WHO Syria, Weeks 9-10, 1-14 March 2019
General developments & political & security situation
The main hot spots remain Deir Ez-Zour, Ar Raqqa, Aleppo and Idlib governorates. SDF military operation in east rural Deir Ez-Zor resumed. Evacuation of civilians and ISIL families took place with surrender of dozens of ISIL militants. While NSAGs conducted an attack against SAA in north rural Hama, which raised the expectations of an incoming SAA/RF operation in the area. Hostilities continue to intensify in Idlib and surrounding areas causing civilian death, injuries and mass population displacements.
On the eve of the foreign ministers’ meeting at the third Brussels Conference on Supporting the Future of Syria and the Region, three UN Principals today warned that the Syria crisis is not yet over and called for sustained and large-scale support to vulnerable Syrians, refugees and the communities hosting them.
United Nations and Humanitarian Partners’ Key Messages for Brussels III Conference were produced.
The United Nations refugee agency should have a bigger presence inside Syria to observe and help refugees returning from abroad and from displacement within the war-torn country, UNHCR Commissioner Filippo Grandi said.
Consultations between the United Nations and the Government of Syria on the 2019 Humanitarian Response Plan for Syria are ongoing. The portfolio of projects approved under the 2019 HRP, available through the following link: https://fts.unocha.org/appeals/663/summary. The portfolio includes 666 projects developed by 15 UN agencies, 52 INGOs and 87 national NGOs appealing organizations, amounting to a total of $ 3.3 billion to provide multi-sectorial assistance to 11.7 million with 9 million people targeted with direct humanitarian assistance and 11.7 million people with service delivery interventions.
Sectors Requested funds (US $) Camp Coordination / Management 48,605,651 Coordination and support services 52,866,753 Early Recovery 173,630,051 Education 257,528,610 Emergency Telecommunications 831,423 Food Security 1,094,934,176 Health 449,133,271 Logistics 6,428,472 Nutrition 83,900,275 Protection 352,576,214 Water Sanitation Hygiene 277,159,857 Shelter / NFI 533,508,549 Grand Total 3,331,103,302
OVERVIEW
KEY HEALTH ISSUES
North-East Syria: Al Hol camp exceeds maximum capacity as people continue to arrive from Al-Baghouz.
Hajin response: shortage of basic services and commodities in areas that recently shifted control. 7 PHC centers and 1 national hospital in Hajin city are not functioning.
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On reported increased mortality and outbreaks in Rukban camp: No cases of suspected cholera or leprosy were detected in the camp. No increase diarrhea cases. The most reported morbidity is upper tract respiratory infections. The monthly death average is seven cases per month (from all causes). No health event was notified during the last period. A separate update was shared on referrals to UN clinic in Jordan.
On 7 March, the UN and SARC completed an interagency convoy delivering humanitarian assistance to meet the urgent needs of 50,000 people in Menbij and surrounding areas in northeast Aleppo Governorate. This was the first time that assistance was delivered to Menbij from Aleppo. WHO delivered 20 tons of health supplies for 82,000 treatments courses and 800 trauma cases.
In collaboration with WHO Regional Office, and with the mental health programme conducted a ToT training on first line support for GBV survivors. The aim of the training was to strengthen health response to violence against women and girls, which will have direct impact on the enhancement of women and gilrs’ health. Its specific objectives were: Enhance the skills of health care providers to respond appropriately and provide first line support to VAWG survivors; Build knowledge on why health providers must respond to VAWGs; Reflect on values and beliefs that affect care to survivors; Become familiar with the GBV/VAWGs referral pathways; Build training skills to train other health providers on the health system response to GBV/VAWGs.
KEY GAPS & CHALLENGES
Al Hol camp:
The humanitarian situation in Al Hol continues to be challenging. In total, the camp population is more than 67,000 people, the vast majority of them women and children. Health response is being carried according to the “Operating Principles Guiding the Humanitarian Response to Al Hol camp”. A total number of deaths since the influx is 120. Mortality rate is being reviewed internally and analyzed separately on a daily basis. 80% are children under 5 years old. 56% are female. The reported mortality for Al-Hikma hospital increased from 11% to 35% comparing with the mid-February following the increase number of referrals, their transportation and overall critical condition while being en route. The referral systems remains overstretched in the situation of limited hospital capacity. Nutrition: 89 SAM cases are in stabilization center. Urgent health interventions needed in Al Hol (total requirements: US$ 5 million) including: o Support 24/7 KRC/UPP fixed health clinic (comprehensive polyclinic) in phase 1 (UPP reported funding problems to support this clinic the services of which are essential for the camp). o Support 24/7 static medical point (operated by 4 medical teams on shift basis) in the reception area (triage and post-triage service in phase 1 (next 2 months). o Support 1 mobile medical team for phase 2. o Support a fixed health clinic in “Annex” (foreign nationals). o Support 24/7 fixed health clinic in phase 5 (most of newly displaced were relocated here). o Support fixed health clinic (pre-fab container) in phase 5 (currently set up by MSF-H and ready to handover after May). o Support 24/7 fixed health clinic in newly constructed phase 7 and1 mobile medical team. o Support 2 24/7 mobile medical teams (operated by 4 medical teams on shift basis) in any of established transit sites (Al Sewar and Omar oil field). o Support with operational costs for DoH teams to enhance vaccination, nutrition, disease surveillance, leishmaniosis, and specialized medicine across the camp. o Support 5 MHPSS mobile teams across the camp. o Supporting secondary and trauma health care services on referral basis including direct engagement with Al Hayat private hospital and expansion of Al Hikma private hospital.
