups in Al Hol camp, including 112

Page | 3

health awareness sessions with 4480 participants on HIV transmission, risk factors and diagnosis, ad prevention and control measures. In addition, the HIV voluntary test and counseling was performed in phase 5. More than 430 voluntary tests have been performed and all cases tested negative.

Suspected HIV cases in Deir-ez-Zor  Two suspected HIV cases were reported in the eastern part of the Euphrates river in Deir-ez-Zor under the Kurdish authority controlled area. The two cases were tested positive HIV by rapid diagnostic tests and the blood samples were collected and transferred to the HIV reference laboratory. The results are still pending.

Suspected Typhoid cases in Deir-ez-Zor  An increase of suspected typhoid cases in Deir-ez-Zor has been noticed since week 26 through EWARS. The number of cases in weeks 30 was 233. The stool samples were collected from four new suspected cases on 12 August and transported to the reference laboratory in Damascus for culture test. The laboratory results are pending. In response to the increasing cases of suspected typhoid cases, DOH is planning to conduct an awareness-raising campaign on the prevention measure of water-borne diseases targeting the local population.

Measles and rubella  WHO delivered 16 laboratory diagnosis kits for measles and rubella to public health laboratories in Damascus to perform 1 536 measles and rubella tests.

WASH  The water quality monitoring visits were conducted in Rural Damascus, Aleppo and Al-Hol camp.  Al-Hol camp: The water samples from 3 water source, 3 from water tanks,7 from water trucks, 13 jerrycans (10L), 1 ice samples from ice factory were tested by ATP measurement, TDS, FRC and PH. Among them, 7 jerry cans and the 1 ice sample were contaminated and not suitable for drinking.  WHO conducted an investigation of 5 ice factories in al-Hasakeh governorate which have provided ice blocks in the camp. Between 4 and 5th of August. The laboratory test result showed that coliform bacteria were found in the samples from 4 factories out of 5 factories. WHO will conduct further laboratory analysis to identify the pathogen with the collaboration of WASH partners. In addition, the water quality testing will be conducted in the water sources which ice factories use to get water from.

Information and Planning  A Joint technical meeting was conducted by the Vital concerned technical officers in UN agencies (UNFPA, WHO, UNERWA,UNICEF and UNHCR) to follow up on IM transition from emergency to early recovery context CRVS (Civil Registration Statistic) for deaths and births modules in terms of documenting and framing the joint work between UN sister agencies and reflect best practice in support MoH to reactivate death and birth notification mechanism in line with WHO standards and ICD classification in health facilitates.  A technical quarterly meeting was held with HIS FPs in governorates to discuss all relates HIS issues.  The following information products were published and distributed: o Summary of WHO key performance indicators snapshot for June 2019 (Across Syria, North-east Syria, North-west Syria, Southern Syria). o Summary of WHO-WoS key performance indicators snapshot for June 2019. o Summary of WHO-WoS key performance indicators snapshot for 1st half 2019 (Q1&Q2). o Flash Update #37 for the recent incident against Syrian Family Planning Association (SFPA) health centre and DoH Al Zebdeyeh public health centre in Aleppo City (31 July 2019) o Shared HeRAMS infographic of Q4 2018 for health facilities at WoS level. o Shared WHO/EMRO - Weekly Summary of Events and Signals (01 - 07 August 2019) and (08 - 14 August 2019). o Shared [Attacks on Health Care] Weekly Update: 8 and 15 August 2019 developed by HQ.  Monitored a weekly update on shift of control, functionality status of public HFs, and control of areas by NSAG areas in North West Syria.

National NGO Coordination

 Monitoring field visits were conducted to Homs and Hama governorates to oversee the performance of WHO implementing partners.

Page | 4

 Under the 13th GPW health emergencies objective “ Health emergencies rapidly detected and responded to” WHO is strengthening access and provision of the essential package of health care services at the community level in NES and NWS through rolling out medical mobile times and supporting static medical points ( detailed intervention in annex 4).  Under the 13th GPW health emergencies objective “ Universal health coverage and healthier population’’ WHO is strengthening access and provision of the essential package of health care services at the community level especially in areas with high health severity scale in Aleppo , Hama , Homs and Southern area.  Monitoring field visit conducted by the TPM to NGO partner in Daraa.

