WHO Syria, Weeks 5-6, 1 – 14 February 2019

General developments & political & security situation

 The security situation in the East of Syria is assessed as tense and unstable, mainly on the frontlines of Hajin pocket (ISIL) in the far South East rural of Deir Ez-Zour, where the fighting intensified between the SDF fighters, backed by US and ICF airstrikes, and ISIL. Meanwhile, the threat of a Turkish military operation against SDF/YPG is on hold.  The military situation in the Northern area remains volatile and tense. While Idlib governorate is still witnessing a series of IED related incidents.  The security situation in the central area remains volatile and unstable. The main hot spots remain north rural Hama and East Rural Homs. Military offensives by SAA are ongoing against NSAGs positions in north rural Hama and against ISIL positions in the deserted areas of Eastern Homs with no change in the areas of control.  The situation in the Southern area was relatively calm but unpredictable. Tension is still witnessed between GoS and reconciled NSAGs in Daraa governorate.

OVERVIEW

KEY HEALTH ISSUES

Key Dates and Events coming up for HPC

 Syria TDG, 4-5 February in Istanbul  HNO published, 15 February  Senior Officials Meeting (SOM), 21 February  HRP finalized & shared with GoS, 9 March  Brussels III Conference, first week of April (date TBC)

Convoy to Rukban: On 6 February, a joint UN/SARC convoy bringing emergency life-saving assistance to over 40,000 displaced people, the majority of whom are women and children, reached Rukban makeshift settlement near the Jordan border. The inter-agency convoy, the second convoy that deployed from within Syria, consists of 133 trucks (118 with humanitarian assistance and 15 with logistical supplies), more than 300 UN and SARC staff and volunteers. It is delivering humanitarian supplies that had been identified as critically needed following the assessment completed during the previous convoy which took place in November 2018. These include food, medicines and medical equipment, items for the cold winter months, shelter materials, dignity kits for women and girls, as well as nutrition, education supplies and children’s recreational kits. The delivery and distribution of the humanitarian assistance are monitored closely by UN and SARC teams to ensure that it is delivered fairly and equitably to civilians in need in addition to conducting distribution and post-distribution surveys. Since the first convoy was not able to target all children in the camp, vaccinations points have been set up inside the camp where an estimated 10,000 children under five-years-of-age will be immunized, including the 5,100 children that were vaccinated during the first convoy who will receive booster vaccination. As of 14 February, the operation is well underway with most materials offloaded, and distributions and vaccination advancing well. The operation is expected to last approximately until 14 February. Health supplies delivered by WHO were offloaded at Sham health clinic after completion of assessment of all other reported health points in the camp (9.6 tons for more than 75,000 treatments). The shipment contained lifesaving and life-sustaining medicines, including NCD medicines, standard health kits, supplies, wheelchairs and a generator.

Response to Al Hol camp: The UN and humanitarian partners continue to scale up the response efforts in Al Hol camp providing life-saving assistance to new arrivals in the reception and screening areas including ready to eat ration, mattresses and blankets, tents, winterization and hygiene kits. The response also includes the presence of 24-hour medical and protection response teams in the reception areas to quickly identify the most vulnerable and provide urgent assistance, especially to unaccompanied or separated children, and those who are in need of immediate medical

1 assistance. Since the beginning of December, a total of 54 children and adults has died either en route or shortly after arriving in the camp.

Vaccination: The National bOPV campaign has started this week (10-14 February 2019) targeting 2,774311 children (0- 59 months) in all governorates, except Idlib (details are below).

KEY GAPS & CHALLENGES

 Shortage of hemodialysis session in the south and north-west of Syria is reported.  Al Hol camp response: o Assess IDPs before they reach Al-Hol camp o Provision of health services in Annex (foreigner’s families) o Active referral system with needed ambulances o Transportation of cold cases to referral hospitals in Al-Hassakeh (including specialized consultation, Lab analysis, and advanced health services) o Risk of disease outbreaks related to harsh winter season, unsafe water, poor sanitation and hygiene, overcrowding, and poor vaccination coverage o Mental health and psychosocial conditions, in addition to gender-based violence o Sustain the life-saving medicines, NCDs treatments

OPERATIONAL UPDATES

1. Coordination:

 Close follow up on planning and response to the emergency situation in and around Al Hol camp in Hassakeh governorate. Regular health sector updates are being circulated through the email list.  Participated in the WoS Health Cluster/IMO meeting in Beirut, 11-13 February. A presentation was shared on the implementation strategy of health sector Syria hub.  Worked with IM to finalize a set of indicators for WHO Syria and WoS WHO KPI snapshots for 2019.  Worked with the WoS health team on the update of consequence of underfunding for health sector.  Updated the list of health sector organizations involved in or planning reconstruction/physical rehabilitation of health facilities and their equipping across Syria in 2019.  Updated with the support of sub-national sectors (Aleppo, Lattakia/Tartous, Homs/Hama, NES) information on coverage by mobile medical teams and health points across the country.  Reviewed, revised and returned for editing drafts of health sector projects. A total of 20 projects were reviewed with the estimated amount of 70,931,471 USD. 7 projects are requested to reduce budgets. 5 projects are rejected. 8 projects have maintained the originally requested budgets. A total of 15 projects are recommended for next stage.  Took part in the technical meeting with representatives of MoFA and line ministries on HNO and HRP. The line ministry has agreed with the reflected health sector priorities.  Submitted 10 WoS WHO projects (health, nutrition, WASH) under 2019 HRP. The projects will undergo the review and vetting process at the WoS level.

