WHO : SITUATION REPORT Weeks 30 – 31 (19 July – 1 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 Daraa, Al- Hassakah, Deir Ezzor, Latakia, , Aleppo and Idlib governorates.  New Israeli offensive hit Syrian targets in rural Damascus, Qunaitera and Daraa. IEDs exploded in the Southern neighborhoods of Damascus, the capital.  Deadly bomb attacks hit the governorates of Aleppo, Daraa at least five people, mostly army soldiers, have been killed in these attacks.  Escalation of violence caused lots of destruction in populated areas of the northwestern Syrian governorate of Hama; over 100 rockets and mortar shells fell in the towns of Joreen and Rassif causing huge material damage to the dwellings of the inhabitants of the area.  The population of Rukban camp in southeast Syria has dwindled to a quarter of the estimated 40,000 who used to live there five months ago.  A new batch of returning families arrived in Jlaighim corridor in the Syrian Desert coming from Al-Rukban makeshift camp in South-east rural Homs.  A new wave of Indirect Artillery Fire attack (IAF) was reported in some parts of Aleppo city where 12 projectiles were registered in different neighbourhoods.  Tension was escalating at Al-Hol camp during the reporting period; crowds were chanting several political and racial slogans against political authorities

II. Key Health Issues

Response to Al Hol camp:

 196 inhabitants more left the camp to their original homes in Deir-ez-Zor governorate, reducing the total number of the camp inhabitants to 70 285.  WHO-supported health teams screened 98 children and diagnosed 7 children with severe acute malnutrition and 7 children with moderate malnutrition. All of the diagnosed children were referred to the outpatient center.  Eight children with severe acute malnutrition were referred to the WHO-contracted Al-Hikmah private hospital for treatment. Three children were cured and discharged while the rest are still under treatment.  Several training sessions were conducted targeting Al-Hassakeh DoH –affiliated medical staffs and other health teams focusing on different health issues like leishmaniasis, TB, HIV and severe acute malnutrition.  WHO has distributed three prefabricated caravans to be used as family wellbeing centers which enables WHO- supported metal health intervention teams to provide social support services as well as individual and mass listening sessions. Moreover, WHO-supported surgical teams and health workers from Al-Hasakeh Directorate of Heatlh (DoH) were enrolled in several heath training sessions to enhance emergency care and provision of essential health services in the camp. The newly established static health point in Phase 5 started operating and providing health services to the camp’s inhabitants.

III. WHO Response

Non-Communicable diseases & Primary health care:

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 Represented WCO at the Extended Pillars’ Group Meeting under the Strategic Framework to present WHO presentation under pillar 1 is shared with RCO.  As a follow up of the WHO/UNICEF joint Session during the UNICEF MENA Regional Management Team meeting, a joint meeting was held with UNICEF OIC for health and nutrition program to elaborate on the WHO/UNICEF joint action plan to advocate PHC at community level in coordination with MOH counterparts.  Carried out surge mission to Al Hol IDP camp in Hassakeh between 23-27 July to follow up on the health response in the camp  Coordinated with PHCMI national expert in MOH and UNICEF to strengthen joint WHO and UNICEF support fort MOH under the Joint Regional PHC Partnership to enhance UHC at community level.  Under PHC fund and in order to expand outreach basic PHC services, a total of 8 mobile clinics have been received and will be donated to local NGOs in NES and SARC.

Trauma

 Trained 100 health workers on trauma and disability related topics in three governorates (Homs, Al Hasakah and Damascus).  Conducted a joint meeting between WHO focal persons for disability and engineering with their counter parts in MoH at the premises of the Rehabilitation and Artificial limbs Centre to discuss the ongoing support to MOH in the field of physical rehabilitation. This included finalizing the preparation of the upcoming 2-week mission to Syria of an international expert in prosthetics and orthotics (P&O) in order to enhance the capacity of MOH technicians through implementing advanced P&O training course. The topics of the training courses are identified as 1) Trans femoral prosthesis with ischial rainal containment design, and 2) knee ankle foot orthosis. The discussion also included the provision of a 45 sq container to the Rehabilitation and Artificial limbs Centre to be used in the workshop for manufacturing prosthetic devices.  Supported public health facilities and health partners with 328,766 treatments and the management of 3,825 trauma cases in addition to the delivery of 22 medical devices needed in health facilities, especially in emergency unit, operating theater and intensive care unit. The details of distribution are as follows:  40,000 treatments of IEHK supplementary kits to Ain Al-Arab (Kobani) Hospital in Aleppo.  39,465 treatments of trauma medicines and IEHK medical kits to Alhasaka Health Authority, Alhayat Hospital, Alhekma Hospital, Al-Mawadda NGO and Souria Alyamama NGO in addition to 1025 trauma cases via Surgical and trauma kits) to health partners in Al Hassakeh; Al-Mawadda NGO, Souria Alyamama NGO, KRC, Qamishli National Hospital, Alhasaka Health Authority and Alhekma Hospital.