External Relations and Communications

 Published the WoS donor update January – June 2019  Conducted a field visit to Al Qamishli city to document WHO health response and prepare visibility video concerning WHO interventions at Al Hol camp.  Preparing humanitarian story on the occasion of the World Humanitarian Day 2019.  Preparing “issue 12” of Al-Hol SitRep .  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, 661 participants benefitted from 20 WHO-supported capacity strengthening activities (Annex 1).

Operational Support and Logistics

 Dispatched 33.8 tons of medical, lab & nutritional supplies – covering 7 governorates (Aleppo, Al-Hasakeh, , Damascus, rural Damascus, Homs & Hama). The recipients included 4 MoH facilities, MoHE hospital, 11 NGOs, SARC & UN agency.  The total number of treatment is 133,624 and 225 trauma cases.

The dispatched supplies included:  3,966 prefilled syringes of human anti-rabies immunoglobulin, 25,000 vials of human anti-rabies vaccine & 2,592 haemodialysis sessions for adults were delivered to MoH central warehouse in Damascus.  Lab examination kits were delivered to MoH – public health labs – measles lab in Damascus.  Different types of PHC, STHC & MH medicines were delivered to Ibn Khalodoun MoH hospital in Aleppo.  3 Fingertip pulse oximeters, 1 otoscope, 1 paediatric mercurial sphygmomanometer + stethoscope and 5 tools for insertion Intrauterine devices were delivered to Aleppo DoH in favour of Al-Massaranyeh PHC.  3 IEHK supplementary kits, 7 IEHK basic kits, 1 Trauma kit both A&B, 13 NCD kits, 7 electricity diesel generators 12.5 KVA and different types of EWARS, PHC, STHC, Trauma medicines and nutritional supplies were delivered to 11 NGOs at Aleppo, Al-Hasakeh, Raqqa, Damascus, Homs & Hama governorates.  2 Cholera kits, 1 surgical kit, 8 NCD kits, and different types of PHC & STHC medicines were delivered to SARC branch at Al-Hasakeh governorate.  1 mother/child function scale was handed over to UNDP at Al Qamishli hub.

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)

Page | 5

Northeast Syria (Al-Hasakeh; Ar-Raqqa, Deir-ez-Zor)

1. Political/Security Situation

The current situation of NES:

 SDF Controlled Territory: The Area is likely subjected to different political, Military scenarios as well .The security situation in the NES area is still volatile, unstable and unpredictable.  The Euphrates region remains complicated . Ar Raqqah city and rural part of Ar Raqqah governorate as well as Al Hasakah city and south countryside of governorate are still suffering from high level of asymmetric attacks in the shape of IEDs, VBIEDs and SAF targeting SDF personnel and patrols .The incidents were reported in Busyrah, Dyban, Al Tayyanah, Hawayij, Al Khurafi High way, Alsuar and Shaddadi town. The SDF-held area appears to be infiltrated by multiple ISIS cells that carry out attacks on civilian and SDF targets on a constant basis.  GoS controlled Area: Clashes broke out between SAA and ISIL sleeper cells after ISIL fighters attacked Pro-GoS positions in two different locations in the desert of Al 44 Km, South-east of Deir Ezzor city. Coordination:  Conducted the regular health working group meeting in Al-Hol camp. The meetings discussed:

1- Updates on the general health situations. 2- The analyzing of EWARS weekly updates. 3- The main gaps and the ways forward solutions. 4- Updates by the three field hospitals. 5- Weekly mortality analyzing.  Coordination in place with the health sector of Syria hub for the preparedness plan of the potential military operations on the northern border . A health working group meeting is planned to take a place next Sunday to discuss the shared drafted scenarios by OCHA.  The mid-term health strategic plan for Al-Hol camp for the coming 18 months was submitted by the health sector to OCHA.  A mission from WCO visited Al-Hol camp to provide the technical support especially regarding the field hospitals functionality.  Coordination was in place with other health actors in Al-Hol camp to support the departure process of IDPs to ensure the proper health services delivery before leaving the camp.  Conduced a meeting with the camp authorities to discuss the acute needs to establish 24/7 services in the annex as a part of the health sector advocacy.