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o Procurement of health supplies to enable non-interrupted services of mobile medical teams and health clinics. o Set up of a field hospital (20-50 beds).
Scale up across the camp – the current scale up with covering the reception area (triage teams, plus mobile teams) and different phases of the camp was for the camp population when it grew to 35,000-40,000 people, the present camp population is more than 67,000. Therefore, technical and operational discussions are required at Qamishli and Damascus levels for a continued scale up in: a) mobile teams; b) fixed health clinics; c) mobile clinics. Access for health teams to the Foreign Annex - it remains essential for health sector to ensure uninterrupted, sustained and predictable access to the Foreign Annex. All teams with plans to cover the Annex were asked to feedback on every single instance when access was not granted for health teams to enter the Annex. Enhanced coordination between health, protection and WASH sectors. While strengthening health presence in phase 7 to ensure a streamlined and agreed upon way forward for this area. Phase 5 and phase 7 require a continuous follow up.
OPERATIONAL UPDATES
1. Coordination:
In collaboration with WCO Lebanon conducted two-day technical WHO consultations on return and reintegration of Syrian refugees: planning and response. Technical consultations are held with the MoH on 2019 health sector HRP narrative. Technical Discussion on Syria planning by regional Peer Support Group (PSG) and Programme Management Team (PMT) Syria is planned on 19th March 2019, Amman, Jordan. The UNCT has asked to conduct full review for the Programme Criticality Assessment (29-30 April). A meeting is scheduled with Mr. Geir Pedersen, Special Envoy of the United Nations for Syria, (OSE-Syria) on 17 March.
2. Information and planning:
Developed infographics of summary of key performance indicators for January 2019 (across Syria; North-east Syria; North-west Syria; Southern Syria). Developed 4W (WHO and Health Sector) snapshots for January 2019. Developed infographics for key performance indicators January 2019 at WoS level. Developed health profiles for five of the potential return areas for refugees (Rural Damascus, Aleppo, Homs, Al- Hassakeh and Dar’a), based on available HeRAMS information. Data processing and analyzing for producing Neonatal resuscitation infographic – December and Annual 2018 for nutrition programme. Conducted site visits to Al-Bairouni hospital (MoHE) to install the CanReg5 program in children department and conduct a training session for staff on using this program. Participated in Joint technical meeting with MoH Head of planning & international cooperation to discuss the HeRAMS workshops plan 2019. In addition, agreed on MoH hospitals Automation, Monthly Report for hospitals, NHIS (National health information system), CRVS (Civil registration and vital statistics) and distribution of IT equipment for HeRAMS team. Produced draft HeRAMS annual report 2018 of the public Hospitals in Syria. Participated in training of trainers on Geographic Information Systems (GIS) in Cairo, 10-14 March.
3. Health operations:
Northern Syria response:
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Almost on a daily basis Aleppo hospitals provide services to UXO victims. WHO continues provision of trauma supplies and follow up with patients’ treatment. Monitoring visits are in place for post-distribution of medical equipment to Aleppo hospitals. 2 field visits to TB center are conducted as well to Fafin camp and Fafin hospital. There are 2 new TB cases in Fafin area. The total number is 54 cases (15 patients complete their treatment successfully, 4 patients dropped out, and 35 patients are under treatment). Support with mental health activities continues: DoH: Ibn khadloun provided 4924 MHPSS services. Mental health directorate provided 294 MHPSS services. DoHE: Number of consultations in university neurological clinic is 93. NGOs: Psychiatric Clinics consultations: 34. Neurological clinics consultations: 103. Counselling sessions provided: 54 Delivery of health supplies continues. Two ongoing MoUs are signed with two WHO partners, Yadan Biyad and Health promotion. Four MMTs are operational in eastern rural of Aleppo and north-rural (Afrin IDPs). 2 PHCs are supported in Jabal Samman (Agiuor) and in eastern rural of Aleppo in Dier Hafier. There are two, trauma and physiotherapy centers in Jabal Samaan (east Aleppo). Support to people with disabilities continues.
Lattakia response:
Conducted a meeting with the Health Directorate of Lattakia and head of Emergency unit in the Ministry of Health to discuss the planned Ventilator management workshop. Conducted a joint field assessment visit with UNFPA to Syrian Family Planning Association. On the occasion of Women’ Day participated in a ceremony arranged by UNFPA.