Immunization

 Following the finalization of the comprehensive field EPI review and data quality assessment of the different components of the EPI in Syria lead by the WHO Regional Office team, an EPI improvement plan workshop was conducted on (17-18 July 2019) where representatives of all 13 governorates involved gathered to identify the points of strength of their program and way forward to fill the gaps. Each governorate team presented their draft improvement plan based on their local needs.  MoH are to set the exact target population and include all marginalized and special population (Nomads, IDPs, refugees, etc…) for equity purposes; update the field guides for VPDs and conduct quality trainings to build capacity of service providers for better documentation, data compilation and analysis. WHO and UNICEF reiterated their commitment to supporting the efforts of the Ministry of Health for the improvement of VPD vaccination activities  The EPI accelerated implementation of Routine Immunization in Der Ez Zor (eastern Euphrates districts) started on 17 July up to 03 August 2019. (35) vaccination teams are mobilized by DOH Der Ez Zor up to date reached 36,561 children. MOH provides vaccines and teams while WHO supports technical and operational costs and UNICEF supports the social mobilization component. The initial reports highlighted that the local population demands continuous vaccination services for their children  Meeting with the Director of Primary Health Care department and the National EPI manager to discuss: The dates of the Supplementary Immunization Activities (SIAs) are set for NID October 13-17 and SNID November 17-21, 2019. The target has not changed much since the February round at the country level; hence

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the targeted population is set at 2.8 million children under the age of 5 years. GAVI Performance Engagement Framework (PEF) is almost finalized, pending the approval of the Cabinet  Due to the high population demand for vaccination in the Eastern Euphrates part of Der Ez Zor; DOH are revising the targeted population figure for the under 1 year of age to dispatch appropriate supplies on the ground to close the immunity gap in this high risk area.  Plans: a) Follow up on the GAVI proposal with HE the Deputy Minister of Health due on 04 August 2019 b) A new request to WHO for urgent procurement of laboratory supplies for the National Polio Laboratory (NPL) is under process.  The Polio Expert Review Committee Meeting at central EPI department in Damascus reviewed the documents of 27 non Polio AFP cases and all were discarded based on the provided documents and field investigations .

Mental Health

 MHPSS services were delivered by NGOs through: Five Active family wellbeing centers as follow:  HAMA with Al-Bir Hama NGO, Lattakia, with Syrian Association for Children with Special Needs, NES in Al-Hassakeh/ Al-Hol camp with, Archbishopric of Syria Catholic Center Mar Assia and Al-Yamama, Dez with Syrian Pulse NGO,  Integrated MHPSS services were delivered on community level in Qunaitra, Rural Damascus, Aleppo, Homs and Al-Hassakeh through agreement with 10 local NGOs.  The procured caravans are positioned in Al-Hol camp and are active as field family centers providing MHPSS services, raising awareness session, providing psychological counselling " individual and group " and psychiatric consultation .  Psychotropic medications were delivered to different partners in Aleppo, basically Ibn khadloun hospital for their new out-patient clinic in the hospital.  Following-up with MOH/ MH director on two main issues: Global survey on progress on SDG health target 3.5 (2019), and the rehabilitation proposed by MoH/ MH directorate for having a training hall to cover the need in MoH trainings, supported by WHO.  Coordinating with GZT HUB MH and MHPSS NES TWG to jointly conduct a mhGAP training course in NES for health partners. The training will be roll-out modality rather than ToT, with joint training for MHPSS workers on the ground.  Finalized M&E MHPSS Global framework to be implemented in Q3-Q4 for MHPSS partners and projects managers for WHO NGOs partners in the week of August; the first workshop will be for NGOs partners in Damascus in the first week of August.  Capacity building activity took place in Aleppo for 25 community workers in CARITAS Aleppo, with discussion to widening collaboration with Damascus office as CARITAS is supporting MHPSS projects in EG.

Nutrition and Child Health Guidelines  Support the national MOH workshop on salt fortification with Iodine to relate WHO guidelines in Iodine deficiency policy statement with the national program .  Support the national workshop to update the Syrian code in breast milk substitute marketing according to the international code in link with EMRO to update the national code . Meetings  Participate in nutrition sector meeting to review the first 2019 semester and plan for the next semester. Data analysis

 Data analysis of nutrition surveillance for the first quarter of 2019 with 448793 services and detection of 7776 Global acute malnutrition , 1,964 Severe acute malnutrition, 5,812 Moderate acute malnutrition ; the Higher number is in Rural Damascus ( 2404 = 30% ) ; 496 were refereed to stabilization centers from nutrition surveillance centers and 1157 were managed in different stabilization centers .  With Data analysis of nutrition surveillance for June from 13 governorates with 73,851 beneficiaries Monitoring Page | 3

 Baby friendly hospital training in Homs to support 4 trained hospitals and monitor severe acute malnutrition management in stabilization centers in MOE in Aleppo.

Secondary Health Care  Delivered the newly received anti-cancer medicines to Basma NGO in Damascus.  Shared with the ministry of health the final report of the study on patients’ and their families’ views and experiences of cancer care in Syria.  Followed up with Qamishil team the availability of health services at the field hospitals in Al Hol camp and way forward in organizing internal and external referrals.

