HEALTH CLUSTER BULLETIN August 2020 Fig.: Critical actions to control COVID-19 transmission. (WHO) Turkey Cross Border Emergency type: complex emergency Reporting period: 01.08.2020 to 31.08.2020 2.8 MILLION* 2.66 MILLION 3.7 MILLION 24**ATTACKS HEALTH PIN IN IDP IN NWS SYRIAN REFUGGES AGAINST HEALTH CARE NWS HNO 2020 31 AUG 2020 IN TURKEY (**JAN - AUG 2020) HIGHLIGHTS • At the end of August, there were 80 SARS-CoV-2 132 HEALTH CLUSTER MEMBERS (COVID-19) cases confirmed in NW Syria, 32 from 40 IMPLEMENTING PARTNERS REPORTING 1 Idleb and 48 from Aleppo governorates. MEDICINES DELIVERED TREATMENT COURSES FOR COMMON • After the increase in transmission between Health 385,045 DISEASES Care Workers the NWS COVID-19 Taskforce FUNCTIONAL HEALTH FACILITIES HERAMS recommended, and the local Health Directorates FUNCTIONING FIXED PRIMARY HEALTH requested in a written announcement that health 150 CARE FACILITIES workers, specially doctors, must avoid dual 63 FUNCTIONING HOSPITALS employment (work in more than 1 health facility) 66 MOBILE CLINICS • As per CCCM Cluster, during the period from 1 HEALTH SERVICES2 August to 31 August 2020, over 30,000 699,537 CONSULTATIONS displacements took place in NW Syria, with DELIVERIES ASSISTED BY A SKILLED departures principally occurring from A’zaz, and 9,057 ATTENDANT other notable departures from Ehsem, as well as 14,233 REFERRALS Dana. The main locations where displaced people 777,852 MEDICAL PROCEDURES arrived to included Atareb, Dana and Maaret 25,831 TRAUMA CASES SUPPORTED Tamsrin sub-districts. 1,760 NEW CONFLICT RELATED TRAUMA CASES • In terms of needs, the top three needs reported for VACCINATION newly displaced persons were Shelter (29%), Safety 10,055 CHILDREN AGED ˂1 VACCINATED3 and security (23%), and Cash (15%). • In NWS, according to HNAP the rate of households MENTAL HEALTH SERVICES who selected health services as a priority need was 6,663 MENTAL HEALTH CONSULTATIONS notably quite low. This is likely due to the comparatively higher level of already existing DISEASE SURVEILLANCE SENTINEL SITES REPORTING OUT OF A humanitarian health provision in the region. 439 • In August, more than 2 million certificates were TOTAL OF 445 4 issued from the WHO’s open learning platform WOS HEALTH HRP & COVID-19 2020 FUNDING $US HRP $82.9 M (18.7% funded) (OpenWHO.org), including 126 courses produced RECEIVED COVID19 IN 2020 $36.1 M (22.8% funded) for the COVID-19 response. * 2.8 Million PIN in NWS includes an estimated 100,000 in NES Tal-Abyad and Ras Alyn under the Government of Turkey control areas. 1 Supplies were cross border delivered by the WHO Gaziantep Hub and distributed to implementing health cluster partners in northwest Syria. 2 Figures reported and updates are from 1 – 31 August 2020. 3 Routine immunization with pentavalent vaccine (5 in 1 vaccine) 4 Source: OCHA Financial Tracking System, Syrian Arab Republic Humanitarian Response Plan (HRP 2020) as of 31 August 2020. https://fts.unocha.org/ 1 Situation Update: According to HNAP Priority Needs & Access to Services -HNAP Summer 2020 Report Series-6 and the CCCM Cluster, by end of August, around 30,000 movements were recorded. Over three quarters of displacements (78%) were recorded in areas under the control of Non-State Armed Groups and Turkish Backed Armed Forces. Specifically, in a trend (see CCCM crop insert graph) that has remained constant since March 2020. Idleb and Aleppo governorates were both the top origin and arrival governorates for the newly IDPs. The most common drivers of displacement were the deterioration of the economic situation (39%) and the deterioration of the security situation (38%), while the improvement of the security situation was the most common reason for arrival into current location (37%). In terms of needs, the top three needs reported for newly displaced persons were Shelter (29%), Safety & security (23%), and Cash (15%). In NWS, ‘health services’ was selected as the highest priority need for only 1% of households, and as one of the top three for 12% of households. Since this was quite low (12th most selected as highest priority needs and 9th most selected as one of the top three priority needs, out of a total of 15), we may conclude that this is likely due to the comparatively higher level of already existing humanitarian healthcare provision in the NWS region. As for the COVID-19 Response, since the first laboratory confirmed case was identified on 9th July, the numbers are as expected increasing. EWARN have confirmed community transmission taking place. Current cases are predominantly in Northern Aleppo while there are still active cases in Idleb area. At the end of August, there were 80 cases confirmed, with 32 from Idleb and 48 from Aleppo governorates. The mean age of the cases was 35 years. Two cases are under 5 years old and 6 cases are over 60 years old. Mild symptoms were reported by 86%, while 6 cases had moderate to severe symptoms and were hospitalized, the rest were asymptomatic. Out of the total 80 cases, 70% recovered. Since