Homs response/ Northern Rural Homs response:
Participated in the UN Inter-Agency assessment mission to Sanjar sub-ditrict (Sanjar and Hawa towns) on the prevailing humanitarian situation in the area. The report of health situation was provided. The main gaps are: there are no fixed health facilities in Sanjar and surrounding area; lack of qualified health personnel; there are no running primary health care activities; there are no RH facilities in the area and no medicines; there are no delivery services (normal and C-section); family planning tools are an urgent requirement. Conducted HWG coordination meeting in presence of UN agencies at Homs Hub, DOH and local NGOs in Homs. Operational updates & suggestions, gap analysis were discussed by health partners. 4 mobile health teams from DOH Homs supported by WHO provide health services (medical consultations and medicines) in northern Homs area. 2 mobile health teams provide health services in villages across eastern and northern Hama, and one health center in Hama city.
Northeast Syria (Al-Hassakeh; Ar Raqqa; Deir-ez-Zor) response:
Priorities across north-east Syria include the establishment of a comprehensive health programme with a focus on: coordination and information management; primary health care (PHC); secondary health care (SHC) including trauma and burns and physical rehabilitation; disease surveillance and response; vaccination; maternal and child health (reproductive health); screening and management of malnutrition; and mental health.
There are aims to secure sustainable and predictable access to and the re-operationalization of all 16 public hospitals and 278 public health centres across the three northern governorates (Al-Hasakeh, Ar-Raqqa and Deir-ez-Zor). This will be achieved through the following main activities:
Distribute life-saving and life-sustaining supplies (medicines, consumables and equipment).
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Support three Directorates of Health (DoHs) to strengthen the provision of PHC and SHC services (including referral systems). Support accessible and functioning public hospitals (and rehabilitate them if required). Expand the disease surveillance system (EWARS). Currently, 237 sentinel sites are reporting to EWARS. Expand the number of health care facilities and community centres providing mental health and psychosocial support (MHPSS) services. Increase the number of nutrition stabilization centres (4 (baseline) and nutrition surveillance centres (50(Baseline). Scale up water quality control programmes in camps and settlements. Strengthen the capacity of national NGOs to implement health projects (e.g., providing health care services in key camps, managing mobile health teams and fixed health clinics, supporting the referral system). Strengthen the public health capacity of health and non-health workers.
Follow up on the situation in Mabrouka camp and possible withdrawal of XB actor and related gaps Situation with the future of Areesha camp is not clear as the authorities’ pressure to close it down. Health teams visited Al Busaira city and Jadeed Bakkara and health facilities there.
Al Hol camp:
Operating 1 fixed health point in phase 1 and 2 mobile clinics moving around between the reception area, phase 5 and phase 7 and foreign annex. Procurement of 14 caravans is in place. Updated the health sector mapping of the camp, including breakdown of service availability by each sector. Conducted camp health sector meetings. There is a plan for international consultancy to assess the health situation in Al Hol camp. The outcome of the assignment will be a detailed report analyzing the main health conditions of IDPs in the camp, the status of camp health care services, water and sanitation facilities and hygiene practices, and to provide recommendations for improving the current situation on the ground. Triage teams provide required services to all newly arrived. Delivery of health supplies to NES: completed air delivery of 65 tons to Qamishli. Another 51 tons are being planned. Immunization: 2 DoH teams continue vaccination in the reception area and phase 7. Communicable disease surveillance: Deworming campaign for children 6 to 15 years old – plans to conduct a deworming campaign for 40,000 children in 10 IDPS camps in NES. The campaign will be carried out by 120 health workers. The duration of the activity is 15 days, from 17 to 31 March in Al Hol, Mabrouka, Ain Issa, Tohenia, Menbej, Abo Khashab, Roj, Neroz, Areesha. Leishmaniasis - WHO in collaboration with leishmaniasis control program in Hassakeh established a fixed medical point to provide diagnosis and treatment. 582 cases have registered and received local treatment. TB cases - Conducted TB screening for the newly arrivals. 20 field teams consist of 40 health workers were deployed to conduct tent to tent screening. During 10 days of field work the teams were able to screen 5,100 families for TB. 43 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 5 cases and who were immediately enrolled in treatment programme. The total number of TB confirmed cases among the newly displaced people in the camp is 15 patients. DoH FP point will be available one day per a week to follow up TB cases inside the camp. More than 1200 people were screened for diarrhea in the reception area and phase 7. 13 patients were checked against cholera rapid tests. 5 stool samples were sent to Damascus labs. Water quality screening continues to take place. Mental health: Community workers are being trained on Psychological First Aid (PFA). 12 social workers supported by WHO provide services on a daily basis 24/7. Psychotropic medications are provided on prescription basis. 2 out of 3 MH experts conduct trainings for health and community workers (mhGAP phase 1 and group counselling). 2 PFA trainings are planned. The MHPSS services 4Ws in Al-Hol camp was developed and shared with the health & protection actors.