Communicable Diseases, Surveillance and WASH Communicable Diseases/Surveillance

Meeting  Technical supporting group meeting for MER grant WHO staff attended the technical supporting group meeting for MER grant from 29 to 31 July 2019 in Beirut, Lebanon. During the meeting, the implementation progress, resource mobilization, best practices and lesson learned were discussed. The participants include WHO EMRO, UNAIDS, IOM, UNICEF, UNDP, UNHCR, INGOs, and MoH officials from MER covered countries. Mission  Leishmaniasis regional training: A WHO staff attended the regional workshop on surveillance, monitoring and evaluation of neglected tropical diseases and the WHO Integrated Data Platform (WIDP) from 22 to 25 July in Cairo, Egypt. During the training workshop, the updates of the surveillance strategy and the current tools available for routine surveillance for leishmaniasis data were provided. The participants were trained on Joint Application Packages (JAP) tool, and field M&E tools for monitoring preventive chemotherapy PC-NTD control intervention. The participants include officers of NTDs, national control program managers and surveillance officers in WHO EMRO.  Monitoring mission of NAP and NTP A 2 day mission was conducted to Hama governorate. The main objectives of LFA mission were to check the availability and the quality of MoH data of 2018. While the NAP data in Hama was very accurate and compatible with the available data at MoH level, NTP data was not the same due to reporting gaps. This gaps applies to 2018 registers when the connection between Hama main TB center and health district center was very hard due to security reasons ; however, the situation in Hama is now getting better and communication channels have been reactivated .  Global Pilot Testing of the WHO Handbook for IHR Public Health Capacity Building and Cross-Border Collaboration at Ground Crossing A WHO staff and 2 MOH officers participated in Global Pilot Testing of the WHO Handbook for IHR Public Health Capacity Building and Cross-Border Collaboration at Ground Crossing from 23 to 25 July, 2019 in Beirut, Lebanon. During the workshop, technical recommendations for the final draft handbook were discussed including the field test in Masna’a, Lebanon in addition to the discussion of IHR implementation at cross boarder collaboration with the neighboring countries  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 by three WHO officers. The objectives of the mission are 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 Qamishili hub and the partners on the current activity implementation, the strategy and the plan. Public health interventions  HIV screening in Al-Hol camp From 22 to 31 July, the HIV campaign was conducted targeting high risk groups in Al Hol camp, including health awareness sessions about HIV testing and counselling and the voluntary test in phase 5. More than 430 voluntary tests have been performed and all cases tested negative. An average 8 sessions were conducted. Page | 4

 TB active case findings o Aleppo: TB active case finding in Aleppo, Sheikh Maqsoud neighborhood has been conducted since 11 of July. Until now, 9000 individuals have been screened, 240 suspected cases have been identified, among those suspected cases ; 18 were confirmed of TB. o Homs for Rukban returnees: More than 15 health workers were trained on field work methodology on Monday 22 July. The campaign started on July 23, 2019.  Suspected Typhoid cases in Deir-ez-Zor An increase of suspected typhoid cases in Deir-ez-Zor has been observed since week 26 through EWARS. Field visits were conducted by WHO focal point in Deir-ez-Zor to verify report, and review patients’ records. Initial investigation showed in total of 747 suspected typhoid cases were reported between week 27 and 30. Most of the cases were reported from areas in the eastern part of the Euphrates river.  Antimicrobial surveillance: Data on antibiotic susceptibility testing (AST) from four selected hospitals in Damascus were collected and shared with WHO/EMRO. The participation of Syria in the Global AMR surveillance will promote and support the globally standardized AMR surveillance and ultimately prevent the emergence and spread of AMR in the country.  Rabies WHO delivered 4000 prefilled syringe of anti-rabies immunoglobulin and 17 000 doses of anti-rabies vaccines as a second batch to MoH of which 4000 doses of anti-rabies vaccines and 2000 doses of immunoglobulins will be sent to NES.

 WASH

The water quality monitoring visits were conducted in Rural Damascus, Aleppo and Al-Hol camp.

 Rural Damascus: the total of 44 water samples (9 water tanks, 25 wells and 10 water networks) in 44 sites were tested. Among them, 3 tanks, 7 wells and 3 water networks were found not safe microbiologically and 25 wells were not chemically safe for drinking.

 Aleppo: The water samples from 48 wells, 27 water reservoirs, 19 jerry cans and 2 water tankers in 13 villages were tested by ATP measurement. Among them 32 wells, 18 reservoirs, 14 jerry cans and 2 tankers were microbiologically not safe for drinking.

 Al-Hol camp: The water samples from 1 water tank, 31 jerrycans (10L), 25 ice samples from ice factory were tested by ATP measurement, TDS, FRC and PH. Among them, 24 jerry cans with ice and the 24 ice samples were contaminated.

 A meeting with WASH sector was held in Al-Hol camp on 28th of July where the standardization of water testing methodologies and sampling were discussed. Also, the sample collection and laboratory analysis of the sample from ice factory was agreed upon . WHO procured the required laboratory media covering 500 tests. The mission to ice factories is to be conducted on the 4th of August.