Project Title Damascus Gaziantep Iraq Total for 2019 Trauma and Disability 15,920,500 6,460,000 875,000 23,255,500 Secondary Health Care 41,925,550 8,540,000 - 50,465,550 Primary Health Care 19,286,000 9,720,000 2,820,000 31,826,000 Immunization 4,800,000 6,620,000 - 11,420,000 EWARS/N 4,922,000 2,985,000 - 7,907,000 Mental Health 3,595,000 2,665,000 6,260,000

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Health Information System 3,630,900 645,000 4,275,900 Coordination 2,450,000 950,000 3,400,000 Total For Health Projects 96,529,950 38,585,000 3,695,000 138,809,950 Nutrition 1,045,000 60,000 1,105,000 WASH 1,000,000 1,000,000 TOTAL 98,574,950 38,645,000 3,695,000 140,914,950 70.0% 27.4% 2.6%

 Worked with the technical officers on finalization of their 2019 PMDS and alignment with GPW 13 objectives.  Followed on day to day updates and next steps for the mission in Rukban camp (offloading and distribution of health supplies; coordination on the ground).

2. Information and planning:

 Developed infographics of summary of key performance indicators for 2018 (across Syria; North-east Syria; North- west Syria; Southern Syria).  Developed 4W (WHO and Health Sector) snapshots for 2018.  Provided 4Ws consolidated figures on delivered assistance by WHO in January 2019.  Developed a draft for Summary of WHO key performance indicators 2019, Whole of Syria.  Updated WHO key performance indicators 2019, Syria.  Conducted site visits to MoH hospitals (Hama National hospital, Al-Assad Medical Complex) in Hama to assess the prior needs as part of strengthening the national health information systems at secondary care level.  Participated in WoS health cluster and IMO meeting in Beirut, 11-13 February.  Participated in the IMWG meeting to discuss 4Ws 2019 at OCHA.  Conducted health assessment visits in Al Mabrouka and Al Hol camps in NES.

3. Health operations:

Northern Syria response:

 Menbij Convoy: UN and SARC informed the KSA that after the KSA approval to send humanitarian convoy to Menbij, MoFA also approved the convoy to Menbij to be implemented by SARC. The draft list of items has been shared with KSA to be channeled to a local relief committee that will be coordinating with SARC teams.  Following-up proposed evacuation of mental health patients’ from Azzaz to Aleppo facility, Aleppo team has been in touch with Aleppo SARC branch. SARC expressed the readiness to facilitate the transportation upon approval of all parties. In addition, Aleppo team met with Ibn Khaldoun mental hospital management in Aleppo, the hospital currently provides services to 210 inpatients and capable to receive up to 300 residents. If and when necessary, WHO Aleppo team will scale up its assistance to the hospital to meet the increased needs with new patients.  6 cases of TB in Fafin area during reporting period with a total number is 48 and all of them are on treatment. Ongoing coordination with SARC to find the best feasible solution to deliver TB medicine for TB cases in Western rural of Aleppo.  Expanding EWAR reporting SSs in Aleppo, as 4 SSs start to report through EWARS electronic system.  Two ongoing MOUs with two national partners.  11 MMTs are deployed: 4 in eastern rural of Aleppo, 3 in southern rural and 4 in Afrin IDPs response.  Yadan Biyad MMTs are specialized with trauma and PWDs. YBY’s Hanano centre: 321 PWDs received their mobile aids (including 110 from Afrin IDPs in Fafin camp and surrounding communities).  2 supported PHCs: 1 in Jabal Samman (Agiuor) and 1 in eastern rural of Aleppo in Dier Hafier, in addition to two trauma and physiotherapy center in Jabal Samaan (former eastern Aleppo).

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 2 new MoUs are under discussion with 2 NNGOs, in addition to 2 planned MHPSS community centres in Aleppo governorate (1 community center in Dier Hafeir, 1 in eastern Aleppo, and 4 MHPSS MMTs) are in the pipeline.