Emergency response: Vaccination:  2 vaccination teams are working on a daily basis in Al-Hol; EWARS & CDs  In coordination with AlHasaka – DoH, Leishmania treatment mobile team supported by WHO provided treatment to the camp residents in phase 5.  A total of 10,184 consultations were recorded in the medical point, in addition to 11,601 recorded mainly in MSJM and ICRC, KRC field hospitals.  The leading causes of morbidity among all age groups remained acute diarrhea in overage of (11%) and influenza-like illnesses (10%) out of all consultations in PHC.  In total, 601 cases of acute diarrhea were reported in week 31and 499 AD (in week 32), a slight decrease over the previous weeks and total consultations have decreased also. WHO’s response activities include provision of medical supplies and improving water quality in the camp.

Page | 6

 Health Education campaign on HIV was conducted during the period 22 July -4th August .At least 8 sessions per day,4480 individuals, have been educated and 756 tested. No positive case was found.

Mental health  Mental health experts started providing the specialized mental health consultations in phase 5 and phase 6.  55 MHPSS social workers operate in Al-Hop camp covering all the phases and providing the PFA, awareness sessions, individual counselling and group counselling services.  Mh-GAP services were provided through the functioning medical points in Al-Hol camp.  Conducted a meeting with the PSS teams operating in Al-Hol camp and started an action plan to start MH consultations.  Conducted a briefed training for PSS teams about communication skills and psychological interventions.  Provided psychological and psychiatric services for 45 cases.  Conducted a meeting with ICRC’s MH experts to discuss services provided in mental health.  Conducted a meeting with the camp management to discuss services provided in mental health. Nutrition and child care  9 SAM with complications were admitted in Al-Hikma .10 were discharged while 7are still under treatment 0 deaths.  4 orientation sessions on IMCI were conducted for new staff in phase 1 Al-Mawada  155 under 5 children were screened :11 cases of MAM and 7 cases of SAM were found and referred to OTP for follow up. Pharmacy and Secondary Health care:  Supported SARC in Hassakeh including medications, supplies and specialized kits.  Supported MSJM field hospital in Al-Hol camp with medications, supplies, and specialized kits.  A mission took a place to the three field hospitals in Al-Hol camp by WHO Qamsihly and Damascus experts to assess the functionality and performance. NGOs coordination in NES:  Coordination was in place regarding the three field hospitals and contracted non-governmental hospital to start supporting the cold surgical cases.  Conducted field visits to Al-Hikmah and Al-Hayat non-governmental hospitals to assess the SHC and Trauma services provision.  Supported four NGOs operating across NES’s camps with electrical generators to support the health services provision in the distributed caravans in NES’s camps  Started the health services provision in Al-Hol camp through kicking off 2 static points in; Phase 7, phase 8 and a mobile team in the annex with St.Ephrem committee. .  Coordination in place with the health actors operating in Al-Mahmoudli camp to avoid duplication and to ensure covering the other IDPs settlements in Raqqa city.  Submitted the 4Ws of July activities across NES.

Annex 2 shows the number and type of services provided in NES .

North West (Aleppo, Homs, Lattakia)

1- Aleppo:

 Aleppo DoH continued the insecticide spraying campaign as a part of the vector control of Leishmaniasis supported by WHO as 55 days were completed and 25 days remain; the Campaign ends at the end of September2019. 25 neighbourhoods have been completed in Aleppo city and 7 remain in Aleppo city; 7,752,255 m2 were sprayed till now and 157,746 people were targeted. 92 villages have been completed in rural Aleppo, 6,179,700 m2 were sprayed till now and 121,594 people were targeted. 114 workers in Aleppo city and 56 workers in rural Aleppo are working in this campaign.

Page | 7

 Following up TB survey in Al-Shiekh Maksoud neighbourhood; the survey has been completed; 5 teams were doing this survey. 15000 people were surveyed (300 suspected cases,”21 TB cases of them were confirmed and started their treatment”).