Information and Planning

 A Joint technical meeting by HIS team and counter partners in MoH (Directorate of Planning and International Cooperation) and UNFPA to follow up on IM transition from emergency to early recovery context CRVS (Civil Registration and Vital Statistic) for deaths and births modules.  Conducted site visits toMOH public hospitals in Tartous governorate to assess the health information systems of secondary health care.  Attended CTFMR technical level meeting with UNICEF and other UN agencies in Damascus.  Attended WoS HCC & IMO meeting 22-23 July in Istanbul.  Attended "Regional Consultative Meeting on Primary Health Care for Universal Health Coverage”, Cairo, 30 July-1 August 2019.  Attended " DHIS 2 Design and Customization Academy", 25-29 July 2019, Sharm El Sheikh, Egypt.  Condcut  The following information products were published and distributed: Page | 5

o (Health Sector & WHO) 4Ws snapshots across Syria for Jun, Q2, Half1 2019. o Shared health sector 4Ws snapshots for April and May 2019at WoS level. o Shared WHO/EMRO - Weekly Summary of Events and Signals (18 - 24 July 2019) and (25 to 31 July 2019). o Shared [Attacks on Health Care] Weekly Update: 18 and 25 July 2019 developed by HQ. o Updated analysis of Al-Hol mortalities as of 17 July April 2019.  Monitored a weekly update on shift of control, functionality status of public HFs, and control of areas by NSAG areas in North West Syria.  Provided (4Ws_Health_Syria) from Jan to Jun 2019 using the Activity Info standard template based on the new HRP indicators 2019 to WoS.

National NGO Coordination

 Monitoring field visits were conducted to areas in Rural Damascus inclusive of Yalda , Ma’araba, Al Tal and Quatifeh to oversee the performance of WHO implementing partners.  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 3).  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 (detailed intervention in annex 4).  WHO plan to strengthen the capacity of its implementing partner is in progress where the procurement process of third party capacity building agency has been launched.

External Relations and Communications

 Applied for the Japanese Supplementary Budget of 2019 through a WoS Concept Note – total amount requested for Damascus is USD 12 million  Negotiating with OFDA additional fund under the 2019 proposal to cover the funding gap of Al Hol camp of 2.5 M USD  Conducting a five-day training course to enhance the interpersonal communication skills for health promoters and IEC personnel at MOH.  Preparing humanitarian story for the donor update, January – June 2019, as well as supporting photos with captions and credits.  Preparing “issue 11” of Al-Hol SitRep and sharing it with Communication team at EMRO for reviewing and getting posted.  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, 576 participants benefitted from 21 WHO-supported capacity strengthening activities (Annex 1).

Operational Support and Logistics

 Dispatched 81.9 tons of medical, lab, WASH & nutritional supplies and printing materials – covering 11 governorates (except Idleb, Tartous & As-Sweidaa). The recipients included 13 MoH facilities, 2 MoHE hospitals 11 NGOs, ICRC, KRC, 5 nongovernmental hospitals, 3 nongovernmental PHC centres, 11 governmental PHC centres & 8 camps.  The total number of treatment is 595,963 and 3,825 trauma cases.  To see the dispatched supply details, please go to ( Annex 7).

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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)

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

1. Political/Security Situation The current situation of NES: Ar-Raqqa  05 IEDs in Ar-Raqqa (Rural Ar-Raqqah, Ar-Raqqa city, Tell Abyad).  SDF continued deploying reinforcements to their positions in Suluk town, 75km north of Ar-Raqqah city Al Hasakah  1 IED in Al-Hasakah.  Turkish Army discharged SAF towards an SDF checkpoint in the western entrance of Ad-Derbasia town, 50Km west of Qamishli city. Deir Ezzour  3 landmines went off in (Al Boukamal, Al-Mayadeen).  SAA combing operation continued on Kabajib Axis on the southwest of Deir Ezzor city searching for ISIL presence.  ISIL sleeper cells attacked SAA positions in SAA’s - positions in Mayadeen desert , South East from Deir Ezzor city. FORECAST AND POTENTIAL IMPACT ON THE UN in NES:  UN Ops in the district are likely to increase. UN staff are more exposed because of the surge in UN activities within areas with high contamination of ERWs (mainly ex-battlefields);  Possible escalation in asymmetric attacks throughout the area.  Exposure to armed confrontation while UN missions travelling alongside the Turkish-Syrian borders. Coordination:  Conducted a sub-sector meeting in WHO Qamishli office and the mid-term health strategy was submitted for the coming 18 months.  Conducted the regular health working group meeting twice in Al-Hol camp; the meetings discussed:  Updates on the general health situations.  The analyzing of EWARS weekly updates.  The referrals of cold cases.  Updates by the three field hospitals  The salary scales and the recruitment of medical staffs.  Weekly mortality analyzing.  Participated in the regular coordination meetings of Al-Hol camp, where many crosscutting issues related to the health were raised to the other sectors; the main issue was WASH interventions and enhancements.  A new psychiatrist was deployed in Al-Hol camp in phase 5 and phase 6 (twice each). Emergency response: Vaccination  2 vaccination teams are working on a daily basis in Al-Hol camp ;

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EWARS & CDs& Water quality;  In coordination with AlHasaka – DoH, Leishmania treatment mobile team supported by WHO provided treatment to the camp residents in phase 5.  The Early warning system is actively operating in the camp. During the reporting period, 12medical points provided reports for the epidemiologic weeks 29 and 30 in addition to the 3 field hospitals.  A total of 11,108 consultations were recorded in the medical point in addition to 11,597 recorded manly in MSJM and ICRC, KRC field hospitals.  The leading causes of morbidity among all age groups remained acute diarrhea (13%) and influenza-like illnesses (10%) out of all consultations in PHC.  The trends of AD remain in the same point of 13% for the last 3 weeks and ILI at 12% of all consultations.  In total, 714 cases of acute diarrhea were reported in week 29 and 657 AD (in week 30), a slight decrease over the previous weeks and consultations decreased . WHO’s response activities include provision of medical supplies and improve water quality in the camp.  During this week , 1 Acute Flaccid Paralyses case was reported in Al- Hol and followed by EWARS focal point  2 on Job training for the medical staff was conducted by EWARS focal point during the period 28-31st of July.  Health Education campaign on HIV was conducted; at least 8 sessions per day and 463 tests were conducted but no positive case was found

Mental health

 Mental health expert started to provide medical consolation in phase 5 and phase 6  23 health workers provided PFA counseling.  Mh-GAP services were provided through the functioning medical points in the camp.