Lattakia response:

 Under the national bOPV campaign, the following resources are mobilized:

Governorate Target Population Fixed centres Mobile teams Vaccinators Vehicles Lattakia 124,000 102 70 800 64 Tartous 117,752 142 176 434 37

 Conducted a supervisory field visit to two fixed health clinics in Squbeen area and two mobile teams in Al-Shatea area and one kindergarten to follow up the implementation process of the vaccination campaign and needs assessment.  Received the following shipments: 20 baby incubators, 8 multi C-Arm x-Ray, 51 examination beds, 40 patient beds, 80 IEHK kits.  Dispatched 15 ambulances to MOH, 3 Portable X-Ray devices in favor of MOHE.

Homs response/ Northern Rural Homs response:

3 mobile health teams (Al Birr NGO) provide health services in northern Homs area. 2 mobile health teams (Al Birr) provide services in villages across eastern and northern Hama. The NGO continues nutrition screening in northern Homs (1703 children: 1768 – normal; 18 – MAM; 2 – SAM; 20 – GAM). 1 mobile health team began to provide services in eastern Homs area (Mheen, Fruglus district), as an urgent response to returnees from Rukban area.

There are plans to support operational costs of 2 DoH medical mobile teams over 6 month’s period in northern rural Homs to cover basic PHC health care services.

Under the national bOPV campaign, the target is 177,000 children under 5 years. WHO supported vaccination campaign in 168 PHCs and 18 mobile teams (including 9 PHCs in Northern Homs area and 3 mobile teams). Monitoring visits were conducted to northern Homs area (Houle, Rastan, Talbiseh), Hasya, shelters in HD3, HD2.

Needs assessment visited carried out in Ayn Hussein Janoubi and Shamali in northern rural Homs. 237 families are returnees to these villages in urgent need to all basic services.

Northeast Syria (Al-Hassakeh; Ar Raqqa; Deir-ez-Zor) response:

Al Hol camp:

Conducted an emergency health working group meeting in Al Hol camp. Participated in all camp related coordination and technical meetings.

Vaccination- An agreement was reached with the camp management to finalize the reception area development, including triage point.

Nutrition - 51 children with complicated SAM were admitted to Al-Hikma hospital stabilization center. 24 out of 51 were discharged. 27 continue to receive treatment. NRP and NBCH trainings were provided to physicians, nurses and health workers in the camp.

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Mobile teams - Deployed 4 mobile teams and 2 mobile clinics to the camp. One fixed health point managed by WHO partner has been functioning in the camp. Finalized the health sector coverage by UNFPA, UNICEF, and UNHCR. Training on triage will take place for the national NGOs and XB partners.

Mental health - Trained 50 social workers of the PFA as a part of the scaling up of the MHPSS services. A distribution plan of medicines for NES has been finalized to cover the needs. Psychotropic procurement has been followed up for 2019. An action plan has been developed to enhance MHPSS services in NES.

Trauma - Delivered wheelchairs on 2 NGOs. Started contracting process with Al-Hayat hospital as a supportive hospital to Al Hikma hospital. Referred 74 patients for secondary health care and 182 trauma patients (most of them were from Al Hol camp and eastern rural area of Deir-ez-Zor.

Communicable disease surveillance - Several meetings took place with DoH for more engagement and presence of DoH team in the emergency response that was reflected on the ground with more cooperation in vaccination and establishment of leishmaniasis team and adding DoH nutrition screening staff. TB cases in Al Hol camp - Since the start of the recent population movement from Hajen to Alhole camp in Hasskah, 15 suspected TB cases were identified among the recently displaced people. WHO facilitated laboratory tests at the TB specialist center in Hassakeh. The lab results confirmed TB for 9 cases. Patients diagnosed with TB were immediately enrolled in treatment programme. WHO will initiate TB screening for the newly arrivals in the camp. 20 field teams consist of 40 health workers are deployed to conduct tent to tent screening. The expected outcome of this activity is to increase the notification of TB in the camp, and reduce TB infection among the IDPs. HIV suspected case in Al Hol camp - WHO was notified about HIV suspected case, blood sample was collected and sent to the reference in Damascus, the case result was positive by HIV rapid test. the child of this suspected HIV case was also tested with rapid test and the result was negative. two other contacts of the case asked for voluntary tests and the results were also negative. To make voluntary HIV testing available in Al Hol and Ain Issa camps, WHO in collaboration with HIV national program, will support one medical point in each camp with HIV rapid tests and training health workers on the voluntary counseling. WHO is also planning to conduct HIV screening for the newly arrivals to Alhole camp, the screening will be carried out by the health workers of HIV control program in Hassaka. Leishmaniasis in Al Hol camp - In respond to high incidence of leishmaniasis among the newly arrivals of Hyjen people to Al Hol camp, and to improve the access of leishmaniasis patients to proper health care; WHO in collaboration with leishmaniasis control program in Hassakeh, has established a fixed medical point in Al Hol camp to provide diagnosis and treatment of leishmaniasis, the clinic will provide health services four days per week. Some 152 cases have received local treatment while 15 cases have received intramuscular treatment. WHO has also supported laboratory evaluation and tests for the cases need for intramuscular treatment.