Mental Health WHO supported:  Ibn Khaldoun psychiatric hospital – 1641 outpatients consultations; and full range of services for 290 in- patients in the hospital. Mental Health directorate – 91 specialized psychiatric consultations, 183 mhGAP consultations; 83 psychological services and consultations, Capacity building activity psychological first aid for the second batch of 25 community workers in eastern Aleppo " Jazmati and Jabal Badro" that took place with CARITAS Aleppo Preparation for mhGAP Capacity building activity for doctors working at health facilities in Aleppo DoH, targeting new doctors to enhance the mental health universal coverage in Aleppo. Preparation for MHPSS M&E for MHPSS partners at the hub level and with up to 10 NGOs implementing partners will take place in the last week of August. MHPSS services were delivered to the community through the contracted NGOs in the city, northern,  eastern and southern rural areas of Aleppo.  14 individual supportive supervision sessions were conducted for trainees in different programmes on MHPSS Trauma No inputs received.

Service provision

No inputs received.

2) Homs

 The total number of people who left Rukban remains 17,964 people ((43.08%) out of 41,700 residents.  The 26th group from Rukban arrived in Homs at the night of 07 July with 240 people (105 males, 58 females, 55 children and 22 infants) and were all hosted in Teacher institute in Al Bayada. The total number of people who are still in the shelters is 721 (after adding group 26)  In Homs , a field monitoring visit to Albir NGO was conducted by WHO team to follow up the health project in Northern Homs area (2 static medical clinics in Rastan and were visited in addition to one mobile team in Ghornata)  In Hama, a monitoring visit was conducted to DOH Hama by WHO FP to follow up the update on the health facilities rehabilitation program in DOH Hama. 3 health centers in need rehabilitation, all located in new accessible areas : Der Shmaiel health center – Jarjesah health center-Alfaehaa health center)  A monitoring field visit was conducted by WHO team to review the NCD program in Hama DOH (including diabetes program and Thalassemia center, Dialysis center, Cancer department, and Cardiovascular department). Assessment was done and the needs were reported.

1. Health situation

 34 children under 5 years from the last arriving 26th group were vaccinated by mobile teams supported by WHO.

 Following up TB survey among Rukban returning families: 3 WHO-supported mobile teams targeted around 3000 families in the shelters and in their second destination: more than 1300 families were screened till day 21. (3 TB cases of them were diagnosed and started their treatment).

Page | 8

 NGO activities:  Albir Homs NGO running health project supported by WHO in northern Homs area :3 static points (Talbessah, Al-Hula and Rastan) and 3 Mobile teams. Total provided consultations: 2862 (Annex 4).

 An Orthodox Association for Helping the Poor health project provided health services through 3 fixed health points in Alghasaniya old Homs city, Fairouza in east Homs, Ayoun Alwadi in Mesyaf Hama district. The total number of beneficiaries was 1008 (Annex 5).  Albir Hama NGO health project provided services from one fixed health point and 2 mobile health teams in Hama city and villages across eastern and northern Hama. The total No of beneficiaries during the period was 1212 and 714 PSS consultations were provided. (Annex 6).

3) Lattakia

 The security situation in the coastal area is considered relatively calm, apart from the ongoing military operation against NSAGs in the North East rural Latakia.  SAA military operation continued in North rural Latakia. Heavy armed clashes have been reported between SAA and NSAGs in the vicinity of Kbani town in the Northeast of . SAA\RF airstrikes hit NSAGs positions in the vicinity of Kbani, Syriatel Hill and Rwiset Al Aliah areas. After fierce clashes, SAA managed to capture Zwayqat hill, overlooking Kbani town in the North-eastern rural Latakia governorate. In their turn, National Liberation front claimed that they launched a surprise attack on SAA positions in the axis of Rasho Hill in Jabal Al-Akrad in North-east rural Latakia and they claimed killing ten SAA soldiers. Also, NSAGs targeted with ATGM SAA positions in the said axis killing and injuring several SAA soldiers.  In terms of IAF, several projectiles landed in the agricultural lands close to Slanfah town in the Northeast rural of Latakia governorate causing material damages. Meanwhile, NSAGs hit the vicinity of Al-Qardahah town in the Southeast of Latakia with several projectiles, wounding five persons. Another round of IAF shelling hit Al- Haffah town in the Northeast of the governorate with no reports on casualties. Some reports stated that three projectiles landed in the vicinity of Basil al-Assad International Airport causing three casualties.  The Russian air defence stated that its air-defence systems shot down several swarms of drone attacks launched against Basil al-Assad International Airport. The airbase was not affected by those attacks.