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Nutrition - Since the beginning of the year, 21,330 children under 5 of new arrivals were screened. 152 SAM cases and 249 MAM are currently in the camp. 1 stabilization center is being supported. 86 children with complicated SAM remain hospitalized. Capacity building events: IMCI, Group counselling for NGOs from Al Hassakeh, Mental Health GAP-intervention Ph1 for NGOs from Al Hassakeh, School mental health program for MoE from Al Hassakeh, Health Program for MoE from Al Hassakeh, Nutrition services for children, stabilization center Referrals - Field hospital: Different options are considered (including interests of KRC, MSJM). KRC has a strategy to approach the set up in two phases (from 15 to 50 beds) with the required support. A total of 103 patients remain hospitalized in Al Hikma hospital and 37 in Al Hayat hospital, supported by WHO. Arrangements are in place to deploy an additional 2 surgeons and 2 nurses from Al Hikma hospital.
Technical Expertise (See Annex 2 for capacity building activities this week)
Non-Communicable diseases / Primary healthcare
On Tuesday 12 March, conducted supervisory visits to Eastern Ghouta schools to follow up the dental health project supported by WHO in cooperation with MOE .The WCO team chaired by WR had visited two schools in Zamalka and Ein Tarma tows in EG, where the 2 mobile dental clinics deployed by MOE had been providing screening oral health services, health promotion sessions and treatments. So far, the project which was launched in October 2018, had supported oral health services to (3814) school students in addition to (3890) educational sessions for both teachers and students with total (11,631) preventive services. Continued follow up for the planned Assessment of the Private Sector in Syria in accordance to EMRO guidance and protocols; the assessment to be conducted in cooperation with EMRO expert and MOH counterparts. A coordination meeting is scheduled on 19 March to discuss protocol, action plan and way forward.
Trauma:
Conducted a meeting for the Physical Rehabilitation Sub-group on 3/3/2019 in WHO office. WHO gave a presentation on “Overview of the Priority Assistive Products List, APL”. In addition, an update of activities and plans was presented by each present member of the group (ICRC, SARC, UNHCR, UNFPA, UNDP, UNICEF, Armadilla and MOH).
Participated in field mission with a WHO team headed by WR to Homs and Hama governorates. The mission included meeting with both DOH directors in the two governorates to discuss the needs of the health facilities. In addition, a visit to the rehabilitated part of the Homs Nationa Hospital was conducted to follow up on the installation of the recently WHO-donated MRI (from Japan fund); the MRI installation was nearly completed and the center will receive patients around the end of March. Moreover, the team visited the nearly-ready hemodialysis center of a NGO (Lamsat Shefa). WHO is to support the center with hemodialysis sessions.
Immunization:
March sub-national polio campaign - The new date of the March sub-national polio campaign will be during the period 17-22 March 2019, the campaigns will target all governorates in line with the following criteria: districts with coverage rate less than 80% in February campaign 2019; border areas with neighboring countries; Bedouin and Gypsies communities; districts with polio 3 coverage less than 70% during 2018; areas of returnees from neighboring countries (Lebanon and Jordan), in addition to returnees from Rukban camp and Deir-ez-Zor. The campaign target is 791,713 children. 3181 field workers will participate in the field work. WHO will cover the operation cost of campaign: transportation cost, incentive for health providers, vaccines delivery, capacity building activities and printing vaccination cards and registries. 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
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Meeting on polio Risk Mitigation plan for Syria - the meeting was conducted in Amman on 24-25/2/2019 with the presence of HQ colleagues after closure of the circulating Vaccine Derived Polio Virus type 2 (cVDPV2) outbreak ,the consultants confirmed that Syria successfully stopped the cVDPV2 outbreak on 30 November 2018 but remains vulnerable. Although EPI services started in rural Deir Ez-Zor in early 2019, EPI is not sustainable in several other pockets in the north of Aleppo and north of Raqqa. The program is on track however the team should avoid complacency because some areas are not accessible and EPI need to be sustainable in northern governorates, Aleppo should have a special plan to strengthen the EPI including training more health staff on EPI and surveillance, increase supervisory visits and strengthening the coordination between Raqqa DOH to cover areas not accessible from Aleppo, in addition to update the outbreak response plan regularly and reach the all children with all antigens in Raqqa and expand the surveillance network.
Mental health program:
MoH: The Dual plan agenda and the training materials has been discussed and approved to be trained by directorate of MH in MoH. Several capacity building took place in many governorates mainly PFA and mhGAP. MoE: Put a draft agenda to train nurses in school health directorate in MoE in Q3 on psychological first aid to expand the MHPSS services to doctors (mhGAP IG-guideline); nurses (PFA intervention); school counsellors (school mental health package). Finalized the selection of 50 ToT trainees for 2nd and 3rd ToT groups under School Mental Health Porgramme. NGOs: Orientation session about MHPSS services for the active NGOs in NWS took place in Aleppo: Update the partners about the template for MHPSS activities; Mapping the current available HR in NGOs’ MHPSS field; Explain the linkage between MHPSS projects with GPW13; Orientation session led by GBV focal point and RH officer in WCO in EMRO about health response to GBV for the active NGOs in the NWS response/ Aleppo. NGOs activities related to GBV and Women Health were discussed, in addition to the way forward to endorse GBV activities in NGOs pipeline MOUs; Family well-being community center proposal discussed and finalized with ASSLs in two sites: Deir Haffer/Aleppo eastern rural, and Almayadin/DEZ rural. Mar Asia in NES finalized the project proposal on the family well-being community center in Al-Hassakeh city in addition to the field community center in Al-Hol camp. The MHPSS mobile team related to the NGO in the Al-Hol response is engaged in group counselling training. Several capacity building activities are taking place in many governorates to enhance the MHPSS response in many programme mainly mhGAP and counselling. Psychotropic: A distribution plan for new psychotropic medications shared with logistic unit, which will cover the needs in NES & NWS.
