WHO biweekly operational update 16-31 October

General developments: political & security situation

 UNSMIL Convenes First Virtual Session of the Libyan Political Dialogue Forum.  ‘5+5’ Joint Military Commission Agrees on Permanent Countrywide Ceasefire.  The members of the Security Council welcomed the permanent ceasefire agreement signed by the 5+5 Joint Military Commission on 23 October in Geneva following talks facilitated by the United Nations.  The General Authority of Searching for the Missing has discovered four more mass graves in the city of

OPERATIONAL UPDATES

COVID-19 response

Pillar 1: Coordination  Continued to provide technical guidance to national and regional COVID-19 committees and disseminate daily and weekly updates on the disease.  Met with the MoH to discuss preparations for a nationalreview of Libya’s COVID-19 response. Due to time constraints, the MoH will not be able to fully use WHO’s intra-action review (IAR) toolkit. WHO has recommended that the review focus on progress meeting objectives; social and public health preventive measures; COVAX; decrees and resolutions; surveillance; health system capacity; stakeholder participation; and how to strengthen public health and social measures to tackle the pandemic.  Met with the head of the National Centre for Disease Control (NCDC) in Sebha as well as the heads of Sebha Medical and Triage Centres and the health services administration to discuss the deteriorating health care services in the city and explore the better use of resources to address needs and gaps.

Pillar 2: Risk communication and community engagement (RCCE)  Conducted two one-day training sessions (on 21 and 25 October 2020) for 67 community health workers (CHWs) in Wadi Ashshatti. Participants were trained on risk communications around infection prevention and control (IPC), waste management and handling dead bodies.  Conducted two three-day training courses (13-15 October and 18-20 October) on IPC, case management and risk communication for another 26 CHWs.  Participated in a virtual meeting organized by EMRO on 18 October 2020 to explore ways to improve risk communications around COVID-19 and promote mask wearing throughout the region.

Pillar 3: Surveillance, rapid response teams and case investigation  Continued to follow up with the NCDC on daily registered COVID-19 cases and the epidemiological situation. WHO also discussed how to enhance COVID-19 surveillance to include infected health care workers.  Supported a two-day training workshop for rapid response teams (RRTs) organized by the NCDC in Ghiryan from 21 to 22 October 2020. Participants were trained on outbreak investigation, sample collection, contact tracing, IPC and data management.  Launched a joint NCDC/WHO/IOM EWARN weekly bulletin that consolidates COVID-19 data from health facilities and from migrant sites covered by IOM’s Displacement Tracking Matrix.

Pillar 4: Points of entry

Pillar 5: National laboratory

 Distributed 2 GenExpert machines to Al Baida and Derna.

Pillar 6: Infection prevention and control (IPC)

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 Conducted a three-day training course (19-21 October) on managing COVID-19 patients for 23 physicians working in triage and isolation centres.  Conducted two training courses (on 19-20 and 20-21 October) on managing COVID-19 patients for 10 psychiatrists and 21 psychologists working in Al Razi psychiatric hospital.  Participated in a meeting of the MoH’s IPC working group (led by UNICEF and WHO) on 22 October 2020. WHO recommended that the MoH include four topics (PPE supplies, training, hygiene supplies and WASH) in its mapping exercise to gather information on the gaps and support required under the IPC pillar of its national COVID-19 plan.  Contracted six IPC officers to support COVID-19 isolation departments throughout the country.

Pillar 7: Case management  Revised its list of COVID-19 facilities to include updated information on bed capacity, human resources and functionality.

Pillar 8: Operational support and logistics  See below

Leadership

 Presented an update on COVID-19 situation in Libya to the diplomatic community  Prepared an update to the EU delegation on WHO operations in Libya  Followed up with DFID on the proposal for support to a Mental Health Programme  Reviewed quarantine measures for UN staff in Libya and prepared a proposal to the Crisis Management Team for an amendment of the current practice  Reviewed numerous proposals and reports (inclusing ECHO and DFID PHC final reports)  Prepared a report on the status of the implementation of the audit recommendations  Briefed the donors in a meeting organized by HQ on the country context and the follow up on the audit recommendations

Coordination and Health Information Management

 Conducted a meeting with HIS unit lead in the MoH discussing the plan and agree to work closely to enhance reporting and health indicators.  Conducted a coordination meeting with National Surveillance and RRT Focal team in NCDC to discuss the reporting templates and the standard daily information for COVID-19.  Developed draft of COVID-19 interactive dashboard and shared with the NCDC.  Shared the 4W dataset/table on MHPSS data, as well as a summary analysis, with MHPSS team.  Designed a first draft of WHO KPI infographic.  Produced health sector Libya, 4W snapshot, September 2020; Map, health sector Libya operational presence in Libya, January – September 2020; Operational presence/response of health sector organizations by municipality level (based on 4W inputs, January – September 2020)  Updated the interactive dashboard: Health sector interactive analysis for the 4Ws  Produced health sector bulletin for October 2020.  Produced a final narrative of Health Sector HRP 2021; final list of districts and municipalities ranked by Health Sector Severity Scale (disaggregated by population groups); health sector inputs to inter-sector operational monitoring framework; Health sector costing (per activity/per unit).