Rest of NES response:

Mobilized 4 teams for the new IDPs transit center in Al-Sewar area, each team consists of 3 specialized doctors, 4 nurses, 1 paramedic , 2 social workers and admin, each team will handle a shift of 6 hours and the four teams will cover 24/7 Coordination is in place with other health actors to assure 2 ambulances for the new transit center of Al-Sewar to evacuate the emergency cases directly to the appropriate facilities.

Nutrition - 7 children with complicated SAM were registered in Al-Tabqa national hospital. 4 were discharged. Vaccination – national polio campaign started across NES.

Secondary health care – consolidating the needs of medicines and supplies for next shipments; visited the dialysis center of Hassakeh national hospital.

Health information – Assessed: Al Qamishli national hospital, Ras Al-Ain Hospital, Tal Abiad Hospital, Tabqa Hospital, Al- Hassakeh national hospital.

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TB prevention and health services in areas of severity scale above 3 in Deir-ez-Zor - WHO supported the implementation of community-based TB activities by NGOs in the areas of which severity scale (3 – 6) in the governorate. The activities were implemented by community health workers supported by NGOs and other civil society organizations. These activities were conducted in community-based structures (e.g. schools, mosques, congregate settings) and IDPs settlements. Three outreach teams have so far provided 95 health educational sessions for about 9,882 individuals in 12 locations in the eastern and western rural of Deir Ezzor. Health sessions focused on basic health messages about TB symptoms, transmission, treatment and prevention.

Technical Expertise (See Annex 2 for capacity building activities this week)

Non-Communicable diseases / Primary healthcare

 Continued a follow up on oral health project in schools implemented by MOE in eastern Ghouta targeting school students. The project started in October 2018 and will be active during the next 6 months period. In January a total of 3,327 students were examined. 15,127 services were provided. Health promotion sessions were provided to teachers and students. A total of 55 schools will be visited on a regular basis. WCO had supported procurement of two shipments of dental supplies and operational cost for the 2 mobile clinics deployed by MOE. A new shipment of dental supplies is under the procurement.  A field visit is conducted to 3 partially damaged PHCs located in rural Damascus namely (Ghasouleh, Kafreen & Karahta) to finalize the technical assessment before launching rehabilitation process.  Followed up a workshop under tobacco control programme (NCD risk approach) to discuss cessation clinics imitative, 9-11 February conducted by PHC Directorate.  Procurement process to equip with furniture 3 PHCs in Homs (Warsheh, Tal Kalakh and Jub Al- Jandali).

Trauma:

 In line with WHO support for Syrian patients and as a follow up on the field visit of a WHO team headed by the WR to Al Beironi Hospital for cancer treatment in MOHE, WHO has supported two cases of children (11 and 13 years old) both diagnosed with sarcoma in the knee (malignant tumor of connective tissue). The children required urgent tumor resection and later joint arthroplasty; otherwise the two children would have been amputated. The two- phased surgery which WHO supported requires fitting an external fixator for few months awaiting the individually designed joint to be manufactured and then restored. The total cost of procuring 2 external fixators and 2 tumor knee joint is around USD 40,000.  Under the signed MOU between WHO and Bambino Gesu’ Hospital in Rome to conduct a joint training programme in collaboration with MOHE, WHO Organized the third mission to Syria by an expert medical team from Bambino Gesu’ hospital to conduct trainings on laparoscopy, interventional radiography, paediatric catheterization and paediatric intensive care to the Syrian medical specialists in the Pediatric and Cardiac surgery hospitals of Damascus University. The participants list was expanded to include a doctor from Aleppo University Hospital.  Following up closely on contracting Al Hayat Hospital in Al Hassakeh be supportive to Al Hikmah hospital (already contracted by WHO) role in receiving cases of trauma and other emergency surgery cases.

Immunization:

The National bOPV campaign has started this week (10-14 February 2019) targeting 2,774311 children (0-59 months) in all governorates, except Idlib. 2,942,500 doses of OPV have allocated for this campaign in coordination with UNICEF. During the first two days of the campaigns, MOH has vaccinated 1,016,072 children in all governorates (36.6%) except Deir-ez-Zor due to lack of communications with the field staff. WHO has facilitated the campaign filed work through supporting the following activities: Transportation means and incentives for the field teams; Support the delivery of vaccines for NES governorates; Printing campaign reports and registries to facilitate the data collection and documentation; Support the cold chain in rural Deir-ez-Zor.

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WHO focal points in most of the governorates are following closely the implementation of the campaign with coordination of MOH staff to provide necessary support during the campaign and to assure that the cold chain is well controlled, at the level of health districts, health centers and mobile teams. Children returning from Lebanon and Jordan have been vaccinated during the campaign and encouraged to visit the health centers for routine vaccination, taking in consideration that all returnees from Lebanon did not receive TB vaccine.