Nutrition and child health:
Coordinated with mental health a plan of trainings for health workers working in newborn care at home program and malnutrition program in Al Hassakeh. Attended Regional Session on mortality with EMRO via webinar with reference on the upcoming WHO-UNICEF Child Mortality Estimation Workshop that will be held from 9 to 12 April 2019 in Dead Sea, Jordan. Monitoring visit to Daraa to assess the actual situation of childhood and nutrition programs, detect gaps and develop plans to enhance programs implementation. Attended annual meeting with newborn care at home MOH officers in Aleppo, Homs, Hama, Lattakia and Tartous to review 2018 achievements and review 2019 plan. Attended IMCI training for rural Damascus in Qatana district. Meet with MOH – PHC to review the Essential Newborn Care Course project.
Secondary health care:
Conducted a meeting with MOH Pharmaceutical affairs deputy and MOH team to finalize the final EML 2019. Prepared the final list of anti-cancer medicines needed in MOHE oncology hospital.
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Conducted a meeting with MOH lab focal point to discuss their proposed study on “Sterilization Quality in public and private hospitals”. Discussed the priorities need of medicines and lab needs in NES health facilities with Qamishli hub. Agreed with MOH Quality Control department to conduct Pharmacovigilance capacity building Q2 during 2019. Supporting of 10 secondary hospitals by WHO health supplies in Lattakia, Damascus, Aleppo, Hama and Al Hassakeh.
Disease surveillance and response and WASH:
The Deworming campaign of 2019: In collaboration with Ministries of Education and Health, WHO is working to control soil-transmitted helminth infections in Syria by implementing a programme that enables access to preventive medicine (mebendazole). A regularly scheduled treatment of preventive medicine can reduce the worm burden in the children. The programme has been implemented in Syria for four years. During the deworming campaigns, children aged 6 to 12 years are given a single dose of chewable mebendazole, by trained health workers. The preventive medicine is donated to Ministry of education through WHO and disseminated by schools’ health staff. WHO also provided educational material on infection prevention and control, and supported training for nurses and health workers on administrating of the medicine. The expected outcome of the regular implementation of this intervention is improving the health and nutrition status of the children, along with improving of school attendance and performance. in the campaign of 2019 . The deworming campaign of 2019 started on 24 February and as of today about 1,500,000 children have been reached. Homs, Aleppo, Quneitra and Daraa have completed the implementation of the campaign.
HIV suspected case in Idleb: Follow up for the notification on three suspected HIV cases in Idleb, the laboratory tests showed positive HIV results for the three cases. the cases were enrolled in the national program and the anti-retroviral thereby will be provided to the patients by WHO.
Acute diarrhea cases in Daraa: On 6 March, WHO was notified about increase of acute diarrhea cases in Dahiet Albasel area in the city of Daraa. More than 300 cases with acute diarrhea were reported by the national hospital and two health centers in Daraa, treatment with ORS was provided to cases. All cases have improved with no need for hospitalization. The Health Directorate tested some samples of drinking water and the results showed contamination in drinking water. The Water institution in Daraa attributed the cases of diarrhea to contamination of drinking water with sanitation water. Significant decline in diarrhea cases coincided with distribution of aqua tablets and repairing the damage in the sanitation system.
National NGO coordination:
Coordination meeting with NGOs from Damascus, Aleppo, Lattakia, Homs and Rural Damascus and the representative of MOSA was conducted to explore potential collaboration opportunities to boost the provision of the health services ; Bilateral meeting was conducted with new NGO from Daraa to explore the potential engagement to provide health care services in Al Sanamein and surrounding areas; Workshop to strengthen medical staff of 6 NGOs in Damascus to integrate primary health care and mental health services at PHC level was conducted Orientation meeting on MHPss services to NGOs directors from Damascus, Rural Damascus and Hama was conducted; Meeting with NGOs for mapping the health care services in Rural Damascus was conducted to insure covering all areas with severity scale above 3/
External Relations and Communications:
Participating together with WHO team headed by the WR in a field visit to:
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Aleppo governorate to follow-up on the work in Aleppo sub-office and to have official meetings with the director of health and the new director of Aleppo university hospital as well as the director of SARC/Aleppo Branch. During the visit WR opened the Health Care Provider training to facilitate the provision of health care services to women. Homs and Hama governorates, WR conducted a meeting with Homs Director of Health and visited Homs National Hospital as well as the hemodialysis session center run by one of WHO-supported NGOs (Lamset Shifa). In Hama governorate WR held a meeting with the governor of Hama and visited Hama National Hospital and a primary health care center. Rural Damascus (Eastern Ghouta) to visit some schools to follow up on the implementation of Oral and Dental Health for schoolchildren in Eastern Ghouta in cooperation between the Ministry of Education and the WHO. Communicating officially with MoFA and MoH on: The GTCR: GHW samples from the entire region's countries; The 140th Assembly of the IPU, Doha, Qatar, 6-10 April 2019; The Regional Strategy and Framework for Action on Tobacco Control. Conducting together with the WR an official meeting with the Minister of Social Affairs and Labor to scale up the health response for vulnerable people in the most affected areas of the country. Preparing a visibility video on the occasion of the 8th anniversary of the Syria crisis. Preparing a human interest story on the occasion of the Woman International Day: http://www.emro.who.int/eha/news/international-womens-day-2019-women-surviving-in-emergency-settings.html Preparing the bi-weekly situation report on Al Hol camp. Following up on WHO-Syria Twitter account, posting several tweets about WHO interventions and health response. Received two emergency grants from HPF and Japan for the response in NES. Organized a donor briefing in Beirut to reiterate WHO's advocacy messages ahead of Brussels conference.