HEALTH OPERATIONS

Sub-office

 See below under OSL update

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Sub-office Sabha

 Maintained a daily follow up with the local health authorities and the crisis committees in the south the new development of COVID-19 pandemic.  Conducted a field visit to the respiratory clinic in Sabha where a temporal isolation department allocated for COVID 19 cases.  Updated SARA report on the status of health facilities in all municipalities in the south.  Participated in the regular monthly ACG South meetings. Provided weekly update on COVID-19 situation in the south.  See below under OSL update

EMT

 Emergency Medical Teams supported 27 health facilities providing primary and secondary health care services across the country with 31 surgical interventions and 8,091 specialized consultations:

S.No Team Specialties Duty station Major Minor Consultation surgery surgery 1 Alzintan EHT Orthopedic Alzintan GH 3 4 292 2 Tarhouna EHT Anesthesia, Neuro Tarhouna GH 5 2 1,538 Surgery, Vascular Surgery, Internal medicine 3 EHT Anesthesia, Orthopedic, Misrata medical Center 4 - 758 General Surgery, Vascular Surgery 4 Al Jofra EHT General Surgery Houn - Al Afia GH - - 5 Benghazi MMT Pediatric, Cardiology, Al Majori PC - - 1,173 GP, Gynecology Tawergha IDPs Camps Sidi Khalifa polyclinic 6 Ejdabia MMT Pediatric, Internal Tawergha IDPs clinic Abu - - 701 medicine, Dermatology Shaala PHC GP Ejdabia Diabetic center 7 Tarhouna MMT Endocrinology, Tarhouna PC 13 905 Gastroenterologist, Suk Alahad PHC - Gynecology, Pediatric Al Khdra polyclinic 8 Sabha EHT Anesthesia Sabha Medical Center - - 711 9 Ghat EHT Pediatric, Gynecology Berket PHC - - 13 10 Leishmania MMT Dermatology Tawergha GH - - 832 NCDC Misrata 11 Al Zwitina MMT Pediatric, Internal Al Zwitina / Al Zwitina PHC + - - 512 medicine, GP Soltan PHC + Al Baydan PHC 12 Al Bayda MMT Pediatric, Dermatology, Al Bayda / Al Guba Rural - - 804 General Surgery Hospita + Al Abraq PHC + Al Gigb PHC 13 Al Sahel MMT Dermatology, Internal Al Sahel/ Toukrah Rural Hospital - - 576 medicine, GP (diabetes) + Tulmitha PHC + Batta Rural hospital 12 19 8,091

EOC

No update

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PHC

 Convened an online meeting with MoH to facilitate the endorsement of Libya Primary Health Care country and vital signs profiles as a follow to the regional office initiative, Primary Health Care Measurement and Improvement (PHCMI).  Conducted an online meeting with GiZ and the German development consultancy group (GFA), discussed an online preparation of noncommunicable diseases (NCDs) training activities at the level of primary health care.  Followed with the NCDs department and focal point at NCDC-MoH on the preparation of Libya case study, use of digital health, mhealth and telemedicine in NCDs awareness and service delivery during COVID-19 outbreak.  Participated in a meeting with Deputy Representative of Helpcode, an international non-governmental organization which works for Libya to share the strategic framework on development of CHWs program and to share the training manuals on CHW which were developed by WHO in collaboration with MoH.  Organized and participated in a meeting with the newly assigned Director General of Primary Health Care Institute of MoH and Project Officer Health, Delegation of the European Union to Libya to discuss the current and upcoming health system strengthening projects.  Responded to World Bank request on information related to health care financing projects in Libya.  Conducted TC with RMNCAH focal person of MoH regarding preparation of presentation for virtual meeting on Sextual and Reproductive Health Research (SRHR) project in the Eastern Mediterranean Region.  Followed with MoH with regard to completion of RMNCAH guideline collection tool for Libya.

GBV

 Had several online meetings with the UNFPA and WHO GBV regional advisor in regards to the joint (WHO & UNFPA) GBV Clinical Management of Rape (CMR) training workshop planned to be conducted during November in .  Reached out to IOM and GIZ GBV focal points to seek out possible areas for collaboration in regards to 16 days of activism during November and December.  In collaboration with WHO colleagues and the GBV regional advisor, prepared a proposal for GBV related activities and required budget until March 2021.