NGO:

Clinics Ramel Jnoubi HC Squbben HC Qnenas HC Mobile team 1 Mobile team 2

Internal 182 151 256

Pediatrics 304 243 261

gynecology 133 133 173

PSS support 35 10 63 128 135

Total 654 537 753 256 269

 Provided all necessary support to Latakia and Tartous DoH vaccination teams to execute their plans. EWARS:  6 cases of acute jaundice syndrome were reported: 3 cases in the Ibrahim Naama Hospital in . 2 cases in the Maternity and Children Hospital.  2 Suspected measles cases were reported: one case in Skantory Health Center and one case in Al Basel Hospital in .  2313 were reported (out of a total number of reviewers 22723) The incidence of flu-like was 5,960 cases (72% of reported cases), acute diarrhea 195 cases (22% of reported cases), 6 suspected hepatitis cases, two suspected measles cases, 21 Severe acute respiratory infection, 5 Meningitis cases, 5 Cases of suspected Leishmania and one suspected Maltese case.

Page | 9

IV. Key Health Actions for the Next 2 Weeks

Secondary Health Care

 Analyze the collected data on the availability of services at the field hospital in Al Hol camp.  Schedule a meeting with the national oncology committee to discuss and agree on SOPs to protect health care staff and the environment throughout the cancer care cycle, from preparing medicines to managing chemotherapy sessions.  implement a training workshop on supply chain for health staff from NGOs and different health facilities.

PHC - UN assessment mission to Al-Rukban, planned on 17-22 August 2019, is pending final approval. Participating UN agencies are WHO, UNICEF, WFP, UNHCR, UNFPA, RC/HC Office, UNDSS, OCHA. Approvals are in process.

KEY CONTACTS: Representative a.i. Dr. Nima Saeed Abid [email protected] Emergency Team Lead Isiaka Stevens ALO [email protected] Communication Officer Yahya Bouzo [email protected]

Page | 10

V. Annexes

Annex 1: WHO supported capacity strengthening (supported 20 activities for 661 participants)

Date No of Detailed title Venue Program participants 02- 25 Communication & Interpersonal MOH/Damascus COM 06/08/2019 skills 03/08/2019 15 Discussion of basic neonatal care PHC Nutrition national guide building/Damascus 03- 25 Managing complicated SAM cases Aleppo hospital Nutrition 07/08/2019 in the hospitals University/Aleppo 04- 25 Congenital hip dislocation Ibn Nafice Disability 06/08/2019 Hospital/Damascus 04- 25 Neonatal resuscitation AL NABEK hospital/R. Nutrition 06/08/2019 programme(NRP) Damascus 05/08/2019 15 Joint technical meetings with UN WHO office/Damascus HIS agencies to follow up the progress of implementing of CVRS project with MoH 05- 25 Iodine titration in Urine laboratory Nutrition 07/08/2019 directorate/Damascus 05- 30 IMCI health information system DoH/Damascus Child Health Care 08/08/2019 06- 25 Communication & Interpersonal MoH/Damascus COM 10/08/2019 skills 07- 25 Monitoring & Evaluation WHO office/Damascus MH 08/08/2019

Annex 2: No and Types of services provided in NES (5th July-18 July 2019)

PHC services SHC services Trauma services # of # Referral of # of First # of referrals treatment aids and # of Mental # of beneficiaries # of Governorate Area for for children emergency Health outpatient reached with trauma secondary with Severe services in Psychosocial the referrals consultations health Acute the camps medicines Services services Malnutrition Hassakeh city 1 0 311 198 4 12 0 center Al-Mabrouka 0 149 545 545 17 8 179 camp 0 0 Ras Al-Ain city 256 256 12 0 0