Operational support and logistics:
Dispatched 107.5 tons of medical/lab/WASH/nutrition supplies, equipment, health kits, vehicles and printing materials - covering 10 governorates (Aleppo, Al-Hassakeh, Deir Ez-Zor, Homs, Hama, Damascus, Daraa, Lattakia, Qunaitra & rural Damascus) The recipients included 16 MoH facilities, 8 MoHE facilities, 4 MoE directorates, MoLA, 7 NGOs, 2 nongovernmental hospitals, IA convoy and SARC. Total number of treatments is 616,439 and 3,500 trauma case. The dispatched supplies included: 85,500 tablets of Mebendazole 500 mg, 102,700 deworming brochures and 30 posters were delivered to MoE central & school health directorates in Aleppo, Daraa and Damascus. 4 mercurial Sphygomometer + stethoscopes, 4 digital thermometers, 1 NCD kit and different types of EWARS, PHC, STHC and trauma medical supplies were delivered to Talbiseh & Al-Houleh PHC centres in Homs. 2 Suction pump (Fazzini), 2 ultrasonic scanner (Doppler DC-30), 20 burn dressing kits, 10 NCD kits, 2 surgical kit, 2 IEHK kit, 2 trauma kit both A&B, 4 cholera kits, 2 family doctors kit, 119 cholera community kits, 15 malaria test kits, 5 fingertip pulse oximeter (Utech/iO2), 1 portable oxygen concentrator (Longfian/JAY-5), 800 haemodialysis session for adults and different types of EWARS, MH, PHC, STHC & nutrition supplies were delivered to Al-Hasakeh DoH. 160 domestic cool freezers, 1 surgical kit, 1 compressor nebulizer, 1 electrocardiograph multi-6 channel ECG and different types of PHC & STHC medical & printing materials were delivered to MoH central warehouse in Damascus. 1 Digital mammography x-ray Villa system were delivered to MoH central warehouse in Damascus in favour of Al- Assad hospital in Hama. Different types of ICT equipment delivered to MoH central warehouse in favor of Deir Ez-Zor DoH. 6 examination beds, 2 portable oxygen concentrators, 1 suction device were delivered to Al-Khaldieh & Al- Massaranyeh PHC centres in Aleppo. 4 Isotherm forced convection incubators, 2 UPS systems and 5 MTB kits delivered to MoH – public health labs in Damascus. 105,750 ampoules of Glucantime 1.5 g/5 ml were delivered to MoH central warehouse in Damascus in favour of Leishmaniosis programme. Different types of lab supplies & consumables delivered to MoH – public health labs – microbiology lab in Damascus. 15 Teflon funnels delivered to MoH – public health labs – polio lab.