the confirmation of the first positive case, one death associated with COVID-19 was recorded. During the reporting period, 7 isolation hospitals and 8 isolation treatment centres for primary care level management (called COVID-19 Community Treatment Centres, or CCTCs) were active in NW Syria. The major focus has been shifted on curbing transmission among Health Care Workers (HCWs), as the number of HCWs infected is significantly high and the outbreak continues to infect the medical community. Over 30% of the cases were among HCWs. To this this effect the task force is drafting a renewed testing strategy for NWS, based on WHO recommendations, adopting to context. Salient features include: testing of HCWs in high risk facilities dealing with respiratory illness, periodicity of testing of HCWs in focus areas (hotspots), HCW where multiple co-infection related service delivery points (for e.g. TB), Health Directorates and Health Cluster recommendations to implementing partners to avoid dual employment of HCWs for the time being. Efforts remain concentrated on contact tracing, interrupting virus transmissions and reducing secondary infections. Health partners continue to raise awareness about COVID-19 precautions among local communities and other stakeholders, emphasizing practices to prevent transmissions including hygiene practices, self- isolation and physical distancing. Distribution of masks based on risk-based prioritization of vulnerable groups and considering distribution modalities. Work is ongoing to intensify interventions to strengthen infection prevention and control at health facilities as means to protect healthcare workers and prevent transmission from healthcare service delivery points, which is as well of high priority. To increase laboratory testing capacity, under the pipeline to be deliver, WHO is providing two PCR machines, one to a laboratory in Afrin city in northern Aleppo governorate, and another to the existing laboratory in Idleb city to complement the existing testing. In addition to the 86 ventilators installed with support from SCHF, 5 ventilators through an in-kind donation from health cluster partners and 15 Continuous Positive Airway Pressure Units (CPAP) are as well on the pipeline. More than 16 million “personal protective equipment” (PPE) items including masks, gloves, goggles and face shields were shipped into NWS on 22 August with the support of the Turkish Red Crescent Society (TRCS) and funded by OCHA managed common pooled funds. Protective gowns are in pipeline and the Personal Protective Equipment (PPE) will be provided to the staff of more than 80 humanitarian organizations who shared specific needs with the COVID-19’s taskforce. 2 Public health risks, priorities, needs and gaps • Community and in-hospital (staff to staff) exposure and transmission are the main routes of the 2019 novel coronavirus (SARS-CoV-2) spreading among health care workers (HCWs) who are the frontline fighters in NWS. One third (medical and non-medical/ancillary personnel) of the total confirmed cases are linked to a health facility; therefore, curbing transmission among HCWs is high on the agenda as the contamination continue to spread. • As COVID-19 spreads, health and social systems across the NWS are struggling to cope in the already disruptive health system. Worsening the picture, the dire ongoing economic crises had further opened the door specially for doctors to work in more than one health facility (a financial incentive), as a result increasing the chances of transmission between health facilities as has been the case. • Densely populated areas in NWS, such as camps and informal settlements, are considered so challenging to apply self-quarantine. This is coming with the the worsening economic situation in NWS as a factor identified to refuse the admission to isolation or quarantine facilities nor even to self-quarantine in their own home due to fear of losing their bread win - when no paid leave system and/or financial support is guaranteed. • There is a need to scale-up testing for HCWs with a special focus on those who are working in COVID-19 designated health facilities (e.g. hospitals, COVID Community Treatment Centres) and those who are providing care for the most vulnerable groups like in TB clinics, dialysis centres, in addition to the expanding timely contact tracing and laboratory capacities. • Precautionary measures should be rigorously implemented at community level; therefore, the camp managers need to be aware on preventive activities and to emphasize hand washing, physical distancing, avoiding mass gatherings and other measures as recommended by the NWS Health Cluster COVID-19 taskforce and WHO. • Although improving, the personal protective equipment (PPE) and infection control and hygiene items for medical staff and community health workers (CHWs) continues to be a gap been prioritised. • Due to shortage of masks in the market, there is a need to enhance the local procurement and production of fabric masks in the field.