Nutrition and child care

 12 SAM with complications were admitted in Al-Hikma; 9 were discharged while 8 are still under treatment . Pharmacy and SHC:  Distributed medicines and kits to cover 386,736 treatments courses and 3,050 trauma cases. 10 health facilities in the three governorates received these supplies. NGOs coordination in NES:  A field visit took place with the technical experts of WHO CO into Al-Hol camp to evaluate the general health situations and the WASH related issues.  A meeting took place with St.Ephrem committee, Mar Assia , Al-Hakim center and Al-Hayat hospital to follow up on the progress of the MoUs under the SHF.  Conducted a meeting with MSJM and discussed the status of the field hospital in Al-Hol and the ways forward to enhance the provided services in line with the other provided services.  A separate meeting with the camp authorities was conducted to discuss the approvals of the referrals outside the camp, and a new mechanism has been coordinated which will be in place soon.  Conducted a meeting with the operational desks in Al-Hol camp to follow up on the main gaps and the frequency of the critical cases compared with the available services in the three field hospitals.  The checklist of the availability of the health services in the filed hospitals has been updated and analyzed.  A mission took a place to Al-Mahmoudli new established camp in Ar- to follow upon coordinated activities with the other health actors; an interagency meeting was in place with other sectors. Annex 2 shows the number and type of services provided in NES .

North West (Aleppo, Homs, Latakia)

1- Aleppo :

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Security Situation

 Violence in northwest Syria has continues since the beginning of May and is putting civilians at risk, and violence in areas directly affected by the conflict is driving displacement into densely-populated areas.  During the reporting period, the city of Aleppo witnessed an increased number of IAF during the past two weeks in several western and central neighborhoods resulting in dozens of injured people and many deaths.

Service provision

 1 ongoing MOU with WHO implementing partner (Al-Taalouf national NGO).  4 WHO MMTs in rural areas are functioning as follows: a) 2MMTs in south rural of Aleppo (2 Al-Taalouf , ) in addition to 1 PHC in Dier Hafer. b) 2 MMTs in north rural Aleppo (Afrin IDPs response), (1 CCS, 1 Al-Taalouf NGO ) In addition to 1 PHC in AL-Hader South rural Aleppo.  Two cost extension requests were finalized with two WHO implementing partners (YBY, ASSLS) in order to expand the coverage areas of WHO supported health facilities.  Following up on 62 identified TB cases in Fafin area (30 completed treatment, 32 under treatment)  Aleppo DoH continuing the insecticide spraying campaign as part of the vector control of Leishmaniasis supported by WHO as 45 days were completed and 35 days remain; the Campaign ends at the end of September2019. 19 neighbourhoods have been completed in Aleppo city and 12 remain in Aleppo city; 5,923,850 m2 were sprayed till now and 118,477 people were targeted. 63 villages have been completed in rural Aleppo, 3,401,750 m2 were sprayed till now and 68,035 people were targeted. 114 workers in Aleppo city and 56 workers in rural Aleppo are working in this campaign.  Following up TB survey in Al-Shiekh Maksoud neighbourhood; 17 days were completed ; the survey will finish on 10th of August 2019, 5 ; teams are doing this survey. 9000 people were surveyed (240 suspected cases,”18 TB cases of them were confirmed and started their treatment”).

Mental Health WHO supported:  a) Ibn Khaldoun psychiatric hospital - 2912 consultations;  b) Mental Health directorate – 132 consultations;  Psychotropic shipment was delivered to Ibn khaldoun mental hospital and different NGOs involved in the response to the situation in NWS.  AField visit was conducted to Ibn khaldoun hospital to assess the need of the new out-patients clinic opened in the hospital and to monitor the delivery of psychotropic medications.  18 individual supportive supervision sessions were conducted for trainees in different programmes on MHPSS.  Orientation session took place for up to 15 partners that have implementations in MHPSS and GBV field in NWS response.  Holding several meeting with UN agencies partners " UNICEF, UNHCR and UNFPA "regarding conducting joint capacity building activities for the implementing partners. " SMHP,PM+,mhGAP"  Participated in GBV sub-working group at Aleppo hub level, where an update about WHO response to GBV was presented as a health response.  Capacity building activity took place with CARITAS Aleppo about PFA for 25 community workers in eastern Aleppo " Jazmati and Jabal Badro"  Preparation for MHPSS M&E for MHPSS partners at the hub level and with the implementing partners.  MHPSS services were delivered to the community through the contracted NGOs in the city, northern, eastern and southern rural areas of Aleppo.  MHPSS preparedness and response in NWS Aleppo were updated.  Several counselling sessions were provided for UN staff from Aleppo HUB upon their request.