EPI/AFP/ Measles surveillance program

 Delivered 200 AFP stool specimen kits to NCDC – AFP surveillance program, to be used for AFP stool specimen collection.  TC with UNICEF discussed WHO-UNICEF joined plan 2020, 14 selected activities (with main 3 objectives (strengthening planning, improvement of effective vaccine management practices, and strengthening reporting, monitoring and evaluation system) to be carried out in 2020 and the first quarter of 2021.  Libya EPI monthly call meeting with EMRO was held. Routine immunization, cold chain, effective vaccine management, COVAX, and disease surveillance were discussed and the action points and way forward were agreed upon.  Consolidated and disseminated AFP weekly epidemiological update reports (Epi week 42 and 43).  3 AFP cases from (Almarij 1, Zaltin 1, and Alkhumis 1) reported during the last two weeks and stool specimens have collected and stored for transportation.  11 AFP stool specimens (collected from 5 AFP cases and 1 contact) will be transported to institute Pasteur lab in Tunisia on 4th November 2020.

Summary AFP indicator performance as on Epi week 43, 2020

 Total AFP cases reported as on EPI-Week 43, 2020 = 83  Early detection and notification within 7 days of paralysis in 2020 = 79 (95%)  Early investigation within 48 hours from date of notification in 2020 = 83 (100%)  Annualized Non-Polio-AFP rate = 3.9/100,000 U15 years Children  % of Stool adequacy for the stool samples received in the lab = (100%).

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 59 (73%) AFP cases are discarded, 1 (1%) classified as aVPDV3 cases.  21 (26%) pending for classification.

Disease surveillance

 Participated in EMRO’s annual Early Warning, Alert and Response Network (EWARN) virtual meeting from 26-28 October 2020. (In Libya, COVID-19 surveillance is done through EWARN.) The meeting was attended by countries in the region facing protracted emergencies (Syria, Yemen, Somalia, Iraq, Afghanistan, Djibouti, Sudan and Libya). Discussions focused on how countries could make the transition from EWARN to routine surveillance. The expected outcomes of this meeting are the development of country plans and exit strategies for integrating EWARN into routine surveillance.

TB

 First face to face meeting with the NCDC to discuss the TB trust fund and the current estate of the Libyan NTB program (October 21, 2020). Issues discussed were: The trust fund granted to Libya by the EUD. The NCDC shared the updated 2020 National TB Guidelines, they were reviewed, and feedback will be issued today.  Meeting with IOM about the EUD TB, and IOM.  Second face to face meeting with the NCDC held on October 27th, to discuss the implementation of the steering committee.

Operational Support and Logistics

Distribution of oxygen concentrators:

From Tripoli WH: Benghazi MSO WH for WHO distribution 48 Benghazi MSO WH for distribution 16 Sabha MSO WH for WHO distribution 60 Subratha Subratha hospital, pediatric unit 8 Subratha Subratha Al-alalga polyclinic 2 Surman Surman isolation center 4 Surman Surman polyclinic 2 Tawergha Tawergha Hospital 5 Tripoli Mitiga isolation center 8 Tripoli Tripoli university hospital, Patient under Investigation unit 12 Zliten Soug-Athulatha polyclinic 3 Zliten Alhuriat polyclinic 3 Zliten Zliten medical center 8 Zliten Zliten isolation center 5 Zwara Zwara triage centre & isolation department 4 Zwara Zwara PHC center 2

From Benghazi Hub: Albayda Althawra Hospital 10 Al Mansoura Al Beida for Almansoura hospital 10 Medical center 10 Al Kufra Alkufra General Hospital 10 Benghazi CMC BGZ 30 Sabha MSO WH for WHO distribution 54 Sirte Ibn Sina Hospital 6 Sirte Isolation Center 4 Sirte Oncology Center 4 Sirte Polyclinic 2

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Distribution of PPE:

From Tripoli WH: Surgical Face Disposable Gloves KN95 Goggles Gowns Coverall Mask Shield Sampler Tripoli NCDC Lab 8000 24000 6000 1000 300 1000 Tripoli RRT Lab 15000 50000 13000 3500 1500 1500 1500 Tripoli NCDC 1999 Zliten NCDC 1000

From Benghazi Hub: Face Swab Mask Gloves KN95 Gown Goggles Coverall Thermometer Shield Benghazi Covid-19 WH MoH IG 3000 Benghazi Covid-19 Lab. BMC 1000 Benghazi Covid-19 Lab. BMC 125 2000 10000 250 200 100 Benghazi RRT 40000 10000 5000 3000 Al Beida - Althawra Hospital 1000 20000 10000 5000 2000 1000 1000 500 5 Tobruk Medical center 700 5000 5000 4000 2000 500 1000 500 Derna Alwahda hospital 10000 5000 5000 1000 500 500 320 10 500 10000 5000 5000 1000 15 10 Alkufra General Hospital 500 20000 5000 5000 1000 1000 1000 800 10 Benghazi WHO Hub 200 Benghazi Benina Airport 5000 2000 500 500 50 Labraq Airport 20000 3000 2000 1000 50 Marg Health Service Directorate 20000 3000 2000 1000 200 Benghazi CMC 20000 5000 7000 4000 1000 700 500 Sabha MSO WH for WHO 163000 33000 20020 11400 4600 4007 2200 25 Sabha MSO WH for WHO 125 5000 10000 500 500 500 100 50 Sirte Ibn Sina Hospital 10000 5000 3000 2000 1000 300 500 4 Sirte RRTs 1000 2000 1000 500 200 Emsaed Medical Center 300 5000 5000 1000 500