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7 Diamond/BPDL 250 (Aneroid Sphygomometers), 2 portable oxygen concentrators, 4 hospital trolleys and 15 examination beds were delivered to MoH central warehouse in Damascus in favour of PHC directorate. 2 CR scanner, 2 electrosurgical unit, 2 suction pump, 40 burn dressing kits, 20 burn dressing kits, 2 surgical kit, 2 IEHK kit, 2 trauma kits A, 4 trauma kits B, 300 haemodialysis sessions for adult, 50 for children, 10 fingertip pulse oximeters (Utech/iO2), 2 ICU beds, 1 infant incubator, 2 haemodialysis machines and different types of EWARS, MH & STHC medicines were delivered to Qamishli national hospital in Al-Hasakeh. 1 electrocardiograph multi-6 channel (ECG), 2 haemodialysis machines, 2,000 normal saline bottles, 2 trauma kits A&B,1 surgical supply kit, 10 nutrition scales and 10 measurement systems delivered to MoHE – Aleppo university hospital. 7 chemotherapy chairs with 7 serum holders and 1 M7 diagnostic ultrasound system were delivered to MoHE - Al Bironi hospital in Damascus. 10 nutrition scales and 10 measurement systems delivered to MoHE - Al-Tawlid hospital in Aleppo. 2 electrocardiographs multi-6 channel (ECG) delivered to MoHE - Al-Mowasat hospital. 2 infant incubators and different types of STHC medicines delivered to MoHE central warehouse in Damascus. 20 nutrition scales and 20 measurement systems delivered to MoHE - children hospital in Damascus. 1 haemodialysis machine, 20 nutrition scales and 20 measurement systems delivered to MoHE – Tishreen university hospital in Lattakia. 1 refrigerated medical waste truck (ISUZU NP-R 71) with 150 medical waste 240 litre bins were handed over to MoLA – Damascus governorate. 1 infant incubator, 152 cans of F75 therapeutic milks and 125 cans of F100 were delivered to 2 nongovernmental hospitals in Damascus & Al-Hasakeh governorates. 30 first aid kits, 1 surgical kit, 1 compressor nebulizer, 1 electrocardiograph multi-6 channel (ECG), 1 family doctors kit, 1 trauma kit A&B, 3 IEHK supplementary kits, 3 IEHK basic kits and different types of EWARS, PHC & STHC medical & printing materials were delivered to 7 NGOs in Aleppo, Damascus, Al-Hasakeh, Qunaitra and rural Damascus governorates. 1 family doctor kit and PHC printing materials delivered to Aleppo SARC. 1,100 bottles of IV fluids, 3 trauma kits B, 1 hospital stretcher, 3 cholera kits, 1 family doctor kits, 2 surgical supply kits, 9 NCD kits, 10 pneumonia kits B, 3 trauma kits A, 10 wheelchairs, 100 body bags for adults, 3 IEHK basic kits and different types of EWARS, PHC, STHC & trauma supplies were delivered to Aleppo Manbej as IA convoy through SARC support.
RESPONSE PRIORITIES
Annex 1: Current WHO agreements with national NGOs
# of ongoing # of MOUs in Governorate Location of current of ongoing MOUs MOUs preparation Damascus Al Zahera 1 3 Rural Damascus / EG Qutaifeh - Douma and Harasta 1 6 Response Lattakia 2
Dara'a Dara'a , Al Laja'at, Al Yarmouk 1 1 Homs 7
Hama city, Souran, Moardes ,Taybet alemam, Alsawa'aek ,Alhashimyaa , ean 1 1 Hama albad, Jarjesah ,tal kartal,tellef ,herbenafsah,maardeften and alzarah. Nabul - Zanairta - Mayasah - AL-Mogambo - Burj Al-Kaaf -Al-Zouk - Tall Refaat - Kafar Naya - Al-Zyara - Deer Jmal - Ihras - Kashtaar - Al-Ukaibeh - Kherbat AL- Hayat - Tal Jbeen - Ibeen - Sheikh said - Salah AL-Deen - Al-Mshatia - Bostan AL- Aleppo / Efrin Response 2 3 Zahra - Al-Villat - Menbej - Agior , Deir Hafer and surrounding villages ((Babiri - Upper Babiri , Babiri -Lower Babiri , Rasm Elbokhar , Kayariyieh , Big Habbuba , little Habobieh , Southern Rasm Elharmal ) NES Deir- Ez-zor - Ar Raqqa city - Al Hasakeh. 4 5 Total 10 28
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Annex 2: WHO supported capacity strengthening (supported 38 activities for 865 participants).
# Date Details/Field Program participants 02-05/03/2019 25 Burn Management for MoH Health workers in Damascus Trauma 02-06/03/2019 25 Ventilator management for MoH Health workers in Homs Trauma Central meeting to discuss the output of peripheral meetings regarding newborn care 03-05/03/2019 25 Child Health Care at home program for MoH focal points in Damascus Evaluation of patients with musculoskeletal system injuries Health workers in 03-05/03/2019 25 Disability Damascus 03-05/03/2019 30 International classification of Diseases for MoH in Damascus HIS Improving utilizing and investing the collecting HeRAMS data using office program for 03-05/03/2019 30 HIS MoH in Damascus 03-04/03/2019 25 Coordination meeting for head of TB centers from all governorates in Damascus Global Fund/TB 04-05/03/2019 30 Social marketing meeting for newborn care at home program Child Health Care Reproductive 05-07/03/2019 25 ToT for health care providers on first line support to GBV survivors in Aleppo Health 05-07/03/2019 25 EWARS Reporting for Rural Damascus Governorate in Damascus EWARS 06-07/03/2019 25 Psychological First Aid "PFA" and Self-care strategies for MoH doctors in Homs MH 