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Trauma:  More than 10 killed and more than 40 wounded have been reported in the mentioned period due to the escalating violence in several neighborhoods in western and central part of Aleppo city  Close coordination and follow-up visits to Al Razi Hospital and Aleppo university hospital were made to assess the needs and respond to urgent needs  Coordination meeting was conducted with UNPD in Aleppo to discuss the issues related to the artificial limb center and the needed technical support from the WHO side to the physiotherapists working in the artificial limbs center in Aleppo, Qamishli and Damascus.  A field visit has been conducted to South Rural Aleppo to assess the health situation in four locations (Tal Eddaman (C1058), Kolet Albuweider (C1116), Amriyeh, and Blas (C1076).

2) Homs

 The total number of people who left Rukban remains at 17,463 people (41.87%) out of 41,700 residents. Between 25 and 30 July, 343 people (112 males, 96 females, 100 children and 35 infants) left Mahmoud Othman shelter.  HWG coordination meeting was conducted on 25th of July, in the presence of UN agencies at Homs Hub, DOH and local NGOs in Homs. Operational updates & suggestions were discussed by health partners.  Updated health sector coverage and the geographical location for the health services in Homs and Hama till end of July 2019.  Assessment visit to Mheen town was made to follow up health situation of 300 families who returned from Rukban camp. Total number of the returnees in the town is 600 families.  In Homs; a field monitoring visit to Albir NGO was conducted by Homs WHO team to follow up the health project in Northern Homs area (2 static medical clinics in Rastan and Talbiseh were visited.  In Hama; a field monitoring visit to Albir Hama NGO was conducted by WHO FP to assess the progress made in the health and community project supported by the World Health Organization  A reviewing and monitoring visit was conducted to Hama DOH by WHO team to review the TB program, data quality and compatibility and the AIDS program and its data quality and laboratories ; the review included the year of 2018 .  A reviewing and monitoring visit was conducted to Hama governorate to review the vaccine program (financial review  An extended meeting was held for the vaccine officers on both levels (governorate level & districts level) with Hama DOH director and communication officers and surveillance officers & warehouse managers, and WHO FP to discuss the vaccine program current situation in the governorate (challenges and gaps) in order to find solutions and ways to support in line with EPI study recommendations.

1. Health situation

 54 children under 5 years from the last arriving 24th group were vaccinated by mobile teams supported by WHO.

NGO activities :  Albir Homs NGO started health project supported by WHO in on 9/7/2019: 3 static points in Northern Rural Homs (Talbessah, Al-Hula and Rastan) and 3 Mobile Clinics (Northern and Eastern Countryside). Total provided consultation s :5485

 An Orthodox Association for Helping the Poor health project provided health services through 3 fixed health points in Alghasaniya old Homs city, Fairouza village in east Homs, Ayoun Alwadi in Mesyaf . The total number of beneficiaries was 1609 (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 2893 and 1173 PSS consultations were provided. (Annex 5).

 Homs DoH started a TB survey among Rukban returnees on 21stof July; three WHO-supported mobile teams

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targeted around 3000 families in the shelters and in their second destination. 350 families were surveyed during the first week in 5 shelters in 4 other locations (Zhoriya Der Balba and Helaliya in north-east Homs and in Mheen town. 3 TB cases of them were diagnosed and started their treatment.

3) Latakia

Security Update:

 The back and forth fight continued between SAA and NSAGs in north east of Latakia mainly Kabani axes. SAA/RF airstrikes targeted NSAGs positions in the vicinity of Al Khouder, casualities .  NGOs :

Ramel Jnoubi Squbben Qnenas Mobile team Clinics Mobile team 2 HC HC HC 1 Internal 364 303 512 Pediatric 608 486 532 s gynecol 265 266 346 ogy PSS 69 21 126 256 269 support Total 1306 1076 1516 256 269

 Response to the IDPs in Lattakia governorate by SACSN:  Medical consultations: 211 beneficiaries  Medicines: 89 Beneficiaries  Psychological support : 233 beneficiaries POLIO:  Provided all support to DoHs in Latakia & Tartous to implement the monthly vaccination plan.  Provided Latakia DoH with 124 rented vehicle.  Provided Tartous DoH with 162 rented vehicle. EWARS:  Four acute chronic inflammatory conditions were reported: 3 cases in Ibrahim Naama Hospital + 1 in the

National Hospital  6952 cases were reported out of the total number of reviewers (63322), Where the cases of disease similar to the flu 5595 cases (50% of reported cases), Acute diarrhea 950 cases (69% of cases reported), 9 cases of suspected hepatitis, 56 cases of severe acute respiratory infection, one suspected Maltese case, and 2 suspected smallpox cases. Capacity building:  Supporting the following workshop :  HeRAMS on line at Governorate level at Tartous.

Logistics: Out:  Dispatching 6.4 tons NCD kits Model Medicines, equipment and renewable to NGOs and WHO HUBs and DOHs in many governorates.  Handing over the HIS items (Network Equipment) to Tishreen university in Lattakia.  Dispatching 626 kg of PHC medicines to Homs and Aleppo Hubs.  Providing Lattakia DOH with 97500 tablets of CHLORINE.