Dispatched the following supplies from Tripoli to Al Baida:

Insulin Biphasic NCDK 1b NCDK 1a NCDK 1c NCDK 1d NCDK 1e (Mixtard 30) w/insulin 10 8 2 10 8 8

Dispatched from Benghazi hub the following supplies:

NCDK 1a NCDK 1c NCDK 1d NCDK 1e TRAUMA - A TRAUMA - B Alkufra General Hospital 1 1 Health Service Directorate 1 1 1 1 1 1

Sirte Ibn Sina Hospital 2 2 2 3 Benghazi Al Majouri Polyclinic 1 1 1 1 1 1

Facilitated the transport of the cartridges from the MoH in Tripoli to Benghazi:

Lab Quantity Al Jofra NCDC 200 Tobruk NCDC 400 Benghazi Medical Center 900 Al Kwefia chest hospital - Benghazi 300 AL-kofra NCDC 250 Igdabya NCDC 150 6

Other distributions:

Sodium RDT RDT EIA Test, blood Stibogluconate, Ciprofloxacin HEPATITIS HEPATITIS HEPATITIS grouping Pentaval B C C

Tripoli NCDC- Zoonotic Disease Unit 1792

Al Baida WHO office 997 25 41 60 4

 Distributed 2,000 body bags to the east  Received 6000 single, 1800 double and 1800 triple blood bags for the blood bank.

Distribution across the south:

PPEs for RRTs:

Items Health Facility Masks Gloves Gown N95 googles Face Shield Coverall RRTs 24450 4920 690 5000 1000 2850 550

PPEs for the labs:

Items Health Facility Masks Gloves Gown NCDC Sabha Lab 8150 1700 250 Sabha Medical Center Lab 8150 1700 250

PPEs to the isolation centers, triage centers, hospitals, PHCs:

Oxygen N95 Face Thermo Mask Gloves Gowns Goggles concentr Coverall Location Municipality Mask shield meters ators Sabha Isolation Center Sabha 25000 5000 5000 1500 1000 1000 3 5 500 Brak Isolation Center Brak 10000 2000 2000 1000 400 300 3 3 200 Bent Baya Isolation Bent Baya 10000 2000 2000 1000 400 300 3 3 200 Center Sabha Medical Center Sabha 20000 3000 3000 1500 300 300 3 3 200 Sabha Triage Center Sabha 5000 2000 500 500 300 100 3 2 100 Brak Triage Center Brak 3000 1000 300 500 150 100 3 2 100 Al Gurtha Ashshatti Al Gurtha 3000 1000 300 200 150 100 2 2 100 Triage Center Jarmah Triage Center Al Gareefah 3000 1000 300 200 150 100 2 2 100 Ghat Health Services Ghat 1000 500 0 0 50 50 2 0 0 Administration (PHCs) Health Services Bent Baya, Al 3000 500 0 0 50 50 3 0 0 Administration (PHCs) Gareefah, Ubari Murzuk Health Services Wadi Etba, Murzuk, 4000 500 0 0 50 50 4 0 0 Administration (PHCs) Tragen, Al Sharguia Ashshatti Health Services Administration Brak, Al Gurtha, Edri 3000 500 0 0 50 50 3 0 0 (PHCs) Al Gatroun Health Services Administration Al Gatroun 1000 500 0 0 50 50 2 0 0 (PHCs) Sabha Health Services Sabha 2000 500 0 0 50 50 3 0 0 Administration (PHCs) Tragen General Hospital Tragen 3000 500 0 100 50 50 2 0 0 7

Murzuk General Hospital Murzuk 3000 500 0 100 50 50 2 0 0 Ubari General Hospital Ubari 3000 500 0 100 50 50 2 0 Brak General Hospital Brak 3000 500 0 100 50 50 2 0 0 Bergen General Hospital Edri 3000 500 0 100 50 50 2 0 0 Emergency Stock 10% Sabha 14500 1980 1620 1650 305 157 5 3 150 (MSO )

KEY GAPS & CHALLENGES

Same as for the last reporting period.

RESPONSE PRIORITIES

Same as for the last reporting period.

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