Mental health program:

 A new programme area "CST children skills training" has been discussed with MoH and agreed upon to be implemented according within the training plan 2019.  Meetings conducted with MoE to finalize the MoU on updating a programme CST to the capacity building courses and adding the group supportive supervision.  Family well-being community center activity list has been finalized and to be shared with the proposed NGOs through NGOs unit.  A mapping of 15 family well-being community centers has been discussed and finalized taking in consideration severity scale and sustainability of WHO implementing partners.  One Family well-being community center has been launched in DEZ.

Nutrition and child health:

 Conducted field visit to Al-Hassakeh governorate. The objective of the mission was to monitor the nutrition program and to follow up with health partners in Al Hol camp on monitoring the implementation of the childhood program in the camp as well as participating in the emergency response concerning the situation in Al Hol camp.  Participated in the training on SMART national nutrition survey in cooperation with the MOH and other partners for 3 governorates (Aleppo, Lattakia, and Tartous). Participated in the SMART survey evaluation meeting to review with MOH and partners the first SMART survey training and to detect gaps and challenges in order to improve the training process.  Followed up with the response in northern rural of Aleppo (Afrin IDPs), southern and eastern rural of Aleppo. A nutrition screening was conducted for 1691 children under 5, detecting 36 - moderate acute malnutrition and 10 - severe acute malnutrition.  Reviewed with EMRO the final country questionnaire for global status report on the prevention of violence against children.  Followed up closely on the Implementation of the neonatal resuscitation of new borne care at home with 40 health workers and volunteers from Al Hol camp.  Met with the management of the national pediatric hospital in Damascus on enhancement of nutrition response for post-surgery patients.

Secondary health care and trauma programs

 In cooperation of WHO international experts and the national EML committee finalized the updated lists of the country’s health needs of medicines and medical equipment and supplies needed for the year 2019.  Communicated with RO to get guidance the needed requirements on prequalification to improve the capacity and quality of work of the central pharmaceutical laboratories at MOH.  Reviewed the final report of the assessment study on patients’ views and experiences on cancer care in Syria to add comments received from HQ.  Overviewed the ongoing Children Hospital rehabilitation project.  Plans for provision of cancer medicines for a local NGO and MoHE.  Supported 6 hospitals in Damascus, Aleppo and Raqqa with medicines and medical equipment needed for secondary care.

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Disease surveillance and response and WASH:

Control of Antimicrobial resistance AMR in Syria - Antimicrobial resistance AMR is an increasingly serious threat to public health that requires action across all government sectors and society. The control of AMR in Syria was identified as one of main MoH priorities for 2019. WHO jointly with the regional office has provided technical assistance to Syria to develop the national AMR action plan. Five days meeting was organized by WHO and facilitated by EMRO consultant to prepare the first national AMR action plan. Senior stakeholders from all relevant sectors in human health, animal health, and environment attended the meeting. Representatives from the Ministry of Health directorates (communicable diseases, pharmaceutical affairs, hospital directorate, public health laboratories, health strategic studies center, primary health directorate, pharmaceutical control, and media office) in addition to other sectors (MoHE, MoE, animal health, Ministry of environment, pharmacists syndicate, doctors syndicate, FAO, and laboratory association) proposed the intial steps to establish muli-sectoral AMR control program in Syria. The action plan focus on four sections (awareness, AMR surveillance, infection control, and rational use of antibiotics), four technical groups have discussed the activities related to each axes, and will be responsible to follow up the implementation. The plan will help MoH with other relevant sectors to prevent and manage antimicrobial resistance.

The Deworming campaign of 2019 - For the fourth year, WHO is supporting the implementation of the deworming campaign. Preparatory meeting with Ministry of Education (School Health Directorate) and Ministry of Health to coordinate for the campaign was conducted in this week. The campaign is planned to be conducted in the last week of February. the deworming campaign aims to reduce the prevalence of soil-transmitted worms among school-age children. The campaign targets 2 million school children (6-12 years) in 13 governorates. WHO’s support was by donating medicine (mebendazole 500mg), train MoE health workers on administrating the medicine, print and distribute health education material, procured water bottles in IDPs camps, and cover the operational costs of the campaign.

Technical assessment in Quneitra - WHO conducted a mission Quneitra governorate to follow up the disease surveillance and EWARS implementation in the newly accessible areas. To assess main health needs of people and returnees in the newly accessible areas. To monitor the implementation of TB awareness raising activities by Syria pulse NGO. Entry of EWARS data at health district level, and support the district with computer, 2G and 3G internet connection. The mission’s team recommended the following points: Strengthen the early detection and response to disease alerts by training and activating rapid response team; Ensure on the provision of regular routine vaccination services in Suissa district; Launching of TB care services in the governorate and support TB center with needed furniture and devices; Sustain on health services by mobile teams of NGOs, and target remote villages where no public or private health providers exists; Support DoH health centers with electricity generators. Maintain on implementing regular health education activities and distribute the EC materials.