In:  Received HIS items from PROTECH Company in favor of Tishreen university hospital in Lattakia.  Received 8 mobile clinics from Lattakia Port under PHC – NES Project. Page | 11

IV. Key Health Actions for the Next 2 Weeks

Secondary Health Care  To analyze the collected data on the availability of services at the field hospital in Al Hol cam  To organize a training workshop on supply chain for health staff from NGOs and different health facilities. PHC  Al Rukban assessment mission, planned on 15-20 August 2019.  Hama mission 5-7 August 2019, to visit diabetes center, Thalassemia center & national hospital in Hama to assess needs /MOFA approval is granted.

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]

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Annexes

Annex 1: WHO supported capacity strengthening (supported 21 activities for 576 participants)

No of Date Detailed title Venue Program participants 20- 25 War Wounded Injuries Management DoH/Damascus Trauma 24/07/2019 21- 25 Children friendly hospitals MoH/ Homs Nutrition 25/07/2019 21- 25 Diagnosis of Diarrhea diseases DoH/Damascus EWARS 23/07/2019 Expand program on Immunization (EPI) Dama Rose 21/07/2019 80 PHC review final results /Damascus 21- Child Health 25 Neonatal resuscitation programme(NRP) MoH/Daraa 23/07/2019 Care 22- Economical feasibility in health domain Strategical study 30 HIS 25/07/2019 workshop at Hospital level (Damascus) center/Damascus 23- Integrated Management of Childhood Child Health 16 MoH/Damascus 30/07/2019 Illness (IMCI) Care 25- Hazmat management and evacuation of Mobile 25 Trauma 28/07/2019 buildings hospital/Homs 26- MoH 25 HeRAMS on line at Governorate level HIS 29//07/2019 Directorate/artus 28- National Child Health 25 Neonatal resuscitation programme(NRP) 30/07/2019 hospital/Aleppo Care Expansion on training regarding nutrition 28/07- 25 surveillance clinics + Infant and Young MoH/Al Hassakeh Nutrition 01/08/2019 Child Feeding (IYCF) counselling Expansion on training regarding nutrition 28/07- 25 surveillance clinics + Infant and Young MoH/ Deir-Ezzor Nutrition 01/08/2019 Child Feeding (IYCF) counselling 28/07- Nutrition surveillance & Infant and Young Aleppo hospital 25 Nutrition 01/08/2019 Child Feeding (IYCF) counselling University 28- Training on early warning for reporting 25 Al Hol Camp EWARS 29/07/2019 officials in Al Hol camp 29- 25 Iodine calibration MoH/Damascus Nutrition 31/07/2019 29- 25 First Aid & Basic Life Support DoH/Damascus Trauma 31/07/2019 Economical feasibility in health domain 29/07 - Strategical study 30 workshop at Hospital level (Rural HIS 1/08/2019 center/Damascus Damascus) 30/07- 25 War Wounded Injuries Management Qamishly Hospital Trauma 03/08/2019 PHC 30-7 Early warning for reporting officials in 25 Directorate/R. EWARS 01/08/2019 Rural Damascus

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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 treatment aids and # of Mental Governorate Area # of beneficiaries referrals # of outpatient reached with for for children trauma emergency Health consultations the secondary with Severe referrals services in Psychosocial medicines health Acute the camps Services services Malnutrition 0 0 Hassakeh city 0 center 472 253 2 1 Al-Mabrouka 0 150 camp 745 741 22 6 160

Ras Al-Ain city 465 465 25 0 0 0 0

Al-Areesha camp 558 517 1 2 3 27 69

Al-Hol camp / 989 989 9 4 4 57 234 Al-Hassakeh Phase 1 Al-Hol camp / 0 0 102 Annex 984 225 0 400 Al-Hol camp / 0 0 13 Phase 6 584 577 0 102 Al-Hol camp/ 0 0 22 phase 7 425 425 0 56 Al-Hol camp/ 0 0 0 65 phase 8 698 698 119 Al-Raqqa city 393 268 0 0 0 0 260 Al-Jurneay + Al- 0 0 0 6 Mansoura 415 375 90 Al-Tabqa 422 375 0 0 0 11 93 Al-Raqqa Ain Issa camp 2671 2581 0 0 0 199 810 Al-Mahmoudli 0 0 0 13 camp 1410 1410 365 Al-Karama 864 847 0 0 0 75 368 Al-Kasrat 767 767 0 0 0 46 254 Aleppo Manbij 1496 1496 0 0 0 18 324 Hajin 1176 1176 0 0 0 15 98 Al-Busayra 288 269 0 0 0 6 62 Dier Ezzour Abu Khashab 0 0 0 53 camp 1317 1317 490 Dier Ezzour city 708 406 0 0 0 0 0 Sub-total: 17847 16177 59 6 14 878 4354

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Annex 3: List of current WHO agreements with national NGOs (by NGO): # of # of MOUs Governorate Location of current ongoing MOUs ongoing in MOUs preparation Damascus Al Zahera 1 Rural Damascus Qutaifeh - Douma - Harasta - Al Tal – Yalda 5 2 Lattakia Lattakia city- Al Baset - Saqubeen- Qnanas and Al Ramel Al Janoubi 1 Dara'a Dara'a , Al Laja'at, Al Yarmouk 1 1 Qunaitera Qunaitera 1 Old Homs, Al Ghassani and Ayoun Al Wadi 2 1 Homs Hama city, Souran, Moardes ,Taybet alemam, Alsawa'aek ,Alhashimyaa , ean albad, Jarjesah ,tal kartal,tellef 1 Hama ,herbenafsah,maardeften and alzarah. Agior , Deir Hafer , Rural villages of Aleppo city ((Babiri -Upper Babiri , Babiri -Lower Babiri , Rasm Elbokhar , Kayariyieh , Big Habbuba , Little Aleppo 3 0 Habobieh , Southern Rasm Elharmal ). Hananou , AL-Martini , Tal Refaat and surrounding villages