06-10/03/2019 25 War Wounded Injuries Management for MoH health workers in Damascus Trauma 06-07/03/2019 30 HeRAMS on line (Damascus -R. Damascus) in Damascus HIS 06-07/03/2019 25 Coordination meeting for head of HIV program in all governorates in Damscus Global Fund/HIV 07-11/03/2019 25 Ventilator management for MoH Health workers in Homs Trauma Integrated Management of Childhood Illness (IMCI) programme for DoH's nurses in Al 09-17/03/2019 25 Child Health Care Qunaitera Health villages volunteers on newborn care at home program for Local community 09-15/03/2019 20 Child Health Care volunteers in R. Damascus 09-11/03/2019 30 HeRAMS follow up workshops at hospital level (MoHE) in Damascus HIS 09-11/03/2019 25 Enhance surveillance and effective detection for Leishmania in Deir Ezzour EWARS 10-14/03/2019 25 Basic counselling for NGOs in Damascus MH 10-14/03/2019 25 Group counselling for NGOs in Al Hassakeh MH 10-14/03/2019 25 Mental Health GAP-Intervention Guide Ph1 for NGOs in Al Hassakeh MH 3 activities on Mental Health GAP-Intervention Guide Ph2 for MoH doctors in Tartous 10-14/03/2019 75 and for for MoE doctors from Hama, Aleppo, Al Raqqa in Hama and MoE doctors from MH Damascus, R. Damascus, Qunaitera, Daraa and As-Swaida in Damascus 10-14/03/2019 25 School Mental Health Program for MoE in Al Hassakeh MH 10-11/03/2019 25 Psychological First Aid "PFA" and Self-care strategies for MoH doctors in Tartous MH 10-12/03/2019 25 Neonatal resuscitation program (NRP) in Lattakia Child Health Care 10-12/03/2019 30 International classification of Diseases for MoH in Damascus HIS Improving utilizing and investing the collecting HeRAMS data using office program for 10-12/03/2019 30 HIS MoH in Damascus Nursing training for children, and nutrition unit for Health workers in Al Hekmeh 11-14/03/2019 25 Nutrition hospital in Al Hassakeh 11-13/03/2019 25 First Aid and Basic Life Support for MoH Health workers in Damascus Trauma 12-15/03/2019 25 Hazmat management and evacuation of buildings for MoH Health workers in Aleppo Trauma 12-14/03/2019 25 EWARS Reporting for Hama Governorate for MoH in Hama EWARS 12-14/03/2019 25 Enhance surveillance and effective detection for Leishmania for MoH in Deir Ezzour EWARS 13-17/03/2019 25 Ventilator management for MoH Health workers in Lattakia Trauma 13-14/03/2019 30 HeRAMS on line (Daraa - Al Qunaitera - Al Hassakeh) for MoH in Damascus HIS 14-18/03/2019 25 Ventilator management for MoH Health workers in Damascus Trauma
Annex: No of health services provided by NNGOs, East rural of Aleppo
# of patients # of outpatient # of MHPSS received # of SHC NGO Health facility District consultations services assistance services PHC services provided with 11
medicines 3 Health promotion Mobile team 1 Dier Hafir 186 126 58 100 4 Health promotion Mobile team 2 Maskana 223 123 18 154 Total 409 249 76 254
Annex: No of health services provided NNGOs, Afrin IDPs response
# of patients # of # of # of received outpatient # of SHC Trauma MHPSS NGO Health facility District assistance consultations services services services with PHC services provided provided medicines 1 YBY Mobile team 1 Fafin Camp - Abin 168 154 0 144 2 YBY Mobile team2 Tenib - Deer Jmal 122 128 0 154 Sub Total 290 282 0 0 298
Annex: No of health services provided NNGOs
# of patients # of outpatient received # of # of SHC NGO Health facility District consultations assistance Trauma services services PHC services with provided medicines Health 1 Saad PHC Jabal Samaan 1420 669 10 promotion Physiotherapy 2 YBY Jabal Samaan 988 512 0 center Sub Total 2408 1181 10
Annex 7: WHO supported health services in northern and eastern Hama and northern Homs:
Area Provision of medical consultations Medicines 2 locations in Alholeh 355 340 5 locations in Rastan 425 277 5 locations in Talbiseh 246 162 Total 1026 779
Area Provision of medical consultations Medicines Eastern rural Hama villages Al- Hamraa district (10 locations) 744 720 Northern Hama(10 locations) 669 652 Health center Abi Alfidaa 797 752 Total 2210 2125
Annex 8: WHO supported Health services in NES:
# of First # of # of # of Mental # of # of aids and beneficiaries secondary Health Governorate Area outpatient trauma emergency Disabilities reached with health Psychosocial consultations referrals services in services the medicines consultations Services the camps
Hasakah city center 1413 1241 104 87 0 18 0 Al-Hassakeh Al-Mabrouka camp 357 357 1 0 140 128 0 Al-Areesha camp 508 461 4 0 12 127 0 Al-Hol camp 3092 2817 150 143 926 0 45 Ain Issa camp 1087 902 0 0 141 117 0 Arraqqa Arraqqa city 924 647 3 0 0 0 0 12
Al-Twehenah camp 471 471 0 0 15 25 0 Al-Karama 74 62 0 0 2 10 0 Al-Kasrat 44 44 0 0 2 7 0 Aleppo Menbej 112 107 0 0 11 8 0 Al-Sewar transit 0 0 0 0 0 0 0 point Al-Busayra 162 151 2 0 3 0 59
Abu Khashab camp 55 55 0 0 2 10 0 Dier Ezzour Al-Jerzi 1022 406 0 0 44 166 0 Dier Ezzour city 1135 735 0 0 0 0 0 Sub-total: 10456 8456 264 230 1298 598 122
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