Al-Hassakeh Al-Hol camp / 4 49 759 759 5 12 133 Phase 1 Al-Hol camp / 0 0 24 687 687 0 125 Annex Al-Hol camp/ 0 0 15 178 177 0 99 phase 7 Al-Hol camp/ 379 379 0 0 0 40 121

Page | 11

phase 8 Al-Raqqa city 249 181 0 0 0 0 255 Ain Issa camp 1359 1359 0 0 0 112 406 Al-Raqqa Al-Mahmoudli 638 638 0 0 0 132 164 Al-Karama 389 378 0 0 0 38 184 Al-Kasrat 375 375 0 0 0 7 164 Aleppo Manbij 556 556 0 0 0 13 125 Abu Khashab 0 0 0 33 716 716 288 camp Dier Ezzour city 516 179 0 0 0 0 0 Sub-total: 7913 7383 38 5 32 612 2243

Annex 3: List of current WHO agreements with national NGOs (by NGO):

# of # of MOUs in Governorate Location of current of ongoing MOUs ongoing preparation MOUs Rural Damascus Qutaifeh - Douma - - Al Tal - Yalda 5 2

Lattakia Lattakia city- Al Baset - Saqubeen- Qnanas and Al Ramel Al 1 1 Janoubi Dara'a Dara'a , Al Laja'at, Al Yarmouk 1 1 Qunaitera Qunaitera 1 1 Homs Old Homs, Al Ghassani and Ayoun Al Wadi 2 1 Hama city, Souran, Moardes ,Taybet alemam, Alsawa'aek Hama ,Alhashimyaa , ean albad, Jarjesah ,tal kartal,tellef 1 1 ,herbenafsah,maardeften and alzarah.

Akramiye polyclinics in Aleppo city. One Static medical point in Al-Hader. 4 Medical mobile teams; 1 operates in the following areas ( Tal Qerah , Babinis , Um - Haoush , Taiena , Al-Alousheh Aleppo 1 2 Farm , Hassin , Oqayba , Wahshiyeh Farm ) . 2 MMTs operate in the following areas ( Abtin, Wdeihi, Haddadin, Blaas, Tall Ed- daman, baradah ), and 1 medical mobile team in Menbje.

Al Hasakeh: Al Hasakeh city, Al Hole camp, Areesheh camp,Mebruka camp and Ras Al Ain.

Ar Raqqa: Ar-Raqqa city, Karama, Maadan, Mahmudli, Ein Issa, NES 8 3 Jurneyyeh and Al-Thawrah

Deir Ez Zor: Deir-ez-Zor city, Al Mayadin, Ashara, Lower Baqras , Abu Khashab (Kisreh), Basira

Total 20 12

Page | 12

Annex 4: Health Service provision in Northern Homs area:

Partner District Commune/Village/Town # of outpatient # of patients received consultations PHC assistance with medicines services

Albir Al Rastan clinic Rastan city 552 0

Albir Al Hola clinics Kafr Laha 433 0

Albir Talbisa clinic Talbisa city 907 0

Albir 3 MMT 20 locations in northern district 970 970

Total 2862 970

Annex 5: Health Service provision in Alghasaniya old Homs city, Fairouza village in East Homs, & Ayoun Alwadi in Mesyaf Hama district.

# of outpatient consultations PHC # of SHC District Commune/Village/Town #Trauma patients services services

Alghassani Homs city 556 15 1 Fairouza. Eastern Homs 336 2 0 Ayoun Alwadi. Western Homs 116 o 0 Total: 1022 17 1

Annex 6: Health Services Provision-Albir Hama NGO

Provision of medical PSS PSS Area consultations with Individual group sessions free medicines sessions Hama city and villages across eastern and northern Hama Eastern-northern rural Hama villages Al- 540 112 158 Hamraa district (20 locations) Northern Hama (20 locations) 488 89 150

Health center Abi Alfidaa 148 75 139

Total 1212 267 447

Page | 13