NES Deir- Ez-zor - Ar Raqqa city - Al Hasakeh. 8 3

Total 23 7

Annex 4: Health Service provision in Northern Homs area. # of outpatient # of patients received Partner District Commune/Village/Town consultations PHC assistance with medicines services

Albir Al Rastan clinic Rastan city 1534 0

Albir Al Hola clinics Kafr Laha 380 0

Albir Talbisa clinic Talbisa city 1329 0

Albir 3 MMT 20 locations in northern district 2242 2242

Total 5485 2242

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 908 20 2 Fairouza. Eastern Homs 636 3 0 Ayoun Alwadi. Western Homs 145 2 0 Total: 1609 25 2

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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- 1084 160 287 Hamraa district (20 locations) Northern Hama (20 locations) 1120 114 362 Health center Abi Alfidaa 689 103 147 Total 2893 377 796

Annex 7: Dispatched supply details

 125,125 chlorine tablets were delivered to 8 camps at Al-Hasakeh, Raqqa, Deir Ez-Zor and Aleppo governorates.  4 infant scales, 3 portable adult/child length/height measuring boards and 3 electric mother/child function scales were delivered to ICRC at Al-Hasakeh to support Al-Hol camp.  13 Cholera kits, 1 family doctor’s kit, 1 surgical supply kit, 2 patient monitor devices, 1 portable oxygen concentrator, 10 serum holders, 2 suction pumps, 4 fingertip pulse oximeters, 1 ultrasonic diagnostic imaging system and different types of MH, PHC, STHC and WASH supplies were delivered to KRC at Al-Hasakeh.  3 operating tables, 1 monitor battery for Dragger anaesthesia machine, 1 cooling bag for keeping the test swabs at operational temperature, 1 patient monitor and 3 surgical supply kits were delivered to Alwaleed hospital in Homs.  1 steam sterilizer with 80 litre capacity was delivered to Jub Jandalii PHC center in Homs.  2,000 tablets of Praziquantel 600 mg tablet were delivered to MoH central warehouse in favour of Zoonotic programme.  9 NCD kits were delivered to MoH central warehouse in Damascus in favour of rural Damascus, Qunaitra & Daraa DoHs.  3 lab kits and consumables were delivered to MoH – PHL – HIV lab.  Different types of lab supplies were delivered to MoH – PHL – microbiology lab.  2 Trauma kits (A) and different types of PHC & STHC medicines were delivered to Qamishli national hospital at Al-Hasakeh governorate.  1 Steriliser 105 litre capacity, 1 table top centrifuge, 4 WNB water baths, 1 isotherm forced convection incubator 54 litres, 50 portable baby/child/adult L-H measuring system, 50 mother/child function scales, 2 aqua snap kits, 39 NCD kits & 97,500 chlorine tablets were delivered to 6 DoHs.  1 Basic x-ray machine was delivered to MoHE – children hospital in Damascus.  Different types of ICT equipment were delivered to MoHE – Tishreen university hospital in Lattakia.  16 IEHK kits, 8 ECG device, 1 defibrillator/monitor device, 2 electrosurgical unit, 1 general & obstetric/gynaecologic ultrasonic, 1 ICU bed, 2 isotherm forced convection incubator 54 litres, 9 surgical supply kits, 6 trauma kits (A), 3 Trauma kit (B), 10 serum holders, 4 WNB water bath, 6 portable baby/child/adult L-H measuring system, 1 portable oxygen concentrator, 6 mother/child function scale and different types of MH, PHC, STHC and nutritional supplies were delivered to 5 NGOs in Aleppo, Al-Hasakeh & Raqqa governorates.

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 2 Sphygmomanometers, 29 cholera kits, 25 NCD kits, 7 surgical kits, 1 compressor nebulizer, 4 IEHK kits, 1 oximeter finger device, 1 patient monitor, 2 trauma kits (B), 6 portable baby/child/adult L-H measuring system, 6 mother/child function scales and different types of EWARS, MH, PHC, STHC & trauma supplies were delivered to 11 NGOs at Aleppo, Al-Hasakeh, Homs, Damascus and rural Damascus governorates.  15 IEHK kits, 8 ECG devices, 1 isotherm forced convection incubator 54 litres, 15 surgical supply kits, 5 trauma kits (A), 2 Trauma kits (B), 3 portable baby/child/adult L-H measuring system, 30 serum holder, 1 spectro-humalyzer, 3 WNB water baths, 1 ultrasonic diagnostic imaging system, 2 family doctor’s kit, 3 portable oxygen concentrator, 1 patient monitor device and different types of MH, PHC & STHC supplies were delivered to 3 non-governmental PHC centres in Al-Hasakeh, Raqqa and Deir Ez-Zor governorates.  10 cholera kits and 20,000 ORS sachets were delivered to 11 governmental PHC centres at Deir Ez-Zor.

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