National NGO coordination:

 Action framework is being developed under the Health Diplomacy concept.  2 field visits were conducted (Al Qutaifeh and Harasta) where WHO supports a health point and medical mobile team and the second one was to Al Dweir shelter.

Operational support and logistics:

Dispatched 166 tons of medical & lab supplies, hemodialysis sessions equipment, health kits, vehicles and printing materials- covering the whole 14 Syrian governorates. The recipients included 15 MoH facilities, 4 MoHE facilities, 13 MoE directorates, 15 NGOs, 5 NGHs, 2 KRC (camp & warehouse) and SARC. Total number of treatments is 1,874,142 and 800 trauma case. The dispatched supplies included: o 15 wheelchairs for adult and 5 for children delivered to KRC in Amuda – Al-Hasakeh. o Different types of STHC, trauma & PHC medicines were delivered to Al-Houl camp managed by KRC – Al-Hasakeh.

8 o 1,770,000 tablets of Mebendazole 500mg delivered to MoE - school health directorates in 13 governorates including Idleb. o 1 device of CYFLOW® counter flow cytometer - model: SYSmex and different types of lab supplies & consumables delivered to MoH – public health labs – HIV lab. o Different types of ICT equipment delivered to MoH central warehouse in favour of Al-Bassel cardiovascular hospital, children & obstetrics hospital in Lattakia, Al-Razi hospital in Aleppo and Public health labs – Influenza lab in Damascus. o 5,000 haemodialysis sessions for adult and 200 for children delivered to kidney hospital in Aleppo. o 2 family doctor’s kit and 1 diagnostic ultrasound system delivered to Aleppo DoH. o 2 autoclave (Uniclave 77), 2 compressor nebulizer, 2 electrocardiograph multi-6 channel ECG, 4 Hospital trolleys delivered to Aleppo DoH in favour of Khaled Ebn Waleed & Maasranay PHCs. o 10 kits of blood glucose strips delivered to "diabetes mellitus main centre” – Homs DoH. o 230 copies of hepatitis strategic guideline 2018-2022 delivered to MoH central warehouse in favour communicable disease directorate - Hepatitis department. o 15 Ambulances handed over to MoH – emergency unit. o 31 Cholera RDT kits delivered to MoH – public health labs - microbiology laboratory. o 20,000 Marker pens - indelible ink used for polio immunization campaign delivered to MoH central warehouse in Damascus. o 3 portable x-ray units (DONGMUN DIG-1100) and different types of STHC medicines delivered to MoHE central warehouse in Damascus. o 1000 haemodialysis sessions for adult, 1 surgical kit, 2,000 sets of sodium chloride intravenous Infusion and 1 trauma kit both A&B delivered to Aleppo university hospital. o 100 sets of blood cell Separat. Fresenius 500m delivered to MoHE central warehouse in favour of Al-Moawasat hospital. o 1020 tablets of Imatinib 100mg delivered to MoHE central warehouse in favour of children hospital. o 1,500 vials of human erythropoietin 4000 IU, 1 Anaesthesia machine (Mindray A5) and different types of nutrition therap. milk delivered to 5 non-governmental hospitals at Aleppo, Al-Hasakeh and Raqqa governorates. o Different types of EWARS, STHC & PHC medical supplies delivered to 15 NGOs at Al-Hasakeh, Homs & Lattakia governorates. o 2 mobile clinics handed over to SARC Damascus. o 1 portable x-ray unit, 15 blood glucose strips kits & 10 vials of Anti-D Immunoglobulin delivered to Aleppo SARC. o 5 RDT cholera kits, 4 compressor nebulizer for aerosol therapy for intensive use - Model- F-205, 10 IEHK basic kits, 1 Italian emergency kit A, 2 cholera kits, 5 IEHK supplementary kits, 3 surgical kits, 5 sphygmomanometer adult cuff, 5 infant scales, 30 adult wheelchairs, 10 for children, 1 examination table, 1 diesel generator 45KVA and different types of EWARS, nutrition, PHC, trauma & STHC delivered to Rukban as an IA convoy through SARC support.

External Relations and Communications:

 Finalized the annual report for 2018.  Conducted a one-day workshop (25 journalists) on community awareness of the World Cancer Day.  Organized a signing ceremony of the MOU with SARC on the donation of 15 ambulances.  Communicated with MoFA and MoH on: INFOSAN Information Request concerning the suspected Outbreak of Salmonella Poona infections linked to internationally distributed infant formula; Preparation of RD Report to the 66th Regional Committee on the implementation of EM/RC64/R.3; WHO INTERNATIONAL ALERT: Falsified ICLUSIG; Accreditation Review for the National Measles & Rubella Laboratory, Syria; The Biorisk Management (BRM) Workshop for internal auditing requirements using Global Action Plan III (GAPIII) elements and poliovirus containment controls, Beirut, Lebanon, 18 to 22 March 2019.  Developed the following statements: · Restoring hearing to a Syrian boy/ story/ :http://www.emro.who.int/syr/syria-news/restoring-hearing-to-a- syrian-boy.html

