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1 Week 17, 20 Week 17, 20 - 27 April 20182018 General developments & political & security situation Al-Yarmouk Camp: SAA military operation against ISIL and AL-Nusra presence in South of Damascus has continued for the seventh day following the failure of negotiations to halt fighting and evacuate ISIL fighters and Al-Nusra out of Tadamoun, Al-Yarmouk Camp, Al-Hajar Al-Aswad and Al-Qadam. Eastern Qalamoun, Rif Damascus/ S Homs - The last phase of NSAGs evacuation from East Qalamoun was concluded according to several reports. About 38 buses were observed gathering in Al-Rehaibeh point and carrying more than 1,500 NSAGs fighter along with their family members and civilians who are not willing to stay in the area. Rural Deir Ez-Zor; The security situation in the ISIL pocket in Eastern rural Deir Ez-Zor is still tense with reports of internal confrontations among them. S Rural Idlib/ W Rural Aleppo; A new ceasefire agreement was announced between HTS, SLF and Souqour Al- Sham to halt the fight in the NSAGs territories in Idlib and West rural Aleppo. SAA and RF warplanes bombarded NSAGs positions in the towns of Hobiet, Abdien, Barsah, Ma'aret Hurmah and Tal Al-A’as in rural Idlib Aleppo Govt: An increase in military activities was witnessed between SAA and NSAGs located in the West of Aleppo city since the beginning of this week. Rural Homs & Rural Hama; AC/IAF: SAA continued its military operation against NSAGs located in the north rural of Homs and South countryside of Hama with a slight decrease in the level of clashes on the ground. OVERVIEW KEY HEALTH ISSUES Afrin: Acute Diarrhoea, upper respiratory infections, and Lice are the most reported communicable diseases among Afrin IDPs. Increasing in reporting of measles suspected cases, particularity from Afrin displacement area was reported in week 15-16. Samples were taken from 4 locations (Fafin town, Fafin camp, Ihres, Tal Refaat). In response to suspected measles cases 1450 children are vaccinated with MMR. East Ghouta: Increased incidence of acute diarrhea, upper respiratory tract infections, reproductive health. Decreasing number of people remaining in shelters. KEY GAPS & CHALLENGES Afrin: - Newly accessible areas require a higher number of equipped mobile clinics/ambulances to improve access to primary health care services. - Suboptimal referral system and approval delays for patients with chronic health conditions. - Limited health care for patients with TB and leishmaniosis. - Family planning activities to be enhanced with distribution of contraceptives, reproductive health kits. - A potential for increase of vector-borne diseases across the shelters. - Further heath supplies required to increase availability of essential medicines. East Ghouta: - Lack of clarity on hospitalization of patients outside the shelters and within Eastern Ghouta. - Remaining populations in East Ghouta communities still inaccessible to most health partners. OPERATIONAL UPDATES 1. Coordination: 1 Regular national health sector meeting in Damascus: Violence against health care; Response to eastern Ghouta and Afrin displacement; Results of Syria Humanitarian Fund for eastern Ghouta and Afrin response; Health sector assessment registry, 2018; Health Cluster Gaziantep and Health Sector Syria hubs monthly snapshots; 2017 End of Year report (Periodic Monitoring Report); Area based preparedness and response plans; May-June 2018 IA convoys; reproductive health update. Coordination at WoS level on: - Coordination on vaccination and disease surveillance, especially in NES. - Ar-Raqqa City Strategic Response Plan (preliminary estimates required for health sector funding is 16,850,000 USD.) Developing inputs on the coverage of WHO activities in HTR and besieged areas. Initiating an exercise for key health agencies on Afrin and eastern Ghouta response, jointly with Aleppo hub, with the objective to enhance response in Afrin as not being current sufficient under the current situation. Upon the request of Qamishli AHCT, developed NES health sector preparedness and response plan for inter- sector plan. Meeting of sector coordinators with the RC/HC on 2019 HNO/HRP (including mapping of sectoral assessments, HRP Costing and proposed way forward) and SSG outcomes. Developed and shared with OCHA a preliminary list of health sector activities under the Southern Syria Preparedness Plan. 2. Information and planning: Produced: - 4 infographics of key indicators for March 2018 (English/Arabic), across Syria; North-east Syria; North- west Syria; Southern Syria). - Health sector 4Ws snapshot for March 2018 across Syria. - Draft HeRAMS summary report Q1 2018 of the public hospitals in Syria. Provided: - Key indicators of HeRAMS Syria for the global HeRAMS.org platform. - Syria Information product catalog and WHO Assessment Registry 2018 to WHE-EMRO. - Key information on public health facilities in NES to Qamishli hub for NES response. Developed maps: - Functionality of public health centres in Rural Damascus, Aleppo, and Al-Hasakeh, Apr 2018; - Current situation and functionality of public health facilities in Eastern Ghouta (Rural Damascus) as of 17 April 2018; - istribution of the NGOs health facilities in Homs governorate. 3. Health operations: East Ghouta response Daily narrative of the health sector response maintained and Inputs provided for weekly OCHA. Assessment missions to the shelters resumed on 25 April. Planned health assessment for 25 public health facilities in East Ghouta under planning with MOH and SARC. Support to 60 medical mobile teams, mobile health units and medical points have been mobilized, including: - 25 medical mobile teams by 13 national NGOs are in shelters providing almost 30,000 outpatient consultations per week. - 23 medical mobile teams from DoH Rural Damascus (estimated 200 health workers) providing health care on a daily basis in shelters and beyond. 15,000 consultations are provided during a week. - 6-8 teams of trained community psychosocial support workers providing basic psychological interventions, educational and recreational activities. People with mental health conditions received psychological and /or 2 pharmacological interventions. People in need for medical assistance were identified and referred by the MHPSS teams to receive the needed health care and medicines in the shelters. An estimated 2,800 people benefit weekly from this program. - 3-4 nutrition surveillance and nutrition screening teams are on the ground. 3 stabilization centers are functioning. 38 EWARS sentinel sites are supported. 1193 injured and critically ill patients referred to Damascus hospitals and under health monitoring. Vaccination activities within the Global Vaccination Week (22-30 April) –estimated 5,000 children covered. A total of 11 shipments completed with health supplies, 50 tons or 600,000 medical treatments to SARC and DoH Rural Damascus, including the first batch of 30 wheelchairs for distribution by SARC. Defined follow up points for the health sector for East Ghouta: Develop clarity among the health workers on the ground on hospitalization of patients outside the shelters and within eastern Ghouta. There are many people who have stayed in different locations across eastern Ghouta and in need of continuous health care (at PHC and secondary levels). o Organizations to work closely through DoH medical teams and centers established inside the shelters and eastern Ghouta for hospitalization. o DoH medical teams are present in IDP shelters and reach areas outside the shelters, such as Kafr Batna, Ein Tarma, Arbin, Saqba, Zamalka, Hazzeh, Harasta, and Douma. o 3 DoH PHC centers were opened in Saqba, Hazzeh and Ein Tarma. Requests for hospitalization should come from and via these 3 PHC centers and any other locations where DoH will open its fixed presence. o SARC and health partners’ objectives are to roll out and enhance service provision inside Eastern Ghouta which will minimize eventually the number of people in need hospitalization in Damascus hospitals. o Use of private hospitals for referrals of patients not currently being considered. Considering the decreased number of people remaining in shelters, SARC objective is to have 1 assigned ambulance per 3 shelters (depending on the size of population). Setting up additional Emergency Health Points in shelters (currently established 3 by SARC): SARC plan to establish additional Emergency Health Points (EHP) only in shelters with more than 4,000 people. Aleppo response: An estimated 137,070 people remain displaced from Afrin in the Tall Refaat area, Nabul and Zahraa, Fafin, and surrounding villages. Afrin IDP registration is progressing slowly, and all IDP numbers remain estimates. Reportedly, IDPs are not able to cross check points on the streets leading to Afrin district. Disease surveillance & immunization: - Increasing in reporting of measles suspected cases, particularity from Afrin displacement area was reported in week 15-16. Samples were taken from 4 locations (Fafin town, Fafin camp, Ihres, Tal Refaat). In response to suspected measles cases 1450 children are vaccinated with MMR. - Routine vaccination program active in Nabul, Zahraa, Deir Jmal, kafar Naya, and Meskan DoH point. - 10,067 children have been vaccinated with oral polio vaccine (OPV), 634 with inactivated polio vaccine (IPV) Essential outreach services: - 26 medical mobile teams, health units and medical points that have been mobilized: 5 DoH donated mobile clinics, 5 SARC mobilized mobile clinics, 8 mobile medical teams by NGOs, 2 DoH PHC centers
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