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· WHO concern over the critical health situation in Al-Hol camp, Al- Hasakeh : http://www.emro.who.int/syr/syria-news/who-concerned-over-critical-health-situation-in-al-hol- camp-al-hasakeh.html  Prepared visibility media coverage on: The World Cancer Day (4th February 2019); The EML workshop, Damascus 3- 4 February 2019; the arrival and the offloading of the medical aid shipment from the Syrian-Jordanian border (Nasib) to WHO warehouse.  Prepared a briefing on the health situation at Al-Hol camp.  Prepared talking points for the upcoming Brussels conference.  Follow up with MoHE on 5 days capacity building training conducted by the Bambino Gesu team for the medical staff in the children’s department at the Paediatric University Hospital in Damascus (9-14 February 2019);  Following up on WHO-Syria Twitter account.

RESPONSE PRIORITIES

 North-west Syria  North-east (Al Hol camp): o Coordinate overall health sector response o Establish active referral systems for trauma and secondary/tertiary care in addition to complicated malnutrition cases. o Increase immunization coverage o Increase coverage and quality of primary healthcare including MCH/RH, NCD and Mental Health o Support identification and management SAM cases including complicated SAM cases. o Detect, identify and respond to communicable disease outbreaks.

 Secondary health care: support the capacity of dialysis centers with supplies needed for hemodialysis treatment; to continue the capacity of dialysis centers at NES by provision of rehabilitation services and supplies needed for hemodialysis treatment; raising community and health staff awareness on the importance of early detection for cancer, rational use of medicines and infection prevention and control; strengthening the capacity of the national cancer registry team at Ministry of Health and Ministry of Higher Education on data collection of morbidity and type of cancer diseases according to different geographical areas; secure funds needed procurement of medicines and medical supplies listed in the EML 2019.

Annex 1: Current WHO agreements with national NGOs

# of MOUs in Governorate Location of current of ongoing MOUs # of ongoing MOUs preparation Damascus Al Zahera 1 3 Rural Damascus / Qutaifeh - Douma and Harasta 1 6 EG Response Lattakia 2

Dara'a 2

Homs 7

Hama 0 1

Agior , Deir Hafer and surrounding villages (Babiri -Upper Babiri, Babiri Aleppo -Lower Babir, Rasm Elbokhar, Kayariyieh, Big Habbuba, little Habobieh, 2 3 Southern Rasm Elharmal) NES Deir- Ez-zor - Ar Raqqa city - Al Hassakeh 4 5 Total 8 29

Annex 2: WHO supported capacity strengthening (supported 36 activities for 964 participants)

Date # participants Details/Field Program 02-05/02/2019 25 Burn Management in Damascus Trauma 10

02-05/02/2019 25 Hazmat management and evacuation of buildings in Lattakia Trauma SARA restoring survey workshops for the new under governmental control area 02-04/02/209 30 HIS in Damascus 02-06/02/2019 66 National Nutrition SMART Survey in Damascus Nutrition 02-07/02/2019 17 ToT workshop regarding to IMCI progrmme in Damascus Nutrition 03-05/02/2019 25 Orthotics manufacturing process in Damascus Disability 03-05/02/2019 30 International classification of Diseases in Damascus HIS 03-04/02/2019 25 Activating the surveillance reporting hospitals in Damascus PHC 04-06/02/2019 25 Leadership and strategic management - Part 1 in Damascus NCD SARA restoring survey workshops for the new under governmental control area 05-07/02/2019 30 HIS in Damascus 2 activities on Psychological First Aid "PFA" and Self-care strategies in Lattakia & 06-07/02/2019 50 MH As-Swaida 06-10 /02/2019 25 Ventilator management in Damascus Trauma 06-07/02/2019 30 HeRAMS on line at district level in Damascus HIS Psychological First Aid "PFA" and Self-care strategies for NGOs from Al Hassakeh 07-08/02/2019 25 MH in Al Hassakeh 08-09/02/2019 25 SARC Reporting Training for Aleppo in Aleppo EWARS 09-10/02/2019 25 Psychological First Aid "PFA" and Self-care strategies for NGOs in Al Hassakeh MH 09/02/2019 25 EWARS data entry system for Aleppo in Aleppo EWARS 09-12/02/2019 25 Hazmat management and evacuation of buildings in Tartous Trauma 09-11/02/2019 30 Neonatal resuscitation programme (NRP) in Al Hassakeh Child Health Care 10-14/02/2019 23 Hospitals Design in Damascus SHC 3 activities on Mental Health GAP-Intervention Guide Ph1 for MoE doctors in 10-14/02/2019 75 MH Homs & Damascus and for NGOs in Damascus Antimicrobial resistance national strategy duration of February 2019 for EWARS 10-14/02/2019 18 EWARS program in Damascus 10-12/02/2019 25 EWARS Reporting for Aleppo in Aleppo EWARS 10-12/02/2019 30 International classification of Diseases in Damascus HIS 10-12/02/2019 25 Neonatal resuscitation programme (NRP) in Hama Child Health Care 11-13/02/2019 25 Adults Life Support in Damascus Trauma 11-14/02/2019 25 Basics of Health research in Damascus NCD 12-14/2/2019 25 Workshop on provided primary health care services at PHC level in Damascus NGOs 12-14/02/2019 30 New born care at home in Al Hassakeh Child Health Care 13-14/02/2019 25 Psychological First Aid "PFA" and Self-care strategies in Aleppo MH 13-14/02/2019 30 HeRAMS on line at district level in Damascus HIS 14-17/02/ 2019 25 Basic Trauma Life Support in Damascus Trauma 14-17/02/ 2019 25 Dealing with chemicals and hazard materials in Homs Trauma

Annex 3: Outpatients consultations provided in southern rural of Aleppo:

# of patients # of outpatient # of MHPSS received # of SHC NGO Health facility District consultations services assistance with services PHC services provided medicines 1 Al-Taalouf Mobile team 1 Al-Sfierh , blaas , AL-Wadihe 245 60 0 22 2 Al-Taalouf Mobile team 2 AL-Hader 211 99 0 18 3 KFAM Mobile team 3 Tal AL-Damman 322 189 0 33 Total 933 367 0 778

Annex 4: Outpatients consultations provided in eastern rural of Aleppo:

# of patients # of outpatient # of MHPSS received # of SHC NGO Health facility District consultations services assistance with services PHC services provided medicines Al-Ber & AL- Big Hmeimeh 1 Mobile team 1 218 255 0 0 Ihsan Little Hmeimeh 11

Al-Ber & AL- 2 Mobile team 2 Khafsa, Um Elmira, Khafsa 491 418 0 0 Ihsan Health 3 Mobile team 1 Dier Hafir 120 121 12 41 promotion Health 4 Mobile team 2 Maskana 175 365 18 23 promotion Total 1004 1159 30 64

Annex 5: Outpatients consultations provided in Afrin IDPs locations (Fafin and surrounding):

# of patients # of outpatient # of MHPSS received # of SHC NGO Health facility District consultations services assistance with services PHC services provided medicines 1 Al-Ihsan Mobile team 1 Kafr Naya - Abin 158 144 0 0 2 Al-Ihsan Mobile team2 Tenib - Deer Jmal 122 128 0 0 3 YBY Mobile team 3 Fafin Camp 431 225 0 12 4 YBY Mobile team 4 Al-Asser Camp 417 227 0 22 Total 1128 724 0 34

Annex 6: Outpatients consultation provided in Aleppo city:

# of patients # of outpatient # of MHPSS received # of SHC NGO Health facility District consultations services assistance with services PHC services provided medicines Health 1 Saad PHC Jabal Samaan 1258 98 12 425 promotion Physiotherapy 2 YBY Jabal Samaan 815 788 0 321 center Total 2073 886 12 746

Annex 7: WHO supported health services in northern and eastern Hama and northern Homs:

Provision of medical Screened by the # of Providing individual Area Medicines consultations malnutrition team psychological support 22 locations in Northern Homs area 3775 3388 1365 281

Area Provision of medical consultations Medicines Eastern rural Hama villages Al- Hamra district (9 locations) 4750 4577 northern Hama (5 locations)

Annex 8: WHO supported Health services in NES:

# of First aids # of Mental # of # of beneficiaries # of secondary # of and Health Governorate Area outpatient reached with the health trauma emergency Psychosocial consultations medicines consultations referrals services in the Services camps Hasakah city center 1999 1567 133 55 0 0 Al-Qamishly city 111 196 8 0 0 0 Rural of Al-Qamishly 196 193 0 0 0 0 Al-Hasakah Al-Mabrouka camp 622 622 0 0 114 162 Al-Areesha camp 594 585 0 0 41 63 Al-Hol camp 2496 2455 54 106 252 129 12

Ain Issa camp 1849 1664 5 5 249 189 Arraqqa city 355 321 1 0 0 0 Al-Twehenah camp 1133 1133 0 0 76 89 Al-Karama 852 763 0 0 0 94 Arraqqa Al-Kasrat 797 797 0 0 0 81 Al-Tabqa 842 841 0 0 44 109 Al-Mansoura 345 345 0 0 0 59 Al-Jurneah 498 498 0 0 0 88 Aleppo Menbej 1187 1139 0 0 0 119 Al-Busayra 616 599 0 0 0 122 Abu Khashab camp 1070 977 1 1 0 39 Dier Ezzour Al-Jerzi 1499 1215 0 0 111 286 Dier Ezzour city 1231 993 0 0 0 0 Sub-total: 18292 16903 202 167 887 1629

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